Research Articles (School of Public Health)

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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.
Care mobilities and associated contexts of hospital-based informal caregiving in Nigeria: towards an explanatory framework
(Public Library of Science, 2025) Somefun, Oluwaseyi Dolapo; Adebayo, Kudus; Omobowale, Mofeyisara
Hospital-based informal caregiving in Nigeria is shaped by care mobilities and contextual factors such as policy contradictions and normative care philosophies. This study explores how these factors influence caregiving practices in a Nigerian tertiary health facility. Using a qualitative approach, data were gathered through interviews and observations, involving 75 participants, including 36 in-depth interviews with caregivers and inpatients, and 39 key informant interviews with staff like nurses, doctors, security guards, and ad-hoc caregivers. Findings showed that many informal caregivers traveled long distances to assist hospitalized relatives, often “hanging around” the hospital and engaging in micro-mobilities, such as running errands. Geographical distance, policy contradictions, and the financial costs of hospitalization significantly affected caregiving dynamics. Care mobilities caregivers moving within the hospital environment emerged as a critical aspect of the caregiving process. Understanding these mobilities and how they intersect with contextual factors is essential to improving caregiving experiences. The study highlights the need for policies that support informal caregivers and enhance patient outcomes, especially in terms of reducing the burdens caregivers face due to long travel distances, hospital policies, and financial challenges.
Key stakeholders’ views on the causes of medicine stock-outs in Mauritania: a qualitative study
(Public Library of Science, 2025) Ravinetto, Raffaella M.; Ag Ahmed, Mohamed Ali; Coulibaly, Issa
The number of medicine stock-outs is increasing globally. In Mauritania, they are recurring, although, to our knowledge, no study has yet been conducted to determine the causes. Therefore, this qualitative study aims to explore the views of key stakeholders in the pharmaceutical sector to identify the main local or national causes of stock-outs. It will thus provide a common understanding and guide policy-makers towards corrective action. The study was carried out in five health districts and at the regional and central levels. The samples were purposive. Two focus groups and twenty semi-structured individual interviews were held with 38 participants, including health professionals, managers from the Central Purchasing Office for Essential Medicines and Consumables, the Pharmacy and Laboratory Department and the Ministry of Health. All interviews were recorded and transcribed. A thematic content analysis was carried out. Our findings indicate the national causes of medicine stockouts at three healthcare system levels (operational, regional, and central). They were grouped into five categories: insufficient human resource capacity (number of staff, training, retention), communication and coordination problems between stakeholders, logistical constraints (transport, storage), financial constraints, inadequate forecasting of needs, and complex procurement procedures. These causes of medicine stockouts are interconnected, and many could be addressed locally through solutions initiated and led by the Mauritanian authorities. To address medicine stock-outs sustainably, we suggest and discuss some possible actions, including reforms to improve Central Purchasing Office for Essential Medicines and Consumables’s governance and accountability and, more broadly, to strengthen the various pillars of the local health and pharmaceutical system.
“I-we-I”: visualizing adolescents’ perceptions and apprehension to transition to adult hiv care at a supportive transition facility in the Cape Town metropole, South Africa
(Multidisciplinary Digital Publishing Institute (MDPI), 2025) Petinger, Charné; van Wyk, Brian Eduard; Crowley, Talitha
Adolescents living with HIV (ALHIV) (10–19 years) make up approximately 4.2% (320,000) of people living with HIV in South Africa. Adolescence is a developmental period characterized by pervasive biological, social and psychological changes, which challenges adherence and retention in care for ALHIV on antiretroviral therapy (ART). Further, as ALHIV grow “older”, they are expected to transition to the adult HIV treatment programme, where they should assume greater responsibility for managing their chronic condition and healthcare pathway. Whereas it is imperative that ALHIV are transitioned when they are ready, little is known about the challenges and experiences of ALHIV before and during transition. The aim of this paper was to report on the experiences and challenges of transition for ALHIV who received ART at an adolescent-friendly service that is adjunct to a public primary healthcare facility in the Western Cape province of South Africa. Methods: Photovoice methods were employed to explore the transition experiences of ALHIV on ART at a “supportive transition” public health facility in the Cape Town Metro in South Africa. Participants took pictures that depict their experience pre- and during transition to adult care and discussed these in groups with peers. Audio data were digitally recorded and transcribed verbatim and subjected to thematic analysis using Atlas.Ti version 24. Results: The emergent themes described their apprehension to transitioning to adult care; self-management; challenges to adherence; the need for psychosocial support; and how adolescent-friendly services were filling the gap. Conclusions: We illuminate the “I-We-I” configuration, to reflect (the first “I”) individual ALHIV experiences as isolated before being transferred to the supportive facility; how they experience a sense of belonging and family (“we”) in the supportive facility; but face apprehension about transitioning to adult care in the local clinic, where they have to self-manage (final “I”).
Menstrual hygiene management practices and associated factors among adolescent schoolgirls in rural Tanzania: a school-based cross-sectional study
(Taylor and Francis Ltd., 2025) Ngilangwa, David Paul; Cooper, Diane; Lembani, Martina
Poor menstruation hygiene management (MHM) is an outcome for a majority of adolescent girls in low- and middle-income countries while in school due to limited knowledge; water, sanitation, and hygiene facilities; and social support. This study aimed to assess practices and factors associated with poor MHM among schoolgirls in the rural district of Kilindi in northeastern Tanzania. A cross-sectional survey was conducted in a sample of 490 adolescent schoolgirls gathered through a two-step stratified random sampling approach. A structured questionnaire was administered to collect MHM data. Descriptive and inferential analysis was conducted using SPSS version 26. The mean age of participants was 13.7 (SD = 0.8). Overall, 44.5% had good menstruation knowledge. Factors associated with good knowledge of MHM include being 12 years old (adjusted odds ratio [AOR] = 0.1, 95% confidence interval [CI]: 0.1–0.2); having a grandmother as a source of menstrual information (AOR = 0.5, 95% CI: 0.2–0.9); ever having missed school due to menses (AOR = 0.5, 95% CI: 0.2–0.9); and coming from households with more than seven family members (AOR = 6.4, 95% CI: 4.0–10.2). Poor MHM practices were reported by 62.7% of schoolgirls. A factor associated with poor MHM practices was using media as the source of information (AOR = 0.5, 95% CI: 0.2–0.9). Findings shows that there were low rates of knowledge of MHM and a high prevalence of poor MHM practices among rural schoolgirls in Kilindi district, suggesting the importance of designing and implementing interventions to ensure access to adequate MHM facilities, education, and social support in schools to facilitate MHM among schoolgirls.
“The dream of justice”
(Springer Science and Business Media B.V., 2025) van Marle, Karin
In the piece below the author, inspired by David Scott (Stuart Hall 2017), writes a letter to the late Drucilla Cornell. She starts off by drawing on Scott’s invocation of “An ethics of receptive generosity” in relation to Hall and attributes such ethics also to Cornell. Cornell, did not only give but also knew how to receive from others. Her engagement with her own context, the different legal theoretical positions in the US legal academy at the time, in The Philosophy of the Limit (Cornell 1992) is unpacked and also used as a way for the author to reflect on the different perspectives on the constitution in South Africa. The author regards Cornell’s renaming of deconstruction to the “philosophy of the limit” and its implications for legal interpretation, as well as her framing of ethical feminism as foundational to a critical jurisprudence, and a feminist jurisprudence, a jurisprudence that is feminist. She focuses on Cornell’s work on/ in South Africa, her view of revolution and her “rethinking of ethical feminism through ubuntu”.
Immunization coverage, equity, and access for children with disabilities: a scoping review of challenges, strategies, and lessons learned to reduce the number of zero-dose children
(Multidisciplinary Digital Publishing Institute (MDPI), 2025) Mano, Oscar; Musuka, Godfrey; Cuadros, Diego Fernando
Background: Children with disabilities, particularly in low- and middle-income countries (LMICs), face heightened risks of vaccine-preventable diseases due to a range of systemic and social barriers. Although immunization is a fundamental human right and a proven public health intervention, this vulnerable group is often overlooked in policy and practice. Understanding the factors compromising vaccine equity for these children is critical to reducing zero-dose prevalence and improving health outcomes. Methods: This scoping review examined peer-reviewed, gray literature from 2010 to 2024. Searches were conducted in PubMed, Google Scholar, and relevant organizational reports (WHO, UNICEF). Studies addressing children with disabilities and focusing on immunization barriers, interventions, or lessons learned were selected. English-language publications were screened in title/abstract and full-text stages. Key data extracted included population, barriers, and immunization outcomes. Since this review focused on articles in English, this is a key limitation. Results were synthesized thematically to identify recurring patterns and to guide improved interventions and policies. Results: Twelve articles met the inclusion criteria. Key barriers identified were inadequate healthcare infrastructure, insufficient provider training, limited follow-up services in rural regions, societal stigma, and pervasive misconceptions around both disability and vaccines. Factors such as maternal education, logistical support for caregivers, and using low-sensory, inclusive vaccination settings were consistently linked with better outcomes. Effective strategies included mobile vaccination units, tailored interventions (e.g., distraction or sedation techniques), school-based immunization programs, and robust community engagement to address stigma. Lessons learned underscored the importance of flexible, individualized care plans and empowering families through transparent communication. Conclusions: Children with disabilities continue to experience significant gaps in immunization coverage, driven by intersecting barriers at the individual, health system, and societal levels. Scaling tailored interventions, inclusive policies, strengthened infrastructure, and ongoing research can help ensure these children receive equitable access to life-saving vaccinations.
The perspectives of key informants on programs and policies pertaining to HIV prevention and treatment for farm workers in rural South Africa
(John Wiley and Sons Ltd, 2025) Lembani, Martina; Mlangeni, Nosimilo; Adetokunboh, Olatunji
Introduction: Farm workers are one of the subpopulations with poor progress toward the 95-95-95 targets in South Africa. The transient nature of farm workers results in treatment disruptions and affects the continuity of care. This study aimed to explore program implementers’ and program experts’ perspectives on the challenges and opportunities in providing HIV prevention and care to people working on farms. Methods: The study was conducted in three provinces of South Africa, using an exploratory qualitative study design. Policy document analysis was performed followed by key informant interviews with HIV program implementers and program experts. Key informants were purposively selected based on their roles in the HIV program at health facilities and other settings. An inductive approach was used to analyze data. Results: Eight policy documents were analyzed, and eight key informants were interviewed. Emerging themes included challenges in providing HIV services to farm workers, effective strategies employed by service providers, and program and policy recommendations. Several challenges in providing HIV care to farm workers were presented, including their high mobility which leads to treatment interruptions and loss to follow-up. As a result, farm workers easily get lost to follow-up and are likely to have poor treatment outcomes. Some of the effective strategies included community-based prevention, treatment and support services, and the use of health passports to improve linkages to care. Community health workers, mobile clinics, and community-based pick-up points improve access to HIV counselling and testing, adherence to antiretroviral therapy, and retention in care. Program and policy recommendations included customized HIV services and designing sector-specific HIV policies. Conclusion: The study reveals ongoing structural barriers that limit sufficient HIV prevention and retention in care for farm workers who are on treatment. Models of care that include patient-held records, workplace-provided services, and mobile healthcare are recommended.
Born too soon: progress and priorities for respectful and rights-based preterm birth care
(BioMed Central Ltd, 2025) Kinney, Mary V.; Ateva, Elena; Cocoman, Olive
Progress: Human rights related to preterm birth encompass access to respectful, evidence-based care; informed consent; protection from discrimination, detention, and unnecessary separation of mother and newborn; and broader social entitlements, such as parental leave and early disability support. Since the 2012 Born Too Soon report, global recognition of these rights has expanded through international treaties, global guidelines, national legal reforms, and social movements. Demand for respectful care, including respectful maternity care and family centred care, has led to its incorporation into global guidelines and policies and a greater evidence-base. However, persistent challenges, such as workforce shortages, discriminatory policies, and the erosion of sexual and reproductive rights, continue to threaten progress. Programmatic Priorities: Ensuring respectful and rights-based preterm birth care requires coordinated action across the continuum of care and across sectors, with the mother–baby dyad at the centre. Programmatic priorities at the individual level include implementing respectful maternity care and family-centred care. Ensuring high-quality, respectful care demands that providers themselves are supported, protected, and empowered to deliver such care. Their well-being is a critical enabler of the rights of patients and an essential component of effective, compassionate service delivery. At the facility-level, health systems must be purposefully designed to safeguard the fundamental human rights of the individuals with them, both care seekers and care providers. Implementing respectful, rights-based care relating to preterm birth requires structural and social changes, as well as robust data systems for accountability. Multi-stakeholder action requires strengthening accountability mechanisms at all levels and partnering with those affected by preterm birth—particularly women, families and healthcare providers—in policy processes, and the design, implementation and monitoring of care. At national-level, action requires the adoption, implementation and monitoring of international and regional human rights instruments, with multisectoral collaboration and social mobilization where violations continue. Pivots: To operationalize respectful and rights-based care for preterm birth, four primary shifts are needed: scale up respectful care; empower and partner with women and families; address the shortage of healthcare providers and protect their rights; and strengthen policy action and accountability.
Gender-associated factors on the occurrence and prevalence of zero-dose children in Sub-Saharan Africa: a critical literature review
(Multidisciplinary Digital Publishing Institute (MDPI), 2025) Mano, Oscar; Musuka, Godfrey; Moyo, Enos
Background: Immunisation remains one of the most effective and cost-efficient public health interventions for preventing infectious diseases in children. Despite global progress, Sub-Saharan Africa (SSA) continues to face challenges in achieving equitable immunisation coverage. Gender-related disparities, rooted in sociocultural and structural inequalities, significantly influence the prevalence of zero-dose and under-immunised children in the region. This review critically examines the gender-associated barriers to routine childhood immunisation in SSA to inform more inclusive and equitable health interventions. Methods: A critical literature review was conducted generally following some steps of the PRISMA-P and CRD guidelines. Using the Population–Concept–Context (PCC) framework, studies were selected that examined gender-related barriers to routine immunisation for children under five in Sub-Saharan Africa. Comprehensive searches were performed across PubMed, Google Scholar, and relevant organisational websites, targeting articles published between 2015 and 2025. A total of 3683 articles were retrieved, with 24 studies ultimately meeting the inclusion criteria. Thematic analysis was used to synthesise the findings. Results: Four major themes emerged: (1) women’s empowerment and autonomy, including limited decision-making power, financial control, and the impact of gender-based violence; (2) male involvement and prevailing gender norms, where patriarchal structures and low male engagement negatively influenced vaccine uptake; (3) socioeconomic and structural barriers, such as poverty, geographic inaccessibility, maternal workload, and service availability; and (4) education, awareness, and health system responsiveness. Conclusions: Gender dynamics have a significant impact on childhood immunisation outcomes in Sub-Saharan Africa. Future policies must integrate these insights to improve immunisation equity and reduce preventable child morbidity and mortality across the region.
Reflections of resilience and vulnerability of adolescents living with HIV during COVID-19: a photovoice study in peri-urban Cape Town, South Africa
(SAGE Publications Inc, 2025) Mayman, Yolanda; Wyk, Brian van; Crowley, Talitha
Background: Adolescents living with HIV (ALHIV) in low socio-economic contexts face challenges related to physical development and health, stigma, and economic instability. The onset of the COVID-19 pandemic exacerbated these vulnerabilities, impacting the physical, mental, and social well-being of ALHIV. ALHIV were positioned in a particularly precarious situation, requiring them to navigate the disruptions caused by the pandemic while simultaneously striving to maintain resilience and adherence to their antiretroviral treatment (ART). Objectives: To explore the resilience and vulnerability of ALHIV on ART in a peri-urban community in Cape Town, South Africa during the COVID-19 pandemic. Methodology: A participatory photovoice study was employed with 20 ALHIV aged 14 to 19 years. Participants received basic training on photography techniques and were asked to capture images representing their experiences during the COVID-19 pandemic. These photographs were shared and discussed in both individual interviews and group discussions. All interviews and discussions were audio-recorded, and the resulting transcripts were analysed using content analysis to identify key themes and insights. Results: Four key themes were identified: (1) disrupted routines and emotional strain, (2) support systems and coping mechanisms, (3) HIV treatment adherence facilitators and barriers, and (4) economic vulnerability and household stress. Despite the compounded challenges and significant hardships, ALHIV in this study demonstrated notable resilience, maintaining treatment adherence and a positive outlook despite economic struggles and social disruptions. Conclusions: This study highlights the resilience and vulnerability of ALHIV in resource-limited settings. Findings underscore the need for targeted mental health and social support interventions to address their unique vulnerabilities. Strengthening healthcare access, social support networks, and local community resources can improve the well-being and coping capacity of ALHIV in future crises.
Peer-learning and support among health policy and systems research actors in West Africa: a social network analysis
(BioMed Central Ltd, 2025) Defor, Selina; Mukinda, Fidele Kanyimbu; Lehmann, Uta
Background: Health policy and systems research (HPSR) is vital for strengthening health systems, yet its development in West Africa remains constrained by limited capacity. To strengthen capacity, the West African Network of Emerging Leaders in Health Policy and Systems (WANEL) was created to foster peer learning and cross-country collaboration among early- and mid-career HPSR actors. This study used Social Network Analysis (SNA) to examine WANEL’s structure and functioning, with the aim of understanding how well the network supports its capacity and HPSR field-building goals. Methods: A cross-sectional whole-network survey was conducted with all 103 WANEL members, supported by document reviews and qualitative interviews. Relationship types assessed included acquaintance, communication, advice, mentorship and research collaboration. Data were analysed using Gephi to visualize relational patterns and compute metrics such as density and centralization, while qualitative findings provided context for interpreting network dynamics. Results: While WANEL has enhanced cross-country awareness and disciplinary diversity, the network exhibits low cohesion and high centralization. Key support relationships, particularly mentorship, advice and collaboration are sparse and unevenly distributed. A few actors dominate the flow of information and access to opportunities, while many, especially early-career and francophone actors, remain peripheral or isolated. Network interactions are driven by prior relationships and linguistic or professional affinity, limiting broader engagement. Conclusion: Findings reveal structural barriers that constrain WANEL’s potential to act as an inclusive platform for HPSR capacity-strengthening. To fulfil its vision, the network must address its current fragmentation by building stronger cross-cutting ties, broadening participation and decentralizing influence. This study contributes empirical insights into the design and governance of regional HPSR networks in low- and middle-income contexts and underscores the importance of relational infrastructure in advancing collective capacity.
Contextual constraints and dilemmas influencing health providers’ prescription practices in a conflict-affected area: qualitative insights from Mopti, Mali
(Public Library of Science, 2025) Ravinetto, Raffaella M.; Coulibaly, Issa; Diarra, Yacouba
Armed conflicts present complex, multidimensional challenges that severely compromise both access to and the quality of healthcare, including the adequate prescription of essential medicines. This study aimed to identify and understand the factors underlying the irrational prescribing of medicine in areas affected by armed conflict in the Mopti region in Mali. An exploratory qualitative study was conducted using a semi-structured interview guide to collect data from 30 participants, including health professionals from three health districts, representatives of the regional health directorate, members of community health associations, and staff from non-governmental organisations (NGOs) working in health sector. Interviews were recorded, transcribed, and subjected to thematic content analysis, using NVIVO 14 (2023 version) to support coding and data retrieval. Study participants reported a range of health system- and patient-related factors contributing to irrational prescribing practices in these conflict-affected areas. Health systems factors included: an imbalance between workload and the availability of qualified staff; limited access to professional training and training resources; poor adherence to prescription guidelines and procedures -often a consequence of contextual constraints; and coercion from armed terrorist groups. Administrative and political challenges were also highlighted, including weak monitoring and supervision mechanisms within the local health system; a lack of oversight by health and regulatory authorities in blockaded areas; the development of an informal pharmaceutical sector to compensate for deficiencies in the formal system; and over prescription of medicines linked to insurance schemes.
Ritshidze's community-led monitoring system as a source of information on health system responsiveness in South Africa
(South African Medical Association, 2025) Govendor, Karessa; Schneider, Helen; Barron, Peter
Ritshidze is a large-scale community-led monitoring (CLM) system in South Africa, which has been conducting quarterly surveys of patient experiences at >400 primary healthcare facilities and community sites since 2019. This in-practice piece examines the data collected and publicly reported by Ritshidze, to highlight its role as an independent, complementary source of information on primary healthcare performance. It argues that CLM has significant potential to enhance health system responsiveness. We provide an overview of the data collection system, involving close to 500 data points organised into seven domains, and then focus on two sets of indicators that illustrate the utility of the monitoring and reporting system. The indicators selected are a set that assesses patient time spent at a facility (as a proxy for waiting times), illustrating both the depth and the breadth of the Ritshidze database; and the length of HIV prescriptions ('length of medicine refill'), as an indicator of the improvements in responsiveness of the health system to the needs of patients. Integrating CLM data into formal health system monitoring and evaluation frameworks could enhance the responsiveness of the health system to patients and communities, one of the key overall objectives of the district health system.

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