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

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Ambient PM₂.₅, soot, black carbon and organic carbon concentrations in a residential area in the Bojanala Platinum District Municipality, North West province, South Africa
Lekwe, Boitshoko; Adeyemi, Adewale Adekunle; Molnar, Peter; Boman, Johan; Alfeus, Anna; Wichmann, Janine (National Association for Clean Air, 2026-06-25)
Air pollution is a major threat to human health globally. In 2021, the World Health Organization (WHO) reported that 7 million premature deaths, mainly from non-communicable diseases, are due to air pollution. Air quality studies on PM₂.₅ and its composition are lacking in South Africa and Africa. To find ways to reduce PM₂.₅sources and its associated health impact in the Bojanala Platinum District Municipality (BPDM), North West province, South Africa, it is necessary to determine PM₂.₅ concentrations, its chemical composition and distant air pollution source areas in this area. PM₂.₅ filter samples were collected manually during 24 hours every sixth day from 10 May 2021 and 4 June 2022 in a residential area in Bapong. Bapong is located in the BPDM. The average PM₂.₅ level during the sampling period was 21 μg.m-3 (range: 2.0 to 78 μg.m-3), which is higher than the yearly WHO guideline (5 μg.m-3), and South African National Ambient Air Quality Standards (SANAAQS) (20 μg.m-3). The 24-hour PM₂.₅ levels exceeded the daily WHO guideline (15 μg.m-3) and daily SANAAQS (40 μg.m-3) on 27 and nine occasions, respectively. The highest PM₂.₅ levels were observed during the cold autumn season (78 μg.m-3: May 2022). Soot levels ranged from 0.1 to 8.0 m-1 × 10-5 with an annual average of 1.8 m-1 × 10-5. The black carbon (BC) levels ranged from 0.1 to 6.0 μg.m-3 with an average of 1.3 μg.m-3. The average level of organic carbon (OC) was 1.4 μg.m-3 (range: 0.1 to 5.0 μg.m-3). Most of the geographical air masses were found to be originating inland (65%). This pioneering study in Bapong provides key insights into the seasonal and weekly variation of PM₂.₅, soot, BC and OC concentrations, distant air pollution source areas that contribute to their concentrations and their potential public health risk in the area.
Air pollution and health studies in the Highveld Priority Area, South Africa : a scoping review
Howlett-Downing, Chantelle Margaret; Wright, Caradee Yael (National Association of Clean Air, 2026-06-25)
Air pollution remains a major environmental health concern in South Africa, particularly in the Highveld Priority Area (HPA), where multiple coal-fired power stations, heavy industry, and household solid fuel use contribute to sustained poor air quality. This review systematically assessed the peer-reviewed evidence on air pollution and health in the HPA to establish a baseline of research, identify gaps, and inform future policy and scientific priorities. Following PRISMA guidelines, we searched four bibliographic databases and key journals for English-language studies published up to October 2024. A total of 130 papers met the inclusion criteria: 98 focused on air quality only, 19 on health only, and 13 addressed both air quality and health outcomes. Air quality studies span more than four decades, documenting trends in criteria pollutants such as SO₂, NO₂, PM₁₀, PM₂.₅, and O₃, with recent analyses highlighting the HPA as one of the world’s NO₂ and O₃ hotspots. Health studies, mostly post-2014, primarily investigated respiratory outcomes, with a few extending to cardiovascular disease and congenital anomalies. Most relied on self-reported health data, while only one study used objective spirometry. Studies combining air quality and health data are few, methodologically limited, and largely unable to establish causal relationships. Nevertheless, evidence consistently suggests that HPA residents—especially children, adolescents, and the elderly—are at heightened risk of respiratory morbidity. The review highlights critical research gaps, including insufficient use of personal exposure monitoring, limited objective health assessments, and a narrow focus on respiratory outcomes. We recommend coordinated, large-scale, interdisciplinary studies leveraging the HPA as a natural laboratory to advance understanding of air pollution–health linkages. Strengthening ambient monitoring networks, integrating indoor and outdoor exposure data, and expanding research beyond respiratory effects are essential to guide effective interventions and uphold the constitutional right to a healthy environment in South Africa.
Patterns of HIV-1 viral load suppression and drug resistance during the dolutegravir transition : a population-based longitudinal study
Martin, Michael A.; Blenkinsop, Alexandra; Moffa, Michelle; Reynolds, Steven James; Nalugoda, Fred; Quinn, Thomas C.; Kigozi, Godfrey; Ssekubugu, Robert; Gupta, Ravindra K.; Grayson, Nicholas E.; MacIntyre-Cockett, George; Kagaayi, Joseph; Nakigozi, Gertrude; Abeler-Dörner, Lucie; Fraser, Christophe; Ratmann, Oliver; Tobian, Aaron A.R; Laeyendecker, Oliver; Moyo, Sikhulile; Kennedy, Caitlin E.; Bonsall, David; Galiwango, Ronald Moses; Grabowski, M. Kate (Oxford University Press, 2026-06)
BACKGROUND : Data on the population-scale impact of dolutegravir (DTG)-based HIV regimens in sub-Saharan Africa are extremely limited. We used data from a surveillance cohort in southern Uganda to assess viral suppression and antiretroviral (ART) resistance over 10-years alongside DTG scale-up. METHODS : Consenting participants in the population-based Rakai Community Cohort Study between August 2011 and March 2023 aged 15–49 completed questionnaires and provided samples for HIV testing, viral load quantification, and viral deep-sequencing. We collected data on DTG utilization at HIV care clinics. We estimated the prevalence of HIV suppression and ART resistance using robust Poisson regression. Bayesian logistic regression quantified associations between resistance and individual-level suppression across surveys. RESULTS : Among 8781 people with HIV (PWH), suppression increased from 57.1% (2014, 95% confidence interval [CI], 55.4%–58.8%) to 90.3% (2022, 95% CI, 89.2%–91.4%). By 2020 84.4% (95% CI, 83.7%–85.2%) and 64.6% (95% CI, 63.9%–65.3%) of men and women on ART were on DTG. Among treatment-experienced viremic PWH, any intermediate/high resistance decreased from 51.1% (95% CI, 40.7%–64.2%, 2014) to 27.9% (95% CI, 21.3%–36.5%, 2022). Two of 258 (0.8%) 2022 participants harbored intermediate/high-level DTG resistance (inQ148R, inE138K, and inG140A). inS153Y (2-fold INSTI resistance) was observed in 23/306 (7.5%) of viremic individuals, with evidence of transmission. By 2022, NNRTI/NRTI resistance was not associated with a reduction in individual-level suppression (risk ratios: 1.15, 95% HPD: 0.93–1.39; 1.14, 0.86–1.42). CONCLUSIONS : Viral suppression increased during the DTG transition with minimal emerging intermediate/high-level resistance. Falling resistance among treatment-experienced PWH underscores the role of ART adherence in reducing viremia. The emergence of inS153Y justifies continued surveillance.
Scoping review of COVID-19 vaccines access, equity, hesitancy, and uptake in Kenya : lessons for the next pandemic
Okungu, Vincent; Mulupi, Stephen; Muriithi, Grace Njeri; Achala, Daniel Malik; Adote, Elizabeth; Mbachu, Chinyere Ojiugo; Beshaha, Senait Alemayehu; Nwosu, Chijioke Osinachi; Ataguba, John Ele-Ojo (Frontiers Media, 2026-05-13)
INTRODUCTION : The global rollout of COVID-19 vaccines was hampered by hesitancy, even as the pandemic intensified, underscoring the urgent need to strengthen vaccination efforts to reach most of the population. The primary objective of this review was to identify the critical barriers to equitable and timely access to and uptake of vaccines in Kenya with a view to mitigating the impacts of future pandemics, such as COVID-19. METHODS : A digital search was conducted between February and March 17, 2024, and between December 2025 and February 2026, using four databases: PUBMED, Google Scholar, Cochrane Library, and Africa Journals Online. The search was limited to peer-reviewed articles only. The keywords used in the search were: COVID-19 vaccine + Access +Kenya; COVID-19 vaccine +Uptake+ Kenya; COVID-19 vaccine +Equity+ Kenya; COVID-19 vaccine +Hesitancy+ Kenya. The search was restricted to studies published from 2020, when the first vaccines were rolled out. Three researchers independently reviewed articles for inclusion and exclusion. RESULTS : A total of 60 articles were included in the review. The main themes identified include geographic access, socio-demographic factors, economic and political determinants, and distrust in government systems. Among the critical determinants of COVID-19 vaccine uptake, confidence in the vaccine's efficacy and safety was a significant consideration. Geographic access to vaccination sites hindered uptake; for example, only 9.7% were vaccinated in a hard-to-reach county, compared to 53% in an urban county. Sociodemographic factors, including age, gender, level of education, occupation, and co-morbidity, significantly influenced vaccine uptake in Kenya. Above all, the Ministry of Health's failure to mount a convincing response to myths and misconceptions about the COVID-19 vaccine ultimately affected vaccination coverage nationwide. CONCLUSION : Future preparedness must ensure inclusive vaccine strategies led by governments with clear policies and tailored outreach. Communication should address vulnerable groups and reduce hesitancy. Improving access and engaging communities are key to equity. Social workers help build trust and local relevance.
Vaccine equity in Africa : a rapid review of policy, legal and governance frameworks to improve research and development
Ataguba, John Ele-Ojo; Muriithi, Grace Njeri; Achala, Daniel Malik; Adote, Elizabeth Naa Adukwei; Nwosu, Chijioke Osinachi; Beshah, Senait Alemayehu; Zegeye, Elias Asfaw; Yaya Bocoum, Fadima Inna Kamina; Sumboh, Jemima; Setshegetso, Naomi; Yakhelef, Nadia; Muhwava, William (Frontiers Media, 2026-08)
BACKGROUND : Vaccines are instrumental in promoting preventive health and improving health outcomes globally. However, stark inequities in vaccine production, distribution, and access disproportionately burden low and middle-income countries (LMICs), which suffer significantly from these disparities. The COVID-19 pandemic further reinforced these existing inequities, prompting renewed debates on scaling up Africa's research and development (R&D) capacity as a proactive approach to enhance very limited domestic vaccine production and counter persistent inequities. However, there has been no consolidated review of the policy, legal, and governance frameworks that shape this capacity and their implications for vaccine equity. This rapid review asked which policy, legal, governance, and investment frameworks influence vaccine R&D and manufacturing capacity in African countries, and how they affect the continent's ability to secure equitable access to vaccines. METHODS : We conducted a PRISMA guided rapid review of peer-reviewed and grey literature. Searches were conducted in Academic Search Premier, Business Source Premier, CINAHL via EBSCOhost, EconLit, Embase, and Ovid Medline via OVID Platform, as well as Google Scholar databases. Eligible documents reported on African vaccine R&D, manufacturing, or related policy, legal, governance, or investment frameworks. Grey literature was identified from the WHO, the World Bank, the Africa CDC, government organizations, private institutions, and policy think tanks. Data was extracted using a structured template and synthesized narratively into thematic areas that aligned with the study objectives. FINDINGS : From 18,038 records, 68 publications met the inclusion criteria. We identified twelve active vaccine manufacturers in Africa and eleven additional initiatives in development, with the majority focusing on fill-and-finish operations and relatively few investing in upstream R&D and drug substance manufacturing. Persistent under-investment in vaccine R&D, fragmented and weak regulatory systems, and dependence on external financing constrain sustainable local manufacturing. Global and regional instruments, including the TRIPS Agreement, the Doha Declaration, ACT-A/COVAX, and the Pandemic Influenza Preparedness (PIP) Framework, create opportunities for technology transfer and impose intellectual property and supply-chain barriers that limit expansion of African vaccine R&D. CONCLUSION : Africa has the capacity to produce vaccines and related health products. However, this potential is undermined by structural under-investment in R&D, constrained access to technologies and inputs, and weak coordination of policy and regulatory frameworks. Strengthening domestic R&D financing, enhancing regional regulatory and policy harmonization, and proactively engaging in IP and trade negotiations, alongside strategic public-private and product development partnerships, are critical to achieving vaccine equity for African populations.
Strengthening diabetes education and peer support in South Africa : insights from a national stakeholder convening ahead of the 2025 Diabetes Summit
Muhwava, Lorrein S.; Ngassa Piotie, Patrick; Mwangi, Kibachio J.; Pienaar, Melanie (AOSIS, 2026-07-31)
No abstract available.
Scaling up and institutionalising multisectoral collaboration and policy action for non-communicable diseases and mental health in South Africa : lessons, gaps and insights from the 2025 Diabetes Summit
Mwangi, Kibachio J.; Ngassa Piotie, Patrick; Pienaar, Melanie; Mashapha, Masindi; Mkhondo, Nkateko; Dysted, Mikkel Pape (AOSIS, 2026-07-30)
No abstract available.
Reframing diabetes mellitus care in South Africa through lived experience, peer support and advocacy : lessons from the 2025 Diabetes Summit
Pienaar, Melanie A.; Van Essche, Alexandra; Singh, Sandhya; Ngassa Piotie, Patrick; Mwangi, Kibachio J. (AOSIS, 2026-08-17)
No abstract available.
From local challenges to local solutions : insights from the 2025 Diabetes Summit Innovation Showcase
Mosam, Atiya; Ngassa Piotie, Patrick; Mwangi, Kibachio J.; Pienaar, Melanie (AOSIS, 2026-07-21)
No abstract available.
Building a type 1 diabetes registry in South Africa : insights from a national multi-stakeholder workshop
Ngassa Piotie, Patrick; Modipane, Penelope; Carrihill, Michelle; Kruger, Michelle; Lazaridis, Marina; Kruger, Adriaan; Shankland, Luke; Klinck, Elsabe; Castelyn, Camille De Villebois; Mwangi, Joseph Kibachio; Pienaar, Melanie; Muchengeti, Mazvita (AOSIS, 2026-07-31)
No abstract available.
From knowledge accumulation to transformative action : research to catalyze progress on social determinants of health equity
Berenson, Julia; Marten, Robert; Mao, Wenhui; Basu, Debashis; Kosinska, Monika; Cassels, Andrew; Yamey, Gavin; Rasanathan, Kumanan (BioMed Central, 2026-08-12)
Despite three decades of expanding scholarship on social determinants of health (SDH), progress in reducing health inequities has remained limited. While the SDH framework has reshaped global health discourse and informed policy rhetoric, the translation of knowledge into transformative action has been insufficient. The gap between evidence and impact is not explained by political constraints alone but is also contributed to by the orientation, methods, and practices of SDH research itself. We identify key limitations in what is studied, how research is conducted, and who leads knowledge production. Thematic gaps include the dominance of descriptive research, limited evidence on effective policy interventions, insufficient engagement with structural determinants and political economy, and underdeveloped attention to emerging drivers such as climate change, digitalization, and commercial determinants. Methodological limitations include underuse of policy, implementation, modelling, and participatory approaches, alongside persistent data gaps. Deficiencies in research practice constrain the transformative potential of SDH scholarship, including a lack of multi-disciplinary work, limited community and policymaker engagement and leadership, and inequitable power dynamics in global health research itself. We propose a reorientation of SDH research toward agency and action with greater focus on solutions and implementation pathways, methodological pluralism, multisectoral and participatory knowledge production, improved communication and policy engagement, and reforms to research incentives, funding and governance. By repositioning SDH research as an active contributor to political and institutional change, researchers can more effectively support equitable and sustainable health outcomes in a global context increasingly inhospitable for attention to health equity.
Financial risk protection and distress financing for cervical cancer treatment in low- and middle-income countries : a systematic review
Okova, Denis; Moodley, Jennifer; Makwambeni, Patricia; Tafadzwa, Akim Lukwa; Guzha, Bothwell T.; Ataguba, John Ele-Ojo (ecancer Global Foundation, 2026-08-19)
BACKGROUND : Cervical cancer is a major health challenge in low- and middle-income countries (LMICs), where households face high out-of-pocket costs and limited financial risk protection (FRP). Insufficient FRP for treatment leads to catastrophic health expenditure (CHE), impoverishing health expenditure (IHE) and distress financing. OBJECTIVE : This review aimed to synthesise evidence and highlight gaps related to FRP and distress financing (cost-coping strategies) associated with treatment-related cervical cancer care in LMICs. METHODS : A systematic search of PubMed, Scopus, Cochrane Library and EBSCOhost was conducted on 1 July 2024 for peer-reviewed observational studies published from 1 January 2003. Using the Population, Exposure and Outcome framework, the review focused on women with cervical cancer or caregivers (Population), treatment and follow-up care (Exposure) and outcomes on CHE, IHE and cost-coping strategies (Outcome). Eligible studies were quantitative or qualitative with independently extractable outcomes. RESULTS : Twenty-nine studies (10 quantitative and 19 qualitative) met the inclusion criteria. Evidence on FRP for cervical cancer in LMICs remains scarce. Only four studies reported on CHE, with incidence ranging from 62% to 86%, all using unadjusted thresholds. No studies assessed IHE. Common coping strategies included selling assets and borrowing, while forgoing care for financial reasons was rarely examined. Predictors and long-term impacts of distress financing remain underexplored. CONCLUSION : This study underscores the need for more research into the financial burden associated with cervical cancer treatment in LMICs and calls for stronger financial protection measures to mitigate these hardships.
Dental fear and anxiety of patients visiting selected oral health centres in Gauteng
Moyo, Tiyiselani; Kruger, Candida; Madiba, Thomas Khomotjo (South African Dental Association, 2025-04)
INTRODUCTION : Dental fear is a concerning public health matter and still prevalent among individuals across communities. Studies have reported greatly varying statistics on the prevalence of dental phobia ranging from 5% to 7%, with other authors reporting higher prevalence rates AIM AND OBJECTIVES : To assess the prevalence of dental fear and anxiety and identification of phobia induced factors and stimuli in patients visiting selected oral health centres in Gauteng DESIGN: Quantitative cross-sectional study comprising South African women and men 18 years and older residing in Gauteng visiting government facilities (Wits Oral Health Centre (WOHC) and Chiawelo Clinic) and private facilities (Mofolo Dental Surgery and Tembisa Dental Surgery METHODS : Information was obtained using a modified, self-administered questionnaire which included the Modified Dental Fear Survey (MDFS). The patient's questionnaire had two sections consisting of sociodemographic information and questions from the MDFS. Data was analysed with the Statistical Package for the Social Sciences (SPSS) software version 29. Quantitative variables were summarised as proportions, frequencies and mean with their standard deviations and percentages. A Chi-square test was used to evaluate the association between variables and the level of significance was set at p< 0.05 RESULTS : The response was 100% of the calculated sample size of 610 patients. The mean age of participants was 28 years (SD=±8.92 years) with more than half of them being male 330 (54%). About 21% of the participants indicated they have dental fear all the time, while 35% indicated they had dental fear sometimes. The vibration of the drill and sight of the needle were the most fear-provoking stimuli in general for all patients. Significantly more females had dental anxiety as compared to males, p<0.05. There was no association between level of education, employment status and dental anxiety, p >0.05 CONCLUSION : This study showed that dental fear is prevalent and leads to patients neglecting their oral care. About 21% of the patients indicated they have dental fear all the time. The results demonstrated a significant difference between males and females, with higher levels of anxiety in women than males, p <0.05. There was no association between level of education, employment status and dental anxiety, p >0.05
A targeted review of available data sources to support evidence-informed decisions : implications for health technology assessment in South Africa
Thsehla, Evelyn M.M.; Holden, Celeste; Boachie, Micheal; Goldstein, Susan (Springer, 2026-06)
BACKGROUND : Universal health coverage (UHC) is central to the global health agenda. South Africa is in the process of developing a single financing system for UHC through a National Health Insurance (NHI). The NHI Act legislates the establishment of a health technology assessment (HTA) body to develop and, over time, add to an explicit package of health services funded by the NHI. This study aims to identify data that is publicly available for conducting HTA using the South African Values and Ethics for Universal Health Coverage (SAVE-UHC) framework. METHODS : A targeted literature review was conducted to identify data sources for conducting HTA using the SAVE-UHC framework. The SAVE-UHC lists 12 domains that can be used to conduct HTA. We searched for published literature on PubMed using the following search terms: ‘South Africa’, ‘healthcare’, ‘data sources’, ‘databases’ and ‘evidence’ in the Title/Abstract fields. We also used our experience in the field to search for existing data from local and international organisations. We then mapped the data sources to the SAVE-UHC domains. RESULTS : South Africa has some data to conduct HTA using the SAVE-UHC domains. Data for six of the domains (burden of disease, harms and benefits, cost effectiveness, budget impact, personal financial impact and equity) is available from local and international databases. Some data for the domain ‘system factors and constraints’ is available from the Office of Health Standards Compliance and the Human Resource Strategy for Health. Data on the five remaining domains (respect and dignity, solidarity and social cohesion, impact on personal relationships, impact on safety and security and ease of suffering) is limited. CONCLUSION : There are a number of data sources available to inform health technology assessment in South Africa. However, the data sources available only measure some of the value elements in the SAVE-UHC framework. Thus, South Africa needs to invest in healthcare data collection and management under the NHI to ensure healthcare decisions are made using relevant and recent evidence.
Air pollution and lung cancer incidence in the Malmö diet and cancer cohort
Wichmann, Janine; Carlsen, Hanne Krage; Xu, Yiyi; Andersson, Eva M.; Molnar, Peter; Gustafsson, Susanna; Oudin, Anna; Stockfelt, Leo (Elsevier, 2026-09)
BACKGROUND : Outdoor particulate air pollution is classified as causing lung cancer, but evidence on specific pollutants and exposure timing remains limited. METHODS : 22,294 participants in the population-based Malmö Diet and Cancer cohort, were enrolled between 1991 and 1996 and followed until 2016. Incident lung cancer cases were identified through national registers. Annual residential exposure to PM2.5, PM10, black carbon (BC), and nitrogen oxides (NOx) was estimated using high-resolution dispersion models and assigned based on residential history. Time-dependent Cox regression models with age as the time scale were used to estimate hazard ratios (HRs) and confidence intervals (CIs) for lung cancer incidence for exposure at baseline (1990–1994), the five years preceding diagnosis or censoring (lag 1–5), and the 6–10 years prior (lag 6–10). Models were progressively adjusted for smoking (status, intensity, duration), environmental tobacco smoke, employment, occupation, education, physical activity, cohabitation, and area-level socioeconomic status. RESULTS : During 325,966 person-years, 499 participants developed lung cancer. In models adjusted for age, sex, and calendar time, positive associations were observed for PM2.5, PM10, BC and NOx. Adjustment for smoking substantially attenuated the estimates leading to imprecise and not statistically significant associations. For example, the HR for PM2.5 (lag 1–5 years) was 1.03 (95% CI: 0.48–2.19) per 5 µg/m³, PM10 (lag 1–5 years) was 1.21 (95% CI: 0.51–2.89) per 10 µg/m³, and for BC (lag 1–5 years) was 1.10 (95% CI: 0.67–1.80) per 0.5 µg/m³, while associations with NOx were close to null. DISCUSSION AND CONCLUSION : We observed suggestive but imprecise associations between long-term PM exposure and lung cancer incidence. The attenuation after adjustment for smoking highlights the importance of careful confounder control. Overall, findings do not provide strong evidence of an independent association in this low-exposure setting and should be interpreted cautiously. HIGHLIGHTS • High-resolution, long-term exposure modelled in a low-pollution population cohort. • Suggestive associations with lung cancer observed for PM2.5, PM10 and black carbon. • Associations were attenuated and became non-significant after adjustment for smoking. • Strong association between smoking duration and intensity and lung cancer. • Results underscore the importance of confounder control in air pollution studies.
Application of artificial intelligence in infectious disease surveillance in sub-Saharan Africa : a scoping review
Makola, Dingiwe; Dzinamarira, Tafadzwa; Duah, Evans; Morerwa, Smangaliso; Maluleke, Kuhlula (Elsevier, 2026-09)
BACKGROUND : The rapid emergence and spread of infectious diseases challenge traditional surveillance methods. Artificial intelligence (AI) offers a modern solution, yet its integration and performance in disease surveillance across sub-Saharan Africa (SSA) remain uneven, with wide variation in infrastructure and adoption. This review maps AI applications in infectious disease surveillance in the region, focusing on prediction, detection, and response. METHODS : A comprehensive literature search was conducted for studies published between 1 January 2015 and 15 August 2025 across PubMed, EBSCOhost, Web of Science, and Scopus. The search followed the PCC framework, PRISMA guidelines, and Arksey and O'Malley's methodology. Two independent reviewers screened articles with inter-rater agreement assessed, and a third reviewer resolved conflicts. Methodological quality was appraised using the Mixed Methods Appraisal Tool (MMAT), and findings were synthesized narratively using thematic analysis. RESULTS : Out of 3143 articles, 62 were included, covering 13 countries and more than eight infectious diseases, mostly malaria and COVID-19. Most studies were descriptive quantitative in rural, urban, or mixed settings, with 60 (97%) rated high quality. Machine learning (ML) methods were most frequently used, followed by deep learning (DL) and hybrid/ensemble models, with k-fold cross-validation being the predominant validation strategy. Five themes emerged: predictive modelling, spatial/geospatial surveillance, informing public health decision-making, disease classification, and diagnostic enhancement. CONCLUSION : This review shows that AI can enhance infectious disease surveillance in SSA, though applications remain limited to a few diseases, highlighting the need for broader coverage, standardized datasets, cross-country and external validation, and context-specific ethical frameworks. HIGHLIGHTS • Machine learning dominates AI surveillance in SSA. • AI predicts outbreaks and identifies disease hotspots. • Ensemble models outperform single-model approaches. • Applications focus mainly on malaria and COVID-19. • Data, infrastructure, and skills gaps limit AI adoption.
Association of tuberculosis active case finding with knowledge, attitudes, stigma and health-seeking behaviour among patients in Eswatini
Chomutare, H.; Yah, Clarence S.; Musekiwa, Alfred; Sibanda, J. (South African Medical Association, 2025)
BACKGROUND. Tuberculosis (TB) poses a significant global public health challenge, with >10 million new infections reported annually, making it one of the top 10 causes of death worldwide. Eswatini has one of the world’s highest TB incidence rates, with an estimated rate of 398 cases per 100 000 population in 2019, as reported by the World Health Organization. In Eswatini, despite the implementation of TB active case finding (ACF) interventions aimed at improving TB case detection and reducing community transmission, there is limited empirical evidence on their association with improved knowledge, attitudes and health-seeking behaviour. This study seeks to address this gap to inform future advocacy, communication and social mobilisation strategies for enhanced TB control and prevention. OBJECTIVE. To assess the association of TB ACF and improved knowledge, attitudes, perceptions of stigma and discrimination and healthseeking behaviours among individuals diagnosed with TB. METHODS. The study employed a cross-sectional design from April to May 2023 to review Eswatini TB patients from treatment registers at 14 selected TB basic management units. The TB treatment register was used to determine the entry point of TB patients into care. Those exposed to the ACF programme were located by the TB champions (community volunteers engaged to conduct TB ACF) (n=208), while the unexposed were drawn from outpatients (n=204). The scores for overall knowledge, attitude and health-seeking behaviour were transformed into binary categories based on the calculated median scores. Descriptive statistics were used to summarise participant characteristics, and a multinomial logistic regression model was applied to determine significant risk factors. RESULTS. A total of 412 TB patients (mean (standard deviation) age 42.21 (4.9) years) were included in the study, and 260 (63%) displayed knowledge about TB. Among the patients, 268 (65%) reported that they had not felt stigmatised, 147 (36%) had sought care early (within 2 weeks) and 297 (72%) exhibited good health-seeking behaviour. Exposure to ACF was associated with higher odds of TB knowledge (adjusted odds ratio (aOR) 6.85; 95% confidence interval (CI) 4.21 - 11.14; p<0.001) and higher odds of seeking care within 2 weeks of symptom onset (aOR 6.84; 95% CI 4.06 - 11.52; p<0.001). CONCLUSION. Generally, patients found through ACF were associated with greater knowledge about TB and favourable health-seeking behaviour. However, there remained a notable proportion of TB patients without adequate knowledge and with suboptimal health-seeking behaviour, who may pose a considerable risk for TB transmission.
Trends in hypertension prevalence among adults aged ≥40 years in Agincourt, South Africa (2014-2022)
Mondlane, Zokwane Lucky; Dewa, Ozius; Patrick, Sean Mark (South African Medical Association, 2025-11)
BACKGROUND : Hypertension is a leading cause of cardiovascular disease. There are limited longitudinal data on temporal trends in hypertension prevalence in rural South Africa (SA). OBJECTIVES : To analyse trends in hypertension prevalence and investigate its associated factors among adults aged >40 years in SA. Methods. A retrospective observational secondary quantitative analysis of a sample from the Health and Aging in Africa: A Longitudinal Study of an INDEPTH Community in South Africa (HAALSI) was conducted. Data for the HAALSI study were collected over three waves during 2014, 2018 and 2021 from the existing Agincourt Health and Socio-demographic Surveillance System (AHDSS) framework, with a total sample of 3 707 participants in the present study. Descriptive statistics were used to summarise sociodemographic data. A bivariate analysis and multivariable generalised estimating equation (GEE) model was applied to determine factors associated with hypertension prevalence, with significance set at p<0.05. RESULTS : The overall prevalence of hypertension declined from 58% (95% confidence interval (CI) 56.42 - 59.58) in wave 1 to 42% (95% CI 40.42 - 43.58) in wave 2, and further decreased to 30% (95% CI 28.58 - 31.42) in wave 3. Transitions between hypertensive and normotensive status were observed, with 1 018 individuals transitioning to normotensive from wave 1 to wave 2, and 1 167 individuals from wave 2 to wave 3. The GEE analysis identified significant predictors of hypertension. High body mass index (BMI) was associated with increased odds in wave 2 (adjusted odds ratio (aOR) 1.11; 95% CI 1.02 - 1.21; p=0.014). Frequent alcohol consumption increased the odds of hypertension in wave 3 (aOR 1.19; 95% CI 1.04 - 1.37; p=0.009). No formal education was associated with higher hypertension prevalence (aOR 1.07; 95% CI:1.00 - 1.14; p=0.0026). Younger age (40 - 49 years) was protective, with decreased odds of hypertension in wave 2 (aOR 0.64; 95% CI 0.48 - 0.84; p=0.014), as was employment (aOR 0.82; 95% CI 0.69 - 0.96; p=0.020) and fruit consumption in wave 3 (aOR 0.95; 95% CI 0.91 - 0.99; p=0.037). CONCUSION : The study found that the prevalence of hypertension in Agincourt decreased from 58 to 30% between waves 1 and 3. High BMI, high alcohol use frequency and no formal education were key predators of hypertension. The study highlights the need for targeted public health interventions, including regular hypertension screening, lifestyle modification and better management of associated factors. These efforts will be crucial in reducing hypertension-related morbidity and mortality in rural SA.
Klebsiella vaccine research and development in Africa : a rapid scoping review of current evidence and future priorities
Iwu-Jaja, Chinwe; Mazingisa, Akhona Victress; Jaca, Anelisa; Iwu, Chidozie Declan; Wiysonge, Charles Shey (BMJ Publishing Group, 2026-07-13)
INTRODUCTION : Klebsiella pneumoniae is a major cause of neonatal sepsis in Africa and a WHO priority pathogen for vaccine development. With growing antimicrobial resistance and limited treatment options, maternal vaccination offers a potential preventive strategy. This scoping review synthesises evidence on K. pneumoniae vaccine research in Africa and highlights gaps to guide future research and development priorities. METHODS : A systematic PubMed search was conducted on 1 September 2025 to identify studies on K. pneumoniae vaccine research in Africa. Additional searches were conducted in ClinicalTrials.gov, the Pan-African Clinical Trials Registry and the WHO International Clinical Trials Registry Platform. Eligible studies were screened, and data were extracted and synthesised using a framework focused on disease burden, vaccine development and implementation considerations. RESULTS : A total of 14 studies published between 2008 and 2024 met the inclusion criteria, with most (11/14) published in the last 5 years. Studies reported a high burden of K. pneumoniae infections across multiple African countries, particularly in neonatal sepsis and meningitis. While genomic and immunological studies provided insights into vaccine target selection, no K. pneumoniae vaccine trials were identified in Africa. Modelling studies suggest that maternal immunisation with a 70% effective vaccine could prevent approximately 400 000 neonatal sepsis cases and 80 000 deaths annually worldwide, including Africa. Key research gaps include limited epidemiological surveillance and absence of immune correlates of protection. CONCLUSIONS : Despite the high burden of K. pneumoniae neonatal infections in Africa, vaccine research remains in its early stages, with no ongoing clinical trials on the continent. Strengthening surveillance systems, advancing vaccine candidates and integrating K. pneumoniae vaccination into existing maternal immunisation programmes are critical next steps. Multisectoral collaboration among researchers, policymakers and continental and global health organisations will be essential to accelerate vaccine development and ensure equitable access in Africa.
Addressing the silent epidemic of antimicrobial resistance in the African region : a scoping review of evidence gaps and research considerations
Iwu-Jaja, Chinwe; Gahimbare, Laetitia; Mazengiya, Yidnekachew Degefaw; Okeibunor, Joseph; Olu, Olushayo Oluseun; Jaca, Anelisa; Mazingisa, Akhona V. Victress; Iwu, Chidozie Declan; Yahaya, Ali Ahmed; Wiysonge, Charles Shey (BMJ Publishing Group, 2026-06-08)
OBJECTIVES : This scoping review mapped antimicrobial resistance (AMR)-related interventions in WHO African region against the five strategic objectives of the WHO Global Action Plan (GAP) on AMR and identified evidence gaps limiting progress. DESIGN : A scoping review using the Arksey and O’Malley framework, enhanced by Levac et al and Joanna Briggs Institute methodology; reported according to the Preferred Reporting Items for Systematic reviews an reviews and Meta-Analyses extension for scoping reviews (PRISMA-ScR). DATA SOURCES : PubMed, CINAHL, Web of Science and Scopus searched on 9 December 2025, with grey literature from Google Scholar and Google (first 100 hits). ELIGIBILITY CRITERIA : Studies of any design reporting interventions addressing GAP strategic objectives—stewardship, surveillance, infection prevention, education or economic approaches in the WHO African region. DATA EXTRACTION AND SYNTHESIS : Data were charted using a pilot-tested Excel tool by GAP strategic objective and evidence gaps and research considerations were synthesised thematically. RESULTS : Forty-nine studies (2016–2025) were included, with country-specific evidence concentrated in South Africa, Ethiopia, Kenya, Ghana and Nigeria. Most evaluated antimicrobial stewardship or awareness/training interventions in tertiary hospitals, showing improvements in prescribing, knowledge and occasional cost savings but few assessed long-term effects or resistance trends. Surveillance had advanced but remained limited by weak laboratory capacity, diagnostic coverage, data quality and limited use of AMR/antimicrobial use data in practice. Evidence on infection prevention, vaccination and One Health interventions was scarce and no full economic evaluations were identified. CONCLUSIONS : AMR research in the African region clusters around antimicrobial stewardship and awareness in tertiary hospitals, leaving infection prevention, vaccination, One Health approaches and economic evaluation substantially underrepresented across the GAP framework. Closing these gaps will require longer-term implementation research, context-specific economic analyses and broader geographical coverage to generate the evidence needed to operationalise the global AMR research agenda in Africa.

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