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

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Factors associated with mortality in patients diagnosed with COVID-19 in the Manzini Region, Eswatini, 2020-2021
Mavundla, Sincobile Victory; Lokotfwako, Vusie; Kuonza, Lazarus; Musekiwa, Alfred; Makamu, Masingita; Ravhuhali, Khuliso (African Field Epidemiology Network, 2025-12-08)
INTRODUCTION : Coronavirus disease 2019 (COVID-19) emerged in late 2019 and rapidly evolved into a global public health crisis. After more than 118,000 cases in 114 countries and 4,291 mortalities were reported, the WHO declared COVID-19 a worldwide pandemic on 11 March 2020. This study aims to determine demographic and clinical factors associated with COVID-19 case fatality among patients diagnosed in the Manzini Region, Eswatini, between March 2020 and August 2021. METHODS : This retrospective cross-sectional study was based on an analysis of secondary data for patients with a positive diagnosis of COVID-19 in the Manzini region who had an outcome of either recovery or death. It then excluded all suspected cases that were not confirmed by laboratory results. A COVID-19 mortality was defined as a death resulting from a clinically compatible illness in a confirmed COVID-19 case. Descriptive statistics were used to summarise demographic, clinical characteristics. The Pearson chi-square test was used to assess differences in categorical variables, and finally used logistic regression was used to investigate factors associated with COVID-19 mortality. RESULTS : After excluding 189 medical records, 15,124 cases and 336 COVID-19 mortalities were analyzed. Most of the participants were Females (54.5%), and the mortality rate in patients with SARS due to COVID-19 was 2.2%. Multivariate logistic regression identified the Year 2021 as the strongest independent predictor of mortality, increasing the odds of death over 15 times compared to 2020 (AOR 15.26, 95% CI: 6.60–35.24). Advanced age was also strongly associated with fatality, with patients aged ≥60 years (AOR 9.27, 95% CI: 3.12–25.92) and 50–59 years (AOR 8.12, 95% CI: 2.81–23.49) showing markedly higher odds of death compared with younger adults. Risk increased significantly with disease severity, ranging from mild (AOR 5.89, 95% CI: 2.94–11.80) and moderate (AOR 12.67, 95% CI: 5.54–29.01) to severe disease (AOR 123.71, 95% CI: 53.44–286.38). Hypertension also remained a significant risk factor (AOR 3.57, 95% CI: 2.01–6.36). Notably, Diabetes Mellitus appeared to be a protective factor (AOR 0.35, 95% CI: 0.18–0.71). CONCLUSION : Age, severity, and hypertension were confirmed risks. Crucially, the protective factor of diabetes suggests effective local prioritization and early management of high-risk patients during the pandemic.
Antiretroviral therapy status and factors associated with ART use among orphaned and vulnerable children (OVC) living with HIV in Namibia
Moyo, Enos; Mangwana, Hadrian; Melese, Endalkachew; Takawira, Simon; Harases, Bernadette; Indongo, Rosalia; Moyo, Perseverance; Nyoni, Ntombizodwa Makurira; Dzinamarira, Tafadzwa (Taylor and Francis, 2026)
This study assessed the antiretroviral therapy (ART) status and factors associated with ART use among Children and adolescents living with HIV (C/ALHIV) enrolled in the Namibia OVC program. This retrospective cross-sectional secondary analysis study used data collected at enrolment of C/ALHIV participating in the OVC program, implemented by Project HOPE Namibia (PHN) from 1 August 2023. Data were analyzed utilizing IBM Statistical Package for Social Sciences (SPSS) version 29. Among the 4599 participants included in this analysis, 4441 (96.6%) participants were on ART, with a 95% confidence interval (CI) (96.1% − 97.1%). Participants more likely to be on ART were from households with little or no hunger (Crude Odds Ratio (COR) = 2.19, 95% CI (1.40 – 3.43)), from Eenhana (adjusted odds ratio (AOR) = 8.24, 95% CI (2.58 – 26.37)), Engela (AOR = 3.72, 95% CI (1.63 – 8.50)), Okongo (AOR = 5.22, 95% CI (1.22 – 22.38)), Oshakati (AOR = 2.50, 95% CI (1.04 – 6.01)), and Oshikuku (AOR = 3.70, 95% CI (1.18 – 11.55)). In contrast, participants who were less likely to be on ART were aged 0–9 years, never enrolled at a school (COR = 0.26, 95% CI (0.18 – 0.37)), and were diagnosed or presumed to be with TB (AOR = 0.10, 95% CI (0.01 – 0.73)). Additionally, participants from child-headed households, those who were sexually abused or sexually exploited, were less likely to be on ART, COR = 0.02, 95% CI (0.01 – 0.03), COR = 0.04, 95% CI (0.02 – 0.06), and COR = 0.12, 95% CI (0.10 – 0.15), respectively. The findings indicate that integrating food support into HIV programs may enhance ART uptake among C/ALHIV. Strategies should be implemented to improve the enrolment for OVC in educational institutions.
Atmospheric PM2.5 and its trace element compositions in Bloemfontein, South Africa : an inhalation health risk assessment
Nkelende, Roland Tshibwabwa; Van der Westhuizen, Deidre; Boman, Johan; Molnar, Peter; Von Eschwege, Karel G.; Howlett-Downing, Chantelle Margaret; Wichmann, Janine (Taylor and Francis, 2026)
Please read abstract in the article.
Factors associated with recent physical violence against orphaned and vulnerable children (OVC) in Namibia : a cross-sectional analysis of programmatic data from 2023 to 2024
Moyo, Enos; Mangwana, Hadria; Melese, Endalkachew; Takawira, Simon; Harases, Bernadette; Indongo, Rosalia; Moyo, Perseverance; Robert, Kopano; Dzinamarira, Tafadzwa (Elsevier, 2026-03)
BACKGROUND : An estimated one billion children aged two to 17 years globally have experienced physical, sexual, or emotional violence or neglect. In Namibia, nearly 50% of girls and boys encounter physical, sexual, or emotional violence during childhood. Orphaned and vulnerable children (OVC) experience significant adverse effects as a result of their living conditions. OBJECTIVE : This study assessed the rate of physical violence and its associated factors against OVC in Namibia. PARTICIPANTS AND SETTING : The study included OVC aged 0 to 20 years in 13 primary health administrative districts in Namibia. METHODS : This retrospective cross-sectional study utilized programmatic data collected from 2023 to 2024 from OVC participating in the Reach program, implemented by Project Hope Namibia. The study included OVC aged 0 to 20 years. Data were analyzed utilizing IBM Statistical Package for Social Sciences (SPSS) version 29. Chi-square tests and binomial and multivariable logistic regression analyses were conducted. RESULTS : Among the 16,507 participants included in this analysis, 1803 (10.9%) participants were recently physically abused, 95% confidence interval (CI) (10.4% – 11.4%). Omuthiya had the highest physical abuse rate (n = 73; 18.2%), while Outapi had the lowest (n = 47; 8.4%). Participants aged 10-14 years were less likely to have experienced recent physical abuse than those aged 15-20, adjusted odds ratio (AOR) = 0.81, 95% CI (0.70 – 0.95). Disabled participants had a lower likelihood of reporting recent physical abuse than the non-disabled ones (AOR = 0.62, 95% CI (0.41 – 0.93)). Furthermore, participants who had caregivers who were HIV-positive were less likely to have experienced recent physical abuse than those whose caregivers were HIV-negative (crude odds ratio (COR) = 0.25, 95% CI (0.06 – 0.99). In contrast, participants from Omuthiya were more likely to have experienced recent physical abuse than those from Windhoek (AOR = 1.74, 95% CI (1.25 – 2.43)). CONCLUSION : Violence against children (VAC) awareness campaigns in high-risk districts, focusing on physical violence and community-level behavior change, must be expanded. Periodical regional VAC assessments must be conducted to identify and address localized drivers of violence. HIGHLIGHTS • 10.9% of OVC were recently physically abused. • Omuthiya had the highest physical abuse rate, while Outapi had the lowest. • Participants aged 10-14 years and the disabled were less likely to have experienced recent physical abuse.
Factors affecting equitable access and uptake of COVID-19 vaccines in Ghana : a scoping review
Akazili, James; Anaseba, Dominic; Chatio, Samuel; Amenah, Michel Adurayi; Achala, Daniel Malik; Beshah, Senait Aleamyehu; Nwosu, Chijioke O.; Masuka, Nyasha; Tlhakanelo, John Thato; Chikezie, Ifeanyi; Adote, Elizabeth Naa Adukwei; Muriithi, Grace Njeri; Ataguba, John Ele-Ojo (Frontiers Media, 2026-02-16)
BACKGROUND : The coronavirus disease (COVID-19) emerged as one of the most serious pandemics that impacted health systems and world economies. Vaccination against the pandemic was considered as an effective tool for the prevention and containment of the virus. Following the outbreak of the Coronavirus pandemic, efforts were made to enhance procurement and distribution of vaccines across countries with the view to containing the pandemic. However, evidence suggested that several factors hindered access, acceptance and use of the COVID-19 vaccines across the globe. This scoping review, thus, explored factors that influenced access, acceptance and use of the COVID-19 vaccines among Ghanaians and strategies that were needed to improve vaccine uptake especially for the vulnerable populations. METHODS : We adopted the five-stage analytic framework developed by Arksey and O’Malley to map existing literature on what has been done and documented on the subject. We searched various electronic databases such as PubMed, Cochrane, African journal online (AJOL), and Google Scholar for relevant articles for the review. RESULTS : In all, fifty-four (54) articles retrieved met our eligibility criteria and were included in this review. Health system factors including untimely payment of vaccinators allowances, shortfalls in logistics and vaccines, lack of transport and long queues at vaccination centers affected access and uptake of the COVID-19 vaccines in Ghana. Additionally, beliefs and perceptions including myths, misconceptions and misinformation around the virus and the vaccines affected people’s decision-making to participate in the vaccination exercise. Also, negative reportage through social media platforms created mistrust in COVID-19 vaccine intensions. CONCLUSION : Even though Ghana made significant progress in addressing the Coronavirus pandemic, hesitancy factors played a crucial role in diminishing Ghana’s effort towards meeting global targets in containing the virus and reducing its impact. Strengthening Ghana’s public health preparedness and response strategy, through a community-based approach and multi-stakeholder engagement, could improve immunization programs and vaccines uptake in addressing future pandemics.
Factors associated with composite anthropometric failures (CIAF) among under five children in Lesotho : an insight from the 2023 to 2024 Demographic and Health Survey Data
Birhan, Nigussie Adam; Belay, Denekew Bitew (Wiley, 2026-03)
Under nutrition is the main cause of child death in developing countries. The Composite Index of Anthropometric Failure (CIAF) combines all three forms of anthropometric failures to assess the nutrition status of children. Thus, the objective of this was to identify factors associated with CIAF of under‐five children in Lesotho. A secondary analysis of the Lesotho Demographic and Health Survey 2023–24 was conducted, using the data for 1089 children under the age of 5 years. The CIAF was used to classify children based on stunting, wasting, and underweight. Descriptive summary statistics were computed. A binary logistic regression model was employed to identify predictors of CIAF for under‐five children. Adjusted odds ratio with 95% confidence interval was estimated. The prevalence of CIAF in Lesotho was 34.68% (95% CI: 31.76–37.73). Female child 0.54 (AOR = 0.54; 95% CI: 0.375, 0.776), age group 24–59 months 2.42 (AOR = 2.42; 95% CI: 1.149, 5.109), rich households 0.29 (AOR = 0.29; 95% CI: 0.151, 0.554), multiple births 12.02 (AOR = 12.02; 95% CI: 1.199, 120.426), rural residence (AOR = 0.56: 95% CI: 0.335, 0.946), living children 3 to 4 were 2.54 (AOR = 2.54; 95% CI: 1.522, 4.226), and larger size at birth were 0.38 (AOR = 0.38; 95% CI: 0.211, 0.683) were found to be significantly associated with CIAF. The prevalence of CIAF among children under five in Lesotho was high. Child's age, child's sex, child's type of birth, wealth tercile, residence, number of living children, and child's birth size were found to be significantly associated with CIAF. We suggest that the government adapt CIAF as a metric for assessing children's nutritional status in order to estimate the overall prevalence of malnutrition and strengthening adequate nutrition intervention programs in rural areas. Furthermore, highlighting the factors influencing child CIAF will help inform future policies and programs designed to approach this major problem in Lesotho.
Perceptions of e-learning amongst public health students at a South African university
Naicker, Kavitha; Van Wyk, Mari (IJISRT Publisher, 2024-12)
Since the introduction of technological advancements in the 1990s, technology has permeated various aspects of our homes and livelihoods, including the educational system. This shift has led to a greater reliance on web-based tools in education, further accelerated by the COVID-19 pandemic in 2020, which forced many institutions to transition to fully online programs to ensure safety and continuity. In this context, understanding students' perceptions of e-learning and the challenges they face is crucial, as these factors significantly impact the success of their academic experiences and outcomes. Therefore, this study aimed to understand Public Health students' perceptions, experiences, and attitudes toward online learning, seeking insights into their level of satisfaction on this mode of education. The study involved 227 students in a South African University's Postgraduate Diploma in Public Health program. All students received a study information link and the Perceptions towards e-learning Questionnaire, with their e-learning perceptions evaluated through descriptive and inferential statistics, covering aspects such as attitude, social influences, effectiveness, accessibility, ease of use, and satisfaction. The study found robust support for online learning, with 98% preferring it and 97% showing increased interest. While 76% valued in-person interactions, 94% noted improved work-school-family balance with online learning. It proved effective, with 90% endorsing benefits for test preparation and 79% favoring it over in-class learning. Accessibility was positive, as 91% reported no information loss, and 86% faced no internet access issues. Regarding ease of use, students preferred the learning management system, choosing online over face-to-face. Overall, students reported enhanced computer skills and high e-learning satisfaction. The study indicates online learning effectively achieves educational goals, providing convenience, enhancing engagement, and boosting overall satisfaction. Surveyed individuals generally express high acceptance and contentment with online education.
Reasons for hesitancy and acceptance of COVID-19 vaccination among the Congolese population : a scoping review
Lobukulu Lolimo, Genese; Khonde, Rodrigue; Matondo, Herve; Kabele, Junias; Yannick, K. Musawu; Beshah, Senait Alemayehu; Achala, Daniel Malik; Njeri Muriithi, Grace; Adote, Elizabeth Naa Adukwei; Zegeye, Elias Asfaw; Mbachu, Chinyere Ojiugo;; Ataguba, John Ele-Ojo; Yaya Bocoum, Fadima Inna Kamina; Manitu, Serge Mayaka (Frontiers Media, 2026-02-17)
INTRODUCTION : Despite over 9.6 billion COVID-19 vaccine doses administered globally, vaccination access remains highly unequal. North America and Western Europe have over 50% vaccination coverage, contrasting sharply with African nations, like the Democratic Republic of Congo (DRC), which has under 10%. This scoping review explores the key factors contributing to the low COVID-19 vaccination rate in the Congolese population. METHODS : We conducted a scoping review using the Arksey and O'Malley framework, searching PubMed, ProQuest, and Scopus databases for peer-reviewed manuscripts published between 2019 and 2023. Six studies met the inclusion criteria, and focused on the factors of COVID-19 vaccine acceptance, hesitancy, and access in the DRC. RESULTS : Although surveys indicated a high willingness on the part of the people to get vaccinated, only 2.7% of the population were fully vaccinated. The primary barrier to vaccination was safety concerns, specifically, perceptions of the vaccine as new and experimental (84.4%) and fear of side effects (83.3%). Additional hesitancy factors included mistrust in vaccine effectiveness (60.4%) and a general lack of confidence (60.0%). Facilitators of acceptance included prior family vaccination, perceived risk of infection, belief in the existence of the virus, and awareness of vaccination strategies. Sociodemographic factors such as being a healthcare professional or male also positively influenced uptake. DISCUSSION : These findings highlight the gap between vaccine willingness and actual coverage in the DRC. Addressing safety concerns and building trust through targeted outreach, especially among key professional groups, may improve vaccine acceptance and equity.
One month preexposure prophylaxis retention rate and associated factors among adolescent girls and young women who participated in the Namibia DREAMS program (2018–2024)
Moyo , Enos; Melese, Endalkachew; Mangwana, Hadrian; Takawira, Simon; Indongo, Rosalia; Harases, Bernadette; Moyo, Perseverance; Nyoni, Ntombizodwa Makurira; Robert, Kopano; Dzinamarira, Tafadzwa (MDPI, 2025-09-10)
BACKGROUND : Daily oral preexposure prophylaxis (PrEP) is one strategy employed to decrease HIV transmission among adolescent girls and young women (AGYW). The Determined, Resilient, Empowered, AIDS-Free, Mentored, and Safe (DREAMS) program, funded by PEPFAR/USAID and implemented by the Project HOPE Namibia (PHN)-led consortium, provided services in the Khomas, Oshikoto, Zambezi, and Oshana regions. This study assessed the one-month PrEP retention rate among AGYW 15–24 and the associated factors. METHODS : The program’s target populations for PrEP included AGYW aged 15–24 years who were at substantial risk for HIV, tested HIV-negative, and resided in the regions where the PHN-led consortium was implementing the DREAMS program. Data between 2018 and 2024 were exported from DHIS2 to IBM SPSS version 29 for secondary data analysis. We analyzed the data using Chi-squared tests and binomial and multinomial logistic regression. RESULTS : Among the 17,277 participants newly initiated on oral PrEP and included in this study, only 2466 returned on time for their one-month appointment. The one-month PrEP retention rate among AGYW was 14.3%, 95% CI (13.8–14.8%). The most common reasons for PrEP discontinuation were traveling away from home, not needing PrEP anymore, forgetfulness, and side effects. Participants from Oshakati and Onandjokwe exhibited a higher likelihood of one-month PrEP retention. Additionally, participants who were in the programs for 7–12 months or over 36 months, who attended the safe space HIV prevention sessions, who were unaware of their partners’ HIV status, and who considered themselves at risk of HIV also exhibited a lower likelihood of one-month PrEP retention. In contrast, individuals who had 1–2 children and those who were either pregnant or breastfeeding exhibited a higher likelihood of one-month PrEP retention, (COR) = 1.28, 95% CI (1.15–1.43), and COR = 2.00, 95% CI (1.62–2.46), respectively. CONCLUSIONS : Targeted, innovative, and context-specific strategies should be developed to support AGYW in identifying their HIV risk and continuing the use of daily oral PrEP during periods of heightened risk. Additionally, prioritizing the introduction of discreet, long-acting PrEP options that require less frequent administration may better align with their needs and preferences.
Clustering of lifestyle risk behaviours and food insecurity in a population of South African adults : a cross-sectional study
Nkosi, Lungile; Ayo-Yusuf, Olalekan Abdulwahab (Springer, 2026-02)
BACKGROUND : Unhealthy lifestyle behaviours may be associated with food insecurity, yet limited research in low- and middle-income countries has examined the clustering of such behaviours and their association with food access challenges. This study explores the clustering of lifestyle risk behaviours, including polytobacco use, and their association with food insecurity among South African adults. METHODS : Data were drawn from the 2021 Tobacco and Other Modifiable Risk Behaviours Online Survey, comprising 11,093 adults aged 18 years or older. Weighted logistic regression models were used to examine associations between lifestyle risk behaviours (any or poly tobacco/nicotine product use, heavy drinking, unhealthy diet, physical inactivity, inadequate sleep) and food insecurity. Statistical significance was set at p < 0.05. RESULTS : Overall, 84.1% (95% CI: 72.90–96.65) were found to engage in two or more risk behaviours, while 7.0% (95% CI: 5.29–9.30) reported all five. The most common clustering involved physical inactivity and inadequate sleep (10.8%; 95% CI: 8.17–14.10). Concurrent daily polytobacco use and heavy drinking were significantly associated with food insecurity (OR = 2.20; 95% CI: 1.10–4.40). Severe financial difficulty (OR = 9.30; 95% CI: 4.78–18.11), Black African race (OR = 8.94; 95% CI: 6.44–12.43), unemployment and lower education were also associated with increased odds. CONCLUSION : Addressing financial hardship, racial disparities, and co-occurring lifestyle risk behaviours is critical to mitigating food insecurity and reducing non-communicable disease risk in South Africa.
Long-acting HIV pre-exposure prophylaxis integrated with community-based sexual and reproductive health services in South Africa (LAPIS) : study protocol for a hybrid (1a) cluster randomised controlled phase 3B trial of effectiveness and implementation
Busang, Jacob; Zuma, Thembelihle; Chimbindi, Natsayi; Ngoma, Nqobile; Herbst, Carina; Okesola, Nonhlanhla; Dreyer, Jaco; Smit, Theresa; Bird, Kristien; Mtolo, Lucky; Behuhuma, Ngundu; Lebina, Limakatso; Hendrickson, Cheryl; Miot, Jacqui; Hanekom, Willem; Herbst, Kobus; Seeley, Janet; Copas, Andrew; Baisley, Kathy; Shahmanesh, Maryam (BioMed Central, 2026-01)
BACKGROUND : Barriers and challenges associated with daily oral HIV pre-exposure prophylaxis (PrEP) contribute to poor uptake, low retention, and adherence rates among youth. Offering a choice of PrEP modalities integrated with peer support and delivered through community-based sexual and reproductive health (SRH) services will overcome these challenges. We describe the design of a trial to evaluate this approach at a population level. METHODS : We are conducting a type 1a hybrid effectiveness, phase 3B, cluster randomised controlled trial (LAPIS) to evaluate the effectiveness and implementation of offering PrEP modality choices through community-based SRH services amongst youth aged 15-30 years living in rural Kwa-Zulu Natal, South Africa. LAPIS is nested within Thetha nami ngithethe nawe (Let's Talk), an ongoing stepped-wedge trial with two periods investigating the effectiveness, implementation, and cost effectiveness of peer-led social mobilisation into decentralised integrated HIV and SRH services on the population prevalence of sexually transmissible HIV amongst youth. In the second period of Thetha nami, 40 trial clusters were randomised 1:1 to receive either a choice of PrEP modalities (oral PrEP, long-acting PrEP, i.e., two-monthly injectable cabotegravir (CAB LA) or dapivirine vaginal ring and HIV post-exposure prophylaxis [PEP] packs) or enhanced standard of care (ESoC) with oral PrEP only. All trial clusters are supported by peer navigators offering peer support and visited monthly by a mobile nurse-led clinic offering adolescent and youth-friendly HIV and SRH services. There are two primary outcomes: (1) effective uptake of PrEP or PEP, and (2) retention on PrEP, defined as attending at least one follow-up appointment after PrEP/PEP initiation, which are based on clinic data. Implementation outcomes are assessed using a mixed-methods and process evaluation following the RE-AIM (Reach, Effectiveness, Adoption, Implementation, and Maintenance) framework. DISCUSSION : LAPIS is a pragmatic trial to evaluate the addition of long-acting PrEP modalities to daily oral PrEP within community-based SRH services. By offering PrEP choices, LAPIS adopts a person-centred approach to improve adherence and retention among youth, including hidden key populations. Findings will provide insights into the real-world implementation of CAB-LA. TRIAL REGISTRATION : ClinicalTrials.gov Identifier-NCT06250504. Registered: 01 February 2024.
The COVID-19 vaccine procurement and supply chain in the Democratic Republic of Congo
Lobukulu Lolimo, Genèse; Kabadi, Yannick Musawu; Beshah, Senait Alemayehu; Khonde, Rodrigue; Beia, Aurore; Makongote, Héritier; Sumaili, Généros; Kabuya, Samue; Bongutu, Joél; Achala, Daniel Malik; Muriithi, Grace Njeri; Adote, Elizabeth Naa Adukwei; Zegeye, Elias Asfaw; Mbachu, Chinyere Ojiugo; Ataguba, John Ele-Ojo; Yaya Bocoum, Fadima Inna Kamina; Mayaka, Serge Manitu; Mafuta Musalu, et Éric (Frontiers Media, 2026-02)
The COVID-19 vaccine has been classified as an ‘essential medicine’, yet shortages and unequal distribution during the pandemic have reignited concerns about vaccine self-sufficiency in Africa. This study examined the mechanisms for acquiring, distributing, and administering existing COVID-19 vaccines in the Democratic Republic of Congo (DRC). A qualitative case study was conducted using semi-structured interviews with 23 key informants selected using reasoned choice, based on their professional roles in vaccine policy, logistics, and implementation. Participants were recruited from public institutions, with most being medical doctors and having experience in vaccination. Data were transcribed and analyzed were transcribed and analysis thematically using Atlas-ti 7.0. The study found that vaccine acquisition in the DRC relied heavily on international donations and multilateral initiatives, with limited national financial contribution. Distribution followed a five-tier supply chain managed by the Expanded Program on Immunization, moving vaccines from Kinshasa to provincial and field offices, then to selected health facilities. The Cold chain limitations, transport issues, and inconsistent vaccine availability challenged the administration. To improve vaccine access and coverage, stakeholders emphasized the need to strengthen logistical infrastructure and promote regional vaccine production. Honoring government commitments to co-finance procurement was also identified as a critical step toward sustainable vaccine supply.
Bridging immunization gaps in Sub-Saharan Africa : a narrative review of microplanning, geospatial, and machine learning approaches to reach zero-dose children and under-immunised children
Musuka, Godfrey; Umar, Al-umra; Dadari, Ibrahim; Moyo, Enos; Mano, Oscar; Iradukunda, Patrick Gad; Mbunge, Elliot; Murewanhema, Grant; Dhliwayo, Tapiwa; Mataruse, Noah; Sayem, Abu Sadat Mohammad; Dzinamarira, Tafadzwa (Elsevier, 2026-04)
Immunization inequities persist across Sub-Saharan Africa, with significant numbers of zero-dose and under-immunised children contributing to preventable morbidity and mortality. This narrative review critically examines the integration and effectiveness of machine learning, geospatial mapping, and microplanning strategies in identifying and reaching these vulnerable populations. The review's primary objective is to synthesise current evidence on how these innovative approaches are being applied within routine immunization systems to address persistent coverage gaps. A systematic search of peer-reviewed literature and grey sources was conducted, focusing on studies and programmatic reports from 2015 to 2025. The review analyses methodological trends, implementation experiences, and outcome data related to machine learning algorithms for risk profiling, geospatial technologies for mapping and targeting, and microplanning tools for local-level action. Data extraction and thematic synthesis were guided by the WHO framework for immunization equity. Findings demonstrate that machine learning models, utilizing demographic, health system, and mobility data, have enhanced the precision of zero-dose child identification, enabling more targeted outreach interventions. Geospatial mapping has further enabled real-time visualisation of immunization deserts and the spatial distribution of missed communities, supporting resource allocation and deployment of mobile teams. Microplanning, when integrated with digital tools and community engagement, has shown promise in translating high-level data into actionable local strategies, improving follow-up, and reducing missed vaccination opportunities. Despite these advancements, several challenges persist. Data quality and interoperability issues limit the scalability of machine learning and geospatial solutions, particularly in remote or fragile settings. Capacity gaps at the sub-national level, including technical skills and digital infrastructure, impede effective microplanning and data use. Furthermore, the sustainability of these approaches is threatened by fragmented investments and limited integration into national health information systems. Opportunities exist to strengthen the routine immunization system by standardising data collection, investing in workforce training, and fostering cross-sectoral collaboration. The review recommends prioritising the development of interoperable platforms, expanding context-specific pilot projects, and embedding evaluation mechanisms to track impact and equity outcomes. Policymakers are urged to leverage the demonstrated benefits of machine learning. HIGHLIGHTS • Immunization inequities persist across Sub-Saharan Africa. • We examined machine learning, geospatial mapping, and microplanning strategies in immunization programmes. • Machine learning models, geospatial and microplanning approaches have utility in zero-dose child identification. • Data quality and interoperability limit the scalability of these solutions
Adapting the emotional dysregulation questionnaire for South Africa : methods of adaptation and psychometric properties of the South African emotional dysregulation scale
Jewkes, Rachel; Chirwa, Esnat; Willan, Samantha; Gigaba, Gugulethu; Abrahams, Naeemah; Ramsoomar, Leane; Mahlangu, Pinky; Machisa, Mercilene; Paile, Charntel; Nöthling, Jani (Elsevier, 2026-06)
PURPOSE : Emotional dysregulation is an important aspect of psychopathology, especially borderline personality disorder, and is prevalent in populations exposed to multiple traumas, like South Africa. We describe adaptation of the emotional dysregulation questionnaire (EDQ) for South Africa and its psychometric performance. METHODS : We enrolled 58 ethnically-diverse women, who had experienced severe intimate partner violence, in eight group discussions held in three Provinces. They were asked what they did when they were upset, and related questions. During the groups, cognitive interviews focused on the EDQ. We adapted the EDQ using these findings, removing very similar or poorly understood items, and drafted new items for matters raised by the women. The resulting 23 items were tested with 236 women in a pilot study. RESULTS : Women described a range of behaviours when they were upset that indicated loss of control such as drinking heavily, being abusive, breaking things and beating their children. In the pilot, two items were highly skewed and three, measuring restricted emotional expression, were also poorly correlated with the rest of the scale and performance was poorer with them included. The remaining 18 items performed well with Cronbach's alpha = 0.862, acceptable item-rest correlations, and KMO = 0.865 (all items were above 0.80). On confirmatory factor analysis, the 18-item measure had the best fit. The measure was positively associated with depression, borderline personality disorder, PTSD and complex PTSD. CONCLUSION : The adapted emotional dysregulation questionnaire had robust psychometric properties and is positioned to be a useful scale with traumatised populations in South Africa. HIGHLIGHTS • The population of South Africa is exposed to multiple traumas and emotional dysregulation is common. • We asked trauma-exposed women to explore what they did when they were upset and their views on a standard measure. • We used information provided by South African trauma-exposed women to adapt and test the measure. • Our measure performed well in tests and was correlated with mental health problems in the way we expected. • We concluded that an 18-item measure of emotional dysregulation can be useful for mental health research in South Africa.
Acceptability of cardiovascular disease point-of-care diagnostics in primary care settings : a scoping review
Moswete, Nakedi; Nxele, Siphesihle Robin; Modipane, Penelope; Duah, Evans; Chale-Matsau, Bettina; Thompson, Gabrielle; Mashamba-Thompson, Tivani Phosa (Wiley, 2026-03)
BACKGROUND AND AIMS : Cardiovascular disease (CVD) remains the leading global cause of death, with 80% of deaths occurring in low- and middle-income countries (LMICs). Improving access to screening and early diagnosis is essential. Point-of-care testing (POCT), which provides rapid results near the patient, is particularly valuable in resource-limited settings. While POCT has been successfully implemented for infectious diseases like HIV and TB, investment in CVD-focused POCT remains limited. This scoping review maps global evidence on the acceptability of CVD POCT, guided by the World Health Organization's REASSURED criteria, to inform future implementation strategies. METHODOLOGY : This review followed the Arksey and O'Malley framework. A comprehensive search was conducted across PubMed, Scopus, Science Direct, Google Scholar, Web of Science, and EBSCOhost databases. A preliminary search confirmed feasibility. Two reviewers independently screened studies at all stages, with agreement assessed statistically. The quality of included studies was appraised using the Mixed Methods Appraisal Tool (MMAT), version 2018. RESULTS : Out of 738 articles identified, 13 primary studies conducted in primary care settings were included. Themes emerging from the review included POCT availability, influence on triage and clinical decision-making, ease of use, sample volume, and feasibility. Only two studies were randomized controlled trials; the rest were observational, mostly comparing POCT accuracy to central laboratory testing. Inter-reviewer agreement was high (Kappa = 0.92), and MMAT scores ranged from 71.4% to 85.7%. CONCLUSIONS : CVD POCTs are generally acceptable and demonstrate strong potential for clinical integration. However, a lack of robust evidence on patient outcomes, particularly from LMICs, limits the establishment of their effectiveness. More randomized controlled trials and economic evaluations in LMICs, where the burden of CVD is highest, are needed to support broader implementation and inform global strategies to reduce the impact of CVD.
Prevalence of depressive and generalized anxiety features among patients with chronic care conditions
Phaahla, R. Dorothy; Musekiwa, Alfred (Taylor and Francis, 2026)
BACKGROUND : Mental illness remains a major public health concern globally. Patients with chronic conditions are vulnerable. OBJECTIVES : The study determined the proportion and associated factors of depression and anxiety among patients with chronic conditions, as it explores the implications for integrated mental healthcare delivery, by determining the prevalence of depressive and generalized anxiety features among patients receiving chronic care. Exploring how the coexistence of chronic physical illness and psychological distress may inform strategies for integrated, patient-centred care within primary healthcare settings. METHODS : Cross-sectional study of adult patients receiving chronic care. A PHQ-9 score of ≥10 indicated positive screening for depression and a GAD-7 score of ≥10 indicated anxiety. Multivariable logistic regression analysis was applied. RESULTS : Out of 286 patients, 30.4%(n = 87) were treated for hypertension and 26.9%(n = 77) for HIV. Depression was positively screened in 60.5%(n = 173) and anxiety in 66.1%(n = 189) patients. The odds of screening positive for depression were higher among patients with diabetes (aOR 1.92, 95%CI: 1.0-3.7), TB(aOR 3.66, 95%CI: 1.4-9.5). Positive screening for anxiety was higher among female residents. CONCLUSION : High rates of undiagnosed depression and anxiety are present in patients with chronic care conditions.
Prevalence and determinants of time to first intimate partner violence incidents among ever-married Ethiopian women
Mengste, Ashefet Agete; Belay, Denekew Bitew; Fenta, Haile Mekonnen; Chen, Ding-Geng (Din) (Elsevier, 2026-03)
BACKGROUND : Intimate partner violence (IPV), including physical, emotional, and sexual abuse disproportionately affects women globally, particularly in sub-Saharan Africa. OBJECTIVE : This study examined the timing and determinants of first experiences of IPV among ever-married Ethiopian women. PARTICIPANTS AND SETTING : The study analyzed nationally representative data from 4720 ever-married women who participated in the 2016 Ethiopian Demographic and Health Survey. METHODS : Cox proportional hazards and parametric accelerated failure time (AFT) models were used to identify factors influencing time to first IPV. Women who had not experienced IPV by the survey date or who reported IPV occurring before marriage were treated as right-censored. Multiple AFT distributions were compared, and the best-fitting models were selected. RESULTS : Approximately 30 % of women reported experiencing at least one form IPV, most commonly emotional (22.3 %). The log-normal AFT model best fit physical and sexual violence, while the Weibull AFT model fit emotional violence. Older women (35–49 years) experienced IPV later than younger women (time ratios [TR]: 2.09 physical, 2.82 sexual, 3.00 emotional). Husband's alcohol use, controlling behavior, family violence history, and fear of the husband were associated with earlier IPV occurrence (TR < 1). More children delayed physical and emotional violence (TR > 1), while older age at marriage predicted earlier emotional violence (TR = 0.7). CONCLUSIONS : Age, regional differences, family background, and husbands' behaviors significantly influence the timing of IPV onset among Ethiopian women. Targeted prevention programs addressing harmful partner behaviors, alcohol use, and intergenerational violence are essential to delay or prevent IPV and safeguard women's wellbeing.
PM2.5 chemical composition and geographic origin of air masses in Mabopane, South Africa
Bhuda, Mandla Freddy; Molnar, Peter; Boman, Johan; Shirinde, Joyce; Wichmann, Janine (Wiley, 2026)
Please read abstract in the article.
The burden of HPV35 in African cervical pathologies : prevalence, contributing factors, and vaccine prospects
Murahwa, Alltalents T.; Dzobo, Mathias; Mahenge, Anifrid; Rantshabeng, Patricia; Dube Mandishora, Racheal S. (Wiley, 2026-03)
Human papillomavirus (HPV35) is globally associated with only 2% of invasive cervical cancers (ICC) but demonstrates a disproportionately higher prevalence in sub-Saharan Africa, reaching up to 10% in previous reports. In this review, we provide updated data from multiple African countries, revealing high HPV35 prevalence rates in women with precancerous and ICC lesions. Among women with ICC, the highest prevalence of HPV35 was observed in Mozambique (30% and 19%), Kenya (26% and 22%), South Africa (17%), Burkina Faso (13.7%), Zimbabwe (11%), and Tanzania (11.2%). Similarly, in women with precancerous lesions (LSIL/HSIL/CIN1-3), the highest rates were recorded in Tanzania (26%) and Botswana (23% and 20%). These findings highlight a significant and underappreciated burden of HPV35-associated cervical disease in African populations, particularly among women with precancerous and invasive lesions. The findings call for an urgent re-evaluation of current HPV vaccination strategies to consider the inclusion of HPV35, which could profoundly enhance the effectiveness of cervical cancer prevention programs in sub-Saharan Africa.
Humoral and cellular immunogenicity of COVID-19 vaccine boosters in participants with advanced HIV disease
Nesamari, Rofhiwa; Crowther, Carol; Chiveto, Dexter Tadiwanashe; Pillay, Thanusha; Kgagudi, Prudence; Shusha, Nomcebo; Manamela, Nelia; Steel, Helen Carolyn; Van der Mescht, Mieke Adri; Slingers, Nevilene; Davids, Lee-Ann; Tshabalala, Khanyisile; Ueckermann, Veronica; Seocharan, Ishen; Reddy, Tarylee; Richardson, Simone I.; Moyo-Gwete, Thandeka; Abdullah, Fareed; Moore, Penny L.; Rossouw, Theresa M. (Elsevier, 2026-02)
BACKGROUND : People living with HIV (PLWH) who experience advanced immunosuppression are susceptible to severe COVID-19 and demonstrate compromised vaccine responses due to low CD4 counts and uncontrolled HIV viral load. Although vaccine boosters enhance immunity in the general population, their immunogenicity in individuals with advanced HIV remains inadequately characterised. METHODS : This study evaluated the humoral and cellular immunogenicity of COVID-19 vaccine boosters in 41 individuals with advanced HIV at baseline and 4 weeks post-vaccination. Binding antibodies, neutralising antibodies, antibody-dependent cellular cytotoxicity (ADCC), as well as spike-specific CD4+ and CD8+ T-cell responses were quantified and characterised. RESULTS : Booster vaccination was found to increase binding antibody titres (8.0-fold) and neutralising activity (3.9-fold), even among participants with CD4 counts <100 cells/mm³, although absolute responses remained lower than the controls. ADCC activity also modestly increased post-vaccination (2.1-fold). Spike-specific CD4+ T-cell responses increased in magnitude (0.001% to 0.160%, p=0.0001) and responder frequency (49% to 83%, p=0.0167) post-vaccination, while CD8+ T-cell responses remained low. Compared to the controls, PLWH had similar magnitudes of spike-specific CD4+ T-cell responses but significantly lower CD8+ T-cell responses. CONCLUSION : COVID-19 vaccine boosters enhance immunity in PLWH, however, the responses remain suboptimal compared to immunocompetent individuals, emphasising the need for tailored vaccination strategies. HIGHLIGHTS • COVID-19 booster vaccination increased binding and neutralising antibodies in PLWH. • PLWH with CD4 <100 cells/mm³ had lower antibody titres. • Spike-specific CD4⁺ T-cell responses increased after vaccination in PLWH. • CD8⁺ T-cell responses remained low compared to controls. • Findings support tailored vaccination strategies for advanced HIV.

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