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

Permanent URI for this collectionhttp://hdl.handle.net/2263/1723

For inquiries regarding this collection or items in the collection, please contact : Estelle Grobler
Tel.: +27 12 354 1433

Browse

Now showing 1 - 20 of 1416

Stakeholders' perspectives on pharmacy-based point-of-care diagnostic services in South Africa : a nominal group technique
Mjuza, Lonwabo; Maimela, Charles; De Beer, Niel; Chetty, Darren; Leuschner, Machel; Ncube, Keith Ntokozo; Salvides, Isabella; Ijeoma, Princess; Chibi, Buyisile; Naidoo, Kiolan; Duah, Evans; Mashamba-Thompson, Tivani Phosa (Wiley, 2026-07)
BACKGROUND AND AIM : Community pharmacies are gaining recognition as key access points for primary healthcare. Incorporating point-of-care (POC) diagnostic services in these environments has the potential to enhance early disease detection. However, regulatory and operational obstacles might impede their implementation. This study aimed at identifying and ranking the factors that facilitate and hinder the introduction of POC diagnostic services in South African community pharmacies. METHODS : A nominal group technique (NGT) workshop was conducted with eight stakeholders, including pharmacists, academics, and diagnostic specialists. The stakeholders generated, discussed, and ranked ideas on a seven-point Likert scale. Quantitative rankings were analyzed descriptively, and qualitative data underwent thematic analysis. Theme scores are reported as a percentage of the maximum possible score (number of scorers × 7), not as a proportion of participants endorsing a theme. RESULTS : The key facilitators included accessibility and convenience (94%), professional training and competence (88%), cost and time savings (82%), patient demand and public health initiatives (80%), and stakeholder engagement (78%). The corresponding barriers included infrastructure and space constraints (88%), training gaps (94%), affordability and reimbursement challenges (80%), patient mistrust (71%), regulatory ambiguities (78%), and system-level challenges (78%). CONCLUSION : Pharmacies seem ideally situated to offer POC diagnostic services; however, structural and regulatory challenges need resolution for effective integration. Establishing clear policy frameworks, investing in pharmacist education, and fostering stakeholder collaboration have been identified as key priorities for sustainable implementation. Due to the exploratory nature of the study and the limited stakeholder sample, these findings should guide further research and policy discussions rather than serve as conclusive implementation advice.
Stakeholders' perspectives on integrating point-of-care diagnostics into forensic death investigations in South Africa
Ramatsokotla, Sebueng; Soul, Bathabile; Maluleke, Kuhlula; Evert, Lucinda; Jansen van Vurren, Stefan; Chale-Matsau, Bettina; Mabotja, Susan; Duah, Evans; Mashamba-Thompson, Tivani Phosa (Wiley, 2026)
Unnatural and unexplained deaths present critical challenges to the criminal justice, medico-legal, and public health systems. This study explored forensic professionals' perspectives on the integration of point-of-care (POC) diagnostics into unnatural death investigations in South Africa. A Nominal Group Technique (NGT) was conducted with eight key forensic stakeholders to identify and prioritize the potential benefits, facilitators, and barriers associated with POC implementation. Stakeholders ranked guidance for investigation and autopsy, improved turnaround times, and resource efficiency as the most significant POC diagnostic benefits. Scientific validity, quality assurance, and alignment with legal and regulatory frameworks were identified as critical facilitators, whereas technical limitations, quality management gaps, and legal uncertainties emerged as key barriers. Participants emphasized that POC diagnostics could support timely decision-making during death scene investigations and autopsies, reduce laboratory backlogs, and improve family and community outcomes through faster case resolution. However, successful integration requires standardized protocols, validation, and appropriate training to ensure scientific and legal defensibility. These findings provide foundational evidence to inform the responsible integration of POC diagnostics into forensic death investigations, with potential benefits for justice delivery and community health in South Africa. HIGHLIGHTS • The forensic value of POC diagnostics in unnatural death investigation in South Africa was examined. • An expert panel evaluated benefits, facilitators, and barriers associated with POC implementation. • Standardized protocols, validation, and training are crucial for scientific and legal defensibility. • POC diagnostics offer benefits for medicolegal death investigation in resource-limited environments.
High prevalence of Hepatitis B virus infection among people living with advanced HIV disease in Botswana
Tsayang, Chanana D.; Schanzer, Emily; Phinius, Bonolo B.; Mulenga, Graceful; Molebatsi, Kesaobaka; Lechiile, Kwana; Bhebhe, Lynnette; Ratsoma, Tsholofelo; Mpebe, Gorata G.A.; Mulenga, Fredah; Phakedi, Basetsana K.S.; Choga, Wonderful T.; Mine, Madisa; Lockman, Shahin; Jarvis, Joseph N.; Moyo, Sikhulile; Anderson, Motswedi; Gaseitsiwe, Simani (MDPI, 2026-05-29)
BACKGROUND : Concomitant HIV/HBV infection results in worse health outcomes, with HBV reactivations being observed in immunocompromised individuals. However, data on HBV infection in people with advanced HIV disease (AHD) remains sparse in Botswana. We aimed to determine the prevalence and molecular characteristics of HBV in people living with HIV (PLHIV) with CD4+ T-cell counts ≤100 cells/µL in Botswana. METHODS : Plasma samples (n = 1097) of PLHIV with CD4+ T-cell count ≤100 cells/uL collected between 2014 and 2016 were screened for hepatitis B surface antigen (HBsAg) and HBV core antibodies (anti-HBc). A 415bp region of the HBV surface gene was amplified and sequenced using Sanger sequencing. Genotypic and mutational analysis was performed using Geno2pheno. Adjusted prevalence ratios (aPRs) were estimated from a modified Poisson regression model to explore factors associated with HBV infection. p-values < 0.05 indicated statistical significance. RESULTS : The median age was 37 years (IQR: 32-43), and 565/1097 (51.5%) were male. HBsAg prevalence was 10.6% (95%CI: 8.8-12.5%) and anti-HBc prevalence was 50.0% (95%CI:46.9-52.9%). Factors associated with HBV infection were male sex [aPR: 1.6 (p < 0.01)] and those that were ART-experienced [aPR: 1.43 (p = 0.04). Eighteen samples were successfully genotyped. The prevalence of genotype A was (12/18, 66.7%) and D (6/18, 33.3%). Sixty-three mutations were identified as associated with drug resistance and immune and diagnostic escape. Highly prevalent immune escape mutations in the surface region were S207N (12/63, 19%) and A194V (9/63, 14.3%). V163I (12/63, 19%) and M129L (12/63, 19%) were highly prevalent in the reverse transcriptase region. Two classical lamivudine-associated drug resistance mutations were observed, each occurring in one participant (L180M and V173L). CONCLUSIONS : The prevalence of HBV in people with AHD is high, highlighting the importance of HBV screening and HIV/HBV co-management in this population.
Trends in lung cancer mortality in Western Cape Province, South Africa (2007–2016)
Kabamba, S.B.; Nyirenda, Thomas Elliot; Moodley, Yoshan (Ghana College of Physicians and Surgeons, 2026-03-31)
OBJECTIVE : The objective of this study was to assess annual trends for lung cancer mortality in the Western Cape. METHODOLOGY : This was a cross-sectional trends analysis. Data on all lung cancer deaths (2006-2017) and population estimates for the Western Cape and South Africa were used to calculate age-standardized lung cancer mortality rates and standardized mortality ratios (SMR). Mortality trends were investigated with trend lines and polynomial regression analyses. RESULTS : The overall (males and females combined) standardized mortality rate for lung cancer in the Western Cape did not vary significantly over time (p=0.070). The overall rate was lowest in 2008 (80.2 per 100,000 population), and highest during 2015 (107.3 per 100,000 population). For males, the standardized mortality rate did not vary significantly over time (p=0.166) and was lowest during 2009 (109.3 per 100,000 population), and highest during 2011 (146.3 per 100,000 population). For females, a significant increasing trend in the standardized mortality rate was observed (p=0.029), being lowest in 2008 (51.6 per 100,000 population) and highest in 2015 (76.6 per 100,000 population). SMRs ranged from 2.1 to 4.6. CONCLUSION : Overall mortality rates for lung cancer in the Western Cape remained constant. Males had higher mortality rates than females. The increasing mortality rate among females is a cause for concern and requires further investigation. Lung cancer mortality in the Western Cape is higher than in the rest of South Africa. There is a need for better lung cancer control and improved access to treatment in the Western Cape.
Detection of hepatitis B virus in cerebrospinal fluid of people with HIV-associated cryptococcal meningitis in Botswana
Phakedi, Basetsana K.S.; Phinius, Bonolo B.; Molebatsi, Kesaobaka; Kelentse, Nametso; Bhebhe, Lynnette; Dobo, Linda Mpofu; Baruti, Kabo; Tsayang, Chanana; Mulenga, Graceful; Ratsoma, Tsholofelo; Mpebe, Gorata G.A.; Ndlovu, Nokuthula S.; Choga, Wonderful; Lawrence, David S.; Moyo, Sikhulile; Jarvis, Joseph N.; Gobe, Irene; Anderson, Motswedi; Gaseitsiwe, Simani (Elsevier, 2026-09)
OBJECTIVES : To investigate hepatitis B virus presence in plasma and cerebrospinal fluid (CSF) of people living with HIV (PLWH) associated cryptococcal meningitis (CM) in Botswana. METHODS : Baseline plasma and CSF samples from the AMBIsome Therapy Induction Optimization for CM study, which enrolled adult PLWH with CM in Botswana (2018-2021), were screened for HBV surface antigen (HBsAg), viral load, occult hepatitis B infection (HBsAg- and HBV DNA+), and sequenced the surface/polymerase region to assess mutations and genetic diversity. RESULTS : Among 81 participants, 67.9% (55/81) were male, median age was 40 years (IQR: 34-44), median CD4+ T cell count was 29 cells/µl (IQR: 11-65). Available plasma (n = 77) and CSF (n = 74) samples were screened for HBV. Plasma HBsAg prevalence was 29.7% (95% CI: 20-42 (19/64) and 18.8% (95% CI: 10-30 (13/69) in CSF. Occult HBV infection (HBsAg- and HBV DNA+) was detected in 35.5% (95% CI: 21-53, 11/31) in plasma and 2.4% (95% CI: 0.06-13, 1/42) in CSF. ART exposure was associated with reduced plasma HBV DNA (P = 0.04), with no significant effect observed in CSF (P = 0.7). In plasma-CSF pairs, plasma showed higher detection rates for HBsAg, HBV DNA, and OBI (P ≤ 0.01). HBV was sequenced in 5 CSF and 4 plasma samples, including 3 pairs. Genotypes A and D detected were concordant between pairs, but 2 pairs showed mutational frequency discordance. CONCLUSION : HBsAg and HBV DNA were detected in CSF of PLWH with CM, suggesting the CSF may be a reservoir. HIGHLIGHTS • HBV HBsAg and DNA were detected in CSF of PLWH with cryptococcal meningitis. • HBV DNA sequences from plasma-CSF pairs showed genotype concordance. • Mutational profiling revealed discordance among plasma-CSF paired samples. • CSF-specific immune escape mutations suggest possible HBV compartmentalization.
Indoor and outdoor air pollutants concentrations at preschools in Melusi informal settlement, Pretoria, South Africa
Bhuda, Mandla Freddy; Malatji, Kemisetso D.; Nchabeleng, Mamagase S.; Shirinde , Joyce (Springer Nature, 2026-03-25)
Air pollution remains a major public health concern in Africa, contributing to an estimated 1.1 million premature deaths annually, with approximately 65% linked to residential exposure. This study assessed indoor and outdoor sulphur dioxide (SO₂) and nitrogen dioxide (NO₂), as well as indoor benzene, toluene, ethylbenzene, and xylene (BTEX), in eight selected preschools within the Melusi informal settlement, Pretoria, South Africa. Pollutants were measured using Radiello passive samplers over a 14-day period. Indoor concentrations ranged from 0.18 to 1.15 µg/m³ for SO₂ and 10.09–22.35 µg/m³ for NO₂, while outdoor levels ranged from 0.45 to 1.90 µg/m³ and 14.09–30.25 µg/m³, respectively. Indoor BTEX concentrations varied from 2.24 to 30.11 µg/m³ for benzene, 5.12–13.30 µg/m³ for toluene, 1.46–6.65 µg/m³ for ethylbenzene, and 1.40–4.06 µg/m³ for xylene. The highest pollutant levels were recorded in preschools using mixed or solid fuels and those located near waste-burning sites or unpaved roads. Indoor/outdoor ratios indicated substantial outdoor infiltration. These findings underscore the urgent need for cleaner household energy, improved ventilation, implementation of indoor air quality policies, and education programs for preschool educators and caregivers to protect children’s health in informal settlement preschools.
Prevalence of underweight and its determinants factors among under-five children in Democratic Republic of Congo
Birhan, Nigussie Adam; Getahun, Kefale Tilahun; Mekonnen, Estibel Dagne; Belay, Denekew Bitew; Asmare, Abebew Aglog; Mengistu , Tsega Asresa (Springer Nature, 2026-03-27)
BACKGROUND: Malnutrition is the leading cause of child mortality in developing nations. Underweight children are more vulnerable to infections and impaired cognitive development. Consequently, this research seeks to evaluate the prevalence of underweight and its contributing factors among children under five years in Democratic Republic of Congo. METHOD: Demographic and health survey data from Democratic Republic of Congo was utilized. Our analysis included a total of 6,847 children under the age of 5 years. To determine factors associated with underweight, multilevel binary logistic regression model was applied. RESULTS: The prevalence of underweight was 22.22% (95%CI: 21.20, 23.27). Child factors significantly linked to underweight included being male child (AOR = 0.65, 95%CI: 0.57, 0.74), being aged 24 to 59 months (AOR = 4.16, 95%CI: 3.26, 5.30), still breastfeeding (AOR = 1.25, 95%CI: 1.04, 1.50), average birth size (AOR = 0.68; 95% CI: 0.55, 0.84), multiple birth (AOR = 3.09, 95%CI: 2.20, 4.34), experiencing diarrhea (AOR = 1.17, 95%CI: 1.01, 1.37), and fever (AOR = 1.16, 95%CI: 1.01, 1.36) and mother- and household-related factors included normal maternal BMI (AOR = 0.52, 95% CI: 0.44–0.61), access to improved water (AOR = 0.85, 95% CI: 0.72–0.99), higher wealth (AOR = 0.68, 95% CI: 0.54–0.85), and secondary or higher maternal education (AOR = 0.67, 95% CI: 0.56–0.81). CONCLUSION: In Democratic Republic of Congo, prevalence of underweight is notably high. Addressing both child-specific factors such as age, sex, birth size and recent illness and mother/household factors including maternal education, nutritional status, and household wealth index is critical for designing targeted interventions. Therefore, multi-sector strategies to improve child nutrition, including strengthening maternal nutrition programs, supporting multiple-birth households, and integrating WASH interventions in high-poverty areas to tackle this pressing problem in Democratic Republic of Congo.
Towards inclusive fiscal policy : a disability-responsive taxation framework for equity and economic empowerment
Willie, Michael Mncedisi; Jikwana, Siyabonga; Mnyaka, Onke Ronaldy; Chitha, Wezile Wilson; Dyantyi, Khona (MDPI, 2026-06)
INTRODUCTION : Disability in South Africa remains a key driver of socioeconomic inequality, affecting labour market participation, income security, and access to social protection. Conventional fiscal instruments, including medical tax credits and deductions, favour formally employed, higher-income taxpayers, leaving many persons with disabilities fiscally excluded. This study used a mixed-methods secondary analysis of peer-reviewed literature, policy documents, labour force data, disability grant records, and household cost estimates to develop a conceptual framework for disability-responsive fiscal inclusion. RESULTS : Labour force data indicate that 10.2% of individuals outside the labour force are due to illness or disability, while discouraged jobseekers rose from 15.2% (2016) to 20.6% (2025). Households with severe disabilities face opportunity costs estimated at R2441 per month from lost earnings, caregiving, transport, and medical expenses. Disability grant patterns show male dominance in permanent disability grants for ages 18–45, with females surpassing males at 50–60. Temporary disability grants follow similar trends, with male predominance in the 18–35 age range and female predominance in the 40–60 age range. These findings reveal systematic gender- and age-related inequities in access to fiscal relief. CONCLUSIONS : Existing tax measures insufficiently address the financial burden of disability, disproportionately favouring urban, formally employed households. Implementing refundable tax credits, simplifying administrative processes, and adopting gender- and age-sensitive policies can enhance fiscal inclusion, reduce inequities, and strengthen economic participation for persons with disabilities in South Africa. This study proposes a framework to guide policymakers in implementing refundable disability tax credits, simplifying administrative processes, and targeting vulnerable groups, including older women, rural households, and low-income earners, to enhance fiscal inclusion, equity, and access to essential services. HIGHLIGHTS Public health relevance—How does this work relate to a public health issue? • Disability affects income, healthcare access, and social protection, influencing health outcomes. • Inequitable tax systems can worsen financial and health vulnerabilities for persons with disabilities. Public health significance—Why is this work of significance to public health? • Highlights how fiscal policies shape social determinants of health and equity. • Supports inclusive policy design to reduce disability-related health disparities. Public health implications—What are the key implications or messages for practitioners, policy makers and/or researchers in public health? • Policymakers can design tax policies that improve access to resources and health outcomes. • Researchers and practitioners can integrate fiscal strategies into broader health equity interventions.
Environmental and socioeconomic factors : weather and COVID-19 cases in Cape Town
Koch, Steven F.; Mashinda, Antoinette Mujinga; Wichmann, Janine (Routledge, 2026-05)
Cape Town, a microcosm of one of the most unequal societies in the world, remains both socially and spatially segregated. In this research, we address whether or not that separation is related to recorded COVID-19 cases in the city. We estimate both the temperature and relative humidity relationship to cases, via distributed-lag nonlinear model (DLNM) components, since the relationship between environmental factors and health can be delayed. The DLNM framework describes the additional time (lag) of the exposure-response association, capturing both the nonlinear exposure-response and the delays. We also expand the discussion to include lockdown measures, their association with infections and socio-economic status in Cape Town. We find that (i) relative humidity, more than temperature, is associated with changes in reported COVID-19 risk; (ii) at relatively high temperatures (21 °C), relative case risk is lower in the low socio-economic status areas; (iii) case risk is generally higher in the same areas.
Characterising acute and chronic care needs: insights from the Global Burden of Disease Study 2019
Anza-Ramirez, Cecilia; Miranda, J. Jaime; Armocida, Benedetta; Correia, Jorge César; Van Spall, Harriette Gillian Christine; Beran, David; Aali, Amirali; Abate, Kalkidan Hassen; Abate, Semagn Mekonnen; Abbafati, Cristiana; Abbasi-Kangevari, Mohsen; Abbasi-Kangevari, Zeinab; Abbastabar, Hedayat; Abdel-Azeem, Ahmed M.; Abdelmasseh, Michael; Abd-Elsalam, Sherief; Abdelwahab, Ahmed; Abdoli, Gholamreza; Abdollahi, Mohammad; Abdoun, Meriem; Abdulah, Deldar Morad; Abdullah, Abu Yousuf Md; Abdurehman, Ame Mehadi; Abebe, Getachew; Abedi, Aidin; Abedi, Vida; Abidi, Hassan; Aboagye, Richard Gyan; Abolhassani, Hassan; Abreu, Lucas Guimarães; Abrigo, Michael R.M.; Abtew, Yonas Derso; Ali, Hiwa Abubaker; Abu-Gharbieh, Eman; Abu-Zaid, Ahmed; Accrombessi, Manfred Mario Kokou; Acuna, Juan Manuel; Adane, Denberu Eshetie; Adane, Tigist Demssew; Addo, Isaac Yeboah; Addolorato, Giovanni; Adeagbo, Oluwafemi Atanda; Adekanmbi, Victor; Adesina, Miracle Ayomikun; Adetokunboh, Olatunji O.; Adeyinka, Daniel Adedayo; Adnani, Qorinah Estiningtyas Sakilah; Afolabi, Aanuoluwapo Adeyimika; Afzal, Muhammad Sohail; Afzal, Saira; Agarwal, Gina; Agarwal, Prerna; Agasthi, Pradyumna; Agrawal, Anurag; Agudelo-Botero, Marcela; Ahinkorah, Bright Opoku; Ahmad, Aqeel; Ahmad, Sajjad; Ahmad, Sohail; Ahmad, Tauseef; Ahmadi, Ali; Ahmadi, Keivan; Ahmadi, Sepideh; Ahmed, Ali; Ahmed, Ayman; Ahmed, Haroon; Ahmed, Jivan Qasim; Ahmed, Luai A.; Aithala, Janardhana P.; Ajami, Marjan; Aji, Budi; Akbarialiabad, Hossein; Akhlaghdoust, Meisam; Aklilu, Addis; Akonde, Maxwell; Al Hamad, Hanadi; Alahdab, Fares; Al- Aly, Ziyad; Alam, Khurshid; Alam, Manjurul; Alam, Nazmul; Alam, Samiah; Alanezi, Fahad Mashhour; Alanzi, Turki M.; Alcalde-Rabanal, Jacqueline Elizabeth; Alemayehu, Astawus; Alemu, Birhanu Alamirew Alamirew; Alene, Kefyalew Addis; Alhabib, Khalid F.; Alhajri, Noora; Al-Hanawi, Mohammed Khaled; Alhassan, Robert Kaba; Ali, Liaqat; Ali, Muhammad; Ali, Syed Shujait; Alian Samakkhah, Shohreh; Alicandro, Gianfranco; Alif, Sheikh Mohammad; Alimohamadi, Yousef; Al-Jumaily, Adel; Aljunid, Syed Mohamed; Alla, François; Almalki, Mohammed J.; Al-Maweri, Sadeq; Almustanyir, Sami; Alomari, Mahmoud A.; Alonso, Jordi; Alonso, Nivaldo; Al-Raddadi, Rajaa M.; Al-Sabah, Salman Khalifah; Al-Tammemi, Ala’a B.; Altirkawi, Khalid A.; Alvis-Guzman, Nelson; Alvis-Zakzuk, Nelson J.; Amare, Azmeraw T.; Amare, Hiwot; Ameyaw, Edward Kwabena; Amin, Tarek Tawfik; Aminian Dehkordi, Javad; Amir, Afreenish; Amiri, Hoda; Amiri, Sohrab; Amu, Hubert; Amuasi, John H.; Amugsi, Dickson A.; Amusa, Ganiyu Adeniyi; Anagaw, Tadele Fentabil; Ancochea, Julio; Ancuceanu, Robert; Anderlini, Deanna; Andrei, Catalina Liliana; Androudi, Sofia; Andrei, Tudorel; Anjana, Ranjit Mohan; Anoushiravani, Amir; Ansar, Adnan; Ansari-Moghaddam, Alireza; Antony, Benny; Antriyandarti, Ernoiz; Antwi, Maxwell Hubert; Anvari, Davood; Anwer, Razique; Anyasodor, Anayochukwu Edward; Apostolaki, Stella; Appiah, Francis; Arabloo, Jalal; Arab-Zozani, Morteza; Areda, Demelash; Aref, Hany Mohamed Amin; Argaw, Zeleke Gebru; Ariffin, Hany; Ärnlöv, Johan; Arruda, Renato; Arshad, Muhammad; Artaman, Al; Artamonov, Anton A.; Artanti, Kurnia Dwi; Arulappan, Judie; Aruleba, Raphael Taiwo; Arumugam, Ashokan; Aryal, Krishna K.; Aryan, Zahra; Asadi-Pooya, Ali A.; Asemi, Zatollah; Asgary, Saeed; Asghari-Jafarabadi, Mohammad; Ashraf, Tahira; Assaye, Ashagre Molla; Astell-Burt , Thomas; Ataei, Mahshid; Atafar, Zahra; Athar, Mohammad; Athari, Seyyed Shamsadin; Atorkey, Prince; Atreya, Alok; Atteraya, Madhu Sudhan; Attia, Sameh; Aujayeb, Avinash; Ausloos, Marcel; Avan, Abolfazl; Ayala Quintanilla, Beatriz Paulina; Ayana, Tegegn Mulatu; Ayele, Alemu Degu; Ayele, Meshesha Tsegazeab; Ayelign, Birhanu; Ayinde, Olatunde O.; Ayuso-Mateos, Jose L.; Azadnajafabad, Sina; Azangou-Khyavy, Mohammadreza; Azari Jafari, Amirhossein; Azzam, Ahmed Y.; Babajani, Amirhesam; Babu, Abraham Samuel; Badar, Muhammad; Badawi, Alaa; Badiye, Ashish D.; Baghcheghi, Nayereh; Bagheri, Nasser; Bagherieh, Sara; Bahadory, Saeed; Baig, Amin Atif; Bairwa, Mohan; Baker, Jennifer L.; Bakkannavar, Shankar M.; Balta, Asaminew Birhanu; Banerjee, Amitava; Banerjee, Indrajit; Banik, Palash Chandra; Bansal, Hansi; Bantie, Abere Tilahun; Bardhan, Mainak; Barker-Collo, Suzanne Lyn; Bärnighausen, Till Winfried; Barone, Mark Thomaz Ugliara; Barone-Adesi, Francesco; Barqawi, Hiba Jawdat; Barra, Fabio; Barrow, Amadou; Barteit, Sandra; Barua, Lingkan; Bashiri, Azadeh; Baskaran, Pritish; Basu, Sanjay; Basu, Saurav; Batiha, Abdul-Monim Mohammad; Baune, Bernhard T.; Bedi, Neeraj; Begum, Tahmina; Bejarano Ramirez, Diana Fernanda; Belay, Hailu B.Y.; Belay, Moges Mareg; Belgaumi, Uzma Iqbal; Belo, Luis; Bendak, Salaheddine; Bennett, Derrick A.; Bensenor, Isabela M.; Benzian, Habib; Berhie, Alemshet Yirga; Berman, Adam E.; Bernstein, Robert S.; Bhagavathula, Akshaya Srikanth; Bhandari, Dinesh; Bhardwaj, Nikha; Bhardwaj, Pankaj; Bhaskar, Sonu; Bhat, AjayNagesh; Bhat, Vivek; Bhattarai, Suraj; Bhojaraja, Vijayalakshmi S.; Bikbov, Boris; Bills, Corey B.; Biondi, Antonio; Birara, Setognal; Biswas, Atanu; Biswas, Raaj Kishore; Bitaraf, Saeid; Blyuss, Oleg; Boachie, Micheal Kofi; Bodicha, Belay Boda Abule; Bodolica, Virginia; Bojia, Hunduma Amensisa; Boloor, Archith; Botelho, João Silva; Bouaoud, Souad; Bourne, Rupert; Bragazzi, Nicola Luigi; Braithwaite, Dejana; Brant, Luisa C.; Breitborde, Nicholas J. K.; Brenner, Hermann; Breugem, Corstiaan; Briko, Nikolay Ivanovich; Britton, Gabrielle; Brown, Julie; Brugha, Traolach; Brunoni, Andre R.; Buchbinder, Rachelle; Bulamu, Norma B.; Buonsenso, Danilo; Burkart, Katrin; Burns, Richard A.; Nagaraja, Sharath Burugina; Butt, Muhammad Hammad; Butt, Nadeem Shafique; Butt, Zahid A.; Cai, Tianji; Calina, Daniela; Cámera, Luis Alberto; Campos, Luciana Aparecida; Cao, Chao; Carneiro, Vera L. A.; Carreras, Giulia; Carvalho, Andre F.; Carvalho, Márcia; Castaldelli-Maia, Joao Mauricio; Castelpietra, Giulio; Catapano, Alberico L.; Cattaruzza, Maria Sofia; Cederroth, Christopher R.; Cembranel, Francieli; Cerin, Ester; Chakraborty, Promit Ananyo; Chandrasekar, Eeshwar K.; Chang, Jung-Chen; Chanie, Gashaw Sisay; Charalampous, Periklis; Chattu, Vijay Kumar; Chaturvedi, Sarika; Chaurasia, Akhilanand; Chen, Meng Xuan; Chen, Simiao; Cherbuin, Nicolas; Ching, Patrick R.; Chitheer, Abdulaal; Cho, William C.S.; Chong, Yuen Yu; Chopra, Hitesh; Chou, Tzu-Chieh; Choudhari, Sonali Gajanan; Chowdhury, Enayet Karim; Chowdhury, Rajiv; Christensen, Hanne; Christensen, Steffan Wittrup McPhee; Christopher, Devasahayam J.; Chu, Dinh-Toi; Chukwu, Isaac Sunday; Chung, Sheng-Chia; Ciuffreda, Raffaela; Clark, Scott Richard; Claro, Rafael M.; Coberly, Kaleb; Conde, Joao; Corso, Barbara; Criqui, Michael H.; Cross, Marita; Cruz-Martins, Natália; Dadras, Omid; Dai, Xiaochen; Damasceno, Albertino Antonio Moura; Damiani, Giovanni; Danawi, Hadi A.; Das, Jai K.; Das, Saswati; Dascalu, Ana Maria; Dastiridou, Anna; Dávila-Cervantes, Claudio Alberto; KairatDavletov; De la Hoz, Fernando Pio; De Luca, Maia; Debela, Sisay Abebe; Degefu, Natanim; Dehghan, Amin; Dehghan, Azizallah; Dejene; Dellavalle, Robert Paul; Demetriades, Andreas K.; Demisse, Biniyam; Demisse, Fitsum Wolde; Demissie, Solomon; Denova-Gutiérrez, Edgar; Dereje, Diriba; Derese, Msganaw; Dervenis, Nikolaos; Desai, Hardik Dineshbhai; Desai, Rupak; Dessalegn, Fikadu Nugusu; Dessie, Gashaw; Desta, Abebaw Alemayehu; Deuba, Keshab; Dey, Sagnik; Dhali, Arkadeep; Dhimal, Meghnath; Dhingra, Sameer; Diao, Nancy; Da Silva, Diana Dias; Dibaba, Diriba Tolesa; Digesa, Lankamo Ena; Diress, Mengistie; Dixit, Abhinav; Dixit, Shilpi Gupta; Djalalinia, Shirin; Doaei, Saeid; Dodangeh, Milad; Doheim, Mohamed Fahmy; Doku, Paul Narh; Dongarwar, Deepa; Dora, Bezabih Terefe; Dorostkar, Fariba; dos Santos, Wendel Mombaque; Doshi, Chirag P.; Doshi, Rajkumar; Doshmangir, Leila; Douiri, Abdel; Dsouza, Haneil Larson; Dube, John; Duraes, Andre Rodrigues; Durojaiye, Oyewole Christopher; Edinur, Hisham Atan; Edvardsson, David; Edvardsson, Kristina; Efendi, Ferry; Ehsani-Chimeh, Elham; Eini, Ebrahim; Ekholuenetale, Michael; Ekundayo, Temitope Cyrus; El Nahas, Nevine; El Sayed, Iman; El Tantawi, Maha; El-Abid, Hassan; Elbarazi, Iffat; Elema, Teshome Bekele; Elgar, Frank J.; Elgendy, IslamY.; ElGohary, Ghada Metwally Tawfik; Elhabashy, Hala Rashad; Elhadi, Muhammed; Elmonem, Mohamed A.; Engelbert Bain, Luchuo; Erkhembayar, Ryenchindorj; Esayas, Hawi Leul; Esezobor, Christopher Imokhuede; Eshrati, Babak; Eskandarieh, Sharareh; Espinosa-Montero, Juan; Esposito, Francesco; Etaee, Farshid; Etafa, Werku; Ezzikouri, Sayeh; Fagbamigbe, Adeniyi Francis; Faghani, Shahriar; Falzone, Luca; Faraon, Emerito Jose A.; Farhang Dehghan, Somayeh; Farinha, Carla Sofia e. Sá; Faro, Andre; Farooq, Umar; Faruk, Md Omar; Fasanmi, Abidemi Omolara; Fasanmi, Akinlolu O.; Fatehizadeh, Ali; Fattahi, Nazir; Fauk, Nelsensius Klau; Feigin, Valery L.; Fekadu, Ginenus; Feng, Xiaoqi; Fereshtehnejad2, Seyed- Mohammad; Feroze, Abdullah Hamid; Ferrara, Pietro; Ferrari, Allegra; Ferrero, Simone; Fetensa, Getahun; eyisa, Bikila Regassa F; Filip, Irina; Fischer, Florian; Flavel, Joanne; Flood, David; Folayan, Morenike Oluwatoyin; Fonseca, Ana Catarina; Fornari, Arianna; Foroutan, Behzad; Fowobaje, Kayode Raphael; Freitas, Alberto; Freitas, Marisa; Friedman, Sara D.; Fukumoto, Takeshi; Gaal, Peter Andras; Gadanya, Muktar A.; Gaidhane, Abhay Motiramji; Gaihre, Santosh; Galali, Yaseen; Galehdar, Nasrin; Gallus, Silvano; Ganesan, Balasankar; Garcia-Gordillo, M.A.; Garg, Priyanka; Fonseca, Mariana Gaspar; Gazzelloni, Federica; Gbadamosi, Semiu Olatunde; Gebrehiwot, Mesfin; Gebrekidan, Kahsu Gebrekirstos; Gebremeskel, Teferi Gebru; Gela, Yibeltal Yismaw; Geleta, Leta Adugna; Gerema, Urge; Getacher, Lemma; Getachew, Tamirat; Ghadiri, Keyghobad; Ghaffarpasand, Fariborz; Ghafourifard, Mansour; Ghahramani, Sulmaz; Ghamari, Seyyed-Hadi; Ghanbari, Reza; Ghasemi Nour, Mohammad; Ghashghaee, Ahmad; Ghazi Sherbaf, Farzaneh; Ghodsi, Zahra; Gholamalizadeh, Maryam; Gholami, Ali; Gholamrezanezhad, Ali; Ghozali, Ghozali; Ghozy, Sherief; Gill, Tiffany K.; Ginindza, Themba G.; Glasbey, James C.; Göbölös, Laszlo; Goel, Amit; Golechha, Mahaveer; Goleij, Pouya; Golinelli, Davide; Gomes, NelsonG. M.; Gopalani, Sameer Vali; Gorini, Giuseppe; Goudarzi, Houman; Goulart, Alessandra C.; Goulart, Bárbara Niegia Garcia; Grivna, Michal; Guadamuz, Jenny S.; Guadie, Habtamu Alganeh; Gubari, Mohammed Ibrahim Mohialdeen; Gudisa, Zewdie; Guha, Avirup; Guimarães, Rafael Alves; Gupta, Bhawna; Gupta, Rajeev; Gupta, Sapna; Gupta, Veer Bala; Gupta, Vijai Kumar; Gupta, Vivek Kumar; Guta, Alemu; Guzman-Vilca, Wilmer Cristobal; Asgarabad, Mojtaba Habibi; Habibzadeh, Parham; Hachinski, Vladimir; Hadei, Mostafa; Hafezi-Nejad, Nima; Hajj Ali, Adel; Haj-Mirzaian, Arvin; Halboub, Esam S.; Halimi, Aram; Hall, Brian J.; Halwani, Rabih; Hamadeh, Randah R.; Hambisa, Mitiku Teshome; Hameed, Sajid; Hamidi, Samer; Hamiduzzaman, Mohammad; Hanif, Asif; Hankey, Graeme J.; Hannan, Md Abdul; Haque, Md Nuruzzaman; Harapan, Harapan; Hargono, Arief; Hariyani, Ninuk; Haro, Josep Maria; Harorani, Mehdi; Hartono, Risky Kusuma; Hasaballah, Ahmed I.; Hasan, Faizul; Hasan, M. Tasdik; Hasan, Md Mehedi; Hasani, Hamidreza; Hassan, Abbas M.; Hassan, Amr; Hassan, Shoaib; Hassanian-Moghaddam, Hossein; Hassanipour, Soheil; Hassankhani, Hadi; Havmoeller, Rasmus J.; Hayat, Khezar; Hebert, Jeffrey J.; Hedna, Khedidja; Heidari, Mohammad; Heidari-Soureshjani, Reza; Hendrie, Delia; Herrera-Serna, Brenda Yuliana; Heyi, Demisu Zenbaba; Hezam, Kamal; Hiraike, Yuta; Holla, Ramesh; Horita, Nobuyuki; Hossain, Md Mahbub; Hossain, Sahadat; Hosseinzadeh, Mehdi; Hostiuc, Mihaela; Hostiuc, Sorin; Hoveidamanesh, Soodabeh; Hsairi, Mohamed; Hsiao, Alexander Kevin; Huang, Junjie; Hudson, Irene Lena; Hussain, Salman; Hussain, Zakir Hussain; Hussein, Nawfal R.; Hussien, Foziya Mohammed; Hwang, Bing-Fang; Ibitoye, Segun Emmanuel; Ilesanmi, Olayinka Stephen; Ilic, Irena M.; Ilic, Milena D.; Immurana, Mustapha; Inbaraj, Leeberk Raja; Irham, Lalu Muhammad; Islam, Md Rafiqul; Islam, Mohammad Mainul; Islam, Rubana; Islam, Sheikh Mohammed Shariful; Islami, Farhad; Ismail, Nahlah Elkudssiah; Iso, Hiroyasu; Isola, Gaetano; Itiola, Ademola Joshua; Iwagami, Masao; Iwu, Chidozie Declan; Iwu-Jaja, Chinwe Juliana; Iyamu, Ihoghosa Osamuyi; Jaafari, Jalil; Jacob, Louis; Jadidi-Niaragh, Farhad; Jahrami, Haitham; Jain, Rajesh; Jaiswal, Abhishek; Jakovljevic, Mihajlo; Jamshidi, Elham; Jani, Chinmay T.; Janodia, Manthan Dilipkumar; Javaheri, Tahereh; Jayanna, Krishnamurthy; Jayapal, Sathish Kumar; Jayarajah, Umesh; Jayaram, Shubha; Jazayeri, Seyed Behzad; Jebai, Rime; Jeganathan, Jayakumar; Jemere, Digisie Mequanint; Jeyakumar, Angeline; Jha, Vivekanand; Ji, John S.; OJohnson, latunji; Jonas, Jost B.; Joo, Tamas; Joseph, Abel; Joseph, Nitin; Joshua, Vasna; Joukar, Farahnaz; Jozwiak, Jacek Jerzy; Jürisson, Mikk; Kaambwa, Billingsley; Kabir, Ali; Kabir, Zubair; Kadashetti, Vidya; Kadir, Dler Hussein; Kakodkar, Pradnya Vishal; Kalani, Rizwan; Kalankesh, Laleh R.; Kalankesh, Leila R.; Kalhor, Rohollah; Kaliyadan, Feroze; Kamal, Vinet Kumar; Kamath, Ashwin; Kamath, Rajesh; Kamiab, Zahra; Kamyari, Naser; Kanchan, Tanuj; Kandel, Himal; Kantar, Rami S.; Kapoor, Neeti; Karami, Hassan; Karanth, Shama D.; Karaye, Ibraheem M.; Karimi, Salah Eddin; Karkhah, Samad; Kashoo, Faizan Zaffar; Kassie, Gizat M.; Katoto, Patrick D.M.C.; Kattea, Mohammad Obadah; Kauppila, Joonas H.; Kayode, Gbenga A.; Keikavoosi-Arani, Leila; Kejela, Gemechu Gemechu; Kempen, John H.; Kerr, Jessica A.; Keskin, Cumali; Keykhaei, Mohammad; Khader, Yousef Saleh; Khajuria, Himanshu; Khalafi, Mohammad; Khalid, Nauman; Khammarnia, Mohammad; Khan, Asaduzzaman; Khan, Atif A.; Khan, Ejaz Ahmad; Khan, Imteyaz A.; Khan, Maseer; Khan, Md Jobair; Khan, Moien A.B.; Khan, M. Nuruzzaman; Khan, Yusra H.; Khanali, Javad; Khatab, Khaled; Khatatbeh, Moawiah Mohammad; Khater, Mona M.; Khateri, Sorour; Khatib, Mahalaqua Nazli; Kashani, Hamid Reza Khayat; Khazaeipour, Zahra; Khosravi, Ahmad; Khubchandani, Jagdish; Kim, Gyu Ri; Kim, Jihee; Kim, Yun Jin; Kimokoti, Ruth W.; Kisa, Adnan; Kisa, Sezer; Kivimäki, Mika; Kneib, Cameron J.; Kochhar, Sonali; Koh, David S. Q.; Kolahi, Ali-Asghar; Kolkhir, Pavel; Koly, Kamrun Nahar; Kompani, Farzad; Koohestani, Hamid Reza; Korshunov, Vladimir Andreevich; Korzh, Oleksii; Kosen, Soewarta; Koul, Parvaiz A.; Koulmane Laxminarayana, Sindhura Lakshmi; Koyanagi, Ai; Krishan, Kewal; Krishnamoorthy, Vijay; Kruger, Estie; Defo, Barthelemy Kuate; Kucuk Bicer, Burcu; Kuddus, Mohammed; Kuddus, Mohammed; Kugbey, Nuworza; Kumar, Akshay; Kumar, Manasi; Kumar, Narinder; Kumar, Naveen; Kumar, Nithin; Kurmi, OmP.; Kusuma, Dian; Kuttikkattu, Ambily; La Vecchia, Carlo; Laflamme, Lucie; Lal, Dharmesh Kumar; Lalloo, Ratilal; Lallukka, Tea; Lám, Judit; Lami, Faris Hasan; Lan, Qing; Landire, Iván; Lang, Justin J.; Langguth, Berthold; Larijani, Bagher; Larsson, Anders O.; Latief, Kamaluddin; Lau, Sum Yuet Joyce; Laurens, Matthew B.; Lauriola, Paolo; Layoun, Habib; Lee, Doo Woong; Lee, Paul H.; Lee, Sang-woong; Lee, Seung Won; Lee, Shaun Wen Huey; Lee, Wei-Chen; Lee, Yo Han; Legesse, Samson Mideksa; Leigh, James; Leonardi, Matilde; Leong, Elvynna; Li, An; Li, Ming-Chieh; Libra, Massimo; Likaka, Andrew Tiyamike Makhiringa; Lim, Lee-Ling; Lim, David Lim; Lim, Stephen S.; Lin, Ro-Ting; Linehan, Christine; Linn, Shai; Liu, Gang; Liu, Jue; Liu, Shiwei; Liu, Wei; Lo, Chun-Han; Lopes, Graciliana; Lopukhov, Platon D.; Loreche, Arianna Maever; Lorenzovici, László; Lotfi, Mojgan; Loureiro, Joana A.; Lucchetti, Giancarlo; Lunevicius, Raimundas; Machado, Vanessa Sintra; Madadizadeh, Farzan; Maddison, Ralph; Magdy Abd El Razek, Hassan; Mahadeshwara Prasad, D.R.; Mahajan, Preetam Bhalchandra; Mahasha, Phetole Walter; Mahjoub, Soleiman; Mahmoud, Mansour Adam; Mahmoudi, Razzagh; Mahmoudimanesh, Marzieh; Majeed, Azeem; Malagón-Rojas, Jeadran N.; Malakan Rad, Elaheh; Malik, Ahmad Azam; Mallhi, Tauqeer Hussain; Manla, Yosef; Mansour, Ali; Mansouri, Borhan; Mansournia, Mohammad Ali; Mantovani, Lorenzo Giovanni; Marjani, Abdoljalal; Marrugo Arnedo, Carlos Alberto; Martinez-Piedra, Ramon; Martinez-Valle, Adolfo; Martini, Santi; Martins-Melo, Francisco Rogerlândio; Martorell, Miquel; Masoudi, Sahar; Mathews, Elezebeth; Mathioudakis, Alexander G.; Maude, Richard James; Maulik, Pallab K.; Maulud, Sazan Qadir; Mechili, Enkeleint A.; Meena, Jitendra Kumar; Meherali Meherali, Salima; Mehmood, Khalid; Mehndiratta, Man Mohan; Mehrabi Nasab, Entezar; Mehta, Kala M.; Mekonnen, Laychiluh Bantie; Memish, Ziad A.; Mendoza, Walter; Mendoza-Cano, Oliver; Menezes, RiteshG.; Mentis, Alexios-Fotios A.; Meretoja, Atte; Meretoja, Tuomo J.; Meselu, Belsity Temesgen; Mesfin, Bezawit Afework; Mestrovic, Tomislav; Miazgowski, Tomasz; Micha, Georgia; Michalek, Irmina Maria; Micheletti Gomide Nogueira de Sá, Ana Carolina; Mihrtie, Gedefaye Nibret; Miller, Ted R.; Mirghaderi, Seyed Peyman; Mirghafourvand, Mojgan; Mirica, Andreea; Mirijello, Antonio; Mirmoeeni, Seyyedmohammadsadeq; Mirrakhimov, Erkin M.; Mirza, Moonis; Mirzaei, Maryam; Mirzaei, Roya; Misganaw, Awoke; Misra, Sanjeev; Mithra, Prasanna; Mittal, Chaitanya; Moghadasi, Javad; Mohamadkhani, Ashraf; Mohamed, Abdalla Z.; Mohammad, Karzan Abdulmuhsin; Mohammad-Alizadeh-Charandabi, Sakineh; Mohammadi, Esmaeil; Mohammadi, Soheil; Mohammed, Hussen; Mohammed, Shafiu; Mohan, Syam; Moka, Nagabhishek; Mokdad, Ali H.; Molokhia, Mariam; Momtazmanesh, Sara; Monasta, Lorenzo; Moncatar, T.J. Robinson T.; Mondello, Stefania; Moni, Mohammad Ali; Moniruzzaman, Md; Montazeri, Fateme; Moosavi, Delaram; Moradi, Yousef; Moradi-Lakeh, Maziar; Moraga, Paula; Moreira, Rafael Silveira; Morgado-da-Costa, Joana; Morovatdar, Negar; Morris, Meg E.; Morrison, Shane Douglas; Mossialos, Elias; Mostafavi, Ebrahim; Motaghinejad, Majid; Mouodi, Simin; Mousavi Khaneghah, Amin; Mubarik, Sumaira; Muccioli, Lorenzo; Mueller, Ulrich Otto; Mukherjee, Soumyadeep; Mulita, Francesk; Mulu, Getaneh Baye; Munblit, Daniel; Murillo-Zamora, Efrén; Murthy, Shruti; Musina, Ana-Maria; Mustafa, Ghulam; Muthupandian, Saravanan; Mwita, Julius C.; Nabhan, Ashraf F.; Nagarajan, Ahamarshan Jayaraman; Naimzada, Mukhammad David; Nair, Tapas Sadasivan; Najafpour, Zhila; Naldi, Luigi; Nangia, Vinay; Naqvi, Atta Abbas; Swamy, Sreenivas Narasimha; Narayana, Aparna Ichalangod; Nascimento, Bruno Ramos; Natarajan, Gopalakrishnan; Natto, Zuhair S.; Nayak, Biswa Prakash; Nayak, Vinod C.; Ndejjo, Rawlance; Nduaguba, Sabina Onyinye; Negoi, Ionut; Negoi, Ruxandra Irina; Nejadghaderi, Seyed Aria; Nena, Evangelia; Nepal, Samata; Netsere, Henok Biresaw; Nguefack-Tsague, Georges; Ngunjiri, Josephine W.; Ngwa, Che Henry; Niazi, Robina Khan; Nigatu, Solomon Gedlu; Nikoobar, Ali; Nikpoor, Amin Reza; Nizam, Muhammad A.; Nnaji, Chukwudi A.; Nomura, Shuhei; Noor, Nurulamin M.; Noroozi, Nafise; Norrving, Bo; Noubiap, Jean Jacques; Nouraei, Hasti; Ntaios, George; Ntsekhe, Mpiko; Nurrika, Dieta; Nutor, Jerry John; Nzoputam, Chimezie Igwegbe; Nzoputam, Ogochukwu Janet; Obi, Felix Chukwudi Abrahams; Odukoya, Oluwakemi Ololade; Oghenetega, Onome Bright; Ogunkoya, Abiola; Oh, In-Hwan; Ojagbemi, Akin; Okati-Aliabad, Hassan; Okekunle, Akinkunmi Paul; Okonji, Osaretin Christabel; Oladunjoye, Adeolu Olufunso; Oladunjoye, Olubunmi Omotola; Olagunju, Andrew T.; Olivas-Martinez, Antonio; Onwujekwe, Obinna E.; Ortega-Altamirano, Doris V.; Ortiz, Alberto; Otoiu, Adrian; Otstavnov, Nikita; Otstavnov, Stanislav S.; Oulhaj, Abderrahim; Ouyahia, Amel; Øverland, Simon; Owolabi, Mayowa O.; P. A, Mahesh; Pacheco-Barrios, Kevin; Padron-Monedero, Alicia; Padubidri, Jagadish Rao; Pal, Pramod Kumar; Palicz, Tamás; Palladino, Raffaele; Panda- Jonas, Songhomitra; Pandi-Perumal, Seithikurippu R.; Pangaribuan, Helena Ullyartha; Pant, Suman; Papadopoulou, Paraskevi; Pardhan, Shahina; Park, Eun-Cheol; Park, Eun-Kee; Park, Seoyeon; Pasupula, Deepak Kumar; Patel, Jay; Patel, Jenil R.; Patel, Rikinkumar S.; Patel, Urvish K.; Pathan, Aslam Ramjan; Patnaik, Ronit Patnaik; Paudel, Uttam; Pawar, Shrikant; Toroudi, Hamidreza Pazoki; Peden, Amy E.; Pedersini, Paolo; Peng, Minjin; Pensato, Umberto; Pepito, Veincent Christian Filipino; Peprah, Emmanuel K.; Perdigão, João; Pereira, Marcos; Pereira, Renato B.; Piracha, Zahra Zahid; Pirouzpanah, Saeed; Pirsaheb, Meghdad; Plotnikov, Evgenii; Podder, Indrashis; Podder, Vivek; Pofi, Riccardo; Polibin, Roman V.; Polkinghorne, Kevan R.; Poluru, Ramesh; Pond, Constance Dimity; Porru, Fabio; Postma, Maarten J.; Pourtaheri, Naeimeh; Prada, Sergio I.; Pradhan, Pranil Man Singh; Prakash, V.; Prasad, Narayan; Proença, Luís; Qattea, Ibrahim; Quazi Syed, Zahiruddin; Rabiee, Navid; Radfar, Amir; Radhakrishnan, Raghu Anekal; Radhakrishnan, Venkatraman; Rafiee, Ata; Raggi, Alberto; Raghav Raghav, Pankaja; Rahim, Fakher; Rahimi, Majid; Rahimi-Movaghar, Vafa; Rahman, Azizur; Rahman, Md Obaidur; Rahman, Mohammad Hifz Ur; Rahman, Mosiur; Rahman, Muhammad Aziz; Rahmani, Amir Masoud; Rahmani, Shayan; Rahmanian, Vahid; Raimondo, Diego; Raimondo, Ivano; Raj Moolambally, Sheetal; Rajput, Prashant; Rajsic, Sasa; Raju, Sree Bhushan; Ram, Pradhum; Ramazanu, Sheena; Rana, Juwel; Ranabhat, Chhabi Lal; Rao, Chythra R.; Rao, Sowmya J.; Raru, TemamBeshir; Rashedi, Sina; Rashidi, Mohammad-Mahdi; Rastogi, Prateek; Rasul, Azad; Ratan, Zubair Ahmed; Ravangard, Ramin; Rawaf, David Laith; Rawassizadeh, Reza; Raza, Rabail Zehra; Razeghian-Jahromi, Iman; Redwan, Elrashdy Moustafa Mohamed; Remuzzi, Giuseppe; Renzaho, Andre M.N.; Reshmi, Bhageerathy; Rezaei, Nazila; Rezaei, Negar; Rezaei, Nima; Rezaei, Zahed; Rezaeian, Mohsen; Riad, Abanoub; Riaz, Mavra A.; Riaz, Muhammad; Ribeiro, Antonio Luiz P.; Ribeiro, Daniel Cury; Ribeiro, Daniela; Ribeiro da Silva, Tércia Moreira; Rickard, Jennifer; Rodrigues, Mónica; Rodriguez, Jefferson Antonio Buendia; Roever, Leonardo; Romero-Rodríguez, Esperanza; Romoli, Michele; Ronfani, Luca; Roosihermiatie, Betty; Rosenthal, Victor Daniel; Rostamian, Morteza; Roy, Bedanta; Rubagotti, Enrico; Rumisha, Susan Fred; Rwegerera, Godfrey M.; S, Manjula; S. N, Chandan; Saad, Aly M.A.; Sabbatucci, Michela; Saber-Ayad, Maha Mohamed; Sabour, Siamak; Sacco, Simona; Sachdev, Perminder S.; Sachdeva, Rajesh; Saddik, Basema; Sadeghi, Erfan; Sadeghi, Malihe; Sadeghi, Masoumeh; Sadeghian, Saeid; Saeb, Mohammad Reza; Saeed, Umar; Saeedi Moghaddam, Sahar; Safdar Safdar, Muhammad Aamir; Safdarian, Mahdi; Safi, Sher Zaman; Sagar, Rajesh; Sagoe, Dominic; Sahebkar, Amirhossein; Sahoo, Harihar; Sahraian, Mohammad Ali; Saif-Ur-Rahman, K. M.; Sajid, Mirza Rizwan; Sakhamuri, Sateesh; Salah, Rehab; Salahi, Saina; Salahi8, Sarvenaz; Salam, Nasir; Salamati, Payman; Salem, Marwa Rashad; Samadi Kafil, Hossein; Samodra, Yoseph Leonardo; Samy, Abdallah M.; Sanabria, Juan; Sanmarchi, Francesco; Santos, Itamar S.; Santric-Milicevic, Milena M.; Sao Jose, Bruno Piassi; Saqib, Muhammad Arif Nadeem; Saraswathy, Sivan Yegnanarayana Iyer; Sarikhani, Yaser; Saroj, Rakesh Kumar; Sarrafzadegan, Nizal; Sarveazad, Arash; Sathian, Brijesh; Sathish, Thirunavukkarasu; Satpathy, Maheswar; Sattin, Davide; Sawhney, Monika; Saya, Ganesh Kumar; Sayegh, Nicolas; Scarmeas, Nikolaos; Schlaich, Markus P.; Schlee, Winfried; Schneider, Ione Jayce Ceola; Schwebel, David C.; Seidu, Abdul-Aziz; Senthilkumaran, Subramanian; Serban, Dragos; Serván-Mori, Edson; SeyedAlinaghi, Seyed Ahmad; Seylani, Allen; Shafeghat, Melika; Shaghaghi, Zahra; Shah, Syed Mahboob; Shahabi, Saeed; Shahbandi, Ataollah; Shaheen, Amira A.; Shahraki-Sanavi, Fariba; Shahsavari, Hamid R.; Shaikh, Masood Ali; Shaji, KS; Shakaib, Reza; Shalash, Ali S.; Shanawaz, Mohd; Sharew, Mequannent Melaku; Sharew, Nigussie Tadesse; Sharifi, Azam; Sharifian, Sakineh; Sharifi-Rad, Javad; Sharma, Purva; Sharma, Saurab; Sharma, Vishal; Shashamo, Bereket Beyene; Shavandi, AminAmin; Shayan, Maryam; Shehaj, Blerta; Sheikh, Aziz; Sheikhi, Rahim Ali; Sheikhtaheri, Abbas; Shekhar, Shashank; Shetty, Adithi; Shetty, B. Suresh Kumar; Shetty, Jeevan K.; Shetty, Pavanchand H.; Shi, Peilin; Shi, Yi; Shiani, Amir; Shigematsu, Mika; Shin, Jae Il; Shiri, Rahman; Shiri, Maryam Shirvani; Shishani, Kawkab; Shivakumar, K.M.; Shivarov, Velizar; Shobeiri, Parnian; Shorofi, Seyed Afshin; Shrestha, Dhan Bahadur Dhan; Shrestha, Sunil; Shuja, Kanwar Hamza; Shuval, Kerem; Sigfusdottir, Inga Dora; Silva, Luís Manuel Lopes Rodrigues; Sima, Ali Reza; Simegn, Wudneh; Simonetti, Biagio; Sinaei, Ehsan; Singal, Anjali; Singh, Ambrish; Singh, Balbir Bagicha; Singh, Garima; Singh, Harpreet; Singh, Jasvinder A.; Singh, Kuldeep; Singh, Narinder Pal; Singh, Paramdeep; Singh, Surjit; Sinto, Robert; Siraj, Md Shahjahan; Skou, Søren T.; Skryabin, Valentin Yurievich; Skryabina, Anna Aleksandrovna; Sleet, David A.; Socea; Socea, Bogdan; Soltani-Zangbar, Mohammad Sadegh; Somayaji, Ranjani; Song, Suhang; Song, Yimeng; Sood, Prashant; Soriano, Joan B.; Sousa, Raúl A.R.C.; Soyiri, Ireneous N.; Sreeramareddy, Chandrashekhar T.; Starodubova, Antonina V.; Steel, Nicholas; Stefan, Simona Catalina; Stein, Dan J.; Steiropoulos, Paschalis; Stephens, Jacqueline H.; Stokes, Mark A.; Stroumpoulis, Konstantinos; Suchdev, Parminder S.; Suleman, Muhammad; Sultana, Abida; Sun, Jing; Sundström, Johan; Szeto, Mindy D.; Szócska, Miklós; Tabaeian, Seidamir Pasha; Tabarés-Seisdedos, Rafael; Tabatabaeizadeh, Seyed-Amir; Tabatabai, Shima; Tabb, Karen M.; Tabish, Mohammad; Tabuchi, Takahiro; Tadakamadla, Santosh Kumar; Taheri, Majid; Abkenar, Yasaman Taheri; Soodejani, Moslem Taheri; Talaat, Iman M.; Tampa, Mircea; Tan, Ker-Kan; Tarigan, Ingan Ukur; Tarkang, Elvis Enowbeyang; Tat, Nathan Y.; Tat, Vivian Y.; Tefera, YibekalManaye; Tehrani, Hadi; Temesgen, Worku Animaw; Temsah, Mohamad-Hani; Teramoto, Masayuki; Tesema, Getaye Worku; Tesfaye, Azene; Thangaraju, Pugazhenthan; Thankappan, Kavumpurathu Raman; Thapar, Rekha; Thienemann, Friedrich; Thomas, Nihal; Thomas, Nikhil Kenny; Thornton, James Douglas; Tichopad, Ales; Ticoalu, Jansje Henny Vera; Tincho, Marius Belmondo; Tonelli, Marcello; Topor-Madry, Roman; Tovani-Palone, Marcos Roberto; Tran, Mai Thi Ngoc; Tripathi, Manjari; Tripathi, Niharika; Tripathy, Jaya Prasad; Truelsen, Thomas Clement; Tsilimparis, Nikolaos; Tudor Car, Lorainne; Tufa, Derara Girma; Tusa, Biruk Shalmeno; Uezono, Deinzel Robles; Ullah, Saif; Ullah, Sana; Umakanthan, Srikanth; Umapathi, Krishna Kishore; Umeokonkwo, Chukwuma David; Unim, Brigid; Unnikrishnan, Bhaskaran; Upadhyay, Era; Vacante, Marco; Vakilian, Alireza; Valadan Tahbaz, Sahel; Valdez, Pascual R.; Valizadeh, Rohollah; Van den Eynde, Jef; Vardavas, Constantine; PrasadVarma, Ravi; Vart, Priya; Varughese, Santosh; Vasankari, Tommi Juhani; Vasic, Milena; Vaziri, Siavash; Venketasubramanian, Narayanaswamy; Verma, Madhur; Veroux, Massimiliano; Vervoort, Dominique; Villafañe, Jorge Hugo; Violante, Francesco S.; Vishwanath, Prashant M.; Vlassov, Vasily; Vo, Bay; Volovici, Victor; Vu, Linh Gia; Wang, Yanzhong; Wang, Yu; Wang, Yuan-Pang; Wang, Ziyue; Ward, Paul; Waris, Abdul; Wei, Melissa Y.; Wen, Yi Feng; Westerman, Ronny; Wiangkham, Taweewat; Wickramasinghe, Nuwan Darshana; Woday, Abay Tadesse; Wolde Tsadik, Daniel Sisay; Woldemariam, Melat; Wolfe, Charles D.A.; Woolf, Anthony D.; Wu, Ai-Min; Wubetie, Gedif Ashebir; Wulandari, Ratna D.W.I.; Xiao, Hong; Xie, Yang; Xu, Hanzhang; Xu, Suowen; Xu, Xiaoyue; Yaghoubi, Sajad; Yahya Yahya, Gahin Abdulraheem Tayib; Yahyazadeh Jabbari, Seyed Hossein; Yamada, Tomohide; Yamagishi, Kazumasa; Yang, Lin; Yano, Yuichiro; Yaya, Sanni; Yazdanpanah, Fereshteh; Ye, Pengpeng; Yi, Siyan; Yiğit, Arzu; Yiğit, Vahit; Yip, Paul; Yisihak, Eshetu; Yon, Dong Keon; Yonemoto, Naohiro; You, Yuyi; Younis, Mustafa Z.; Yousefi, Zabihollah; Yousefinezhadi, Taraneh; Yusefi, Hossein; Zadey, Siddhesh; Zadnik, Vesna; Tajrishi, Farbod Zahedi; Zahir, Mazyar; Zakaryaei, Farima; Zaki, Nazar; Zaman, Sojib Bin; Zamora, Nelson; Zangeneh, Alireza; Zangiabadian, Moein; Zare, Iman; Dehnavi, Ali Zare; Zarea, Kourosh; Zareshahrabadi, Zahra; Zastrozhin, Mikhail Sergeevich; Zegeye, Zelalem Banjaw; Zeitoun, Jean-David; Zenebe, Getachew Assefa; Zepro, Nejimu Biza; Zhang, Jianrong; Zhang, Zhi-Jiang; Zhao, Xiu- Ju George; Zhong, Chenwen; Ziaeian, Boback; Zoladl, Mohammad; Zuhlke, Liesl J.; Zumla, Alimuddin; Zuniga, Yves Miel H. (Nature Research, 2025-05)
Chronic care manages long-term, progressive conditions, while acute care addresses short-term conditions. Chronic conditions increasingly strain health systems, which are often unprepared for these demands. This study examines the burden of conditions requiring acute versus chronic care, including sequelae. Conditions and sequelae from the Global Burden of Diseases Study 2019 were classified into acute or chronic care categories. Data were analysed by age, sex, and socio-demographic index, presenting total numbers and contributions to burden metrics such as Disability-Adjusted Life Years (DALYs), Years Lived with Disability (YLD), and Years of Life Lost (YLL). Approximately 68% of DALYs were attributed to chronic care, while 27% were due to acute care. Chronic care needs increased with age, representing 86% of YLDs and 71% of YLLs, and accounting for 93% of YLDs from sequelae. These findings highlight that chronic care needs far exceed acute care needs globally, necessitating health systems to adapt accordingly.
Examining the influence of alcohol consumption on the protective function of social support in reducing intimate partner violence among adolescent girls and young women
Oyekunle, Victoria; Gibbs, Andrew; Jonas, Kim; Tomita, Andrew (Taylor and Francis, 2026)
Intimate partner violence (IPV) remains a major public health and human rights concern in South Africa, particularly among adolescent girls and young women (AGYW). While social support is widely recognized as a protective factor against IPV, its effectiveness may be compromised in contexts of alcohol use. This study investigated the influence of alcohol use on the risk of IPV and the moderating role of perceived social support in reducing this risk. This study used baseline data from the HERStory 1 study, a cross-sectional survey of 4,399 adolescent girls and young women aged 15–24 years. Social support was measured using the Multidimensional Scale of Perceived Social Support (MSPSS). Multivariable logistic regression assessed main and interaction effects, with alcohol use as a moderator. Marginal effects and plots illustrated predicted IPV probabilities across social support and alcohol use levels. Emotional IPV (23.1%) was most prevalent, followed by physical (17.0%) and sexual (6.3%) IPV; 25.2% reported harmful alcohol use. Higher perceived social support was associated with reduced odds of emotional, physical, and sexual IPV across all support domains. Family and friends’ support showed strong protective associations. For example, family support was associated with lower odds of emotional (aOR = 0.53, 95% CI: 0.42–0.66), physical (aOR = 0.59, 95% CI: 0.45–0.75), and sexual IPV (aOR = 0.41, 95% CI: 0.29–0.58). In contrast, support from a significant other was not significantly associated with sexual IPV. Harmful alcohol use increased the odds of all IPV forms and attenuated the protective effects of social support. Additional age-stratified analyses indicated that social support was more consistently protective against IPV among adolescents (15–19 years) than young adults (20–24 years). Social support, particularly from family and friends, plays an important role in reducing IPV risk among young women, but its protective effect is diminished when alcohol use is present. These findings highlight the need for integrated IPV prevention strategies that strengthen external support networks and also address harmful alcohol use.
Incidence patterns and temporal trends of breast, prostate, oesophageal and cervical cancer in rural Eastern Cape Province, South Africa 1998–2021
Ramaliba, Thendo Micheal; Muchengeti, Mazvita Molleen; Sithole, Nomfuneko; Motlhale, Melitah; Ncinitwa, Akhona Balindile Assiria; Bovell, Andre; Metekoua, Carole; Nyirenda, Makandwe; Matzopoulos, Richard; Ncayiyana, Jabulani (Elsevier, 2026-08)
BACKGROUND : In South Africa, prostate, breast, and cervical cancers are prioritised under the National Cancer Strategic Framework (2017–2022), while oesophageal cancer remains a major public health concern in the Eastern Cape Province. This study describes the incidence patterns and temporal trends of breast, cervical, prostate, and oesophageal cancers in the Eastern Cape from 1998 to 2021. METHODS : Cancer incidence data were obtained from the Eastern Cape Population-Based Cancer Registry for 1998–2021. Population denominators were derived from the 2001 and 2011 national censuses, with intercensal and postcensal estimates used to generate annual age- and sex-specific populations. Age-standardised incidence rates were calculated using direct standardisation to the World Standard Population. Temporal trends were analysed using Joinpoint regression models. RESULTS : A total of 10 240 cancer cases were recorded, with a median age at diagnosis of 61.6 years (IQR: 50.7–71.0). Of the 10 240, oesophageal cancer accounted for 40.1% (4 108), followed by cervical cancer 36.4% (3 732), breast cancer 13.0% (1 327), and prostate cancer 10.5% (1 073). Incidence rates increased significantly for prostate cancer 9.6% (95% CI: 6.9%–12.4%), breast cancer 4.1% (95% CI: 2.4%–5.4%), and cervical cancer 3.8% (95% CI: 1.7%–5.8%). In contrast, oesophageal cancer incidence declined significantly in both sexes −3.0% (95% CI: −4.4% to −3.1%). CONCLUSIONS : Prostate, breast, and cervical cancer incidence has increased substantially in the Eastern Cape over the past two decades, while oesophageal cancer incidence decreased significantly. Strengthened cancer surveillance and targeted control strategies are needed in this predominantly rural setting. HIGHLIGHTS • The four cancers accounted for over 60% of the cancer burden between 1998 and 2021. • Cervical cancer remains above the WHO elimination threshold. • Oesophageal cancer was the only cancer showing a significant decline in incidence.
Establishing shared definitions of virological failure and discontinuation for long-acting injectable cabotegravir and rilpivirine therapy (the CONSENSUS-LAI study) : an international survey and Delphi process
Orkin, Chloe; Paterson, Amy; Elias, Alexa; Smuk, Melanie; Ring, Kyle; Volny-Anne, Alain; Calmy, Alexandra; Hazra, Aniruddha; Geretti, Anna Maria; Radix, Asa; Titanji, Boghuma K.; Spire, Bruno; Del Rio, Carlos; Foster, Caroline; Moore, Carolyn Bolton; Cortes, Claudia P.; Mussini, Cristina; Kuritzkes, Daniel R.; Tan, Darrell H.S.; Martinez, Esteban; Wit, Ferdinand W.N.M .; Cresswell, Fiona; Venter, Willem Daniel Francois; Levy, Itzchak; Zucker, Jason; Molina, Jean-Michel; Hoy, Jennifer; Arribas, Jose; Llibre, Josep M.; Currier, Judith; Rockstroh, Juergen; Sutinen, Jussi; Gebo, Kelly; Waters, Laura; Gisslen, Magnus; O’Reilly, Mark; Boffito, Marta; Thompson, Melanie; Parczewski, Milosz; John, Mina; Gandhi, Monica; Kumarasamy, Nagalingeswaran; Paton, Nicholas; Mackie, Nicola; Cahn, Pedro; Elion, Rick; Noe, Sebastian; Walmsley, Sharon; Collins, Simon; Cole-Haley, Susan; Apea, Vanessa; Short, William R.; Gilleece, Yvonne; Paparini, Sara; SHARE Collaborative; Orkin, C.; Paterson; Paterson, A.; Smuk, M.; Ring, K.; Apea, V.; Paparini, S.; Hazra, A.; Geretti, A.M.; Radix, A.; Titanji, B.K.; Spire, B.; Del Rio, C.; Foster, C.; Moore, C. Bolton; Cortes, C.P.; Mussini, C.; Kuritzkes, D.R.; Tan, D.H.S.; Martinez, E.; Wit, F.W.N.M.; Cresswell, F.; Venter, Willem Daniel Francois; Levy, I.; Zucker, J.; Molina, J.-M.; Hoy, J.; Arribas, J.; Llibre, J.M.; Currier, J.; Rockstroh, J.; Sutinen, J.; Gebo, K.; Waters, L.; Gisslen, M.; O’Reilly, M.; Boffito, M.; Thompson, M.; Parczewski, M.; John, M.; Gandhi, M.; Kumarasamy, N.; Paton, N.; Mackie, N.; Cahn, P.; Elion, R.; Noe, S.; Walmsley, S.; Collins, S.; Cole-Haley, S.; Short, W.R.; Gilleece, Y. (Elsevier, 2025-09)
BACKGROUND : Definitions of virological failure and treatment discontinuation for long-acting injectable (LAI) cabotegravir and rilpivirine antiretroviral therapy are inconsistent in clinical practice and observational studies, which complicates interpretation and implementation of findings. The CONSENSUS-LAI study aimed to establish consistent definitions of virological failure and treatment discontinuation to enhance evidence transferability and support optimal clinical outcomes. METHODS : The study had two phases. Phase 1 was an international online survey exploring existing definitions of virological and treatment discontinuation, conducted between April 25 and July 1, 2024. Eligible participants were health-care professionals working in infectious disease or sexual health services who had provided care to at least ten people living with HIV in the past 6 months, had prescribed LAI cabotegravir and rilpivirine in clinical trials or clinical practice, and were able to give informed consent. Participants were recruited via social media and mailing lists of medical specialist societies. Phase 2 was a Delphi process, in which a panel of experts, selected to ensure representation from all six WHO regions, scored leading definitions from phase 1 on a 9-point Likert scale. The proposed definitions were scored according to four validity criteria: clarity, usability in the expert’s setting, appropriateness across clinical purposes, and applicability across relevant population groups. Revisions were suggested in iterative rounds until consensus was reached. Consensus was predefined as at least 75% of experts agreeing or strongly agreeing (scores 7–9) with the validity criteria. FINDINGS : 386 LAI cabotegravir and rilpivirine prescribers across 28 countries completed the survey, revealing 15 definitions for virological failure on LAI cabotegravir and rilpivirine and nine for treatment discontinuation. 52 experts participated in the Delphi process. Consensus agreement on both definitions was reached after two rounds for all validity criteria. For virological failure, the consensus definition was as follows: (a) viral load 200 copies or more per mL or more on two occasions 2–4 weeks apart, or (b) a single viral load of more than 1000 copies per mL, and/or (c) emergent resistance, in the context of timely injections and prior suppression of less than 200 copies per mL, OR (d) unable to suppress viral load to less than 200 copies per mL on continuous therapy. For treatment discontinuation the consensus definition was as follows: people on LAI cabotegravir and rilpivirine who have missed two consecutive injections and have not taken oral bridging in the interim, irrespective of reason for discontinuation. INTERPRETATION : The consensus definitions provide a foundation for aligning practice and evaluating patient outcomes. Further validation of the viral load threshold for virological failure and the optimal viral load retesting window is required.
Pathogenic variants reveal candidate genes for prostate cancer germline testing formen of African ancestry
Gheybi, Kazzem; Soh , Pamela X.Y.; Jiang, Jue; Mbeki, Tumisang M.N.; Louw, Melanie; Burns, Daniel; Mundra, Piyushkumar; Kiriy, Daria; Hasan, Md. Mehedi; Jaratlerdsiri, Weerachai; Lebelo, Maphuti Tebogo; Campbell, Raymond A.; Radzuma, Mulalo B.; Nenzhelele, Mukudeni; Obida, Muvhulawa; Obida, Martin; Ombuki, Winstar M.; Oyaro, Micah O.; Patrick, Sean Mark; Loda , Massimo; Wedge, David C.; Bristow, Robert G.; Brewer, Daniel S.; Cooper, Colin S.; Cancel-Tassin, Geraldine; Cussenot, Olivier; Cocoran, Niall M.; Stricker, Phillip D.; Schlomm, Thorsten; Prins, Gail S.; Karina Dalsgaard; Sørensen, Karina Dalsgaard; Maria S. (Riana); Bornman, Maria S. (Riana); Eeles , Rosalind A.; Cooper, Colin S.; G. Steven S.; Bova, G. Steven S.; Bristow, Robert G.; Brook, Mark N.; Brors, Benedict; Burns, Daniel; Adam; Butler, Adam; Favero, Francesco; Gerhauser, Clarissa; Gihawi, Abraham; Girma, Etsehiwot G.; Vincent J.; Gnanapragasam, Vincent J.; Hamid, Anis; He, Housheng Hansen; Hovens, Chris M.; Imada, Eddie Luidy; Jakobsdottir; Jakobsdottir, G. Maria; Jiang, Jue; Jung, Chol-Hee; Khani, Francesca; Kiriy, Daria; Zsofia; Kote-Jarai, Zsofia; Leeman, Gregory; Loda, Massimo; Lutsik, Pavlo; Marchionni; Marchionni, Luigi; Papenfuss, Anthony T.; Pellegrina, Diogo; Pope, Bernard; Queiroz, Lucio R.; Queiroz, Lucio R.; Tobias; Rausch, Tobias; Robinson, Brain; Sahli; Sahli, Atef; Sørensen, Karina Dalsgaard; Wedge, David C.; Weischenfeldt , Joachim; Xu; Xu, Yaobo; Zanettini, Claudio (Nature Research, 2025)
Prostate cancer (PCa) germline testing, while gaining momentum, is ancestry restrictive and African exclusive. Through whole genome sequencing for 217 African ancestral cases (186 southern African, 31 Pan representative), we identify 172 potentially pathogenic variants in 78 DNA damage repair or PCa related genes. Prevalence for reported (13/217, 5.99%) and cumulative predicted (24/217, 11.06%) variants of significance (11 genes) falls below that reported for non-Africans. Conversely, BRCA1, HOXB13, CDK12, MLH1, MSH2, and BRIP1 remain unimpacted. Through pathogenic ranking based on variant frequency and functionality, clinical presentation and tumour-matched biallelic inactivation, top-ranked candidates include PREX2, POLE, FAT1, BRCA2, POLQ, LRP1B and ATM. Besides notable impact of DNA polymerases, including POLG, Fanconi anaemia genes include FANCD2, FANCA, FANCG, ERCC4, FANCE and FANCI, while DNA mismatch repair genes MSH3 and PMS1 outranked known namesakes MSH6 and PMS2. This study provides insights into the spectrum of African-relevant potentially pathogenic PCa variants, highlighting much-needed gene candidates for ancestry-inclusive germline testing.
Multilevel analysis of severe anthropometric failure among under-five children in Benin : a cross-sectional study using 2017 to 2018 demographic and health survey data
Mekonnen, Estibel dagne; Birhan, Nigussie Adam; Belay, Denekew Bitew (Ubiquity Press, 2026-05-13)
BACKGROUND : Child undernutrition remains a major global health challenge and a leading cause of child mortality in low- and middle-income countries. To our knowledge, the combined burden of severe malnutrition has not been assessed in Benin. This study aimed to assess the prevalence of severe anthropometric failure and identify associated risk factors among children under five in Benin. METHODS : A cross-sectional study was conducted using data from the BDHS 2017-18, including a weighted sample of 11,568 children under five years old. The Composite Index of Severe Anthropometric Failure (CISAF) was used to classify children based on severe stunting, wasting, and underweight. Multilevel logistic regression was employed to identify factors associated with CISAF. RESULTS : The prevalence of CISAF was 12.02%. Factors significantly linked to CISAF included children aged 12-23 months (AOR = 1.62), multiple births (AOR = 3.60), small birth size (AOR = 2.11), having diarrhea (AOR = 1.25), lack of improved water sources (AOR = 1.21), having healthcare access problems (AOR = 1.16), rich wealth index (AOR = 0.52), female children (AOR = 0.66), institutional delivery (AOR = 0.61), having media exposure (AOR = 0.83), urban residents (AOR = 0.85), and high community literacy level (AOR = 0.79). CONCLUSIONS : This study found that 12.02% of children under five experienced CISAF. To reduce this burden, stakeholders should expand access to maternal and child healthcare, improve access to safe water, strengthen poverty alleviation programs, and enhance community education and media-based health awareness.
Meningococcal outbreaks in tertiary education settings in the United Kingdom : lessons from the 2026 Kent Cluster for surveillance, vaccination policy, and institutional preparedness in Sub-Saharan Africa—a narrative review
Mhango, Malizgani; Moyo, Enos; Tungwarara, Nigel; Denhere, Knowledge; Chirimbana, Moses; Dzinamarira, Tafadzwa (MDPI, 2026-05-26)
BACKGROUND : In March 2026, a meningococcal cluster centred on the University of Kent, England, caused two deaths and resulted in over 20 reported cases within the first week, including confirmed and suspected invasive cases. Subsequent UKHSA updates in early April 2026 reported 21 laboratory-confirmed MenB cases (18 linked to the outbreak strain) and two deaths, with the outbreak subsequently spreading to a second Canterbury university, Canterbury Christ Church University, and confirmed as Neisseria meningitidis serogroup B (MenB). Sub-Saharan Africa (SSA) bears a disproportionate global burden of meningococcal disease, yet university settings remain a critically understudied outbreak amplifier. This narrative review extracts epidemiological and policy lessons from the Kent event and applies them to the SSA context. METHODS : We conducted a narrative review following the SANRA criteria, searching PubMed, Embase, Scopus, Google Scholar, and African Journals Online (2000-2026), with supplementary grey literature retrieved from World Health Organisation (WHO), Africa Centre for Disease Control, and United Kingdom Health Security Agency (UKHSA). Outbreak data were drawn from official UKHSA public-health statements (grey literature, archived), the University of Kent communications, and peer-reviewed expert commentary. RESULTS : The Canterbury outbreak exposed six reproducible vulnerabilities: unprotected serogroup circulation (confirmed MenB, not covered for the current university-age cohort), nightlife-linked transmission amplification, delayed serogroup identification, poor student symptom-recognition, inadequate institutional response capacity, and, critically, multi-institutional spread via shared nightlife venues (confirmed extension to Canterbury Christ Church University within five days). Each vulnerability is demonstrably more severe in SSA universities, which face a broader multi-serogroup threat environment (NmA, B, C, W, X), virtually no university-entry vaccination requirement, and critical evidence gap of campus-specific meningococcal evidence in the published literature. CONCLUSIONS : This review proposes a five-pillar preparedness framework for SSA tertiary institutions, derived from a synthesis of the Kent outbreak and broader epidemiological evidence, intended to inform policy discussion and future research. Moreover, these should be embedded within a broader age-linked prevention strategy that begins before university entry, particularly during the transition into secondary school in high-risk settings. Priority measures include meningococcal vaccination at key educational transition points, prophylactic antibiotic pre-positioning, serogroup-capable surveillance, symptom-recognition training, and pan-continental alert A predominantly reactive response may carry substantial risk in SSA settings.
Socioeconomic and regional predictors of antenatal care contact frequency among ever-married somali women with recent pregnancies
Ali, Mahad Ibrahim; Belay, Denekew Bitew; Mohamed, Jama; Jama, Umalkhayr Abdi; Dessie, Zelalem G.; Chen, Ding-Geng (Din) (Springer Nature, 2026-07-01)
BACKGROUND : Antenatal care (ANC) is critical for preventing complications and reducing maternal and child mortality. Apart from essential services, such as hypertension treatment and HIV testing, ANC provides women with preventive healthcare, including tetanus vaccinations, advice on healthy pregnancy practices, warning signs, and social and emotional support. This study evaluated the factors associated with the number of ANC contacts among ever-married women with recent pregnancies in Somalia. METHODS : This cross-sectional study used data from the 2020 Somalia Health and Demographic Survey. This study included 8,909 women aged 15–49 years who met the inclusion criteria. Count regression models were used to examine factors associated with the number of ANC contacts among ever-married women with recent pregnancies in Somalia, and Incidence Rate Ratio (IRR) with 95% CI were reported. RESULTS : In this study, 67.96% of women had no contact with ANC during their last pregnancy. Zero-inflated Poisson (ZIP) regression model was obtained to be the best fit. According to this model, women with secondary education (IRR = 1.21, 95% CI 1.03–1.42) and higher education (IRR = 1.27, 95% CI 1.08–1.48) had more ANC contacts than women with no formal education. Being in the highest wealth quintile (IRR = 1.27, 95% CI 1.09–1.49) was also associated with increased ANC contacts. Living in certain regions was associated with the number of ANC contacts. In the zero-inflated section, maternal age, education, region, media exposure, and wealth index emerged as key predictors of ANC utilization in Somalia. CONCLUSIONS : Many ever-married women with recent pregnancies did not receive any ANC, and socio-demographic factors such as educational level, maternal age, wealth index, place of residence, media exposure, and region were significantly associated with the number of ANC contacts in Somalia. Implementing initiatives based on these findings and developing public health strategies on promoting a culture of increased ANC utilization could improve maternal and child health outcomes.
Association between second-hand smoke exposure and respiratory symptoms among teenagers attending school in Soshanguve, South Africa
Makhoba, Sinenhlanhla Noluthando; Bhuda, Mandla Freddy; Shirinde, Joyce (Springer Nature, 2026-06-07)
BACKGROUND : Second-hand smoke (SHS) is a major risk factor for respiratory symptoms and conditions in children. Despite tobacco control laws in South Africa, exposure persists. This study investigated the association between second-hand smoke exposure and respiratory symptoms among teenagers attending school in Soshanguve, Gauteng Province. METHODS : A cross-sectional survey was conducted among 2885 schoolchildren aged 12–15 years using the modified validated ISAAC questionnaire. Associations between SHS exposure and respiratory symptoms were analysed using chi-square tests and multiple logistic regression at p ≤ 0.05. RESULTS : SHS exposure was significantly associated with ever wheeze (in cars/transport > 20 days: OR 1.84; 95% CI: 1.17–2.90), current wheeze (home > 20 days: OR 2.34; 95% CI: 1.41–3.91), and asthma (school > 20 days: OR 1.69; 95% CI: 1.20–2.57). Rhinitis was linked to maternal smoking (OR 1.44; 95% CI: 1.09–1.89) and SHS at home > 20 days (OR 1.51; 95% CI: 1.12–2.07). CONCLUSION : SHS exposure significantly increases the risk of respiratory symptoms and conditions among teenagers in Soshanguve. Strengthened enforcement of smoke-free policies is crucial to protect children’s respiratory health.
A narrative review of the implementation and monitoring of the food-based dietary guidelines within the healthcare sector in South Africa
Dimo, Raisibe P.; Muchiri, Jane Wanjiku; Shirinde, Joyce; Schonfeldt, H.C. (Hettie Carina) (Springer Nature, 2026-06-18)
BACKGROUND : Food-based dietary guidelines (FBDGs) are a public health nutrition intervention that plays a crucial role in promoting healthy eating habits and preventing nutrition-related diseases in the population. OBJECTIVES : To synthesise evidence on the implementation and monitoring of FBDGs with respect to nutrition education in healthcare settings and the influence on dietary patterns and behaviour in South Africa (SA). DESIGN AND SETTINGS : A narrative review was conducted. A comprehensive search strategy was used to identify relevant literature tailored to Africa-Wide Information, CINAHL, MEDLINE via EBSCOHOST, PubMed and ScienceDirect. The selection criteria were based on the Population, Intervention, Control, Outcome and Time (PICOT) framework. The search was focused on SA (97 literature). After removing 43 duplicates, a total of 54 research articles were screened. In the data extraction phase, six articles and six reports were selected. The results of these studies were compared and narratively described in relation to the objectives. RESULTS AND DISCUSSION : The review revealed a few studies focusing on the implementation and monitoring of FBDGs in SA. Despite improved dissemination of FBDGs, gaps posed by the lack of monitoring persist. After nearly 25 years of SA adopting FBDGs, and more than 10 years of adopting a revised version of FBDGs, the implementation and impact of FBDGs remain uneven and under-evaluated. There is a notable lack of a standardised FBDGs monitoring tool and reporting. CONCLUSION AND IMPLICATIONS : Given the identified gaps in both implementation and monitoring, there is a need for a structured and context-specific monitoring framework that integrates clear indicators, standardised data collection systems, and accountability mechanisms within the South African health sector.
Educational attainment and associated factors among women in Somaliland using the 2020 Somaliland Health and Demographic Survey
Ali, Mahad Ibrahim; Daud, Eid Ibrahim; Birhan, Nigussie Adam; Mohamed, Jama; Jama, Umalkhayr Abdi; Mohamed, Ahmed Ismail; Adam, Mohamed Ali; Belay, Denekew Bitew (Springer Nature, 2026)
Education is a crucial factor for advancing social and economic development and achieving gender equality. In Somaliland, many women continue to face considerable obstacles in accessing education, particularly beyond the primary level. Therefore, this study identified the main factors that affect women’s educational attainment in different regions of Somaliland. This research utilized data from the 2020 Somaliland Health and Demographic Survey, including 3,938 women aged 15 to 49. Educational level was classified as no education, primary education, and secondary or higher education. A partial proportional odds ordinal logistic regression model was fitted to identify risk factors of women’s education level in Somaliland. We found that about 77% of women had no education, 15% had primary education, and 8.37% had secondary education or higher. The key factors affecting women’s education included access to media, socioeconomic status, regional disparities, and the age of marriage. Policymakers should address these factors to create equitable opportunities for women.

Browse

Recent Submissions