Research Articles (School of Public Health)

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Adherence to methotrexate safety guidelines in rheumatoid arthritis: real-world evidence from South Africa’s public health system
(John Wiley and Sons Inc, 2025) Akunne, Onyinye; Coetzee, Renier; Johnson, Yasmina; Van Heerden, Yasmine; Keuler, Nicole; Wehmeyer, Alex
What is Known and Objective?: Methotrexate (MTX) is the cornerstone therapy for rheumatoid arthritis (RA) but is associated with potential haematologic and hepatic toxicities. In South Africa, treatment guidelines emphasise regular laboratory monitoring and folic acid supplementation to enhance treatment safety and reduce adverse effects. This study evaluates the implementation of these safety measures in a resource-constrained public health setting. Methods: A retrospective review of electronic health records was conducted for adult RA patients (≥ 18 years) who had been prescribed oral MTX for at least six months in the Western Cape Province between January and December 2022. Data collected included patient demographics, MTX and folic acid prescriptions, laboratory test results (white cell count [WCC], platelet count [PLT] and alanine aminotransferase [ALT]) and comedications. Laboratory abnormalities were classified according to the WHO reference ranges. Correlation analysis assessed associations between MTX/folic acid doses and laboratory values. Results and Discussion: Among 820 patients included in the study (82.1% female, mean age 55 ± 13 years), 94.9% were prescribed folic acid at the initiation of MTX and 96.2% at their most recent visit. Monitoring adherence improved over time: At MTX initiation, 71.8% had baseline WCC/PLT and 72.2% had ALT records; within 6 months of the last visit, over 88% had follow-up laboratory results. Most patients had normal laboratory results at follow-up (WCC: 85.9%; PLT: 73.8%; ALT: 90.4%). Spearman’s correlation analysis did not identify significant associations between MTX/folic acid dose and laboratory values, likely reflecting narrow dose ranges and limited subgroup size. These findings highlight the success of safety monitoring practices and the coprescription of folic acid in reducing the risks associated with MTX. What is New and the Conclusion?: This study demonstrates that MTX safety monitoring and folic acid supplementation are well integrated into public RA care in South Africa, with a low incidence of laboratory abnormalities. Our exploratory correlation analysis did not identify significant associations between MTX/folic acid dose and laboratory values; however, this likely reflects narrow dose ranges and limited subgroup data rather than the absence of effect. These findings highlight the success of current safety practices while underscoring the need for larger, prospective studies to better characterise dose–toxicity relationships.
Risk factors associated with hearing loss in neonates: A retrospective cross-sectional study from Qatar
(HBKU Press, 2025) Andreas, Jarreth Noël; Amde, Woldekidan Kifle; Roomaney, Rifqah Abeeda
Background: Hearing loss (HL) affects approximately 3 in every 1,000 infants worldwide. However, current Early Hearing Detection and Intervention (EHDI) guidelines may not fully account for region-specific neonatal risk factors. In the Middle East, conditions such as gestational diabetes mellitus (GDM), pre-eclampsia, and consanguinity are highly prevalent but remain underexplored in HL research. This study investigates the association between these and other neonatal risk factors and HL outcomes in newborns in Qatar. Methods: A retrospective cross-sectional review of electronic health records was conducted for 5,098 neonates born between March 2019 and March 2022 at a tertiary hospital in Qatar. After exclusions, 4,126 neonates were analyzed. Maternal and neonatal risk factors, along with newborn hearing screening outcomes, were assessed using Fisher’s exact test, Chi-square test, and logistic regression analysis. Results: Overall, 6% of neonates failed the hearing screening (n = 248). The most common risk factors were GDM (34.5%), hyperbilirubinemia (21.0%), and gentamicin exposure (9.6%). However, GDM showed no significant association with failed screening. The strongest association was found with Down syndrome (odds ratio [OR] = 14.215; 95% confidence interval [CI]: 4.286–47.151; p < 0.001), followed by cleft lip/palate (OR = 4.371; 95% CI: 1.384–13.801; p < 0.012), and high-risk categorization (OR = 1.973; 95% CI: 1.266–3.076;p < 0.003). Conclusion: Contrary to expectations, GDM and hyperbilirubinemia were not associated with an increased risk of HL. In contrast, Down syndrome and cleft lip/palate showed significant associations with HL risk. These findings highlight the importance of incorporating regionally relevant risk factors—such as genetic syndromes and craniofacial anomalies—into local Early Hearing Detection and Intervention (EHDI) frameworks. Contextualizing hearing screening within the Gulf region may enhance early detection and optimize care pathways.
Healthcare-associated bloodstream infections caused by bacterial and fungal contamination of intravenous fluids and medicines in healthcare facilities in low- and middle-income countries: a scoping review
(Elsevier, 2025) Ravinetto, Raffaella; Nyandwaro, Jemima Nyaboke; Hyland, Peter
Introduction: We reviewed culture-confirmed healthcare-associated outbreaks linked to bacterial and fungal contamination of intravenous fluids and medicines (further “infusates”) in low-income countries and lower and upper middle-income countries (LIC, Lower-MIC and Upper-MIC). We assessed the scope, impact, risks, and gaps in knowledge. Methodology: Literature search including PubMed, Web of Science, Worldwide Database for Nosocomial Outbreaks, Global Health, and Google Scholar. National essential medicine lists (NEMLs) of sub-Saharan countries were searched for listing of pediatric infusates. Results: Between 1975 and 2023, 50 articles were retrieved. Median (range) number of patients affected was 12 (3–185); 74.2% (761/1025) of all patients affected were children. All patients presented with bloodstream infections; median case fatality ratio was 21.1% (0.0–87.5%). Upper-MIC, Lower-MIC and LIC accounted for 21, 25 and 4 articles, respectively. Most frequently affected wards were neonatal and adult intensive care units (19 and 6 articles). The 50 articles revealed 59 contaminated infusates: IV fluids (n = 37), including TPN (n = 10, of which 8 were from Upper-MIC), and IV medicines (n = 22), comprising amongst others propofol (n = 4) and Water for Injection (n = 3). The 63 isolates included Enterobacterales (46.0% (29/63) of isolates), non-fermentative Gram-negative bacteria (NFGNB, 47.6% (30/63)), fungi (4.8%, 3/63)) and Bacillus circulans (1.6% (1/63)). Among the Enterobacterales, the genera Serratia, Klebsiella, and Enterobacter represented 82.8% (24/29) of isolates. Burkholderia cepacia was the most frequent NFGNB (53.3% (16/30) isolates). Excluding TPN, 18 IV fluids and 7 IV medicines (representing half (51.0%, (25/49) of these infusates) were incorrectly used as multidose vial. A third (33.9%, 20/59) of infusates in 40.0% (20/50) of articles was intrinsically contaminated. In LIC and LMIC, staff in neonatology units turned to in-ward preparation of infusates because of lack of access to pediatric IV formulations and sizes. Less than a third (31.8%, 18/44) of the NEMLs listed neonatal IV premixtures. Conclusion: Infusate contamination is a serious, underreported risk especially for children in LICs and Lower-MIC. Outstanding issues are access to pediatric infusates and preventing in-ward preparation of IV medicines in LIC and Lower-MIC, and safe preparation and administration of TPN in Upper-MIC.
Assessing patterns of authorship of low- and middle-income countries in global commercial clinical trials in oncology
(BioMed Central Ltd, 2026) Ravinetto, Raffaella; Payedimarri, Anil Babu; Mouhssine, Samir
Poor authorship practices in global health research may be a sign of unequal partnerships. Previous studies have shown that authors from low- and middle-income countries (LMICs) are frequently underrepresented in publications from global research collaborations between LMICs and high-income countries (HICs). To the best of our knowledge, the patterns of authorship from LMICs in international industry-sponsored clinical research on breast, lung and colon cancer have not yet been investigated. Therefore, as a spin-off to broader research on globalization of commercial clinical trials in oncology, we conducted an analysis of authorship in the publications from completed industry-sponsored therapeutic trials in breast, lung and colon cancer (from phase I to IV) that involved LMICs. Only articles published in a peer-reviewed journal in English by March 30, 2024 were included. A total of 302 publications from 173 trials were analysed. 63% (n = 191) of them have at least one author from a middle-income country (MIC); 14% (n = 42) articles have the first author from a MIC; and 13% (n = 39) articles have the last author from a MIC. Conversely, 37% (n = 111) of articles had no author from MIC, including two trials conducted only in MICs. In conclusion, our study found an imbalance in authorship, suggestive of significant inequalities, in collaborative research in industry-sponsored clinical trials for breast, lung and colon cancer. Industry sponsors need to work towards greater equity in authorship when collaborating with researchers in (L)MICs, and oncology researchers and opinion leaders in HICs should actively advocate for greater fairness to their colleagues in (L)MICs.
Investigating nutrition information and marketing strategies of packaged food products in the Tanzanian market
(Elsevier B.V., 2026) Khan, Alice S.; Frank, Tamryn; Kaale, Lilian Daniel
Tanzania faces a complex nutrition challenge, with rising rates of malnutrition and nutrition-related non-communicable diseases (NCDs). A significant driver of this trend is the growing availability of ultra-processed packaged foods, which are often high in unhealthy ingredients, poorly labeled, and aggressively marketed. This lack of transparency makes it incredibly difficult for consumers to make healthy choices. This cross-sectional study analysed 5243 packaged foods from 19 purposively selected retail outlets in Dar es Salaam, Arusha, and Zanzibar. Twenty-eight percent of the products assessed lack a nutrition information panel or ingredients list. The vast majority of items, over 82 % were classified as ultra-processed, and over 90 % contained at least one nutrient of concern, such as high levels of fat, sugar, or sodium. The research also highlighted the pervasive use of on-package marketing, which was present on 87 % of products and often targeted children. These findings reveal significant weaknesses in Tanzania's current food regulations. Urgent policy interventions are needed to standardize and improve nutrition labeling, implement clear and easy-to-read front-of-package labels, and restrict marketing practices, especially those aimed at children. Such measures, guided by an evidence-based nutrient profile model, are critical for promoting a healthier food environment.
A primary health care re-engineering approach to enhance PrEP initiation and adherence among high-risk, sexually active adolescents and young adults in KwaZulu-Natal, South Africa
(BioMed Central Ltd, 2025) Mathole, Thubelihle; Nicol, Jeannine Uwimana; Hlongwa, Mbuzeleni
Objective: This study explores the decentralisation of PrEP services through primary health care (PHC) re-engineering structures such as schools, pharmacies, youth zones, community halls, and mobile clinics to improve PrEP uptake and adherence among adolescents and young adults (AYAs) in KwaZulu-Natal, South Africa. Methods: In-depth interviews were conducted from August 2021 to July 2023 with 48 purposively selected participants from a cohort of 2,772 newly diagnosed HIV-negative, sexually active, high-risk individuals. These included 36 adolescent girls and young women aged 15–24 years and adolescent boys and young men aged 15–35 years who initiated PrEP within one month at various service delivery points, including clinics, schools, and community-based services. An additional 12 participants who had not initiated PrEP were also included. Data were analysed thematically using a comprehensive codebook developed to guide the coding process. All transcripts and audio recordings were validated for completeness and accuracy before coding. Findings: The study identifies critical factors that support successful PrEP implementation and expansion among high-risk, sexually active AYAs. The PHC re-engineering programme emerged as a crucial strategy for increasing both PrEP uptake and adherence. Participants expressed a strong preference for decentralised service models, including community-based facilities, outreach teams, and home delivery systems. These models were most appealing to AYAs compared to traditional healthcare facilities. They effectively addressed common barriers such as long waiting times, unfriendly healthcare professionals, overcrowding, stigma, and transportation challenges. Some participants noted that home delivery of PrEP saved both time and money, contributing to better adherence. Conclusion: Decentralised, community-based approaches play a vital role in improving PrEP uptake, adherence, and continuation among AYAs in South Africa.
Co-creating strategies and recommendations to enhance the physical activities of undergraduate students at a South African University: a social ecological approach
(Multidisciplinary Digital Publishing Institute (MDPI), 2025) Johannes, Chanté; Roman, Nicolette Vanessa; Onagbiye, Sunday Olawale; Titus, Simone; Leach, Lloyd
Engagement in physical activity (PA) has been considered to be influenced by multiple psychosocial factors (such as mental health, motivation and social support). However, current interventions often neglect these complex interactions. The Social Ecological Model (SEM) highlights the need for context-specific strategies addressing individual, social, environmental, and public engagement domains to enhance student PA. Therefore, this study aimed to develop strategies and recommendations to enhance the PA levels of undergraduate university students by using a SEM Approach. A co-creative consensus workshop, held between July and August 2024, was employed. The stakeholder group (n = 25) comprised undergraduate university students, professors and academic doctors specialising in PA and health-related disciplines. Data generated from the workshop were uploaded into Atlas Ti. V8 and thematically analysed. The co-created strategies underscore the importance of a multi-level approach to enhancing PA participation among undergraduate students. A total of 32 strategies were developed, reflecting the interconnected influence of psychosocial factors across the levels of the SEM. These include strategies related to PA (9), mental health (7), motivation (9), and social support (7). By developing context-specific strategies and recommendations that address individual, social, physical, and public engagement levels, the research offers practical, student-centred solutions to enhance PA participation. The co-created strategies hold the potential to foster long-term behavioural change and promote active, healthier lifestyles within the South African university context.
Prevalence of metabolic syndrome among adolescents in Cape Town, South Africa: a cross-sectional analysis comparing five diagnostic criteria to explore suitability
(Elsevier Ireland Ltd, 2026) Wentzel, Annalie; Mchiza, Zandile June Rose; Nguyen, Kim Anh
Background: Metabolic syndrome (MetS) among adolescents is a growing public health concern globally, yet data from sub-Saharan Africa remain scarce. Variability in diagnostic criteria further complicates surveillance efforts. This study aimed to estimate the prevalence of MetS among adolescents in Cape Town, South Africa, using five diagnostic criteria, to assess the agreement between definitions and explore criteria suitability. Methods: We conducted a cross-sectional study among 489 adolescents aged 13–18 years, sampled from coeducational public high schools in Cape Town's Metro South district. Anthropometric, blood pressure, and fasting biochemical measurements were collected. MetS prevalence was assessed using the Cook, Ford, de Ferranti, International Diabetes Federation (IDF), and Agudelo criteria. Agreement between definitions was evaluated using unweighted Kappa statistics. Results: The MetS prevalence with four criteria were similar, ranging from 4.7 % (IDF) to 5.7 % (Ford), while one criterion differed significantly with 17.8 % (de Ferranti). Central obesity and raised blood pressure were the most prevalent MetS components across criteria. Females exhibited higher MetS prevalence than males across the five criteria. Very good agreement was observed between Cook, Ford, and Agudelo definitions (κ > 0.85), while agreement involving IDF and de Ferranti definitions was fair to moderate (κ = 0.33–0.42). Conclusions: Our results underscore the need for locally validated, population-specific MetS criteria and diagnostic thresholds to support early identification of adolescents at risk of cardiometabolic disease (CMD). In the absence of such criteria, the Cook and Ford definitions appear particularly suitable for identifying MetS among South African adolescents, while the Agudelo definition is appropriate when waist circumference (WC) measures are unavailable. Finally, our findings reveal a concerning CMD risk profile among adolescents in Cape Town, South Africa, with a particularly high burden observed in females.
Quantifying the fatal and non-fatal burden of disease associated with child growth failure, 2000–2023: a systematic analysis from the global burden of disease study 2023
(Elsevier B.V., 2026) Okonji,Osaretin Christabel; Troeger, Christopher E; Arndt, Michael Benjamin
Background: Child growth failure (CGF), which includes underweight, wasting, and stunting, is among the factors most strongly associated with mortality and morbidity in children younger than 5 years worldwide. Poor height and bodyweight gain arise from a variety of biological and sociodemographic factors and are associated with increased vulnerability to infectious diseases. We used data from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2023 to estimate CGF prevalence, the risk of infectious diseases associated with CGF, and the disease mortality, morbidity, and overall burden associated with CGF. Methods: In this analysis we estimated the all-cause and cause-specific (diarrhoea, lower respiratory tract infections, malaria, and measles) disability-adjusted life-years (DALYs) lost and mortality associated with stunting, wasting, underweight, and CGF in aggregate. We combined the burden associated with mild, moderate, and severe forms of CGF: stunting was defined as height-for-age Z scores (HAZ) less than –1, underweight was defined as weight-for-age Z scores (WAZ) less than –1, and wasting was defined as weight-for-height Z scores (WHZ) less than –1, according to WHO Child Growth Standards. Population-level continuous distributions of HAZ, WAZ, and WHZ were estimated for 2000 to 2023 using data from surveys, literature, and individual-level study data. The risk of incidence of, and mortality due to, diarrhoea, lower respiratory infections, malaria, and measles was separately estimated in a meta-regression framework from longitudinal cohort data for Z scores less than –1. Finally, fatal outcomes associated with these diseases were estimated with vital registration, verbal autopsy, and case-fatality data, while non-fatal outcomes were estimated with surveys as well as health-care utilisation and case reporting data. The exposure prevalence and relative risk estimates were from continuous distributions, allowing for direct assessment of the attributable fractions for mild, moderate, and severe stunting, underweight, wasting, and the combined impact of child growth failure within populations.
Behavioural and Social Drivers (BeSD) of HPV vaccination in Zimbabwe: a rapid scoping review of literature
(Asian Pacific Organization for Cancer Prevention, 2025) Adjagba, Alex Olateju; Chuma, Denford Munyaradzi; Machacha, Ransom
Background: Regardless of the World Health Organization’s recommendation for human papillomavirus (HPV) vaccination, Zimbabwe still faces challenges in achieving optimal vaccination coverage among female adolescents and young adults. Objectives: This rapid scoping review of literature aims to identify the behavioural and social drivers (BeSD) influencing HPV vaccination uptake in Zimbabwe over the past ten-year period. Methods: A scoping review of published and grey literature from 2014 to 2024 was conducted. Data analysis was guided by theoretical frameworks. Eligibility criteria: English language published and grey literature relevant to public health, vaccination, and social and behavioural sciences from Zimbabwe from 2014 to 2024. Sources of evidence: Ministry of Health & Child Care archives, African Journals Online, PubMed, Google Scholar, Scopus, and Web of Science. Charting methods: Tables with author information, year of publication, and relevant findings were used to chart the results. Results: Twenty-eight articles and grey literature sources were included. Key themes encompassed knowledge and attitudes, costs, vaccine uptake, healthcare provider perspectives, and feasibility of delivery methods. High knowledge levels regarding HPV and vaccination coexisted with misinformation and fears, impacting uptake. Socioeconomic factors and religious beliefs influenced HPV vaccination decisions. School-based vaccination was deemed feasible but faced challenges such as misinformation. Communication strategies, including a “Communication for Development” (C4D) approach, were crucial for addressing barriers and fostering community engagement. Discussion: The findings align with numerous theoretical frameworks including the Health Belief Model, Theory of Planned Behaviour, and Social Ecological Model. Addressing barriers at multiple levels, promoting cultural competence, and integrating HPV vaccination into existing healthcare activities are recommended. Conclusion: To enhance HPV vaccination uptake in Zimbabwe, tailored health literacy campaigns, leveraging existing healthcare infrastructure, increased political commitment, and integration into national immunization programmes are crucial. Implementation should draw on existing policies and guidelines to ensure sustainability and equity in vaccination efforts.
Mapping health policies for optimum service delivery to adolescents on HIV treatment in Zambia: a document review
(BioMed Central Ltd, 2025) Moomba, Kaala; Crowley, Talitha; van Wyk, Brian Eduard
Introduction: Despite significant advances in HIV treatment regimens, adolescents living with HIV (ALHIV) report lower rates of viral suppression compared to other age groups, reflecting sub-optimal adherence and lower engagement in care. In Zambia, adolescents lag behind in meeting the 95-95-95 targets for HIV care, when compared to adults. It is imperative that the specific needs of ALHIV are addressed in health policies that direct service delivery. This paper reports on Zambian health policies (policy documents and guidelines) that direct the provision of HIV care and treatment services for ALHIV, by assessing their alignment with recommendations for global best practice as presented in global health policies. We contextualize the policy review within the problem that exists in Zambia with respect to poor performance of the adolescents on the HIV cascade. Methods: We conducted a document review of national health policies and guidelines (N = 10) that relate to HIV service delivery for ALHIV in Zambia and assessed these against the global health policies (N = 6) of which Zambia is a signatory using the four-step READ methodology for document review in health policy research. We used thematic content analysis to develop key themes that describe the components of health service delivery according to the World Health Organization’s (WHO) health systems framework, and comparative analysis to map national health policy against global health policies. Results: The Zambian policies are aligned with global recommendations for health service delivery for ALHIV by including psychosocial support, peer support, mental health services and sexual and reproductive health education in their offering. In addition, Zambian health legislation advocates for a change in the age of consent for health services and comprehensive sexual education in schools, as globally recommended. However, there is a lack of deliberate involvement of adolescents, caregivers and community stakeholders in policy development. With respect to health financing, the national policies promote the integration of HIV financing with other health financing mechanisms but lack dedicated funding for adolescent HIV services. While community involvement is emphasised through youth advisory boards, training, and support groups, there is a notable absence of intentional adolescent engagement at the high-level program design stage. Conclusions: Zambian health policies and guidelines align with global recommendations to optimize health service delivery for ALHIV in four of the six WHO Health Systems building blocks, as evidenced in the relevant global health policies. However, significant gaps remain in areas such as health legislation, financing and community engagement.
The influence of heat exposure on birth and neonatal outcomes in Mombasa, Kenya: a pooled time series analysis
(Elsevier Masson s.r.l., 2025) Jackson, Debra; Brimicombe, Chloe; Mungatia, Aquinius
Introduction: The African continent has been identified as an area of high risk to increasing exposure of heat and has higher levels of social vulnerability. Heat exposure can lead to a rise in certain perinatal and maternal adverse health conditions. We explored the association of heat on seven perinatal and maternal health outcomes. Material and Methods: In this study, data is from Aga Khan University Hospital in Mombasa, Kenya. We evaluated the influence of heat exposure metrics on the outcomes of caesarean sections, low birth weight, low apgar score, preterm birth, stillbirth, assisted vaginal deliveries and long duration of stay in hospital. We carried out pooled time series regression using distributed-lag nonlinear models (lag 0–9 months). Results: We observed an increased odds of caesarean sections with heat exposure at lag 0 indicated by maximum daily Universal Thermal Climate Index (UTCI) between the 50th and the 95th percentile (relative risk 1.21 (1.01,1.46, 95 %CI)) and maximum daily temperature (1.25 (1.03,1.53)). There were increased odds of Low-Birth-Weight Births for lag 0 mean and maximum UTCI. We did not find any significant responses for Wet Bulb Globe Temperature (WBGT). Discussion and Conclusion: Our results show different risk responses for different heat exposure metrics for all perinatal and maternal health outcomes, significantly increasing for low-birth-weight births and caesarean sections. Further research is warranted for Kenya regarding maternal mortality and higher blood loss sometimes associated with caesarean deliveries. In addition, more research is needed on socioeconomics and heat exposure, especially in low– and middle income countries.
Disease burden attributable to intimate partner violence against females and sexual violence against children in 204 countries and territories, 1990–2023: a systematic analysis for the Global Burden of Disease Study 2023
(Elsevier B.V., 2026) Adebiyi, Babatope Oluwadamilare; Flor, Luisa S; Spencer, Cory N
Background Violence against women and against children are human rights violations with lasting harms to survivors and societies at large. Intimate partner violence (IPV) and sexual violence against children (SVAC) are two major forms of such abuse. Despite their wide-reaching effects on individual and community health, these risk factors have not been adequately prioritised as key drivers of global health burden. Comprehensive x§and reliable estimates of the comparative health burden of IPV and SVAC are urgently needed to inform investments in prevention and support for survivors at both national and global levels. Methods We estimated the prevalence and attributable burden of IPV among females and SVAC among males and females for 204 countries and territories, by age and sex, from 1990 to 2023, as part of the Global Burden of Diseases, Injuries, and Risk Factors Study 2023. We searched several global databases for data on self-reported exposure to IPV and SVAC and undertook a systematic review to identify the health outcomes associated with each of these risk factors. We modelled IPV and SVAC prevalence using spatiotemporal Gaussian process regression, applying data adjustments to account for measurement heterogeneity. We employed burden-of-proof methodology to estimate relative risks for outcomes associated with IPV and SVAC. These estimates informed the calculation of population attributable fractions, which were then used to quantify disability-adjusted life-years (DALYs) attributable to each risk factor. Findings Globally, in 2023, we estimated that 608 million (95% uncertainty interval 518–724) females aged 15 years and older had ever been exposed to IPV, and 1·01 billion (0·764–1·48) individuals aged 15 years and older had experienced sexual violence during childhood. 18·5 million (8·74–30·0) DALYs were attributed to IPV among females and 32·2 million (16·4–52·5) DALYs were attributed to SVAC among males and females in 2023. IPV and SVAC were among the top contributors to the global disease burden in 2023, particularly among females aged 15–49 years, ranking as the fourth and fifth leading risk factors, respectively, for DALYs in this group. Among the eight health outcomes found to be associated with IPV, anxiety disorders and major depressive disorder were the leading causes of IPV-attributed DALYs, accounting for 5·43 million (–1·25 to 14·6) and 3·96 million (1·71 to 6·92) DALYs in 2023, respectively. SVAC was associated with 14 health outcomes, including mental health disorder, substance use disorder, and chronic and infectious disease outcomes. Self-harm and schizophrenia were the leading causes of SVAC-attributed burden, with SVAC accounting for 6·71 million (2·00 to 12·7) DALYs due to self-harm and 4·15 million (–1·92 to 13·1) DALYs due to schizophrenia in 2023. Interpretation IPV and SVAC are substantial contributors to global health burden, and their health consequences span a variety of individual health outcomes. Importantly, mental health disorders account for the greatest share of disease burden among survivors. Investing in prevention of these avoidable risk factors has the potential to avert millions of DALYs and considerable premature mortality each year. Our findings represent strong evidence for global and national leaders to elevate IPV and SVAC among public health priorities. Sustained investments are needed to prevent IPV and SVAC and to implement interventions focused on supporting the complex social and health needs of survivors. Funding Gates Foundation.
Antimicrobial resistance and Its impact on food safety determinants along the beef value chain in Sub-Saharan Africa—a scoping review
(Multidisciplinary Digital Publishing Institute (MDPI), 2025) Mano, Oscar; Musuka, Godfrey; Machakwa, Jairus
Antimicrobial resistance (AMR) poses a significant threat to human, animal, and public health, particularly in Sub-Saharan Africa (SSA), where the beef sector is vital to food security and livelihoods. We conducted a scoping review to explore the determinants and impacts of AMR within the beef value chain in SSA, highlighting the challenges and progress in mitigating AMR risks in livestock production. This review identifies key factors contributing to AMR, including the overuse and misuse of antimicrobials, inadequate veterinary oversight, and weak regulatory frameworks. These practices are prevalent across various stages of the beef value chain, from farm to slaughterhouse, and are exacerbated by informal markets and insufficient infrastructure. Our findings also highlight the role of environmental factors, such as contamination of feed, water, and manure, in the spread of resistant pathogens. Additionally, gaps in AMR surveillance, education, and enforcement limit effective control measures in the region. While efforts to combat AMR have gained momentum in some countries, including the development of national action plans and surveillance systems, substantial challenges remain. These include poor adherence to antimicrobial guidelines, insufficient veterinary training, and the lack of integration between sectors. There is a need for targeted research to better understand antimicrobial misuse, socio-economic drivers, and the environmental pathways of AMR, as well as the need for stronger regulatory frameworks and cross-border cooperation. Addressing these challenges will be essential to safeguarding food safety, public health, and the sustainability of the beef industry in SSA.
The 2025 report of the Lancet Countdown to 2030 for women's, children's, and adolescents' health: tracking progress on health and nutrition
(Elsevier B.V., 2025) Kinney, Mary; Amouzou, Agbessi; Barros, Aluisio J D
In line with previous progress reports by Countdown to 2030 for Women's, Children's, and Adolescents' Health, this report analyses global and regional trends and inequalities in health determinants, survival, nutritional status, intervention coverage, and quality of care in reproductive, maternal, newborn, child and adolescent health (RMNCAH) and nutrition, as well as country health systems, policies, financing, and prioritisation. The focus is on low-income and middle-income countries (LMICs) where 99% of maternal deaths and 98% of child and adolescent deaths (individuals aged 0–19 years) occur, with special attention to sub-Saharan Africa and South Asia.
Multi-level factors affecting adolescent and youth engagement in HIV-research in low- and middle-income countries: a qualitative evidence synthesis
(John Wiley and Sons Ltd, 2025) Schmidt, Bey-Marrié; Späth, Carmen; Morar, Neetha Shagan
Objectives: This is a protocol for a Cochrane Review (qualitative). The objectives are as follows:. To explore the views and experiences of adolescents and youth who engaged with (i.e. were approached for participation) or participated in HIV research in low-and middle-income countries. To develop a logic model or visual representation that depicts the variety of factors affecting adolescent and youth engagement in HIV-related research, and how these factors potentially work together.
Food and nutrition security of adolescents and young adults NEETs and non-NEETs in two low socioeconomic urban settlements in South Africa
(BioMed Central Ltd, 2025) Siro, Sicelosethu S; Sayed, Nazeeia; Swart, Elizabeth Catherina
Introduction Adolescents and young adults not yet in employment, education, or training (NEETs) account for a sizable fraction of the global population. In South Africa, 34.3% of young individuals aged 15 to 24 were classified as NEETs in 2022. Lack of work in low-income areas may lead to poverty and food insecurity, negatively impacting diet quality. Objective This cross-sectional study aimed to evaluate and compare the anthropometric status, dietary intake, and food security of NEET and non-NEET adolescents and young adults (aged 18–24 years) in Langa and Fisantekraal, two low socioeconomic settlements in South Africa. Methods Participants were recruited through door-to-door visits. Standardized instruments including a sociodemographic questionnaire, household hunger score, lived poverty index, anthropometric assessments, and 24-hour dietary recalls were used for data collection. Results There were no significant differences in the prevalence of household hunger (p = 0.496), the lived poverty index (p = 0.111) and the prevalence of low micronutrient intakes between the NEETS and non-NEETs (p > 0.05). The prevalence of inadequate daily iron intake had the lowest prevalence while the prevalence of inadequate calcium intake was highest in this group of adolescents and young adults. The insufficient intake of micronutrients among adolescents and young adults can be attributed to the diets consumed by this demographic group.
Effective coverage measurements and cascade for maternal, newborn, child and adolescent health in high-income countries: systematic review
(University of Edinburgh, 2025) Jackson, Debra J.; Zanette, Marianna; Konstantinou, Georgia
Background The concept of ‘effective coverage' (EC) aims to combine the j concept of coverage with the quality of care delivered and, ultimately, the health benefits received by the population in need. To date, systematic rej views of EC of maternal, newborn, child and adolescent health (MNCAH) have focused on low-and middle-income countries (LMICs). No review has j examined whether and how the concept has been applied in high-income j countries (HICs). To address this gap, this systematic review investigated the application of EC measures in MNCAH care in HICs. Methods This was a systematic review that followed the Preferred Report-jing Items for Systematic reviews and Meta-Analyses (PRISMA) reporting j guidelines. The search strategy was developed from previous EC reviews conducted in LMICs and further adapted to the HIC setting. Additional search terms were identified through discussion with experts from the Life Stage Quality of Care Metrics Technical Working Group subgroup on EC. We searched three databases, PubMed, Embase, and Web of Science, over 10 years. We conducted additional searches in Google Scholar and by con-j sulting members of the Life Stage Quality of Care Metrics Technical Work-j ing Group. We did not pose any language or type of article limits. Results The database search identified 18 976 studies for screening. Of these, 672 abstracts were screened, and none of the full texts considered met our inclusion criteria (e.g. human immunodeficiency virus/hepatitis c virus continuum of care cascade, intervention type, qualitative search-interviews/questionnaire type studies). Thirty-two articles were retrieved through the additional search strategies, and none were included because of LMIC-focused research. Therefore, examples of EC of MNCAH care ap-j plied in HICs were not identified. Conclusions Further investigation should be conducted into the application of the EC concept for assessing MNCAH care in HICs. This research will help us understand how this concept can be used to support health system effectiveness, efficiency, and equity in HICs. Registration The study protocol was registered at the Open Science Frame-j work: https://doi-org.ezproxy.uwc.ac.za/10.17605/OSF.IO/FMCG8.
Telemedicine contraceptive counselling through whatsapp in South African abortion care: a mixed-methods acceptability study
(Taylor and Francis Ltd., 2025) Knight, Lucia C.; Weinryb, Maja; Larsson, Elin Charlotte
Introduction: While telemedicine contraceptive counselling may enhance access and uptake, particularly in low-resource settings, the evidence for its acceptability as an alternative to in-person counselling remains limited. We therefore assessed the acceptability of PlanUrFam, a comprehensive WhatsApp-based contraceptive counselling tool, among women seeking abortion care in South Africa. Methods: We conducted a mixed-methods pilot study at two public health clinics. Women seeking abortion care (n = 31) used PlanUrFam for contraceptive counselling and were followed-up at two weeks (n = 28). The primary outcome was a composite measure acceptability, informed by the Theoretical Framework of Acceptability (TFA). The secondary outcome was choice of long-acting reversible contraception (LARC) and preference for future counselling. In-depth interviews with a nested subgroup (n = 8) explored experiences of the tool using the TFA and content analysis. Results: There was high acceptability (89%, n = 25/28) across framework domains. Qualitative results confirmed that PlanUrFam was acceptable, easy to use, understand and reduced judgement experienced in in-person care. Comprehensive information increased perceived confidence and agency in contraceptive decision-making. After using PlanUrFam, most participants chose LARC methods (64%, n = 18/28), chose a different contraceptive than previously used (96%, n = 27/28), and preferred either PlanUrFam alone (54%) or in combination with in-person counselling (36%) for future contraceptive care. Discussion: This pilot demonstrates high acceptability of PlanUrFam in abortion care and supported informed decision-making and choice of LARC. The effectiveness of PlanUrFam or similar interventions compared to standard care should be explored in randomised controlled trials measuring method initiation, continuation, recurrent pregnancy and abortion.
Representation, activism, health promotion, and communication: the role of art in advancing global health and social justice
(Public Library of Science, 2025) Orth, Zaida; Reñosa, Mark; Perry, Kelly
This viewpoint advocates for the inclusion of art in global health discourse and practice. We explore four areas in which art can be leveraged to improve global health: to amplify disenfranchised voices, to advance social justice activism, to strengthen communities and individuals, and to improve global health communication. Drawing on community-driven art initiatives, we argue for an inclusive approach that respects diverse cultural perspectives and uplifts marginalized voices. Emphasizing interdisciplinary collaboration and ethical engagement, our framework invites global health discourse and practice to integrate art in order to foster empathy, challenge systemic inequities, and envision sustainable futures. By centering art, we seek to enrich the global health discipline with insights and transformative potential grounded in human experiences, cultural diversity, and shared humanity.

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