Wits Health Sciences Research Review │DECEMBER 2023

December 2023

WITS HEALTH SCIENCES RESEARCH REVIEW

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NEWS

SPOTLIGHT

RESEARCH

A YEAR OF WINS!

Restonic Ezintsha Sleep Clinic pioneers sleep research and treat sleep disorders in SA

Focus on:

Multi-trait discovery and fine-mapping of lipid loci in 125,000 individuals of African ancestry

Faculty researchers inducted as Fellows of the Royal Society of South Africa

Stillbirths and neonatal deaths caused by Group B Streptococcus in Africa and south Asia identified

ASSAf gold medal bagged

Future-proofing pandemic preparedness and response

2023 - A year of worldclass healthcare research and training fit for an everchanging world

Alumni receive lifetime achievement awards

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Research in high-impact factor journals: Safety and upscaling of remote consulting for long-term conditions in primary health care in Nigeria and Tanzania (REaCH trials): stepped-wedge trials of training, mobile data allowance, and implementation Lancet Global Health

Wits researcher involved: Frances Griffiths In-person health care poses risks to health workers and patients during pandemics. Remote consultations can mitigate these risks. The REaCH intervention comprised training and mobile data allowance provision for mobile phones to support remotely delivered primary care in Africa compared with no training and mobile data allowance. The aim of this study was to estimate the effects of REaCH among adults with noncommunicable diseases on remote and face-toface consultation rates, patient safety, and trustworthiness of consultations.

Methods In these two independent stepped-wedge cluster randomised controlled trials, this study enrolled 20 primary care clusters in each of two settings (Oyo State, Nigeria, and Morogoro Region, Tanzania).

Eligible clusters had 100 or more patients with diabetes, hypertension, and cardiovascular or pulmonary disease employing five health workers.

Clusters were computer-randomised to one of ten (Nigeria) or one of seven (Tanzania) sequences to receive the REaCH intervention. Only outcome assessors were masked. Primary outcomes were consultation, prescription, investigation rates, and trustworthiness collected monthly for 12 months (Nigeria) and 9 months

(Tanzania) from open cohorts. Ten randomly sampled consulting patients per cluster month completed patient-reported outcome measures. This trial was registered with ISRCTN, ISRCTN17941313.

Findings Overall, 40 clusters comprising 8776 (Nigeria) and 3246 (Tanzania) patients’ open cohort data were analysed (6377 [72·7%] of 8776 females in Nigeria, and 2235 [68·9%] of 3246 females in Tanzania). The mean age of the participants was 55·3 years (SD 13·9) in Nigeria and 59·2 years (14·2) in Tanzania. In Nigeria, no evidence of change in face-to-face consulting rate was observed (rate ratio [RR] 1·06, 95% CI 0·98 to 1·09; p=0·16); however, remote consultations increased four-fold (4·44, 1·34 to >10; p=0·01). In Tanzania, face-to-face (0·94, 0·61 to 1·67; p=0·99) and remote consulting rates (1·17, 0·56 to 5·57; p=0·39) were unchanged. There was no evidence of difference in prescribing rates (Nigeria: 1·05, 0·60 to 1·14; p=0·23; Tanzania: 0·92, 0·60 to 1·67; p=0·97), investigation rates (Nigeria: 1·06, 0·23 to 2·12; p=0·49; Tanzania: 1·15, 0·35 to 1·64; 0·58) or trustworthiness scores (Nigeria: mean difference 0·05, 95% CI –0·45 to 0·42; p=0·89; Tanzania: 0·07, –0·15 to 0·76; p=0·70). *Read the full study

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Multi-trait discovery and fine- Safety of COVID-19 booster dose: is the juice worth the squeeze? mapping of lipid loci in 125,000 individuals of African Nature Communications Wits researchers involved: Shabir Madhi, Alane Izu ancestry Nature Communications

Wits researchers involved: Abram Bunya Kamiza, Tinashe Chikowore Health is pivotal to human development.

Nevertheless, progress towards achieving improved health worldwide has been slow, especially in Africa.

Most genome-wide association studies (GWAS) for lipid traits focus on the separate analysis of lipid traits.

Moreover, there are limited GWASs evaluating the genetic variants associated with multiple lipid traits in African ancestry. To further identify and localize loci with pleiotropic effects on lipid traits, this study conducted a genome-wide meta-analysis, multi-trait analysis of GWAS (MTAG), and multi-trait finemapping (flashfm) in 125,000 individuals of African ancestry.

In this issue of The Lancet Infectious Diseases, Dan Yamin and colleagues used a self-controlled case series design to evaluate the safety of COVID-19 vaccine boosters. The authors compared mRNA monovalent and bivalent boosters (i.e. third to fifth doses) of the mRNA monovalent and bivalent (mainly used as a fifth dose) boosters by comparing a 28-day post-booster period (and a sensitivity analysis period up to 42 days post-booster) with a 28-day baseline period that ended 7 days before vaccination. The analysis was focused primarily on individuals categorised as being at high risk of susceptibility to severe COVID-19 and was limited to analysis of only those patients hospitalised for 29 medical conditions (collectively termed as non-COVID-19 hospitalisations) that are potential adverse events associated with COVID-19 vaccination. *Read the full study

WHO pandemic accord: Full adherence to the principle of sovereignty Nature Communications Wits Researcher Involved: Precious Matsoso

This paper’s meta-analysis and MTAG identified four and 14 novel loci associated with lipid traits, respectively. Flashfm yielded an 18% mean reduction in the 99% credible set size compared to single-trait fine-mapping with JAM. Moreover, this study identified more genetic variants with a posterior probability of causality >0.9 with flashfm than with JAM. In conclusion, the study identified additional novel loci associated with lipid traits, and flashfm reduced the 99% credible set size to identify causal genetic variants associated with multiple lipid traits in African ancestry.

Although the process of drafting a pandemic accord has been transparently informed to global communities in 2022 and 2023, there has been a substantial amount of misinformation related to the contents of the WHO Convention, Agreement, or Other International Instrument on Pandemic Prevention, Preparedness, and Response (WHO CA+) circulated on platforms such as YouTube and X (formerly Twitter). This misinformation includes assertions that this pandemic treaty threatens national sovereignty, that WHO would deploy troops to enforce the treaty, and that national armed forces would be deployed to implement the treaty under UN orders. There have been rumours of vaccine mandates and digital passports enabling WHO to track individuals’ movements, concerns about WHO's authority to sanction countries, and opposition to ceding authority to WHO, among others.

* Read the full study

*Read the full study

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All-cause and pathogen-specific lower respiratory tract infection hospital admissions in children younger than 5 years during the COVID-19 pandemic (2020–22) compared with the pre-pandemic period (2015–19) in South Africa: an observational study Findings Nature Communications

Wits researchers involved: Alane Izu, Marta Nunes, Fatima Solomon, Vicky Baillie, Natali Serafin, Charl Verwey, David Moore, Marius Laubscher, Musawenkosi Ncube, Courtney Olwagen, Ziyaad Dangor, Shabir Madhi

Overall, there were 42 068 all-cause hospital admissions, including 18 303 all-cause LRTI hospital admissions, from Jan 1, 2015, to Dec 31, 2022, 17822 (42·4%) of whom were female, 23 893 (57·0%) were male, and 353 (0·8%) had missing data. All-cause LRTI incidence risk ratio (IRR) was 30% lower in 2020 (IRR 0·70, 95% CI 0·67–0·74) and 13% lower in 2021 (0·87, 0·83–0·91), but 16% higher in 2022 (1·16, 1·11–1·21) compared with the pre-pandemic period. Furthermore, compared with the pre-pandemic period, incidence of RSV-associated LRTI (0·52, 0·45–0·58), influenzaassociated LRTI (0·05, 0·02–0·11), and pulmonary tuberculosis (0·52, 0·41–0·65) were lower in 2020, with similar trends observed for human-metapneumovirusassociated LRTI, pertussis, and invasive pneumococcal disease (IPD).

Compared with the pre-pandemic period, by 2022, RSV-associated LRTI incidence was similar (1·04, 0·95–1·14) and influenza-associated LRTI showed a non-significant increase (1·14, 0·92–1·39), whereas Non-pharmaceutical interventions affected the incidence remained lower for tuberculosis (0·79, 0·65– circulation of illness due to endemic respiratory 0·94) and IPD (0·51, 0·24–0·99). In 2022, the pathogens during the COVID-19 pandemic. This incidence of COVID-19-associated LRTI hospital study investigated the incidence of admissions to admission (65 per 100 000 children younger than 5 hospitals for overall and specific pathogenyears) was lower than pre-pandemic RSV-associated associated lower respiratory tract infection (LRTI) LRTI (0·23, 0·19–0·27) but higher than pre-pandemic during the COVID-19 pandemic compared with the influenza-associated LRTI (1·19, 0·97–1·45), although incidence in the pre-pandemic period. the difference was not significant. All-cause LRTI death Methods in 2022 (57 per 100 000 children younger than 5 years) In this observational study, researchers analysed was 28% higher than in the pre-pandemic period (1·28, surveillance data for children younger than 5 years from 1·03–1·58). two public hospitals in Soweto, South Africa, for allcause LRTI, respiratory syncytial virus (RSV), influenza, Interpretation human metapneumovirus, and Bordetella pertussis from The higher incidence of all-cause LRTI admissions to Jan 12015, to Dec 31, 2022. Data were obtained from hospitals in 2022 compared with the pre-pandemic an electronic database that includes information for all period is partly due to ongoing COVID-19 admission to admissions to the general paediatric wards at the two hospital and could worsen if other endemic respiratory hospitals, automatically identified by a computer pathogens revert to pre-pandemic incidence. program. This study excluded children admitted to Interventions, including the introduction of vaccines for hospital with incidental SARS-CoV-2 infection or people who are pregnant, that aim to prevent RSV and COVID-19 without LRTI diagnosis. Incidence during possibly COVID-19 in young children, are warranted. the COVID-19 pandemic years (2020, 2021, and 2022) were compared with pre-pandemic rates (2015–19). *Read the full study

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Metagenomic sequencing of post-mortem tissue samples for the identification of pathogens associated with neonatal deaths

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The Nobodies: Unidentified dead bodies - a global health crisis requiring urgent attention Lancet Global Health

Nature Communications

Wits researchers involved: Vicky Baillie, Shabir Madhi, Courtney Olwagen Post-mortem minimally invasive tissue sampling together with the detailed review of clinical records have been shown to be highly successful in determining the cause of neonatal deaths.

However, conventional tests including traditional culture methods and nucleic acid amplification tests have periodically proven to be insufficient to detect the causative agent in the infectious deaths.

In this study, metagenomic next-generation sequencing was used to explore for putative pathogens associated with neonatal deaths in postmortem blood and lung tissue samples, in Soweto, South Africa. Here it shows that the metagenomic sequencing results corroborate the findings using conventional methods of culture and nucleic acid amplification tests on postmortem samples in detecting the pathogens attributed to the causal pathway of death in 90% (18/20) of the decedents.

Wits researcher involved: Craig Adam Keyes Every year, millions of dead people across the globe remain unidentified and are never returned to their families or communities. The circumstances surrounding their death are often unknown, and their bodies go unclaimed.

Furthermore, metagenomic sequencing detected a putative pathogen, including Acinetobacter baumannii, Klebsiella pneumoniae, Escherichia coli, and Serratia marcescens, in a further nine of 11 (81%) cases where no causative pathogen was identified. The antimicrobial susceptibility profile was also determined by the metagenomic sequencing for all pathogens with numerous multi-drug resistant organisms identified. In conclusion, metagenomic sequencing is able to successfully identify pathogens contributing to infection-associated deaths on postmortem blood and tissue samples.

Identification represents one of the most basic of all human rights and yet with continuing humanitarian disasters, infectious disease outbreaks, mass migrations on precarious and often deadly land and sea routes, as well as human trafficking, the number of unidentified dead bodies grow. The presence of unidentified bodies raises pressing ethical and practical concerns that demand immediate attention to successfully attain global health objectives including serving the vulnerable, reducing health inequalities, and responding to humanitarian crises. From an ethical standpoint, these individuals are often denied the respect they deserve, as they are buried without proper identification, often in mass graves, and without accompanying religious or cultural ceremonies. On a practical level, the shortage of resources results in the hasty disposal of these bodies without due regard.

Recognising the dignity and personhood of unidentified dead bodies restores respect for those left behind, rectifies injustices, and acknowledges a longneglected global problem.

*Read the full study

*Read the full study

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Regression of cutaneous xanthomata in patient with homozygous familial hypercholesterolemia using novel therapies

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Surgery's place in the UHC2030 Action Agenda The Lancet

The Lancet

Wits researchers involved: Brett Stephen Mansfield, Frederick Raal A 24-year-old woman attended our follow-up clinic reporting that the multiple tendinous and cutaneous xanthomas on her hands, elbows, and feet had markedly improved.

The patient had developed lesions on her hands and feet, aged 2 years. Laboratory investigations, done at the time, showed marked hyperlipidaemia with a total cholesterol concentration of 21·3 mmol/L (typical level 5 or below) and a low-density lipoprotein (LDL) cholesterol concentration of 18·5 mmol/L (typical range 1·81–3·62). She had been diagnosed with homozygous familial hypercholesterolaemia (HoFH).

Genetic testing, done at the time of diagnosis, found biallelic mutations of the LDL receptor (LDLR) gene (c.681C>G and c.1285G>A). Additionally, the patient's mother was heterozygous for the FH Afrikaner-2 mutation (c.1285G>A) but had no evidence of atherosclerotic cardiovascular disease; her father was heterozygous for the FH Afrikaner-1 mutation (c.681C>G) and had a coronary stent inserted when he was aged 46 years. The patient's brother had been diagnosed with HoFH and had died from atherosclerotic cardiovascular disease aged 6 years.

Wits researcher involved: Gabriella Hyman

*Read the full study

*Read the full study

On Sept 21, 2023, the UN General Assembly's 78th Session (UNGA-78) will dedicate one of three highlevel meetings to universal health coverage (UHC).

With UHC2030 target deadlines fast approaching, amplified efforts and political commitments from the global health community will focus on the right to essential healthcare services without impoverishment.

Safe, timely, and affordable surgical care is an indivisible component of UHC, and achieving UHC underlies the surgical community's core priorities. The surgical community's long-standing support for UHC is underpinned by two landmark World Health Assembly resolutions for equitable surgery provision (i.e., 68·15 and 76·2). Consequent policy development, regional collaboration, and interventions to improve surgical care have been integrated into the UHC framework and can be further optimised to augment the relationship between UHC and equitable surgical care provision.

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Diabetes risk and provision of diabetes prevention activities in 44 low-income and middle-income countries: A cross-sectional analysis of nationally representative, individual-level survey data income countries). Overall, the reach of diabetes prevention activities was low at 40·0% (38·6–41·4) for Wits researcher involved: Justine Davies physical activity counselling, 37·1% (35·9–38·4) for weight loss counselling, 42·7% (41·6–43·7) for dietary The global burden of diabetes is rising rapidly, yet counselling, and 37·1% (34·7–39·6) for blood glucose there is little evidence on individual-level diabetes screening. Diabetes prevention varied widely by prevention activities undertaken by health systems national-level wealth: 68·1% (64·6–71·4) of people at in low-income and middle-income countries (LMICs). Here, the study describes the population at high risk of diabetes in low-income countries reported high risk of developing diabetes, estimate diabetes none of these activities, whereas 49·0% (47·4–50·7) at high risk in upper-middle-income countries reported at prevention activities, and explore least three activities. Educational attainment was sociodemographic variation in these activities across LMICs. associated with diabetes prevention, with estimated increases in the predicted probability of receipt ranging between 6·5 (3·6–9·4) percentage points for Methods dietary fruit and vegetable counselling and 21·3 (19·5– We performed a pooled, cross-sectional analysis of 23·2) percentage points for blood glucose screening, individual-level data from nationally representative, among people with some secondary schooling population-based surveys conducted in 44 LMICs compared with people with no formal education. between October2009, and May 2019. Our sample included all participants older than 25 years who did Interpretation not have diabetes and were not pregnant. This study The final pooled sample included 145 739 adults (86 defined the population at high risk of diabetes on the 269 [59·2%] of whom were female and 59 468 [40·4%] basis of either the presence of impaired fasting of whom were male) across 44 LMICs, of whom 59 308 glucose (or prediabetes in countries with a (40·6% [95% CI 38·5–42·8]) were considered at high haemoglobin A1c available) or overweight or obesity, risk of diabetes (20·6% [19·8–21·5] in low-income consistent with the WHO Package of Essential countries, 38·0% [37·2–38·9] in lower-middle-income Noncommunicable Disease Guidelines for type 2 countries, and 57·5% [54·3–60·6] in upper-middlediabetes management. This study estimated the income countries). Overall, the reach of diabetes proportion of survey participants that were at high risk prevention activities was low at 40·0% (38·6–41·4) for of developing diabetes based on this definition. The physical activity counselling, 37·1% (35·9–38·4) for study also estimated the proportion of the population weight loss counselling, 42·7% (41·6–43·7) for dietary at high risk that reported each of four fundamental counselling, and 37·1% (34·7–39·6) for blood glucose diabetes prevention activities: physical activity screening. Diabetes prevention varied widely by counselling, weight loss counselling, dietary counselling, and blood glucose screening, overall and national-level wealth: 68·1% (64·6–71·4) of people at high risk of diabetes in low-income countries reported stratified by World Bank income group. Finally, the none of these activities, whereas 49·0% (47·4–50·7) at study used multivariable Poisson regression models to high risk in upper-middle-income countries reported at evaluate associations between sociodemographic least three activities. Educational attainment was characteristics and these activities. associated with diabetes prevention, with estimated increases in the predicted probability of receipt Findings ranging between 6·5 (3·6–9·4) percentage points for The final pooled sample included 145 739 adults (86 dietary fruit and vegetable counselling and 21·3 (19·5– 269 [59·2%] of whom were female and 59 468 [40·4%] of whom were male) across 44 LMICs, of whom 59 308 23·2) percentage points for blood glucose screening, among people with some secondary schooling (40·6% [95% CI 38·5–42·8]) were considered at high compared with people with no formal education. risk of diabetes (20·6% [19·8–21·5] in low-income countries, 38·0% [37·2–38·9] in lower-middle-income *Read the full study countries, and 57·5% [54·3–60·6] in upper-middle-

The Lancet Global Health

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Neuropsychiatric manifestations and sleep disturbances with dolutegravir-based antiretroviral therapy versus standard of care in children and adolescents: a secondary analysis of the ODYSSEY trial The Lancet Child & Adolescent Health

Wits researchersinvolved: Afaaf Liberty, Tumelo Moloantoa, Avy Violari Cohort studies in adults with HIV showed that dolutegravir was associated with neuropsychiatric adverse events and sleep problems, yet data are scarce in children and adolescents. This study aimed to evaluate neuropsychiatric manifestations in children and adolescents treated with dolutegravir-based treatment versus alternative antiretroviral therapy.

Methods This is a secondary analysis of ODYSSEY, an openlabel, multicentre, randomised, non-inferiority trial, in which adolescents and children initiating first-line or second-line antiretroviral therapy were randomly assigned 1:1 to dolutegravir-based treatment or standard-of-care treatment. This study assessed neuropsychiatric adverse events (reported by clinicians) and responses to the mood and sleep questionnaires (reported by the participant or their carer) in both groups. The study compared the proportions of patients with neuropsychiatric adverse events (neurological, psychiatric, and total), time to first neuropsychiatric adverse event, and participantreported responses to questionnaires capturing issues with mood, suicidal thoughts, and sleep problems.

Findings Between September 20, 2016, and June 22, 2018, 707 participants were enrolled, of whom 345 (49%) were female and 362 (51%) were male, and 623 (88%) were Black-African. Of 707 participants, 350 (50%) were randomly assigned to dolutegravir-based antiretroviral therapy and 357 (50%) to non-dolutegravir-based standard-of-care. 311 (44%) of 707 participants started first-line antiretroviral therapy (ODYSSEY-A; 145 [92%] of 157 participants had efavirenz-based therapy in the standard-of-care group), and 396 (56%) of 707 started second-line therapy (ODYSSEY-B; 195 [98%] of 200 had protease inhibitor-based therapy in the standard-of-care group). During follow-up (median 142 weeks, IQR 124–159), 23 participants had 31 neuropsychiatric adverse events (15 in the dolutegravir group and eight in the standard-of-care group; difference in proportion of participants with ≥1 event p=0·13). 11 participants had one or more neurological events (six and five; p=0·74) and 14 participants had one or more psychiatric events (ten and four; p=0·097).

Among 14 participants with psychiatric events, eight participants in the dolutegravir group and four in standard-of-care group had suicidal ideation or behaviour. More participants in the dolutegravir group than the standard-of-care group reported symptoms of self-harm (eight vs one; p=0·025), life not worth living (17 vs five; p=0·0091), or suicidal thoughts (13 vs none; p=0·0006) at one or more follow-up visits. Most reports were transient. There were no differences by treatment group in low mood or feeling sad, problems concentrating, feeling worried or feeling angry or aggressive, sleep problems, or sleep quality.

Interpretation The numbers of neuropsychiatric adverse events and reported neuropsychiatric symptoms were low.

However, numerically more participants had psychiatric events and reported suicidality ideation in the dolutegravir group than the standard-of-care group.

These differences should be interpreted with caution in an open-label trial. Clinicians and policy makers should consider including suicidality screening of children or adolescents receiving dolutegravir. *Read the full study

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Terminally ill patients need more than prayer from spiritual leaders This is the first study to assess the spiritual and religious needs, and religious and spirituality care provided to advanced cancer patients who received palliative care in Soweto, says Ratshikana-Moloko.

Since the study was concluded in 2018, Wits University has developed a course in Spiritual and Chaplaincy in Palliative Care. The first cohort of faith leaders from all Pictured above L-R: Relebogile Mabotja, Dr Mpho religious backgrounds completed their training in Ratshikana-Moloko September 2023.

A study conducted among advanced cancer Palliative Care to increase patients in Soweto has found that most patients who received palliative care and are at the end of Palliative care is one of the key pillars in illness management among terminally ill patients who are life, have spiritual needs beyond regular prayers judged by a specialist physician as unlikely to benefit from spiritual leaders. Furthermore, patients who from curative-intent therapy. Often, patients are received religious or spiritual care had less physical pain, used less morphine and had higher unlikely to survive beyond six months. odds of dying where they wished than those who The South African National Policy Framework and did not.

Strategy for Palliative Care (2017–2022) incorporates A team of local and international experts led by Wits spirituality into health care. However, palliative care researchers conducted the study involving 233 services in South and southern Africa and elsewhere, participants. rarely address these needs, despite available policies, guidelines and evidence.

Lead researcher Dr Mpho Ratshikana-Moloko from the Centre for Palliative Care in the Faculty of Health “We have to implement what we know. The integration Sciences at Wits University says that previous research of spiritual care within the clinical care setting is has shown that religion and spirituality are important to recommended,” says Ratshikana-Moloko. most patients facing life-threatening illnesses.

However, this study probed further.

South Africa faces a heavy burden of communicable Using the African Palliative Care Association Palliative Outcome Scale, the research confirmed previous international findings that nearly 98% of the participants had a religious or spiritual need.

The most common spiritual need expressed by patients in Soweto was “seeking a closer connection with their God” and “forgiveness of sins”, says RatshikanaMoloko. This finding is of significance because it calls on faith leaders to provide relevant support that responds to the needs of patients. This research-led intervention empowers leaders to move beyond prayer, explains Ratshikana-Moloko.

and non-communicable diseases. One in six deaths globally is due to cancer, and cancer diagnoses are expected to increase by 70% in the next two decades, especially in low- and middle-income countries.

Failure to identify and address the religious and spiritual needs of terminally ill patients may increase distress and suffering, concludes Ratshikana-Moloko.

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What happens to South Africans when they have sleep disorders?

The Restonic Ezintsha Sleep Clinic will pioneer South African sleep research and treat sleep disorders.

The first facility of its kind in South Africa, the Restonic Ezintsha Sleep Clinic combines the research capabilities of Wits University's Ezintsha Research Unit with the bedding brand’s mission to enable wellbeing and success through the power of sleep.

Ezintsha, a division within the Wits Health Consortium, is a multidisciplinary research centre that focuses on advancing research in HIV and non-communicable diseases (NCDs) – and now the intersection of these with sleep. Ezintsha specialises in clinical trials, medical technologies, and peer reviewed research publications.

says Bentley, and explains that the Restonic Ezintsha Sleep Clinic will fulfil three key functions: clinical, research and training.

Clinical offering The clinic offers four overnight sleep rooms for patients with a sleep problem who have been referred by their doctor for sleep analysis, including a dedicated bedroom for sleep studies focusing on children.

Patients are also able to book a consultation to discuss their sleep issues with a doctor who understands and has training in the sleep field.

“In future, the Restonic Ezintsha Sleep Clinic hopes to offer lectures and group treatment options for the As a Centre of Excellence for sleep analysis, the public on topics ranging from snoring to sleep apnoea Restonic Ezintsha Sleep Clinic will service patients with and insomnia,” says Bentley. sleep problems, advance local sleep research and the interplay of sleep with other health conditions, and Understanding sleep in South Africans train other doctors to diagnose and treat sleep Bentley says the development of sleep studies is disorders. important in Africa for three reasons: “Firstly, Dr Alison Bentley is a sleep disorder specialist in practice for some 30 years. She ran the first diagnostic sleep laboratory in South Africa from 1990 to 1998. A Wits alumna, Bentley is a medical doctor at the Restonic Ezintsha Sleep Clinic, which was launched on 14 September 2023.

Sleep touches every area of medicine and remains under-researched in South Africa. There is no other academic facility that is research focused, that is clinical focused, that is aimed at finding out how sleep works in South Africans,

we do need a Centre of Excellence that’s looking at the academic interest - the real detail - behind sleep.

Secondly, it’s really important to understand that as South Africans we are different from everybody else – we just are. There’s very little research done on NCDs and how they link to sleep so there’s really a big gap in the information about what happens to South Africans when they have sleep disorders. [Thirdly], we need to get creative about how we are going to treat patients in the public sector, because it is extremely frustrating to be able to diagnose a sleep disorder and not treat it.

So we do need to come up with solutions to both diagnose and treat those patients, and part of that is training doctors.“

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Research capabilities Dr Nomathemba Chandiwana is a Director and Principal Scientist at Ezintsha. She says: “Ezintsha is known for being an infectious diseases site. HIV is mostly what we’ve been doing for 10, 20+ years. However, in one of our flagship trials a couple of years ago, called ADVANCE, we found that people were gaining weight, and this got us into non-communicable diseases, and actually that’s what’s killing most South Africans,” says Chandiwana, whose passion is obesity, a NCD.

We believe we have an opportunity to explore how sleep potentially affects other major healthcare concerns in the country, such as HIV, obesity, cardiovascular disease and diabetes,

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these problems,” says Bentley.

Doctors residing in Johannesburg are able to attend inperson case presentations, while those further afield can attend remote video call discussions or arrange to visit for a week or more. The Sunnyside Hotel is conveniently located adjacent to the clinic in Parktown, allowing for residential visits.

“From training point of view, we’d love to have doctors come in here, work with us, we’d love doctors who are interested in sleep medicine to come and have a consulting room, see patients with insomnia for a morning...” says Bentley.

Chandiwanda concurs: "Once we have locally relevant data, you can do so many things: you can write guidelines that work for us, we’re able to train doctors The sleep clinic is perfectly placed to undertake large- for an environment that works for us because right now, scale research projects to gather more and better data, all the training we’re doing we’re doing based on North American standards – we don’t know if that actually she says, as there is currently very little known about works for our populations here.” how sleep impacts other medical disorders in the South African population.

This seven-question survey will help you to assess whether you should consult a medical professional: “We do not have an academic sleep lab on the continent and that’s not acceptable. As Africans, with 1. How many hours of sleep per night do you all the issues that we have, we also need our own usually get? The average is 7 to 8 hours per night, solutions,” says Dr Chandiwana. but this may not be normal for everyone.

2. Do you usually feel well-rested when you wake “From a research perspective, if you are changing up in the morning? Not feeling rested is either a policy, you need evidence, and evidence that is locally result of too few hours of sleep or enough hours but relevant. Other trials have been done in North America, a poor quality of sleep. but when they come to Africa, we’ve seen totally 3. Does daytime sleepiness or fatigue interfere different things because we’re a different population – with your daytime functioning? Falling asleep we’re younger, we’re seeing our people are having during the day is not normal if you have had the diabetes much younger.” correct duration and quality of sleep at night.

An Epworth sleepiness scale score of > 10 is The clinic will also enable research and explore considered excessively sleepy. alternatives to the use of the current (expensive) 4. Do you snore loudly and appear to stop treatments for sleep disorders, such as the CPAP breathing during your sleep? This may indicate machine for obstructive sleep apnoea [OSA]. CPAP is obstructive sleep apnoea, which causes poor 'continuous positive airway pressure', a machine that quality of sleep with excessive daytime sleepiness. delivers just enough air pressure to a mask on a 5. Do you get an urge to move your legs with an person's face to keep the upper airway passages open. uncomfortable feeling in the evening before This prevents snoring and sleep apnoea. going to sleep? This may be an indication of Restless Legs Syndrome (RLS), which can be Training for medical professionals diagnosed with four questions.

The Restonic Ezintsha Sleep Clinic is also an ideal 6. Do you have difficulty in getting enough hours environment to train doctors in the broad field of sleep of sleep when you go to bed? There are many medicine. “Given the prevalence of sleep disorders causes, and most can be treated. and their effects on other medical disorders, it is 7. Are you worried about your sleep? essential that most doctors are exposed and trained on

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3 Minutes Thesis (3MT) Competition

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Health Sciences Research Office presents: Faculty Lecture The Faculty of Health Sciences Research Office, in collaboration with the Supporting Health Initiatives Research Unit, presented a Faculty Lecture on 7 November 2023.

Pictured above L-R: Dr Stephanie De Rapper, Ms Laura Khumalo, Prof Maria Papathanasopoulos, Dr Jacoba Kleynhans

The Faculty of Health Sciences Research Office hosted its first Three Minute Thesis (3MT) Competition on 2 November 2023, wherein the Faculty’s PhD graduate students showcased their research and communication skills. Developed by The University of Queensland, 3MT cultivates students’ academic, presentation, and research communication skills. The 3MT competition challenged the PhD graduate students to present their research in just three minutes, using language that is accessible to everyone. It was an inspiring showcase of their hard work and innovation.

Congratulations to the winners: In first place was Dr Jacoba Kleynhans with the topic: “Severe acute respiratory syndrome corona virus 2 (SARS-CoV-2} transmission dynamics and social contact patterns.”. Dr Kleynhans was supervised by Prof Cheryl Cohen and Prof Stefano Tempia.

In second place was Dr Stephanie De Rapper with the topic: “The prediction of synergy in essential oil combinations used in the treatment of respiratory infections through experimental design and chemometric modelling.” Dr De Rapper was supervised by Prof Sandra van Vuuren.

In third place was Dr Ivana Beesham with the topic: “An evaluation of the integration of oral preexposure prophylaxis (PrEP) as standard of care for HIV prevention in clinical trials in South Africa.” Dr Beesham was supervised by Prof Matgorzata Beksinska.

The Lecture was presented by two speakers, Dr Lieve Fransen with a talk titled “From HIV/AIDS to COVID19 and Beyond - Shaping Responses in Security or/and Equity Frameworks?” and Professor Garrett Brown, with a talk titled “Preparing for Future Pandemics? The Emerging Global Pandemic Preparedness and Response Agenda and its Challenges.”

Dr Lieve Fransen is an executive member of Supporting Health Initiatives, a Research Unit within the Wits Health Consortium, as well as a former Director at the European Commission where she developed highprofile international public health initiatives, including the creation of the Global Fund to Fight AIDS, Tuberculosis and Malaria. Professor Garrett Brown is also an executive member of Supporting Health Initiatives,as well as Chair of Global Health Policy and Director of Global Health Research at the University of Leeds, UK.

Pictured above L-R: Dr Lieve Fransen and Prof Garrett Wallace Brown

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Unlocking Hope: Launch of the biliary atresia awareness campaign

The Biliary Atresia Awareness Committee under the auspices of Wits University and Gauteng Provincial Solid Organ Transplant Division launched the Biliary Atresia Awareness Campaign on 16 October 2023 at Charlotte Maxeke Johannesburg Academic Hospital.

Biliary Atresia (BA) is a rare paediatric liver disease that affects infants, leading to the blockage or absence of bile ducts. Without early diagnosis and surgical intervention, it can result in severe liver damage and the need for a liver transplant, a scarce resource in our country. Early detection is crucial for better treatment outcomes. BA compromises infants by obstructing or obliterating bile ducts, leading to potentially severe liver damage without expedited diagnosis and intervention. The success of the campaign is therefore underpinned by the awareness of a collective of healthcare professionals from various divisions, so they are cognisant to the symptoms and possibility of BA as presented in patients.

We rally healthcare professionals and communities to converge in efforts towards the early detection and adept management of BA, ensuring a more promising future for our children,

states Dr Christina Hajinicolaou, Paediatric Gastroenterologist and Head of Division of Paediatric Gastroenterology at the Faculty of Health Sciences.

This campaign raises awareness and support from the perspective of promoting the commitment to community health as the overwhelming reason that leads to BA not being treated properly, is a lack of information and knowledge. This has resulted in only a 40% overall success in treating Biliary Atresia in 2021.

Part of the focus of this campaign is to also educate parents of infants to immediately seek medical advice if their children have symptoms such as yellow eyes, jaundice longer than 14-21 days after birth, white stool from birth, yellow or darker skin and dark urine.

Raising Awareness can achieve this by educating diverse demographics about BA whilst also supporting affected families by offering the necessary resources and empathetic support. Most importantly, to advance the understanding of any disease and improve patient care, more research is required to accentuate the progression of diagnostic tools and innovative treatments of BA. To address this disease as a global and local health challenge, medical research collaborations need to be fostered between entities around the world.

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Future-proofing pandemic preparedness and response The COVID-19 pandemic highlighted major shortcomings in the ability of the world to prevent, prepare for, and respond to pandemics. These shortcomings spanned multiple areas, including the surveillance of pathogens of pandemic potential, the effectiveness of International Health Regulations (IHR), and disparities in the supply of vaccines, diagnostics and therapeutics. These issues have led to efforts to reform the governance, regulation and international financing regimes for public health emergencies and pandemics.

Negotiations relating to the CA+ and the IHR amendments are running concurrently and are due to be concluded by the World Health Assembly in May 2024. There are inevitably overlaps and inconsistencies in scope and content between the two instruments.

Furthermore, there are questions relating to what subject matter belongs in each of the two instruments, and a lack of clarity among negotiators as negotiating positions in key contentious areas.

In early 2023, this study commissioned a comparative analysis, consultation, and research exercise to clarify issues relating to the inclusion of specific points in one or other instrument, to identify areas of concern and opportunities for consensus. From 3 May 2023 to 5 October 2023, a range of experts and country negotiators were interviewed on their key priorities, concerns and what they believed should be in the IHR

versus the Pandemic Accord.

These inputs were contextualized with desk review, including scholarship on the character of different legal instruments.

This analysis highlighted that treaties and conventions are designed to be: Political signals of priority.

Facilitators of multilateral cooperation where domestic law and other policy (including other international instruments) have failed.

Applicable to issues where universal adherence will take time to achieve.

Regulations, on the other hand, pertain to: Technical and regulatory matters, and matters related to implementation on a particular issue.

Nomenclatures on technical terms.

Standards (for example on safety and purity of pharmaceuticals).

In addition, the analysis dissects country positions on 9 key areas, including One Health, Pathogen Access and Benefit Sharing, and Common but Differentiated Responsibilities.

For more findings and analysis, read or download the full report: Future-proofing pandemic preparedness and response [PDF]

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Advancing healthcare: wits advanced drug delivery platform enthralls high learners at national science week 2023 offered a glimpse into the critical thinking and creative problem-solving aspect of the field and fostered an interest in pursuing careers in pharmaceutical science and related disciplines.

The WADDP team’s commitment to the Science Engagement Strategy shone through in their interactions with the group. They patiently answered every question, nurturing curiosity, and fuelling aspirations of over 10 000 learners! The impact of their efforts reverberates to colleagues, sowing the seeds of passion for pharmaceutical science in the hearts of those who dreamt of shaping the future of medicine.

In an awe-inspiring display of scientific marvels, Wits Advanced Drug Delivery Platform (WADDP) researchers took their place at the National Science Week (NSW) 2023, captivating highschool learners in alignment with the South African Department of Science and Innovation's (DSI) Science Engagement Strategy to create a scientifically literate and critically engaged society. The event was held at the Mondi Science, Career Guidance and FET skills centre in Mpumalanga as part of a national initiative to ignite scientific curiosity.

At the heart of this enthralling exhibition was the passion of the researchers from the WADDP, who embarked on a mission to showcase the cutting-edge advancements revolutionising healthcare in South Africa and beyond.

As the curtain fell on the NSW 2023 event, the team reflected on this honourable and unique experience on their journey as young pharmaceutical researchers.

Our engagement with high school students at NSW has been an incredibly enriching experience. We are deeply committed to inspiring young minds and showcasing the boundless possibilities that science and academia offer, said one researcher.

NSW provided an exceptional platform for these motivated high school students to immerse themselves in the world of higher education and scientific exploration. Witnessing their eagerness to learn, ask probing questions, and actively participate in discussions with us and other presenters has reinforced The exhibition provided a unique opportunity for the our belief in the potential of the next generation.” says researchers to engage with learners, who represent the Sameera Khatib. future generation of scientists, healthcare professionals, and innovators. By explaining the “Teaching the students science has been a rewarding importance of nanomedicine, advanced drug delivery experience, as it allowed me to spark their curiosity and tissue engineering in modern medicine, the and foster a deeper understanding of pharmacy and the researchers highlighted how their work contributes to science involved in developing novel drug delivery optimising treatment regimens and reducing side systems. It's fulfilling to witness the moments when effects for patients. Drawing inspiration from DSI's complex concepts clicked, and to see their enthusiasm Science Engagement Strategy goals, the WADDP for experimentation and discovery. Engaging with researchers designed interactive displays that diverse young minds reminded me of the importance of transcended the confines of traditional classrooms; clear communication and creating awareness of the hands-on activity where learners were encouraged to numerous opportunities available to them. Overall, experimenting with materials to solve challenges guiding students through science was a phenomenal allowed them to experience the complexities that experience and a privilege and I hope the time they pharmaceutical scientists face in their research. It have spent engaging with us has inspired them to

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pursue careers in science and research.” says Theresa Varughese.

“Pharmacy opens a gateway to a world where science and care converge, and during NSW, we bridge the gap between curiosity and knowledge by engaging with school children. Exploring the realms of medicine and healing, we inspire young minds to envision a future of scientific discovery and compassionate healthcare. Together, let's ignite the spark of curiosity, empowering the next generation to explore the pharmacy's vital role in shaping a healthier society” says Irfaan Moolla.

“It was truly an honour to guide the youth to envision themselves as architects of health, as they build a foundation of scientific excellence through the pursuit of a degree in pharmacy. In a celebration of creativity, innovation, and scientific exploration, schools across the nation are coming alive with the spirit of discovery during National Science Week. This annual event, dedicated to igniting curiosity among school children, has once again captured the imagination of young minds, fostering a love for science that promises to shape the future” says Christian van Zyl. “This was a fulfilling experience, contributing towards nurturing and moulding future generations of scientists.

This is something I would like to do again in the future” says Atang Motaung.

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“It was a rewarding experience. The children were awestruck as we demonstrated the various experiments. The smiles on the children’s faces are something that I will always treasure. An African proverb reads “If you want to go quickly, go alone. If you want to go far, go together.” National Science Week was a success because we all worked together to achieve a common goal-contributing to the development of youth that are scientifically literate” says Tama Mwale.

The Wits Advanced Drug Delivery Platform concerns itself with passing the baton to continue the efforts of creating a scientifically knowledgeable and innovative society by answering big questions, societal relevance through the development of effective, safe interventions, collaboration, and inspiring skilled pharmaceutical researchers.

“I am super proud of what the WADDP team has achieved at this event. It’s the kind of passion nurtured in the labs that transcends into public spaces to ensure that the disruptive scientific innovations produced respond to the needs of humankind. In providing the youth with access to scientific minds and spaces it makes science ‘’fashionable’’ and helps promote improved collaboration among stakeholders toward us achieving the ‘science relevant’ UN Sustainable Development Goals (SDGs) as a country” says Professor Yahya Choonara, Director of the WADDP research unit.

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2023: A YEAR OF WORLD-CLASS HEALTHCARE RESEARCH AND TRAINING FIT FOR AN EVERCHANGING WORLD

WITS-RHI joins pioneering study on innovative vaginal film for HIV prevention in women The week of the 2nd of November marked the commencement of an unprecedented study to evaluate a novel vaginal film designed to dissolve gradually over 30 days. The aim is to assess its acceptability and potential as an HIV prevention method for women.

monthly vaginal films, initially containing no active drug. This approach allows researchers to fine-tune the film's design, including its shape, ahead of the first human trial of the monthly dapivirine film. MATRIX-002 aims to enroll 100 women and 30 sexual partners across five sites in Kenya, South Africa, Zimbabwe, and the The research, a collaborative effort between the United United States. The first participants were enrolled at States and several African nations, is spearheaded by the U.S. site, located at the University of Pittsburgh MATRIX, a project funded by the United States Agency and Magee-Womens Research Institute (MWRI), which for International Development (USAID). This initiative is is also the development hub for the monthly dapivirine part of the early stages of research and development vaginal film products. into innovative HIV prevention products specifically tailored for women. The insights gained from this study The study is slated to expand to all five clinical research will be instrumental in refining the design of a monthly sites (CRS) by early 2024. These include the University film embedded with the antiretroviral (ARV) drug of Pittsburgh/MWRI, Zimbabwe, Kenya, and two South dapivirine. This dapivirine film is among nine products African locations, one of which is the Wits being developed under the MATRIX initiative, which Reproductive Health and HIV Institute (Wits RHI) CRS includes a dual-purpose film combining dapivirine with in Johannesburg. a hormonal contraceptive to simultaneously prevent HIV and pregnancy.

The follow-up of all participants is expected to be completed around July or August 2024, with results Vaginal films, similar in concept to thin, dissolvable anticipated by the end of the year. Following this, breath mint strips, are being explored as a novel MATRIX plans to commence the first human study of method for HIV prevention. Unlike previous studies that the monthly dapivirine film in 2025. focused on quick-dissolve films or those designed to dissolve within a week, this study introduces a longer- Leading the project are Sharon Hillier, Ph.D., from lasting, monthly option.

MWRI and the University of Pittsburgh School of Medicine, and Thesla Palanee-Phillips, Ph.D., of the The study, known as MATRIX-002, is set to evaluate Wits RHI and University of Witwatersrand, South Africa, the acceptability, usability, and safety of two prototype serving as the deputy director.

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Wits advanced drug delivery platform takes early career researchers to the world of pharmaceutical sciences

The year 2023 has been a hallmark of world-class healthcare training at the Faculty of Health Sciences. With a commitment to adapting to an ever-changing world, the Faculty's endeavours this year have been strategically aligned with this vision across all specialities. A prime example of this global reach is the Wits Advanced Drug Delivery Platform (WADDP), known for its extensive pharmaceutical sciences research and its expansion of meaningful global partnerships.

The WADDP's Early Career Researchers (ECRs) programme stands out, providing exceptional research training and mentorship, and creating opportunities for ECRs to gain international exposure, thereby promoting a global, cohesive approach to pharmaceutical science innovation.

Professor Yahya Choonara, Director and Principal Researcher at WADDP, highlights the program's international acclaim: “The WADDP is renowned for its excellence in designing patient-centric therapeutics for the 21st century. Our high-impact collaborative research with international labs enriches the experiences of our ECRs, fostering diversity and integration across various countries and backgrounds.”

This year, the ECRs have garnered global attention, receiving invitations to prestigious conferences and institutions to showcase their innovative research.

Highlights include: Cancer Nanomedicine at Johns Hopkins University, Baltimore Lindokuhle Ngema, a PhD candidate at WADDP, participated in the Fulbright Foreign Student Program Scholarship, spending nine months at Johns Hopkins University's School of Medicine. His pioneering

research in cancer nanomedicine at the Sidney Kimmel Comprehensive Cancer Centre has equipped him with advanced skills in nanoparticle-based drug delivery, which he plans to integrate into his lung cancer therapy project at WADDP. Theragnostic Systems at Novartis, Basel, Switzerland Mashudu Mphaphuli, another PhD candidate, attended the Novartis Next Generation Scientist Program. His project focused on advancing fluorescence-based detection and imaging techniques, knowledge he plans to apply to healthcare challenges and pharmaceutical research in South Africa.

Molecular Imprinted Biomaterials in Warsaw, Poland Dr Khonzisizwe Somandi, a Postdoctoral Fellow, undertook a month-long research training in the synthesis and analysis of molecularly imprinted biomaterials at the Medical University of Warsaw. His work contributes to collaborative projects in tissue engineering and nanomedicine at WADDP. SADC Industrial Pharmacy Training Fellowship in Moshi, Tanzania This program, a collaboration between GIZ GmbH (SADC), WADDP, the Kilimanjaro School of Pharmacy, and the University of Zambia, focused on pharmaceutical product development and Good Manufacturing Practice (cGMP). It's a step towards industrializing the pharmaceutical sector in Africa.

Reflecting on the program's impact, WADDP ECR Dr Hillary Mndlovu expressed optimism about the future: “The skills acquired from this training will not only benefit our students but also pave the way for the industrialization of the pharmaceutical sector in Africa.”

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to ESCC is derived from studies in China, where the Genome-wide association study disease is also common. The African study detected a of esophageal squamous cell strong and novel association with genetic variants cancer identifies shared and around a gene called FAM120A, which increased the distinct risk variants in African risk of ESCC. This gene plays a key part in how cells respond to oxidative stress and detoxify molecules and Chinese populations

which damage their DNA. The scientists also did a combined analysis of genetic data from African and Chinese ESCC which strengthened the evidence for the FAM120A association and for a gene called CHEK2, which is a known tumour-suppressor gene linked to other cancers such as breast and prostate cancer.

Wits researchers involved: Wenlong Carl Chen,Jean-Tristan Brandenburg, Ananyo Choudhury, Mahtaab Hayat, Dhriti Sengupta, Cassandra Soo, Michele Ramsay, Christopher Mathew Scientists at the Sydney Brenner Institute for Molecular Bioscience, University of the Witwatersrand in South Africa and their collaborators have published a study on the contribution of genetic factors to the development of oesophageal cancer in the Black South African population. The study is the first genome-wide association study of oesophageal squamous cell carcinoma (ESCC) in an African population. This form of cancer, which is very common in populations of African ancestry in Eastern and Southern Africa, is generally detected at a late stage when patients have difficulty swallowing food and have a very poor prognosis.

This disease is the eighth most common cancer in the world: an estimated 544 100 deaths occurred globally in 2020. The primary histologic types are either adenocarcinoma or squamous cell carcinoma.

Esophageal squamous cell carcinoma (ESCC) has a high disease burden in sub-Saharan Africa and has a very poor prognosis. Genome-wide association studies (GWASs) of ESCC in predominantly East Asian populations indicate a substantial genetic contribution to its etiology, but no genome-wide studies have been done in populations of African ancestry.

Most prior knowledge of genetic factors contributing

This study reports a GWAS in 1 686 African individuals with ESCC and 3 217 population-matched control individuals to investigate its genetic etiology. A genome-wide-significant risk locus was identified on chromosome 9 upstream of FAM120A (rs12379660, p = 4.58 × 10−8, odds ratio = 1.28, 95% confidence interval = 1.22–1.34), as well as a potential African-specific risk locus on chromosome 2 (rs142741123, p = 5.49 × 10−8) within MYO1B. FAM120A is a component of oxidative stress-induced survival signals, and the associated variants at the FAM120A locus co-localized with highly significant cis-eQTLs in FAM120AOS in both esophageal mucosa and esophageal muscularis tissue. A trans-ethnic meta-analysis was then performed with the African ESCC study and a Chinese ESCC study in a combined total of 3,699 ESCCaffected individuals and 5,918 control individuals, which identified three genome-wide-significant loci on chromosome 9 at FAM120A (rs12379660, pmeta = 9.36 × 10−10), chromosome 10 at PLCE1 (rs7099485, pmeta = 1.48 × 10−8), and chromosome 22 at CHEK2 (rs1033667, pmeta = 1.47 × 10−9).

This indicates the existence of both shared and distinct genetic risk loci for ESCC in African and Asian populations. The unique geographical distribution of high-risk regions for ESCC across north-central China to the Caspian Sea and eastern to southern Africa suggests possible shared disease etiology among populations located far apart. The common epidemiological risk factors described for ESCC to date do not account for the global burden of the disease.

This study sheds light on the role of genetic factors in the development of African oesophageal cancer and has potential relevance in future for the design of new therapies that target the aberrant molecular pathways involved. It could also lead to the development of genetic risk scores which identify individuals at high risk of this type of cancer. *Read the full study

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Strengths, weaknesses, opportunities, and threats analysis of the use of digital health technologies in primary health care in the Sub-Saharan African region: qualitative study Transcripts were compiled verbatim and systematically reviewed by 2 independent reviewers using framework analysis to identify emerging themes. The COREQ (Consolidated Criteria for Reporting Qualitative Research) checklist was used to ensure the study met the recommended standards of qualitative data reporting.

Results A total of 33 participants participated in the study (n=13 and n=23 in the interviews and in focus groups, respectively; n=3 participants participated in both). The strengths of using DHTs ranged from improving access to care, supporting the continuity of care, and increasing care satisfaction and trust to greater collaboration, enabling safer decision-making, and Wits Researcher Involved: Shabir Moosa hastening progress toward universal health coverage.

Digital health technologies (DHTs) have become Weaknesses included poor digital literacy, health increasingly commonplace as a means of delivering inequalities, lack of human resources, inadequate primary care. While DHTs have been postulated to training, lack of basic infrastructure and equipment, and reduce inequalities, increase access, and poor coordination when implementing DHTs. DHTs strengthen health systems, how the implementation were perceived as an opportunity to improve patient of DHTs has been realized in the sub-Saharan Africa digital literacy, increase equity, promote more patient(SSA) healthcare environment remains inadequately centric design in upcoming DHTs, streamline explored. expenditure, and provide a means to learn international best practices. Threats identified include the lack of Objective buy-in from both patients and providers, insufficient This study aims to capture the multidisciplinary human resources and local capacity, inadequate experiences of primary care professionals using DHTs governmental support, overly restrictive regulations, to explore the strengths and weaknesses, as well as and a lack of focus on cybersecurity and data opportunities and threats, regarding the protection. implementation and use of DHTs in SSA primary care settings.

Conclusions Methods A combination of qualitative approaches was adopted (i.e. focus groups and semi-structured interviews).

Participants were recruited through the African Forum for Primary Care and researchers' contact networks using convenience sampling and included if having experience with digital technologies in primary health care in SSA. Focus and interviews were conducted, respectively, in November 2021 and January to March 2022. Topic guides were used to cover relevant topics in the interviews, using the strengths, weaknesses, opportunities, and threats framework.

The research highlights the complex challenges of implementing DHTs in the SSA context as a fast-moving health delivery modality, as well as the need for multistakeholder involvement. Future research should explore the nuances of these findings across different technologies and settings in the SSA region and implications on health and healthcare equity, capitalizing on mixed-methods research, including the use of real-world quantitative data to understand patient health needs. The promise of digital health will only be realized when informed by studies that incorporate patient perspective at every stage of the research cycle. *Read the full study

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The negative association of lower body Inter-Rater Reliability Of The Extended fat mass with cardiometabolic Composite Quality Score (CQS-2) disease risk factors is partially Wits researcher involved: Steffen Mickenautsch mediated by adiponectin Wits researchers involved: Philippe Jean-Luc Gradidge, Nicole G Jaff, Shane Norris, Marketa Toman, Nigel Crowther Gluteofemoral fat correlates negatively with a number of cardiometabolic disease risk factors, but the mechanisms involved in these relationships are unknown. This study aimed to test the hypothesis that gluteofemoral fat attenuates the risk of cardiometabolic disease by increasing blood adiponectin levels.

This was a cross-sectional study in which arm, leg, gluteofemoral, abdominal s.c. and visceral fat levels were measured by dual-energy X-ray absorptiometry in 648 African females. Fasting serum adiponectin, lipid, insulin and plasma glucose levels and blood pressure were measured. Relationships between variables were analysed using multivariable linear regression and structural equation modelling.

Adiponectin correlated positively (β = 0.45, P < 0.0001) with gluteofemoral fat in a multivariable regression model that included age, height, and arm, s.c. and visceral fat levels. In further regression models, there was a negative correlation of gluteofemoral fat with fasting glucose (β = −0.28; P < 0.0001) and triglyceride levels (β = −0.29; P < 0.0001) and insulin resistance (HOMA; β = −0.26; P < 0.0001).

Structural equation modelling demonstrated that adiponectin mediated 20.7% (P < 0.01) of the association of gluteofemoral fat with insulin resistance and 16.1% (P < 0.01) of the association with triglyceride levels but only 6.67% (P = 0.31) of the association with glucose levels. These results demonstrate that gluteofemoral and leg fat are positively associated with adiponectin levels and that the negative association of lower body fat with insulin resistance and triglyceride levels may partially be mediated by this adipokine. Further studies are required to determine other factors that mediate the effect of lower body fat on cardiometabolic disease risk factors.

This paper received the SEMDSA best publication in the category Diabetes – Basic Science. *Read the full study

The Composite Quality Score (CQS) is a recently established appraisal tool for prospective, controlled, clinical therapy trials based on the deductive falsification approach. Trial appraisal that follows such an approach assumes that any trial design characteristic (or the lack thereof) which lies outside a particular set of applied trial appraisal criteria, such as that of the Jadad scale or Cochrane’s Risk of Bias (RoB) tool may completely falsify the truthfulness of trial results.

It therefore rejects any confidence in “low bias risk.” Consequently, the approach accepts that, in principle, it is impossible to establish “low bias risk” for any trial. Instead, the CQS follows the concept that, although “low bias risk” cannot be proven, it is possible to establish with high certainty whether bias risk is high. High bias risk is recognized when essential characteristics are absent for a therapy trial to reflect the true effect estimate.

Materials and methods Four independent raters were selected to rate 45 clinical trial reports using CQS-1 and CQS-2. The raters remained unaware of each other’s participation in the study until all rating had been completed. Each rater received only one rating template at a time in a random sequence for CQS-1 and CQS2 rating. Raters completed each template and sent these back to the principal investigator. Each rater received their next template 2 weeks after submission of the completed previous template. The inter-rater reliabilities for the overall appraisal score of the CQS-1 and the CQS-2 were established by using the Brennan-Prediger coefficient (BPC). The coefficients of both CQS versions were compared by using the two-sample ztest. During secondary analysis, the BPCs for every criterion and each corroboration level for both CQS versions were established.

Results The BPC for the CQS-1 was 0.85 (95% CI: 0.64–1.00) and for the CQS-2 it was 1.00 (95% CI: 0.94–1.00), suggesting a very high inter-rater reliability for both.

The difference between the two CQS versions was statistically not significant (p = 0.17). The null hypothesis was accepted. *Read the full study

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Morning perception of sleep, stress, and mood, and its relationship with overnight physiological sleep: Findings from the national consortium on alcohol and neurodevelopment in adolescence (NCANDA) study

Wits researcher involved: Fiona Baker

Discussion The subjective experience of sleep is a complex phenomenon with multiple components. Distinct physiological sleep processes contribute to the morning perception of sleep and related measures of mood and readiness. More than 70% of the variance (based on a single observation per person) in the perception of sleep, mood, and morning readiness is not explained by overnight sleep-related physiological measures, suggesting that other factors are important for the subjective sleep experience.

This cross-sectional study investigated objectivesubjective sleep discrepancies and the physiological basis for morning perceptions of sleep, mood, and readiness, in adolescents. Data collected during a single in-laboratory polysomnographic assessment from 137 healthy adolescents (61 girls; age range: 12-21 years) in the United States National Consortium on Alcohol and Neurodevelopment in Adolescence (NCANDA) study were analysed. Upon awakening, participants completed questionnaires assessing An additional finding from this study is that a lower TST sleep quality, mood, and readiness. predicted higher levels of sadness, stress, exhaustion, and irritability, and reduced alertness, supporting the Results importance of achieving a proper sleep amount for From this, a relationship was evaluated between optimal morning mood and readiness. For example, overnight polysomnographic, electroencephalographic, those adolescents sleeping < 7 h (30.7% of the total sleep autonomic nervous system functioning measures, sample) had, on average, 7.7% reduced morning and next morning self-reported indices. Results alertness compared to those achieving≥7 h of sleep. showed that older adolescents reported more This finding supports numerous studies confirming the awakenings, yet they perceived their sleep to be relationship between sleep, mood, fatigue, and deeper and less restless than younger adolescents. morning performance, with insufficient sleep being Prediction models including sleep physiology measures related to lack of motivation, inattention, poor (polysomnographic, electroencephalographic, and decision-making skills, and daytime sleepiness, sleep autonomic nervous system) explained between impacting academic performance, and affecting 3% and 29% of morning sleep perception, mood, and executive function in adolescents. readiness indices. *Read the full study

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Macrovascular and renal microvascular complications in West Africans with intermediate hyperglycemia living in West Africa and Europe: The RODAM study migrants) were included. Logistic regression analyses were used to determine the associations between migrant status and macrovascular [coronary artery disease (CAD) and peripheral artery disease (PAD)] and renal microvascular[nephropathy] complications with adjustment for age, sex, socioeconomic status, smoking, systolic blood pressure, BMI, total cholesterol, HbA1c, C-reactive protein, and serum uric acid.

Wits Researcher Involved: Kerstin KlipsteinGrobusch

Findings The prevalence of microvascular/macrovascular complications was higher in non-migrants than in migrants (nephropathy 15.3vs.9.7%; PAD 3.1%vs.1.3%; and CAD 15.8% vs. 5.0%). The differences persisted in the fully adjusted model: nephropathy [odds ratio, 2.12; 95% CI (1.46-3.08); PAD, 4.44(1.87-10.51); CAD 2.35(1.64-3.37)]. Non-migrant females had higher odds of nephropathy [2.14(1.34-3.43)], PAD [ 7.47(2.38-23.40)] and CAD [2.10(1.34-3.27)] compared to migrant females. Non-migrant males had higher odds of nephropathy [2.54(1.30-4.97)] and CAD [2.85(1.48-5.50)], but not PAD [1.81(0.32-10.29)], than their migrant peers.

Interpretation Macrovascular and renal microvascular complications were more prevalent in non-migrants than in migrant West Africans with IH. This study’s findings are in line with the existing evidence linking migration to cardiometabolic disease including type 2 diabetes.

Post-migration factors that are likely to increase the likelihood of IH include altered dietary habits (for example adoption of a Western diet characterized by high consumption of red meat, processed meat, sweets, and high-fat dairy products), decreased physical activity, and increased psychosocial stress, which are key drivers of obesity and impaired fasting glucose. The high prevalence of IH among migrants is of clinical and public health significance because Methods individuals with IH may have a higher cardiometabolic Data from the multicentre Research on Obesity and Diabetes among African Migrants (RODAM) study were disease risk including T2D. Similar observations were made in both males and females in sex-stratified analysed. In brief, the RODAM study was conducted from 2012 to 2015 and included Ghanaian adults living analyses. Further studies are needed to identify factors that increase the risk to aid preventive/treatment in rural and urban Ghana as well as in three European strategies. cities (namely Amsterdam, Berlin, and London).

Ghanaians with IH (524 non-migrant and 1439 *Read full study

Metabolic conditions, including intermediate hyperglycemia (IH), affect migrants to a greater extent than the populations of origin. Evidence suggests that IH increases the risk of vascular complications, but it is unclear whether the differences in IH between the non-migrant and migrant populations translate to differences in vascular complications between the two populations. This study compared the prevalence of macrovascular and renal microvascular complications among West Africans with IH living in West Africa and their migrant compatriots in Europe.

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Ultrastructure for the diagnosis of primary ciliary dyskinesia in South Africa, a resource-limited setting Results TEM observations confirmed 43% (6) of the clinically suspected cases (hallmark ultrastructural defects in the dynein arms of the outer doublets), whilst 57% (8) required another PCD testing modality to support ultrastructural observations. Of these, 25% (2) had neither ultrastructural defects nor did they present with bronchiectasis. Of the remaining cases, 83% (5) had very few ciliated cells (all of which were sparsely ciliated), together with goblet cell hyperplasia. There was the apparent absence of ciliary rootlets in 17% (1) case.

Wits researchers involved: Monica Birkhead, Theodore Mabaso, Keketso Mopeli , Dorcas Tlhapi, Charl Verwey, Ziyaad Dangor

Discussion In resource-limited settings in which TEM is the only available testing modality, confirmatory and probable diagnoses of PCD can be made to facilitate early initiation of treatment of children with chronic respiratory symptoms.

This study sought to evaluate TEM in the early Early diagnosis of primary ciliary dyskinesia (PCD) is diagnosis of PCD, given that early diagnosis can direct both the initiation of treatment (in order to reduce of paramount importance for affected children's recurrent infections, lung damage, the rate of disease morbidity and longevity, particularly given the progression, and the development of bronchiectasis) subsequent treatment and management demands and of appropriate cost-effective management of PCD on resource-limited, healthcare settings.

International guidelines recommend a multi-faceted patients. Although the lack of any other PCD approach for successful diagnoses of primary ciliary diagnostic test limited the direct comparisons that dyskinesia (PCD). In the absence of a gold standard could be made between individual clinical diagnoses test, a combination of genetic testing/microscopic and the corresponding TEM observations, clinical analysis of structure and function/nasal nitric oxide suspicion of PCD and ciliary ultrastructure overall measurement is used. In resource-limited settings, appeared concordant in 43% of the cases. This value compares well with other recent PCD-TEM-only often none of the above tests are available, and in South Africa, only transmission electron microscopy reports from resource-limited settings, for example, 17.9% in an Iranian study, 34% in the Palestinian cohort (TEM) is available in central anatomical pathology departments. The aim of this study was to describe and 43% (all cases) − 70% (only cases with high clinical the clinical and ultrastructural findings of suspected suspicion) in a Brazilian study. These studies were based on large numbers of clinically suspected PCD PCD cases managed by paediatric pulmonologists cases of all age groups, in contrast to the current small at a tertiary-level state-funded hospital in paediatric study in which the correlation between Johannesburg. clinical and ultrastructural data was probably due to Methods the paediatric pulmonologists' heightened awareness Nasal brushings were taken from 14 children with of PCD as part of a diagnostic differential, to the small chronic respiratory symptoms in keeping with a PCD sample size, and to the lack of any other test to phenotype. Ultrastructural analysis in accordance with corroborate the clinical - TEM findings. the international consensus guidelines for TEM-PCD diagnostic reporting was undertaken. *Read the full study

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Immunogenicity of tetanus, diphtheria and acellular pertussis vaccination among pregnant women living with and without HIV Wits researchers involved: Marta Nunes, Amy Tamblyn, Lisa Jose, Mathapelo Ntsimane, Ntoetse Lerotholi, Charmaine Machimana, Ashleigh Taylor, Farzanah Laher, Shabir Madhi Pertussis (whooping cough) is a highly contagious vaccine-preventable respiratory tract disease, caused by the bacterium Bordetella pertussis.

Pertussis can affect people of all ages; however, young unimmunised or partially immunised infants are the most vulnerable group for severe illness and death. In 2014, there were an estimated 24.1 million pertussis cases and 160 700 associated deaths worldwide, with the African region having the largest burden (7.8 million cases and 92 500 deaths). Globally, infants (<12 months of age) account for 5.1 million cases and approximately 85,900 deaths annually.

Vaccination during pregnancy with tetanus– diphtheria–acellular pertussis (Tdap) vaccine is recommended to protect the young infants against pertussis. There is a paucity of data on immune responses to Tdap in pregnant women with HIV (PWWH), and its impact on the protection of their infants has not been described.

Methods Pregnant women attending antenatal care at clinics in Soweto, South Africa, were screened for enrolment into the study. Healthy, pregnant women 18–39 years of age, 20–36 weeks of gestational age of a singleton pregnancy, considered to be at low risk for complications, and documented to be HIV-infected or HIV-uninfected were eligible for enrolment (full

inclusion and exclusion criteria in supplement.

In an open label phase IV clinical trial in South Africa, this study evaluated the immunogenicity and safety of Tdap in PWWH compared with HIV-uninfected women. Antigen-specific immunoglobulin G (IgG) to pertussis toxoid, filamentous haemagglutinin, pertactin, fimbriae, diphtheria and tetanus were measured by electrochemiluminescence-based multiplex assay.

Results Overall, 91 PWWH and 136 HIV-uninfected pregnant women were enrolled. All PWWH were on antiretroviral treatment and 94.5% had HIV viral loads <40 copies per millilitre. Antibody levels prevaccination were lower among PWWH compared with HIV-uninfected women for all antigens. At 1-month postvaccination PWWH compared with HIVuninfected women had lower fold-increase and antibody concentrations for all epitopes. Also, a lower proportion of PWWH achieved ≥4-fold increase from pre to postvaccination for pertussis toxoid and pertactin, or diphtheria IgG levels ≥0.1 IU/ml and ≥1 IU/ml postvaccination. Adverse events postvaccination were similar in PWWH and HIVuninfected.

Conclusion Tdap vaccination was safe and immunogenic. PWHW had, however, attenuated humoral immune responses, which could affect the effectiveness of protecting their infants against pertussis compared with those born to women without HIV. *Read the full study

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Stillbirths and neonatal deaths caused by Group B Streptococcus in Africa and south Asia identified through child health and mortality prevention surveillance (CHAMPS) Wits researchers involved: Sana Mahtab, Shabir Madhi, Peter Swart, Sithembiso Velaphi Invasive Group B Streptococcus (GBS) is a common cause of early-onset neonatal sepsis and is also associated with stillbirth. This study aimed to determine the proportion of stillborn infants and infants who died between 0 and 90 days attributable to GBS using postmortem minimally invasive tissue sampling (MITS) in 7 low- and middle-income countries (LMICs) participating in Child Health and Mortality Prevention Surveillance (CHAMPS).

Methods Deaths that occurred between December 2016 and December 2021 were investigated with MITS, including culture for bacteria of blood and cerebrospinal fluid (CSF), multi-pathogen polymerase chain reaction on blood, CSF, and lung tissue and histopathology of lung, liver, and brain. Data collection included clinical record review and verbal autopsy.

Expert panels reviewed all information and assigned causes of death.

Results We evaluated 2966 deaths, including stillborn infants (n = 1322), infants who died during first day of life (0 to <24 hours, n = 597), early neonatal deaths (END) (1

day to <7 days; END; n = 593), and deaths from 7 to 90 days (n = 454). Group B Streptococcus was Methods determined to be in the causal pathway of death for 2.7% of infants (79 of 2, 966; range, 0.3% in Sierra Leone to 7.2% in South Africa), including 2.3% (31 of 1322) of stillbirths, 4.7% (28 of 597) 0 to <24 hours, 1.9% (11 of 593) END, and 2.0% (9 of 454) of deaths from 7 to 90 days of age. Among deaths attributed to GBS with birth weight data available, 61.9% (39 of 63) of decedents weighed <2500 grams at birth. Group B Streptococcus sepsis was the postmortem diagnosis for 100% (31 of 31) of stillbirths. For deaths <90 days, postmortem diagnoses included GBS sepsis (83.3%, 40 of 48), GBS meningitis (4.2%, 2 of 48), and GBS pneumonia (2.1%, 1 of 48).

Conclusions Our study reveals significant heterogeneity in the contribution of invasive GBS disease to infant mortality across different countries, emphasizing the need for tailored prevention strategies. Moreover, our findings highlight the substantial impact of GBS on stillbirths, shedding light on a previously underestimated aspect in LMICs. *Read the full study

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Detecting and managing childhood onset hypertension in Africa: A call to action

Wits researchers involved: Ashleigh Craig, Shane Norris Hypertension is a public health concern, particularly in Africa where the prevalence is steadily increasing among children and adolescents. With a shift towards elevated BP during childhood as a key driver of adult hypertension, the importance of early elevated BP detection, prevention, and intervention strategies is critical. Reliable estimates of childhood hypertension serve as the basis for prevention, treatment, intervention and evidence-based health resource allocation and policy making.

Thus, the purpose of this study is to review recent evidence on childhood hypertension across Africa, identifying knowledge gaps, challenges and priorities, and highlight clinical perspectives in managing primary hypertension.

Methodological Issues While BP is a vital sign and a standard diagnostic tool in clinical practice, measurement of BP in children and follow-up is often neglected in clinical practice. When measured, several errors have been reported which seem to have universal characteristics for both children and adults. Some of these errors are related to observer bias or mistakes due to a lack of proper training, the patient’s behaviour or experience during measurements, while some errors are inherent to the device algorithms due to proprietary rights from manufacturers who are unwilling to disclose algorithm coefficients and factors used in their algorithm or transfer function development.

The Patient Measuring BP accurately largely depends on the cooperation of the patient and their understanding of

the conditions under which the measurements should be taken. Barriers specific to the patient can include anguage, age, body size, mood, culture, and illness or circumstances in which BP is measured. In Africa, over 2 000 languages are spoken. Furthermore, the rural population comprise more than half of Africa [63], which poses several barriers in terms of education and communication.

The Observer The nurse, medical specialist, clinician, or researcher is referred to as the observer taking the BP measurement.

Similar barriers, as for patients, are evident in the clinical setting whereby nurses or clinicians have to measure BP. However, apart from language differences, managing a very young child, and device preference may lead to several observer-specific barriers that lead to errors in BP measurements.

The Device The validation of BP devices is one of the persistent global methodological challenges in the hypertension sphere [60]. Several BP devices have been validated for clinical use, while no BP device has been validated in Africa or specifically in any African population group.

The Protocol and Guidelines Even among the internationally recognised hypertension guidelines there are various discrepancies contributing to confusion and nonstandardised methodology when applied in Africa. The variety of hypertension guidelines in paediatrics is also a potential pitfall for African countries (and others) that do not have their own nomograms for BP in children and adolescents. *Read the full study

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Barriers and facilitators to end-of-life care in the adult intensive care unit: A scoping review Methods There were four selected databases searched electronically to identify published qualitative studies.

Data extraction was with a standard data extraction tool and independently extracted by two reviewers.

The review was guided by the question: “What are the barriers and facilitators nurses perceive and experience when delivering end-of-life care in the intensive care unit?”

Wits researchers involved: Emmanuel Kwame Korsah, Shelley Schmollgruber The intensive care unit (ICU) is an organised setting in the hospital that provides specialised nursing and medical care to the patients with lifethreatening illnesses using highly sophisticated technology. The aim of intensive care is to comprehensively manage patients, support the further damage to failing organ systems (such as lung, kidneys and heart) and ensure patients are in an acceptable state on discharge. Despite the remarkable advances in technology, pharmaceuticals and patient care, the mortality rate in the intensive care unit (ICU) remains high, approximately 20%, with a considerable variation noted across regions and countries. It is also estimated that 60–70% of these deaths occur after a decision to limit life-sustaining treatments; thus, either withdraw or withhold treatments.

These statistics make caring for critically ill and dying patients at the end of life and their family members an integral part of the care provided in the ICU. There can be several interventions implemented, according to nurses, which are necessary to humanise patient care and shift the focus to comfort care. This study identifies qualitative studies that describe the barriers and facilitators nurses perceive and experience when delivering end-of-life care in the Adult Intensive Care Unit.

Two reviewers independently examined the titles and abstracts of the retrieved studies together for their inclusion in the study. Consultation with a third independent reviewer occurred at every point of disagreement; however, there was consensus reached in most cases. Upon achieving consensus, the reviewers developed a standardised data extraction tool to extract essential items from each included article.

Results In total, 20 qualitative studies were eligible for result extraction. The majority of studies (19; 95%) presented findings on the barriers to end-of-life care, and a few (11; 55%) focused on the facilitators of end-of-life care. The provision of adequate end-of-life care training and education for nurses, formulation of policies and guidelines in the ICU, and working with family members are vital measures to enhancing the quality of care patients and families receive at the end of life.

Discussion The review found the behaviour of patients’ families, the nature of the intensive care environment, physician behaviour, and nurse-attributed factors considerably hindered the delivery of optimum end-of-life care in the ICU. As described, family members’ limited knowledge of lifesaving measures, unrealistic expectations, and refusal to accept patients’ prognoses are the most significant challenges to providing effective EOL care. These findings support that of an earlier study by, which described the behaviours of patients’ families as one of the biggest obstacles to appropriate EOL care in the ICU. Such behaviours take the healthcare professionals’ attention away from patient care, and lead to inconsistencies in EOL care. *Read the full study

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The wits pharmacy undergraduate research expo: Fostering leaders

The Department of Pharmacyat Wits University launched INVEST in 2017 as a Pharmacy Career Mentorship Program. The INVEST Undergraduate (UG) Research Expo provides third and fourth (final) year Bachelor of Pharmacy students with a platform to present their research undertaken within that particular year of their undergraduate curriculum. The INVEST Research Expo is a prestigious occasion that provides a platform for undergraduate pharmacy students to showcase their innovative ideas and projects.

develop a project protocol, research the topic, and comprehensively communicate their findings at the expo. Then, they provide a comprehensive research report by the end of the year. This is an exciting teaching and learning method, aimed at developing critical-thinking pharmacists capable of research for the future.

This year’s Undergraduate Expo was hosted on 21September 2023 where the third-year students presented their business pitches at the eZone; while the fourth years presented their research findings in the WITS Public Health Auditorium.

This year, the students presented their findings to a panel of esteemed adjudicators in the profession. The competition was tight with exceptional research projects presented, below are the winners in each category.

Pharmacy Practice: Assessing the knowledge, attitude and perception of final year health science students regarding religious constraints on prescribing and dispensing practices by Faadhil Saloojee, Ibrahim Bana and Humzah Moola Pharmaceutics: Use of Molecular Imprinting Technology and Nanocrystals to optimise and control the release of low bioavailability drugs by Scott Gilbert and Senamile Kunene Clinical Pharmacy: A guided review for the tapering of pharmaceuticals by Rumaanah Samsoodien Pharmaceutical Microbiology: Antimicrobial activity of essential oils in a polymicrobial environment by Fatima-tu-Zahra Booley and Maseeha Akoob

Special project The Special Project is a unique course initiated by the Department of Pharmacy and Pharmacology wherein students research a topic within the field of pharmacy.

Students are supervised throughout the year to

The best overall oral presentation was awarded to the talk: “Formulation and characterization of a honeyladen cryogel for potential application as a wound dressing” by Boitumelo Malapane and Katlego Mashiane.

Each year, a segment that is dedicated to entrepreneurial ventures is featured in the pharmaceutical domain – PharmApprentice. In this segment, students pitch their business ideas to a panel of adjudicators. Concurrently, the fourth-year students present the findings of their year-long research elective projects. Both cohorts present these results to their peers, internal and to an expert panel of adjudicators.

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Christine Venter (Director of Training at Pharmacy Development Academy), Nicola Brink (CEO of SelfPharmApprentice Care Association of South Africa) and Selloane The PharmApprentice programme, in partnership with Chaoane (Manager: Sales and Business Development Aspen Pharmacare, facilitates pharmaceutical business at the Standard Bank Group). The Top three groups leadership development and a growth mind-set for listed below were determined based on their pitches entrepreneurship and innovation in pharmacy. Students and the validity of the solution to practical application. pitch real-world problem-solving business They presented to a panel of Aspen executives at the interventions to a panel of esteemed adjudicators in the Aspen Pharmacare in Woodmead, where the 2023 industry and followed by a Q&A slot. This year’s focus winning team was determined. was on the codeine crisis and how pharmacists can alleviate the burden.

The team has been awarded a trip to the Aspen manufacturing site in Gqeberha for two days. The team Thirteen innovative ideas were pitched this year to an will also receive Gold Reef City Mint silver coins to be esteemed panel including the external adjudicating handed out at the School of Therapeutic Sciences panel of Ayanda Swana (CEO of Siemens Healthineers), Awards Ceremony, sponsored by Aspen Pharmacare.

Pictured above L-R: Winning BPharm 3 students, Left to right: Talhah Norath, Tayyibah Fakiry, Fatima Zahra Mohamed, Swalehah Latif, Dr Stephanie Leigh-de Rapper (WITS, Pharmacy Practice), Dr Stavros Nicolaou (Aspen Pharmacare), Yusuf Loonat, Dominique Peterkin and Mrs. Rubina Shaikh (WITS, Pharmacy Practice) Ms. Daniela Sefora Goeieman won first place in the oral presentation for the School of Clinical Medicine Research Day. Ms. Goeieman is a postgraduate student at Stellenbosch University pursuing an MPhil in Family Medicine in addition to her role as an associate lecturer at the Department of Family Medicine and Primary Care's Division of Clinical Associates. Her presentation delved into the crucial realm of women who use drugs (WWUD) in South Africa.

The study examined the specific challenges these women face, including higher rates of HIV infection, unsafe injecting practices, gender-based violence, and their access to harm reduction services.

Shristi Misser, a MSc student at the Wits Research Institute for Malaria received the Best firsttime poster presentation prize of the Parasitological Society of Southern Africa. The title of her poster: The effect of larval exposure to plastic pollution on the life history of the major malaria vector Anopheles arabiensis (Diptera: Culicidae).

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Professors Peter Kamerman and Shabir Madhi receive Medals and Fellowships from Royal Society of South Africa

Pictured above L-R: Professor Jonah Choiniere, Professor Shabir Madhi, Professor Jennifer Fitchett and Professor Peter Kamerman.

Medals for established and emerging researchers, eminent scholars inducted as Fellows.

Professor Jonah Choiniere, Professor Peter Kamerman, and Professor Shabir Madhi were inducted as Fellows of the Royal Society of South Africa at a ceremony held in Pretoria on 4 November 2023.

The Society also awarded Professor Jennifer Fitchett its 2023 Meiring Naudé Medal, which recognises outstanding early career scientists (under 35-yearsold) who have already made a mark in their field and who are poised to become scientific leaders.

From the Faculty of Health Sciences, Professor Kamerman, and Professor Madhi were inducted into the Royal Society of South Africa - the country’s premier multidisciplinary scientific organisation. These fellows are entitled to the post-nominal letters FRSSAf after their names.

Understanding pain Peter Kamerman is a Professor in the School of Physiology at Wits. He undertook his PhD training in thermoregulation and fever, but soon after shifted his focus to studying pain in people living with HIV. Since then, he has led an active research programme in the field of pain.

Vaccinating a nation and saving babies Professor of Vaccinology Shabir Madhi is a paediatrician, infectious disease epidemiologist, and

expert in vaccines. He was elected as a Fellow of the Royal Society of South Africa in 2016 when he was still the Director of the National Institute for Communicable Diseases. Since 2021, he has been the Dean of the Faculty of Health Sciences at Wits, where he is also the founder and Executive Director of the Vaccines and Infectious Diseases Analytics (Wits VIDA) research unit, and Co-Director of African Leadership in Vaccinology Expertise (ALIVE).

Madhi will receive the Society's John F.W. Herschel Medal in October 2024. This medal is awarded to those who are outstanding in either multidisciplinary fields of research, or in more than one unrelated field.

The Society’s senior medal recognises Madhi’s major contributions in the field of vaccinology and the related fields of epidemiology, immunology and infectious diseases, and in mother and child health, as well as in vaccination policy and public health.

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One ASSAf gold medal and 15 Academy memberships Academy of Science of South Africa (ASSAf) research unit focused on HIV prevention and treatment awards Gold Medal to world-renowned HIV expert and inaugurates 15 Wits scholars as new For the past two decades, Gray has focused on HIV members. vaccine development, leading major phase 2b/3 trials of candidate vaccines in sub-Saharan Africa, as well as Wits Professor Glenda Gray was awarded the Academy of Science of South Africa (ASSAf) Science- contributing to the clinical development of South Africa’s own HIV vaccines. for-Society Gold Medal for outstanding achievement Gray has influenced the marked change in the HIV at the ASSAf annual awards ceremony held on 9 vaccine field from a US/Euro-centric based scientific November. programme, to having almost all candidate vaccines designed for the Southern African epidemic and all the critical immunogenicity trials and efficacy trials conducted in this region.

During Covid-19, Gray set the SAMRC research strategy for Covid-19, enabling South Africa to emerge as a global scientific leader on Covid-19 vaccines.

ASSAf annually honours the country’s most outstanding scholars by electing them as members of the Academy.

This singular honour recognises scholastic achievement across the spectrum of academic disciplines. Members constitute the core asset of the Academy and give of their time and expertise voluntarily in the service of society.

The ASSAf Science-for-Society Gold Medal recognises the scholastic and scientific contributions of Professor Glenda Gray , to HIV research, prevention, treatment and vaccines, as well as her fundamental role in vaccines during the Covid-19 pandemic.

Gray is a National Research Foundation A1-rated scientist and world-renowned for her research in HIV. She is currently President of the South African Medical Research Council (SAMRC) – the first woman to hold this position – and she remains a Research Professor in the School of Clinical Medicine at Wits University. She is also a Wits alumna, having studied medicine and paediatrics here.

Her clinical research career began in the field of preventing mother- to-child transmission of HIV, focusing on breastfeeding transmission and postexposure prophylaxis. She co-founded the renowned Perinatal HIV Research Unit (PHRU) at Chris HaniBaragwanath Hospital, today a world-renowned

The new ASSAf members from the Wits Faculty of Health Sciences are listed below:

Prof Daynia Ballot

Prof Angela Woodiwiss

Professor Ballot, a paediatrician with a subspecialty in neonatology, is the Head of the School of Clinical Medicine.

Professor Angela Woodiwiss is the Director of the Cardiovascular Pathophysiology and Genomics Research Unit in the School of Physiology

Prof Lisa du Toit

Prof Stephen Tollmant

Professor Lisa du Toit is Assistant Director and Senior Researcher in the Wits Advanced Drug Delivery Platform Research (WADDP) Unit in the Department of Pharmacy and Pharmacology.

A Research Professor in the School of Public Health, Stephen Tollman is also Director of the Medical Research Council/Wits University Rural Public Health and Health Transitions Research Unit (Agincourt)

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Professor Miles Markus

Professor Lizette Koekemoer

Dr Monique Keller

Professor Yahya Choonara

Prof Markus of the Wits Research Institute for Malaria for being awarded (2023) the Elsdon-Dew Medal of the Parasitological Society of Southern Africa.

Received the WiVC Excellence Award: Senior Career. The award ceremony took place during the 9th PAMCA Annual Conference & Exhibition. Read more

Congratulations to Dr Keller of the Department of Physiotherapy on obtaining her PhD from the University of Free State

The Head of Pharmacy and Pharmacology and Director of WADDP was elected as a fellow of the Africa Science Leadership Programme.

WADDP Team Professor Michele Ramsay She has been appointed as a member of a WHO Technical Advisory Group – Genomics (TAG-G). She was also invited

by Spanish Presidency of the Council of the European Union to speak at the Conference on Personalised Medicine: the evolution of healthcare to improve people's lives. Her talk was titled “Landscape of African Genomics and PM: Bidirectional cooperation EUAfrica”.

Professor Lisa du Toit, Professor Patrick Hulisani Demana and Professor Yahya Choonara from Pharmacy & Pharmacology on winning the best publication award for their article in Pharmaceutics entitled: “A nano-enabled biotinylated anti-LDL theranostic system to modulate systemic LDL cholesterol” at the 42nd National Academy of the Pharmaceutical Sciences of South Africa (APSSA) conference in Durban, South Africa

Huang-Miao Chen

Dr Jarrod Zamparini

Mrs Chen Pharmacology/Nursing Education on being awarded the best oral presentation entitled “The knowledge, attitudes and practices of malaria and COVID19 – a survey” at the International Nursing Conference 2023

Dr Zamparini received the Imperial-ARUA Research Seed Fund grant for collaborative research between Wits in Obstetric Internal Medicine and the Imperial College London.

Professor Desiré Brits

Professor Helen Rees

Prof Brit became the third certified forensic anthropologist in South Africa and the only 5th individual to be certified as a level 1 forensic anthropologist by FASE. She was recently accepted to write the level 1 forensic anthropology certification exam.

Forensic anthropologists assist in the analysis of decomposed and skeletonized skeletal remains to aid in the identification of unknown decedents and are experts in bone trauma.

Prof Rees was appointed as Chair of the Vaccine Investment Strategy Steering Committee

by Gavi, the Vaccine Alliance.

The VIS Steering Committee guides Gavi’s evidence-based process to identify new and under-used vaccines of the highest importance to its supported countries and with the greatest need for financial support.

School of Oral Health Sciences In October, joint staff from Wits School of Oral Health Sciences participated in the first ever Gauteng Provincial Oral Health Research Conference under the theme “Achieving Integrated Oral Health Services through Collective Action”. Seven out of the 14 research presenters who contributed to the conference were Wits staff and postgraduate students.

The participation is a reflection on their commitment to improve patient outcomes using their knowledge for social good.

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Professor Ananyo Choudhury Professor Choudhury has received a National Institute of Health (NIH) grant (valued at about 13 million ZAR) under the Data Science for Health Discovery and Innovation Africa (DSI-Africa) consortium. The proposed, Integrated Models for Early Risk Assessment (ILERA) study funded by this grant would aim to combine clinical, environmental and lifestyle-based risk predictors (such as smoking, alcohol intake, sedentary lifestyle) with genetics (polygenic risk scores) and gene expression data (RNA-seq) to generate integrated risk predictors for cardiovascular disease and traits.

To allow for complex non-linear interactions between these factors, data-driven approaches (such as machine learning, neural-network) will be employed for integrating these variables. The models generated by this approach will be finetuned using in-depth evaluation of the predictivity of these models in independent cohorts and in longitudinal data from the same cohort. The models are also anticipated to have the potential for use as an early warning system aimed both at personalized medicine and public health intervention for obesity, hypertension, diabetes, and other cardiovascular diseases.

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Congratulations!

LIFETIME ACHIEVEMENT AWARDS Dr Peter Robin Hull: 2023 CDA Lifetime Achievement Award

Professor Heather Zar: ERS Lifetime Achievement Award: Paediatrics

The Canadian Dermatology Association named Dr Peter Hull (MBBCh 1970, PhD 1987?) as the corecipient of the 2023 CDA Lifetime Achievement Award. Among many of Dr Hull’s professional accomplishments are his notable research contribution and the various leadership roles that he has led throughout his career.

Professor Heather Zar (MBBCh 1985) was bestowed the Lifetime Achievement Award in Paediatrics for minimizing worldwide health disparities and guaranteeing that every child has access to efficacious interventions. She is the current Director of the University of Cape Town's Red Cross Children's Hospital's SA-MRC Unit on Child and Adolescent Health and an advisor the WHO, UNICEF, and the Gates Foundation, respectively. Professor Zar previously served as the Pan African Thoracic Society's former president, and the Forum of International Respiratory Societies' president.

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PUBLICATIONS

Authored by Dr Yemi Adewoyin Researcher at the Wits Demography and Population Studies Programme School of Public Health Through its direct and indirect impacts on labour productivity, population health and wellbeing matter for the social and economic development of households and national economies. Yet, health is not uniform in space. And neitheris development. Comparatively, on many health and development indicators, Africa fairs poorly. The variation in health may present as differences in the occurrence and spread of diseases, the distribution of and access to healthcare facilities, and/or in health outcomes among the population.

Reasons for these variations range from biology to the population’s levels of exposure and susceptibility to elements in their environment, including the social interactions taking place within the environment. The field of health and medical geography focuses on the spatial patterns and processes underlying these variations and provides pathways for understanding and addressing them. More specifically, the sub-discipline of health and medical geography focuses on, among others, how places (their characteristics and processes that go on in them) and environmental factors underlie and/or influence disease patterns, exposure and susceptibility to diseases, health variations, health behaviour, health outcomes, and the provision of and access to healthcare services. This edited volume documents perspectives and applications in health and medical geography in Africa for academics, students, health practitioners, and development policymakers. Case studies discussed by 55 experts and practitioners in the 500-page book include those from Benin, Cameroon, Gabon, Ghana, Lesotho, Malawi, Nigeria, South Africa, Tanzania, Zimbabwe, the EAC and SADC blocs, and the whole of Africa.

1 Nobel Prize winner 2 DSI/NRF Centres of Excellence 2 ANDI Centres of Excellence 7 research intensive Schools 8 DSI/NRF SARChI Chairs A-rated

9 A-rated scientists 28 Research Entities 96 NRF-rated scientists

2023

Wits Faculty Of Health Sciences IN NUMBERS

WORLD RANKINGS

nd

TOP 150

TOP 300

262

Shanghai Ranking 2022

Times Higher Education 2022

QS Ranking 2022

Clinical Medicine

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WORLDWIDE

Life Sciences & Medicine

Training healthcare professionals fit for the 21st century in an ever-changing world