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

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Exploring performance engagement in online postgraduate learning : utilisation of digital activities
Van Wyk, Mari; Patrick, Sean Mark; Wolvaardt, Jacqueline Elizabeth (Liz) (Wiley, 2026-06)
BACKGROUND TO THE STUDY : As fully online postgraduate programmes expand, questions remain regarding whether sufficient student engagement is achieved and how such sufficiency can be measured. This study examined the types and levels of engagement within a fully online postgraduate module and explored how engagement can be operationalised using learning management system (LMS) analytics. OBJECTIVE : To explore whether there is sufficient student engagement in an online module, and the types and levels of online engagement. METHODS : A quantitative single-case study analysed LMS trace data from 773 students. Data were analysed using the Online Engagement Framework and Moore's interaction typology. Engagement was operationalised using four behavioural indicators: submissions, interactions, time-on-platform and Grade Center access. Cluster analysis was applied to identify engagement profiles. RESULTS : Findings indicate high levels of social, cognitive, behavioural and collaborative engagement, with participation substantially exceeding minimum requirements. In contrast, structured opportunities for emotional engagement were absent. Frequent Grade Centre access (mean = 68 views per student) suggests a digitally observable form of performance engagement characterised by academic self-monitoring behaviour Cluster analysis revealed four distinct engagement profiles, highlighting heterogeneity in student interaction patterns. CONCLUSION : The findings suggest that high-density programmatic assessment is associated with sustained engagement behaviours in online contexts. This study contributes to the literature by proposing a trace-based operationalisation of performance engagement and offering a practical framework for examining engagement sufficiency in fully online programmes. KEY POINTS • What is already known about this topic ○ Student engagement predicts success in online learning. ○ Engagement is multidimensional (behavioural, cognitive, social, emotional). ○ LMS analytics are increasingly used to measure engagement. • What this paper adds ○ Demonstrates how engagement sufficiency can be operationalised using LMS trace data. ○ Introduces performance engagement as digitally observable academic self-monitoring behaviour ○ Identifies four distinct engagement profiles using clustering. • Implications for practice and/or policy ○ Assessment design strongly shapes engagement behaviour. ○ Time-on-platform alone is insufficient as an engagement indicator. ○ Emotional engagement requires intentional design in online programmes. ○ Multidimensional analytics dashboards may better support early identification of diverse engagement patterns.
Heat-related health impacts on primary schoolchildren’s health : measured and estimated risks in Gauteng, South Africa
Bidassey-Manilal, Shalin; Shirinde, Joyce; Kapwata, Thandi; Wright, Caradee Yael (Elsevier, 2025-09)
BACKGROUND : Schoolchildren spend a substantial amount of time in classrooms and therefore, the classroom environment should be acceptable and tolerable with an aim to support their welfare and comfort. Globally, temperatures are projected to increase between 1.4 °C and 4.4 °C; however, Southern Africa will likely experience a temperature increase at twice the global rate, resulting in the prevalence of extreme temperatures and more intense heatwaves. An increase in the frequency and intensity of heat waves can lead to overheating in classrooms. This study aimed to describe classroom thermal conditions and understand possible impacts on schoolchildren's health. METHODS : A cross-sectional quantitative study was conducted among 904 grade 4 primary school children. The study collected meteorological data, i.e, hourly temperature and humidity data from the South African Weather Service's (SAWS) weather station closest to the participating schools and took place during summer. This data was used to calculate apparent temperature to determine the perceived human body temperature when exposed to the combined effects of temperature and humidity and analyse the potential health implications linked to the symptoms category developed by the United States National Weather Service and the National Oceanic and Atmospheric Administration. Schoolchildren also participated in this study by completing a self-reported hourly heat-related health symptom questionnaire. Data was analysed using STATA. Linear regression was used to investigate the association between apparent temperature and heat-related symptoms. RESULTS : The hourly temperature (mean of 34 °C) and humidity levels (maximum of 80.38 %) exceeded the World Health Organization and the United States Environmental Protection Agency's recommended levels. Out of the 456 apparent temperature range, 203 (44,5 %) of the readings was associated with no health risks, 226 (49,6 %) ranges fell within the caution category and 27 (5,9 %) within the extreme caution category these ranges were associated with health effects such as heat cramps, heat exhaustion and a heat stroke were possible with prolonged exposure. Regression results showed that for every 1 °C in apparent temperature, a 0.05 unit increase in the number of learners who report feeling tired between 8:00–9:00 is predicted; however, this was not statistically significant. CONCLUSIONS : Future research should incorporate physiological measures to better assess the direct impact of heat on learner health and longitudinal and intervention-based studies are encouraged to evaluate the effectiveness of school-based heat adaptation strategies in low-resource settings.
Exploring effects of household air pollution on pregnant mothers and their offspring in Africa : a scoping review
Muthelo, Livhuwani; Ngwenya, Mxolisi Welcome; Shirinde, Joyce; Mothiba, Tebogo Maria (MDPI, 2026-03)
In recent decades, air pollution has been the cause of major mortality and morbidity worldwide. WHO attributes about 4.2 million of these to ambient pollution and 3.2 million to household sources. Pregnant women are no exception to those mortalities. Therefore, this review aims to explore and critique existing evidence on the implications of household air pollution in homes among pregnant women. In this review, we adhered to the 2018 PRISMA Scoping Review guidelines. We followed the iterative steps. The time horizon of the literature was 2014–2024. The literature search was conducted on databases such as ProQuest, ScienceDirect, EBSCOhost, and PubMed. Only 19 publications met the inclusion criteria and were critically analyzed using thematic analysis technique. The review yielded two themes: (1) practices that predispose pregnant women to household air pollution and (2) impacts of household air pollution on the health of pregnant women. The study highlighted that socioeconomic status and gender roles play a vital role in exposure to air pollution among pregnant women. Therefore, this review finds it vital for future research to directly examine the impact of socioeconomic factors on air pollution. There is a particular need to develop strategies to mitigate air pollution in the African context. Furthermore, this review recommends that future research also focuses on the long-term biological effects of air pollution among pregnant women. HIGHLIGHTS Public health relevance: How does this work relate to a public health issue? • This scoping review addresses household air pollution as a critical public health concern that leads to preventable mortality and morbidity in pregnant women, resulting in negative pregnancy outcomes and long-term health implications for both mothers and their children. Public health significance: Why is this work of significance to public health? • Household air pollution is a potentially modifiable environmental risk factor that leads to adverse health outcomes for mothers and their children. The findings from this review are important for guiding public health efforts to protect pregnant women and lower unnecessary illness and death rate. Public health implications: What are the key implications or messages for practitioners, policymakers, and/or researchers in public health? • The findings highlight the need to integrate household air pollution screening, risk awareness, and clean household energy interventions into maternal and prenatal health programmes, with policies that prioritize low-income households and gender-sensitive approaches.
Healthcare workers' perspectives on patient bypassing of primary health care facilities in Mpumalanga province, South Africa
Majola, Thobelani N.; Blose, Ntombifuthi; Mthethwa, Mashudu; Mtwane, Zinhle; Africa, Algernon M.; Mokganya, Matome S.; Burnett, James M.; Ndlovu, Noluthando; Padarath, Ashnie (AOSIS, 2026-05-11)
BACKGROUND : South Africa’s Referral Policy and Implementation Guidelines aim to ensure continuity of care, manage patient flow, and improve health system efficiency. However, in Mpumalanga province, a growing number of patients bypass Primary Health Care (PHC) clinics and seek hospital services without formal referral. This trend undermines the structured referral pathway and strains healthcare resources. AIM : This study sought to identify the key factors that influence patients to bypass PHC facilities in Mpumalanga province. SETTING : The study was conducted across the three districts in Mpumalanga province. METHODS : A qualitative exploratory design was employed to better understand the factors influencing patients to bypass PHC clinics from the perspective of healthcare workers (HCWs). Using purposive sampling techniques, key informant interviews were conducted with 20 HCWs from 10 selected hospitals. Thematic analysis of the qualitative data was conducted using an inductive approach, with NVivo® software facilitating systematic coding, theme development and data organisation. RESULTS : Key factors that influenced patients to bypass included a lack of adherence to the referral system, perceptions of poor quality at PHC facilities, long waiting times, negative HCWs’ attitudes and concerns pertaining to stigma and confidentiality. CONCLUSION : Insights gained from this study contribute to the understanding of factors that lead patients to bypass PHC facilities. CONTRIBUTION : By understanding the underlying reasons for such bypassing, policymakers and healthcare providers can develop targeted interventions to enhance the quality and utilisation of PHC services. Moreover, addressing these challenges is crucial for achieving equitable healthcare access.
Evidence on regulatory policies and guidelines governing point-of-care diagnostic services in pharmacies globally : a scoping review
Mjuza, Lonwabo; Maimela, Charles; Nekhumbe, Anwani; Ramatsokotla, Sebueng; Duah, Evans; Mashamba-Thompson, Tivani Phosa (Wiley, 2026-04-16)
BACKGROUND AND AIM : Community pharmacies are increasingly recognized as key access points for primary healthcare, particularly in resource-limited settings. Integrating point-of-care (POC) diagnostic services into these pharmacies can enhance early disease detection and patient management. However, regulatory frameworks guiding such integration remain fragmented or underdeveloped. This scoping review synthesized global evidence on regulatory policies and guidelines governing the implementation of POC diagnostic services in community pharmacy settings to inform regulatory and policy development in South Africa. METHODS : The Arksey and O’Malley framework and Preferred Reporting Items for Systematic Reviews and Meta-Analysis extension for scoping reviews (PRISMA-ScR) reporting standards were followed. A comprehensive search was conducted across PubMed, EBSCOhost, Scopus, Web of Science, and ProQuest. Eligible peer-reviewed and gray literature discussed policies or frameworks regulating pharmacy-based POC diagnostic services. Data were extracted and thematically analyzed to identify regulatory trends, enablers, and barriers. Methodological quality was assessed using the Mixed Methods Appraisal Tool 2018and Scale for the Assessment of Narrative Review Articles (SANRAs). RESULTS : A total of 5780 records were screened, and six studies met the inclusion criteria. Most originated from high-income countries such as the United States and Canada, where frameworks like the Clinical Laboratory Improvement Amendments(CLIA) waivers and collaborative practice agreements (CPAs) support pharmacy involvement in diagnostics. Four themes emerged: (1) regulatory frameworks, (2) training and competency, (3) implementation challenges, and (4) public health opportunities. No policy governing pharmacy–based POC diagnostics exists in South Africa. CONCLUSION : Regulatory structures for pharmacy-based POC diagnostics remain inconsistent globally and absent in South Africa, informing the need for context-speciﬁc policy, structured training, and sustainable reimbursement mechanisms.
Initiation of dolutegravir vs. efavirenz on 12-and 24-month retention and viral suppression : a target trial emulation
Zheng, Amy; Brennan, Alana T.; Greener, Ross; Kileel, Emma M.; Bor, Jacob; Venter, Willem D.F.; Murray, Eleanor J.; Pisa, Pedro Terrence; Goeieman, Bridgette; Fox, Matthew P.; Maskew, Mhairi (Taylor and Francis, 2026)
BACKGROUND : South Africa's antiretroviral therapy (ART) treatment guidelines in 2019 were revised to use dolutegravir as part of first-line ART instead of efavirenz due to recommendations from the World Health Organization and findings from clinical trials indicating noninferior efficacy and reduced side effects. Utilizing the target trial framework, we estimated the effect of initiating a dolutegravir-based regimen compared to an efavirenz-based regimen among treatment-naïve people living with HIV initiating treatment in Johannesburg, South Africa from 2019 to 2022 on retention and viral suppression. METHODS : We used linear regression to estimate causal risk differences on 12- and 24-month retention and viral suppression. Characteristics of those who initiated dolutegravir vs. efavirenz were balanced through inverse probability of treatment weighting. The covariates included: natal sex, age, year of initiation, education level, employment status, tuberculosis, WHO stage, smoking and alcohol use. RESULTS : Of the 2930 individuals initiating ART, 1847 initiated a dolutegravir-based regimen and 1083 initiated an efavirenz-based regimen. The median age was 45.1 years (IQR: 37.1, 53.0). Initiation of dolutegravir was associated with a 5-percentage point increase (95% confidence interval (CI): -0.02, 0.11) in retention and 4-percentage point increase (95% CI: -0.06, 0.16) in viral suppression at 12 months. At 24 months, dolutegravir was associated with a 10-percentage point (95% CI: 0.03, 0.16) increase in retention and a 14-percentage point (95% CI: -0.02, 0.30) increase in viral suppression. CONCLUSIONS : Initiation of dolutegravir led to an appreciable increase in retention and viral suppression over 24 months when compared to efavirenz. Dolutegravir may lead to increases in long-term retention.
Why data is the most cost-effective investment for health technology assessment in South Africa
Thsehla, Evelyn M.M. (South African Medical Association, 2026-05)
No abstract available.
Defining the elements of a self and peer assessment system for academic institutions of public health in Africa as a precursor to accreditation
Ledibane, Neo R.T.; Patrick, Sean Mark; Voyi, K.V.V. (Kuku) (Public Library of Science, 2025-10-21)
BCKGROUND : Current challenges facing the overburdened health systems in Africa, warrant a review of the public health training and development of the health workforce for the attainment of the envisioned global goal of universal health coverage (UHC) and the United Nations Sustainable Development Goals (SDG). The integral components informing the relevance of public health education in the context of UHC comprise the academic workforce, curricula and the capacity of the academic institutions of public health. This study aims to assess the quality improvement strategies of academic institutions of public health with respect to the curriculum and the academic faculty staff within the WHO African region, in order to develop an institutional self- and peer-assessment tool to ensure the quality of public health education. METHODS : This study will be a three-phase, multicentre sequential mixed-methods design within the WHO African region, targeting 52 ASPHA (Association of Schools of Public Health in Africa)-affiliated institutions. Phase 1 will comprise a cross-sectional survey to determine the current programme assessment standards. Phase 2 will employ a modified Delphi method to reach consensus on these standards that will comprise a newly developed assessment tool. Phase 3 will pilot the tool through institutional self-assessment. MPH coordinators and department heads will participate. Convenience sampling and electronic questionnaires will be used. Quantitative data will be analysed using STATA 18, and ATLAS.ti for qualitative data. PROJECTED OUTPUTS AND IMPACT : The study findings are envisaged to result in a set of agreed standards reflecting the institutional arrangements to ensure quality postgraduate public health education in Africa. These standards, in the absence of regulation or formal accreditation, will be the basis of a self- and peer-assessment tool to enable the African academic institutions of public health to advance capacity development and monitor progressive educational goals suitable for local health needs, within the global context of the SDG and UHC implementation. Thus, laying the ground for a uniquely African accreditation system. The findings will be shared with the relevant stakeholders; ASPHA, the academic institutions of public health, and the scientific community at conferences and published in accredited journals.
“Girls get stressed due to the situation we are facing” : multi-level mental health stressors and resilience enablers among adolescent girls and young women in South Africa
Duby, Zoe; Bunce, Brittany; Bergh, Kate; Cwele, Nokuthula; Wagner, Colleen; Kuo, Caroline; Abdullah, Fareed (Public Library of Science, 2025-05-28)
Poor mental health, including high levels of stress, is associated with increased risk behaviours and subsequent negative sexual and reproductive health (SRH) outcomes amongst adolescent girls and young women (AGYW). Multilevel mental health stressors reflect various levels of AGYW’s social ecology. We use the social-ecological model as a framework to analyse qualitative data collected through interviews with 51 AGYW in two South African communities characterised by high rates of HIV, early pregnancy and school drop-out. We explore AGYW’s narratives of stressors, coping strategies, and impacts of participating in an intervention on mental well-being. Individual level stressors included low self-esteem, non-heteronormative sexuality, academic stress, and early child-bearing. Interpersonal level stressors included perceived lack of psychosocial support, emotional isolation, communication barriers, peer pressure and bullying. Microlevel stressors at the family or household level included violence, conflict and substance use. Structural level stressors included household food insecurity, economic hardship and gendered inequalities. Coping strategies and resilience enablers at the individual level included maintaining a positive outlook, engaging in self-care activities and spending time with family. Resilience strategies at the interpersonal level included seeking psychosocial and emotional support and talking about feelings, whilst resilience enablers at the macrosystem level included faith communities and access to social workers. Respondents who had participated in the intervention reported improved mental health and well-being due to increased access to psychosocial support. Intersecting factors across individual, interpersonal and structural levels are salient mental health stressors experienced by AGYW. However, some AGYW manage to draw on internal individual resources and external interpersonal and contextual resources to increase resilience and promote coping. Strengthening and bolstering resilience enabling resources available to AGYW, through enhancing AGYW’s competence and self-efficacy in accessing psychosocial support, alongside ensuring that support is available, may be important components to include in future interventions to support AGYW mental wellbeing.
Integration of a vertical voluntary medical male circumcision program into routine health services in Zimbabwe : a solution for sustainable HIV prevention
Chung , Amanda Marr; Murungu, Joseph; Chitapi, Precious; Chikodzore, Rudo; Case, Peter; Gosling, Jonathan; Gosling, Roly; Xaba, Sinokuthemba; Ncube, Getrude; Mugurungi, Owen; Kunaka, Patience; Bertozzi, Stefano M.; Feldacker, Caryl (Public Library of Science, 2025-07-10)
The global health community has recognized the importance of integrating and sustaining health programs within national health systems rather than managing stand-alone ‘vertical’ interventions. Corresponding with these objectives, international aid donors are embracing the principle of localization. Voluntary Medical Male Circumcision (VMMC) in Zimbabwe is a large vertical HIV prevention program that was primarily funded through development assistance for health. Program stakeholders want to sustainably integrate VMMC into routine health services so that the program will continue to be a cost-effective HIV prevention strategy. The research team studied the effectiveness of a district-level intervention to empower local stakeholders in this integration effort. To evaluate this intervention, the research team conducted a document review of district-level work plans, combined with a survey administered to district teams assessing sustainability capacity of the program. Over a two-year period, Task Teams in all five intervention districts successfully integrated the VMMC program by reducing barriers and leveraging opportunities in other parts of the health system. Key outcomes impacted all WHO health system building blocks, including enhanced leadership and governance, improved service delivery through better access and acceptability, an expanded health workforce through training, more efficient use of medical technologies, improved data quality, and the mobilization of local funds to support program financing and sustainability. The sustainability survey showed a reduction in funding stability but a significant increase in communications, program adaptation, and organizational capacity. By institutionalizing participatory work planning, fostering local ownership, and mobilizing resources, the project demonstrated a successful model for integrating, scaling, and sustaining VMMC services. Other health programs in low- and middle-income countries seeking to integrate and sustain health services at subnational levels should consider this diagonal, bottom-up model to promote local leadership development and health system strengthening.
Evidence on the reasons and factors influencing contraceptive nonutilization among women of childbearing age in suburban setting in Sub-Saharan Africa: a scoping review
Baloyi, Tinyiko Violet; Madela-Mntla, Edith; Duah, Evans; Maluleke, Kuhlula; Kgarosi, Kabelo; Pieters, Josephine N.; Mashamba-Thompson, Tivani Phosa (Wiley, 2026-03)
Family planning and the use of modern contraceptives are pivotal in promoting women's health, enhancing gender equality, and supporting socioeconomic development. However, in many regions, including sub-Saharan Africa, a substantial gap remains in the utilization of modern contraceptives. This scoping review aimed to explore the reasons and factors contributing to contraceptive nonutilization among women of childbearing age in suburban areas in sub-Saharan Africa. The review was conducted using the Arksey and O'Malley framework in accordance with the PRISMA-ScR guidelines. The analysis identified the following reasons for contraceptive nonutilization: age-related barriers, cultural, and social influences, gender dynamics and partner involvement, lack of knowledge and misinformation, health system barriers, fear of side effects, and the desire for more children. This review recommends that future research address gaps in understanding age-related barriers to contraceptive use by exploring the unique needs of younger and adult women within the reproductive age group, examining the influence of cultural norms and gender dynamics, and focusing on dispelling misinformation, mitigating health system barriers, and developing interventions to reduce fears of side effects through community-based approaches. KEY POINTS • Fear of side effects and negative embodied experiences emerged as the most prominent factor deterring contraceptive use, highlighting the need for improved counseling and personalized patient support to address anxieties about health impacts. • Lack of knowledge and widespread misinformation about contraceptives—especially among adolescents and in settings with limited health literacy—remains key barriers, indicating an urgent need for community-specific educational programs. • Cultural and gender-related barriers, including partner opposition, societal expectations around fertility, and religious norms, significantly hinder contraceptive uptake, emphasizing the importance of male involvement and culturally tailored interventions in clinical practice.
Feeding practice and its association with nutritional status of infants aged 0–6 months in Endumeni sub-district, South Africa
Khosa, Thomson; Napoles, Lizeka; Pretorius, Beaulah (Elsevier, 2026-02)
BACKGROUND : Inappropriate infant feeding practices contribute significantly to malnutrition, which underlies approximately 54% of global infant mortality. This study examined feeding practices and their association with nutritional status among infants aged 0–6 months attending well-baby clinics in Endumeni, KwaZulu-Natal, South Africa. METHODOLOGY : A cross-sectional study was conducted in 2023 involving 329 mothers or primary caregivers (aged 18–40 years) of infants aged 0–6 months from nine clinics. Data were collected using structured questionnaires and analyzed using Stata. Associations between feeding practices and infant nutritional status were assessed using Chi-square tests. RESULTS : Among the infants, 49.9% were male and 50.1% female. Most (49.5%) were between 1–4 months old. Breastfeeding was reported in 72.0% of infants, with 36.8% exclusively breastfed. Formula feeding occurred in 28.0% (22.7% exclusively and 5.3% mixed-fed). Among those introduced to complementary feeding, common first foods included soft porridge (39.5%), commercial baby foods (10.9%), and water (3.0%). Nutritional assessments indicated that 59.3% had normal weight-for-age, while 26.8% were overweight, 4.6% obese, 4.6% underweight, and 4.3% severely underweight. A significant association was found between feeding practices and nutritional status (P < 0.05). Notably, 82.6% of breastfed infants had normal weight, whereas non-breastfed infants were overrepresented in both undernutrition and overweight categories. CONCLUSION : Breastfeeding was positively associated with optimal anthropometric outcomes in early infancy, suggesting a protective effect against both under- and overnutrition. Strengthening caregiver education and breastfeeding support should be prioritized in infant nutrition interventions and policy. HIGHLIGHTS • 63.5% of infants were currently breastfed; 36.8% exclusively breastfed. • Exclusive breastfeeding and formula feeding were nearly equally prevalent. • 56.5% of infants received early complementary foods, mainly porridge and water. • Non-breastfed infants showed higher rates of severe underweight or obesity. • 19.5% of caregivers lacked knowledge of appropriate complementary foods.
East meets West : a multisite validity study of the China medical professionalism inventory
Li, Honghe; Hirsh, David A.; Song, Xinzhi; Krupat, Edward; Yang, Xue; Ho, Ming-Jung; Manning, Dianne Mary; Wen, Deliang (Ubiquity Press, 2025-09-25)
INTRODUCTION : The characteristics of medical professionalism (MP) vary across cultural contexts. Professionalism constructs and MP tools currently rely on Western cultural perspectives. Chinese leaders are calling for MP tools that connect to historical traditions, current culture, and modern conceptualizations of MP inside and outside China. METHODS : The authors developed the China Medical Professionalism Inventory using standard processes in two steps. Phase I, “development of item pool,” involved reviewing the literature to generate an item pool and conducting a first survey of Chinese clinical experts to develop content evidence. Phase II, “delineation of validity evidence,” included three psychometric studies of practicing physicians and a second expert survey to create the final version of the tool; these processes aimed to determine validity evidence for content, internal structure, and relationships to other variables. RESULTS : Systematic review of the English- and Chinese-language literature identified 1537 professionalism-specific items from 63 sources to form the item pool. The authors conducted two rounds of expert review, including surveying nationally prominent Chinese clinician-leaders (n = 34, response rate 85%, and n = 76, response rate 63%). The authors conducted three psychometric studies of practicing Chinese physicians (n = 360, response rate 92%; n = 3653, response rate 90%; and n = 955, response rate 95%). The results generated the 20-item CMPI, with four factors: “Respect, Compassion, and Communication; Integrity; Excellence; and Responsibility.” DISCUSSION : The CMPI presented validity evidence for content, internal structure, and relationship to other variables. This study may extend the conceptualization and reach of MP measurement.
An audit of theatre operating efficiency at a central hospital in South Africa
Nair, Shanal; Cotwall, F.; Basu, Debashis; Tshabalala, Khanyisile (Elsevier, 2025-09)
BACKGROUND : The South African health system functions within a resource-constraint environment. By improving the efficiency of theatre services, costs can be reduced alongside improvement in service delivery. This study aimed to assess theatre operating efficiency at a central hospital in Gauteng Province, South Africa. OBJECTIVES : To assess theatre efficiency by determining the theatre utilization rate, theatre cancellation rate, and determining the causes of inefficiency. METHODS : An audit was conducted from 15 May 2023 to 19 May 2023, between the hours of 08h00 and 16h00, in 7 operating rooms. The 5-day audit was conducted to capture a snapshot of theatre efficiency to inform operational management decision making. Times were collected for each surgical case including the anaesthesia start and finish time, surgical start and finish time, and turnover time. Cancellations of cases were documented with reasons, additional delays observed were recorded. RESULTS : A total of 16 320 min were available for utilization for elective and emergency cases. A total of 63 elective and 6 emergency cases were performed. The theatre utilization rate accounted for 67,7 % (11 047 min) of block time. Surgical time was 40 % of the block time. Non-surgical time accounted for 60 % and included anaesthetic time (25 %), time lost due to early finish (10 %), turnover time (3 %), time lost due to late starts (4 %) and post-surgical time (3 %). The day of surgery cancellation rate was 39 %, with 40 elective cases cancelled of 103 elective cases booked. Hospital-related factors accounted for 90 % of all cases and 10 % were secondary to patient-related factors, illustrating a greater need to address hospital related factors to reduce day of surgery cancellations. CONCLUSIONS : The theatre utilization rate did not meet standards reflected in literature. The day-of-surgery cancellation rates were higher than what is recommended. Causes of inefficiency need to be addressed to optimize theatre functions. RECOMMENDATIONS : Key strategies include realistic scheduling of elective theatre cases, maximizing theatre availability, implementing staff rotations, enhancing professional communication and performing continuous theatre audits. These interventions aim to improve theatre utilization and reduce day of surgery cancellations, which will ultimately enhance patient outcomes.
Marburg virus disease : epidemiology, immune responses, and innovations in vaccination and treatment for enhanced public health strategies
Dzinamarira, Tafadzwa; Muvunyi, Claude Mambo (MDPI, 2025-05-12)
Marburg virus disease (MVD) remains an important global health concern, in part because of its particularly high mortality rate. Caused by orthomarburgviruses, members of the Filoviridae family, the disease mainly appears in sporadic outbreaks in Sub-Sharan Africa, making the surveillance and response efforts difficult. Nearly 20 outbreaks of MVD have been reported globally, including recent events in Tanzania (June 2023 and January 2025) and Rwanda (November 2024). The recurrence emergency of MVD outbreaks in Ebola-prone regions underscores the complexity of controlling filovirus outbreaks and the need for continued research and robust health system preparedness.
Public health impact of waste-related air pollution in Africa : scoping review
Muthelo, Livhuwani; Ngwenya, Mxolisi Welcome; Shirinde, Joyce (Bentham Open, 2025-11-27)
BACKGROUND : In the reforming world, with the expeditious development of urbanisation and industrialisation; environmental issues have become a global crisis that requires immediate interventions and has posed a major threat to the health of the population. Air pollution is identified as one of the major environmental health hazards. However, there is a dearth of comprehensive data on the public health impact of waste-related air pollution in Africa. Thus, this scoping review seeks to explore and describe the effects of waste-related air pollution on public health in Africa. METHODS : We followed the 2018 PRISMA Scoping Review Guidelines for reporting this review. We browsed literature from 2014 to 2024 using keywords such as “Air pollution”, “Health impact” and “Africa”. From the yielded potential literature, only 23 studies were eligible for the review. RESULTS : The review revealed four themes. Among the themes are sources of pollution, pollutants of air pollution, understanding the health impact of air pollution among the vulnerable population, and factors impeding the mitigation of air pollution. CONCLUSION : The review revealed the sources and the health effects of air pollution. It underscored the role that socio-economic injustices, corruptions, and political issues have in exacerbating air pollution, particularly in rural areas. Therefore, this study recommends the development and implementation of innovative improvement strategies to remediate air pollution in remote areas of Africa.
Listeria monocytogenes in organic and conventional farming : epidemiology, risks, and solutions within a one health framework
Ryzhova, Ekaterina; Wichmann, Janine; Howlett-Downing, Chantelle; Holý, Ondřej (Elsevier, 2025-12)
Listeria monocytogenes is a resilient, zoonotic pathogen that poses significant challenges across human, animal, plant, and environmental health systems. This review explores the epidemiology of L. monocytogenes within the One Health framework, emphasizing its transmission dynamics, risk factors, and implications for food safety. The pathogen's ability to persist in diverse environments, form biofilms, and withstand extreme conditions highlights its role as a major public health concern, particularly for vulnerable populations such as pregnant women, immunocompromised individuals, and the elderly. The review examines the intersection of organic and conventional farming practices with L. monocytogenes contamination, noting the unique risks associated with organic fertilizers, wildlife exposure, and limited antimicrobial interventions. In contrast, conventional systems face challenges such as crowded animal housing and antimicrobial resistance. The role of plants as vectors, particularly through contaminated soil, irrigation water, and fertilizers, is underscored, with a focus on the risks linked to minimally processed and ready-to-eat foods. Environmental reservoirs, including soil, water, and biofilms, are identified as critical contributors to the pathogen's persistence and transmission. Climate change, agricultural practices, and industrial processes further exacerbate the complexity of L. monocytogenes control, necessitating cross-disciplinary approaches. The review concludes with a call to strengthen the One Health framework through integrated surveillance, sustainable farming practices, public awareness campaigns, and innovative technologies. By addressing the multifaceted challenges posed by L. monocytogenes, this approach aims to ensure food safety, promote ecological sustainability, and protect public health in an increasingly interconnected and climate-impacted world.
Rare pathogenic structural variants show potential to enhance prostate cancer germline testing for African men
Gong , Tingting; Jiang, Jue; Uthayopas, Korawich; Bornman, Maria S. (Riana); Gheybi, Kazzem; Stricker, Phillip D.; Weischenfeldt, Joachim; Mutambirwa, Shingai B.A.; Jaratlerdsiri, Weerachai (Nature Research, 2025-03-10)
Prostate cancer (PCa) is highly heritable, with men of African ancestry at greatest risk and associated lethality. Lack of representation in genomic data means germline testing guidelines exclude for Africans. Established that structural variations (SVs) are major contributors to human disease and prostate tumourigenesis, their role is under-appreciated in familial and therapeutic testing. Utilising clinico-methodologically matched deep-sequenced whole-genome data for 113 African versus 57 European PCa patients, we interrogate 42,966 high-quality germline SVs using a best-fit pathogenicity prediction workflow. We identify 15 potentially pathogenic SVs representing 12.4% African and 7.0% European patients, of which 72% and 86% met germline testing standard-of-care recommendations, respectively. Notable African-specific loss-of-function gene candidates include DNA damage repair MLH1 and BARD1 and tumour suppressors FOXP1, WASF1 and RB1. Representing only a fraction of the vast African diaspora, this study raises considerations with respect to the contribution of kilo-to-mega-base rare variants to PCa pathogenicity and African-associated disparity.
Methylation reprogramming associated with aggressive prostate cancer and ancestral disparities
Craddock, Jenna; Lutsik , Pavlo; Soh, Pamela X.Y.; Louw, Melanie; Hasan, Md Mehedi; Patrick, Sean Mark; Mutambirwa, Shingai B.A.; Stricker, Phillip D.; Förtsch, Hagen E.A.; HEROIC PCaPH Africa1K; Bornman, Maria S. (Riana); Gerhäuser, Clarissa; Hayes, Vanessa M. (Springer, 2025-12)
African men are disproportionately impacted by aggressive prostate cancer (PCa). The key to this disparity is both genetic and environmental factors, alluding to epigenetic modifications. However, African-inclusive prostate tumour DNA methylation studies are lacking. Assembling a multi-geo-ancestral prostate tissue cohort, including men with (57 African, 48 European, 23 Asian) or without (65 African) PCa, we interrogate for genome-wide differential methylation. Overall, methylation appears to be driven by ancestry over geography (152 southern Africa, 41 Australia). African tumours show substantial heterogeneity, with universal hypermethylation indicating more pervasive epigenetic silencing, encompassing PCa suppressor genes and enhancer-targeted binding motifs. Conversely, African tumour-associated heterochromatic hypomethylation suggests chromatin relaxation and developmental pathway activation via enhancer targets. Notably, non-prostate lineage elements appeared preferentially exploited in African tumorigenesis, with ancestry potentially influencing the extent of lineage-inappropriate activation, and tumour progression marked by repression of developmental regulators. Together, these findings point to extensive epigenetic plasticity in African tumours, with intergenic regulatory remodelling promoting genomic instability, metastatic potential and aggressive disease phenotypes.
Assessing the burden and inequality in the unmet need for hypertension and type 2 diabetes care using a care cascade framework in Tanzania, Lesotho, and South Africa
Okova, Denis; Lukwa, Akim Tafadzwa; Oyando, Robinson; Akinsolu, Folahanmi Tomiwa; Olunike, Abodunrin; Chiwire, Plaxcedes; Hongoro, Charles (Cambridge University Press, 2026-02-25)
BACKGROUND : The rapidly growing burden of non-communicable diseases (NCDs) in sub-Saharan Africa necessitates a better understanding of access gaps along the care continuum. This study assessed the prevalence and inequality in unmet need for hypertension and diabetes care in Tanzania, South Africa, and Lesotho using a care cascade framework. METHODS : We conducted a cross-sectional analysis of nationally representative Demographic Health Survey (DHS) datasets from Tanzania (2022), South Africa (2016), and Lesotho (2023/24), focusing on adults aged 15 years and older. The study estimated the proportion of adults with hypertension or diabetes who had not been screened, diagnosed, treated, or achieved disease control. Inequality was assessed using Erreygers Normalized Concentration Indices (ENCI), stratified by sex and residence. RESULTS : Hypertension prevalence was 12.6% (95% CI: 11.7-13.4) in Tanzania, 46.7% (95% CI: 45.0-48.4) in South Africa, and 15.4% (95% CI: 13.8-17.2) in Lesotho. In Lesotho, 9.1% (95% CI: 7.8-10.6) of adults had diabetes. Unmet need was substantial across all countries: 96.5% for hypertension in Tanzania, 84.2% in South Africa, 65.8% in Lesotho, and 84.2% for diabetes in Lesotho. The care cascade framework revealed critical bottle-necks at screening and treatment stages. Inequality analyses revealed strong pro-poor gradients, particularly in screening (ENCIs: Tanzania -0.19, South Africa -0.17, Lesotho hypertension -0.15, Lesotho diabetes -0.24; all p < 0.01), with poor men experiencing the most disparities. CONCLUSION : Substantial and inequitable gaps exist in hypertension and diabetes care. Policy strategies should prioritize community-based screening, primary care integration, and equity-focused interventions targeting poor men to improve NCD outcomes in the region.

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