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

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Safety, pharmacokinetics, and neutralisation activity of PGDM1400LS, a V2 specific HIV-1 broadly neutralising antibody, infused intravenously or subcutaneously in people without HIV-1 in the USA (HVTN 140/HPTN 101 part A) : a first-in-human, phase 1 randomised trial
(Elsevier, 2025-06) Seaton, Kelly E.; Paez, Carmen A.; Yu, Chenchen; Karuna, Shelly T.; Gamble, Theresa; Miner, Maurine D.; Heptinstall, Jack; Zhang, Lu; Gao, Fei; Yacovone, Margaret; Spiegel, Hans; Dumond, Julie B.; Anderson, Maija; Piwowar-Manning, Estelle; Dye, Bonnie; Tindale, India; Proulx-Burns, Lori; Trahey, Meg; Takuva, Simbarashe G.; Takalani, Azwidihwi; Bailey, Veronique C.; Kalams, Spyros A.; Scott, Hyman; Mkhize, Nonhlanhla N.; Weiner, Joshua A.; Ackerman, Margaret E.; McElrath, M. Juliana; Pensiero, Michael; Barouch, Dan H.; Montefiori, David; Tomaras, Georgia D.; Corey, Lawrence; Cohen, Myron S.; Huang, Yunda; Mahomed, Sharana; Siegel, Marc; Kelley, Colleen F.
BACKGROUND : PGDM1400LS is a human monoclonal antibody targeting the HIV envelope V2 apex with a lysine-serine modification intended to enhance serum and tissue half-lives and is being considered for use in combination monoclonal antibody trials. We sought to test whether PGDM1400LS was safe and had favourable serum concentration, pharmacokinetics, and neutralising ability in healthy adults. METHODS : HVTN 140/HPTN 101 part A is an open-label, dose escalation, first-in-human phase 1 trial of PGDM1400LS given intravenously or subcutaneously to healthy adults aged 18–50 years without HIV-1. The study enrolled participants at four sites in the USA, across five groups, each receiving one dose of PGDM1400-LS intravenously (group 1: 5 mg/kg; group 2: 20 mg/kg; and group 4: 40 mg/kg) or subcutaneously (group 3: 20 mg/kg; and group 5: 40 mg/kg). Participants in group 1 were enrolled sequentially without random assignment. Participants in groups 2 and 3 were block randomised and enrolled simultaneously after group 1 safety review. Groups 4 and 5 followed the same process, contingent on groups 2 and 3 safety review. The primary endpoints were safety and tolerability of PGDM1400LS, serum concentration of PGDM1400LS, and serum neutralising activity after single administration of PGDM1400LS. Serum PGDM1400LS concentrations collected at seven timepoints (day 0, day 3, day 6, day 28, day 56, day 112, and day 168) were assessed via an anti-idiotype binding assay and characterised via non-compartmental pharmacokinetic analysis. Serum neutralisation activity (ID80) was assessed by a TZM-bl assay. The study is registered with ClinicalTrials.gov, NCT05184452. FINDINGS : Between Nov 15, 2021, and March 4, 2022, 15 participants were enrolled into the five study groups (three participants per group) with 6 months of follow-up. Ten of 15 participants were female, 14 of 15 participants were non-Hispanic, and 11 of 15 participants were White, with a median age of 27 years (range 24–47). PGDM1400LS was safe and well tolerated, with mild to moderate solicited symptoms. Serum concentrations showed dose proportionality by administration route, with peak concentrations observed immediately after intravenous infusion (range 95·7–727·4 μg/mL) or on day 6 after subcutaneous infusion (205·6–547·1 μg/mL). The median elimination half-life was 55 days (range 48–59), representing a 2-to-3-times increase versus parental PDGM1400. Estimated subcutaneous (vs intravenous) bioavailability was 50–60%. ID80 titres showed agreement with concentration-predicted ID80 titres, indicating maintenance of neutralisation activity in vivo. INTERPRETATION : PGDM1400LS is a promising candidate for combination monoclonal antibody efficacy trials going forward.
Immunization coverage, equity, and access for children with disabilities : a scoping review of challenges, strategies, and lessons learned to reduce the number of zero-dose children
(MDPI, 2025-03) Musuka, Godfrey; Cuadros, Diego F.; Miller, F. DeWolfe; Mukandavire, Zindoga; Dhliwayo, Tapiwa; Iradukunda, Patrick Gad; Mano, Oscar; Dzinamarira, Tafadzwa
BACKGROUND : Children with disabilities, particularly in low- and middle-income countries (LMICs), face heightened risks of vaccine-preventable diseases due to a range of systemic and social barriers. Although immunization is a fundamental human right and a proven public health intervention, this vulnerable group is often overlooked in policy and practice. Understanding the factors compromising vaccine equity for these children is critical to reducing zero-dose prevalence and improving health outcomes. METHODS : This scoping review examined peer-reviewed, gray literature from 2010 to 2024. Searches were conducted in PubMed, Google Scholar, and relevant organizational reports (WHO, UNICEF). Studies addressing children with disabilities and focusing on immunization barriers, interventions, or lessons learned were selected. English-language publications were screened in title/abstract and full-text stages. Key data extracted included population, barriers, and immunization outcomes. Since this review focused on articles in English, this is a key limitation. Results were synthesized thematically to identify recurring patterns and to guide improved interventions and policies. RESULTS : Twelve articles met the inclusion criteria. Key barriers identified were inadequate healthcare infrastructure, insufficient provider training, limited follow-up services in rural regions, societal stigma, and pervasive misconceptions around both disability and vaccines. Factors such as maternal education, logistical support for caregivers, and using low-sensory, inclusive vaccination settings were consistently linked with better outcomes. Effective strategies included mobile vaccination units, tailored interventions (e.g., distraction or sedation techniques), school-based immunization programs, and robust community engagement to address stigma. Lessons learned underscored the importance of flexible, individualized care plans and empowering families through transparent communication. CONCLUSIONS : Children with disabilities continue to experience significant gaps in immunization coverage, driven by intersecting barriers at the individual, health system, and societal levels. Scaling tailored interventions, inclusive policies, strengthened infrastructure, and ongoing research can help ensure these children receive equitable access to life-saving vaccinations.
Antimicrobial resistance and its impact on food safety determinants along the beef value chain in sub-Saharan Africa-a scoping review
(MDPI, 2025-03) Musuka, Godfrey; Machakwa, Jairus; Mano, Oscar; Iradukunda, Patrick Gad; Gashema, Pierre; Moyo, Enos; Nsengimana, Amon; Manhokwe, Shepherd; Dhliwayo, Tapiwa; Dzinamarira, Tafadzwa
Antimicrobial resistance (AMR) poses a significant threat to human, animal, and public health, particularly in Sub-Saharan Africa (SSA), where the beef sector is vital to food security and livelihoods. We conducted a scoping review to explore the determinants and impacts of AMR within the beef value chain in SSA, highlighting the challenges and progress in mitigating AMR risks in livestock production. This review identifies key factors contributing to AMR, including the overuse and misuse of antimicrobials, inadequate veterinary oversight, and weak regulatory frameworks. These practices are prevalent across various stages of the beef value chain, from farm to slaughterhouse, and are exacerbated by informal markets and insufficient infrastructure. Our findings also highlight the role of environmental factors, such as contamination of feed, water, and manure, in the spread of resistant pathogens. Additionally, gaps in AMR surveillance, education, and enforcement limit effective control measures in the region. While efforts to combat AMR have gained momentum in some countries, including the development of national action plans and surveillance systems, substantial challenges remain. These include poor adherence to antimicrobial guidelines, insufficient veterinary training, and the lack of integration between sectors. There is a need for targeted research to better understand antimicrobial misuse, socio-economic drivers, and the environmental pathways of AMR, as well as the need for stronger regulatory frameworks and cross-border cooperation. Addressing these challenges will be essential to safeguarding food safety, public health, and the sustainability of the beef industry in SSA.
Primary and tertiary management of ocular surface lesions in HIV-infected patients in Ehlanzeni, Mpumalanga Province
(South African Medical Association, 2024-06) Mhlanga, S.; Turner, Astrid Chrisilda; Bibbulph, S.J.
BACKGROUND : In sub-Saharan Africa, ocular surface squamous neoplasia (OSSN) is the most common ocular surface tumour and is strongly associated with HIV infection. This range of ocular malignancies can be managed early to prevent large tumours requiring invasive treatment, facial disfigurement and mortality. Primary healthcare workers (HCWs) play a critical role in the early identification of the lesion. In addition, the ocular lesion can also be the presenting sign of HIV infection in individuals who have not yet been diagnosed. The aim of the present study was to assess the management of suspicious conjunctival growths in HIV-infected patients in primary health facilities and a specialist eye clinic in South Africa. OBJECTIVES : To assess the knowledge, attitude and current practice of HCWs working in HIV clinics regarding ocular surface lesions and to evaluate the management of patients with ocular surface lesions at a tertiary hospital. METHODS : A cross-sectional study design was used (November 2020 - May 2021), for which 149 HCWs were invited to assessments about their knowledge, attitudes and practices regarding ocular surface lesions. In addition, files of patients with ocular surface lesions who presented between January 2018 and August 2020 to the eye clinic were reviewed using a data extraction sheet. RESULTS : One hundred-and-three HCWs agreed to participate in the survey (response rate 69.1%). Of these participants, 84.5% were experienced professional nurses (6 - 15 years of work experience) but had minimal experience with detection and management of eye complaints and lesions. Twenty-seven (26.2%) of the participants recognised some ocular surface lesions and 86 (83.5%) reported that they would refer patients with suspicious lesions. Sixty-two files were reviewed and 51 (82.2%) of the patients had an HIV-positive diagnosis. Fifty percent had carcinoma-in situ and squamous cell carcinoma of the conjunctiva. Thirty-one (50%) of the patients were lost to follow-up. CONCLUSION : OSSN is an important manifestation of HIV infection. It would be beneficial for patients to receive a basic ocular examination as part of the baseline clinical evaluation; this may contribute to early referral to an eye care facility. The health system would benefit from establishing an eye health support system with the nearby health facilities, thereby educating primary HCWs about the association between HIV and OSSN.
Knowledge of pregnant women regarding prevention of mother-to-child transmission of HIV infection in Gert Sibande District, Mpumalanga Province, South Africa
(South African Medical Association, 2024-06) Manyawu, V.; Musekiwa, Alfred; Moyo-Chilufya, Maureen; Yah, Clarence S.; alfred.musekiwa@up.ac.za
BACKGROUND : Prevention of mother-to-child transmission (PMTCT) of HIV helps in closing the gaps for new HIV infections, thereby contributing to achieving the global targets of an AIDS-free generation. OBJECTIVE : To explore knowledge regarding PMTCT among pregnant women in Gert Sibande District, Mpumalanga Province, South Africa (SA). METHODS : The study was performed in two clinics in Chief Albert Luthuli Municipality, Gert Sibande District. It was a qualitative and descriptive exploratory study involving in-depth, one-on-one interviews with pregnant women regarding their PMTCT knowledge and perspectives. RESULTS : The study findings showed that pregnant women from the two clinics have a good knowledge of PMTCT. However, they were not aware that caesarean section can minimise mother-to-child transmission (MTCT) of HIV infection. CONCLUSION : PMTCT is important in establishing an HIV-free generation. The study revealed that women had a good understanding of MTCT; nevertheless, additional education is necessary, particularly regarding birthing procedures that minimise the risk of MTCT.
Insights into prostate cancer awareness and perceptions among men in Tshwane
(South African Medical Association, 2024-06) Nzombe, L.; Shirinde, Joyce; Patrick, Sean Mark; sean.patrick@up.ac.za
BACKGROUND : Globally, prostate cancer (PCa) accounts for 6.6% of deaths, while in South Africa (SA), PCa accounts for 13% of deaths in males, with over 4 000 SA men diagnosed with PCa annually. This may be attributed to the inadequate availability of screening, early detection and possibly other socioeconomic and lifestyle factors. OBJECTIVES : To determine the factors associated with knowledge and perceptions of PCa among men in the Tshwane district. METHODS : A descriptive cross-sectional survey was conducted between August 2022 and June 2023 in a study population of men, ≥18 years, residing in Tshwane district located in Gauteng, South Africa. RESULTS : In this study, 91.7% of the subjects responded that they had heard about PCa, while 11% thought they might be at risk for having PCa. While 93.7% of the respondents reported that they had never tested for PCa, 98.3% said that if they were offered the opportunity to test voluntarily, they would agree to test for PCa. There was a significant association between age and knowledge of PCa (p≤0.001). There was also a significant association between perception of PCa and smoking (p=0.034), age (p=0.035) and level of education (p=0.04). CONCLUSION : This study shows significant associations between age and level of education with knowledge, perception and awareness of PCa. Educational campaigns targeting diverse age and education groups are recommended, along with smoking cessation programmes, improved PCa screening access, tailored messaging, healthcare collaborations, and cultural sensitivity to enhance awareness and early detection.
HIV status and contraceptive use in Zimbabwe among sexually active adolescent girls and women : secondary analysis of Zimbabwe demographic health survey data
(South African Medical Association, 2024-06) Musuka, G.; Murewanhema, G.; Mukandavire, Z.; Chingombe, I.; Cuadros, D.; Mutenherwa, F.; Dzinamarira, Tafadzwa; Eghtessadi, R.; Malunguza, N.; Mapingure, M.; u19395419@up.ac.za
BACKGROUND : Understanding the pattern of contraceptive use among women living with HIV is critical for formulating relevant public health interventions to improve the uptake and use of reliable methods in this population. This helps to reduce the incidence of unintended pregnancies. OBJECTIVE : In this secondary data analysis, we aimed to describe contraceptive use by HIV-positive and HIV-negative sexually active adolescent girls and women, using data from the Zimbabwe Demographic and Health Survey (2015-16). METHOD : We used statistical analysis to determine the association between the use of various methods of contraception and HIV status using the Zimbabwe Demographic and Health Survey, 2015-16 data. RESULTS : Overall, the contraceptive use prevalence in this study was 60%. Sexually active adolescent girls and women on the Pill and injections were less likely to be HIV-positive compared with those not using any method of contraception (odds ratio (OR)=0.54, 95% confidence interval (CI) (0.45 - 0.64), p=0.001; and OR=0.75, 95% CI (0.59 - 0.96), p=0.020, respectively). Those using either a male or female condom were more likely to be HIV-positive, OR=3.36, 95% CI (2.63 - 4.28), p=0.001. CONCLUSIONS : This study revealed that there is still a considerable unmet need for contraception among the study population, highlighting the need to devise strategies to increase contraception uptake among women. Statistically significant differences were noted in the use of condoms, with those who are HIV-positive having a higher use of condoms compared with those who are HIV-negative. This may reflect that HIV-positive individuals have received appropriate counselling messages on the need to use barrier methods.
Frequent outbreaks of cholera in Zimbabwe : urgent need for strengthened public health interventions
(South African Medical Association, 2024-05) Dzinamarira, Tafadzwa; Murewanhema, G.; Mapingure, M.; Chingombe, I.; Musuka, G.
No abstract available.
Evaluation of choices and time spent on an open online elective course by undergraduate medical students during the COVID-19 pandemic
(South African Medical Association, 2024-06) Mfeka, Z.; Turner, Astrid Chrisilda; Wolvaardt, Jacqueline Elizabeth (Liz); Muganhiri, D.; liz.wolvaardt@up.ac.za
BACKGROUND : The COVID-19 pandemic highlighted the weakness of relying on in-person tuition in higher education. Massive open online courses (MOOCs) have been a successful addition to higher education. In this study, educators had to replace a planned elective in the medical curriculum with an online option during the pandemic. The roles of the competency framework of the Health Professions Council of South Africa (HPCSA) (Leader and Manager, Health Advocate, Professional, Communicator, Collaborator, Scholar, and Healthcare Practitioner) were used to guide its development. This elective emphasised the non-clinical roles of medical practitioners and was offered in 2020 and 2021. OBJECTIVES : To describe the choices of third-year medical students and time spent participating in a modified online elective in 2020 and 2021. METHODS : A descriptive cross-sectional study design was used, involving the participation of 629 medical students. Data were collected and analysed from three primary sources: registration data from LinkedIn Learning, data from the Foundation for Professional Development, and self-reported estimates by students of the average time spent on selected courses. Data included identification of the associated competency acquired. Data analysis was conducted using Python, version 3.10.11. RESULTS : The course choices of 629 students were analysed. In 2020 there were 300 participants and in 2021 there were 329. All the students had one compulsory inclusion in the elective (Management and Leadership Short Course for Undergraduate Healthcare Students). Students in both years reported spending the most average time on courses related to clinical knowledge (Healthcare Practitioner), followed by financial literacy and management (Professional), diversity management (Collaborator), and priority actions to identify and/or respond to (Health Advocate). The most popular courses related to the Leader and Manager role were around decision-making in human resources, problem-solving, and managing healthcare teams. Based on the top 10 LinkedIn Learning course selections of both cohorts, there appeared to be a preference for courses that were consistent with the role of medical professionals in practice. The most popular LinkedIn Learning course was The Six Morning Habits of High Performers. CONCLUSION : Students gravitated toward courses aligned with their role as professional doctors within the HPCSA competency framework. More studies are needed to understand how medical students develop the six non-clinical roles in the HPCSA framework and the effectiveness of MOOCs in a medical curriculum.
Community perceptions of community health worker effectiveness : contributions to health behaviour change in an urban health district in South Africa
(South African Medical Association, 2024-02) Thomas, Leena Susan; Pillay, Y.; Buch, Eric; leena.thomas@up.ac.za
BACKGROUND : Community health worker (CHW) programmes contribute towards strengthening adherence support, improving maternal and child health outcomes and providing support for social services. They play a valuable role in health behaviour change in vulnerable communities. Large-scale, comprehensive CHW programmes at health district level are part of a South African (SA) strategy to re-engineer primary healthcare and take health directly into communities and households, contributing to universal health coverage. OBJECTIVE : These CHW programmes across health districts were introduced in SA in 2010 - 11. Their overall purpose is to improve access to healthcare and encourage healthy behaviour in vulnerable communities, through community and family engagements, leading to less disease and better population health. Communities therefore need to accept and support these initiatives. There is, however, inadequate local evidence on community perceptions of the effectiveness of such programmes. METHODS : A cross-sectional descriptive study to determine community perceptions of the role and contributions of the CHW programme was conducted in the Ekurhuleni health district, an urban metropolis in SA. Members from 417 households supported by CHWs were interviewed in May 2019 by retired nurses used as fieldworkers. Frequencies and descriptive analyses were used to report on the main study outcomes of community acceptance and satisfaction. RESULTS : Nearly all the study households were poor and had at least one vulnerable member, either a child under 5, an elderly person, a pregnant woman or someone with a chronic condition. CHWs had supported these households for 2 years or longer. More than 90% of households were extremely satisfied with their CHW; they found it easy to talk to them within the privacy of their homes and to follow the health education and advice given by the CHWs. The community members highly rated care for chronic conditions (82%), indicated that children were healthier (41%) and had safer pregnancies (6%). CONCLUSION : As important stakeholders in CHW programmes, exploring community acceptance, appreciation and support is critical in understanding the drivers of programme performance. Community acceptance of the CHWs in the Ekurhuleni health district was high. The perspective of the community was that the CHWs were quite effective. This was demonstrated when they reported changes in household behaviour with regard to improved access to care through early screening, referrals and improved management of chronic and other conditions.
A decomposition analysis of sociodemographic factors and non-cigarette tobacco use as contributors to the change in smoking rates in South Africa between 2017/18 and 2021
(South African Medical Association, 2024-06) Kali, K.; Ayo-Yusuf, Olalekan Abdulwahab; lekan.ayo-yusuf@up.ac.za
BACKGROUND : Trends data up to 2018 suggest that tobacco smoking was increasing in South Africa (SA), but only limited information is available on the impact of the COVID-19 pandemic on the current pattern of use of tobacco and nicotine products (TNPs). OBJECTIVES : To assess trends in sociodemographic patterns in the use of TNPs and the extent to which sociodemographic factors and non-cigarette tobacco use may explain possible changes in rates of TNP use between 2017/18 and 2021. METHODS : Data from three waves (2017, 2018 and 2021) of the South African Social Attitudes Survey (total N=8 140) were analysed. The sociodemographic correlates of current daily and non-daily use of factory-manufactured cigarettes (FMCs), roll-your-own (RYO) cigarettes, waterpipe/hubbly, electronic cigarettes (ECigs), snuff (a smokeless tobacco) and any combination of FMCs, RYO cigarettes and waterpipe/hubbly (‘current smoking’) in 2017/18 (pre-pandemic) were compared with those for 2021 (during the pandemic). Chi-square analyses and generalised linear models were used to compare the prevalence of TNP use between the two periods. A Blinda-Oaxaca decomposition analysis was also used to explore the roles of various sociodemographic factors, including any differences in the use of TNPs, that may explain any observed differences in smoking rates between 2017/18 and 2021. RESULTS : Current smoking increased significantly from 22.4% (95% confidence interval (CI) 20.4 - 24.5) in 2017/18 to 27.6% (95% CI 24.3 - 31.1) in 2021 (p=0.009). Smoking of FMCs did not change significantly overall between these two periods (20.1% v. 22.1%; p=0.240), except for a significant increase among those who self-identified as black African and a decrease among those who self-identified as coloured and those currently employed. However, the use of waterpipe/hubbly, ECigs, RYO cigarettes and snuff increased significantly. Women, individuals aged <35 years and black Africans had the largest increase in waterpipe/hubbly and ECig use. A decomposition analysis showed that increased waterpipe/hubbly and RYO use explained 52% and 15%, respectively, of the increase in smoking rates, while lower employment during 2021 compared with 2017/18 explained 15% of the increase in smoking rates during 2021. CONCLUSION : The use of all TNPs continued to increase in SA, particularly among women and unemployed people. These findings have policy and practice implications for addressing socioeconomic disparities in tobacco-related diseases.
Exploring the role of district clinical specialist teams in maternal health outcomes in a South African district : a mixed method study from 2012 to 202
(South African Medical Association, 2024-12) Basu, Jayati Kusari; Stewart, A.; Basu, Debashis; Wing, J.; Feucht, Ute Dagmar
BACKGROUND : High maternal and child mortality in South Africa (SA) necessitated the establishment of district clinical specialist teams (DCSTs) in all health districts in 2012, mandated to work in collaboration with district managers and health professionals to achieve joint goals of improved maternal and child health services and outcomes. OBJECTIVE : Within the context of SA district health services, to explore the various obstetric intervention measures undertaken by a DCST over an 8-year period (July 2012 - February 2020), as aligned to the national DCST policy framework, and to document the knowledge and perceptions among managers and health professionals on the work done by the DCST in the district health service. METHODS : A review of DCST reports and documents was conducted along with in-person structured interviews among health professionals and district health managers in the Ekurhuleni Health District in SA. Health professionals who had a working relationship with the DCST and relevant managers of health, including CEOs, clinical managers, community health centre managers, maternal and child health co-ordinators and municipal managers were selected for the interview. Interviews were conducted by the interviewer using a data collection tool focused on the scope of work and acceptance of the DCST in improving maternal health services in a geographically defined district health system. Data collection tools were completed by the interviewer upon questioning the participants. Data were analysed by documenting the activities of the DCST, and thematic analysis was performed for the interviews. RESULTS : Analysis of DCST reports and documents revealed the broad range of activities, including clinical training and mentoring, clinical work, supervision, audit, research, monitoring and evaluation and clinical risk management. Thematic analysis extracted seven themes, namely clinical effectiveness, clinical risk management, professional development, accountability for maternal and child health, clinical work, monitoring and evaluation, and leadership and governance. All (n=20) participants acknowledged the positive impact of the DCST on the improvement in maternal health services. CONCLUSION : The DCST was perceived by local peers as a successful strategy to improve maternal health services in a district health service. This success is likely rooted in its focused intervention measures, within a supportive environment of district managers and health professionals. Such district-based clinical teams are a potential strategy to improve maternal health services within primary healthcare services.
Perceptions and views of key implementers on the implementation of the health-promoting school programme in the City of Tshwane, South Africa
(South African Medical Association, 2024-06) Mbatha, Nothando; McCrindle, Cheryl; Shirinde, Joyce; nothando.mbatha@up.ac.za
BACKGROUND : The health-promoting school programme has been associated with numerous benefits for school communities where it is well implemented. In Tshwane, the implementation processes have not been evaluated. OBJECTIVE : A qualitative research approach based on grounded theory was used to investigate the experiences of 27 health-promoting school programme implementers across Tshwane. METHODS : Data were collected through a combination of methods, including semi-structured interviews with principals (n=6), educators (n=10) and school governing body members (n=4), one focus group discussion with health promoters (n=7), field notes from school observations and memos. RESULTS : Implementation fidelity was weak in the City of Tshwane, as a result of poor training of implementers, poor leadership and collaboration, weak accountability structures, and lack of resources and communication. A grounded theory was developed which showed that schools needed guidance and accountability to properly implement the programme. The theory offers a framework that could be used to improve implementation and evaluation outcomes. CONCLUSION : Implementers were keen on improving the lives of learners – health-wise and academically. With proper guidance, support and accountability measures by government at district and provincial level, implementation of the programme is feasible in the City of Tshwane.
Temporal socio-economic inequalities in the double burden of malnutrition (DBM) among under-five children : an analysis of within- and between-group disparities in 20 sub-Saharan African countries (2004–2024)
(Elsevier, 2025) Lukwa, Akim Tafadzwa; Okova, Denis; Bodzo, Paidamoyo; Maseko, Sikelela Charles; Bhebe, Melisa; Akinsolu, Folahanmi Tomiwa; Olunike, Abodunrin; Nzeribe, Emmanuella; Siya, Aggrey; Nyabunze, Admire; Hongoro, Charles; Chiwire, Plaxcedes
BACKGROUND : The double burden of malnutrition (DBM) in sub-Saharan Africa is a pressing public health issue, particularly among children under five years old. DBM encompasses both undernutrition (stunting) and overnutrition (overweight) within the same population, often shaped by socio-economic disparities. Addressing DBM in early childhood is vital, as malnutrition can lead to long-term health, cognitive, and developmental challenges. METHODS : Using nationally representative data from the Demographic and Health Surveys (DHS) across 20 sub-Saharan African countries, this study examines temporal socio-economic inequalities in DBM. Countries include Zimbabwe, Kenya, Nigeria, and Mozambique, among others. DBM was defined using anthropometric measures, while socio-economic status (SES) was categorized as poor, middle, or rich. Temporal trends were analyzed, and inequalities were quantified using Erreygers Normalized Concentration Indices (ENCI) and Theil indices to explore within- and between-group disparities by SES and urban/rural residence. RESULTS : DBM prevalence across countries ranged from 0.2 % to 4.6 %. Declines were noted in Zimbabwe and Kenya. Socio-economic inequalities were significant, with overnutrition increasingly concentrated in wealthier households, while undernutrition remained prevalent among poorer populations. Theil index analyses revealed within-group disparities as the primary drivers of overall inequality, particularly in urban wealthier populations, though rural and low-SES groups also contributed significantly in countries like Senegal and Mali. CONCLUSION : DBM is still present in sub-Saharan Africa and is driven by socio-economic inequalities. Targeted interventions focusing on improving access to nutritious food, healthcare, and education for vulnerable populations, particularly in rural and low-SES groups, are essential to reduce malnutrition disparities.
Celebrating a quarter-century of the UP School of Health Systems and Public Health (SHSPH)
(South African Medical Association, 2024-06) Ayo-Yusuf, Olalekan Abdulwahab; lekan.ayo-yusuf@up.ac.za
No abstract available.
Assessing awareness and treatment knowledge of preventable blindness in rural and urban South African communities
(South African Medical Association, 2024-06) Kiva, Z.; Wolvaardt, Jacqueline Elizabeth (Liz)
BACKGROUND : Preventable blindness is a global public health problem. In South Africa (SA) the prevalence of blindness is increasing, with a higher proportion of cataracts than the global norm, and a large rural population with limited access to specialised eye-care services. OBJECTIVE : To determine the level of knowledge regarding preventable blindness and treatment options within a rural and urban population. SETTING : Rural and urban areas in the Eastern Cape, SA. METHODS : A descriptive cross-sectional study was conducted among 309 participants. Questionnaires were administered by fieldworkers at the different sites. Proportions were calculated and χ2 tests done to determine whether there was any significant relationship between the categorical variables. Data analysis was done using Stata version 15. RESULTS. Participants were almost equally distributed among the urban (49.2%) and rural areas (50.8%). Both groups had a similar composition of males and females. Most participants had completed high school. The results showed a statistically significant difference between the urban and rural participants' knowledge about the causes of blindness: refractive error χ2 (1, N=30) = 8.20, p<0.05, and cataract χ2 (1, N=28) = 8.64, p<0.05. The top two differences in the views between urban and rural participants regarding symptoms associated with eye problems (p<0.05) were: 'people who need spectacles have double vision', χ2 (1, N=122) = 28.19; and 'people who need spectacles squint their eyes', χ2 (1, N=124) = 17.37. The majority of urban participants reported opting to go to a private optometrist for eye health services, while the majority of rural participants would go to a pharmacy. Both groups were aware of the role of ageing in blindness. CONCLUSION : Urban participants in this study appeared to be more knowledgeable than rural participants about the causes and symptoms of blindness and its treatment options. These findings should provide some value to those who provide primary healthcare services in rural areas as there is a clear opportunity for patient education and health promotion regarding the causes and symptoms of these common preventable causes of blindness. Addressing this knowledge gap regarding the causes and symptoms of blindness and the treatment options is a critical first step for awareness programmes in rural areas. Without this, there will be little demand for any treatment or service. Future studies are needed to understand which health promotion interventions are effective in preventable blindness in rural populations.
An investigation of factors associated with antenatal care attendance in Gauteng in 2015
(South African Medical Association, 2024-06) Mostert, J.; Webb, Elizabeth M.; Girdler-Brown, B.V. (Brendan); Ngcobo, Sanele
BACKGROUND : Many studies have shown that South African women tend to initiate antenatal care late in their pregnancies. This presents challenges in the provision of quality healthcare to both mother and child. There are several studies on the social and cultural reasons for late booking. However, understanding the factors in a woman's choice to initiate antenatal care is important in informing healthcare strategies and policies. METHODS : This study was an analytical cross-sectional study of household and general health factors associated with attendance of antenatal care by pregnant women in Tshwane in 2015. It was a secondary data analysis from complete data sampling households registered on AitaHealth™. Univariate and multivariate logistic regression was used to assess which factors are associated with antenatal care attendance. RESULTS : The age of the head of the household was a significant factor in the attendance of antenatal care. The odds of attending antenatal care were 3.3, 2.1 and 1.8 times higher in households where the head of the household was 30 - 39 years of age, 20 - 29 or 40-49 years of age, respectively, than when between 10-19 years of age. Factors that increased the odds of attending antenatal care were living in households that had electricity and piped water, and running a business from home. Residing in a permanent dwelling and being food secure increased the odds of antenatal care attendance. CONCLUSION : The identified health and household factors should inform policies and programmes geared towards improving services around antenatal care provision.
Just energy transition from coal in South Africa : a scoping review
(Elsevier, 2025-05) Patrick, Sean Mark; Shirinde, Joyce; Kgarosi, Kabelo; Makinthisa, Takalani; Euripidou, Rico; Munnik, Victor; sean.patrick@up.ac.za
BACKGROUND : South Africa’s just energy transition (JET) aims to reduce coal dependency and shift toward a low-carbon, sustainable energy framework. However, achieving this goal requires addressing the socio-economic, health, and environmental burdens that coal dependency has placed on communities, particularly in regions like Mpumalanga. Integrating principles of social and restorative justice is essential to ensure an equitable transition. OBJECTIVE : This scoping review examine how South Africa's policymaking, regulatory frameworks, and public participation in the JET align with principles of social and restorative justice and global energy transition frameworks. METHODS : A systematic literature search was conducted across Scopus, Web of Science, and PubMed to identify relevant studies on energy transition and justice frameworks. Network analysis was employed to compare South Africa’s JET strategies with global trends, focusing on indicators related to health, environmental, and socio-economic impacts. RESULTS : Findings reveal significant challenges in South Africa’s JET, including regulatory limitations, stakeholder conflicts, and gaps in policy alignment with community needs. Although efforts to incorporate justice principles are emerging, disparities in policy implementation suggest the need for more tailored, inclusive approaches. Network analysis identified both overlaps and gaps between South Africa’s JET policies and international frameworks, particularly in areas of public health and social equity. CONCLUSION : To achieve a balanced and inclusive energy transition, the study recommends strengthening regulatory coherence, enhancing public engagement, and implementing concrete actions for social and restorative justice. Aligning domestic policies with international commitments while addressing local socio-economic conditions is critical for South Africa’s JET to serve as a model for coal-dependent economies globally.
Prevalence of lower back pain and associated workplace and ergonomic factors among mineworkers in a nickel mine, Zimbabwe
(MDPI, 2024-09-16) Zenda, Kumbirai P.; Rathebe, Phoka C.; Moto, Tshepo Paulsen; Masekameni, Daniel M.; Mbonane, Thokozani P.
Lower back pain is a common occurrence among mine workers due to the nature of their work. Globally, workplace (occupational) and ergonomic risk factors have been reported to influence the prevalence of lower back pain among workers. This study aimed to determine ergonomic risk factors associated with lower back pain and associated risk factors (workplace and ergonomics) among mineworkers in a nickel mine in Zimbabwe. A cross-sectional study design was employed, and participants were randomly selected to complete a questionnaire that included the Dutch Musculoskeletal Questionnaire (DMQ). A total of 420 mine workers were interviewed, with the majority being male (n = 259, 61.7%) and aged between 31 and 44 years old (n = 159, 37.9%). The study found that the prevalence of lower back pain was 41.43% (n = 174). Several risk factors were found to be associated with lower back pain, including working overtime (AOR = 1.13, p < 0.01; 95% CI: 0.07–0.22), performing repetitive tasks (AOR = 8.06, p < 0.01; 95% CI: 4.67–13.93), bending (AOR = 7.77, p < 0.01; 95% CI: 3.97–15.22), and twisting (AOR = 3.32, p < 0.01; 95% CI: 1.83–6.03). Based on these findings, it is recommended that an ergonomic risk assessment and prevention program be implemented, which should include educational awareness about lower back pain and its prevention among mine workers.
High burden of abnormal cervical smears in South African primary health care : health programmes implications
(Oxford University Press, 2025-02) Omole, Olufemi B.; Francis, Joel M.; Musonda, John M.; Sodo, Pumla P.; Reji, Elizabeth; Phukuta, Nyundu S.J.; Mabuza, Honey L.M.; Musonda, Joyce Sikwese; Akii, Jimmy; Ndimande, John V.; Ayo-Yusuf, Olalekan Abdulwahab
Cervical cancer is the second most common malignancy among South African women and the load of abnormal cervical smears has clinical, programmatic and policy implications. This cross-sectional study of women who presented for cervical cancer screening aimed to determine the prevalence of abnormal cervical smears and associated factors in primary health care (PHC) facilities in Gauteng—the most densely populated province in South Africa. A questionnaire collected data on socio-demography, tobacco use, sexual behaviours, HIV status, past treatment for sexually transmitted infections (STI) and cervical cancer screening in the past 10 years. Cytology reports were extracted from the laboratory reports. Of 749 participants, most were black (89.7%), aged 30–49 years (62.2%), single (57.5%) and attained high school education (76.8%). About 43.9% were HIV positive with almost all (97.2%) on antiretroviral therapy. Cytology results were available for 612 (81.9%) participants. Of these, 25.8% (159) were abnormal: 13.2% low-grade squamous intraepithelial lesion; 5.7% atypical squamous cells of undetermined significance and 4.9% high-grade squamous intraepithelial lesion. In bivariate and multivariable analysis, abnormal cervical cytology was not associated with any sociodemographic characteristics, HIV status, tobacco use status, sexual behaviours or past treatment for STI. In conclusion, the prevalence of abnormal cervical smears is high across all demographic groups and irrespective of HIV status and highlights the need to increase screening uptake, including advocacy for self-sampling. It also calls for capacity building to allow for the devolution of some downstream clinical care from specialist to district hospitals and large PHC facilities.

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