Wits School of Public Health Building, Parktown BOOK OF
Oral presentation abstracts 7
Influence of Household Decision-Makers on Maternal Vaccine Acceptance: Insights from a South African ContextX
Economic Evaluation of Free Prevention of Mother-to-Child Transmissions (PMTCT) Services to Non-South African Women Living in South AfricaX
Acceptability of the RTS,S Malaria Vaccine among Healthcare Workers in the Kassena Nankana Municipality, GhanaX
A qualitative exploration of the barriers to reporting of intimate partner violence among migrant women in Ekurhuleni, South Africa.
Changes in chronic diseases prevalence and multimorbidity clusters among the deceased in rural northeast South Africa (2012-2022)X
The Intergenerational continuity of violence: Pathways between childhood violence, intimate partner violence and the use of violence against children in the home among young women and men in South AfricaX
Enhancing Community Health Worker Roles in rural Primary Healthcare: Evaluating a learning intervention institutionalizing community participation in Mpumalanga province, South AfricaX
Estimating price and expenditure elasticities for select foods and drinks in South Africa using a demand systems model X
Inequalities in Healthcare Utilization Among People with Disabilities in Ethiopia: Evidence from the 2021/22 Ethiopian Socio-Economic Panel SurveyX
Effects Of Pyrazinamide And/Or Ethambutol Resistance On Tuberculosis Treatment Outcomes By Whole Genome Sequencing, South Africa 2020 - 2022X
An investigation of the knowledge, attitude, and practices of Public Health Medicine specialists on climate-related health risks.X
The Effect of Climate Change on Somali Women’s Mental Health: Socio-demographic Factors, Violence, and Resilience in the Context of Droughts and FloodsX
Beyond the Framework: Stakeholder Insights into Rehabilitation Policy Implementation in Gauteng, South AfricaX
Institutional support for breastfeeding: a qualitative study that is translating knowledge to actionX
Building a Child Health Dashboard in Soweto: A Data Integration Approach for Evidence-Based Decision MakingX
Projections of the impact of transmission-reducing pediatric influenza vaccine in South Africa using high resolution immunologic and infection dataX
A Roadmap Towards NHI Readiness: Experiences and Lessons from the Ekurhuleni Health DistrictX
Evaluating the acceptability, usability and clinical appropriateness of Your Path, an AI-powered tool facilitating relevant access to HIV services post-HIV self-testing in South AfricaX
When the Church Became a Wound: Faith, Queerness, and Black Izitabane Women’s Spiritual ResistanceX
Infant Feeding Education in Clinical Undergraduate Curricula: a case study from a faculty of health science at one South African university X
Factors influencing maternal vaccine demand and interventions to increase maternal vaccine demand and uptake in low-and middle-income countriesX
Preferences of Public Sector Doctors, Nurses and Rehabilitation Therapists for Multiple Job Holding Regulation: a Discrete Choice Experiment.
Perceptions, attitudes and experiences of mental health and mental health services among adolescents in a Johannesburg high school
Melanoma Incidence among People Living with HIV - The South African HIV Cancer Match Study, 2004-2021
Evaluating Patient Costs and Time Spent Accessing Pre Exposure Prophylaxis Among Young Adults at Community Based Mobile Clinics in Cape Town, South Africa
The Economic Costs of Congenital Hearing Loss in a South African Cohort
Contact Tracing Under Pressure: Policy and Equity Insights from South Africa’s COVID-19 Response
The Acceptability of a Real-Time Medication Monitoring-based Digital Adherence Tool Among Young People Living with HIV in Malawi
Essentiality and Mental Health: Experiences of Migrant Cross-Border Truck Drivers at the South Africa-Zimbabwe Borderscape During COVID-19
Missing Data Imputation in the HAALSI Study: Comparative Evaluation of Statistical, Machine Learning, and Deep Learning Techniques
Migration as a Social Determinant of Multimorbidity in the Migrant Health Follow-Up Study (MHFUS)
The Effort-Time Trajectory Model: A Pedagogical Planning Tool for Masters of Medicine Research Training
Trust in Vaccines Among Healthcare Professionals in South African Maternity Care Settings: A Cross-sectional Study using the Vaccination Trust Indicator
Experience of Body Changes and Sexuality among Middle-aged Men and Women: A Community-Based Exploratory Qualitative Study
“You have to make it alone”: wellbeing, hope and aspiration of young people in urban South Africa
Where Is The Whey? An Investigation Of Labeled Vs Measured Whey Protein Supplement Protein Content
Ageing Across the Spectrum: Demographic Shifts in Elderly, Middle-Aged and Young Nations
Integrating HIV and SRHR in Narok County Through Culturally-Responsive Approaches
Exploring Healthcare Workers’ Perspectives on Vaccination Education and the Maternal Health Record in Maternal and Child Health Services in Gauteng
Intimate partner violence among adolescent girls and young women accessing HIV pre-exposure prophylaxis in South Africa, 2019-2022
Prevalence and risk factors associated with major congenital disorders identified through the UBOMI BUHLE pregnancy exposure registry in Soweto, South Africa
From Clinical to Care: Understanding Maternity Care Journey’s of Mothers in Soweto and Thembelihle.
Coping with stillbirth: Insights from parents in rural Limpopo, South Africa
Beyond Comorbidity: A Syndemic Analysis on Intimate Partner Violence, Mental Health, and HIV and their influence on parental use of violence among women in South Africa
Epidemiology of schistosomiasis in Mpumalanga Province, South Africa, 2016 - 2024: A retrospective cross-sectional study
Patient Journey Mapping: The experience of patients receiving hand injury care services in Gauteng
Awareness of hereditary breast cancer and genetic testing among patients with breast cancer in Nigeria: A multicenter study
Using the Consolidated Framework for Implementation Research to explore the contextual determinants of private healthcare providers’ participation in the Public -Private Mix for Tuberculosis in Bauchi, Nigeria.
Gender representations in unhealthy food advertisement that appeal to adolescents- implications for obesity preventionX
Incidence and Severity of Incomplete Abortions Admitted in South African Public Hospitals: A Comparison Between 1994, 2000, and 2018X
The availability of digital health technologies and infrastructure in the district hospitals of Gauteng ProvinceX
Does life expectancy vary by disability status in low and middle-income countries?: a systematic review and metaanalysisX
Left behind in primary healthcare: A qualitative exploration of healthcare experiences of people with disabilities in Ethiopia X
Time and money costs of seeking pre-exposure prophylaxis for HIV in rural KwaZulu NatalX
Assessing HIV risk behaviors, perception of HIV risk, PrEP knowledge and preferences, and the feasibility of using the BART to measure risky behaviors among young women in uMkhanyakudeX
Assessing the Impact of Carotenoids on Persistent Inflammation, Lipid Peroxidation and Redox Imbalance PostTuberculosisX
Transformed through the CARTA experience:X
Establishing the Maternal Immunisation Readiness Network in Africa and Asia (MIRNA) to Strengthen Maternal Vaccine IntroductionX
Designing and evaluating the implementation of a monitoring and evaluation system for enhancing the use of data for cost efficiency at a central hospital in Gauteng, South AfricaX
Internal migration and the HIV care cascade: A cross-sectional analysis among young adults in rural South AfricaX
Occupational lead exposure among lead handlers in a copper mining company, Zambia. X
Exploring Health Science Educators’ Perspectives on Gamification and Digital Game-Based Learning: Implications for Public Health EducationX
Characterising time-activity patterns for exposure assessment in communities near mine tailings in West Rand, South AfricaX
Measles outbreak investigation in Lejweleputswa district, Free State province, February - June 2025X
Implementing a dedicated orthopaedic emergency theatre at Charlotte Maxeke Johannesburg Academic Hospital.X
The Burden Of Respiratory Syncytial Virus (RSV) Infections In Young Children (<5 Years) In South AfricaX
“..If I had an adolescent I would say she should not take PrEP”: The Influence of Socio-Cultural Factors and Gender Norms on PrEP Access and Utilization Among Adolescent Girls and Young Women in Mpumalanga, South AfricaX
The corporate political activity of national and transnational corporations in South Africa in response to the climate crisis and their considerations of non-communicable diseases X
Performance of COVID-19 symptom-based case definitions in detecting SARS-COV-2 infection among individuals ≥18 years in South Africa’s Pneumonia Surveillance Program, 2020-2023X
Arts-based community engagement boosts acceptance of the Sterile Insect Technique for malaria control in rural South AfricaX
Factors influencing influenza vaccine uptake among adults in Johannesburg, South Africa: A qualitative studyX
Beyond checklists - innovating quality assessments by incorporating fundamental qualitative design principlesX
Examining intimate partner narratives on X: a social listening study in South AfricaX
The Cost of a Family Centered Early Childhood Intervention: Economic Costs of the HI HOPES Programme for Children with Hearing Loss in Southern AfricaX
Factors Associated with Cognitive Reasoning and Attention Among Adults participating in a behavioural lab study in Gauteng, South Africa: Implications for Health Behaviour X
Measles outbreak investigation in Lejweleputswa Characteristics of Healthcare Innovations in South AfricaX
Community drivers of maternal vaccine demand in SOWETO: qualitative insights from women and stakeholdersX
Global Aspects on Topics in Healthy Aging: A Narrative Review of the Current Literature by the Consortium of Students as Stakeholders for Healthy AgingX
Multimorbidity patterns among middle and older adults in rural South Africa: a comparative analysis of clustering methodsX
Mental health patterns and associated social determinants among university and college students in Sub-Saharan Africa during the COVID-19 pandemic era: A Scoping Review X
Vindicating the Right to Food: Leveraging Market Inquiries as a Form of Accountability X
Perceptions, attitudes and experiences of mental health and mental health services among adolescents in a Johannesburg high school.X
The Social Determinants of Multimorbidity in Sub-Saharan Africa: a narrative review X
The Role of Comprehensive Sexual Education in the Prevention and Management of Learner Pregnancy: Experiences of Learners and Educators in Secondary Schools in Soweto, South AfricaX
Effectiveness of advertising complaints mechanisms in South Africa: Public health implications and regulatory gapsX
Malaria Prophylaxis Amongst Sickle Cell Patients In Southwest Nigeria: An Assessment Of Knowledge, Practice And ImpactX
Trends and determinants of public healthcare dissatisfaction among youth in Gauteng ProvinceX
Non-optimal indoor temperatures measured in informal dwellings during cold months in Johannesburg, South Africa: implications in a changing climateX
Health capability deprivations associated with USAID’s closure in an urban Swati community- a participatory ethnography X
Understand Barriers to HIV testing Among Pregnant women in Soweto, Johannesburg: A Socio-Ecological Model X
Caregiver and child factors affecting utilization of dental services in preschool children aged 3-5 years in Ibadan, Nigeria.X
Influence of Household Decision-Makers on Maternal Vaccine Acceptance: Insights from a South African Context
The ACTION Study: Addressing global inequities in breast cancer genetic testing, counselling, and management among breast cancer patients in Nigeria
Oral presentation abstracts
Prevalence and patterns of workplace violence in primary health care settings in Ekurhuleni, South Africa: a cross-sectional study
Background: Workplace violence (WPV) is increasingly recognised as a critical occupational and public health concern, yet it there are few studies from South African that have looked at the burden in primary health care (PHC) settings. There are legal obligations for all employers under the Occupational Health and Safety Act and Protection from Harassment Act. PHC workers often face elevated risks due to both facilitybased and community service delivery. This study examined WPV experiences and witnessing as well as responses among healthcare workers (HCWs) in Ekurhuleni to inform policy and facility-level interventions. Methods: A cross-sectional survey of HCWs with at least one year working in participating PHC facilities was conducted using a self-administered questionnaire adapted from the ILO/ICN/WHO/PSI tool. Descriptive and multivariable logistic regression analyses were performed, with findings considered in relation to existing South African WPV prevention frameworks. Results: The response rate was 70.4%. Among the 723 respondents, 34.8% reported psychological abuse, 6.8% physical abuse, and seven reported sexual violence in the previous 12 months. A third reported witnessing psychological and 22.2% physical WPV. Patients and their families were the primary perpetrators, though colleagues and managers were also implicated. Doctors, nurses, and those working overnight faced higher risks. Only 52.2% were aware of reporting procedures. Half who experienced psychological and 26.1% of those who experienced physical WPV took no action. Conclusion: WPV in PHC facilities is concerning, especially for frontline clinical staff. Strengthening OHSA compliance, integrating WPV indicators into Ideal Clinic and Office of Health Standards Compliance tools, and embedding prevention measures in National Health Insurance contracts are recommended. Implications: There is a need for facility-level guidelines, confidential reporting systems, staff training, and intersectoral collaboration are essential to ensure safe, violence-free PHC workplaces.
Economic Evaluation of Free Prevention of Mother-to-Child Transmissions (PMTCT) Services to Non-South African Women Living in South Africa
Authors: Micheal Kofi Boachie, Vinayak Bhardwaj, Bontle Mamabolo, Winfrida Mdewa, Susan Goldstein, Karen Hofman, and Evelyn Thsehla
Email: micheal.boachie@wits.ac.za
Keywords: Migrants, HIV/AIDS, South Africa, PMTCT, cost-effectiveness
Abstract:
Background South Africa, a major destination for migrants, records approximately 1.33 million pregnancies annually, with 25% among non-South African women. About 30% of pregnant women in South Africa are HIV-positive, elevating the risk of mother-to-child transmission (MTCT). Despite constitutional rights to universal maternal healthcare, migrant women face barriers to accessing free prevention of mother-to-child transmission (PMTCT) services. Objectives To establish the cost-effectiveness of providing free PMTCT services alongside antenatal care (ANC) to non-South African migrant women in South Africa, compared to ANC alone or no intervention, from a public sector healthcare payer perspective. Methods A prevalence-based cost-effectiveness analysis was conducted using a Microsoft Excel-based decision tree model, comparing ANC + PMTCT services to ANC alone and a do-nothing scenario. Data on costs, HIV prevalence, PMTCT coverage, and health outcomes (averted pediatric HIV infections and disability-adjusted life years [DALYs]) were sourced from peer-reviewed literature. One-way sensitivity and budget impact analyses were conducted. Results Providing ANC + PMTCT services to 52,762 HIV-positive migrant women prevents 14,562 pediatric HIV infections and averts 246 DALYs per 1,000 live births. The expected cost of ANC + PMTCT is $52,889 per 1,000 live births, compared to $191,000 for ANC alone and $73,535 for no intervention. ANC + PMTCT is cost-saving, with an incremental cost-effectiveness ratio of -$733 per DALY averted, well below the $2,081 threshold. Sensitivity analyses confirmed robustness across parameter variations. Universal PMTCT coverage requires an additional $1.5 million annually over five years. Discussion and Implications Free PMTCT services for migrant women are highly costeffective, reducing vertical HIV transmission and long-term healthcare costs. Policymakers should eliminate barriers such as medical xenophobia and documentation requirements. Allocating an additional $1.5 million annually and establishing a Southern African Development Community (SADC) healthcare fund is recommended to improve service delivery while distributing costs regionally.
Acceptability of the RTS,S Malaria Vaccine among Healthcare Workers in the Kassena Nankana Municipality, Ghana
Authors: Eustace Bugase, Latifat Ibisomi, Alfred Kwesi Manyeh
Introduction: Malaria remains a significant public health challenge in sub-Saharan Africa, particularly among children under five years. Despite sustained control efforts, Ghana continues to experience a high burden of malaria. The World Health Organization (WHO) introduced the RTS,S/AS01 malaria vaccine, the first malaria vaccine to show substantial efficacy in reducing cases among young children. Ghana, alongside Kenya and Malawi, piloted the vaccine, which is now incorporated into routine childhood immunization programs. Healthcare workers (HCWs) are critical to the successful implementation of vaccination programs. Understanding their views on the RTS,S vaccine is essential for sustaining high uptake. Objective: This study explored the acceptability of the RTS,S malaria vaccine among healthcare workers in the Kassena-Nankana Municipality of Ghana. Methods: An exploratory qualitative design was employed. Fifteen Community Health Nurses (CHNs) were purposively selected and interviewed using in-depth interviews guided by the Theoretical Framework of Acceptability (TFA). The interviews were conducted in English and lasted 30-45 minutes. They were audio-recorded, transcribed verbatim, and analyzed thematically using NVivo 12.0 software. Results: CHNs reported high acceptability of the RTS,S vaccine, highlighting perceived effectiveness, safety, and minimal interference with routine work. They demonstrated strong confidence in administering the vaccine, a clear understanding of its purpose, and observed reductions in malaria cases among children under five. Discussion: The high acceptability among CHNs is influenced by their trust in the vaccine’s efficacy and alignment with professional responsibilities. Positive personal experiences and perceived community benefits further reinforced acceptance. Implications: Strengthening HCW training and addressing concerns promptly can sustain high acceptance and ensure effective integration of the RTS,S vaccine into routine immunizations. Findings can inform strategies to enhance vaccine uptake and contribute to malaria control efforts in similar settings.
A qualitative exploration of the barriers to reporting of intimate partner violence among migrant women in Ekurhuleni, South Africa.
Authors: Christine Chawhanda, Oludoyinmola Ojifinni, Jonathan Levin and Latifat Ibisomi
Introduction: Intimate partner violence (IPV) remains a pervasive public health issue and women’s human rights violation, with migrant women facing unique challenges in seeking help and reporting its occurrence. The intertwining suboptimal economic and migration status of women further complicates the reporting process, as these expose them to additional layers of marginalization and discrimination. Objective: This study explored the factors that hinder migrant women from reporting IPV in Ekurhuleni, South Africa, shedding light on the complexities of their experiences. Methods: Indepth interviews (IDIs) were conducted with internal and international migrant women aged 18-49 years. Snowball sampling was used to select both internal and international migrant women. The IDIs were digitally recorded, transcribed verbatim and analysed thematically. Results: Participants reported several barriers to reporting including societal norms that stigmatise IPV reporting and fear of deportation for international migrant women without valid legal migration documents. Additionally, perpetrator characteristics, language barriers, lack of familiarity with the local laws and support systems, concerns about the safety and financial dependency on their partners further hindered migrant women from reporting intimate partner violence. Implications: Understanding and addressing the barriers is crucial to developing tailored interventions and support mechanisms to empower migrant women to report violence perpetrated by their intimate partners. Engaging communities in participatory discussions about IPV may reduce stigma and encourage more supportive environments for victims, especially the marginalized groups.
Changes in chronic diseases prevalence and multimorbidity clusters among the deceased in rural northeast South Africa (2012-2022)
Introduction Rural South Africa is undergoing an epidemiological transition, with chronic non-communicable diseases (NCDs) increasingly contributing to mortality alongside traditionally high infectious disease burdens. We aimed to investigate changes in chronic disease prevalence and multimorbidity clusters among deceased individuals in rural northeast South Africa from 2012 to 2022. Methods Verbal autopsy data collected at the Agincourt Health and Demographic Surveillance Site (HDSS) from 2012-2022 were analysed. A total of 5,892 deceased individuals were included. We identified reported chronic conditions leading to death and applied cluster analysis, Partitioning Around Medoids (PAM) and latent class analysis (LCA) to identify patterns of co-occurring diseases (multimorbidity clusters). Temporal trends in condition prevalence were assessed, and multinomial logistic regression was used to examine associations of cluster membership with various behavioral factors. Results Over the 11-year period, hypertension prevalence among decedents rose from approximately 25% in 2012 to over 50% by 2022, with diabetes reaching ~25% and dementia over 10%. In contrast, deaths reported due to tuberculosis and HIV declined markedly. The proportion of decedents with multimorbidity (≥2 chronic conditions) increased, and complex multimorbidity (≥3 conditions) nearly doubled over time. Dominant multimorbidity clusters evolved from an early focus on HIV/TB comorbidity to later clusters centered on cardiometabolic conditions (e.g., hypertension-diabetes) and neurodegenerative illnesses. Older adults (≥65 years) and females experienced the highest multimorbidity burden, being more likely to have multiple chronic conditions and to belong to the complex disease clusters. Conclusions Mortality patterns in this rural population have shifted toward chronic NCDs and multimorbidity. Following these trends and identifying disease clusters is essential for targeting patient-centered care. Our findings underscore the importance of integrating care for NCDs and infectious diseases in rural health systems to address the growing multimorbidity burden, with particular focus on older adults and women.
The Intergenerational continuity of violence: Pathways between childhood violence, intimate partner violence and the use of violence against children in the home among young women and men in South Africa
Keywords: Intergenerational continuity of violence, Intimate partner violence, violence against children, path analysis
Abstract:
Introduction: The continuation of violence across generations perpetuates vulnerabilities in women, men, and children, contributing to adverse health and social outcomes. However, pathways explaining this intergenerational cycle remain underexplored, particularly in Africa. This study investigates a conceptual model of violence continuity by examining how exposure to violence in childhood relates to intimate partner violence (IPV) experiences or perpetration in adulthood and the subsequent use of violence against children among young adults in South Africa. Methods: Data were collected through interviewer-administered questionnaires from 730 young women and 578 young men during the third wave of a longitudinal study in Mpumalanga. Measures included childhood abuse, IPV experiences or perpetration, and use of emotional and physical violence against children. A conceptual model was tested using path analysis, focusing on three trajectories: (1) child abuse without IPV, (2) childhood abuse leading to IPV, and (3) IPV leading to violence against children (without childhood abuse). Multivariable regression and path models were applied separately for women and men, with combined analysis for women and logistic regression for men. Results: Women’s mean age was 25.4 years, with 75.9% primary caregivers; men were 25.2 years with 40.3% caring for a child. For women, direct effects emerged for caregiver death, HIV-affected households, early pregnancy, suicidality, anxiety, PTSD, financial stress, inequitable gender beliefs, corporal punishment endorsement, and gendered parenting beliefs. Indirect effects involved substance abuse through PTSD, and food insecurity via financial stress. Among men, gendered parenting attitudes were consistently linked to all violence trajectories; suicidality and PTSD correlated with childhood abuse leading to IPV perpetration. Conclusion: Distinct typologies and complex, interlinked pathways explain intergenerational violence transmission among South African youth. Mental health, parenting stress, and gendered attitudes are key factors. Implications: Addressing poverty, supporting adolescent parents, improving mental health services, and implementing gender-transformative parenting programs are crucial for breaking the cycle of violence.
Enhancing Community Health Worker Roles in rural Primary Healthcare: Evaluating a learning intervention institutionalizing community participation in Mpumalanga province, South Africa
Authors: Lucia D’Ambruoso, Maria Mambane, Mikateko Temba, Jennifer Hove, Knowme Nkalanga, Maria van der Merwe, Gerhard Goosen, Jerry Sigudla, Cheryl Nelson, Stephen Tollman, Sophie Witter
Email: Lucia.dambruoso@abdn.ac.uk
Keywords: Community Health Workers, participatory training, primary health care, community mobilisation, health system resilience, rural health, equity, South Africa
Abstract:
Community participation is a key enabler of pro-equity health systems. Despite policy endorsement, participation remains poorly operationalized. This study evaluates a participatory learning initiative to building Community Health Worker (CHW) competencies in community participation and health systems learning in Primary Health Care (PHC). The VAPAR (Verbal Autopsy with Participatory Action Research) programme, in partnership with Mpumalanga Department of Health, implemented a CHW learning initiative in 2024 across all three provincial districts. Over 100 CHWs and Outreach Team Leaders (OTLs) participated, combining weekly theory and practice in structured training cycles of three to sixweeks duration. Participatory learning tools, including problem trees, stakeholder mapping, and action pathways, were applied to real-world challenges, such as patient adherence and community stigma. Additional clinic-based staff joined the training, contributing to broader team cohesion.
A mixed-methods evaluation was performed consisting of document synthesis, policy review, and 25 key informant interviews with training recipients. Data were analysed to explore uptake, effectiveness, impacts on roles and working environments, and sustainability considerations. The intervention significantly improved CHW confidence, problem-solving, and facilitation skills, while strengthening peer learning and team collaboration. Participants reported stronger patient engagement and more inclusive decision-making. The training acted as a catalyst for interprofessional cooperation and enhanced service responsiveness. A significant ‘multiplier effect’ was also observed, with training spontaneously cascaded to peers and clinic teams. Sustainability barriers were identified, however: resource constraints, transport limitations, and lack of formal recognition for CHWs. Participants strongly advocated for decentralized, inclusive training pathways, routine in-service training, and institutional integration of participatory learning tools. The intervention supporting CHWs to drive data-driven decision making grounded in local needs and priorities requires modest resource support, and implementation cognisant of the relationships of CHWs, and wider PHC teams. Institutionalizing participatory learning within PHC was found to be feasible and acceptable, with strong alignment to PHC.
Estimating price and expenditure elasticities for select foods and drinks in South Africa using a demand systems model
Authors: Chengetai Dare, Maxime Bercholz, Michael Boachie, Evelyn Thsehla, Shu Wen Ng
Email: chengetai.dare@wits.ac.za
Keywords: demand model, price elasticity, income, South Africa, health economics
Abstract:
Introduction: In 2018, South Africa introduced a tax on sugary drinks, called the Health Promotion Levy (HPL). The country is also working on new food labels for packaged products that have too much sugar, salt, or unhealthy fats. However, there is no data on how changes in prices affect how much people buy these products. This makes it hard to predict what will happen if the HPL is expanded to other unhealthy products. Objectives: This study looked at how sensitive people in South Africa are to price and spending changes for certain food and drink products. It also compared people from different income groups (measured using the Living Standards Measure, (LSM)). Methods: We used a special economic model to analyse shopping data from both lower- and higher-income households, collected between January 2016 and March 2019. This helped us estimate how price and spending changes affect demand for various products. Results: We found that when prices go up by 10%, demand drops between 10.5% and 19.1%, depending on the product. For example, demand for packaged fruits, vegetables, nuts, and seeds fell by 10.5%, while demand for low-sugar dairy drinks dropped by 19.1%. Lower-income households were more sensitive to price changes. Some products, like fruit juice and soft drinks, are substitutes while others (like desserts and fruits/vegetables) tend to be compliments. Discussion and Implications: The results show that the sugary drink tax is helping reduce unhealthy food and drink consumption, especially among poorer households. Expanding the tax to include more sugary drinks could cut consumption even more and bring in money for health programs. Linking taxes with better food labels could help people make healthier choices. This study supports the idea of expanding the HPL and offers insights for other countries considering similar taxes, especially those focusing on fairness for lower-income groups.
Inequalities in Healthcare Utilization Among People with Disabilities in Ethiopia: Evidence from the 2021/22 Ethiopian Socio-Economic Panel Survey
Introduction: People with disabilities, on average, have higher healthcare needs than others in the population. Yet, they frequently face barriers to access healthcare facilities and incur greater costs when accessing services, although evidence is lacking for sub-Saharan Africa. Objective: This study aimed to assess inequalities in health status and healthcare utilization among people with disabilities in Ethiopia. Methods: This secondary data analysis used the 2021/22 Ethiopian Socio-Economic Panel Survey (ESPS). The analysis included 17,181 respondents. We used multivariable logistic regression to calculate adjusted odds ratios (AOR) and 95% confidence intervals. This analysis assessed independent association between disability status and health status and healthcare utilization, while adjusting for confounding factors such as age and sex. Results: People with disabilities were more likely to report illness (AOR = 2.78, 95% CI: 1.38-5.57), and this pattern was consistent among men (AOR = 3.06, 95% CI: 1.21-7.71) and women (AOR = 2.67, 95% CI: 1.26-5.68). People with disabilities also reported more frequent use of healthcare services (AOR = 1.56, 95% CI: 1.02-2.39) than those without disabilities. Sex-disaggregated analyses showed that this association remained apparent in men with disabilities compare to those without (AOR = 1.99, 95% CI: 1.16-3.43), but not among women (AOR = 1.22, 95% CI: 0.67-2.24). Additionally, people with disabilities incurred higher mean annual healthcare expenses (US$ 133.73) compared to those without disabilities (US$ 37.89, p = 0.04). Discussion & implication: the study showed that people with disabilities in Ethiopia had greater healthcare needs and utilization, yet access remained inadequate, especially for women, indicating systemic inequalities in health. A twin-track approach-mainstreaming disability inclusion while also providing targeted support-can help address these gaps and support the realization of human rights of people with disabilities in Ethiopia.
Effects Of Pyrazinamide And/Or Ethambutol Resistance On Tuberculosis
Treatment Outcomes
By Whole Genome Sequencing, South Africa 2020 - 2022
Introduction: In South Africa, both pyrazinamide (PZA) and/or ethambutol (EMB) were included in the all-oral shortcourse regimen despite the high resistance rates to pyrazinamide (PZA) and/or ethambutol (EMB) reported among people with MDR-TB. The effect of resistance to these drugs on treatment outcomes is poorly understood. This study evaluated the effects of PZA and/or EMB resistance on treatment outcomes among MDR-TB cases treated with the all oral short course regimen in South Africa from 2020 to 2022. Methods: We conducted a retrospective cohort study of MDR-TB patients diagnosed via whole genome sequencing at Braamfontein and Greenpoint laboratories, treated with the all-oral short-course regimen. Drug susceptibility patterns for PZA and EMB were classified into four categories: susceptibility to both drugs (EMB-S & PZA-S), resistance to PZA only (EMB-S & PZA-R), resistance to EMB only (EMB-R & PZA-S), and resistance to both drugs (EMB-R & PZA-R). Treatment outcomes were categorized as either successful patient outcomes or unsuccessful patient outcomes. A directed acyclic graph guided the selection of variables for the generalized linear model. Adjusted incident rate ratio (aIRR) were calculated with 95% confidence intervals using modified Poisson regression with robust error variances. Results: Among the 598 people with MDR-TB included in the analysis, 60% (356/598) were resistant to one or both TB drugs. There was no evidence that resistance to PZA and/ or EMB increased USPO or SPO: resistance to PZA (aIRR = 1.18, 95% CI: 0.86-1.63), resistance to EMB alone (aIRR = 0.94, 95% CI: 0.67-1.32), and resistance to both drugs (aIRR = 0.97, 95% CI: 0.73-1.27). Conclusion: This study also highlights PZA or EMB does not affect treatment outcomes in patients with MDR-TB. This observation supports the rationale behind the 2023 adoption of the all-oral MDR TB regimen. WGS is recommended to guide treatment regimens that include PZA and EMB.
An investigation of the knowledge, attitude, and practices of Public Health Medicine specialists on climate-related health risks.
Authors: Roxanne Govender
Email: roxanne.govender@wits.ac.za
Keywords: Climate change; curriculum reform; Public Health Medicine
Abstract:
Introduction Climate change is a major public health threat in Africa, disproportionately affecting vulnerable populations. Public Health Medicine (PHM) specialists are strategically positioned to drive equitable climate-health policies and interventions. However, formal training on climate-health intersections in the College of Public Health Medicine (CPHM) curriculum remains limited. Understanding PHM specialists’ knowledge, attitudes, and practices (KAP) can inform targeted curriculum reform to strengthen applied competencies. Objectives To assess the KAP of PHM specialists in South Africa regarding climate-related health risks and to identify opportunities to integrate applied climate-health competencies into specialist training. Methods A cross-sectional study was conducted using a self-administered online questionnaire distributed to PHM specialists nationally. Descriptive statistics summarised participant demographics and KAP scores; associations with demographic and educational factors were explored. Results Twenty-three specialists participated (56.5% female; median age 45 years). All achieved “Good” or “Excellent” knowledge scores, but only 39.1% identified climate change as primarily human-induced. Most believed climate change is occurring (96%) and were concerned (83%). Practical engagement was limited, with only 30.4% involved in climate-health interventions. Almost all (95.7%) supported PHM’s role in climate action, and 87% recommended greater climate-health content in the training curriculum. Discussion and Implications The findings highlight a strong theoretical knowledge base among PHM specialists but limited translation into practice. This knowledge-practice gap signals an urgent need to embed applied, systems-oriented climate-health modules into the CPHM curriculum. Strengthening specialist training in this area will better equip South Africa’s public health workforce to design and lead equitable, evidence-based responses to the climate crisis.
The Effect of Climate Change on Somali Women’s Mental Health: Socio-demographic Factors, Violence, and Resilience in the Context of Droughts and Floods
Authors: Gallad D. Hassan, Salad Ahmed Halane, Jamal Hassan Mohamoud, Fatumo Osman
Climate change and mental health represent urgent global challenges. Internally displaced persons (IDPs) often face compounded vulnerabilities, where socio-demographic conditions, violence, and resilience influence mental health outcomes. Somali women displaced by droughts and floods face particular risks that remain underexplored. Objectives: This study aimed to examine the effect of climate change on Somali women’s mental health by assessing sociodemographic factors, experiences of violence, and resilience capacities as predictors of depression among displaced women. Methods: A descriptive cross-sectional study was conducted among 297 Somali women displaced by drought or floods and living in eight IDP camps across four districts. Data were collected on socio-demographic characteristics, resilience capacities (SERS and sense of competence), experiences of violence, and depression measured using the PHQ-9. Descriptive and logistic regression analyses were applied. Results: Depression prevalence was high (63%). Displacement timing (2023 and later) and region (Bay, Bakool) significantly affected depression. Violence-especially physical, psychological, and conflict exposure-substantially increased risk, while resilience capacities (transformative, adaptive, financial, social, learning, and early warning) strongly reduced depression. Conclusion: Climate shocks and conflict intensify Somali women’s depression, but resilience capacities provide strong protective effects. Interventions should strengthen psychosocial and gender-based violence services, enhance women’s financial and social resilience, and integrate mental health into climate adaptation and humanitarian policies.
Beyond the Framework: Stakeholder Insights into Rehabilitation Policy Implementation in Gauteng, South Africa
Authors: Naeema Ahmad Ramadan Hussein El Kout, Sonti Pilusa, Natalie Benjamin-Damons, Juliana Kagura
Email: naeema.husseinelkout@wits.ac.za
Keywords: Beyond the Framework: Stakeholder Insights into Rehabilitation Policy Implementation in Gauteng, South Africa
Abstract:
Introduction: The Framework and Strategy for Disability and Rehabilitation (FSDR) in South Africa aims to improve equitable access to rehabilitation services for persons with disabilities. While the policy aligns with the World Health Organization’s Rehabilitation 2030 agenda, there is limited evidence on its real-world implementation, particularly at provincial level. Objectives: To explore stakeholder perceptions and experiences of the FSDR’s implementation in Gauteng Province, and to identify barriers, facilitators, and opportunities for policy improvement. Methods: A descriptive qualitative single-case study design was applied. Data were collected through 15 semi-structured interviews and six focus group discussions with rehabilitation managers, clinicians, community health workers, academics, members of disabled persons’ organisations, and professional bodies. Purposive and snowball sampling ensured diverse representation. Thematic analysis was conducted using MAXQDA software, guided by the Exploration, Preparation, Implementation, and Sustainment (EPIS) framework. Results: Findings revealed limited awareness of the FSDR, insufficient end-user engagement, outdated internal policies, and inconsistent dissemination. Implementation followed a top-down approach without standardised national guidelines, leading to uneven uptake. Challenges included inadequate training, human and material resource shortages, weak intersectoral collaboration, and poor integration between hospital- and community-based rehabilitation. Sustainment was constrained by a lack of formal monitoring and evaluation systems, gaps in undergraduate policy training, and minimal long-term planning. Discussion and Implications: The FSDR holds potential to transform rehabilitation services, but systemic barriers undermine its effectiveness. Strengthening communication, ensuring policy dissemination at all service levels, embedding monitoring and evaluation indicators, and investing in capacity-building are critical for sustainable implementation. Policy adaptations should reflect frontline realities, foster accountability, and promote intersectoral partnerships. These findings provide locally relevant, evidence-based recommendations to enhance disability and rehabilitation policy outcomes in South Africa, contributing to the global discourse on implementation science in health systems.
Institutional support for breastfeeding: a qualitative study that is translating knowledge to action
Authors: Sara Jewett, Wiedaad Slemming, Violet Bosire, Lume Morrow, Bulelwa Fihla, Pamela Maluleke
Email: sara.nieuwoudt@wits.ac.za
Keywords: breastfeeding support; higher education; gender equity; transformation; research to action; qualitative; South Africa
Abstract:
Introduction Breastfeeding benefits both infants and mothers but requires social support. Global evidence shows that unsupportive work and education environments lead to early cessation of breastfeeding. For those with breastfeeding aspirations, the degree to which breastfeeding is supported has both personal and professional implications. As such, breastfeeding support needs to be considered in discussions of equity and transformation at South African universities. Objectives The study aim was to review Wits’ support for breastfeeding based on the lived experiences of staff and/ or students who had breastfed within the past five years, also informed by the perspectives of managers and decisionmakers. Methods We conducted in-depth interviews with 38 staff and students regarding their experiences and recommendations. Through 13 key informant interviews and a participatory workshop with managers and strategic stakeholders we probed institution-level barriers and opportunities. Sampling was purposive, seeking maximum variation. Transcripts and notes were analysed thematically in MaxQDA. Results Based on the interviews with staff and students, we found that while motivations to breastfeed were diverse, as were experiences, a common impression was that the university breastfeeding support was invisible, meaning that they navigated breastfeeding decisions alone. Those with support were grateful, while those who were not supported described discomfort, stress and some even considered leaving Wits. In addition to designated breastfeeding spaces, they recommended gender-sensitive policies and training for managers/lecturers. Managers acknowledged policy gaps and poor awareness of the issue. They identified short- and long-term actions to improve support. Discussion: The results point to the importance of overt (visible) breastfeeding support and the potential for inclusive participatory research focused on practical solutions. Implications The research has already resulted in the launch of one breastfeeding room, divestment in a Nestle award and increased visibility in Wits media. The research team is also participating in policy review processes at university level.
Building a Child Health Dashboard in Soweto: A Data Integration Approach for EvidenceBased Decision Making
Keywords: Child health; data linkage; dashboard; social determinants of health; evidence-based health policy
Abstract:
Introduction Effective health surveillance requires integrated data systems, but child health data in South Africa remain fragmented. With many children living in multidimensional poverty, data integration is crucial for informing policies that address social, economic, and environmental factors. This study piloted a child health data integration approach in Soweto. Objectives To implement a data-linkage methodology to connect records across multiple datasets collected through the Child Health and Mortality Prevention Surveillance (CHAMPS) network to optimize indicator monitoring, increase data usability for decision-making, and provide a model for evidence-based child health policy. Methods Three datasets were integrated: Health and Demographic Surveillance System (HDSS): Demographic, socioeconomic, health, and mortality data on ~207,000 individuals in ~57,000 households (Soweto/Thembelihle). Hospital data: Paediatric and neonatal admissions (<13 years) to Chris Hani Baragwanath Academic Hospital and Bheki Mlangeni since 2017, including outcomes, diagnoses, and conditions. Minimally Invasive Tissue Sampling (MITS): Detailed child cause-ofdeath data from CHAMPS. Data processing and linking methodology was done in three main steps: 1. Preprocessing: Addressing missing data and standardizing formats. 2. Deduplication: Identifying and removing duplicates using exact and probabilistic matching 3. Linking: Connecting individuals across datasets using exact matches, probabilistic matching, and sorted neighbourhood search techniques based on variables like name, date of birth, and address. Results and Discussion Data linking connected records across datasets: ~4,200 between Hospital and HDSS, ~800 between Hospital and MITS, and ~600 between HDSS and MITS. This integration offers a comprehensive view of child wellbeing by linking socioeconomic, hospital, and mortality data. An interactive Power BI dashboard enables filtering and exploration of health and social indicators for children, mothers, and households, supporting analyses of social determinants of health. Implications This pilot highlights the potential value of integrated data and dashboards for improving child health outcomes, identifying research gaps and informing policy.
Projections of the impact of transmission-reducing pediatric influenza vaccine in South Africa using high resolution immunologic and infection data
Authors: Jackie Kleynhans, Cécile Viboud, Molly Sauter, Stefano Tempia, Nicole Wolter, Jocelyn Moyes, Anne von Gottberg, Lorens Maake, Alexandra Moerdyk, Cheryl Cohen, Kaiyuan Sun
Email: jackiel@nicd.ac.za
Keywords: Projections of the impact of transmission-reducing pediatric influenza vaccine in South Africa using high resolution immunologic and infection data
Abstract:
Introduction Influenza vaccination programs focus on preventing severe illness through direct effects. Vaccinating children may reduce overall burden by lowering transmission, especially in high infection settings when effective transmission reducing vaccines become available. This strategy could improve equity by reducing influenza burden across all age groups, including those less likely to access vaccines or care. Objectives To evaluate how paediatric vaccination impacts community-wide influenza burden using a model informed by immunological correlates and viral shedding duration. Methods We developed a Susceptible-Latent-Infectious-Recovered (SLIR) compartmental transmission model calibrated with high-resolution virological and immunological data sourced from a multiyear household cohort study in urban and rural South Africa. The model explicitly accounted for variations in susceptibility, infectiousness, and viral shedding duration by age group, pre-season hemagglutination inhibition antibody titre and influenza subtype/lineage. We simulated paediatric vaccination scenarios targeting children aged 6 months - 5 years or 6-12 years, varying vaccine coverage and vaccine effectiveness in reducing susceptibility and transmission. Scenarios were compared to no-vaccination counterfactuals to project reductions in infections, illness episodes, hospitalizations, and deaths in South Africa. Results Vaccinating 50% of children aged 6 months - 5 years or 6-12 years with a vaccine that is 50% effective in reducing both susceptibility and viral shedding could reduce overall infection incidence by 48-60%, illness episodes by 20-60%, hospitalizations by 26-64%, and deaths by 21-59%. The optimal pediatric age group for maximizing indirect protection varied by season, lineage, and urbanization level. Discussion and Implication Incorporating immunological markers into models strengthens policy-relevant evidence for targeting vaccine strategies. This work highlights the potential of public health research to inform equitable vaccination policies tailored to local epidemiology and health system priorities. This research provides an evidence-based tool to guide equitable vaccine policymaking in low- and middle-income settings.
A Roadmap Towards NHI Readiness: Experiences and Lessons from the Ekurhuleni Health District
Authors: Astrid Kouatcho, Shanal Nair, John Musonda, Leena Thomas
Email: Astrid.Kouatcho@wits.ac.za
Keywords: NHI readiness, governance, CUP demarcation
Abstract:
Introduction National Health Insurance (NHI) aims to achieve Universal Health Coverage by integrating the fragmented health system into a single-purchaser model. District-level readiness is critical to this process. Ekurhuleni Health District (EHD) is an urban Metropolitan with a population of over 4.2 million. A multidisciplinary task team was established to guide the demarcation of Contracting Units for Primary Health Care (CUPs), map providers, and pilot interventions for the NHI rollout. Objectives To explore and describe the governance structures and technical processes emanating from EHD’s NHI readiness activities, and focusing on CUP demarcation, population and provider mapping. Methods An exploratory sequential mixed-methods design was used. Phase 1 applied qualitative analysis of terms of reference, meeting minutes, and reports supplemented by the task team formation and governance processes. Phase 2 applied a quantitative, retrospective, cross-sectional design using GIS, census data, and health information systems used to demarcate CUPs, determine population profiles, and map public and private providers. Results The EHD NHI Task Team was formed in 2024 with multidisciplinary membership and structured workstreams. Twenty CUPs were demarcated using customer care centres, integrated with facility catchments and the 2022 census projections. Population mapping revealed a wide variation in the CUP size and demographics. Provider mapping identified an uneven distribution of services. Urban CUPs showed a strong private sector presence, and peri-urban CUPs relying on overstretched public facilities. Pilot sites (CUP 10 and CUP 20) demonstrated contrasting readiness. The CUP 20 benefited from a dense public-private mix and diagnostic capacity, while CUP 10 faced capacity gaps. Discussion Phases 1 and 2 established strong governance and data-driven CUP demarcation aligned with local realities, enabling an objective assessment to capture nuanced factors and generate actionable recommendations for NHI rollout. Implications The Ekurhuleni approach shows how structured governance and GIS mapping can guide equitable resource allocation and support NHI readiness in other district.
Evaluating the acceptability, usability and clinical appropriateness of Your Path, an AIpowered tool facilitating relevant access to HIV services post-HIV self-testing in South Africa
Authors: Nomsa Mahlalela, Onthatile Maboa, Caroline Govathson, Laura Rossouw, Lawrence Long, Ross Greener, Sarah Morris, Shawna Cooper, Sasha Frade, Sophie Pascoe, Candice Chetty-Makkan
Email: nmahlalela@heroza.org
Keywords: Acceptability, Usability, Artificial intelligence, HIV self-testing, AI-powered tool, South Africa
Abstract:
Introduction HIV self-testing (HIVST) increases access to HIV testing, but its impact depends on effective linkage to prevention or treatment services. Uncertainty about next steps could limit linkage to care. Your Path, an AI-powered conversational companion, was developed to guide clients after HIVST and facilitate linkage to appropriate HIV services. Objectives To evaluate the usability, acceptability, clinical appropriateness, and potential influence of Your Path on intentions to seek HIV services. Methods An exploratory mixed-methods study (Nov-Dec 2024) recruited 100 community members (CMs) and 25 healthcare providers (HCPs) from Indlela’s Behavioural Hub in Gauteng, South Africa. CMs completed a baseline survey on service-seeking intentions, used Your Path during a simulated HIVST session where they were randomly assigned a mock HIV-negative or HIV-positive test result, then completed a follow-up survey measuring intentions, usability (SUS, system usability scale), and acceptability. A sub-sample of 25 CMs completed in-depth interviews. HCPs reviewed chat transcripts for clinical appropriateness. Results CMs were predominantly female (59.0%), median age 28.8 years. After using Your Path, most (91.0%) reported increased intention to access HIV services. Usability was high (mean SUS score 81.6, SD 17.5); and acceptability was strong (83.7% finding it easy to use, 94.9% willing to use it again). However, some (15.3%) noted that the tool did not always provide consistent responses, and a third (33.6%) anticipated needing initial assistance to fully understand the tool. CMs valued its private, non-judgmental tone. HCPs found it clinically appropriate but highlighted limited emotional responsiveness and language barriers. HCP perspectives were based on chat transcripts and differed from those expressed by CMs. Discussion and Implications Your Path was acceptable, usable, and clinically appropriate for supporting linkage to appropriate HIV services after HIVST, and showed potential to increase intentions to seek care. Further field-based research is needed to assess real-world effectiveness and scalability.
When the Church Became a Wound: Faith, Queerness, and Black Izitabane Women’s Spiritual Resistance
Introduction: Black Izitabane (queer) women in Pietermaritzburg, KwaZulu-Natal, navigate spaces of faith and exclusion, often distancing themselves from mainstream Christian denominations that perpetuate homophobic and gendered violence. Their spiritual lives, however, are sites of resilience, creativity, and reimagination, where faith is reclaimed as both personal and political. Objectives: This paper examines how Black Izitabane women reinterpret and reconstruct their spiritual practices in response to exclusionary religious doctrines, highlighting the intersection of sexuality, embodiment, and theology. Methods: Grounded in an autoethnographic and decolonial feminist framework, the paper draws on interviews and focus groups with nine Black Izitabane women from a broader doctoral study. As a researcher, listener, and co-participant, I engaged in a triadic dialogue with these women’s stories, wounded and liberative theologies, and my own embodiment experiences. Data analysis employed thematic reflection, memory work, and reflexive narrative techniques. Results: Participants’ narratives reveal a profound reconfiguration of faith that affirms sexuality and spirituality simultaneously. Everyday practices, praying in natural landscapes, singing, performing ancestral rituals, emerge as theological acts of survival, resistance, and belonging. These practices demonstrate how Black Izitabane women reclaim agency and spiritual authority, creating alternative sacred spaces beyond institutional religion. Discussion: Findings are interpreted through Queer Theology and Izitabane Zingabantu Ubuntu Theology, illustrating how embodied spiritual practices challenge exclusionary doctrines and foster community, resilience, and self-definition. Participants’ approaches highlight the possibilities of relational and inclusive theologies rooted in lived experience. Implications: This study contributes to broader discussions on inclusive religious practices, the decolonization of knowledge, and the development of theologies from below. It underscores the importance of centering marginalized voices in spiritual and academic discourses, demonstrating how faith can serve as a living archive of resistance, healing, and creative survival.
Infant Feeding Education in Clinical Undergraduate Curricula: a case study from a faculty of
Authors: Pamela Maluleke, Wiedaad Slemming, Sara Niewoudt (Jewett)
Introduction Healthcare workers have a significant influence on the infant feeding practices that parents use. It is important to know what and how healthcare workers are taught and trained on infant feeding. There is a paucity of data on how infant feeding education (IFE) is included in the undergraduate curricula for clinical health science students who are being trained to have a direct involvement in patient care. Objectives This study explored the timing, duration, delivery methods, content, and institutional factors that shape how IFE is included in the undergraduate clinical health science degrees at Wits University. This including potential commercial milk formula (CMF) industry influences. Methods We conducted in-depth key informant interviews with 13 staff members involved in either teaching, developing, or curriculum curation of clinical undergraduate students directly involved with patients. An embedded record review enabled us to characterize the timing, duration, and delivery methods of IFE. The qualitative transcripts were analysed thematically. Results Nursing students received more in-depth lessons than other degrees, where lessons were minimal and unstructured, which was reinforced by the notion that infant feeding is a nurse’s job. Lessons delivered across all degrees were based on the evidence of breastfeeding benefits, with less attention to biopsychosocial or practical components. Though CMF companies did not directly influence the curriculum, their presence in faculty awards subtly shaped perceptions. Discussion The prioritisation of IFE within nursing curricula is a global phenomenon; however, many nurses report feeling inadequately prepared to provide high-quality support to mothers. This leaves other healthcare professionals, whose training receives even less emphasis on IFE, at a greater disadvantage. Implications The study highlights the need to define the different roles that can be played by healthcare professionals to promote breastfeeding, encourage collaboration across degrees, and promote ongoing training, especially on CMF regulations and evolving IFE guidelines.
Factors influencing maternal vaccine demand and interventions to increase maternal vaccine demand and uptake in low-and middle-income countries
Introduction The Maternal Immunization Readiness Network in Africa and Asia (MIRNA) was established to advance the Maternal Immunization (MI) readiness agenda in low-and middle-income countries (LMICs), including Ethiopia, Ghana, Kenya, South Africa, Uganda, and Pakistan. A key objective of MIRNA is to apply social science approaches to understand vaccine demand and to develop and test interventions to increase demand and uptake. Objective We conducted an umbrella review to identify barriers and facilitators to maternal vaccine demand and provide an overview of interventions used to improve maternal vaccine demand in LMICs. Methods A literature search of qualitative and quantitative articles published between January 2014 and January 2024 was conducted across six Ovid databases. Using the PRISMA chart, 269 articles on barriers and facilitators were screened, with nine included in the final review. These were organized according to the WHO Behavioural and Social Drivers of vaccination (BeSD) framework: thinking and feeling, social processes, motivation, and practical issues. For interventions, 141 articles were screened, with 28 included and summarized using the Socio-Ecological Model. Results Key factors influencing maternal vaccine demand included trust, safety perceptions, perceived benefits and risks, fear, education, age, awareness, and knowledge. Practical issues such as affordability, access, service quality, and social processes, including Health Care Provider (HCP) recommendations, also influenced maternal vaccine demand. Effective interventions included financial incentives, mHealth apps, community engagement, HCP recommendations and education, training HCPs, case management, and implementing public-private partnerships. These improved attitudes, awareness, willingness, and vaccine uptake. Discussion Understanding factors influencing maternal vaccine demand is important to facilitate strategies to support uptake and sustained demand. Insights into these drivers can enhance maternal and child health outcomes. Implications Findings provide evidence to address structural and psychosocial barriers, strengthen trust, and leverage HCP influence. Identified interventions can be adapted and built on for future vaccination campaigns, enhancing MI readiness in LMICs.
Preferences of Public Sector Doctors, Nurses and Rehabilitation Therapists for Multiple Job Holding Regulation: a Discrete Choice Experiment.
Authors: Busisiwe Precious Matiwane, Laetitia C. Rispel and Duane Blaauw.
Email: busisiwe.matiwane@wits.ac.za
Keywords: Discrete choice experiment, Dual practice, multiple job holding, health workforce, regulation, South Africa
Abstract:
Background: Regulating multiple job holding (MJH) among health professionals is challenging for many health systems. In South Africa, MJH is legally permissible with specific stipulations. The effectiveness of regulation depends on the behavioural responses of different health professional groups, which remain largely unknown. Aim: Investigate the preferences of public sector doctors, nurses, and rehabilitation therapists in two South African provinces for different MJH regulations. Methods: We developed a novel discrete choice experiment (DCE) to evaluate the preferences of health professionals for jobs with varying MJH policy interventions. The DCE attributes included restrictive regulations (banning MJH) versus reward-oriented policies (increased public sector salaries, expanded overtime, well-resourced clinical practice environment, and better management). We produced an unlabelled DCE using an efficient design and administered it to a representative sample of health professionals. Generalized multinomial logit models were employed for the analysis. Results: 1387 participants completed the DCE. The doctors, nurses and rehabilitation therapists were strongly opposed to banning MJH, requiring salary increases of 45.7%, 20.0% and 42.8%, respectively, to accept an MJH ban. Increased public sector salaries significantly increased public sector retention. However, non-financial interventions were also influential. Doctors, nurses, and rehabilitation therapists were willing to forgo 57.9%, 54.8%, and 38.9% of their salaries, respectively, for an improved clinical practice environment. Competent hospital management was also important. There was some preference heterogeneity. Nurses had significantly different preferences for certain attributes compared to the other two groups, and professionals currently engaged in MJH were significantly more opposed to banning MJH. Discussion: Health professionals strongly oppose an MJH ban, valuing a better practice environment and hospital management, even if MJH is prohibited. Policy implications Improved clinical practice environment and better MJH management could reduce attrition and offset the impact of an MJH ban; however, fiscal constraints limit implementation of these interventions in LMICs.
Influence of Household Decision-Makers on Maternal Vaccine Acceptance: Insights from a South African Context
Background: Household decision-making dynamics can significantly influence maternal vaccine uptake, particularly in contexts where extended family and community leaders hold authority over health choices. In South Africa, cultural norms, gender roles, and health system practices may shape how fathers, senior female relatives, and other influencers engage with maternal health decisions. Understanding these “gatekeepers” is essential to designing culturally responsive immunisation strategies. Methods: The Vaccine Demand mixed-methods data collection is ongoing, and data presented here are interim results for the qualitative component. Participants were purposively recruited through healthcare facilities and community networks. Results: Household influence on maternal vaccination was shaped by gender, family role, and clinic practices. Male partners were less directly involved than anticipated: while some accompanied women to clinics or supported child immunisations, they were often excluded from consultations and relied on second-hand information, which was not always shared by the women. Senior female relatives, particularly maternal figures (mothers, sisters, mothers-in-law), played a more consistent role, using maternal health records and Road to Health cards to monitor care. Among women without close female relatives, healthcare providers became the main source of vaccine information, but unwelcoming clinic environments, fear of being reprimanded, and long queues discouraged questions. However, cultural norms, secrecy around pregnancy, and fear of witchcraft further limited open discussion, while some women turned to Google, friends, or neighbours for information on maternal vaccinations. Discussion and implications: Household decision-makers can both enable and hinder maternal vaccine uptake. Senior female relatives often act as advocates, while male partners’ involvement is limited by social norms and clinic policies. Strengthening demand requires engaging these influencers in vaccine education, training healthcare providers to involve them in consultations, improving clinic environments, and revising policies to allow partner participation. Using religious and traditional platforms with culturally tailored communication could further build trust and uptake.
Melanoma Incidence among People Living with HIV - The South African HIV Cancer Match Study, 2004-2021
Authors: Rethabile W. Mothosola, Caradee Y. Wright, Mazvita Muchengeti, Lazarus Kuonza and Judith MwansaKambafwile
Email: 1362785@students.wits.ac.za
Keywords: Melanoma, HIV, Incidence, South Africa, probabilistic linkage
Abstract:
Introduction: In South Africa, studies on melanoma incidence are fragmented and largely limited to the general population, with little focus on people living with HIV (PLWH). Objective: To describe melanoma incidence among PLWH in South Africa. Methods: We retrospectively analyzed data from the South African HIV Cancer Match study, a nationwide cohort of PLWH established through privacy-preserving probabilistic linkage of HIV laboratory records and cancer registry data (2004-2021). We calculated the overall crude incidence rate per 100,000 person-years (PYs) and estimated hazard ratios (HRs) for risk factors using Royston-Parmar flexible parametric survival models. Results: Among 9,415,806 PLWH, 123 melanoma cases were diagnosed. The overall crude incidence rate was 0.22 per 100,000 PYs. PLWH diagnosed between 2010-2015 had a 51% lower melanoma risk than those diagnosed 2004-2009 (aHR = 0.49; 95% CI: 0.33-0.72). PLWH residing within 30°S-34°S had 3.4 times higher melanoma risk than those at <25°S (aHR = 3.43; 95% CI: 1.22-9.62). Females had a 91% lower risk than males (aHR = 0.09; 95% CI: 0.04-0.21). White PLWH had 7.3 times higher risk of developing melanoma than Coloured PLWH (aHR = 7.32; 95% CI: 2.96-18.08). The melanoma risk increased with age. Discussion: Melanoma risk in PLWH is very low (2 cases per million PYs). The risk of developing melanoma is higher in males than in females. Contrary to expectations based solely on proximity to the equator, we found PLWH living farther from the equator being at increased risk of melanoma, possibly reflecting intermittent UV exposure. Implications: Routine skin cancer screening, targeted surveillance, and preventive strategies should be integrated into HIV care in South Africa, focusing on identified high-risk groups.
Evaluating Patient Costs and Time Spent Accessing Pre Exposure Prophylaxis Among Young Adults at Community Based Mobile Clinics in Cape Town, South Africa
Authors: Mazvita Shereen Matsa, Refiloe Motaung , Sharon Kgowedi , Constance Mongwenyana , Elzette Rousseau , Cheryl Hendrickson , Sydney Rosen , Lawrence Long , Jacqui Miot
Email: mmnangagwa@heroza.org
Keywords: Pre-exposure prophylaxis (PrEP), HIV prevention, Client costs, Direct costs, Indirect costs, Mobile clinics, Young adults, South Africa, Cape Town, Health economics
Abstract:
Background: Access to and uptake of pre-exposure prophylaxis (PrEP) among populations with high HIV vulnerability, including young adults, remains suboptimal. In South Africa, PrEP is provided free of charge in the public sector; however, client-incurred costs may still present barriers to uptake and continued use. We describe the direct and indirect costs incurred by young adults initiating daily oral PrEP through community-based mobile clinics in Cape Town, South Africa. Methods: We conducted a survey among young adults initiating daily oral PrEP at Desmond Tutu Health Foundation community-based mobile clinics between November 2023 and August 2024. Participants reported direct costs (transport, childcare, food) and time spent accessing services. Indirect costs were calculated as total travel and clinic time multiplied by the 2024 South African minimum wage (R28/hour). Results: We enrolled 252 adults (63.5% female; median age 24 years, IQR: 21-28). Most participants (75%) travelled less than 25 minutes (mean 19, range 1-90) to the clinic and spent less than an hour there (mean 57 minutes, range 10-240), with the maximum reported clinic time being four hours. One-way transport costs varied widely; 60% (n=151) reported no cost, while among those incurring a cost, the mean was R29 (SD R37, range R10-R250). Childcare and food costs were reported by 1.6% and 16% of participants, averaging R75 (SD R29) and R26 (SD R18), respectively. The mean total direct cost among those with any direct cost (43%, n=119) was R36 (SD R44, range R5-R290). Mean indirect costs were R35 (SD R21, range R6-R124). Overall, the average combined cost (direct + indirect) was R52 (SD R41, range R6-R331). Conclusion: Although PrEP is provided free at the point of care, accessing services cost clients the equivalent of roughly two hours’ wages. These economic costs, in the context of high unemployment, may pose significant barriers to sustained PrEP use among young adults.
The Economic Costs of Congenital Hearing Loss in a South African Cohort
Keywords: Congenital hearing loss, societal cost of illness, economic costs
Abstract:
Background The prevalence of congenital hearing loss in South Africa is estimated to be between 3 and 6 per 1,000 live births, which is higher than most high-income countries but consistent with rates observed in other parts of Africa. While policymakers typically focus on direct healthcare-related costs, many of the broader societal and economic impacts of congenital hearing loss remain hidden, including educational, vocational, and psychosocial consequences. Understanding the full economic burden is essential for informed policy and healthcare planning. Objectives To assess the full economic burden of congenital hearing loss, including indirect and intangible costs in South Africa. Methods We conducted a cost-of-illness study from a societal perspective . We constructed a cohort-survival model to estimate the societal lifetime costs of congenital hearing loss. Cost components included direct medical expenses (diagnostics, devices, surgeries), non-medical costs (special education), indirect costs (lost productivity, reduced earnings) and quality of life losses. Model inputs were derived from published literature and consultation with experts. Results Total economic cost for the cohort was R 16 378 631 114,25(USD1 016 674 805) per lifetime or R 255 916 111,20 (USD 15 885 543,83) per year. Productivity losses made up the largest proportion of societal costs with losses of approximately R2,4 billion (52% of total costs). Total discounted cost per person with hearing loss was R 1 128 614,19 (USD 70 056,75) per lifetime. Discussion Congenital hearing loss has far-reaching implications beyond immediate healthcare expenses, including significant societal and economic costs. Early childhood interventions such as newborn screening and early identification, assistive devices and speech and language therapy interventions may reduce the high costs associated with congenital hearing loss and may provide substantial returns on investment. Implications Quantifying costs highlights the hidden burden of congenital hearing loss and the South African government should include services for the deaf in universal health coverage (UHC) packages.
Contact Tracing Under Pressure: Policy and Equity Insights from South Africa’s COVID-19 Response
Authors: Priscilla Monyobo, DT Goon
Email: priscilla.kgarebe18@gmail.com
Keywords: Contact tracing, COVID-19, outbreak response, health systems strengthening, epidemiology, outbreak preparedness, equity, South Africa, public health policy
Abstract:
Introduction: Rapid containment is essential for equitable outbreak control, yet sustaining operational capacity under epidemic pressure remains challenging. In South Africa, intensive early contact tracing effectively slowed COVID-19 transmission before sustained community spread occurred. Mangaung Metro, the COVID-19 epicentre of the Free State, implemented intensive contact tracing in the early phase. Analyzing this intervention offers insights for sustaining speed, coverage, and equity during public health emergencies. Objectives: To assess early-phase contact tracing performance and identify equity and system gaps informing future preparedness policy. Methods: A retrospective descriptive analysis was conducted using the National Institute for Communicable Diseases’ COVID-19 contact line list (16 March-30 June 2020). Indicators included contacts traced per case, positivity rates, and trends relative to lockdown phases. Results: Between March and June 2020, 639 confirmed cases were detected; 99 (15.5%) were identified through contact tracing. A total of 3,553 contacts were traced, yielding 179 positives. March recorded the highest performance: 73.2% of cases (52 of 71) detected through tracing, 1,563 contacts traced (44% of the total), and 92 positives (51% of all positives). April achieved 51.4% tracing (19 of 37 cases) with 640 contacts traced and 18 positives. From May, performance declined sharply: 26.7% in May (20 of 75 cases) and 1.8% in June (8 of 456 cases) despite 529 and 821 contacts traced, respectively. Healthcare workers accounted for 7.9% of all cases, underscoring occupational vulnerability. Discussion and Implications: Intensive early-phase tracing in March yielded the highest detection and positivity rates but proved unsustainable as cases surged, reducing capacity to shield high-risk groups. Strengthening preparedness frameworks with surge staffing, interoperable digital tracing systems, and equity-focused resource allocation is critical to preserving containment capacity during future health emergencies.
The Acceptability of a Real-Time Medication Monitoring-based Digital Adherence Tool Among Young People Living with HIV in Malawi
Authors: Takondwa Charles Msosa, Felix Phuka, Marion Sumari-de Boer, Owen Mhango, Hussein Hassan Twabi, Madalo Mukoka, Iraseni Swai, Rob Aarnoutse, Tobias F Rinke de Wit, Kennedy Ngowi, Edred Lunda, Wongani Mphande, Chisomo Msefula, and Marriott Nliwasa
Email: takondwamsosa@outlook.com
Keywords: HIV, RTMM, Digital Health, ART, Adolescents, Young People, Adherence
Abstract:
Background: Adherence to antiretroviral therapy (ART) is essential for young people living with HIV (YPLHIV, aged 1524 years) to achieve viral suppression, prevent transmission, and reduce morbidity and mortality. Real-time medication monitoring-based digital adherence tools (RTMM-DATs), which combine smart pillboxes, customised feedback, SMS reminders, and optional alarms, offer promising interventions to improve adherence and viral suppression in this group. Objectives: This study assessed the concurrent acceptability of an RTMM-DAT intervention among non-adherent YPLHIV in Malawi enrolled in a randomised controlled trial (RCT) evaluating its effect on ART adherence and viral suppression. A secondary aim was to explore barriers to adherence during intervention use. Methods: We conducted a phenomenological study with 14 YPLHIV in the intervention arm of the RCT who had used the tool for at least six months. Semi-structured interviews were conducted between June and July 2024, guided by the Theoretical Framework of Acceptability. Data were analysed thematically using inductive and deductive approaches. Results: Participants expressed positive attitudes toward the intervention, valuing its portability, discreet design, and role in addressing forgetfulness and supporting routine medication use. Neutral SMS reminders and tailored feedback were appreciated for promoting adherence while protecting privacy. Challenges included device recharging in areas with limited electricity, reliance on mobile phones for SMS, lack of remote access to adherence reports, unintended disclosure from audible alarms, and social insecurities linked to stigma. Persistent barriers to adherence included food insecurity, side effects, forgetfulness, and stigma, regardless of intervention use. Conclusion: RTMM-DATs are generally acceptable for supporting ART adherence among YPLHIV in Malawi. Addressing electricity limitations, stigma, and enhancing user control and access to adherence data could improve acceptability. Tailoring RTMM-DATs to the socio-cultural context is critical for optimising uptake and effectiveness.
Essentiality and Mental Health: Experiences of Migrant Cross-Border Truck Drivers at the South Africa-Zimbabwe Borderscape During COVID-19
Authors: Blessing Mukuruva, Jo Vearey, Julia Hornberger
Introduction This paper explores the mental health experiences of migrant cross-border truck drivers at the Beitbridge Border between South Africa and Zimbabwe during the COVID-19 pandemic. Global public health strategies, including lockdowns and international border closures, coincided with the designation of truck drivers as essential workers. This paradox placed them at the centre of conflicting biopolitical logics: while populations were instructed to remain at home, essential workers were simultaneously required to maintain mobility to sustain economies and supply chains. Objectives To examine the mental health impacts of COVID-19 on migrant cross-border truck drivers. Methods The study employed a retrospective qualitative methodology, drawing on memory-eliciting, mediated in-depth interviews with 30 cross-border truck drivers. Participants were selected through convenience sampling based on their availability at the Beitbridge Border Post. Results Findings reveal that pandemic-related restrictions, despite their public health intent, significantly exacerbated the mental health vulnerabilities of migrant truck drivers. Contributing factors included prolonged separation from families, grief, social stigmatisation, increased workload, diminished earnings, and pervasive fear of infection. The research underscores how pandemic responses produced uneven risk exposures through biopolitical governance, where the essentiality of labour translated into increased psychosocial burdens without adequate institutional support. Discussion and Implications The study demonstrates that pandemic responses inadvertently deepened the mental health risks faced by essential mobile workers, highlighting the gap between public health objectives and lived realities at border spaces. For future crises, it is critical that policy frameworks integrate mental health support, clear communication, and social safety nets tailored to the needs of transnational workers. By addressing these gaps, governments and institutions can mitigate psychosocial harm, foster resilience among essential workers, and ensure that the burden of maintaining supply chains does not come at the expense of worker wellbeing.
Missing Data Imputation in the HAALSI Study: Comparative Evaluation of Statistical, Machine Learning, and Deep Learning Techniques
Keywords: Missing data imputation; statistical methods; machine learning; deep learning; Random Forest; XGBoost; variable importance.
Abstract:
Background Missing data is common in surveys and longitudinal studies, creating significant challenges for statistical analysis. Current approaches often fail to address the complexity of datasets containing multiple variable types and diverse missingness patterns. Limited evidence exists on optimal predictor selection for imputation. This study compared statistical, machine learning (ML), and deep learning (DL) methods for imputing missing values and examined the role of variable importance in guiding predictor choice. Methods Using the HAALSI baseline dataset, a complete-case sample was created, and missing values were simulated to match the original data’s missingness patterns. Seven imputation methods were assessed: statistical (simple central tendency, MICE), ML (Random Forest, XGBoost, SVM), and DL (CTGAN, Copula GAN). Each method was repeated five times to assess consistency. Categorical variables were evaluated using accuracy, Kappa, sensitivity, and specificity; numerical variables via RMSE, MSE, and MAE. Variable importance analyses identified key predictors for each imputed variable. Results Tree-based ML models(XGBoost, Random Forest) achieved the highest performance, with mean accuracy exceeding 80% for three-quarters of variables and minimal variance across repetitions. SVM performed moderately well, while simple central tendency methods performed worst. GAN-based models yielded moderate results. Variable importance analysis showed most variables required fewer than five predictors-e.g diabetes was predicted by glucose (standardised importance >0.5), while marital status depended on household size, BMI, age and sex. Discussion Tree-based ML models offer robust, consistent performance for mixed-type datasets with complex missingness. GANs may be less suited to real-world epidemiological data, as they require large training samples and have been shown to perform better under MCAR conditions. Variable importance findings support parsimonious imputation models. Implications It is crucial to move beyond one-size-fitsall methods-especially in population health studies. Choosing imputation methods tailored to data type, missingness pattern, and study context can enhance reproducibility, reduce computational demands, and improve predictive reliability.
Migration as a Social Determinant of Multimorbidity in the Migrant Health Follow-Up Study (MHFUS)
Authors: Tariro Ndoro, Carren Ginsburg, F. Xavier Gomez-Olive
Email: tarirondoro@gmail.com
Keywords: multimorbidity, migration, social determinants, panel data, rural health
Abstract:
Introduction: South Africa is experiencing an increase in chronic illness multimorbidity, with detrimental individual and public health implications. Social factors play a significant role in multimorbidity development; and can be leveraged to design cost-effective healthcare interventions. Although South Africa has high rates of rural/urban migration which may impact health outcomes, there is a dearth of studies on internal mobility and health. Objectives: This study aims to ascertain the prevalence and determinants of multimorbidity in a mobile population. Methods: The study uses panel data from the first four waves of the MHFUS, based on a simple random sample of 18-40-year-olds selected from the Agincourt HDSS. We define participants residing in Agincourt as non-migrants, and participants residing elsewhere as migrants. Following data description and bivariate analyses, random effects models were used to ascertain the relationships between various social factors and multimorbidity. Results: At baseline (2018), 3092 participants with a median age of 28 years (IQR=24 - 33) were included in the study. More than half of the participants were non-migrants (56.95%). At Wave 4 (2022), 10.5% of participants were multimorbid (5.4% nonmigrants, 5.1% migrants). Migration AOR=0.98 (0.97 - 0.99), increasing age AOR=1.01 (1.00 - 1.01), male gender 0.98 (0.96 - 0.99), social support 1.02 (1.00 - 1.03), and biomedical healthcare access 1.01 (1.01 - 1.02) were strongly associated with MM after four years of observation. Discussion: These findings indicate that migrant adults have better health outcomes than their nonmigrant counterparts, highlighting that women and older individuals are more likely to become multimorbid. Implications: Increased focus on best health interventions for rural residents, women, and ageing individuals is required to improve multimorbidity management. Further research is required to elucidate the complex effects of healthcare access and social support on multimorbidity.
The Effort-Time Trajectory Model: A Pedagogical Planning Tool for Masters of Medicine
Research Training
Authors: Gabriel Nel, Tanya Ruder, Shuaib Khauchali
Introduction Since 2011, the Health Professions Council of South Africa (HPCSA) has required specialist trainees to complete both a Master of Medicine (MMed) degree and the College of Medicine of South Africa (CMSA) fellowship. The MMed research component has lengthened training and introduced challenges in balancing clinical and academic demands. Locally, training registrars take a median of 30 months to complete the thesis. Late thesis submissions often delay graduation, with similar issues reported internationally. These challenges necessitate structured planning tools to support trainees. Objectives To design and describe the Effort-Time Trajectory Model, a novel pedagogically grounded visual tool for guiding MMed trainees and supervisors through the research process. Methods The model was developed by the lead author using Constructivist learning theory and the spiral curriculum concept. Literature on registrar research timelines and common bottlenecks informed the identification of milestones, which were mapped onto a time-effort curve (y-axis: relative effort; x-axis: time) with a colour gradient indicating workload intensity. Preliminary application in a paediatric registrar setting provided informal feedback for refinement. Results The model shows an initial steep rise in effort during the first year (e.g., supervisor identification, protocol development), a plateau during data collection, and a second peak during analysis and dissertation writing. Colour grading provides intuitive visual cues for workload peaks. In pilot use, supervisors reported improved understanding of trainee research demands, and trainees described greater confidence in project pacing. Discussion The model bridges project management and pedagogy, fostering self-regulated learning and making research timelines explicit for both the supervisor and registrar. It can preemptively highlight systemic issues, such as absent milestones or inadequate preparatory training, and guide effort requirements during strenuous trainee programmes. Implications The Effort-Time Trajectory Model offers a practical, theory-based tool for postgraduate research planning. Future work should evaluate its impact on MMed research completion rates.
Trust in Vaccines Among Healthcare Professionals in South African Maternity Care Settings: A Cross-sectional Study using the Vaccination Trust Indicator
Authors: Asiphekhona Ngema, Gabriel Ncube, Michelle Groome, Shelley Schmollgruber
Email: asiphekhona.ngema@wits-vida.org
Keywords: vaccine trust, healthcare professionals, vaccine trust indictor, South Africa, maternity care, vaccine hesitancy
Abstract:
Introduction: Vaccine hesitancy is a global challenge, and healthcare professionals (HCPs) are key to promoting vaccine uptake. In South Africa, where maternal and child health is a priority, understanding HCP trust in vaccines is essential for promoting vaccination programs. Objective: To assess general vaccine trust among HCPs working in maternity care settings across the three levels of care and their perceived community trust in vaccines using the Vaccine Trust Indicator (VTI). Methods: A cross-sectional survey was conducted from May - July 2025 in Gauteng community clinics and hospitals. Data were collected using the VTI which measured trust in safety, government health policies, healthcare providers, information sources, and the community’s perceived trust in vaccines. Ordinal logistic regression identified socio-demographic factors associated with vaccine trust levels: low (≤40), moderate (41-70), or high (≥71). Results: Among 231 HCPs surveyed, majority had high vaccine trust 183 (79.2%) and the perceived community trust score was median 62.5 (IQR 50 - 77.5). In the ordinal logistic regression model, perceived community trust score (OR 1.06; 95%CI 1.04 - 1.08), master’s degree or higher (OR 8.79; 95% CI 1.41-54.80), and less than 1 year experience (OR 17.93; 95% CI 3.05-105.28) were significantly associated with high vaccine trust levels. Discussion: While there are high levels of trust in vaccines among HCPs in Soweto, disparities across maternal healthcare levels and concerns about misinformation highlight areas that require attention. This study highlights the importance of vaccine acceptance among HCPs given their critical role as trusted sources in vaccine recommendation. Trust in vaccines influences their confidence in recommending maternal vaccines to pregnant women. Implications: Policymakers should prioritize vaccine communication and training strategies tailored toward HCPs. Knowledge on safety and effectiveness of vaccines could potentially alleviate vaccine safety concerns among pregnant women and increase maternal vaccine uptake.
Experience of Body Changes and Sexuality among Middle-aged Men and Women: A Community-Based Exploratory
Keywords: Midlife, Reproductive health, Emotions, Cultural norms, Health care access
Abstract:
Introduction The midlife is the period at the crossroads between the growth experienced in youth and the decline of old age which is associated with reduction in cognitive performance and physical health in addition to increasing responsibilities at the workplace, family and the community. Concerning sexual and reproductive health, the midlife is poorly researched compared to other age categories. Nonetheless, significant body changes occur during this phase, which may affect their mental state and sexuality negatively. Objective Thus, this study explored the experience of body changes, sexuality and health among adults in midlife. Methodology This exploratory qualitative study was conducted in Ekurhuleni North Sub-District, Ekurhuleni district, Gauteng Province, South Africa. The study included focus group discussions and in-depth interviews among men and women aged 45-64 years. Transcribed interviews were analysed thematically. Results The themes identified include a description of the body and sexuality changes experienced, challenges with understanding the changes and gaining access to care as well as the effect of the changes. Body changes included hot flushes, reduced appetite and loss of beauty. While women described either heightened or reduced libido, the men described reduced libido. Challenges with understanding the changes were due to lack of information, effect of cultural norms and poor information provided by health workers from whom the participants sought guidance. The changes led to fragile emotions and performance anxiety among the participants. Discussion and Implications The effect of midlife changes among men and women can be far-reaching when combined with other stressful factors such as household stresses and higher demands at the workplace. It is therefore important to raise awareness about the challenges experienced in this age group and to provide interventions to mitigate these effects so they are better able to cope.
“You have to make it alone”: wellbeing, hope and aspiration of young people in urban South Africa
Authors: Nirvana Pillay, Ntsako Ishmael Chauke, Ogopoleng Maremela
Email: nirvana.pillay@wits.ac.za
Keywords: young people, wellbeing, hope, aspiration, future
Abstract:
Introduction-Young people between 18-24 in urban Johannesburg, South Africa live in contexts of deep and widening structural inequality. There is a growing literature in the global south about youth aspiration in relation to inequality, unemployment and poverty. Much less is written about hope and aspiration in relation to health, wellbeing and futuremaking. In South Africa, and elsewhere in Africa, young people are often located between reductive, binary discourses of hope and hopelessness, where hopelessness is framed primarily through a biomedical and economic lens and hope is framed within the potential of a demographic dividend as an opportunity for development and a future of possibility. Objectives-The study aims to explore the intersections of hope and aspiration with health and wellbeing. The objectives seeks to understand the hopes and aspirations of young urban South Africans including their livelihood strategies, social relations of care, friendship, and family and interaction with government and NGO services. Methods-We used qualitative, ethnographic methods to conduct thirty interviews (N=30) with young people aged 18-24 young people in the urban areas of Alexandra (n=15) and Lorentzville (n=15), Johannesburg. We interviewed regional and national NGOs (n-=7) working with young people. A participatory, art expression workshop was conducted to explore how hope and aspiration is imagined and creatively expressed by young people. Results & Discussion-We found that young people hope and dream of more than their daily lives allow. Aspirations are adjusted to cope with social and structural barriers to employment, education, and recreation. Income generation requires a mix of entrepreneurship, flexibility and opportunity. Employment opportunities are often short-term, precarious, and dangerous and require travel which present barriers to ongoing employment. Implications-The health and wellbeing of young people in resource constrained urban areas is contingent on their everyday experiences of navigating their social and structural context.
Where Is The Whey? An Investigation Of Labeled Vs Measured Whey Protein Supplement
Protein Content
Authors: Mosibudi Rampya, Gary Gabriels, Dr. Armorel van Eyk and Dr. Carla Martins-Furness
Email: 1620135@students.wits.ac.za
Keywords: Protein supplements, adulteration, supplement regulation
Abstract:
Sufficient dietary protein is essential for maintaining lean muscle mass and muscle function. Protein supplements may be recommended in cases where dietary protein does not meet the recommended dietary allowance (RDA) - in people with extraordinary physiological needs such as athletes and those suffering from muscle wasting orders. Consumers and health care practitioners generally rely on supplement packaging labels for accurate information on product contents with consumers generally paying more for supplements with higher percentages of protein. Unfortunately, the product labels are often misleading, failing to include, or accurately document supplement additives, adulterants, and their side effects. Nitrogen-rich compounds like melamine (MEL), cyanuric acid (CYA) and free amino acids are commonly used as adulterants in protein supplements (PS), to increase reported protein percentage without actually increasing protein content. The use of protein-specific methods to quantify supplement protein content may give insight into false product claims and possible nitrogen adulteration. This study, as part of a larger study, aimed to establish the veracity of the claims of 17 whey protein supplements commercially available in RSA in terms of declared protein content. Despite all PS emphasising the quality of their product, the measured protein concentrations using the proteinspecific Bicinchoninic acid (BCA) and Lowry assay were lower than the protein concentrations reported on labels, with percentage differences ranging from 0.6 % to 42.5 %. Furthermore, High performance liquid chromatography (HPLC) and qualitative Fourier-transform infrared spectroscopy (FTIR) indicated the presence of undeclared MEL, CYA, and uric acid. The current global regulation of protein supplements is inadequate in ensuring the accuracy of labels, the safety, and the quality of these nutraceuticals.
Ageing Across the Spectrum: Demographic Shifts in Elderly, Middle-Aged and Young Nations
Authors: Amukelani Sambo, Kaavya Venkatesh
Email: amusambo4@gmail.com
Keywords: Ageing; Demographic transition; Global health; Social policy; Healthy ageing
Abstract:
Introduction: Global demographic transitions are reshaping health and social systems as nations face diverse challenges of ageing. While elderly societies such as Japan and the United States focus on sustaining long-term care and community-based support, younger nations such as Uganda and Niger contend with rapid population growth and limited infrastructure. Middle-aged nations, including India and Brazil, stand at a critical juncture where early interventions could mitigate future ageing burdens. Objectives: This study aimed to compare how nations at different stages of demographic transition prepare for ageing, highlighting gaps, strengths, and implications for global health equity. Methods: The project was structured by demographic category rather than geography alone. Each researcher focused on one population stage - elderly, middle-aged, or young nations - selecting representative countries (Japan, USA, Brazil, India, Uganda, Niger). Literature review and national data were examined for policies, social structures, and health outcomes. Findings were then compiled into a cross-demographic synthesis. Results: Elderly nations demonstrate advanced health financing and “ageing-in-place” initiatives but grapple with caregiver shortages and infrastructural inequities. The United States, despite Medicare, relies heavily on informal caregivers with limited rural support. Middle-aged nations face high burdens of chronic illness, caregiver strain, and financial insecurity due to weak pension systems. Younger nations such as Niger and Uganda prioritize youth in policy, leaving ageing largely unaddressed. Rapid urbanisation, climate vulnerability, and reliance on traditional caregiving create additional challenges. Discussion and Implications: Findings reveal that preparedness for ageing mirrors broader social and economic priorities. Nations with established welfare systems focus on sustainability, while younger nations neglect ageing until pressures intensify. Strengthening social protection, investing in midlife health, and integrating ageing into development agendas are critical to reduce inequity across the life course. Cross-country insights emphasise the importance of proactive, context-specific policies for achieving healthy ageing worldwide.
Integrating HIV and SRHR in Narok County Through Culturally-Responsive Approaches
Authors: James Saningo
Email: jamiebiegon@gmail.com
Keywords: SRHR - SEXUAL AND REPRODUCTIVE HEALTH RIGHTS AGYW- ADOLESCENT GIRLS AND YOUNG WOMEN FGM- FEMALE GENITAL MUTILATION
Abstract:
The intersection between culture, health and youths is one of the most critical and often underexplored section in public health research in Kenya. In Narok County, the adolescents and young people always face significant negative challenges related to sexual and reproductive health and rights (SRHR) and HIV. Mostly, the cultural practices such as female genital mutilation (FGM), early marriage and silence around sexuality within the Maasai communities hinder the access to health, education and SRHR services. This study delves into the integration of HIV and SRHR through culturally responsive youth-led approaches that respect both the local traditions while similarly advancing health equity. This research adopted a multiple-methodology design, including in-depth interviews, conducting surveys, convening focus group discussions and also a review of service utilization data. A total of 700 adolescents (aged 15-24), 30 healthcare workers and 25 community elders and cultural leaders were engaged across Narok East, Narok South and Transmara west sub-counties. The process incorporated lived experience storytelling, participatory learning and mobile health clinic outreach. A youth-designed model called Olpurkel e Maa (“Wisdom in Our Culture”) was developed thereby blending community education, mobile HIV/SRHR clinics and traditional dialogue circles which was welcomed by the community elders. The preliminary results showed that 68% of the AGYW who responded a took part in the process had never received comprehensive SRHR education, while the remaining 32% of girls had experienced or were at risk of FGM. Through the pilot intervention, 3,100 young people were reached in three months, resulting in a 49% increase in dual HIV and SRHR service uptake and a 53% reduction in self-reported stigma. Elders in two wards publicly endorsed girls’ education and expressed support for abandoning FGM practices. This project shows that integrating HIV and SRHR in the rural settings is most effective when cultural engagement is central to the given interventions.
Exploring Healthcare Workers’ Perspectives on Vaccination Education and the Maternal Health Record in Maternal and Child Health Services in Gauteng
Authors: Shelley Schmollgruber, Asiphekhona Ngema, Gabriel Ncube, Michelle Groome
Introduction: Maternal immunisation can contribute to improved maternal and child health, yet pregnant women often face barriers in accessing and understanding vaccine information. Healthcare workers are central to supporting women’s learning, but tools like the MCR may not fully support women’s learning or vaccination tracking. Understanding healthcare workers’ perspectives on these challenges is essential for improving maternal vaccination education literacy. Objective: To explore healthcare workers’ views on vaccination education given to pregnant women and the usability of the Maternal Case Record (MCR) for vaccination education, focusing on accessibility, language and design. Methods: Semi-structured interviews were conducted with 32 healthcare workers in maternal and child health services in Soweto, Gauteng during July-Aug 2025 to explore experiences and perceptions regarding vaccination education and MCR use. Data were analysed using content analysis to identify key themes, challenges and recommendations. Results: Findings highlighted several barriers to effective vaccination education. Clinical based information was limited in reach, language and literacy challenges hindered comprehension. Healthcare workers reported that many women struggle to understand written materials. Visual aids, simplified language and clearer formatting were suggested to improve understanding. Digital tools such as MomConnectR were seen as beneficial for education support but limited by accessibility, especially in rural areas. The participants also indicated that combining maternal and child health records into a single MCR could risk losing critical information. Conclusion: Improving vaccination education requires community-based outreach, visually accessible and simplified materials, and enhanced MCR design. Digital tools should be made to be more inclusive. Further research is needed to evaluate the advantages and risks of combined verse separate vaccination records for mothers and their infants. Implications for Public Health: Strengthening educational materials and record-keeping tools can improve vaccination tracking and maternal health education, particularly in underserved communities, supporting more equitable and effective maternal and child health services.
Intimate partner violence among adolescent girls and young women accessing HIV preexposure prophylaxis in South Africa, 2019-2022
Authors: Nare Seboko, Catherine Martin and Ms Relebogile Mapuroma
Email: 301831@students.wits.ac.za
Keywords: Intimate parter violence, adolescent girls & young women, PrEP, mental health, substance use, South Africa
Abstract:
Introduction: Intimate partner violence (IPV) is a health concern in South Africa (SA), causing adverse health outcomes among adolescent girls and young women (AGYW). Objectives: This study aimed to determine the prevalence, patterns and factors associated with IPV among AGYW. Methods: A cross-sectional study analysed data from 1811 AGYW aged 15-24 who accessed HIV pre-exposure prophylaxis (PrEP) at 12 study sites in SA. Past three months prevalence and patterns (self-reported experience of emotional, physical, financial and/or sexual IPV) data were collected using a standardized interviewer-administered questionnaire adapted from the World Health Organization Study on Women’s health and Domestic Violence Against Women. Frequencies and proportions were used to summarise the prevalence of the various forms of IPV. Logistic regression was used to identify factors associated with IPV. Results: The prevalence of any IPV was 9.2%. Emotional, physical, financial and sexual IPV had a prevalence of 5.5%, 4.1%, 3.9% and 2.2% respectively. Not having vaginal sex (adjusted odds ratio (AOR) 0.11, 95% confidence interval (CI):0.01-0.79), social support (AOR 0.72, 95%_CI:0.50-1.03) and living in Nelson Mandela Bay compared to OR Tambo district (AOR 0.21, 95%_CI:0.10-0.44) were protective against IPV. Completing tertiary education or more (AOR) 1.79, 95%_CI:1.02-3.14), drug use (AOR 1.96, 95%_CI:1.08-3.55), sex under the influence of alcohol or drugs (AOR 1.93, 95%_CI:1.29-2.90), PrEP use stigma (AOR 1.47, 95%_CI:1.02-2.10), depression symptoms (AOR 1.85, 95%_CI:1.28-2.66), transactional sex (AOR 2.19, 95%_CI:1.21-3.98), living in City of Tshwane (AOR 1.75, 95%_CI:1.14-2.68), living in urban-informal (AOR 2.45, 95%_CI:1.60-3.76) or rural areas (AOR 2.12, 95%_CI:1.19-3.78) compared to urban, were predictors of IPV. Discussion: AGYW accessing PrEP experience a high burden of IPV, with emotional IPV reported most frequently. Interventions to address IPV should include collaborative context specific interventions which address substance use, PrEP stigma and mental health, while supporting AGYW. Implications: This study identifies key factors for developing targeted IPV
Prevalence and risk factors associated with major congenital disorders identified through the UBOMI BUHLE pregnancy exposure registry in Soweto, South Africa
Authors: Dorothy Sefara, Diane Lavies, Ashleigh Fritz, Bongani Ntimani, Ushma Mehta, Lee Fairlie, Michelle J. Groome
Introduction: Congenital disorders (CD) contribute to neonatal and under-5 mortality, especially in low- and middleincome countries. The UBOMI BUHLE Pregnancy Exposure Registry enrols women at sentinel obstetric facilities in three provinces in South Africa. Objective: We estimated the prevalence of major CD among live- and stillbirths and investigated risk factors at the sites in Soweto. Method: Pregnant women were prospectively consented, enrolled and followed through to pregnancy outcome. Neonates were examined at birth. Major CDs were defined as structural anomalies affecting physical, intellectual, or social wellbeing. Data on maternal demographics, history, pregnancy and delivery outcomes were collected. Women giving birth to infants with a major CD were compared to those without any identified CD. Results: Participants enrolled from July 2021 with a documented birth outcome to June 2025 were included. A total of 8530 babies were born to 8401 women. There were 122 babies (1.4%) born with any CD. Fifty-one babies (0.6%) had at least one major CD. The most common major CD were talipes-equinovarus (n=26) and cleft lip and/or cleft palate (n=7). Of those with major CD, 5/51 (9.8%) were stillborn, 21 (41.2%) had a birthweight <2500g and 11 (32.4%) were born at <37 weeks gestation. There were no significant differences in maternal age, HIV prevalence, substance use, or history of a CD between women who gave birth to a baby with a major CD and those who did not. Discussion: This study offers preliminary estimates of major CD prevalence in Soweto. Training of health care workers was provided through the study which will improve identification, notification and correct referral for babies born with CD. Implications: Expanding the analysis to include all UB PER sites will enhance the robustness and generalisability of findings. Findings can be used to assist policy makers in resource allocation and planning for comprehensive care.
From Clinical to Care: Understanding Maternity Care Journey’s of Mothers in Soweto and Thembelihle.
Authors: Shabnam Shaik, Lunghile Shivambo, Lerato Ntsie, Thabisile Qwabi, John Blevins, Maria Meixenchs, Siobhan Johnstone, Ziyaad Dangor.
Introduction: Antenatal care (ANC) is a public health intervention that important in providing comprehensive healthcare services to pregnant women to prevent maternal and infant mortality. In low- and middle-income countries, ANC attendance is hindered by varying factors and in some instances these factors emerge from the healthcare system itself, e.g. infrastructure, resources, and health care worker attitudes and behaviours. Objectives: 1. Explore barriers and facilitators experienced by pregnant women in accessing ANC services. 2. Understand cultural and religious factors that influence ANC attendance. Methods: The study was conducted in Soweto and Thembelihle (Johannesburg) as part of a multi-site study across the Child Health and Mortality Prevention Surveillance network. Through purposive sampling, semi-structured interviews were conducted with seven mothers, three fathers, and four grandparents; whilst two focus group discussions were conducted with health care workers and traditional healers respectively. The data was translated and transcribed into English, and deductive and inductive coding was formulated to analyse the data in Dedoose. Thematic analysis was subsequently applied. Results: The study found that mothers faced several challenges during ANC attendance, which included long clinic waiting times, poor treatment and judgemental attitudes from nurses, and poor health education especially upon discharge with their baby. Family support was found to be incredibly important, improved the pregnancy experience, and maternal family provided health education. Implications: Negative ANC experiences may reduce care-seeking and delay the detection of complications leading to increased risk for mothers and newborns. Strong family support improved maternal well-being and filled education gaps, reflecting the need for more efficient, respectful, and family-inclusive maternal healthcare services.
Coping with stillbirth: Insights from parents in rural Limpopo, South Africa
Authors: Lunghile Shivambo, Dumile Gumede
Email: lunghile.shivambo@wits-vida.org
Keywords: stillbirth; coping mechanisms; parents; rural South Africa; Transactional Model
Abstract:
Introduction: Stillbirth remains a significant global public health concern, with profound emotional consequences for parents. Effective coping mechanisms are essential for processing grief and promoting healing. However, there is limited research on how South African parents, particularly in rural settings, navigate coping after stillbirth. Objectives: This study explored the coping mechanisms employed by parents following stillbirth, guided by the Transactional Model of Stress and Coping. Methods: A qualitative exploratory design was used, involving in-depth interviews with 12 purposively selected parents in the Mopani District, Limpopo Province. Interviews were conducted in participants’ preferred language, Xitsonga, then transcribed, translated into English, and thematically analysed using Atlas.ti. Results: Parents employed both emotion-focused and problem-focused coping strategies. Emotion-focused strategies included acceptance, avoidance, reframing the loss, sharing experiences, seeking support from healthcare professionals, and engaging in prayer or spiritual guidance. Problem-focused strategies primarily involved distraction through meaningful activities. Despite using these strategies, some parents continued to experience unresolved grief that impeded effective coping. Discussion: Coping after stillbirth is multifaceted, combining emotional, social, and spiritual resources. The persistence of unresolved grief highlights the complex nature of parental bereavement and the need for comprehensive support systems. Implications: The findings underscore the importance of multidisciplinary care that integrates psychological, social, and spiritual support to address the complex emotional needs of grieving parents in rural South Africa.
Beyond Comorbidity: A Syndemic Analysis on Intimate Partner Violence, Mental Health, and HIV and their influence on parental use of violence among women in South Africa
Introduction: Women in low- and middle-income countries (LMICs) face a disproportionate burden of intimate partner violence (IPV), poor mental health (MH), and HIV. These interconnected conditions form a syndemic, amplifying health risks and negatively affecting parenting. While each condition has been studied extensively, little is known about their combined impact on parental use of violence toward children, particularly in South Africa. Understanding these dynamics is crucial for interventions that address the syndemic to disrupt the intergenerational transmission of violence. Objectives: This study examined the additive and interactive effects of IPV, MH, and HIV on parental use of physical and emotional violence among female caregivers in South Africa. Methodology: Secondary data analysis was conducted using wave three of the Interrupt_Violence study. The sample included 547 young women, primary caregivers of children under 18 years, who completed structured interviews. Parenting behaviours were measured using the ICAST-P. Logistic regression and marginal effects models assessed the independent and interactive effects of IPV, MH, and HIV. Results: Prevalence rates for IPV, poor MH, and HIV were 36.4%, 44.1%, and 17.6%, respectively. Nearly half (45.8%) of the participants reported experiencing two or more of the epidemics. Parental violence was widespread, with 44.6% reporting using physical violence and 31.1% reporting the use of emotional violence towards their children. Women with IPV and poor MH had higher odds of using physical (OR=1.80; 95% CI=1.22, 2.64; p=0.002) and emotional violence (OR=1.54; 95% CI=1.04, 2.28; p=0.032). IPV and MH interacted synergistically, tripling the odds of parental use of emotional violence (OR=3.04; 95% CI=1.86, 4.98; p<0.001), accounting for 21% of the risk. Implications: • IPV and poor MH significantly increase the risk of parental violence. • Their interaction compounds the risk, particularly for emotional violence. • Parenting interventions should integrate IPV and MH support. • Longitudinal and intervention studies are needed to confirm findings and assess culturally adapted
Epidemiology of schistosomiasis in Mpumalanga Province, South Africa, 2016 - 2024: A retrospective cross-sectional study
Introduction: Schistosomiasis remains a public health concern in Sub-Saharan Africa. South Africa has not yet implemented mass drug administration, and recent national stock depletion led to prioritization of high-burden areas in Mpumalanga Province. However, available data are limited to one district and school-aged children in the province. Therefore, the study aimed to describe the provincial epidemiology of schistosomiasis to inform targeted interventions. Methods: We conducted a retrospective cross-sectional study using all laboratory-confirmed schistosomiasis data from the Notifiable Medical Condition Surveillance System, 2016-2024. Descriptive statistics was used to characterize cases. We estimated the alert and action threshold using the cumulative sum method. Point prevalences were estimated by year and sex. We calculated and illustrated sub-district prevalences using a choropleth map and further identified hot spot sub-districts. Results: A total of 18,954 laboratory-confirmed schistosomiasis cases were reported. The most affected were males, 85.5%(n=16,209) and individuals aged 10-14 years, at 45.4%(n=8,609). The highest peaks above the threshold were observed in 2016 and 2022. Prevalence among males remained higher compared to females (P<0.001; 95% CI=1.41;2.19). However, it decreased throughout the study period (P=0.133; 95% CI=-0.13;0.12) in both sexes. The City of Mbombela and Bushbuckridge experienced higher prevalence (≥500 cases/100,000 population). Nkomazi, City of Mbombela, and Bushbuckridge were significant hot spot areas. Discussion: The high prevalence among males and early adolescents may be attributed to increased freshwater exposure through outdoor activities such as bathing, playing, and swimming in water bodies. Sub-tropical environmental conditions in hotspot sub-districts likely support parasite survival Implications: This study provided adequate information on schistosomiasis in the province. Therefore, we recommend mass drug administration of preventive prophylaxis treatment in the high-burdened and hot spot sub-districts for all ages, mostly targeting pre-schools and primary schools. We further recommend the establishment of thresholds to continuously monitor the schistosomiasis patterns to detect developing epidemics timeously.
Patient Journey Mapping: The experience of patients receiving hand injury care services in Gauteng
Authors: Tsakane Sono, Kirsty van Stormbroek
Email: tsakane.sono@wits.ac.za
Keywords: public healthcare, hand injury, occupational therapy, journey mapping, patient-centred care
Abstract:
Introduction Understanding the experiences of hand-injured patients accessing care is key to supporting care that is responsive to patients’ needs. This study aimed to describe the journey of hand-injured patients using journey mapping to enable an in- depth understanding of patients’ experience of accessing hand-injury care services in Gauteng, South Africa. Objectives • To map the journey of hand-injured patients through the healthcare system. • To describe the experience of accessing hand-injury care services in Gauteng. • To describe the experience of accessing occupational therapy intervention for a hand injury. Methods A qualitative descriptive design was used. Data collection was undertaken at one private and one public healthcare facility in Gauteng. Twelve adults who had sustained traumatic hand injuries were recruited. Three data collection techniques were employed: review of patients’ clinical notes, a patient journey mapping exercise, and in-depth interviews. Reflexive thematic analysis was used, and rigour was pursued using a reflexive journal, data triangulation, and dense description within reporting. Results Five themes were generated from analysis: Spectrum of Satisfaction captured participants’ varying levels of satisfaction with the care they received. An Emotional Journey describes the trauma and emotional impact associated with hand injuries. Now everything has stopped capturing that life-changing nature of hand-injury including a sense of dependence and pain. The Cost included medical and travel expenses, the role of temporary disability grants, and the cost to the family. Finally, The Occupational Therapist captured participants’ experience of the occupational therapist as trainer and cheerleader. Discussion and Implications Opportunities should be available for generalist occupational therapists to develop the necessary clinical competencies to respond to the needs of patients. Similar studies in other provinces are recommended. It is also recommended that all healthcare professionals offering hand-injury care services consider the psychological impact of a hand injury and refer patients for psychosocial support.
Awareness of hereditary breast cancer and genetic testing among patients with breast cancer in Nigeria: A multi-center study
Authors: Funmilola Olanike Wuraola, Jenine Ramruthan, Emma Reel, Agodirin Olaide, Nneka Sunday-Nweke, Mary Ogunyemi, Olawale Boladuro, Saheed Lawal, Olusegun Isaac Alatise, Tulin Cil
Introduction: Breast cancer (BC) is a major public health challenge in Nigeria, diagnosed at advanced stages due to delayed presentation and limited awareness. Understanding patient knowledge of BC is essential to improve early detection. Objectives: This study aimed to assess the demographic and clinical characteristics of patients with BC in Nigeria and evaluate their knowledge of BC symptoms, risk factors and hereditary BC. Methods: A cross-sectional study was conducted among 230 newly diagnosed BC patients across 3 centres (Ile-Ife, Ilorin, and Abakaliki) in Nigeria. Demographic and clinicopathological data were collected. Knowledge of BC symptoms, risk factors and hereditary BC was assessed using a structured questionnaire. Univariable and multivariable analyses identified factors associated with knowledge. Results: The mean age was 48.3 years; 99.1% were female; most were traders (51.1%) and of low socioeconomic status (SES) (66.5%). Education levels varied, with 33.0% having tertiary education. Advanced presentation was common (Stage III:51.7%, Stage IV:21.3%), with 64.3% having triple-negative BC. Knowledge of BC risk factors was low, with higher knowledge associated with tertiary education (p<0.001) and higher SES (p<0.001), while older age (≥65) had lower scores (p=0.040). Participants from Ilorin (p < 0.001) and those of Hausa ethnicity (p=0.014), had significantly lower awareness of BC symptoms. Regarding hereditary BC, only 11 patients (4.8%) were familiar with BRCA1/2 genes, most had a tertiary education. Willingness to undergo BRCA1/2 genetic testing was high (95.7%), with 94.8% willing to inform siblings and 96.1% willing to encourage genetic testing for family members. Discussion: Awareness of hereditary BC was low, despite high willingness for genetic testing. Higher education and SES were strong predictors of knowledge. Knowledge gaps were more pronounced among older, less educated patients with lower SES. Implications: These findings highlight the need for targeted patient education to improve understanding of hereditary BC and genetic testing in Nigeria.
Using the Consolidated Framework for Implementation Research to explore the contextual determinants of private healthcare providers’ participation in the Public -Private Mix for Tuberculosis in Bauchi, Nigeria.
Introduction: In Bauchi, located in Northeastern Nigeria, the local tuberculosis (TB) program utilizes the public private mix (PPM) approach as specified in the national tuberculosis strategy; however, the contribution of private healthcare providers to the TB care cascade has remained inconsistent. There is a shortage of evidence employing an implementation science lens to explore the factors involved. Objectives: This study aimed to explore the barriers and facilitators of private providers’ engagement in the PPM strategy for TB control in Bauchi, using an implementation science determinants framework. Methods: An exploratory qualitative method guided by the Consolidated Framework for Implementation Research (CFIR) was used. The study was conducted in Bauchi, Nigeria. Data was collected through in-depth interviews, key informant interviews, and focus group discussions involving private healthcare providers and health system stakeholders in the state TB program. Deductive thematic analysis was used to identify themes across the CFIR domains with the MAXQDA software. Results: The study identified 16 barriers and 10 facilitators shaping private providers’ participation in the PPM approach for TB control. Key barriers included complex reporting requirements, high financial and opportunity costs, limited diagnostic infrastructure, stigma, inconsistent training and lack of incentives. In contrast, perceived effectiveness of the PPM approach, flexibility in choosing engagement levels, supportive implementers, and providers intrinsic motivation to save lives, emerged as key facilitators. Discussion and implications: This study highlights several policy consideration crucial for strengthening private sector involvement in TB control efforts.There is need to optimize PPM in Nigeria, which is among the highburden countries for TB. While the PPM approach is well-regarded, multiple systemic and individual-level barriers hinder full participation by private providers. Strengthening incentives, improving infrastructure and support systems, and fostering inclusive collaboration are critical for scaling and sustaining PPM efforts in Bauchi.
Poster presentation abstracts
Gender representations in unhealthy food advertisement that appeal to adolescentsimplications for obesity prevention
Authors: Michelle Brear, Bontle Mamabolo Sameera Mahomedy Susan Goldstein
Email: michelle.brear@wits.ac.za
Keywords: Gender, food environment, obesity, health promotion, commercial determinants of health
Abstract:
Introduction Adolescent obesity in South Africa is prevalent and highly gendered, with three times more adolescent girls experiencing overweight or obesity, compared to adolescent boys. Food and beverage advertisements contain gender representations that likely contribute to gendered obesity prevalence. Objectives To identify food and beverage advertisements that appeal to adolescents; describe how gender is represented in these advertisements; and discuss the implications for adolescent obesity prevention policy and programming. Methodology We conducted six focus group discussions, three each with Grade 9 boys (N=26) and girls (N=25) from three Johannesburg high schools about the food and drink advertisements they like. We identified, wrote summary narratives and conducted content analysis of the advertisements, to identify: food or drink advertised; gender of primary character and/or narrator; setting; and presence or absence of 10 stereotypical or alternative gender representations. Results Participants made specific references to 149 advertisements they liked, of which 17 were duplicates and 55 were identified and analysed. They were mainly for fast food (N=15), sugary drinks (N=7), sweet snacks (N=9), salty snacks (N=4), condiments (N=4) and alcohol (N=7). Stereotypical gender representations, such as men drinking beer or driving cars in public places, and women cooking or wearing revealing clothing in domestic settings, predominated. The few advertisements containing alternative gender representations all portrayed alcohol consumption as a feminine aspiration. Illustrative examples of gender representations are presented. Discussion Representing gender in stereotypical and alternative ways is a strategically employed marketing tactic. Gender representations are a feature of unhealthy food and drink advertising in South Africa, that create appeal for adolescent boys and girls. Implications Acknowledging and addressing gender, including its representation in unhealthy food and beverage advertisements, could enhance policies and programs that aim to address adolescent obesity.
Perceptions of service users of trauma-sensitive yoga as an adjunct treatment option for posttraumatic stress disorder (PTSD) in the South African setting.
Introduction: Low and middle income countries (LMIC) including South Africa face a mental health treatment gap where the burden of mental, neurological or substance abuse exceeds those who access treatment. Up to 50% of those that access treatment for PTSD locally, fail to respond adequately to treatment. A growing body of research suggests utilizing yoga as an effective treatment for PTSD. This research report fills a gap in the field and takes the user’s perspective to provide deep and valuable understanding of the experiences and needs of PTSD service users and the possible openness towards trauma-sensitive yoga (TSY) as a PTSD treatment option in South Africa. Methods: A qualitative study methodology was employed, where in-depth interviews were conducted with PTSD service users (n = 9). The framework approach was applied to the data analysis. Results: The majority of PTSD service users reported a lack of clarity on PTSD diagnoses and PTSD treatment approaches being used in their treatment. Furthermore, they perceived interpersonal harm from their healthcare professionals, such as physical and psychological abuse. Alternative and complementary approaches to treatment were popular among PTSD service users. Benefits were found in biological, spiritual and nature-oriented approaches. However, yoga as a PTSD treatment option received mixed results, particularly as different forms of yoga that were not TSY were experienced. There was also particular concern raised on the use of TSY where comorbid psychiatric diagnoses are present. Conclusion: Clear communication on PTSD diagnoses and shared-decision making in PTSD treatment is an important part of improving health outcomes. Differentiating and protocolising yoga for PTSD treatment from other forms of yoga in South Africa, is an important next step as the experiences differ greatly. Furthermore, better understanding the adaptation of TSY for patients with psychiatric comorbidities is another important research priority in this field.
Incidence and Severity of Incomplete Abortions Admitted in South African Public Hospitals: A Comparison Between 1994, 2000, and 2018
Authors: Daphney Nozizwe Conco; Jonathan Levin, Boitumelo Komane and Sharon Fonn
Email: Daphney.Conco@wits.ac.za
Keywords: Abortion, Sexual and Reproductive Health Rights, Public hospitals, South Africa
Abstract:
Introduction Unsafe abortion remains a preventable contributor to maternal morbidity and mortality globally. South Africa’s progressive reproductive rights framework, anchored in the 1996 CTOP Act, aimed to improve access to safe abortion. However, barriers such as stigma, provider resistance, and limited access to abortion care persist. In this context This study investigates whether these systemic challenges have influenced the incidence and severity of ICA over time. Objectives To estimate the national incidence of ICA and describe the prevalence of abortion-related morbidity in South African public hospitals in 2018, comparing findings with similar studies conducted in 1994 and 2000. Methods A cross-sectional, retrospective record review was conducted in a stratified random sample of public hospitals. Data were extracted from records of women presenting with ICA during a fixed 21-day period in 2018. National incidence was estimated using population data for women aged 12-49 years and live births. 2018, 1994 and 2000 results were compared using consistent indicators of incidence, clinical severity, and management practices. Results 2018 ICA incidence of 367 (95% CI: 274-459) per 100,000 women aged 12-49 years, remained stable: 375 (1994), 362 (2000), and 367 (2018). However, clinical severity declined, with fewer signs of infection and organ failure. Surgical evacuation dropped from 95.3% to 78.8%, while antibiotic use rose from 33.5% (2000) to 57.3% (2018). General anaesthesia use declined sharply, while use of abortifacients and blood transfusions increased. Discussion Despite legislative reform, ICA incidence has not decreased, suggesting persistent barriers to accessing safe abortion. However, reduced morbidity reflects improvements in clinical management. Implications The decline in morbidity may be partly attributed to increased availability of medication abortion, which offers a safer, less invasive option. South Africa should expand access to medication abortion, ensure provider training, and address systemic barriers that limit uptake of legal services.
The availability of digital health technologies and infrastructure in the district hospitals of Gauteng Province
Authors: Thomas de Beer, Laetitia Rispel
Email: 2303077@students.wits.ac.za
Keywords: digital health technologies, health workforce, district hospitals
Abstract:
Introduction Within the context of the rapid growth of digital health technologies (DHT), South Africa’s Digital Health Strategy aims to enhance healthcare services for patients and the work experience of the health workforce. However, the strategy lacks details on its implementation in the public health sector, exacerbated by knowledge gaps on the availability of infrastructure and DHT in district hospitals as first referral facilities. Objectives The aim of the study was to audit the availability of DHT and supporting infrastructure in Gauteng district hospitals. Methods Following ethics and health authority approvals, the research team conducted an audit at each of the 12 Gauteng district hospitals. Using a structured checklist, we assessed available infrastructure (such as computers, network access, etc.) and WHOrecommended DHT for HCWs across different hospital sections. Data were analysed in Microsoft Excel using descriptive statistics (counts, frequencies, percentages, medians, and IQRs) Results Each hospital had an IT department, with a median of three staff members for data capturing (IQR: 2-4.5). Internet access via LAN or Wi-Fi was universal in administrative areas, but none (0%) was available in clinical areas. Hospitals had a median of 169.5 computers (IQR 150-242.5), with only 11.5 (IQR 8-21) located in clinical areas. None operated an electronic health record. Eight hospitals (67%) used a Health Information System for patient registration, and three (25%) used Vula Mobile for tertiary referrals. Discussion Despite basic IT infrastructure in administrative areas, HCWs lack access to clinical-area infrastructure or WHO-recommended DHT. This limits DHT integration into patient care, undermining its potential to improve efficiency, care coordination, health outcomes, or transform the work of HCWs. Implication An improved implementation strategy is needed to equip clinical areas with the infrastructure and DHT necessary for effective, equitable health service delivery.
Does life expectancy vary by disability status in low and middle-income countries?: a systematic review and meta-analysis
Keywords: Life expectancy, years of life lost, disability, equity, Meta analysis, Ethiopia
Abstract:
Background: Over 1.3 billion people globally, with 80% in LMICs, face healthcare barriers, poorer health, and higher mortality due to disabilities, potentially reducing life expectancy (LE). Despite its importance, LE gaps for disabled individuals in LMICs lack systematic review. Objectives: To review and synthesize LE and years of life lost (YLL) estimates comparing people with disabilities to those without. Method: A systematic review was conducted across six databases: Medline, Embase, Global Health, Web of Science, Scopus, and Cochrane Library. Data were analyzed with metafor packages of R 4.3.3. The study assessed heterogeneity with I2 and publication bias with a funnel plot. Randomeffects model estimated pooled mean LE and YLL as weighted averages. Subgroup and meta-regression analysis was performed to explore sources of data variability, and the risk of bias was evaluated using the JBI tool. Results: Twelve full-text articles were included in this meta-analysis. The pooled mean LE was lower in people with disabilities (57.98 years; 95% CI: 53.40, 62.95) compared with people without disabilities (70.86 years; 95% CI: 64.06, 78.38). The overall weighted years of YLL in people with disabilities was 15.84 years (95% CI: 11.1 - 22.61). There was no significant difference in YLL between men (16.33 years; 95% CI: 11.49-23.21) and women (13.7 years; 95% CI: 8.45 - 22.22).
Discussion: The average LE in people with disabilities was substantially lower compared to those without disabilities in LMICs. This inequity highlights that health systems and public health efforts are failing to meet the needs of people with disabilities, and must be improved to become more disability-inclusive. Implication: The study emphasizes the need for inclusive policies and robust research in the health system to address health disparities.
Left behind in primary healthcare: A qualitative exploration of healthcare experiences of people with disabilities in Ethiopia
Authors: Desta Debalkie Atnafu, Hannah Kuper, Femke Bannink Mbazzi
Introduction: People with disabilities, who make up 1.3 billion globally, frequently face systemic exclusion from healthcare due to a range of barriers. This study explored the healthcare access experiences of people with disabilities in Bahir Dar City, Ethiopia, aiming to identify barriers, facilitators, and context-driven solutions. Objective: An exploratory phenomenological qualitative design was used, involving 30 adults with disabilities. Methods: Both purposive and snowball sampling was conducted to identify participants. In-depth interviews were conducted in the local language. Data were analysed using reflexive thematic analysis in NVivo 14, guided by the Missing Billion Health System Framework service delivery components. The study identified five key themes each for barriers, facilitators, and coping strategies. Major barriers included low health literacy, unaffordable care, negative provider attitudes, inaccessible infrastructure, and lack of assistive technologies and rehabilitation services. Facilitators included family support, community-based health insurance, disability-sensitive training of healthcare workers, presence of a rehabilitation centre, and initiation of renovation infrastructure in model facilities. Participants proposed actionable strategies such as increasing awareness, insurance coverage, local production of assistive technologies, assigning personal assistants in health facilities, improving accessibility, and establishing disability units within governance structures. Discussion & implication: People with disabilities experienced persistent, intersecting barriers to healthcare access in Ethiopia. However, scaling disability-inclusive training, infrastructure, and governance reforms-rooted in lived experience and aligned with human rights of people with disabilities-can help drive progress toward Universal Health Coverage.
Time and money costs of seeking pre-exposure prophylaxis for HIV in rural KwaZulu Natal
Authors: Siyabonga Dubazana, Refiloe Motaung, Maryam Shahmanesh, Lawrence Long, Jacqui Miot, Sydney Rosen, Cheryl Hendrickson
Email: sdubazana@heroza.org
Keywords: HIV prevention; PrEP; Cost analysis; rural health
Abstract:
Background: Despite its effectiveness, accessibility to oral pre-exposure prophylaxis (PrEP) for HIV prevention is hindered by both direct (transport, childcare, and food expenses) and indirect (travel time and time at facility) costs, which are rarely considered in PrEP implementation. Cost disproportionately affects vulnerable populations in rural areas. We estimated costs incurred by clients seeking PrEP in rural KwaZulu Natal. Methods: From August 2023-December 2023 we recruited 79 first-time PrEP users at mobile clinics provided by the Africa Health Research Institute in uMkhanyakude District. Participants were drawn from a cluster randomised trial and were interviewed by trained research assistants. Mobile clinics were located in the intervention clusters every 2 weeks and delivered nurseled HIV testing, prevention and care. Direct costs, including roundtrip transport, childcare and food expenses, were also recorded. We used the South African minimum wage of R27.50 per hour to value time spent accessing PrEP services. Data on self-reported time spent were also reported. Results: The average age of the participants in this study is 24 (SD 3.46). The average roundtrip travel time of 51.7 minutes and an average waiting time of 48.1 minutes were reported, resulting in a total average time spent of 99.8 minutes. The opportunity cost of this time is valued at R85, which is equivalent to 30% of a day’s minimum wage. Among the 79 participants surveyed, 2.17% (n=2)reported incurring transport costs to access HIV prevention care services, which also indicates the accessibility of mobile clinics. Childcare costs were reported by 1.27% of the participants, with an average of R12.84 (SD 112.50).Food costs were more prevalent, affecting 11.39% of participants. Only 12 (15.18%) incurred any direct costs. Conclusion: For young PrEP users in rural KwaZulu Natal, provision of PrEP through mobile clinics located in their communities imposed very few direct costs but required a time investment equivalent to 30% of days’ minimum wage. Further reducing the time required for PrEP services may improve uptake and persistence.
Assessing HIV risk behaviors, perception of HIV risk, PrEP knowledge and preferences, and the feasibility of using the BART to measure risky behaviors among young women in uMkhanyakude
Authors: Siya Dubazana, Darshini Givindasamy, Maryam Shahmanesh, Lawrence Long, Cheryl Hendrickson, Eustacius Musenge, Jacqui Miot
Email: sdubazana@heroza.org
Keywords: HIV prevention; risk perception; risk-taking propensity; young women; PrEP
Abstract:
BACKGROUND Young women face a disproportionately high risk of HIV acquisition, with biological susceptibility, sexual risk behaviors, and structural factors contributing to this vulnerability. Despite these risks, young women often perceive themselves as being at low risk of HIV acquisition, which can hinder engagement with HIV prevention services. This study aims to explore the correlations between behavior-based risk, self-perceived risk, and risk-taking propensity among young women. METHODS This cross-sectional study will recruit a sample of 250 young women aged 18-30 years from the Africa Health Research Institute’s Health and Demographic Surveillance System, which forms part of the South African Population Research Infrastructure Network. Risk-taking propensity will be assessed using the BART, a computerized measure of risk-taking propensity, alongside two self-reported measures: The perceived Risk of HIV Scale and the VOICE Risk Score. PrEP knowledge, use, and preference will be measured using a self-report scale. Descriptive and inferential statistical analyses, including correlations and regression models, will be used to examine relationships between BART scores, self-perceived risk, and behavior-based HIV risk. RESULTS The feasibility of the BART as a tool to measure risk-taking propensity in this population is a novel approach to understanding young women’s likelihood of engaging in risky sexual behavior. Moreover, this study moves beyond the traditional single-question measures of risk perception, allowing for a more nuanced understanding of young women’s risk. Findings will help identify whether behavioral tasks such as BART can complement or enhance self-report measures of HIV risk perception and behavior. CONCLUSION This study has the potential to contribute to how HIV risk is assessed among young women and in the general population by introducing a behavior-based measure of risk propensity. Insights gained from this study could improve HIV prevention strategies by highlighting the value of integrating behavioral risk tasks like BART into risk screening and tailoring interventions for young women in high-burden settings.
Assessing the Impact of Carotenoids on Persistent Inflammation, Lipid Peroxidation and Redox Imbalance Post-Tuberculosis
Authors: Nondumiso Dube, Santiago Carrero Longlax, Clement Gascua, Ngalulawa Kone, Nancy Moran, Andrew DiNardo
Introduction: Carotenoids are potent antioxidants that neutralize lipid peroxidation and mitigate inflammation, key processes underlying many chronic diseases. In TB survivors, even after successful treatment, persistent inflammation, lipid peroxidation, and altered redox capacity are frequently observed. These disruptions are linked to epigenetic changes that accelerate cellular aging and compromise immune recovery. The long-term health burden associated with these post-infectious sequelae highlight the need for targeted recovery strategies. Objectives: To investigate the relationship between plasma carotenoid concentrations and persistent inflammation, lipid peroxidation, and redox imbalance in TB patients. Methods: Participants were drawn from a TB cohort in Eswatini (2013-2020), including 167 TB patients and 78 healthy household contacts, followed over a 12-month period. Biomarkers of inflammation (CRP), redox capacity (Trolox assay), lipid peroxidation (oxidized LDL), DNA methylation, and immune function were measured at TB diagnosis and post-treatment. Plasma carotenoids were quantified using high-performance liquid chromatography. Results: Post-treatment TB survivors showed persistent inflammation (CRP >3 mg/dL in 43%), reduced redox capacity (69%), and elevated lipid peroxidation (61%). Only 30% reached carotenoid levels comparable to healthy controls. Carotenoid concentrations were inversely correlated with lipid peroxidation and positively with redox capacity. High CRP levels were associated with lower carotenoid concentrations. TB survivors with normalized carotenoid concentrations demonstrated increased DNA hypermethylation in genes and pathways associated with inflammation and immune response. Discussion: Despite microbiological cure, TB survivors experience ongoing oxidative stress and inflammation. Reduced carotenoid concentrations contribute to these post-infectious changes and influence epigenetic aging and immune dysregulation. Implications: Restoring carotenoid concentrations is a critical strategy in TB recovery protocols. These findings also inform post-infectious care in diseases like HIV and schistosomiasis, where oxidative stress and inflammation are similarly implicated.
Transformed through the CARTA experience:
Authors: Sharon Fonn, Anne Ruhweza Katahoire, Jill Allison and Marta Vicente-Crespo
Introduction Transformative learning occurs when a person, group, or larger social unit encounters ideas that are at odds with their prevailing perspective. This discrepant perspective can lead to an examination of previously held beliefs, values, and assumptions. The Consortium for Advanced Research Training in Africa (CARTA) has since 2011 been training and supporting faculty from different African universities, to become more reflective and productive researchers, research leaders, educators, and change agents who will drive institutional changes in their institutions. Methods As part of a mid-term evaluation of CARTA, an open-ended question was posed to the CARTA fellows asking them to describe any changes they had experienced in their professional lives as a result of the CARTA Programme. Responses were inductively coded and analysed using qualitative thematic analysis. These themes were subsequently mapped onto Hoggan’s typology of transformative learning outcomes. Results The 135 responses were received. CARTA fellows reported shifts in their sense of self; worldviews; beliefs about the definition of knowledge, how it is constructed and evaluated; and changes in behaviour/practices and capacities. Discussion We argue that the changes described by the CARTA fellows reflect transformative learning that is embedded in CARTA’s Theory of Change. The reported transformation was enabled by a curriculum intentionally designed to facilitate critical reflection, further exploration, and questioning, both formally and informally during the fellows’ PhD journey with the support of CARTA facilitators. Implication Documenting and disseminating these lessons provide a guide for future practice, and educators wishing to revitalise their PhD training may find it useful to review the CARTA PhD curriculum.
Establishing the Maternal Immunisation Readiness Network in Africa and Asia (MIRNA) to Strengthen Maternal Vaccine Introduction
Authors: Michelle Groome, Shelley Schmollgruber, Janan Dietrich, Ijeoma Edoka, Stefanie Vermaak, Gabriel Ncube and MIRNA Consortium
Email: michelle.groome@wits-vida.org
Keywords: Keywords: Maternal immunisation, Respiratory syncytial virus (RSV), Group B Streptococcus (GBS), Lowand middle-income countries (LMICs).
Abstract:
Introduction: Respiratory syncytial virus (RSV) and group B streptococcus (GBS) are leading causes of neonatal and infant morbidity and mortality. Maternal immunisation (MI) protects mothers and infants, as demonstrated by tetanus vaccination. New RSV and GBS vaccines are in advanced development, with a maternal RSV vaccine recently licensed and GBS candidates showing promising results. Effective implementation in low- and middle-income countries (LMICs) requires strong antenatal care platforms, integration with immunisation services, evidence on disease burden and economics, and strategies to address regulatory, financing, and vaccine hesitancy challenges. Aim: This initiative aims to accelerate the introduction and scale-up of maternal RSV and GBS vaccines in LMICs by generating evidence, identifying implementation barriers, strengthening delivery platforms, and fostering regional collaboration. Methods: This multi-country initiative, coordinated from South Africa, engages partners across Africa and Southeast Asia (Bangladesh, Burkina Faso, Ethiopia, Ghana, Kenya, Nigeria, Pakistan, Uganda). Across these nine countries, activities include disease surveillance and modelling, health system assessments, stakeholder mapping, and evaluation of community and provider perceptions. To achieve this, five work packages cover disease burden, economic modelling, MI situational analysis, social science approaches to vaccine demand, and stakeholder engagement through in-country Communities of Practice. Outcomes: With the project currently underway, evidence is being generated to guide MI decision-making, context-specific readiness assessments, co-created interventions to overcome barriers, and strengthened MI research and implementation capacity. This multi-country MI consortium provides a sustainable platform for equitable vaccine introduction. Public Health Implications: By increasing MI uptake and confidence, the MIRNA initiative aims to support the reduction of maternal and neonatal morbidity and mortality, strengthening health system resilience, supporting broader maternal and child health improvements, and contributing to universal health coverage and Sustainable Development Goals.
Designing and evaluating the implementation of a monitoring and evaluation system for enhancing the use of data for cost efficiency at a central hospital in Gauteng, South Africa
Authors: Dimakatso B. Gumede and Tshegofatso Maimela
Introduction: The rising cost of healthcare in low-to middle-income countries (LMICs), notably South Africa, has contributed to persistent inequities in access to quality healthcare services. Public hospitals in South Africa, which serve approximately 84% of the population are the primary cost drivers in the public sector. This is attributed to the lack of robust monitoring and evaluation (M&E) systems to regulate resource allocation and financial management, leading to overspending and wastage. To address this challenge, functional business units (FBUs) to manage operational activities within clinical departments have been established. However, no M&E framework currently exists to systematically assess cost efficiency and resource utilisation at FBU level, thus limiting data-driven interventions that reduce wastage and enhance accountability. Aim and objectives: This study aims to develop and implement an M&E framework to evaluate FBU expenditure and promote evidence-based approaches for cost efficiency and resource utilisation in a central hospital, using the surgical unit as a pilot. The objectives of this study are to: 1) describe the Surgical FBU data needs for evidence-based expenditure and cost-efficiency, 2) develop and implement an M&E framework using the contextual PRISM model within the Surgical FBU, and 3) evaluate expenditure and cost-efficiency practices in the surgical FBU post-implementation using the RE-AIM framework. Methods: A mixed method approach will be employed for the study. Qualitative data will involve conducting semi-structured interviews and focus group discussions with Heads of Departments (HoDs), Unit Managers (HoUs), clinical managers, and nurse managers in surgical and theatre units. Quantitative data collection will involve micro-costing of commonly performed surgical procedures as well as assess key performance indicators to support cost efficiency and data-driven decision making. Implications: An effective M&E framework will reduce FBU-level wastage, enhance cost-efficiency, strengthen accountability, and support equitable healthcare delivery through data-driven decision-
Internal migration and the HIV care cascade: A cross-sectional analysis among young adults in rural South Africa
Authors: Sadson Harawa, Carren Ginsburg, Mark Collinson
Email: sadson.harawa@wits.ac.za
Keywords: Internal migration; HIV care cascade; HIV prevalence; viral suppression; young adults; rural South Africa; health-service utilization
Abstract:
Introduction: Internal migration is hypothesized to disrupt the HIV care cascade, yet evidence is mixed. We examined whether migration status was associated with HIV prevalence and viral suppression in rural northeast South Africa. Objectives: To test whether migrants differ from non-migrants in (i) HIV prevalence and (ii) viral suppression at three thresholds (<1,000, <200, <50 copies/mL), and to identify demographic and service-use factors associated with these outcomes. Methods: We analysed Wave 1 MHFUS survey data (n=3,800) with DBS HIV testing (n=2,161) and viral load among PLHIV (n=524). Exposure was self-reported migration status (migrant vs non-migrant). Logistic regression with robust standard errors estimated associations with HIV prevalence and suppression. Adjusted models included age group, gender, education, employment, friend nearby, family nearby, and recent health-service use. Margins yielded predicted probabilities and average marginal effects. Results: HIV prevalence among those tested was 24.3% (525/2,161). Among PLHIV with viral load, suppression was 67.6% (<1,000), 58.0% (<200), and 51.2% (<50). For HIV prevalence, migrants had lower odds unadjusted (OR 0.77). In adjusted models (n=1,543), migration remained protective by average marginal effect (-8.3 percentage points) with a borderline odds ratio. Older age increased odds, while men and those with matric or higher education had lower odds. For viral suppression, migrants were less likely to be suppressed in crude analysis at <1,000 copies/mL, but differences were not significant after adjustment at any threshold. Recent health-service use was consistently associated with higher suppression (approximately two to threefold higher odds across thresholds). Discussion: Internal migration was associated with lower HIV prevalence at baseline but showed no independent association with viral suppression after adjustment, suggesting that differences were explained by demographic and service-use factors. Implications: Programs should prioritise routine health-service use, linkage, and retention for all PLHIV, including mobile populations. Limitations include the cross-sectional design and reduced samples due to missing covariate data.
Occupational lead exposure among lead handlers in a copper mining company, Zambia.
Keywords: Occupational Exposure Lead Blood Pathway
Abstract:
Enlisted among the World Health Organization’s 10 chemicals of major public health concern and causing 0.6% of the global disease burden, lead exposure occurs through multiple routes. Zambian literature is scanty. This study characterised exposure among lead handlers at a Zambian copper mine. The study was University of the Witwatersrand Medical Human Research Ethics Committee(HREC), Troprical Diseases Research centre HREC, and Zambian National Health Research Authority approved. Forty-seven blood lead values(BLLs), versus external exposure assessment were measured. Participants additionally filled in a questionnaire. External assessment samples included palmar wipes(n=53), surface wipes(n=27), breathing zone(n=37), and room air(n=5) to determine lead concentration. South African National Accreditation System-recognised laboratories performed chemical analyses. Jefferey’s Amazing Statistics Program was used. International reference standards were adopted since Zambia has none known to us. Partcipants’ mean age, all male, was 41-years with median exposure duration of 10-years. Mean BLL was 0.39 units higher than the Occupationals Health and Safety Administration’s(OSHA) recommended value(10ug/dl). Personal and room air time-weighted-average values were below the following recommended values: OSHA(o.o5mg/m3), National Institute for Occupational Safety and Health(o.1mg/m3), and American Conference of Governmental Industrial Hygienists(o.o5mg/m3). No reference standards for dermal and ingestion routes were available. Health risk exposure assessment findings were: Dermal chronic daily intake(CDI=6.76x10^-11 mg/kg/day), oral(CDI=5.97x10^-3 mg/kg/day), and inhalation(CDI=4.20x10^-2 mg/kg/day). All routes showed low risk for adverse health effects having hazard quotient values less than one. This study showed that the highest contributing pathway was inhalation although air sampling was within exposure limits. The internal body burden of lead was in exceedance of recommended standard but below action and suspension levels for occupational exposure. The study findings provide a basis for the development of intervention strategies to prevent negative health impacts. A larger sample sized study would yield generalisable evidence and is recommended.
Exploring Health Science Educators’ Perspectives on Gamification and Digital Game-Based Learning: Implications for Public Health Education
Authors: Amanda Jankowitz, Paula Barnard, Judith Bruce
Email: a0060813@wits.ac.za
Keywords: Gamification Digital Game-Based Learning (DGBL) Health Sciences Education Public Health Practice Self-Directed Learning (SDL) Educational Innovation Teaching Strategies Educator Perspectives Student Engagement Curriculum Design
Abstract:
Gamification and digital game-based learning (DGBL) are increasingly recognized as transformative tools in health sciences education. This study explores South African health science educators’ awareness, experiences, and perspectives on integrating DGBL into teaching, with a focus on its potential to strengthen public health education and practice. A digital survey was distributed to 120 educators via REDCap, using non-probability and snowball sampling. Participants included educators registered for health science education courses or actively teaching in the field. Ethical clearance was obtained, and data were anonymized and analysed using descriptive statistics. Findings reveal that while educators recognize the potential of DGBL to foster self-directed learning (SDL), creativity, and student engagement, many face barriers such as limited digital literacy, lack of training, and institutional support. Motivators for adoption included teaching philosophy, passion for innovation, and the need to adapt during the COVID-19 pandemic. Collaboration with IT teams and game developers, and involving students in game design, were seen as key enablers. DGBL was found to enhance learning environments by supporting shy students, boosting self-esteem, and promoting inclusive participation. Educators emphasized the importance of aligning gamified activities with clear learning outcomes and public health competencies. The skills developed through DGBL, such as critical thinking, problem-solving, collaboration, and reflective practice are foundational to effective public health practice, particularly in community engagement, health promotion, and interprofessional teamwork. This research advocates for institutional investment in digital teaching strategies and highlights the role of DGBL in advancing equitable, engaging, and contextually relevant health science education and practice across Africa.
Characterising time-activity patterns for exposure assessment in communities near mine tailings in West Rand, South Africa
Authors: Limbani Kalumbi, Wells Utembe, Masilu Daniel Masekameni, Derk Brouwer
Email: 2766999@students.wits.ac.za
Keywords: Mine tailings exposure Micro-environments Time-activity patterns Age groups
Abstract:
Introduction Estimating population exposure is a key element of human health risk assessment for environmental contaminants. Such assessments rely on understanding time-activity patterns across the various microenvironments where people spend their time. Most studies use default values, for example, USEPA Exposure Factors Handbook, however, community-specific studies are essential for accurately characterising time-activity patterns to improve exposure assessments. Objectives This study aimed to assess the time-activity patterns among residents living near mine tailings storage facilities in the West Rand district, South Africa. Methods A cross-sectional study was conducted between June and August 2025, involving 327 participants selected through systematic random sampling. The sample comprised diverse population groups, including toddlers, children, adolescents, adults, and the elderly. Data were collected using a researcher-administered structured questionnaire. Descriptive data analysis was conducted using STATA 18. Results The reported mean daily indoor time across all groups was 18.28 [Standard deviation (SD), 3.02] hours, translating to 76.1% of a typical day. Adolescents (15.98, SD 2.33 hours), children (16.50, SD 2.33 hours), and adults (17.75, SD 3.12 hours) reported lower indoor time compared to toddlers (20.35, SD 2.28 hours) and the elderly (20.26, SD 1.64 hours). On average, toddlers spent 104.96 (SD 77.51) minutes per day playing outside the home within household premises. Participants also engaged in other recreational activities for an average of 70.24 (SD 56.65) minutes per week. Discussion The findings show that the time spent indoors by West Rand residents was nearly 10 percentage points lower than that reported by USEPA (86.9%). There are also significant differences among demographic groups, indicating that time-activity patterns may result in significant differences in exposure to indoor and outdoor pollutants. Implications The findings indicate that time-activity patterns vary considerably. Consequently, exposure modelling should be guided by time-activity patterns that reflect the specific behaviours and routines of affected populations.
Measles outbreak investigation in Lejweleputswa district, Free State province, FebruaryJune 2025
Keywords: Outbreak investigation, Measles, Lejweleputswa district, Free State
Abstract:
Background: Despite the availability of effective vaccines, measles outbreaks persist in South Africa. In March 2025, a laboratory-confirmed measles case in the Lejweleputswa District, Free State Province, triggered an outbreak alert. The outbreak investigation aimed to determine the source, assess the magnitude, and guide the implementation of public health control measures. Method: A descriptive study was conducted from February to May 2025 using standard measles case investigation and contact tracing forms. Cases were identified through active case finding, contact tracing, and medical record reviews. Measles IgM laboratory testing was performed to confirm cases, while some were confirmed through epidemiological linkage. Environmental assessments focused on hygiene, water supply, and the overall condition of households and surroundings. Data were entered into Microsoft Excel and analysed using descriptive statistics to summarise demographic, clinical, temporal, and geographical patterns of measles cases. Results A total of 100 suspected measles cases were identified, including 48 confirmed cases (45 laboratory-confirmed and 3 probable). Forty-one cases (85.1%) were from Matjhabeng sub-district, predominantly affecting children aged 5-9 years (60%). A cumulative attack rate of 48% and a case fatality rate of 2.1% were recorded. Of the confirmed cases, 18 (37%) were fully vaccinated, 1(2%) partially vaccinated, 5 (10%) were unvaccinated, and 24 (50%) had an unknown vaccination status. Environmental assessments revealed poor hygiene and overcrowding in some households, which may have contributed to the transmission. Discussion: The outbreak highlights the vulnerability of underimmunised populations and the need for strengthened immunisation and surveillance. A key recommendation is to reduce overcrowding, improve hygiene, and expand targeted outreach to support measles elimination. Implications This outbreak demonstrates the ongoing risk of measles resurgence in areas with suboptimal vaccination coverage. It reinforces the necessity for sustained investment in immunisation infrastructure and rapid outbreak response capacity.
Implementing a dedicated orthopaedic emergency theatre at Charlotte Maxeke Johannesburg Academic Hospital.
Authors: Astrid Kouatcho, Mary Kawonga, G23 Team Charlotte Maxeke Johannesburg Academic Hospital
Email: Astrid.Kouatcho@wits.ac.za
Keywords: Implementing a dedicated orthopaedic emergency theatre at Charlotte Maxeke Johannesburg Academic Hospital.
Abstract:
Introduction The orthopaedic department at Charlotte Maxeke Johannesburg Academic Hospital (CMJAH) faced a significant elective surgical backlog exacerbated by high patient volume, limited theatre capacity and the COVID-19 pandemic. Consequently, elective surgeries were increasingly cancelled to make way for emergency cases, more emergency cases filled the orthopaedic wards to await surgery and waiting times for elective surgery increased. Objectives To implement and evaluate a dedicated orthopaedic emergency theatre to increase emergency surgical capacity, reduce elective surgery cancellations, and address the backlog. Methods A phased approach, guided by the EPIS (Exploration, Preparation, Implementation, Sustainment) framework, was applied. Stakeholders included orthopaedic surgeons, anaesthetists, theatre nurses, human resources managers, information management teams, and public health medicine. Key strategies included collaborative planning, accelerated nurse recruitment and on-thejob training, targeted resource allocation, and robust monitoring and evaluation for periodic review. Results Initially operating two days per week, the theatre reached full-time operation by December 2023. Between September 2023 and March 2024, there was a 41% increase in emergency orthopaedic surgeries performed. The average cancellation rate for elective orthopaedic surgeries was 19%, with a reduction in cancellations due to acute trauma. Nursing capacity improved through recruitment and targeted training. Discussion The intervention demonstrated that phased implementation, coupled with strong multidisciplinary collaboration, can effectively expand surgical capacity and mitigate the displacement of elective procedures. Implications This model provides a scalable approach for policymakers and hospital managers to address surgical backlogs equitably. Phased, stakeholder-driven implementation can enhance trauma care services, optimise theatre utilisation, and strengthen health system responsiveness in highdemand settings.
The Burden Of Respiratory Syncytial Virus (RSV) Infections In Young Children (<5 Years) In South Africa
Authors:
Rujeko Maahingaidze
Email:
rujekomm@gmail.com
Keywords: RESPIRATORY SYNCTIAL VIRUS; SOUTH AFRICA; VACCINE
Abstract:
INTRODUCTION Respiratory syncytial virus (RSV) is a common cause of acute lower respiratory tract infections (LRTIs) in children <5 years. The WHO estimates that RSV causes over 3.6 million hospitalizations and about 100 000 deaths in children under 5 years of age. The National Institute of Communicable Diseases has a surveillance system set up to monitor cases of RSV in children <5 years. There is currently no approved RSV vaccine in South Africa for young children. OBJECTIVES To describe the burden of RSV in children (<5years) in South Africa between 30 December to 20 July 2025 METHODS RSV is tested using a commercial multiplex RT-PCR assay (Allpex SARS-CoV-2/FluA/FluB/ RSV PCR kit). A specimen is considered positive for RSV if the PCR cycle threshold (Ct) is <40 for the respective target. RESULTS The 2025 RSV season started on 11 March 2025 (week 11), when the detection rate of RSV in hospitalized young children enrolled into surveillance crossed the seasonal threshold. RSV activity reached the high threshold in the week starting 28 April 2025 (week 18) and peaked in the week starting 05 May 2025 (week 19). RSV activity dropped to the low level in the week starting 26 May 2025 (week 22). Between 30 December 2024 and 20 July 2025, 4 354 samples were tested for common respiratory viruses. There were 716 (16.4%) confirmed cases of respiratory syncytial virus (RSV) DISCUSSION RSV remains a global public health challenge in young children (<5 years). Surveillance of RSV cases shows a significant burden on both public and private health care resources in South Africa. The South African Health Products Regulatory Authority approved the maternal RSV vaccine (Abrysvo) in December 2024, but it is currently only available in the private sector. IMPLICATIONS The health ministry must move forward with implementation of this vaccine in the public sector where the burden is highest.
“..If I had an adolescent I would say she should not take PrEP”: The Influence of SocioCultural Factors and Gender Norms on PrEP Access and Utilization Among Adolescent Girls and Young Women in Mpumalanga, South Africa
Authors: Denny Mabetha, Nozipho Becker, Hannah H. Leslie, Deborah Baron, Kathleen Kahn, Sheri A. Lippman
Email: denny.mabetha@wits.ac.za
Keywords: AGYW, PrEP, HIV, South Africa, culture, social norms
Abstract:
Introduction: Adolescent Girls and Young Women (AGYW) in South Africa are disproportionately impacted by HIV. While AGYW are amenable toward PrEP, their social networks, families, and communities influence their decisions about how they engage and utilize HIV prevention services. Methods: Twenty in-depth interviews were conducted with AGYW PrEP users, healthcare workers (HCP) and community stakeholders as part of a larger study that investigated barriers and facilitators of PrEP delivery in Bushbuckridge sub-district between December 2021 and June 2022. We conducted constant comparative analysis guided by Consolidated Framework for Implementation Research (CFIR) to assess PrEP delivery and AGYW PrEP use at the intersection of social, cultural, and gender norms, and their influences on access and utilization of PrEP services among AGYW in rural communities of Mpumalanga province, South Africa. Findings: The impact of socio-cultural factors and norms were reported as major barriers to PrEP use across multiple societal structures (including clinic, home, social networks, and community). AGYW PrEP use was affected through the following mechanisms: 1) Gender norms and societal expectations regarding AGYW sexuality, 2) Misconceptions about who needs PrEP for HIV prevention, 3) HCP attitudes influenced AGYW’s PrEP engagement and delivery of services, 4) familial influence and social support, 5) Intimate relationships and power dynamics between AGYW and their sexual partners, and 6) standards regarding communication, decision making, and respect for elders. Discussion: PrEP uptake and consistent use among AGYW remain a challenge. Input from family, social networks, community members, and healthcare providers influences AGYW’s access to and use of PrEP. Implications: It is critical to adopt a multi-level approach that engages families, intimate partners, healthcare providers, and broader community structures in the design and implementation of interventions to improve PrEP use among AGYW.
The corporate political activity of national and transnational corporations in South Africa in response to the climate crisis and their considerations of non-communicable diseases
Authors: Bontle Mamabolo, Nina Abrahams, Vuyokazi Mdlungu, Awah Kum, Tchouaffi, Maylene Shung King, Elizabeth Thomas, Susan Goldstein
Email: bontle.mamabolo@wits.ac.za
Keywords: Low- and middle-income countries, urbanization, non-communicable diseases, climate crisis, corporate political activity.
Abstract:
Commercial actors, positively and negatively, influence human and environmental health, through a complex link termed ‘commercial determinants of health’. Limited evidence exists on how these unhealthy commodity industries respond to the climate crisis, and if in doing so, consider non-communicable disease (NCDs) risk factors, diet and physical activity, to shape public policies in South Africa. To assess the corporate political activity narratives and action strategies of national and transnational unhealthy commodity industries (UCIs) and to see if these lead to commercial actors’ favorable policy outcomes in South Africa. We used a four phased approach which included (1) identifying unhealthy commodity companies, (2) identifying data sources, and (3) collecting, extracting and (4) analysing the data. We collected data from publicly available sources from 01 January 2013 to 30 June 2024. We analysed the abstracted data using a taxonomy framework developed by Ulucanlar et al., 2023. Ten companies from the food and beverage, alcohol, transport and fossil fuel industries were selected. Of the 107 data records abstracted, the most common response to the climate crisis and non-communicable diseases was corporate social responsibility (n=77). This included industries’ changes to product packaging and to environmentally sustainable manufacturing processes, (n=44) and partnership with public and private sectors and non-governmental organizations (n=48). Data on industries’ engagement with policy was limited (n=6) and showed industries opposing proposed climate mitigation policies, using arguments such as job loss and preference for self-regulation. Industry also used their relationships with the public sector to circumvent existing policies (n=2). Identified CPA strategies mimic previous tactics used by commercial actors in the tobacco industry, proven circumvent NCD targeted policies. Understanding the commercial actors CPA tactics in this regard is required to help them develop an integrated approach to diet, physical activity and climate policy that are insulated from commercial interference.
Performance of COVID-19 symptom-based case definitions in detecting SARS-COV-2 infection among individuals ≥18 years in South Africa’s Pneumonia Surveillance Program, 2020-2023
Authors: Cynthia Chiedza Manabile, Jocelyn Moyes, Sibongile Walaza, Anne von Gottberg, Nicole Wolter, Mignon du Plessis, Fahima Moosa, Kathleen Kahn, Gary Reubenson, Heather Zar, Jeremy Nel, Ebrahim Variava, Halima Dawood, Mvuyo Makhasi, Thembekile Zwane, Lazarus Kuonza and Cheryl Cohen
Email: 2856065@students.wits.ac.za
Keywords: SARS-COV-2, COVID-19 case definitions, sensitivity, specificity, negative predictive value and positive predictive value.
Abstract:
INTRODUCTION Sensitive and specific case definitions (CD) are key to effective surveillance. OBJECTIVES We aimed to evaluate the performance of COVID-19 CD among individuals tested for SARS-COV-2 during the pre-Omicron and Omicron periods in the Pneumonia Surveillance Programme (PSP) in South Africa, 2020-2023. METHODS Hospitalised individuals aged ≥18 years enrolled into the PSP were included in this cross-sectional analysis based on a diagnosis of lower respiratory tract infection, irrespective of symptoms. Symptoms were compared between individuals testing SARS-COV-2 PCR-positive (cases) and negative, and by pandemic period. We evaluated the World Health Organization Severe Acute Respiratory Infections (WHO SARI), WHO COVID-19 and SA Notifiable Medical Conditions (SA-NMC) CDs to detect SARS-COV-2 infection. Analysis included sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV). RESULTS SARS-COV-2 was detected in 2,602/14,286 (18%) individuals. Cases were older (median age 56 vs 49 years) and presented <10 days from symptom onset. Loss of smell and taste were associated with cases; adjusted odds ratios (aORs) 1.6, 95% confidence interval (CI): 1.3-1.9 and 1.4, 95% CI: 1.2-1.7, respectively. The SA-NMC CD was most sensitive (83%, 95% CI: 81%-85% pre-Omicron: 69%, 95% CI: 65%-72% during Omicron), and less specific (31%, 95% CI: 29%-32% pre-Omicron: 34%, 95% CI:33%-35% during Omicron). The WHO SARI CD was more specific (73%, 95% CI: 71%-74% pre-Omicron and 76%, 95% CI:75%-77% Omicron). PPVs declined, WHO COVID-19 CD decreasing from 40% (95% CI: 38%-42%) pre-Omicron to 8% (95% CI: 7%-9%) during Omicron. NPVs increased, with WHO COVID-19 CD increasing from 74% (95% CI: 72%-76%) to 92% (95% CI: 91%-93%) across periods. DISCUSSION None of the CD performed well. Findings highlight the need to adapt case definitions in an evolving pandemic. IMPLICATIONS Updating case definitions reflecting changing symptom profiles is essential to improve case detection and guide public health responses as new variants emerge.
Arts-based community engagement boosts acceptance of the Sterile Insect Technique for malaria control in rural South Africa
Authors: Pinky N Manana, Sara Jewett, Givemore Munhenga
Email: 599225@students.wits.ac.za
Keywords: arts-based, Sterile Insect Technique, malaria, South Africa, community engagement
Abstract:
Introduction The Sterile Insect Technique (SIT) is a promising malaria vector control innovation, but its uptake depends on public understanding and support. In rural malaria-endemic areas, communication inequities persist, with conventional health messaging often failing to engage all socio-demographic groups. Arts-based community engagement (CE), through locally developed music, drama, and radio storytelling, offers a culturally resonant, participatory alternative. However, there is limited empirical evidence globally, and none in Africa, on its measurable impact on acceptance of SIT. Objective To determine whether exposure to arts-based CE was associated with improved knowledge, attitudes, and acceptance of SIT in KwaZulu-Natal, South Africa. Methods A cross-sectional survey of 614 adults collected socio-demographic data and assessed SIT-related knowledge, attitudes, and acceptance. The main exposure variable was participation in arts-based CE activities. Associations were analysed using chi-square tests and multivariate ordinal logistic regression, adjusting for age, gender, and education. Results Only 26.2% (n = 161) of participants were exposed to arts-based CE. Exposure was associated with better knowledge (correctly identifying that female mosquitoes feed on blood: 95.0% vs. 85.8%, p = 0.008) and higher acceptance of SIT (98.1% vs. 89.4%, p = 0.003). In adjusted models, exposure remained a significant predictor of SIT acceptance (aOR = 0.65, 95% CI: 0.45-0.94). Positive attitudes and accurate knowledge also independently predicted higher acceptance. Discussion This is the first empirical study in Africa to quantify the effect of arts-based CE on acceptance of a novel vector control method. Findings suggest such approaches can bridge communication gaps, strengthen informed decision-making, and promote equity in health innovation uptake. Implications Scaling arts-based CE could accelerate equitable malaria control implementation and inform policy design for other novel health interventions.
Factors influencing influenza vaccine uptake among adults in Johannesburg, South Africa: A qualitative study
Authors: Mulalo Mashamba, Tshepiso Msibi, Gugulethu Tshabalala, Lerato Tsotetsi, Stefanie Vermaak, Nellie Myburgh, Sarah Malycha, Isabella Goldstein, Elliot Grainger, Maatla Dave Temane, Takwanisa Machemedze, Kimberley Gutu, Heidi J. Larson, Catherine Hill, Ziyaad
Introduction Influenza vaccination coverage in South Africa is less than 3% among the general adult population despite its recommendations as a cost-effective measure to reduce influenza-related disease burden. Objective This study explored factors influencing influenza vaccine uptake using the World Health Organization’s Strategic Advisory Group on Immunization (SAGE) 3C model of vaccine hesitancy (confidence, complacency, convenience) Methods This qualitative study was conducted as part of the Bambisana project- a mixed-methods pretest-posttest intervention study conducted from 29 April 2023 to 15 April 2024. Participants aged ≥18 years were purposively recruited from communities within the Wits-VIDA-led Health and Demographic Surveillance System (HDSS) in Soweto and Thembelihle. Six focus group discussions (FGDs), stratified by age (≥18-34 and ≥35years) were conducted between 15 and 26 May 2023. FGDs were audio recorded, transcribed verbatim, and coded in Dedoose using Framework Analysis. Results A total of 48 participants participated in the study, most (66.7%, n=30) were aged 18-34 years, 65.9% (n=29) had completed high school, and 70.2% (n=33) were unemployed. Overall, influenza vaccine uptake was associated with three key factors: low confidence, high complacency, and a lack of convenience. Low confidence in the influenza vaccine was associated with negative experiences with COVID-19 vaccines, fear of side effects, vaccine misconceptions, fear of needles, mistrust of public health institutions, and concerns about vaccine effectiveness. Complacency factors included reliance upon traditional and alternative medicines, lack of knowledge about vaccines, and minimising the seriousness of influenza illness. Convenience factors included perceived costs of the vaccine and a lack of influenza vaccine promotion. Discussion Findings indicate that addressing confidence, complacency and convenience factors is crucial to increasing influenza vaccine acceptance and uptake in South Africa. Implications Increasing influenza vaccination in South Africa requires community engagement, convenient and affordable vaccination services. These approaches could improve vaccine acceptance, uptake, and overall public health outcomes.
Beyond checklists - innovating quality assessments by incorporating fundamental qualitative design principles
Authors: Busisiwe Precious Matiwane, Pamela Maluleke and Michelle Brear
Email: busisiwe.matiwane@wits.ac.za
Keywords: Research design principles, Research quality assessment, Qualitative methodology, Qualitative checklists
Abstract:
Introduction Public health researchers, reviewers and journal editors with limited training in, or experience using qualitative methodologies, may rely on checklists to assess the quality of qualitative research. However, checklists have been critiqued for adopting a positivist approach that is better suited to quantitative research, essentialising techniques designed for specific applications and omitting qualitative design principles. Checklists may encourage perceptions of quality that are inconsistent with qualitative research paradigms. Objective To appraise (a) the applicability of contentious items on qualitative research checklists, and (b) incorporate qualitative research fundamentals into quality assessments and develop guidance for public health researchers, reviewers and others. Methods The results were generated through a selective review of qualitative methods articles and discussions amongst members of the Wits SPH qualitative research group, within and beyond their journal club meetings, based on our review of the literature, discussions and reflection on lived experiences. Key points were synthesised. Results Qualitative research checklists often omit fundamental qualitative research design principles with universal relevance, such as acknowledging subjectivities, iteration, flexibility and open-endedness. Conversely, by including procedures with specific applications, such as returning transcripts to participants, developing coding trees, and discussing “saturation”, they imply these practices are universally required. We provide recommendations for navigating the expectations imposed on researchers by qualitative research checklists. We outline fundamental qualitative research design principles, including designing coherent qualitative research methodologies and instruments, and incorporating reflexivity, positionality and intersectionality. Discussion Incorporating fundamental qualitative research design principles within or alongside checklists is a meaningful innovation and key approach to improving quality in qualitative public health research. Providing guidance on addressing inapplicable checklist items can further enhance research quality. Implications The findings can inform quality assessment criteria development at the Wits School of Public Health, including postgraduate research proposals, while raising awareness that qualitative procedures are not universally applicable.
Examining intimate partner narratives on X: a social listening study in South Africa
Authors: Nompumelelo Mbanjwa, Sara Nieuwoudt, Mpho Silima
Email: 309871@students.wits.ac.za
Keywords: Intimate partner femicide, social listening, sentiment analysis, gender-based violence, public discourse
Abstract:
Introduction The rate of intimate partner femicide (IPF) in South Africa of 4.9 per 100,000 women in 2017 was alarmingly high compared to the global figure of 0.8 per 100,000 women in 2018. While social media platforms like X were crucial in raising awareness, they also provided a space for harmful narratives to thrive. Therefore, there was an urgent need for research to understand how the public engaged with and reacted to different messages and influencers. Such an understanding is essential for developing effective social and behaviour change communication (SBCC) interventions. Objectives This study aims to analyse the sentiment and emotional tone of IPF narratives on X in South Africa, identify key influencers, and examine public engagement patterns with IPF-related content and messaging from these influential voices. Methods This study employed a mixed-methods retrospective cross-sectional study design. Data was collected from X using a custom-built browser extension developed to scrape tweets. Relevant IPF cases were identified through a systematic search of major South African news outlets, crime documentary series, and GBV advocacy organization pages on X. From a list of 279 names, 60 cases were selected, yielding a dataset of 18,053 tweets and comments. After a two-stage cleaning process, 3,615 posts were retained for the sentiment analysis. Additionally, the top 15 victim-related and 15 perpetrator-related tweets were analysed qualitatively to identify prevalent themes and influential stakeholders. Preliminary Results Preliminary findings indicated that victim-related posts generated higher engagement and overall sentiment scores, with anger being the dominant emotion, while perpetrator-related posts were largely neutral. Narratives that blamed the victim’s actions, originating from the general public, received significant engagement. On the other hand, social media influencers and celebrities were the most influential voices, generating the most engagement for messages of outrage at the perpetrator, followed by political activists who critiqued the government for inaction on GBV.
The Cost of a Family Centered Early Childhood Intervention: Economic Costs of the HI HOPES Programme for Children with Hearing Loss in Southern Africa
Keywords: Congenital hearing loss, family-centred early childhood intervention, economic costs, early childhood development, childhood hearing loss , HI HOPES, South Africa, Sub-Saharan Africa
Abstract:
Introduction In South Africa, an estimated 6,000 infants are born annually with bilateral, permanent hearing loss. Early intervention is essential for supporting optimal linguistic, cognitive, and socio-emotional development. The HI HOPES programme is the only free, home-based early intervention service for children under 6 years with hearing loss in South Africa, supporting both children and their families. Objectives The aim of this study was to estimate the total economic and financial costs of delivering the HI HOPES programme in South Africa in 2022, and the projected costs for expanding it nationally and into Namibia, Zimbabwe, and Tanzania. Methods An ingredient-based costing approach was employed from the provider’s perspective. Cost estimates were developed for the current programme covering six South African provinces-three fully and three partially-as well as for expansion to the remaining three provinces and three sub-Saharan African countries. Results In 2022, the programme served 311 children and their families. Financial costs were R4,3 million in total, while economic costs were R5,3 million. Staff salaries (55%) were the largest cost component, followed by home intervention visits (R1,6 million) and overheads (R603 000). The projected financial and economic costs for a three-year national scale-up were R82 million and R85 million, respectively. Expansion to the three additional countries was estimated at R5,5 million. Discussion The study provides critical financial and economic cost estimates for a unique, home-based intervention model supporting children with hearing loss. These findings offer valuable insights for policymakers and public health managers aiming to enhance early childhood development and educational outcomes through scalable, family-centred interventions. Implications These findings can be used to inform budgeting and planning for support programs for children with hearing loss
Factors Associated with Cognitive Reasoning and Attention Among Adults participating in a behavioural lab study in Gauteng, South Africa: Implications for Health Behaviour
Authors: Preethi Mistri, Ross Greener, Lawrence Long, Hope Shateyi, Onthathile Maboa, Candice Chetty-Makkan, Harsha Thirumurthy
Email: Pmistri@heroza.org
Keywords: Behavioural lab, health decision-making, information processing, poverty, stressors, psychological factors, behavioural assessment
Abstract:
Introduction Poverty and other stressors influence how people focus attention and process information when making health-related choices. In South Africa, there is limited measurement of these psychological factors that influence decision-making among populations vulnerable to HIV. Objectives We recruited participants from the Indlela Behavioural-Hub to the Indlela Behavioural-Lab to measure attention, fluid intelligence and explore associated drivers of decision-making. Methods Between 2 December 2024 and 23 April 2025 we invited participants to complete computerised assessments and a socio-demographic survey. Assessments included (1) Raven’s Progressive Matrices (RPM), a non-verbal assessment of problem-solving and pattern recognition skills; and (2) Psychomotor Vigilance Task (PVT), which measures alertness and sustained attention. We generated descriptive statistics of each measure and examined associations with socio-demographic factors and HIV status. Results Among 200 participants enrolled, median age was 29 years (IQR 24-35), 53% were female, 85% had high school education, 69% received a government grant in the last month, 87% self-reported HIV-negative status, 44% were employed (57% part-time) and 41% earned a monthly income between R1,500 and R3,000. For the RPM, an average of 16 out of 24 puzzles were correctly completed (median score of 17 (IQR 14-19)). In the unadjusted analyses males scored higher than females (17 vs.15, p=0.04), and those with self-reported HIV negative status scored higher compared to those who disclosed being HIV positive (16 vs. 13, p = 0.00). PVT mean response time was 393 milliseconds (SD 206.9), no sub-group differences were observed. Discussion and Implications Results indicate key differences in abstract reasoning across gender and self-reported HIV status which may have implications for HIV prevention and treatment. As cognitive factors-such as problem-solving abilities and attentiveness-may influence how individuals assess risk, adhere to treatment, and engage with health services, future work will assess whether these measures can be used to design targeted interventions.
Title: Mapping the Prevalence and Frugal Characteristics of Healthcare Innovations
in South Africa
Authors: Kgaile Benjamin Mogoye, Prudence Ditlopo, Colin Menezes, Yasser Bhatti
Email: kmogoye@gmail.com
Keywords: National Health Insurance, frugal innovation, public healthcare, accessibility, affordability, adaptability, healthcare innovation
Abstract:
Introduction Despite significant reforms since democracy, South Africa’s healthcare system remains fragmented and under-resourced, limiting equitable access. Although the National Health Insurance (NHI) promises to bridge the gaps, the ecosystem of innovations across the public sector remains poorly documented. Existing information is siloed at different care levels, hindering a comprehensive understanding of how the healthcare system has innovated to address constraints. Objective Identifying, categorising and assessing the prevalence and frugality of public sector healthcare innovations at multiple facility types across the country. Methods A cross-sectional study involving 142 participants from 71 public healthcare facilities (Primary healthcare (PHC) clinics, hospitals and pathology laboratories). Two participants per facility independently rated their innovations on self-administered questionnaires using a 7-point Likert scale. Innovations were categorised as product, process or business model, with frugality assessed using a three-dimensional framework: accessibility, affordability and adaptability. Descriptive statistics and Chi-Square tests assessed associations and characteristics. Results A total of 201 facility-innovation instances were recorded. Product innovations were most prevalent (78), followed by business model (69) and process innovations (54). In total, 57% of innovations were frugal. Widely diffused innovations included CCMDD, POCT and HPRS. Most innovations (89%) were push-driven. Frugal innovations were found across all facility types. Discussion The study uncovered a widespread but an under-reported ecosystem of healthcare innovations with frugal characteristics, responding to affordability, accessibility and adaptability constraints. The findings can inform policy on how institutionalising frugality can advance UHC access and equity objectives. Implications • The study lays a foundation for future case studies on frugal innovations in public healthcare by offering a practical framework to classify and assess innovations by alignment with frugality dimensions • The findings highlight the policy imperative to institutionalise frugal innovation to support universal health coverage, aligning with international trends
Community drivers of maternal vaccine demand in SOWETO: qualitative insights from women and stakeholders
Introduction: Maternal immunisation can protect newborns, but uptake remains limited in many low-resource settings. Understanding community knowledge, influencers and health system challenges is essential to design demand-building strategies. Objectives: To explore knowledge, trusted information sources, and decision-making influences related to maternal immunisation among women (15-49 years) and key stakeholders in Soweto, South Africa. Methods: The Vaccine Demand mixed-methods data collection is ongoing and data presented here are interim results from the qualitative component. We conducted 11 focus group discussions with women stratified by age and pregnancy status (15-21; 22-30; 31-49 years and pregnant; infants <12 months; no children) and 20 key informant interviews with midwives, community health care providers (HCPs), religious/traditional leaders, and household decision-makers. Participants were purposively recruited through healthcare facilities and community networks. Data were analysed thematically using a rapid analysis approach. Results: Four major themes emerged: (1) Knowledge gaps and uncertainty, women expressed willingness to vaccinate but cited gaps in understanding and inconsistent communication from healthcare workers. Many preferred one-on-one education or group sessions in clinic waiting areas; (2) Influential household/community actors, Household decision-makers influenced vaccination differently by gender: male partners often accompanied women but, excluded from consultations, relied on incomplete second-hand information, while senior female relatives actively monitored care through maternal health records; (3) Trust in HCPs, among women without supportive female relatives, healthcare workers became the primary source of vaccine information, though unwelcoming clinic environments discouraged questions; (4) Practical barriers, healthcare professionals reported limited training on new vaccines. Additionally, women reported inefficiencies in the healthcare system including, restrictive ANC booking system, lack of patient-centered care and long waiting times. Discussion and Implications: Improving provider communication, involving household decision-makers, creating welcoming clinic environments, and leveraging religious/ traditional networks could strengthen maternal vaccine demand and uptake in similar settings.
Global Aspects on Topics in Healthy Aging: A Narrative Review of the Current Literature by the Consortium of Students as Stakeholders for Healthy Aging
Keywords: Healthy Aging; Policy; Social Determinants; International Collaboration; Cultural Health Norms; ICEP Global
Abstract:
Introduction: Population ageing is driving profound demographic shifts globally, presenting challenges to healthcare systems, economies, and societies. Understanding the determinants of healthy ageing is critical for shaping responsive policies and interventions. Objectives: This narrative review, conducted by a global consortium of health sciences students through the International Collaboration and Exchange Program (ICEP Global), compares healthy ageing across nine countries - Denmark, Germany, Italy, Japan, Kenya, South Africa, Taiwan, United Kingdom, and United States. The review synthesises evidence on five key determinants: socioeconomic factors, dietary patterns, health policies, physical and mental health, and community culture. It aims to identify universal trends and context-specific differences to inform future research and policy development. Methods: Literature searches conducted across PubMed and Scopus, yielded 6577 articles of which 1824 were included based on relevance. Studies focusing exclusively on the biological aspects of ageing were excluded to maintain emphasis on the aforementioned determinants. Through thematic analysis, researchers from diverse cultural and professional backgrounds ensured comprehensive coverage and inclusion of multiple perspectives. Results: Findings reveal that socioeconomic disparities, healthcare access, cultural norms, and nutrition significantly shape healthy ageing outcomes, with notable contrasts between countries. High-income nations benefit from advanced healthcare systems and structured community-based policies, while lower-income countries face challenges such as limited health infrastructure, reliance on kinship caregiving, and non-communicable disease burdens. Across all contexts, social engagement and culturally tailored support emerged as universal priorities. While global policy convergence offers opportunities for knowledge exchange, it risks deepening inequalities without locally adapted strategies. Discussions: The review underscores the need for policies that integrate global insights with contextsensitive approaches, avoiding standardised models. Strengthening social connectedness and culturally responsive care is vital for promoting healthy ageing worldwide. These findings highlight the importance of multidisciplinary, inclusive frameworks to guide research, policy, and practise in addressing the challenges of ageing populations.
Multimorbidity patterns among middle and older adults in rural South Africa: a comparative analysis of clustering methods
Authors: Rumbidzai Mupfuti, Cyril Chironda, F. Xavier Gomez-Olive, Chodziwadziwa W. Kabudula
Introduction: Multimorbidity (MM) is a growing global health challenge. MM measurement remains inconsistent, often relying on simple disease counts failing to capture complex disease patterns. Unsupervised machine learning (ML) methods are increasingly used to identify MM patterns. However, the application of ML methods is critically limited in sub-Saharan Africa (SSA) where the interplay between chronic infectious and non-communicable diseases (NCDs) creates unique multimorbidity patterns. Objectives: This study aims: 1) to characterize MM patterns using three unsupervised machine learning clustering algorithms-Latent Class Analysis (LCA), Partitioning Around Medoids (PAM), and Hierarchical Cluster Analysis (HCA), 2) to compare cluster interpretability and cross-validation performance; and 3) to examine determinants of the most robust clustering solution. Methods: We analyzed baseline data from HAALSI, a cohort study of population aged ≥40 years in rural South Africa which includes fourteen chronic conditions. Clustering algorithms were evaluated using adjusted Rand index (aRI) and predictive strength (PS) via five-fold cross-validation. Multinomial logistic regression assessed the determinants of cluster membership. Results: Prevalence for MM was 69%, with hypertension (72-78%), dyslipidaemia (52-55%), and anaemia (52-55%) being the most common conditions. PAM outperformed LCA and HCA (aRI = 0.895; PS = 0.916), identifying eight clinically meaningful clusters. Age, waist circumference, BMI, and marital status significantly predicted cluster membership. Discussion: PAM produced the most stable and granular clusters, demonstrating strong applicability and generalizability for categorical health data. The frequent occurrence of NCDs with anemia and infectious diseases underscore the need for integrated care models in SSA. Notably, a unique Anemia/Dyslipidemia cluster reveals context-specific MM patterns that may otherwise be overlooked. Implications: Comparative ML approaches enhance the understanding of MM and support targeted, context-specific healthcare interventions. Future research should incorporate broader disease profiles and longitudinal data to refine clustering approaches and inform health system planning in SSA.
Mental health patterns and associated social determinants among university and college students in Sub-Saharan Africa during the COVID-19 pandemic era: A Scoping Review
Authors: Memory Muturiki, Ntsiki Mapukata, Lawrence Chauke, Sara Jewett (Nieuwoudt)
Email: 9501266r@students.wits.ac.za
Keywords: COVID-19, student mental health, university mental health services, social determinants of health, social determinants of mental health, Sub-Saharan Africa
Abstract:
Background: While numerous studies have explored student mental health, there is a notable lack of multi-country research in Sub-Saharan Africa (SSA), particularly studies that examine the interplay between mental health patterns and social determinants. As such, this scoping review aimed to identify gaps in the existing literature that documents student mental health patterns and associated social determinants during the COVID-19 era and highlight key areas for future research within universities in the SSA region. Methods: We searched eight databases, MEDLINE (PubMed), PsycInfo, Open Access Journals, CINAHL, Google Scholar, the Cochrane Library (Ovid) and grey literature for English-language studies published from 2020-2023 in SSA. Ninety-four studies met inclusion criteria from 1,396 screened documents. Results: The 95 included studies varied widely in their examination of student mental health and associations with social determinants of health (SDoH). Most studies framed mental health in terms of mood disorders, suicidality, substance use disorders, and general psychological distress. Mood disorders (depression and anxiety) were the most reported among students with fewer studies investigating help-seeking behaviours and this maybe attributable to the COVID-19 pandemic. Reported social determinants aligned with structural factors (e.g., socioeconomic and political contexts, cultural norms, gender disparities) and intermediary factors (e.g., academic stress, access to services, material conditions, and behaviours such as substance use, physical activity, sleep, and diet). Conclusions: While numerous studies have reported on the social determinants of student mental health within SSA, none included comparable data across HEIs in the region. Most studies focused on undergraduates and medical students, with few addressing postgraduates. Future work should prioritize multi-country, comparative research across diverse SSA universities, with greater focus on help-seeking and context-specific strategies to support at-risk student populations.
Vindicating the Right to Food: Leveraging Market Inquiries as a Form of Accountability
Keywords: adequate food; competition law; food security; market inquiry; nutritious; right to food
Abstract:
Food insecurity, both in South Africa and globally, persists as a pressing challenge, with anti-competitive practices, market concentration, and inefficiencies in food supply chains impeding the realisation of the constitutional right to adequate and nutritious food. Market inquiries, which are formal investigations conducted by competition authorities to assess the state of competition in a particular sector, offer a promising mechanism to address these barriers. This study contributes to addressing these issues by exploring market inquiries as a competition law mechanism to dismantle these barriers and promote food security. Using doctrinal and desktop research methodologies, the paper examines the interplay between food security, the right to food, and the role of competition regulation. The Fresh Produce Market Inquiry serves as a focal point to demonstrate how market inquiries can uncover and address anti-competitive practices, while lessons from the Health Market Inquiry and international examples in the food sector offer comparative insights. It further draws attention to the link between food insecurity and adverse health outcomes, such as undernutrition and non-communicable diseases, thereby underscoring the public health implications of unequal food access. The results highlight that market inquiries are an effective tool to vindicate the right to food by fostering accountability, empowering civic organisations, and driving reforms to enhance equitable food access. The findings underscore competition law’s potential to address systemic inequities in food systems and provide actionable recommendations to strengthen its impact. Limitations include the evolving nature of competition policy in relation to socio-economic rights, and the need for further empirical research on the long-term impacts of market inquiries. By positioning market inquiries as a mechanism to advance the right to food, this research contributes to the broader discourse on competition law’s role in achieving social justice and ensuring a fair, sustainable food system.
Perceptions, attitudes and experiences of mental health and mental health services among adolescents in a Johannesburg high school.
Authors: Nkhluleko Ndlangamandla, Nicola Christofides and Abigail Dreyer
Email: Josh.ndlangamandla@gmail.com
Keywords: Adolescents; Perceptions and knowledge; Mental Health; Mental Health Services
Abstract:
Introduction: Adolescence is a critical stage of human development where there is a susceptibility to developing mental health disorders that last into adulthood. Socioeconomic factors such as poverty, lack of adequate resources for adolescent mental health, and poor mental health literacy hinder their overall health. Objectives: The study aimed to investigate adolescents’ understanding of mental health by assessing the adolescents’ knowledge and perceptions of mental health and mental health services, and assessing the mental health challenges experienced by adolescents. Methods: This study used an exploratory qualitative research method, using an in-depth interview guide. Purposive and convenience sampling methods were used for participant recruitment. The participants engaged in a collage/ activity after which the interview guide was implemented. Results: The adolescents’ overall understanding of mental health was low and varied along a continuum from understanding social well-being to creative and intellectual ability. The adolescents viewed mental health as a lived experience that they should manage on their own. Most adolescents had a negative association with mental health and experienced a myriad of risk factors, including, but not limited to, rape, bullying, grief, loneliness, and academic stress. Use of stigmatising and dehumanising language indicated misinformation and a negative association with mental illness and mental health care services. Discussion Knowledge of mental health is varied, and mental health services are low, which hinders access to mental health care. The lived experiences of adolescents inform their mental health and development. The inclusion of parents and teachers as stakeholders in school-based intervention strategies should be prioritised to equip them with the necessary skills to identify adolescents’ mental health struggles. Implications This research seeks to inform policy and intervention programmes that are socio-culturally relevant. Mental health programmes should be aware of the understanding of mental health, to circumvent the prevailing stigma and bolster mental health information.
The Social Determinants of Multimorbidity in Sub-Saharan Africa: a narrative review
Authors: Tariro Ndoro, Rumbidzai Mupfuti, Carren Ginsburg, F. Xavier Gomez-Olive
Email: tarirondoro@gmail.com
Keywords: rapid review, etiology, multimorbidity, sub Saharan Africa, socio-economic status
Abstract:
Introduction Sub-Saharan Africa (SSA) is currently experiencing an increase in multimorbidity (MM) prevalence, posing a threat to the already strained healthcare system. It is vital to identify social determinants of MM to tailor evidencebased interventions for MM and alleviate the strain on healthcare systems. However, there exists a paucity of SSA specific reviews. Objectives This narrative review aims to identify existing knowledge on social determinants of MM in sub-Saharan Africa. Methods PubMed, ISI Web of Science, and Scopus were systematically searched for primary studies using pre-defined search terms, including: SSA (population), risk factors/ determinants (exposure) and MM (outcome). Titles, abstracts, and full texts were independently screened by two reviewers from a pool of four. Data extraction was carried out using an Excel template and data were summarized in a narrative synthesis. The AXIS and NOS tools were used to assess risk of bias for cross sectional and cohort studies, respectively. Results The initial search yielded 2547 primary publications, and 27 of them were eligible for analysis. Reported risk factors for MM include increasing age, adverse childhood events, being divorced/widowed, food insecurity, family history of noncommunicable diseases (NCDs), race and alcohol consumption. Receiving a salary and male gender were protective against MM while educational attainment and wealth showed mixed results. Discussion Primary studies report clear relationships between physical and demographic factors and MM, while socio-economic factors present mixed associations with MM. This may be explained by complex interactions between socio-economic position and behavioural factors affecting MM incidence differently. Implications These findings provide vital evidence needed to direct programmatic interventions to tackle MM in SSA. Interventions should target particular demographics (ageing adults/women) or behaviour change (diet/smoking). Longitudinal research is required to explain more complex effects of socio-economic factors on MM development.
The Role of Comprehensive Sexual Education in the Prevention and Management of Learner Pregnancy: Experiences of Learners and Educators in Secondary Schools in Soweto, South Africa
Authors: Nokulunga Ntuli, Hlologelo Malatji
Email: 2088550@students.wits.ac.za
Keywords: Experiences, Learner Pregnancy, Secondary Schools, Sexual Education. Comprehensive Sexuality Education, Life Orientation subject.
Abstract:
Learner pregnancy remains a significant public health and social concern, with serious implications for adolescent girls’ education and life opportunities. Many learners who conceive at a young age withdraw from school, limiting future employment prospects and perpetuating cycles of poverty. Comprehensive Sexual Education (CSE) is recognised as an essential intervention, equipping learners with knowledge about contraception, pregnancy prevention, condom use, and informed sexual decision-making. Despite these benefits, barriers such as cultural and religious norms, parental resistance, and educators’ discomfort in addressing sexuality continue to undermine effective CSE delivery in South Africa. This study aimed to explore the role of CSE in the prevention and management of learner pregnancy in secondary schools in Soweto, South Africa. Specific objectives included assessing learners’ knowledge of sexual health and contraception, exploring learners’ and educators’ attitudes toward CSE, identifying delivery features that encourage participation, and examining challenges to programme implementation. A qualitative, phenomenological design was employed, using purposive sampling to recruit twenty female learners (Grades 11-12) and six Life Orientation educators from two public secondary schools. Semi-structured one-on-one interviews were conducted, and data were analysed thematically using Bronfenbrenner’s bioecological theory to interpret findings within learners’ sociocultural contexts. Results revealed that while CSE improved learners’ awareness of contraceptives and pregnancy prevention, educators’ discomfort and sociocultural taboos restricted open discussions. Consequently, learners often turned to peers and online platforms for sexual health information, which frequently resulted in misinformation. The findings highlight the need to expand teacher training, improve CSE curriculum design to encourage open dialogue, and increase collaboration with healthcare professionals to provide in-school resources. Strengthening the implementation of CSE could reduce learner pregnancy rates, enhance educational retention, and contribute to improved health and social outcomes for adolescent girls in South Africa.
Effectiveness of advertising complaints mechanisms in South Africa: Public health implications and regulatory gaps
Authors: Nosiphiwo Nzimande, Sameera Mahomedy, Susan Goldstein
Email: nosiphiwo.nzimande@wits.ac.za
Keywords: child directed marketing; NCD prevention; unhealthy food and beverages; alcohol regulation; public health law and policy.
Abstract:
There is an increasing prevalence of overweight and obesity amongst South African children, with one of the contributing elements being the marketing of unhealthy food and beverages. Marketing of unhealthy food and beverages has been associated with various negative outcomes: including increased risks for diet-related non-communicable diseases (DRNCDs), changes in children’s preferred foods and changes to overall household purchases. This study evaluates the efficacy of complaints mechanisms of different advertising regulatory bodies in South Africa regarding child-directed marketing complaints. A ‘mystery shopper’ methodology was employed to test the procedural and substantive efficacy of complaints’ mechanisms of different advertising regulatory bodies in South Africa, to protect children from harmful marketing. We identified advertisements (adverts) falling within the ambit of these bodies and proceeded to complain to them. Complaints covered adverts on television, radio, YouTube and outdoor platforms. Each process was evaluated for timeliness, accessibility, jurisdictional clarity, and substantive adjudication. The study found that the current advertising regulatory framework in South Africa is largely self-regulatory (through the Advertising Regulatory BoardARB) and operates on a voluntary basis, subsequently limiting its scope of application. Complaints procedures were often cumbersome, with delays, incorrect referrals, inconsistent procedural requirements, and fragmented jurisdiction between bodies. None of the problematic cases were satisfactorily resolved. Substantively, the ARB applied a narrow “specifically directed to children” test, overlooking evidence that mere exposure influences behaviour, particularly among adolescents. Contrasting case outcomes with public health campaigns revealed asymmetries in evidentiary standards, with public health messages held to a stricter scrutiny than commercial advertising. These patterns reflect the structural conflicts of interest inherent in self-regulation. The current self-regulatory framework is procedurally inefficient, substantively inconsistent, and structurally biased, limiting its ability to protect children from harmful marketing. A centralised complaints body with statutory backing is recommended to ensure accountability, accessibility, and effective enforcement.
Malaria Prophylaxis Amongst Sickle Cell Patients In Southwest Nigeria: An Assessment Of Knowledge, Practice And Impact
Authors: Ochuko Maureen Orherhe, , Samuel Oloruntoba Salami
Introduction and Objectives Malaria has continued to challenge the Nigerian health system, posing a significant threat to all. Its co-existence with sickle cell disease (SCD) in individuals living with SCD calls for yet a greater concern for public health, as it worsens the rates of mortality and morbidity in sickle cell patients, thereby making the need for prophylaxis paramount in this population. This study aimed to assess the current trends in knowledge, practice, and impact of malaria prophylaxis amongst sickle cell patients in southwest Nigeria. Methods A cross-sectional study of 175 sickle cell patients in South-Western Nigeria. Participants were sourced from sickle cell support groups using the convenience and snowball sampling methods. Data were collected with a structured questionnaire; with descriptive (frequencies and percentages) and inferential statistics (Chi-square, Kruskal-Wallis, and Mann-Whitney) carried out in the SPSS V26 at a level of significance of 0.05. Results About half of the respondents, (49.7%), were found to have excellent knowledge of malaria prophylaxis. Very few of the participants; 17.1% and 6.3%, were adherent to prophylactic antimalarial in the last week and month, respectively, indicating a low level of adherence in stark contrast to the high level of knowledge recorded. Majority, 69.1%, of respondents reported being infected with malaria in the last three months. Significant associations were observed between knowledge score and gender (p-value = 0.041), and between knowledge score and educational level (p-value = 0.020). Discussion and Implications Contrary to the sound level of knowledge observed among sickle cell patients in South West Nigeria, this did not translate into good adherence levels to malaria prophylaxis, as evidenced by high levels of hospitalisation due to malaria infection. Barriers such as forgetfulness, inaccessibility, and side effects were reported to limit adherence levels. Therefore, these barriers should be tactically addressed for better outcomes.
Trends and determinants of public healthcare dissatisfaction among youth in Gauteng Province
Authors: Thulani Sherperd Ramotsoka
Email: ramotsokathulani@gmail.com
Keywords: Determinants of public healthcare dissatisfaction
Abstract:
The burden of Disease among South African youth is high. However, data are weak, and little is known about how people in the perceive their health or their health care. Globally, patient satisfaction is considered an important aspect which shapes the equality of health system reforms and healthcare service delivery. Hence, this paper seeks to determine trends and socio-demographic factors associated with public healthcare dissatisfaction among youth in Gauteng Province 2015-2021. Methodology This was a quantitative study which utilised cross sectional data obtained from the Gauteng City-Region Observatory`s (GCRO`s) Quality-of-life survey. This is a biennial survey conducted to measure the quality of life among residents of the Gauteng region since 2009. Key themes included in the survey are infrastructure, dwelling, health, socio-political attitudes, and global life satisfaction. Data for 11 146 males and females from ages 18-34 who use public healthcare facilities. Stata version 18 was used to analyse the data at three levels. Descriptive statistics was used at the univariate level and binary logistic regression was used to examine the association between the outcome variable, public healthcare dissatisfaction and multiple predictor variables. Results Of the 11,146 young people sampled, over 33% expressed dissatisfaction with public healthcare. This represents an increase in dissatisfaction from 27.19% in 2014/15 to 44.09% in 2020/21. A clear sex differential exists, the prevalence of dissatisfaction was 39.8% for males and 60.2% for females. Binary logistic regression analysis revealed that females were 23% more likely to be dissatisfied with public healthcare than males (OR = 1.23, 95% CI: 1.13-1.33). Interestingly, those with low income were 16% less likely to be dissatisfied than those with no income (OR = 0.84, 95% CI: 0.71-0.98).
Conclusion There are sex differentials with regards to public healthcare dissatisfaction, with factors such as education, medical aid and perceived health status influencing dissatisfaction.
Non-optimal indoor temperatures measured in informal dwellings during cold months in Johannesburg, South Africa: implications in a changing climate
Keywords: Environmental health; Housing; Low-income communities; Public health; Temperature extremes; Thermal comfort
Abstract:
Background Exposure to non-optimal temperatures is associated with adverse health outcomes. Low-income communities living in informal housing (colloquially called shacks) are vulnerable to the negative health outcomes associated with non-optimal temperatures given the characteristics of their dwellings. Objective The study aimed to measure wintertime temperatures in shacks in Bekkersdal, West Rand District Municipality (South Africa). Methods iButtons were installed in 10 shacks for 13 days to measure temperature at 10-min intervals. Ambient outdoor temperature data were collected for the same period as the dwelling temperature campaign from the nearest automatic weather station operated by the South African Weather Service. A questionnaire was administered to 127 shack residents to determine household socio-demographics (participant age/gender; number living in dwelling; and length of stay in dwelling) and dwelling characteristics (type of wall/floor; presence/absence of insulation; energy used for heating). Results Indoor temperatures ranged between 3 °C-33 °C (mean: 13 °C, median 12 °C). Daily mean indoor temperatures for all shacks combined were below the World Health Organization threshold for minimum indoor temperature of 18 °C for 94 % of the study duration. Indoor temperature increased as outdoor temperatures increased and this association was statistically significant (R = 0.98, p < 0.001). The majority of shacks (n = 108, 85 %) were made from corrugated iron sheeting and had no insulation hence the strong correlation between indoor and outdoor temperatures. Conclusions The poor insulation of shacks exposes residents to cold outdoor temperatures. Thus, people living in shacks are vulnerable to the adverse health effects associated with extreme cold. Guidance on how to create thermally efficient shacks with insulation is recommended as a temporary solution. However, the main goal should be to replace shacks with adequate formal, low-cost housing, which the government should provide.
Health capability deprivations associated with USAID’s closure in an urban Swati communitya participatory ethnography
Keywords: Health capabilities Resilience USAID’s closure Vulnerable groups
Abstract:
Introduction The closure of USAID resulted in numerous programs intended to benefit marginalised people in Africa, shutting down. The impacts, which are assumed significant, are poorly understood, which impairs effective policy and program responses. Objective To document policy relevant insights about the impact of USAID’s closure in an urban township in Eswatini. Methods Data are being collected by community co-researchers, through ongoing participatory ethnography, incorporating participant observation and individual interview methods. About 20 participants aged >12 years, who were impacted by USAID’s closure, will be followed for 6-12 months, and/or formally interviewed. Ongoing data analysis will employ within and between case, thematic approaches, informed by health capability theory, which defines 10 capabilities that constitute health. Results To date, eight female participants (sex workers, women caring for vulnerable children and would-be entrepreneurs) have been recruited. Reported impacts, including difficulty accessing health services and supplies for soup kitchens, and loss of hope, school fee payments and income are deprivations of health capabilities (e.g. for life, bodily and emotional health). Participants have demonstrated resilience, withstanding the shock of sudden program closures and related health capability deprivations, by drawing on community-based social networks. However, the temporary “fixes” participants have arranged (e.g. begging for or borrowing money or food) are unsustainable and further undermine health capabilities (e.g. mutuallyrespectful affiliation). Discussion Significant negative impacts, which represent health capability deprivations and disproportionately affect women, have resulted in the Swati study community, from USAID’s closure. The negative impacts occur partly because USAID programs did not develop instrumental health capabilities, such as political control, that addressed the structural roots of problems like hunger and unemployment. Implications Development aid is urgently needed to fill the gaps created by USAID’s closure. Future programming should prioritise long term sustainability by developing health capabilities that have intrinsic and instrumental value.
Understand Barriers to HIV testing Among Pregnant women in Soweto, Johannesburg: A Socio-Ecological Model
Authors: Lunghile Shivambo, Shabnam Shaik and Lerato Ntsie
Introduction: Vertical transmission of HIV remains a major obstacle to maternal and child health in high-burden settings. Early maternal HIV diagnosis is crucial for timely antiretroviral therapy initiation and prevention of transmission during pregnancy, childbirth, and breastfeeding. Objectives: This study explored barriers to HIV testing uptake among pregnant women attending antenatal care (ANC) in Soweto, Johannesburg. Methods: A qualitative design was used, with in-depth interviews conducted with ten adult women who had accessed ANC services. Data were analysed thematically using Atlas.ti 23. Results: Barriers were identified across multiple socio-ecological levels. At the individual level, fear of testing and its outcomes limited participation. Interpersonal relationships, particularly with partners and family, influenced decision-making. Institutional challenges included negative healthcare provider attitudes, lack of privacy, and insufficient counselling. Community-level stigma and discrimination further deterred testing, while systemic gaps in policy enforcement constrained access to services. Discussion: HIV testing decisions among pregnant women are shaped by a complex interplay of individual, social, institutional, and systemic factors. These findings underscore the importance of understanding multi-layered influences to improve healthcare access and utilization. Implications: Targeted, multi-level interventions are urgently needed to address structural, social, and personal barriers to HIV testing. These insights can inform policymakers, healthcare providers, and public health stakeholders to strengthen maternal HIV prevention strategies and enhance ANC service delivery
Caregiver and child factors affecting utilization of dental services in preschool children aged 3-5 years in Ibadan, Nigeria.
Authors: Adeola T. WILLIAMS, Clara A. AKINYAMOJU Obafunke O. DENLOYE Joel O. WILLIAMS
Email: awilliams@cartafrica.org
Keywords: Preschool children, dental visit, caregivers, perceived need, normative needs
Abstract:
Introduction Utilization of dental services among preschool children in Nigeria has been reported to be low, and majority of dental visits are symptom-based. Therefore, there is a need to assess factors that affect utilization of dental services among preschool children. Objective To assess the caregiver and child factors that affect dental services utilisation among preschoolers aged 3 to 5 year old in Ibadan, Nigeria Methods This was a cross-sectional study conducted among 430 preschool children and their caregivers, in Ibadan, south-western Nigeria. Data was obtained from the parents/guardians using a self-administered questionnaire. Child and caregiver related predisposing, enabling and illness/need factors adapted from Andersen and Neumann’s theoretical framework were explored. Mean and standard deviation were used to summarize the ages of the caregivers and preschoolers, while percentages were used for gender, utilisation of dental services, perceived and normative needs. Bivariate analysis was done with chi-square to determine the factors associated with dental utilization. Data analysis was done using SPSS 23.0. Result The mean age of the preschool children was 4.29±0.75, while that of their caregivers was 38.2±7.3 years. Only 21 (4.9%) of the preschoolers had ever visited the dentist. Furthermore, a higher proportion, 13(13.3%), of preschoolers whose caregivers perceived they had oral health needs had visited the dentist compared with those whose caregivers did not think their children had any oral health needs, and this association was found to be statistically significant. (p <0.001) None of the other explored factors was found to be associated with dental utilization. Discussion Utilisation of dental services among preschoolers in Ibadan, Nigeria is very low. Caregiver sociodemographic factors and presence of normative oral health needs did not affect utilization. Implication There is a need to explore the influence of other factors such as caregivers’ oral health knowledge, cultural norms and beliefs on utilization of dental services by preschoolers.
The ACTION Study: Addressing global inequities in breast cancer genetic testing, counselling, and management among breast cancer patients in Nigeria
Authors: Funmilola Olanike Wuraola, Jenine Ramruthan, Nneka Sunday-Nweke, Olayide Sulaiman Agodirin, Olusegun Isaac Alatise, Andrea Covelli, Anna Dare, Sharif Folorunso, Michelle Jacobson, Colleen Kerrigan, Saheed Lawal, Ogechukwu Nwafor, Olalekan Olasehinde
Introduction: Breast cancer (BC) is a significant health challenge in Nigeria, characterized by early onset, late-stage diagnosis, and high prevalence of triple-negative tumors. Survival outcomes are significantly worse compared to North America (43.6% vs 90%). Germline BRCA1 and BRCA2 pathogenic variants are markedly higher, reported at 7.0% and 4.1% respectively, compared to 1.4% and 2.6% among Black patients in North America. While genetic testing and counselling are widely accessible in North America to assess lifetime cancer risk and guide management, access in Nigeria remains extremely limited. Objectives: This pilot study aims to assess the feasibility of BRCA1/2 genetic testing in Nigeria. Methods: This prospective study enrolled 100 patients, aged 18-60 years, with newly diagnosed invasive BC from three tertiary hospitals in Nigeria (North Central, Southwest, and Southeast). Saliva samples were collected at enrollment and processed for BRCA1/2 germline analysis by a third-party testing provider. All participants received pre- and post-test genetic counselling from trained providers, culturally tailored patient education, and personalized follow-up care to discuss results, familial implications, and risk management. Primary endpoints included BRCA1/2 prevalence, changes in clinical management based on genetic results, and patient-reported outcomes. Results: All participants received BRCA1/2 results within a three-week turnaround. Pathogenic variants in BRCA1/2 were identified in 16% of patients; 80% tested negative and 4% had a variant of uncertain significance (VUS). Initially 15 samples failed due to insufficient DNA concentration or specimen quality issues, but retesting was successful. Among BRCA-positive patients with localized disease, genetic results guided risk-reducing surgery: four underwent bilateral mastectomy, two unilateral mastectomy, and two bilateral oophorectomies. Two patients discontinued treatment. Discussion: This study is the first of its kind in Nigeria, offering genetic testing and yielding real-time results used in clinical decision making. Implications: This study underscores the importance of global, multidisciplinary collaboration in addressing disparities in cancer care.
