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

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Chemical analyses and geographical origins of residential attic dust in central South Africa
Van der Westhuizen, Deidré; Welman‑Purchase, Megan; Wichmann, Janine; Von Eschwege, Karel G. (Springer, 2025-04-10)
Particulate matter (PM) is a widely used air pollution proxy indicator. Substantial supporting evidence links exposure to PM with adverse health effects. This study compares long-term accumulated particulate matter's chemical and morphological properties and possible sources from various locations in Bloemfontein, Kimberley, and the Vanderbijlpark residential areas. As the first study of this kind in South Africa, dust samples were collected from the attics of houses built over fifty years ago. Potential area PM sources located far away were identified by analyzing every tenth year from 1972 to 2022, representing five decades of backward Long-Range Transport (LRT) clusters, for air masses that passed the sampling sites. Several PM sources were determined by combining LRT geographic origin studies and chemical analyses of collected samples. Elemental compositions of samples were determined by the use of scanning electron microscopy, and electron dispersive spectroscopy. Mineral content was determined by X-ray fluorescence, X-ray diffraction, and electron probe microscopy techniques, revealing airborne sources that moved significantly due to climate change, over the 5-decade period. Potential area PM sources located far away included various South African provinces, neighboring states to the north, and the Atlantic and Indian Oceans west and east of South Africa. Elemental composition included: Al, Ag, C, Ca, Cl, Cu, Fe, K, Mg, Mn, Na, O, S, Si, Ti, and Zn. Mineral composition included SiO2, TiO2, Al2O3, Fe2O3, MnO, MgO, CaO, Na2O, K2O, P2O5, SO3, Cr2O3 and NiO. The most prominent minerals found were quarts and plagioclase. While considering relevant mining activities, combining methods allowed a successful study of change in source distribution associated with climate change.
Cervical cancer awareness among women recently diagnosed with cervical cancer in South Africa and Zimbabwe
Govender, Sudarshan; Phillips, Tamsin K.; Walter, Fiona M.; Day, Sarah; Guzha, Bothwell; Scott, Suzanne E.; Chirenje, Zvavahera M.; Ataguba, John Ele-Ojo; Mbatani, Nomonde; Fakie, Nazia; Moodley, Jennifer (ecancer , United Kingdom, 2025-10)
Incidence and mortality rates of cervical cancer remain high in Southern Africa (SA). We explored awareness of cervical cancer symptoms and risk factors, as well as risk lay beliefs among women recently diagnosed with cervical cancer from SA and Zimbabwe. Patients were asked to complete a locally validated questionnaire with unprompted, open-ended questions to assess awareness of cervical cancer symptoms and risk factors. Among 501 women (SA 285, Zimbabwe 216), 46% (229) were able to recall one or more symptoms (SA 24%, Zimbabwe 76%) and 19% (93) were able to recall one or more risk factors of cervical cancer (SA 27%, Zimbabwe 73%). In SA, factors associated with increased symptom awareness included higher education level (completion of secondary education compared to not completing secondary education; adjusted odds ratios (aOR) 2.74, 95% confidence interval (CI) 1.17–6.43) as well as living in urban and peri-urban areas compared to living in rural areas (Urban: aOR 2.98, 95% CI 1.35–6.80; Peri-urban: aOR 3.28, 95% CI 1.13–9.35). Having a self-reported history of a chronic condition was associated with lower risk factor awareness compared to not having a self-reported chronic condition (aOR 0.07, 95% CI 0.00–0.42). In Zimbabwe, those who self-reported living with HIV were more likely to know one or more risk factors compared to those without HIV (aOR 2.69, 95% CI 1.31–5.67). Overall, 90 (18%) women mentioned at least one lay belief about risk factors for cervical cancer, with the most reported being inserting herbs, creams or objects into the vagina (9%, n = 43). The low levels of cervical cancer awareness in two Southern African countries highlight the urgent need to improve cervical cancer awareness, as low levels of awareness can impact timely cancer diagnosis and limit the uptake of cervical cancer prevention programs.
Spatial analysis of under-five mortality in Africa using geographically weighted poisson regression
Olusola, Johnson Adedeji; Oyinloye, Adedeji Adigun; Akeju, Kemi F.; Ogunsakin, Ropo Ebenezer; Moyo, Sibusiso (Springer, 2025-07)
Child mortality remains a significant public health challenge in developing countries despite the global decline in under-five deaths. The disparities in child mortality rates can be attributed to socioeconomic and environmental inequalities across nations. While several studies have examined geographic variations in under-five mortality in Africa using economic and health indicators, few have applied spatial analysis to characterize these patterns. This study employs Geographically Weighted Poisson Regression (GWPR) to uncover spatially varying in effects of global indicators on under-five mortality across Africa, offering a detailed understanding not captured by conventional global models. Data on under-five mortality rates and economic and health indicators were obtained from the World Bank’s World Development Indicators (WDI) for 2022 across 54 African countries. A Poisson regression model and GWPR were applied to examine the associations between under-five mortality and various socioeconomic and environmental factors. The results indicate substantial spatial heterogeneity in child mortality across countries. The GWPR model (AICc = 221.25, Pseudo R2 = 86.5%) outperformed the conventional Poisson regression model (AICc = 360.733, Pseudo R2 = 58.4%), highlighting the benefits of incorporating spatial variability. Key findings revealed that under-five mortality was positively associated with open defecation and negatively associated with literacy, health expenditure, access to electricity, and basic sanitation. Additionally, the relationship between under-five mortality, gross national expenditure, and access to basic drinking water varied across regions. These findings emphasize the need for localized, evidence-based interventions to address child mortality more effectively in Africa.
Socioeconomic and demographic factors associated with anaemia among women of reproductive age in Zimbabwe : a supervised machine learning approach
Chemhaka, Garikayi; Mbunge, Elliot; Dzinamarira, Tafadzwa; Musuka, Godfrey; Batani, John; Muchemwa, Benhildah; Fashoto, Stephen; Mapingure, Munyaradzi; Makota, Rutendo Birri; Petrus, Ester (Springer, 2025-04)
Anaemia affects approximately one-third of women of reproductive age globally, with the highest burden observed in resource-limited countries. Therefore, this study aimed to determine the socioeconomic and demographic factors associated with anaemia and predict anaemia among women in Zimbabwe. Using nationally representative, cross-sectional data from the 2015 Zimbabwe Demographic and Health Survey (DHS), a dataset from a sample of 5412 women of reproductive age was analyzed. The Chi-square test and multivariate logistic regression were employed to identify independent predictors of anaemia, while Elastic Net was used for feature importance scoring. To address the class imbalance, the Synthetic Minority Oversampling Technique (SMOTE) was applied. The prevalence of anaemia among women in Zimbabwe was 24.1%. Multivariate logistic regression revealed significant associations between anaemia and several factors, including older age (35–49 years) (adjusted Odds Ratio [aOR] = 1.31), marital status (being married) (aOR = 0.72), higher education (aOR = 0.47), middle household wealth (aOR = 1.32), professional occupation (aOR = 1.60), current use of modern contraceptives (aOR = 0.59), and overweight/obesity (aOR = 0.56). The highest burden was observed in Matabeleland South province (aOR = 3.44). Among prediction models, the random forest classifier outperformed K-Nearest Neighbors (KNN) and decision trees, achieving an accuracy of 74%, recall of 78%, F1-score of 75%, precision of 72%, and an Area Under the Curve (AUC) of 81.5%. Targeted interventions focusing on key socioeconomic and demographic characteristics could help reduce anaemia in women of reproductive age. Predictive models can aid healthcare practitioners in identifying at-risk individuals and implementing timely interventions to mitigate the impact of anaemia.
Community-led interventions for HIV and AIDS prevention, treatment, and care in Southern Africa : a scoping review
Moyo, Enos; Moyo, Perseverance; Murewanhema, Grant; Mhlanga-Gunda, Rosemary; Dzinamarira, Tafadzwa (Springer, 2025-03)
BACKGROUND : Over the past few decades, significant progress has been made in containing the HIV epidemic worldwide. A few countries, primarily in Southern Africa, have met the UNAIDS 95-95-95 goals. However, this does not warrant complacency. The contribution of communities to these gains is immeasurable. Therefore, there is a need to sustain and expand the involvement of communities in the testing, prevention, and treatment of HIV. AIM : This study aims to assess the scope and outcomes of community-led HIV interventions conducted in Southern Africa. STUDY DESIGN : This study followed a scoping review design. DATA SOURCES : PubMed, ScienceDirect, SCOPUS, Google Scholar, and Africa Journals Online (AJOL) databases were searched for peer-reviewed articles published in English between 2013 and 2023. METHODOLOGY : The scoping review was guided by the Joanna Briggs Institute methodology for scoping reviews. The reporting followed the Preferred Reporting Items for Systematic Reviews and Meta-Analysis Extension for Scoping Reviews (PRISMA-ScR) checklist. Primary studies using mixed-methods, quantitative, and qualitative approaches that detailed HIV and AIDS community-led interventions carried out in Southern Africa were considered for this review. Two reviewers separately extracted the data from the included studies using a data extraction tool in Microsoft Excel. We used NVivo to develop codes and categories for the scope and outcomes of community-led interventions. RESULTS : Thirteen articles were included in this scoping review. Eleven of the studies were quantitative studies, one was a mixed-methods study, and another one was a qualitative study. Peer-based programs, adherence clubs, community conversations, support groups, community-based HIV testing, and antiretroviral therapy (ART) linkage are some of the community-led interventions found in this scoping review. The outcomes of these interventions include increased awareness of HIV and AIDS, decreased risky behaviours and stigma related to HIV, increased disclosure of partners' HIV status, increased testing for HIV, linkage to care, adherence to ART, retention in care, and viral suppression. CONCLUSION : Based on the promise demonstrated in this review, further investment in and support for community-led HIV interventions in Southern Africa is justified. Scaling up these interventions, alongside robust evaluation efforts, holds significant potential to contribute to a more comprehensive and effective response to the HIV epidemic in the region.
A qualitative study of Nigerian community members awareness of Mpox and their willingness and barriers to receiving the Mpox vaccine
Olufadewa, Isaac Iyinoluwa; Adesina, Miracle Ayomikun; Oladele, Ruth Ifeoluwa; Olufadewa, Toluwase Ayobola; Okpokoro, Evaezi; Daodu, Oluwafemi Babatunde; Ige, Fehintola; Adebajo, Sylvia; Igumbor, Ehimario Uche; Shaibu, Joseph Ojonugwa; Ibrahim, Musbaudeen Olaitan; Audu, Rosemary Ajuma (Springer, 2025-05)
BACKGROUND : Two vaccines, the JYNNEOS and ACAM 2000 have been approved for use for Mpox protection, however vaccine hesitancy and vaccine refusal poses a significant challenge in its uptake. This study explored participants’ awareness of Mpox, willingness, and barriers to receiving the approved Mpox vaccines when they become available in Nigeria. METHOD : This was a qualitative cross-sectional study. Participants were recruited using a purposive sampling technique. A total of 16 Focus Group Discussions (FGDs) and 64 in-depth interviews (IDIs) were conducted by trained research assistants among community members in four states in Nigeria (Bayelsa, Delta, Lagos, and Rivers states) between October 1 and November 30, 2023. The interviews were audio-recorded and transcribed before thematic analysis was conducted. RESULTS : One hundred and sixty-four persons, comprising 71 males and 93 females, participated in this study. The anticipated rollout of the Mpox vaccine in Nigeria elicited mixed reactions; while some participants expressed willingness to be vaccinated, others expressed their concerns about the vaccine side effects, vaccine safety, and their mistrust of new vaccines. There were also reports about physical access and financial cost being a barrier to receiving the Mpox vaccine. CONCLUSION : The study highlights the critical need for more community-based public health education campaigns to enhance awareness and correct misconceptions about Mpox. Effective communication strategies that address specific community issues and emphasize vaccine safety are important for increasing vaccination uptake and controlling the spread of Mpox in Nigeria.
Evaluating variant pathogenicity prediction tools to establish African inclusive guidelines for germline genetic testing
Zhou, Kangping; Gheybi, Kazzem; Soh, Pamela X.Y.; Hayes, Vanessa M. (Nature Research, 2025-05)
BACKGROUND : Genetic germline testing is restricted for African patients. Lack of ancestrally relevant genomic data perpetuated by African diversity has resulted in European-biased curated clinical variant databases and pathogenic prediction guidelines. While numerous variant pathogenicity prediction tools (VPPTs) exist, their performance has yet to be established within the context of African diversity. METHODS : To address this limitation, we assessed 54 VPPTs for predictive performance (sensitivity, specificity, false positive and negative rates) across 145,291 known pathogenic or benign variants derived from 50 Southern African and 50 European men matched for advanced prostate cancer. Prioritising VPPTs for optimal ancestral performance, we screened 5.3 million variants of unknown significance for predicted functional and oncogenic potential. RESULTS : We observe a 2.1- and 4.1-fold increase in the number of known and predicted rare pathogenic or benign variants, respectively, against a 1.6-fold decrease in the number of available interrogated variants in our European over African data. Although sensitivity was significantly lower for our African data overall (0.66 vs 0.71, p = 9.86E-06), MetaSVM, CADD, Eigen-raw, BayesDel-noAF, phyloP100way-vertebrate and MVP outperformed irrespective of ancestry. Conversely, Mutation Taster, DANN, LRT and GERP-RS were African-specific top performers, while Mutation Assessor, PROVEAN, LIST-S2 and REVEL are European-specific. Using these pathogenic prediction workflows, we narrow the ancestral gap for potentially deleterious and oncogenic variant prediction in favour of our African data by 1.15- and 1.1-fold, respectively. CONCLUSION : Although VPPT sensitivity favours European data, our findings provide guidelines for VPPT selection to maximise rare pathogenic variant prediction for African disease studies.
Exploring the application of dietary approaches to stop hypertension (DASH) in the management of patients with chronic kidney disease : a systematic review and meta-analysis
Aderoju, Yaa Boahemaa Gyasi; Hayford, Frank Ekow Atta; Achempim-Ansong, Gloria; Duah, Evans; Baloyi, Tinyiko Violet; Morerwa, Smangaliso; Agordoh, Percival; Dzansi, Gladys (Elsevier, 2025-10)
BACKGROUND & AIM : Chronic Kidney Disease (CKD) remains a significant global non-communicable disease (NCD) that affects more than 10 % of the world's population. Attention is gradually shifting to tertiary prevention of CKD to avoid End-Stage Renal Disease (ESRD) progression. This study reviewed evidence of the use of a Dietary Approach to Stop Hypertension (DASH) and its effect on disease progression among patients living with CKD. METHODS : A comprehensive search was conducted using the Scopus, PubMed, Web of Science, ProQuest, and EBSCO Host databases for studies published from 1997 to 2025. The PICO framework guided the search, focusing on patients with CKD, DASH as the intervention, other dietary and non-dietary approaches as comparisons, and CKD progression measured by changes in estimated Glomerular Filtration Rate (eGFR) and/or Urine Albumin-to-Creatinine Ratio (UACR) as outcomes. Effect sizes with 95 % confidence intervals and pooled effects were calculated using random effects REML models and Z-tests. Percentage changes in renal function post-intervention, based on eGFR, were also computed. Cochran's Q test and the I-squared (I2) statistic assessed study heterogeneity. This review protocol is registered with PROSPERO (CRD42024588682). RESULTS : Of the 174 studies screened, four met the eligibility criteria and were included in the review. All were prospective cohort studies with an average follow-up of 5.5 years and a combined patient sample size of 7033. Across studies, low DASH adherence was defined as scores in the lower half of the possible range used, and high adherence as scores in the upper half (e.g., 0-40 vs. 41-80; 0-4 vs. 5-9; 8-24 vs. 25-40). Low DASH adherence was associated with a mean eGFR improvement of 0.54 ml/min/1.73 m2 (1.2 %) (Z = 0.57, p = 0.57), while high adherence showed a greater improvement of 3.34 ml/min/1.73 m2 (6.8 %) (Z = 1.77, p = 0.08). Only one study assessed UACR, reporting a lower median UACR with high DASH adherence (33.6 mg/g) compared to low adherence (55.6 mg/g). CONCLUSIONS : The DASH diet has the potential to slow CKD progression; however, consistent adherence is crucial to maximize its clinical benefits and improve renal outcomes. Although improvements in eGFR with DASH diet adherence are clinically meaningful, they lack statistical significance. These findings support global efforts towards achieving Sustainable Development Goal 3 for NCDs.
Feasibility of implementing a non-invasive self-sampling method for saliva specimens that can be used for the diagnosis of respiratory infections among paediatric patients in the Tshwane District, South Africa : a study protocol
Nxele, Siphesihle Robin; Dlangalala, Thobeka Nomzamo; Gxekwa, Nobuhle Vanessa; Ramatsokotla, Sebueng; Musekiwa, Alfred; Kgatle, Mankgopo Magdalene; Hatchett, Daniel B.; Shin, Albert; Tu, Wan-chen; Robertson, Ingrid H.; Su, Xiaojing; Berthier, Erwin; Thongpang, Sanitta; Theberge, Ashleigh B.; Mashamba-Thompson, Tivani Phosa (BMJ Publishing Group, 2025-10)
INTRODUCTION : Effective community-based disease management is essential for public health. In low- and middle-income countries, sustainable strategies for timely diagnosis and treatment are a research priority. This study aims to assess the feasibility of a non-invasive saliva self-sampling method, paired with digitally linked molecular point-of-care diagnostics, for detecting respiratory infections among paediatric patients in the Tshwane District, South Africa. METHODS AND ANALYSIS : A field study will be conducted at Steve Biko Academic Hospital to compare saliva collection using the CandyCollect lollipop device and standard mouth swabs. The spiral groove of the lollipop device captures pathogens, which are stored in DNA/RNA preservation media and later analysed using quantitative PCR and commercially available rapid antigen tests. The multiplex respiratory pathogen panel, based on TaqMan real-time PCR technology, targets key paediatric pathogens including Streptococcus pneumoniae, Haemophilus influenzae, Mycoplasma pneumoniae, respiratory syncytial virus (RSV) and influenza A/B. Nucleic acids will be extracted using standard viral extraction kits and analysed following manufacturer protocols. Internal controls will be included in each qPCR run, and samples with CT values below defined thresholds will be considered positive. Rapid antigen tests will detect common pathogens such as influenza A/B, RSV and SARS-CoV-2 for comparative analysis. User experience and acceptability will be assessed via child-friendly and caregiver surveys following sample collection. The study will be implemented in two phases: diagnostic performance evaluation and user feedback assessment. The protocol is aligned with the Standard Protocol Items: Recommendations for Interventional Trials 2013 checklist. ETHICS AND DISSEMINATION : Ethical approval has been granted by the University of Pretoria (509/2023) and the Gauteng Department of Health (GP_202406_032). The study is registered in the Pan African Clinical Trial Registry (PACTR202411743094783). Findings will be disseminated through peer-reviewed journals, conferences and stakeholder briefings. The study complies with South Africa’s Protection of Personal Information Act. Data collection is scheduled from November 2024 to February 2025, with project completion expected within 1 year. TRIAL REGISTRATION NUMBER : Pan African Clinical Trial Registry (PACTR202411743094783).
Understanding stakeholder perspectives on integrating and sustaining a vertical HIV prevention programme into routine health services in Zimbabwe : a qualitative study
Chung , Amanda Marr; Murungu, Joseph; Case, Peter; Chitapi, Precious; Chikodzore, Rudo; Gosling, Jonathan; Xaba, Sinokuthemba; Ncube, Getrude; Mugurungi, Owen; Kunaka, Patience; Prata, Ndola; Gosling, Roly Daniel; Bertozzi, Stefano M.; Auerswald, Colette (BMJ Publishing Group, 2025-08-11)
INTRODUCTION : The transition of voluntary medical male circumcision (VMMC), an HIV prevention service, in Zimbabwe from a donor-funded to a government-owned programme involves the collective efforts and alignment of national and subnational government leaders, managers, healthcare providers, village health workers, community members, donors and implementing partners. We sought to understand stakeholders' perspectives on barriers, facilitators and recommendations as a vertical HIV prevention programme transitioned to an integrated, government-led model. METHODS : We conducted 54 semistructured stakeholder interviews at the national and subnational levels. Interviews were audio recorded, transcribed and thematically analysed. RESULTS : Participants highlighted a range of psychological and structural barriers and facilitators to integrating and sustaining the VMMC programme. Respondents mentioned financing and staffing barriers to integration, particularly a lack of domestic resources, the transition from a fee-for-service to a facility-based performance model and staff attrition. Notably, resistance to changing the VMMC programme's operations was a significant barrier that may be tied to individual psychological barriers such as loss of power and job security. Donors and partners continued to control the funding for VMMC. Ideally, the Ministry of Health and Child Care should have more autonomy over these decisions. At the subnational level, there is an opportunity for increased responsibility and a greater sense of ownership through the decentralisation of governance. CONCLUSIONS : To ensure successful integration and local ownership of VMMC as an HIV prevention programme, stakeholders must address both psychological and structural barriers while aligning their perspectives on the transition. Individual providers have valid concerns about their financial security and the burden of additional responsibilities without adequate compensation. It is crucial for donors and partners to reduce their involvement and oversight. Additionally, resolving the financial barriers that prevent the government from having complete control of the programme will require empowering local government stakeholders to fully take ownership.
Evaluating performance of the Bioline™ HCV point-of-care test in Ghana
Duah, Evans; Mathebula, Evans Mantiri; Maluleke, Kuhlula; Azumah, Daniel Edem; Ephraim, Richard Kobina Dadzie; Mashamba-Thompson, Tivani (BioMed Central, 2025-10)
BACKGROUND : Hepatitis C Virus (HCV) causes liver diseases including chronic hepatitis, cirrhosis, and hepatocellular carcinoma. In low- and middle-income countries (LMICs), particularly sub-Saharan Africa (SSA), HCV diagnostic resources are limited. Moreover, most evaluations of point-of-care (POC) invitro diagnostics (IVDs) are conducted outside the region using non-African populations, which may not reflect their performance in local settings where they are mostly used. This study assessed the diagnostic performance of the Bioline™ HCV POC test in Ghanaian HCV target populations. METHODS : A cross-sectional field evaluation was conducted among HCV priority populations including incarcerated individuals, patients requiring HCV testing, and voluntary blood donors undergoing pre-donation screening. Venous blood samples were tested using the Bioline™ HCV POC test, and the results were compared with the Enzyme-Linked Immunosorbent Assay (ELISA) reference standard. The sensitivity, specificity, test efficiency, Youden index, predictive values, likelihood ratios, and receiver operating characteristic (ROC) indicators were calculated. RESULTS : The Bioline™ HCV POC test demonstrated a sensitivity of 96.7% (95% CI: 82.8–99.9%), specificity of 99.8% (95% CI: 98.9–100%), and positive and negative predictive values of 96.7% (95% CI: 82.8–99.9%) and 99.8% (95% CI: 98.9–100%), respectively. The test efficiency was 99.6% (98.6–99.9%), Youden index 0.97 (0.82–0.99) with a ROC area of 0.98 and highly favorable likelihood ratios (LR + 483.5, LR − 0.03). CONCLUSION : This study highlights the high diagnostic performance of the Bioline™ HCV POC test in Ghanaian populations. The test’s reliability underscores its potential as a valuable tool for HCV screening and early detection in resource-limited settings, contributing to efforts to reduce the global HCV burden. TRIAL REGISTRATION : This study is part of a diagnostic trial registered in the Pan African Clinical Trial Registry (https://pactr.samrc.ac.za) on 24th October 2024 with trial registration number: PACTR202410837698664.
Fine-tuning a sentence transformer for DNA
Mokoatle, Mpho; Marivate, Vukosi; Mapiye, Darlington; Bornman, Maria S. (Riana); Hayes, Vanessa M. (BioMed Central, 2025-10)
BACKGROUND : Sentence-transformers is a library that provides easy methods for generating embeddings for sentences, paragraphs, and images. Sentiment analysis, retrieval, and clustering are among the applications made possible by the embedding of texts in a vector space where similar texts are located close to one another. This study fine-tunes a sentence transformer model designed for natural language on DNA text and subsequently evaluates it across eight benchmark tasks. The objective is to assess the efficacy of this transformer in comparison to domain-specific DNA transformers, like DNABERT and the Nucleotide transformer. RESULTS : The findings indicated that the refined proposed model generated DNA embeddings that exceeded DNABERT in multiple tasks. However, the proposed model was not superior to the nucleotide transformer in terms of raw classification accuracy. The nucleotide transformer excelled in most tasks; but, this superiority incurred significant computing expenses, rendering it impractical for resource-constrained environments such as low- and middle-income countries (LMICs). The nucleotide transformer also performed worse on retrieval tasks and embedding extraction time. Consequently, the proposed model presents a viable option that balances performance and accuracy.
Leveraging risk communication and community engagement and lessons from previous outbreaks to strengthen a public health response : a case study of Disease X in the Panzi region, DRC
Gashema, Pierre; Iradukunda, Patrick G.; Sesonga, Placide; Bigirimana, Radjabu; Mugisha, Jean C.; Harelimana, Jean dD.; Fallah, Mosoka P.; Dzinamarira, Tafadzwa; Muvunyi, Claude M. (AOSIS, 2025-06-30)
On 08 December 2024, the World Health Organization (WHO) reported an outbreak of Disease X in the Panzi Health Zone, Kwango province, Democratic Republic of the Congo (DRC). This unknown pathogen, with 406 cases and 31 deaths at the time of its declaration, predominantly affects children under 5 years. Disease X, hypothesised to be a zoonotic ribonucleic acid (RNA) virus, poses significant challenges because of limited healthcare infrastructure, gaps in risk communication and ineffective community engagement. This opinion article aims to explore these challenges and advocate for the urgent need for culturally tailored, inclusive communication strategies that foster trust and empower local communities in responding to outbreaks. Key approaches highlighted include mobilising local leaders, utilising mobile laboratories for decentralised diagnostics and improving sample collection techniques. Drawing on lessons from previous epidemics, such as COVID-19 and Ebola, this article emphasises the importance of robust surveillance systems, community engagement and effective risk communication, skilled health workforce and collaborative management frameworks. Strengthening early warning systems and ensuring equitable access to diagnostic and treatment resources are essential for mitigating future outbreaks of unknown diseases in resource-limited settings.
The epidemiology of human schistosomiasis in Gauteng Province, South Africa, 2017-2022
Makhubele, Nchucheko; Ngoma, Nqobile; Matjokotja, Tebogo; Nyasulu, Peter S.; Neti, Mzimasi; Mokgetle, Refilwe (AOSIS, 2025-08)
BACKGROUND : Schistosimiasis affects over 250 million people globally. It is considered a moderately endemic condition in South Africa, with 36 people per 100 000 infected annually between 2011 and 2018. Despite its ability to cause long-term complications, it remains under-studied in Gauteng Province, and its epidemiological patterns are poorly understood. AIM : To describe the prevalence and trends of human schistosomiasis from 2017 to 2022. SETTING : Gauteng Province, South Africa. METHODS : A descriptive cross-sectional study was conducted using all clinical and laboratory human schistosomiasis cases in Gauteng Province from 2017 to 2022. Descriptive statistics summarised cases. Annual trends, seasonal patterns, and geographic distribution were assessed. Yearly incidence rates and overall provincial prevalence were estimated per 100 000 population. RESULTS : There were 2526 human schistosomiasis cases recorded. The median age was 28 years (interquartile range [IQR]: 19–42), and men aged 10–19 years were most affected (15%). Cases declined by 37 per year over the study period, with seasonal peaks in February–March and August–September. The highest incidence occurred in 2019 (3.83 cases per 100 000). City of Tshwane Metropolitan and Mogale City had region-specific prevalence of > 25 cases per 100 000; overall provincial prevalence was 15 cases per 100 000. CONCLUSION : Enhanced surveillance, strengthened reporting, targeted awareness and preventative measures in vulnerable communities are recommended to reduce transmission. Ongoing research is crucial to inform evidence-based interventions in Gauteng Province and South Africa. CONTRIBUTION : The study identified key demographic patterns, geographic hotspots, and temporal trends of human schistosomiasis cases in Gauteng Province.
The role of pioneering transcription factors, chromatin accessibility and epigenetic reprogramming in oncogenic viruses
Kgatle, Mankgopo; Mbambara, Saidon; Khoza, Leon; Fadebi, Olalekan; Mashamba-Thompson, Tivani Phosa; Sathekge, Mike Machaba (Frontiers Media, 2025-06-16)
Oncogenic viruses typically manipulate host cellular mechanisms to drive tumorigenesis. They exploit pioneering transcription factors to modify gene expression, enabling uncontrolled proliferation. These viruses alter chromatin accessibility and induce chromatin remodelling, disrupting DNA repair and promoting viral genome integration. Additionally, epigenetic reprogramming through mechanisms like DNA methylation and histone modifications silences tumor suppressor genes and activates oncogenes. Understanding these mechanisms is critical for identifying more improved therapeutic targets, improving diagnostics, and predicting disease progression. Advances in this field can guide the development of innovative treatments and early detection tools. This comprehensive review synthesizes existing knowledge on the contributions of oncogenic viruses such as hepatitis B virus (HBV), hepatitis C virus (HCV), human papillomavirus (HPV), and human T-cell leukaemia virus type 1 (HTLV-1), Epstein–Barr virus (EBV), human herpesvirus 8 (HHV-8), and Merkel cell polyomavirus (MCV) to cancer development, highlighting their therapeutic relevance and driving forward research in viral oncogenesis.
In silico multi-epitope-based vaccine design for Mycobacterium avium complex species
Kashiri, Leah; Choga, Wonderful T.; Musasa, Tinashe; Nziramasanga, Pasipanodya; Gutsire, Rutendo B.; Zijenah, Lynn S.; Mukarati, Norman L.; Gaseitsiwe, Simani; Moyo, Sikhulile; Chin'ombe, Nyasha (Frontiers Media, 2025-06-05)
IINTRODUCTION : The Mycobacterium avium complex (MAC)—comprising M. colombiense, M. avium, and M. intracellulare—is an emerging group of opportunistic pathogens responsible for significant morbidity and mortality, particularly in immunocompromised individuals. Despite this growing burden, no vaccines currently provide cross-species protection. In silico vaccine design offers a rapid, cost-effective strategy to identify immunogenic epitopes and assemble multi-epitope constructs with optimized safety and efficacy. Accordingly, we aimed to develop a candidate multi-epitope vaccine (MEV) targeting conserved antigens across multiple MAC species. METHODS : From a genomic survey of nontuberculous mycobacteria (NTM) in Zimbabwe, we assembled complete genomes for M. colombiense (MCOL), M. avium (MAV), and M. intracellulare (MINT). Using both local and global reference datasets, we screened the conserved immunodominant proteins 85A, 85B, and 85C for high-affinity T-helper lymphocyte (THL) epitopes. Promising epitopes were further evaluated for antigenicity, immunogenicity, physicochemical stability, and population coverage. RESULTS : Epitope mapping across the nine target proteins yielded 82 THL epitopes predicted to bind 13 MHC class II (DRB*) alleles, ensuring broad coverage within Zimbabwean and pan-African populations. Clustering analyses consolidated 26 unique epitopes into 11 consensus peptides, 65.4% of which derived from the 85B proteins. In silico immune simulations predicted robust humoral and cellular responses, including elevated IgG titers, T-helper and T-cytotoxic cell proliferation and increased secretion of IFN-γ and IL-2 following MEV administration. CONCLUSION : These findings indicate that our construct possesses strong immunogenic potential and cross-species applicability. We present here a rationally designed MEV candidate that merits further experimental validation as a broad-spectrum vaccine against multiple MAC species.
Examination of the association between temperature variability and cardiovascular and respiratory mortality in South Africa, 2006–2016
Makunyane, Malebo Sephule; Rautenbach, Hannes; Wichmann, Janine (Frontiers Media, 2025-06-03)
BACKGROUND : Evidence is limited on the impact of temperature variability (TV) on health in low-and-middle-income countries (LMICs), such as South Africa. This study examined the association between TV and cardiovascular disease (CVD) and respiratory disease (RD) mortality in five South African cities. METHODS : Daily mortality and meteorological data in five South African cities (Bloemfontein, Cape Town, Durban, Johannesburg, and Gqeberha) were collected from Statistics South Africa and the South African Weather Service for the period 2006–2016. TV was calculated as the standard deviation of the daily minimum and maximum temperatures over the exposure period. City-specific risks were estimated using quasi-Poisson regression models combined with distributed lag nonlinear models, adjusting for potential confounders. A meta-analysis was then conducted to pool the overall estimates across cities. Additionally, stratified analyses by age group and sex were performed to assess effect modification. RESULTS : A total of 213,875 cardiovascular and 114,887 respiratory deaths were recorded in the five cities during the study period. The risks with increasing TV were higher for RD mortality as compared to CVD mortality. The pooled estimates showed the highest and significant increase in RD mortality of 1.21(95% CI: 1.04;1.38) per an increase in TV at 0–2 days from the 25th to the 50th percentile for all ages combined. The elderly appeared more vulnerable to RD mortality than <65 years age group, with significant mortality risks per increase in TV at 0–2 days (RR = 1.18, 95% CI: 1.04; 1.32),0–3 days (RR = 1.16, 95% CI: 1.04; 1.28) and at 0–7 days (RR = 1.12, 95% CI: 1.02; 1.22) from the 50th to the 75th percentile. A stratified analysis showed the elderly and women as more vulnerable. The pooled results across the five cities suggested no statistically significant TV effect on CVD mortality. CONCLUSION : This study found a short-term association between temperature variability and respiratory mortality, especially among elderly individuals and women, in five South African cities. No significant effect was observed for cardiovascular mortality. The findings support targeted public health strategies that account for temperature-related risks in vulnerable populations.
Lessons learnt in the response to COVID-19 in Mozambique : enabling readiness for the next pandemic
Posse, Mariana E.; Muriithi, Grace Njeri; Achala, Daniel Malik; Adote, Elizabeth Naa Adukwei; Mbachu, Chinyere Ojiugo; Beshah, Senait Alemayehu; Nwosu, Chijioke Osinachi; Ataguba, John Ele-Ojo (Frontiers Media, 2025-07-31)
INTRODUCTION : The coronavirus disease 2019 (COVID-19) has led to a dramatic loss of human lives worldwide and caused economic and social disruptions. The risk of another pandemic occurring is ever-present requiring countries to document factors that influenced the response to COVID-19 to guide the response to future pandemics. This study documents lessons learnt from Mozambique's COVID-19 response, considering the perspectives of various stakeholders and examining different components of the response. METHODS : We used a qualitative phenomenology research design and collected data using in-depth interviews. We used purposive sampling by selecting institutions with relevant experience and knowledge to inform the study objectives. We also used snowballing techniques by asking respondents for other potential informants. We interviewed 19 individuals indicated by the representatives of the institutions selected for the study. The institutions were mostly based in Maputo city, the country's capital. Participants were asked about their role in the organization; responsibility in vaccine distribution and delivery in Mozambique; their opinion on what worked well in the country's response to COVID-19, and what could be improved as preparation to future pandemics. Data was coded using a computer-assisted qualitative data analysis software Maxqda 2020 and analyzed using a deductive thematic approach. A validation meeting was held, in which research participants were asked to check the accuracy of the results and interpretations. RESULTS : Key drivers of the COVID-19 response were strong leadership; a clear plan and strategies; a functional coordination mechanism; the use of evidence to make decisions; a careful consideration of priority groups; investments in the supply chain and surveillance systems; the utilization of pre-existing vaccination structures; and partnership between the government and several stakeholders. There is room for improvement including the development of a clear budget, a communication plan, creation of an emergency fund, accountability in the use of funds, decentralization of surveillance infrastructure and representation of vulnerable, marginalized, and hard-to-reach populations in the design and implementation of pandemic response. CONCLUSION : The lessons learned from the COVID-19 response in Mozambique, which could be considered when preparing for an effective and equitable response to future pandemics, are in essence the following: there should be government leadership, a response plan, adequate resources, use of data to inform decisions, constant vigilance, a prompt response, involvement of all stakeholders and documentation of actions for continuous learning. These lessons could improve pandemic preparedness nationally and globally.
Equitable access to COVID-19 vaccines in Botswana : a scoping review
Tlhakanelo, John T.; Ataguba, John Ele-Ojo; Pagiwa, Vincent; Ramabu, Nankie; Kadimo, Khutsafalo; Molosiwa, Dintle; Muriithi, Grace Njeri; Achala, Daniel Malik; Adote, Elizabeth Naa Adukwei; Mbachu, Chinyere Ojiugo; Beshah, Senait Alemayehu; Masuka, Nyasha; Nwosu, Chijioke Osinachi; Akazili, James; Ifeanyi, Chikezie (Frontiers Media, 2025-07-29)
INTRODUCTION : Despite global market complexities, Botswana acquired about 2.6 million COVID-19 vaccine doses between March 2021 and March 2022, 76% of which were purchased while 24% were donations. Thus, the study was envisaged to aggregate evidence on the case of Botswana's COVID-19 vaccine access patterns, hesitancy, and uptake. MATERIALS AND METHODS : We conducted a scoping reviewof Botswana-based articles using a predetermined search strategy to search databases including Medline, CINAHL, Web of Science, PubMed, Scopus, and Google Scholar. The review included all the English-language written peer-reviewed and grey literature reporting on vaccination in Botswana, to broaden coverage in recognition of limited publications on COVID-19 vaccinartion in Botswana. Non-English articles were excluded due to limited translation resources. Due to the heterogeneity of studies, a narrative synthesis approach was used to collect, synthesize, and map the literature. RESULTS : As of 31 December 2021, 80.6% of the Botswana national target of 1,390,856 people over 18 years had received at least one dose of a COVID-19 vaccine, while 71.9% were fully vaccinated. Various vaccine distribution channels were utilized, including public facilities and outreaches, to improve access and uptake of vaccines. COVID-19 vaccine acceptance was considered generally high (73.4% amongst adults), and found positively associated with the male gender, those with comorbidities, those with non-restrictive religious beliefs, and those aged 55–64 years who thought the vaccine was safe for use. COVID-19 vaccine delivery relied on existing Expanded Program on Immunization (EPI) structures and therefore experienced to existing EPI challenges including, lack of transport, shortage of human resources, and vaccine stock-outs. CONCLUSIONS : Under-performance of immunization programs at the district level, characterized by declining immunization coverage and inadequate outreach services, exacerbates disparities in vaccine access. Efforts to strengthen healthcare infrastructure and expand outreach services are essential for reaching populations with limited access to healthcare facilities, particularly in rural and hard-to-reach areas. Collaboration with other government entities and the private sector improved vaccine access.
COVID-19 vaccine hesitancy in Ethiopia : a scoping review for equitable vaccine access
Beshah, Senait Aleamyehu; Adem, Jibril Bashir; Degefa, Mosisa Bekele; Ayalew, Melkamu; Lakew, Yohannes; Garoma, Sileshi; Adote, Elizabeth Naa Adukwei; Achala, Daniel Malik; Muriithi, Grace Njeri; Mbachu, Chinyere Ojiugo; Akazili, James; Ifeanyi, Chikezie; Zegeye, Elias Asfaw; Nwosu, Chijioke O.; Ataguba, John Ele-Ojo (Frontiers Media, 2025-09-03)
INTRODUCTION : COVID-19 vaccines are crucial for preventing severe illness from the virus. Despite their effectiveness; vaccine hesitancy, unequal access, and economic disparities hinder vaccination programs across Africa, posing significant challenges in Ethiopia. METHOD : This scoping review followed the methodological guidelines outlined in the Joanna Briggs Institute Reviewer's and employed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses - Extension for Scoping Reviews (PRISMA-ScR) checklist and explanation to ensure transparency. To analyze the data, we developed tailored search strategies for key databases [HINARI, PubMed, Cochrane, African Journals Online (AJOL), and Science Direct] and gray literature sources. These strategies combined controlled vocabulary and relevant keywords. A descriptive thematic analysis was then employed to identify and categorize the various findings within the included studies. The results are presented in a narrative format, summarizing the key themes and providing a clear and comprehensive overview of the current evidence base. RESULTS AND RECOMMENDATIONS : A review of 34 Ethiopian studies revealed significant COVID-19 vaccine hesitancy, with rates exceeding 50% in over 40% of the studies. The lowest hesitancy was found in adults from Addis Ababa (19.1%), while the highest rates were seen among healthcare workers in Oromia (69.7%) and pregnant women in Southwest Ethiopia (68.8%). Factors contributing to vaccine hesitancy in Ethiopia include being female, having only primary education, residing in rural areas, younger age, limited knowledge about the vaccine, reduced trust in authorities, and misperceptions about the risk of the virus. To address this challenge effectively, policymakers should prioritize interventions that build public trust, enhance awareness of the vaccine's benefits, and counter misinformation.

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