Research Articles (School of Health Systems and Public Health (SHSPH))

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Celebrating a quarter-century of the UP School of Health Systems and Public Health (SHSPH)
(South African Medical Association, 2024-06) Ayo-Yusuf, Olalekan Abdulwahab; lekan.ayo-yusuf@up.ac.za
No abstract available.
Assessing awareness and treatment knowledge of preventable blindness in rural and urban South African communities
(South African Medical Association, 2024-06) Kiva, Z.; Wolvaardt, Jacqueline Elizabeth (Liz)
BACKGROUND : Preventable blindness is a global public health problem. In South Africa (SA) the prevalence of blindness is increasing, with a higher proportion of cataracts than the global norm, and a large rural population with limited access to specialised eye-care services. OBJECTIVE : To determine the level of knowledge regarding preventable blindness and treatment options within a rural and urban population. SETTING : Rural and urban areas in the Eastern Cape, SA. METHODS : A descriptive cross-sectional study was conducted among 309 participants. Questionnaires were administered by fieldworkers at the different sites. Proportions were calculated and χ2 tests done to determine whether there was any significant relationship between the categorical variables. Data analysis was done using Stata version 15. RESULTS. Participants were almost equally distributed among the urban (49.2%) and rural areas (50.8%). Both groups had a similar composition of males and females. Most participants had completed high school. The results showed a statistically significant difference between the urban and rural participants' knowledge about the causes of blindness: refractive error χ2 (1, N=30) = 8.20, p<0.05, and cataract χ2 (1, N=28) = 8.64, p<0.05. The top two differences in the views between urban and rural participants regarding symptoms associated with eye problems (p<0.05) were: 'people who need spectacles have double vision', χ2 (1, N=122) = 28.19; and 'people who need spectacles squint their eyes', χ2 (1, N=124) = 17.37. The majority of urban participants reported opting to go to a private optometrist for eye health services, while the majority of rural participants would go to a pharmacy. Both groups were aware of the role of ageing in blindness. CONCLUSION : Urban participants in this study appeared to be more knowledgeable than rural participants about the causes and symptoms of blindness and its treatment options. These findings should provide some value to those who provide primary healthcare services in rural areas as there is a clear opportunity for patient education and health promotion regarding the causes and symptoms of these common preventable causes of blindness. Addressing this knowledge gap regarding the causes and symptoms of blindness and the treatment options is a critical first step for awareness programmes in rural areas. Without this, there will be little demand for any treatment or service. Future studies are needed to understand which health promotion interventions are effective in preventable blindness in rural populations.
An investigation of factors associated with antenatal care attendance in Gauteng in 2015
(South African Medical Association, 2024-06) Mostert, J.; Webb, Elizabeth M.; Girdler-Brown, B.V. (Brendan); Ngcobo, Sanele
BACKGROUND : Many studies have shown that South African women tend to initiate antenatal care late in their pregnancies. This presents challenges in the provision of quality healthcare to both mother and child. There are several studies on the social and cultural reasons for late booking. However, understanding the factors in a woman's choice to initiate antenatal care is important in informing healthcare strategies and policies. METHODS : This study was an analytical cross-sectional study of household and general health factors associated with attendance of antenatal care by pregnant women in Tshwane in 2015. It was a secondary data analysis from complete data sampling households registered on AitaHealth™. Univariate and multivariate logistic regression was used to assess which factors are associated with antenatal care attendance. RESULTS : The age of the head of the household was a significant factor in the attendance of antenatal care. The odds of attending antenatal care were 3.3, 2.1 and 1.8 times higher in households where the head of the household was 30 - 39 years of age, 20 - 29 or 40-49 years of age, respectively, than when between 10-19 years of age. Factors that increased the odds of attending antenatal care were living in households that had electricity and piped water, and running a business from home. Residing in a permanent dwelling and being food secure increased the odds of antenatal care attendance. CONCLUSION : The identified health and household factors should inform policies and programmes geared towards improving services around antenatal care provision.
Just energy transition from coal in South Africa : a scoping review
(Elsevier, 2025-05) Patrick, Sean Mark; Shirinde, Joyce; Kgarosi, Kabelo; Makinthisa, Takalani; Euripidou, Rico; Munnik, Victor; sean.patrick@up.ac.za
BACKGROUND : South Africa’s just energy transition (JET) aims to reduce coal dependency and shift toward a low-carbon, sustainable energy framework. However, achieving this goal requires addressing the socio-economic, health, and environmental burdens that coal dependency has placed on communities, particularly in regions like Mpumalanga. Integrating principles of social and restorative justice is essential to ensure an equitable transition. OBJECTIVE : This scoping review examine how South Africa's policymaking, regulatory frameworks, and public participation in the JET align with principles of social and restorative justice and global energy transition frameworks. METHODS : A systematic literature search was conducted across Scopus, Web of Science, and PubMed to identify relevant studies on energy transition and justice frameworks. Network analysis was employed to compare South Africa’s JET strategies with global trends, focusing on indicators related to health, environmental, and socio-economic impacts. RESULTS : Findings reveal significant challenges in South Africa’s JET, including regulatory limitations, stakeholder conflicts, and gaps in policy alignment with community needs. Although efforts to incorporate justice principles are emerging, disparities in policy implementation suggest the need for more tailored, inclusive approaches. Network analysis identified both overlaps and gaps between South Africa’s JET policies and international frameworks, particularly in areas of public health and social equity. CONCLUSION : To achieve a balanced and inclusive energy transition, the study recommends strengthening regulatory coherence, enhancing public engagement, and implementing concrete actions for social and restorative justice. Aligning domestic policies with international commitments while addressing local socio-economic conditions is critical for South Africa’s JET to serve as a model for coal-dependent economies globally.
Prevalence of lower back pain and associated workplace and ergonomic factors among mineworkers in a nickel mine, Zimbabwe
(MDPI, 2024-09-16) Zenda, Kumbirai P.; Rathebe, Phoka C.; Moto, Tshepo Paulsen; Masekameni, Daniel M.; Mbonane, Thokozani P.
Lower back pain is a common occurrence among mine workers due to the nature of their work. Globally, workplace (occupational) and ergonomic risk factors have been reported to influence the prevalence of lower back pain among workers. This study aimed to determine ergonomic risk factors associated with lower back pain and associated risk factors (workplace and ergonomics) among mineworkers in a nickel mine in Zimbabwe. A cross-sectional study design was employed, and participants were randomly selected to complete a questionnaire that included the Dutch Musculoskeletal Questionnaire (DMQ). A total of 420 mine workers were interviewed, with the majority being male (n = 259, 61.7%) and aged between 31 and 44 years old (n = 159, 37.9%). The study found that the prevalence of lower back pain was 41.43% (n = 174). Several risk factors were found to be associated with lower back pain, including working overtime (AOR = 1.13, p < 0.01; 95% CI: 0.07–0.22), performing repetitive tasks (AOR = 8.06, p < 0.01; 95% CI: 4.67–13.93), bending (AOR = 7.77, p < 0.01; 95% CI: 3.97–15.22), and twisting (AOR = 3.32, p < 0.01; 95% CI: 1.83–6.03). Based on these findings, it is recommended that an ergonomic risk assessment and prevention program be implemented, which should include educational awareness about lower back pain and its prevention among mine workers.
High burden of abnormal cervical smears in South African primary health care : health programmes implications
(Oxford University Press, 2025-02) Omole, Olufemi B.; Francis, Joel M.; Musonda, John M.; Sodo, Pumla P.; Reji, Elizabeth; Phukuta, Nyundu S.J.; Mabuza, Honey L.M.; Musonda, Joyce Sikwese; Akii, Jimmy; Ndimande, John V.; Ayo-Yusuf, Olalekan Abdulwahab
Cervical cancer is the second most common malignancy among South African women and the load of abnormal cervical smears has clinical, programmatic and policy implications. This cross-sectional study of women who presented for cervical cancer screening aimed to determine the prevalence of abnormal cervical smears and associated factors in primary health care (PHC) facilities in Gauteng—the most densely populated province in South Africa. A questionnaire collected data on socio-demography, tobacco use, sexual behaviours, HIV status, past treatment for sexually transmitted infections (STI) and cervical cancer screening in the past 10 years. Cytology reports were extracted from the laboratory reports. Of 749 participants, most were black (89.7%), aged 30–49 years (62.2%), single (57.5%) and attained high school education (76.8%). About 43.9% were HIV positive with almost all (97.2%) on antiretroviral therapy. Cytology results were available for 612 (81.9%) participants. Of these, 25.8% (159) were abnormal: 13.2% low-grade squamous intraepithelial lesion; 5.7% atypical squamous cells of undetermined significance and 4.9% high-grade squamous intraepithelial lesion. In bivariate and multivariable analysis, abnormal cervical cytology was not associated with any sociodemographic characteristics, HIV status, tobacco use status, sexual behaviours or past treatment for STI. In conclusion, the prevalence of abnormal cervical smears is high across all demographic groups and irrespective of HIV status and highlights the need to increase screening uptake, including advocacy for self-sampling. It also calls for capacity building to allow for the devolution of some downstream clinical care from specialist to district hospitals and large PHC facilities.
Advancing sustainable HIV services through integration in primary healthcare in Sub-Saharan Africa : a perspective on practical recommendations
(MDPI, 2025-01) Dzinamarira, Tafadzwa; Rwibasira, Gallican; Mwila, Loveday; Moyo, Enos; Mangoya, Derek; Moyo, Perseverance; Oladele, Edward; Akinjeji, Adewale; Chimene, Munashe; Muvunyi, Claude Mambo
Sub-Saharan Africa continues to bear a disproportionate burden of the global HIV epidemic. Integrating HIV services into primary healthcare is a crucial strategy to accelerate progress towards ending the epidemic. However, several challenges hinder effective integration, including underfunding, human resource shortages, infrastructure limitations, weak health systems, and sociocultural factors. With this perspective, we discuss strategies to address these challenges. A comprehensive, multi-faceted approach is necessary to overcome these barriers. Investing in human resources, improving infrastructure, and strengthening health information systems are essential for strengthening the health system. Implementing patient-centered care, integrated service delivery models, and community engagement can optimize service delivery. Utilizing digital health tools, such as mobile health applications and electronic health records, can enhance service delivery and data management. Mobilizing for an increase in domestic resources, aligning donor funding, and using cost-effective approaches are crucial for effective financing. Finally, robust monitoring and evaluation systems are necessary to track progress, identify challenges, and inform decision-making. With these strategies, among many others, sub-Saharan African countries can significantly improve the integration of HIV services into primary healthcare, leading to better health outcomes for people living with HIV and more sustainable HIV programs.
Scaling up mental health interventions for people living with HIV in Zimbabwe : evidence for integration into differentiated service delivery programmes
(Cambridge University Press, 2024-12) Mangezi, Walter; Mapingure, Munyaradzi; Dzinamarira, Tafadzwa; Chingombe, Innocent; Makoni, Tatenda; Mpofu, Amon; Musuka, Godfrey
No abstract available.
Validation of screening instruments for alcohol and substance use disorders among men and women in Eastern Cape, South Africa
(Elsevier, 2025-03) Stockton, Melissa A.; Mazinyo, Ernesha Webb; Mlanjeni, Lungelwa; Ngcelwane, Nondumiso; Nogemane, Kwanda; Nobatyi, Phumza; Sweetland, Annika C.; Basaraba, Cale; Greene, M. Claire; Bezuidenhout, Charl; Grobler, Christoffel; Wall, Melanie M.; Medina-Marino, Andrew; Wainberg, Milton L.
INTRODUCTION : Valid Alcohol Use Disorder (AUD) and Substance Use Disorder (SUD) screeners are needed to identify and link people to services. We evaluated the performance of several AUD and SUD screeners in South Africa using the Mini International Neuropsychiatric Interview (MINI)-5 diagnostic gold standard. METHODS : Adults at primary and tertiary care facilities in Buffalo City Metro, South Africa, were screened by research assistants using the AUDIT and AUDIT-C (AUD), DAST-10 (SUD) and NIDA Quick Screen (AUD and SUD). Nurses administered the MINI-5 to identify AUD and SUD. We assessed the internal consistency, criterion validity, sensitivity and specificity of these tools, stratified by gender. RESULTS : Among 1885 participants, the prevalence of AUD and SUD were 9.5 % and 1.6 %, respectively. All tools demonstrated adequate internal consistency and criterion validity. A positive AUDIT screen (men: ≥8; women: ≥7) yielded sensitivity/specificity of 70.6/87.3 % (men: 78.7/82.6 %; women: 64.8/89.8 %). A positive AUDIT-C screen (men: ≥4; women: ≥3) yielded sensitivity/specificity of 66.1/82.0 % (men: 64.0/78.8 %; women: 67.6/81.3 %). Endorsing the NIDA alcohol use question yielded sensitivity/specificity of 71.1/68.1 % (men: 74.7/59.7 %; women: 68.6/72.5 %). Endorsing either NIDA substance use questions yielded sensitivity/specificity of 80.6/91.7 % (men: 80.8/89.0 %; women: 80.0/93.1 %). A DAST-10 cut-off of ≥ 3 yielded sensitivity/specificity of 71.0/96.0 % (men: 73.1/83.7 %; women 60.0/97.4 %). CONCLUSIONS : The AUDIT and AUDIT-C performed similarly among men and women, although lower cut-offs may optimize performance among women. The low number of SUD cases hampered our ability to draw conclusions about the SUD screeners’ performance.
The germline and somatic origins of prostate cancer heterogeneity
(American Association for Cancer Research, 2025-05) Yamaguchi, Takafumi N.; Houlahan, Kathleen E.; Zhu, Helen; Kurganovs, Natalie; Livingstone, Julie; Fox, Natalie S.; Yuan, Jiapei; Sietsma Penington, Jocelyn; Jung, Chol-Hee; Schwarz, Tommer; Jaratlerdsiri, Weerachai; Van Riet, Job; Georgeson, Peter; Mangiola, Stefano; Taraszka, Kodi; Lesurf, Robert; Jiang, Jue; Chow, Ken; Heisler, Lawrence E.; Shiah, Yu-Jia; Ramanand, Susmita G.; Clarkson, Michael J.; Nguyen, Anne; Espiritu, Shadrielle Melijah G.; Stuchbery, Ryan; Jovelin, Richard; Huang, Vincent; Bell, Connor; O'Connor, Edward; Mccoy, Patrick J.; Lalansingh, Christopher M.; Cmero, Marek; Salcedo, Adriana; Chan, Eva K.F.; Liu, Lydia Y.; Stricker, Phillip D.; Bhandari, Vinayak; Bornman, Maria S. (Riana); Sendorek, Dorota H.S.; Lonie, Andrew; Park, Daniel J.; Hovington, Helene; Kerger, Michael; Bergeron, Alain; Sabelnykova, Veronica; Seo, Ji-Heui; Pomerantz, Mark M.; Zaitlen, Noah; Waszak, Sebastian M.; Gusev, Alexander; Lacombe, Louis; Fradet, Yves; Ryan, Andrew; Kishan, Amar U.; Lolkema, Martijn P.; Weischenfeldt, Joachim; Tetu, Bernard; Costello, Anthony J.; Hayes, Vanessa M.; Hung, Rayjean J.; He, Housheng H.; McPherson, John D.; Pasaniuc, Bogdan; Van der Kwast, Theodorus; Papenfuss, Anthony T.; Freedman, Matthew L.; Pope, Bernard J.; Bristow, Robert G.; Mani, Ram S.; Corcoran, Niall M.; Reimand, Jueri; Hovens, Christopher M.; Boutros, Paul C.
Newly diagnosed prostate cancers differ dramatically in mutational composition and lethality. The most accurate clinical predictor of lethality is tumor tissue architecture, quantified as tumor grade. To interrogate the evolutionary origins of prostate cancer heterogeneity, we analyzed 666 prostate tumor whole genomes. We identified a compendium of 223 recurrently mutated driver regions, most influencing downstream mutational processes and gene expression. We identified and validated individual germline variants that predispose tumors to acquire specific somatic driver mutations: these explain heterogeneity in disease presentation and ancestry differences. High-grade tumors have a superset of the drivers in lower-grade tumors, including increased frequency of BRCA2 and MYC mutations. Grade-associated driver mutations occur early in tumor evolution, and their earlier occurrence strongly predicts cancer relapse and metastasis. Our data suggest high- and low-grade prostate tumors both emerge from a common premalignant field, influenced by germline genomic context and stochastic mutation timing. SIGNIFICANCE : This study uncovered 223 recurrently mutated driver regions using the largest cohort of prostate tumors to date. It reveals associations between germline SNPs, somatic drivers, and tumor aggression, offering significant insights into how prostate tumor evolution is shaped by germline factors and the timing of somatic mutations.
Young women's perspectives on a user-friendly self-sampling intervention to improve the diagnosis of sexually transmitted infections in underserved communities in KwaZulu-Natal, South Africa
(BioMed Central, 2025-05) Jaya, Ziningi Nobuhle; Mapanga, Witness; Mashamba-Thompson, Tivani Phosa; u21848522@tuks.ac.za
INTRODUCTION : Young women are disproportionately affected by sexually transmitted infections (STIs), especially in the KwaZulu-Natal province of South Africa thus the need for availability and accessibility to STI healthcare services. The main objective of this study was to collaborate with young women, using a nominal group technique (NGT), to identify barriers to existing STI healthcare services to ultimately identify strategies to inform attributes for a discrete choice experiment (DCE) towards developing a user-friendly self-sampling intervention for STI diagnosis in young women. The NGT was underpinned by the theoretical domains framework to identify and analyse factors that influence healthcare seeking behaviour. METHODS : Eight young women, aged 18-24 years, were purposively selected from primary healthcare clinics in underserved communities. An NGT was conducted comprising the following steps: silent generation where individuals considered and recorded their responses to a question; round-robin sharing, recording and discussion of individual responses; followed by ranking of contributions. Thematic analysis was used to analyse data. RESULTS : The following barriers to accessing STI healthcare services were identified: the clinics were too far from home; young women feared judgement by clinic staff; young women feared being told to inform their partners; clinic hours clashed with school hours and other personal commitments; and young women did not know enough about the signs and symptoms of STIs. The following strategies to improve access to STI healthcare services were suggested: campaigns to promote self-sampling; self-sampling kits should be available free of charge; an online system to assess symptoms and register to receive self-sampling kits via delivery or collection to accommodate people with disabilities. CONCLUSION : The strategies identified informed the attributes for the DCE which is aimed towards the development of a user-friendly self-sampling intervention for STI diagnosis in young women in KwaZulu-Natal.
Enhancing HIV self-testing uptake among university students in Rwanda : the proportion, barriers, and opportunities
(BioMed Central, 2025-03) Mukashyaka, Ritah; Kaberuka, Gerald; Favina, Alain; Lutasingwa, Dan; Mulisa, Fred; Turatsinze, Everest; Karanja, Ann; Kansiime, Deborah; Niyotwagira, Egide; Ikuzo, Basile; Kaggwa, Mark Mohan; Kagaba, Aflodis; Mathebula, Evans Mantiri; Rwibasira, Gallican N.
INTRODUCTION : University students in Rwanda are at high risk for HIV, yet they have a low uptake of HIV self-testing, which is crucial for HIV diagnosis and prevention. This study investigated their knowledge, behaviors, and perceptions towards HIV self-testing, highlighting the barriers and opportunities whose consideration is necessary for the improvement of HIV self-testing uptake in this population. METHOD : A concurrent mixed-method design was used, and it involved 424 students from five universities across Rwanda. Quantitative data was collected through surveys, and descriptive statistics were performed. Chi-square tests were performed, and sociodemographic variables were stratified against the awareness of HIV self-testing and HIV self-testing for the past 12 months variables. Qualitative data was collected through in-depth interviews and focus group discussions using interview guides developed based on the Health Belief Model (HBM) framework; data was then analyzed thematically. RESULTS : The mean age was 23 (IQR: 21; 24), with 51.2% (n = 214/424) females. 64.7% (n = 261/424) of students had never heard of HIV self-testing, yet 37.74% (160/424) were sexually active. Among sexually active students, 17.87% were aware of HIV self-testing, but 35.82% had never used it. The reported perceived HIV self-testing barriers include high cost, unavailability of testing kits, lack of awareness, misinformation, and absence of post-test counseling. However, some HIV self-testing opportunities, like the availability of testing kits and motivating factors for university students to test, were also reported. CONCLUSION : Although university students reported the needs and benefits of HIV self-testing, uptake remains low due to misinformation, unawareness, unavailability, and the high cost of HIV self-testing kits. Increasing awareness, availing HIVST kits, and addressing the other reported barriers to HIV self-testing, is essential for the achievement of the universal goal of HIV status awareness among university students.
Correspondence on 'Increasing awareness and surveillance of sexually transmitted infections among adolescents is an essential element of HIV epidemic control in sub-Saharan Africa' by Murewanhema et al.
(BMJ Publishing Group, 2025-03) Murewanhema, Grant; Moyo, Enos; Dzinamarira, Tafadzwa
No abstract available.
The effectiveness of an m-health intervention on the sexual and reproductive health of in-school adolescents : a cluster randomized controlled trial in Nigeria
(BioMed Central, 2024-01-13) Akande, Oluwatosin Wuraola; Muzigaba, Moise; Igumbor, Ehimario; Elimian, Kelly; Bolarinwa, Oladimeji Akeem; Musa, Omotosho Ibraheem; Akande, Tanimola Makanjuola
BACKGROUND : The implementation of the country-wide comprehensive sexuality education (CSE) curriculum among in-school adolescents remains abysmally low and mHealth-based interventions are promising. We assessed the effect of a mHealth-based CSE on the sexual and reproductive health (SRH) knowledge, attitude and behaviour of in-school adolescents in Ilorin, northcentral Nigeria. METHODS : Using schools as clusters, 1280 in-school adolescents were randomised into intervention and control groups. Data was collected at baseline (T0), immediately after the intervention (T1) and 3 months afterwards (T2) on SRH knowledge, attitude and practice of risky sexual behaviour (RSB). Data analysis included test of associations using Chi-square, independent t-test and repeated measures ANOVA. Predictors were identified using binary logistic regression. RESULTS : In the intervention group, there was a statistically significant main effect on mean knowledge score (F = 2117.252, p = < 0.001) and mean attitude score (F = 148.493, p = < 0.001) from T0 to T2 compared to the control group which showed no statistically significant main effects in knowledge (p = 0.073), attitude (p = 0.142) and RSB (p = 0.142). Though the mean RSB score declined from T0 to T2, this effect was not statistically significant (F = 0.558, p = 0.572). Post-intervention, being female was a positive predictor of good SRH knowledge; being male was a positive predictor of RSB while being in a higher-class level was a negative predictor of RSB. CONCLUSION : The mHealth-based CSE was effective in improving SRH knowledge and attitude among in-school adolescents. This strategy should be strengthened to bridge the SRH knowledge and attitude gap among in-school adolescents. Trial registration Retrospectively registered on the Pan African Clinical Trial Registry (pactr.samrc.ac.za) on 19 October 2023. Identification number: PACTR202310485136014. PLAIN LANGUAGE SUMMARY : In Nigeria, the implementation of a nationwide sex education programme for adolescents going to schools is below expectation but using mobile health (mHealth) interventions could help. In this study, we looked at how a mHealth-based sex education programme affected the sexual and reproductive health (SRH) knowledge, attitude, and behaviour of in-school adolescents in Ilorin, Nigeria. We divided 1280 students into two groups, one received the mHealth-based intervention and the other did not receive it. We collected data before the intervention, right after it, and 3 months later to see any changes in SRH knowledge, attitudes, and risky sexual behaviours. We used various statistical tests to analyze the data and find patterns. The results showed that the group that received the mHealth intervention had significant improvements in their knowledge and attitudes about SRH from the start of the study to 3 months after the intervention. However, the control group, which didn't get the intervention, didn't show these improvements significantly. While the risky sexual behaviour score decreased slightly in the intervention group, this change was not significant. After the intervention, we found that being female was associated with better SRH knowledge, while being male was linked to more risky sexual behaviours. Also, being in a higher class level was associated with low risky behaviour. In conclusion, using mHealth for sex education helped improve the SRH knowledge and attitudes of students. This approach could be scaled to fill the gap in SRH knowledge and attitudes among adolescents in schools.
Performance evaluation of SARS-CoV-2 rapid diagnostic tests in Nigeria : a cross-sectional study
(Public Library of Science, 2024-07-15) Omonkhua, Akhere A.; Faneye, Adedayo; Akinwande, Kazeem S.; Evaezi, Okpokoro; Shehu, Nathan Y.; Onayade, Adedeji; Ochu, Chinwe Lucia; Popoola, Mustapha; Emmanuel, Nnadi; Ojo, Temitope; Ohonsi, Cornelius; Abubakar, Abdullahi; Odeh, Elizabeth; Akinduti, Paul; Folarin, Onikepe; Bimba, John Samson; Igumbor, Ehimario; Elimian, Kelly; Edem, Victory Fabian; Luka, Pam D.; Olusola, Tunde; Ntoimo, Loretta; Olugbile, Michael; Opayele, Adewale Victor; Kida, Ibrahim; David, Shwe; Onyeaghala, Augustine; Igbarumah, Isaac; Maduka , Omosivie; Mahmoud, Magaji A.; El-Fulatty, Abdul Rahman; Olaleye, David O.; Simon, Omale; Osaigbovo, Iriagbonse Iyabo; Obaseki, Darlington Ewaen; Tolulupe, Afolaranmi; Happi, Christian; Jibrin, Yusuf Bara; Okonofua, Friday; Eliya, Timan; Simji, Gomerep; Izang, Joy Abi; Ameh, Emmanuel; Maigari, Ibrahim Mahmood; Alhaji, Sulaiman; Adetifa , Ifedayo; Salako, Babatunde; Bogoro, Suleiman; Ihekweazu, Chikwe; Odaibo, Georgina N.; COVID-19 RDT Validation in Nigeria (CORVAN) study group
The COVID-19 pandemic challenged health systems globally. Reverse transcription polymerase chain reaction (RT-PCR) is the gold standard for detecting the presence of SARS-CoV-2 in clinical samples. Rapid diagnostic test (RDT) kits for COVID-19 have been widely used in Nigeria. This has greatly improved test turnover rates and significantly decreased the high technical demands of RT-PCR. However, there is currently no nationally representative evaluation of the performance characteristics and reliability of these kits. This study assessed the sensitivity, specificity, and predictive values of ten RDT kits used for COVID-19 testing in Nigeria. This large multi-centred cross-sectional study was conducted across the 6 geo-political zones of Nigeria over four months. Ten antigen (Ag) and antibody (Ab) RDT kits were evaluated, and the results were compared with RT-PCR. One thousand, three hundred and ten (1,310) consenting adults comprising 767 (58.5%) males and 543 (41.5%) females participated in the study. The highest proportion, 757 (57.7%), were in the 20–39 years’ age group. In terms of diagnostic performance, Lumira Dx (61.4, 95% CI: 52.4–69.9) had the highest sensitivity while MP SARS and Panbio (98.5, 95% CI: 96.6–99.5) had the highest specificity. For predictive values, Panbio (90.7, 95% CI: 79.7–96.9) and Lumira Dx (81.2, 95% CI: 75.9–85.7) recorded the highest PPV and NPV respectively. Ag-RDTs had better performance characteristics compared with Ab-RDTs; however, the sensitivities of all RDTs in this study were generally low. The relatively high specificity of Ag-RDTs makes them useful for the diagnosis of infection in COVID-19 suspected cases where positive RDT may not require confirmation by molecular testing. There is therefore the need to develop RDTs in-country that will take into consideration the unique environmental factors, interactions with other infectious agents, and strains of the virus circulating locally. This may enhance the precision of rapid and accurate diagnosis of COVID-19 in Nigeria.
Triage of HPV positivity in a high HIV prevalence setting : a prospective cohort study comparing visual triage methods and HPV genotype restriction in Botswana
(Wiley, 2024-05) Luckett, Rebecca; Ramogola-Masire, Doreen; Gompers, Annika; Moraka, Natasha; Moyo, Sikhulile; Sedabadi, Leatile; Tawe, Leabaneng; Kashamba, Thanolo; Gaborone, Kelebogile; Mathoma, Anikie; Noubary, Farzad; Kula, Maduke; Grover, Surbhi; Dreyer, Greta; Botha, Matthys H.; Makhema, Joseph; Shapiro, Roger; Hacker, Michele R.
OBJECTIVE : Guidelines for effective triage following positive primary high-risk human papillomavirus (HPV) screening in low- and middle-income countries with high human immunodeficiency virus (HIV)-prevalence have not previously been established. In the present study, we evaluated the performance of three triage methods for positive HPV results in women living with HIV (WLHIV) and without HIV in Botswana. METHODS : We conducted baseline enrollment of a prospective cohort study from February 2021 to August 2022 in South-East District, Botswana. Non-pregnant women aged 25 or older with an intact cervix and no prior diagnosis of cervical cancer were systematically consented for enrollment, with enrichment of the cohort for WLHIV. Those who consented completed a questionnaire and then collected vaginal self-samples for HPV testing. Primary HPV testing for 15 individual genotypes was conducted using Atila AmpFire® HPV assay. Those with positive HPV results returned for a triage visit where all underwent visual inspection with acetic acid (VIA), colposcopy, and biopsy. Triage strategies with VIA, colposcopy and 8-type HPV genotype restriction (16/18/31/33/35/45/52/58), separately and in combination, were compared using histopathology as the gold standard in diagnosing cervical intraepithelial neoplasia (CIN) 2 or worse (CIN2+). RESULTS : Among 2969 women enrolled, 1480 (50%) tested HPV positive. The cohort included 1478 (50%) WLHIV; 99% were virologically suppressed after a mean of 8 years on antiretroviral therapy. In total, 1269 (86%) women had histopathology data for analysis. Among WLHIV who tested positive for HPV, 131 (19%) of 688 had CIN2+ compared with 71 (12%) of 581 in women without HIV. Screening by 8-type HPV genotype restriction was more sensitive as triage to detect CIN2+ in WLHIV 87.79% (95% CI: 80.92–92.85) and women without HIV 85.92% (95% CI: 75.62–93.03) when compared with VIA (WLHIV 62.31% [95% CI: 53.39–70.65], women without HIV 44.29% [95% CI: 32.41–56.66]) and colposcopy (WLHIV 70.77% [95% CI: 62.15–78.41], women without HIV 45.71% [95% CI: 33.74–58.06]). However, 8-type HPV genotype restriction had low specificity in WLHIV of 30.88% (95% CI: 27.06–34.90) and women without HIV 37.06% (95% CI: 32.85–41.41). These results were similar when CIN3+ was used as the outcome. When combining 8-type HPV genotype restriction with VIA as the triage strategy, there was improved specificity to detect CIN2+ in WLHIV of 81.65% (95% CI: 78.18–84.79) but dramatically reduced sensitivity of 56.15% (95% CI: 47.18–64.84). CONCLUSIONS : Eight-type HPV genotype restriction is a promising component of effective triage for HPV positivity. However, novel triage strategies in LMICs with high HIV prevalence may be needed to avoid the trade-off between sensitivity and specificity with currently available options. CLINICAL TRIALS REGISTRATION : This study is registered on Clinicaltrials.gov no. NCT04242823, https://clinicaltrials.gov/ct2/show/NCT04242823.
Concentrations of potentially toxic metals and trace elements in pregnant women and association with birth outcomes : a cross-sectional study in Malawi
(Public Library of Science, 2024-11-14) Mwapasa, Mphatso; Xu, Shanshan; Chakhame, Bertha Magreta; Maluwa, Alfred; Rollin, Halina B.; Choko, Augustine; Huber, Sandra; Odland, Jon Oyvind
Potentially toxic metals and trace elements have been used in Malawi for a long time. However, data on exposure to these elements by susceptible groups like pregnant women and its associations with reproductive health outcomes in Malawi and southern hemisphere is limited. We investigated the concentrations of potentially toxic metals as well as trace elements in pregnant women and assessed the relationship between the levels these elements in maternal blood and sociodemographic factors, dietary habits and birth outcomes. Maternal data was collected from 605 pregnant women. Provider administered questionnaire was used to collect data on maternal sociodemographic factors, life style and immediate birth outcomes. Maternal venous blood samples were collected from 506 pregnant women in southern Malawi between August 2020 and July 2021. An inductively coupled plasma mass spectrometry (ICP-MS) technique was used to analyse maternal blood samples for concentrations of arsenic (As), copper (Cu), lead (Pb), mercury (Hg), nickel (Ni), selenium (Se) and zinc (Zn). Maternal age emerged as the primary predictor for Cu (p = 0.023), As (p = 0.034) and Hg (p = 0.013) blood concentrations, followed by area of residence, which had significant impact on Ni (p = 0.024) and As (p < 0.001) concentrations. High maternal blood concentrations of Ni were associated with increased birth weight (p = 0.047), birth length (p = 0.026), head circumference (p = 0.029) and gestational age (p = 0.035). Negative associations were observed between maternal whole blood total arsenic (combining organic and inorganic As) concentration and neonatal birth length (p = 0.048) and head circumferences (p < 0.001). Similarly, higher maternal blood Pb concentrations were associated with smaller head circumference (p = 0.002) and birth weight (p = 0.016). This study demonstrates the need to introduce biomonitoring studies in Malawi and countries with similar settings in the global south.
Explaining socioeconomic inequality in food consumption patterns among households with women of childbearing age in South Africa
(Public Library of Science, 2024-10-21) Nglazi, Mweete D.; Ataguba, John E.
The changing food environment shifts peoples’ eating behaviour toward unhealthy food, including ultra-processed food (UPF), leading to detrimental health outcomes like obesity. This study examines changes in socioeconomic inequalities in food consumption spending between 2005/06 and 2010/11 in South African households with women of childbearing age (15 to 49) (WCBA). Data come from the 2005/06 and 2010/11 Income and Expenditure Surveys. The distribution of spending according to the NOVA food classification system groupings (unprocessed or minimally processed foods, processed culinary ingredients, processed and UPF products) was analysed using standard methodologies. Changes in spending inequalities between 2005/06 and 2010/11 were assessed using the concentration index (C), while the factors explaining the changes in spending inequalities were identified using the Oaxaca decomposition approach. The Kakwani index (K) was used to assess progressivity. Results show that average real spending on all food categories, including UPF, increased between 2005/06 and 2010/11. Socioeconomic inequality in UPF consumption spending decreased (C = 0.498 in 2005/06 and C = 0.432 in 2010/11), and spending on processed foods (C = 0.248 in 2005/06 and C = 0.209 in 2010/11). Socioeconomic status, race, and urban residence contributed to overall socioeconomic inequality and changes in UPF consumption inequality between 2005/06 and 2010/11. Spending on all food categories was regressive in 2005/06 (K = -0.173 for UPF and -0.425 for processed foods) and 2010/11 (K = -0.192 for UPF and -0.418 for processed foods) because such spending comprises a larger share of poorer household’s income than their wealthier counterparts. The government should address these contributors to inequality to mitigate the risks associated with UPF consumption, especially among less affluent households.
Did socioeconomic inequalities in overweight and obesity in South African women of childbearing age improve between 1998 and 2016? A decomposition analysis
(Public Library of Science, 2024-11-14) Nglazi, Mweete D.; Ataguba, John E.
Overweight and obesity in adult women contribute to deaths and disability from non-communicable diseases (NCDs) and obesity-related health problems in their offspring. Globally, overweight and obesity prevalence among women of childbearing age (WCBA) has increased, but associated socioeconomic inequality remains unclear. This study, therefore, assesses the changing patterns in the socioeconomic inequality in overweight and obesity among South African non-pregnant WCBA between 1998 and 2016. It uses data from the 1998 and 2016 Demographic and Health Surveys. Socioeconomic inequality in overweight and obesity was assessed using the concentration index (C). The index was decomposed to identify contributing factors to obesity and overweight inequalities. Factors contributing to changes in inequalities between 1998 and 2016 were assessed using the Oaxaca-type decomposition approach. Socioeconomic inequalities in overweight and obesity among WCBA in South Africa increased between 1998 (C of 0.02 and 0.06, respectively) and 2016 (C of 0.04 and 0.08, respectively). Socioeconomic status was the biggest contributor to overweight and obesity inequalities for both years. The Oaxaca-type decomposition showed that race and urban residence are major contributors to changes in overweight and obesity inequalities. Policies such as the current tax on sugar-sweetened beverages and subsidising fruits and vegetables, among others, are needed to prioritise WCBA, especially for those from disadvantaged socioeconomic backgrounds, in addressing inequalities in overweight and obesity in South Africa.
Practical recommendations for artificial intelligence and machine learning in antimicrobial stewardship for Africa
(Wiley, 2025-04) Dzinamarira, Tafadzwa; Mbunge, Elliot; Steiner, Claire; Moyo, Enos; Akinjeji, Adewale; Yamba, Kaunda; Mwila, Loveday; Muvunyi, Claude Mambo; u19395419@up.ac.za
The challenge of antimicrobial resistance (AMR) represents one of the most pressing global health crises, particularly, in resource-constrained settings like Africa. In this paper, we explore artificial intelligence (AI) and machine learning (ML) potential in transforming the potential for antimicrobial stewardship (AMS) to improve precision, efficiency, and effectiveness of antibiotic use. The deployment of AI-driven solutions presents unprecedented opportunities for optimizing treatment regimens, predicting resistance patterns, and improving clinical workflows. However, successfully integrating these technologies into Africa's health systems faces considerable obstacles, including limited human capacity and expertise, widespread public distrust, insufficient funding, inadequate infrastructure, fragmented data sources, and weak regulatory and policy enforcement. To harness the full potential of AI and ML in AMS, there is a need to first address these foundational barriers. Capacity-building initiatives are essential to equip healthcare professionals with the skills needed to leverage AI technologies effectively. Public trust must be cultivated through community engagement and transparent communication about the benefits and limitations of AI. Furthermore, technological solutions should be tailored to the unique constraints of resource-limited settings, with a focus on developing low-computational, explainable models that can operate with minimal infrastructure. Financial investment is critical to scaling successful pilot projects and integrating them into national health systems. Effective policy development is equally essential to establishing regulatory frameworks that ensure data security, algorithmic fairness, and ethical AI use. This comprehensive approach will not only improve the deployment of AI systems but also address the underlying issues that exacerbate AMR, such as unauthorized antibiotic sales and inadequate enforcement of guidelines. To effectively and sustainably combat AMR, a concerted effort involving governments, health organizations, communities, and technology developers is essential. Through collaborations and sharing a common goal, we can build resilient and effective AMS programs in Africa.

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