South African Journal of Public Health
type: channel
description: South African Journal of Public Health (Southern African Journal of Public Health) aims to bridge the divides between academia, policy and implementation in health systems intervention and reform. We publish papers with recognisable policy impact that draw on robust research and operational experience from both academic and non-academic authors on Population health and Preventive Medicine.
publisher: South African Medical Association
language: en
publication name: South African Journal of Public Health
issn: 2708-9509
copyright: The SAJPH is published under an Attribution-Non Commercial International Creative Commons Attribution (CC-BY-NC 4.0) License. Under this license, authors agree to make articles available to users, without permission or fees, for any lawful, non-commercial purpose. Users may read, copy, or re-use published content as long as the author and original place of publication are properly cited.
items: CPD
items: Bridging the gap - The urgent imperative for dedicated, multidisciplinary adolescent health services in South Africa
items: Factors associated with adherence to HIV treatment among adolescent girls and young women in the Imagine pro- gramme in South Africa: A mixed-methods study protocol
items: Reviving Preventive Medicine as a clinical specialty in South Africa
items: Applications of GRADE-Adolopment in South African health policy: Assessing affordability in South Africa’s GRADE-Adolopment processes
items: Reflections on the SAPHPMA symposium – where public health medicine stands today
items: Book Review: Malviya R, Sundram S. (Eds.). Blockchain for Healthcare 4.0: Technology, Challenges, and Applications (1st ed.). CRC Press; 2023
items: How race, internal migration and gender are associated with consistency in healthcare-seeking behaviour in South Africa: Nationally representative longitudinal evidence from 2008 to 2015
items: Estimation of postpartum morbidities and risk factors of women presenting for their first postpartum visit at a midwife obstetric unit in eThekwini, South Africa
items: Algorithmic governance in artificial intelligence-driven health systems: A southern African perspective
items: Cost analysis of the school-based human papillomavirus vaccination programme in Tshwane Health District, South Africa
items: Helicobacter pylori infection: Knowledge and attitudes of college students in South Darfur State, Sudan
items: Spatiotemporal analysis of visceral leishmaniasis in the state of Bahia, Brazil, 2007 - 2017: Socioeconomic and environmental aspects
items: Integrated person centered care for improved coordination
items: Determining the incidence of breast cancer in Mbekweni, Paarl, South Africa, and the lived experiences of the women involved: A mixed-methods study
items: Factors influencing stroke outcomes and the experiences of healthcare workers managing stroke patients in a South African hospital: A protocol for a mixed‐methods study
items: 47th World Hospital Congress, International Hospital Federation, Rio de Janeiro 09 - 12 September 2024
items: Oxford University Government Outcomes Lab 2024 Social Outcomes Conference, 5 – 6 September 2024
items: Determinants of TB data quality in completeness, accuracy, and timeliness for TB programme decision-making in Tshwane District : A protocol for a cross-sec tional analytical study
items: A complex tapestry of urban health in South Africa
items: A cross-sectional study of the factors associated with the acceptance of oral HIV self-testing among medical students at Joseph Ki-Zerbo University in Ouagadougou in 2021
items: Annual district research conferences organised in the Gauteng Province
items: Effects of sociodemographic status, HIV disclosure, and self-reported adherence on treatment outcome among HIV/AIDS patients in south-western Nigeria
items: https://samajournals.co.za/index.php/sajph/article/view/2007
items: Role of the patient and citizen in health technology assessment and decision-making in South Africa
items: Factors associated with advanced HIV in the Tshwane District drainage area: A protocol for a cross-sectional analytical study
items: Global surgery in Africa: Access to surgery, an opportunity to adopt a participatory community-based approach

CPD
type: item
subject: CPD
  topic: section
subject: Cpd
  topic: keywords
creator: D Basu
rights: Copyright (c) 2026 D Basu https://creativecommons.org/licenses/by-nc/4.0
date: 2026-03-20
publication date: 2026-03-20
doi: 10.7196/

Bridging the gap - The urgent imperative for dedicated, multidisciplinary adolescent health services in South Africa
type: item
subject: Editorial
  topic: section
subject: Adolescent;
  topic: keywords
subject: South Africa;
  topic: keywords
subject: Adolescent
  topic: subjects
subject: Preventive health
  topic: disciplines
creator: D Basu
rights: Copyright (c) 2026 D Basu https://creativecommons.org/licenses/by-nc/4.0
date: 2026-03-20
publication date: 2026-03-20
starting page: e4771
ending page: e4771
doi: 10.7196/

CPD
type: item
description: -
subject: CPD
  topic: section
subject: CPD
  topic: keywords
creator: D Basu
rights: Copyright (c) 2025 D Basu https://creativecommons.org/licenses/by-nc/4.0
date: 2025-11-14
publication date: 2025-11-14
doi: 10.7196/

Factors associated with adherence to HIV treatment among adolescent girls and young women in the Imagine pro- gramme in South Africa: A mixed-methods study protocol
type: item
description: Background. Adherence to antiretroviral therapy (ART) is critical to achieving viral suppression and reducing HIV-related morbidity and transmission. However, consistent adherence remains a challenge, particularly among adolescent girls and young women (AGYW) in sub-Saharan Africa (SSA), an already vulnerable group disproportionately affected by HIV. In SSA, AGYW account for the majority of new infections, and despite widespread availability of ART and ambitious national targets, optimal adherence is not being consistently achieved. Objectives. To identify factors associated with adherence to HIV treatment among AGYW enrolled in the Imagine programme, a school-based HIV and pregnancy prevention intervention implemented in 14 rural schools in North West and KwaZulu-Natal provinces, South Africa (SA). Methods. Employing a mixed-methods design, the cross-sectional study will conduct secondary quantitative analysis of data collected in the Imagine programme. Additionally, primary data will be obtained from in-depth interviews conducted with a subset of participants to explore perceptions, barriers and experiences related to adherence. Quantitative data will be analysed using descriptive statistics and logistic regression to assess associations between adherence and sociodemographic, behavioural and structural factors. Qualitative data will be analysed thematically to provide contextual insights. Conclusion. This study addresses a critical evidence gap by focusing on adherence in a rural AGYW population. The findings are expected to inform both programme implementation and broader adolescent HIV treatment strategies in SA.
subject: Postgraduate studies
  topic: section
subject: Adolescent girls and young women (AGYW)
  topic: keywords
subject: ART adherence
  topic: keywords
subject: School-based intervention
  topic: keywords
subject: HIV
  topic: keywords
subject: HIV
  topic: subjects
subject: Antiretroviral Therapy
  topic: subjects
subject: Adherence
  topic: subjects
subject: Adolescent Girls and Young Women
  topic: subjects
subject: Mixed-Methods Research
  topic: subjects
subject: School-Based Intervention
  topic: subjects
subject: Public Health Medicine
  topic: disciplines
subject: Adolescent Health
  topic: disciplines
subject: Infectious diseases
  topic: disciplines
subject: Health Systems Research
  topic: disciplines
creator: L Naushin
creator: T Phashe
creator: F Abdullah
rights: Copyright (c) 2026 L Naushin, T Phashe, F Abdullah https://creativecommons.org/licenses/by-nc/4.0
date: 2026-03-20
publication date: 2026-03-20
starting page: e4263
ending page: e4263
doi: 10.7196/SHS.2026.v8i3.4263

Reviving Preventive Medicine as a clinical specialty in South Africa
type: item
description: -
subject: Editorial
  topic: section
subject: Preventive medicine
  topic: keywords
subject: South Africa
  topic: keywords
subject: Clinical specialty
  topic: keywords
subject: Preventive medicine
  topic: subjects
subject: Clinical specialty
  topic: subjects
subject: South Africa
  topic: subjects
subject: Preventive medicine
  topic: disciplines
creator: T Maimela
creator: H Volmink
creator: D Basu
rights: Copyright (c) 2025 T Maimela, H Volmink, D Basu https://creativecommons.org/licenses/by-nc/4.0
date: 2025-11-14
publication date: 2025-11-14
starting page: e4101
ending page: e4101
doi: 10.7196/

Applications of GRADE-Adolopment in South African health policy: Assessing affordability in South Africa’s GRADE-Adolopment processes
type: item
description: Background. South Africa’s (SA) progress toward universal health coverage (UHC) is marked by efforts to prioritise primary healthcare and improve access to cost-effective and affordable health services. Central to this reform is the adoption of evidence-based processes, such as Health Technology Assessment (HTA) and the GRADE-Adolopment approach, which support the contextualisation of global clinical guidelines through local epidemiological, health system, and cost data. Despite progress in considering clinical effectiveness and cost-effectiveness, explicit integration of affordability and equity considerations remains limited. This review assessed SA case studies applying the GRADE-Adolopment and Evidence-to-Decision (EtD) frameworks to evaluate how affordability, particularly through budget impact analysis (BIA), has been addressed. Methods. We conducted a review of both published and grey literature from 2015 to May 30 2025, searching PubMed, Scopus, and the websites of the SA National Department of Health and the Council for Medical Schemes, using terms such as ‘GRADE,’ ‘Adolopment,’ ‘South Africa,’ ‘guidelines,’ and ‘affordability.’ Eligible studies included those applying the GRADE or Evidence-to-Decision (EtD) frameworks in the development of guidelines or policies in South Africa. We extracted data on the use of GRADE, EtD domains, and affordability frameworks (including cost-effectiveness analysis, budget impact analysis, equity trade-offs, resource mapping, and feasibility), assessing their impact on policy through comparative analysis. Additionally, we performed inductive thematic analysis to synthesise cross-cutting lessons and barriers related to the integration of affordability within decision-making processes. Results. Across six SA case studies, the integration of affordability assessments within GRADE-Adolopment processes varied considerably. National initiatives demonstrated structured approaches, consistently applying cost-effectiveness and budget…
subject: Population Medicine
  topic: section
subject: GRADE-Adolopment
  topic: keywords
subject: affordability
  topic: keywords
subject: guideline development
  topic: keywords
subject: health technology assesment
  topic: keywords
subject: budge impact analysis
  topic: keywords
subject: South Africa
  topic: keywords
subject: Universal Health Coverage
  topic: subjects
subject: Health Technology Assesment
  topic: subjects
subject: GRADE-Adolopment
  topic: subjects
subject: Clinical guidelines
  topic: subjects
subject: Evidence-to-Decision frameworks
  topic: subjects
subject: Policy development
  topic: subjects
subject: Affordability
  topic: subjects
subject: Decision-making frameworks
  topic: subjects
subject: Cost-effectiveness analysis
  topic: subjects
subject: Budget impact analysis
  topic: subjects
subject: Equity in healthcare
  topic: subjects
subject: South Africa - health policy
  topic: subjects
subject: Health Policy and Management
  topic: disciplines
subject: Health Economics
  topic: disciplines
subject: Clinical Epidemiology
  topic: disciplines
subject: Public Health
  topic: disciplines
subject: Global health
  topic: disciplines
creator: T D Leong
creator: P Daames
rights: Copyright (c) 2026 T D Leong, P Daames https://creativecommons.org/licenses/by-nc/4.0
date: 2026-03-20
publication date: 2026-03-20
starting page: e4100
ending page: e4100
doi: 10.7196/SHS.2026.v8i3.4100

Reflections on the SAPHPMA symposium – where public health medicine stands today
type: item
description: -
subject: Correspondence
  topic: section
subject: Public health medicine
  topic: keywords
subject: Preventive medicine
  topic: keywords
subject: South African Public Health and Preventive Medicine Association;
  topic: keywords
subject: SAPHPMA
  topic: keywords
subject: Public health communication
  topic: subjects
subject: Public Health Medicine
  topic: disciplines
creator: V Naidoo
rights: Copyright (c) 2025 V Naidoo https://creativecommons.org/licenses/by-nc/4.0
date: 2025-11-14
publication date: 2025-11-14
starting page: e4075
ending page: e4075
doi: 10.7196/

Book Review: Malviya R, Sundram S. (Eds.). Blockchain for Healthcare 4.0: Technology, Challenges, and Applications (1st ed.). CRC Press; 2023
type: item
subject: Commentary
  topic: section
subject: Blockchain
  topic: keywords
subject: Healthcare
  topic: keywords
subject: Healthcare
  topic: subjects
subject: Health Technology Assessment
  topic: subjects
creator: R F Mahmoud
rights: Copyright (c) 2026 R F Mahmoud https://creativecommons.org/licenses/by-nc/4.0
date: 2026-03-20
publication date: 2026-03-20
starting page: e3808
ending page: e3808
doi: 10.7196/

CPD
type: item
description: -
subject: CPD
  topic: section
subject: cpd
  topic: keywords
creator: D Basu
rights: Copyright (c) 2025 D Basu https://creativecommons.org/licenses/by-nc/4.0
date: 2025-06-04
publication date: 2025-06-04
doi: 10.7196/

How race, internal migration and gender are associated with consistency in healthcare-seeking behaviour in South Africa: Nationally representative longitudinal evidence from 2008 to 2015
type: item
description: Background. In South Africa (SA), consistently seeking out primary healthcare is more important than ever as the country ages and undergoes epidemiological transition. SA’s most racialised individuals – those identifying as black and coloured – often need to migrate within the country to ensure their families’ economic stability, and internal migrants often experience difficulties in accessing healthcare compared with non-migrants. But gender matters too, as women tend to seek out healthcare more than men throughout the world, and internal migration affects women’s and men’s lives differently in SA. Objectives. To examine differences in the consistency of healthcare-seeking behaviour between internal migrants and non-migrants, among black and coloured residents of SA, by gender. No study in SA to date has been able to examine all three of these elements, despite their important confluence stemming from apartheid and before. Methods. To do so, this article uses data from the first four waves (2008, 2010 - 2011, 2012, and 2014 - 2015) of the National Income Dynamics Study. A total of 6 131 black and coloured men and women aged ≥18 years in 2008 form the analytical sample. Logistic regressions, with panel weights adjusted for respondent loss to follow-up, predict the likelihood that individual respondents will be consistent in seeking health consultations over the four waves as a function of their racialised identity, internal migrant status, and gender. Results. Black residents (compared with coloured) and men (compared with women) have the lowest chances of consistently seeking out healthcare. There is no direct internal migration difference in seeking healthcare, but it is conditional upon racial and gender identity. Conclusion. Black South Africans – especially, but not exclusively, migrant men – do not have the same chances of seeking primary care as their also-racialised coloured counterparts. For population health and clinical efforts, identifying who is at risk…
subject: Preventive Medicine
  topic: section
subject: Gender Identity, Healthcare, Longitudinal Analyses, Racial Identity, Migration, South Africa
  topic: keywords
subject: Gender Identity, Healthcare, Longitudinal Analyses, Racial Identity, Migration, South Africa
  topic: subjects
subject: Public Health
  topic: disciplines
subject: Demography
  topic: disciplines
subject: sociology
  topic: disciplines
creator: T W Myroniuk
rights: Copyright (c) 2026 T W Myroniuk https://creativecommons.org/licenses/by-nc/4.0
date: 2026-03-20
publication date: 2026-03-20
starting page: e3635
ending page: e3635
doi: 10.7196/SHS.2026.v8i3.3635

Estimation of postpartum morbidities and risk factors of women presenting for their first postpartum visit at a midwife obstetric unit in eThekwini, South Africa
type: item
description: Background. Despite reduction of the global maternal mortality ratio by 38% between 2000 and 2017, morbidities during the postpartum period remain the leading cause of maternal death in developing countries. In Africa, most maternal deaths occur during the postpartum period, and deaths during this period are common in South Africa (SA). Objectives. To estimate the incidence of postpartum morbidities and associated risk factors among women attending a community health centre in SA. Methods. A facility-based cross-sectional study was undertaken. Both continuous and categorical variables were described using descriptive statistics. Factors associated with postpartum conditions were determined by logistic regression with adjusted odds ratios (ORs), 95% confidence intervals (CIs) and p-values. Statistical significance was set at p<0.05. Results. A total of 399 postpartum women participated, with a mean age of 26.1 years. The teenage pregnancy rate was 19.3%, the majority fell into the age group 20 - 34 years (66.5%) and were single (70.1%), and 68.4% had no income. Only 30.2% of mothers had planned the index pregnancy. All of them knew their HIV status, and 41.7% were HIV infected. The postpartum morbidity rate was 35.9%. Logistic regression analysis showed that women who had normal vaginal deliveries (NVDs) and were in full-time employment had lower ORs for any postpartum morbidity (OR 0.47; 95% CI 0.26 - 0.86; p=0.014 and OR 0.44; 95% CI 0.21 - 0.88; p=0.022, respectively). Participants with no education had an OR of 3.1 (95% CI 1.21 - 8.15; p=0.019). Conclusion. The high postpartum morbidity rate is comparable to previously reported findings at midwife obstetric units in SA. Women who had no education were at increased risk of postpartum conditions, while full-time employment and NVD had protective effects. Skilled obstetric care and maintenance of strict asepsis during delivery are necessary to prevent common postpartum morbidities. Postnatal care should be improved …
subject: Preventive Medicine
  topic: section
subject: Postpartum
  topic: keywords
subject: Maternal Morbidity
  topic: keywords
subject: First Postnatal Visit
  topic: keywords
subject: Risk factors
  topic: keywords
subject: Maternal Health
  topic: subjects
subject: Postpartum
  topic: subjects
subject: Women's health
  topic: subjects
subject: obstetrics and gynecology
  topic: disciplines
creator: A M Hoque
creator: S Buckus
creator: M Hoque
creator: R Hoque
rights: Copyright (c) 2025 A M Hoque, S Buckus, M Hoque, R Hoque https://creativecommons.org/licenses/by-nc/4.0
date: 2025-11-14
publication date: 2025-11-14
starting page: e2807
ending page: e2807
doi: 10.7196/SHS.2025.v8i2.2807

Algorithmic governance in artificial intelligence-driven health systems: A southern African perspective
type: item
description: The use of algorithmic systems in public health is expanding rapidly in southern Africa, particularly in areas such as disease prediction, resource allocation and personalised healthcare. While these technologies offer efficiencies, their outputs are shaped by the quality, representativeness and governance of the underlying data. Tools such as polygenic risk scores and pathogen genomics often underperform in black African populations owing to under‐representation in genomic datasets, limiting clinical accuracy and access to precision health benefits. In low‐ and middle‐income countries, these disparities are amplified by fragmented health data systems, limited digital infrastructure, and weak regulatory oversight. Such conditions undermine the ability to detect and correct algorithmic bias, increasing the risk that digital health tools perpetuate inequities affecting rural, low‐income and marginalised populations. In this context, algorithmic systems may unintentionally reinforce existing health disparities. This commentary draws on the concept of biopolitics to highlight how algorithmic tools classify and manage populations through data‐driven processes. It emphasises the need for greater transparency, inclusion and accountability in the development and deployment of these technologies. Aligning health technology assessment processes with equity‐driven metrics and locally governed standards is essential to ensure that algorithmic governance supports, rather than undermines, equitable public health outcomes in the region.
subject: Forum
  topic: section
subject: algorithmic governance
  topic: keywords
subject: artificial intelligence
  topic: keywords
subject: health equity
  topic: keywords
subject: biopolitics
  topic: keywords
subject: genomic data
  topic: keywords
subject: health technology assessment
  topic: keywords
subject: Southern Africa
  topic: keywords
subject: Algorithmic governance and decision-making
  topic: subjects
subject: Artificial intelligence applications in public health
  topic: subjects
subject: Biopolitics
  topic: subjects
subject: Data bias and under-representation in Southern Africa
  topic: subjects
subject: Genomic data gaps
  topic: subjects
subject: Public health
  topic: disciplines
subject: Health policy & systems research
  topic: disciplines
subject: Bioinformatics and genomics
  topic: disciplines
subject: Data science and machine learning
  topic: disciplines
subject: Digital ethics
  topic: disciplines
creator: S Naidoo
creator: R Naidoo
rights: Copyright (c) 2026 S Naidoo, R Naidoo https://creativecommons.org/licenses/by-nc/4.0
date: 2026-03-20
publication date: 2026-03-20
starting page: e3530
ending page: e3530
doi: 10.7196/SHS.2026.v8i3.3530

Cost analysis of the school-based human papillomavirus vaccination programme in Tshwane Health District, South Africa
type: item
description: Background. Cervical cancer is a significant public health concern globally. Persistent infection with high-risk human papillomavirus (HPV) types is the necessary cause of virtually all cervical cancers, although rare HPV-negative cervical cancer cases have been reported. HPV is one of the most common sexually transmitted infections worldwide and is responsible for approximately 90% of all cervical cancer cases globally. Objectives. To estimate the financial costs and cost per fully vaccinated girl (FVG) of the school-based HPV vaccination programme in Tshwane Health District, South Africa. Methods. We conducted a cross-sectional cost analysis of the 2019 vaccination campaign using the World Health Organization Cancer Prevention and Control Costing (C4P) tool. The data for the programme were obtained from the District Health Information System and financial records. Costs were categorised by component and converted to USD. Results. The programme reached 15 734 girls with two doses (71.3% uptake). The total financial cost was ZAR21 127 298 (USD1 458 704). Service delivery (71.8%) and vaccine procurement (27.1%) were the main cost drivers. The cost per FVG was ZAR1 343 (USD92.94). Conclusion. The Tshwane school-based HPV vaccination programme had a high financial cost per FVG compared with other low- and middle-income countries, largely owing to staffing and procurement costs. Optimising delivery strategies can improve cost-efficiency and sustainability.
subject: Population Medicine
  topic: section
subject: vaccination coverage
  topic: keywords
subject: cost analysis
  topic: keywords
subject: Human papillomavirus
  topic: keywords
subject: Vaccination coverage
  topic: subjects
subject: Human papillomavirus
  topic: subjects
subject: cost analysis
  topic: subjects
subject: vaccination programme
  topic: subjects
subject: Public Health Medicine
  topic: disciplines
subject: Public health
  topic: disciplines
subject: Infectious diseases
  topic: disciplines
subject: Public Health system and policy
  topic: disciplines
creator: T Ledibane
creator: N R Ledibane
creator: M Matlala
rights: Copyright (c) 2025 T Ledibane, N R Ledibane, M Matlala https://creativecommons.org/licenses/by-nc/4.0
date: 2025-11-14
publication date: 2025-11-14
starting page: e3466
ending page: e3466
doi: 10.7196/SHS.2025.v8i2.3466

Helicobacter pylori infection: Knowledge and attitudes of college students in South Darfur State, Sudan
type: item
description: Background. Helicobacter pylori infection is a significant global health issue, affecting ~4.4 billion individuals worldwide in 2015, ~60% of the world’s population at that time. Knowledge and attitudes regarding H. pylori among college students remain poorly understood. Objectives. To assess knowledge and attitudes of college students regarding H. pylori infection. Methods. A cross-sectional study of 323 participants from a college population was conducted from March to April 2023. Results. Of the 323 participants, (42.7%) were male and (57.3%) were female. The majority of the students (86.4%) lived in urban areas, as opposed to 12.1% in rural areas. Overall, the participants demonstrated good knowledge about H. pylori; 87.3% knew that it is a bacterium that causes peptic ulcers, and 57.0% were aware that it can cause cancer. Personal reading was the most common source of information (44.0%), followed by mass media (31.3%) and social media (24.8%). Most participants (87.9%) believed that H. pylori infection can be treated with medication (‘tablets’). Just over half (50.2%) had undergone testing for H. pylori. The diagnostic investigation that most participants would prefer was the stool antigen test (36.5%), followed by a blood test (26.9%), the urea breath test (9.0%) and endoscopy (6.5%). While most of the participants demonstrated a reasonable understanding of H. pylori infection, some knowledge gaps were identified. Conclusion. The study findings highlighted the importance of implementing targeted education programmes to address the knowledge gaps identified among college students.
subject: Population Medicine
  topic: section
subject: H. pylori, knowledge, attitudes, College Student, cross-sectional, South Darfur
  topic: keywords
subject: EPidemiology, Health Statistics
  topic: disciplines
creator: S I Alamin
creator: A H Altyb
creator: S Z Izza
creator: A H Ahmed
creator: A A Adam
creator: E M Ibrahim
creator: T H Musa
creator: R M Abdelrahman
rights: Copyright (c) 2026 S I Alamin, A H Altyb, S Z Izza, A H Ahmed, A A Adam, E M Ibrahim, T H Musa, R M Abdelrahman https://creativecommons.org/licenses/by-nc/4.0
date: 2026-03-20
publication date: 2026-03-20
starting page: e3015
ending page: e3015
doi: 10.7196/SHS.2026.v8i3.3015

Spatiotemporal analysis of visceral leishmaniasis in the state of Bahia, Brazil, 2007 - 2017: Socioeconomic and environmental aspects
type: item
description: Background. Visceral leishmaniasis (VL) is a neglected zoonosis caused by the parasite Leishmania infantum, present throughout the world. In Bahia, a state in the north-eastern region of Brazil, there is a high prevalence. Objectives. To evaluate the role of socioeconomic and environmental factors in the epidemiology of VL though spatiotemporal analysis. Methods. Epidemiological data for Bahia were extracted from the System for Notification of Diseases of the Ministry of Health (SINAN), data on prolonged droughts were obtained through the Civil Bureau of the Government of the State of Bahia, and socioeconomic indicators were obtained through the Socioeconomic Performance Index (IPESE) and DATASUS, the Brazilian public unified health system department responsible for providing health data. Relative risk for VL was calculated for age classes, clinical manifestations, comorbidities and deaths, while spatial analysis relied on kernel density analyses to determine spatial patterns. Correlations between socioeconomic indices and epidemiological markers were explored. Results. From 2007 to 2017, 3 847 new VL cases and 227 deaths were reported in Bahia. The mean incidence was 1.73 per 100 000 population. Cases and deaths were concentrated in the central-northern region of the state, a relatively poor area with a dry/semi-arid climate. Cases were more frequent in urban areas (54.1%), in males (60.7%) and in children aged <10 years (48.2%). Municipalities that declared a state of emergency due to prolonged drought (SECO dataset) and IPESE were positively correlated (p=0.0001 and p=0.013, respectively) with VL cases reported in all age groups. Deaths from VL were significantly correlated with the Gini index (p=0.043). Conclusion. Our results paint a picture of socioeconomic and climatic vulnerability as determinants of VL epidemiology. Addressing socioeconomic inequalities and enhancing models to predict prolonged drought are actions that should be included in the prevention a…
subject: Population Medicine
  topic: section
subject: one health
  topic: keywords
subject: leishmania infantum
  topic: keywords
subject: climate
  topic: keywords
subject: prolonged drought
  topic: keywords
subject: children
  topic: keywords
subject: epidemiology
  topic: subjects
subject: neglected tropical disease
  topic: subjects
subject: epidemiology
  topic: disciplines
creator: L B da Costa
creator: R Lustosa
creator: M Solcà
creator: C G Zeppelini
creator: E Silver Soares
creator: E Martins Neto
creator: C R Franke
rights: Copyright (c) 2025 L B da Costa, R Lustosa, M Solcà, C G Zeppelini, E Silver Soares, E Martins Neto, C R Franke https://creativecommons.org/licenses/by-nc/4.0
date: 2025-11-14
publication date: 2025-11-14
starting page: e3324
ending page: e3324
doi: 10.7196/SHS.2025.v8i2.3324

Integrated person centered care for improved coordination
type: item
description: -
subject: Editorial
  topic: section
subject: Care coordination;
  topic: keywords
subject: integrated person centred care
  topic: keywords
subject: multimorbidity;
  topic: keywords
subject: South Africa;
  topic: keywords
subject: universal health care
  topic: keywords
subject: integrated care; care coordination;
  topic: subjects
creator: D Basu
rights: Copyright (c) 2025 D Basu https://creativecommons.org/licenses/by-nc/4.0
date: 2025-06-04
publication date: 2025-06-04
starting page: e2904
ending page: e2904
doi: 10.7196/

Determining the incidence of breast cancer in Mbekweni, Paarl, South Africa, and the lived experiences of the women involved: A mixed-methods study
type: item
description: Background. Breast cancer was the most common cancer diagnosed in South African (SA) females in the year 2022, accounting for 24.1% of all cancers diagnosed. There are cultural factors that are thought to affect the early diagnosis of breast cancer in black SA women. No information on the incidence of breast cancer or its determinants specific to the study setting could be found. Objectives. To determine the incidence of breast cancer in women aged 35 - 69 years living in the Mbekweni community in Paarl, SA, and to evaluate the lived experiences of the women involved. Methods. This was a prospective observational study, with a convergent parallel mixed-methods design. The quantitative data were collected by means of a self-completed questionnaire, and findings on clinical breast examination, imaging reports and referrals to higher levels of care. The qualitative data were collected through small focus group discussions which were recorded, transcribed, and analysed through inductive thematic analysis. Results. Of the sample population of 381 participants, a total of 55 (14.4%) were found to have suspicious clinical findings and required an imaging study. Upon receipt of the imaging reports, 4 (1.0%) required referral for biopsies or further management. At the time of writing, only 1 participant (0.3%) had been confirmed as having cancer, which was used to calculate an incidence of breast cancer of 6 cases per 1 000 person-years. Although only a single case was identified during the study period, there was some awareness of and insight into breast cancer in this community. There was also a perceived increase in the prevalence of breast cancer. However, it is a disease still stigmatised by a plethora of myths and cultural beliefs, which negatively influences women’s choice to seek help early. Conclusion. The incidence of breast cancer in women aged 35 - 69 years in Mbekweni was low in absolute terms, with only one confirmed case during the study period. Despite this, …
subject: Preventive Medicine
  topic: section
subject: incidence
  topic: keywords
subject: breast cancer
  topic: keywords
subject: experiences
  topic: keywords
subject: attitudes
  topic: keywords
subject: Breast cancer
  topic: subjects
subject: Incidence
  topic: subjects
subject: public health
  topic: subjects
subject: perceptions
  topic: subjects
subject: community
  topic: subjects
subject: experiences
  topic: subjects
subject: Breast cancer
  topic: disciplines
subject: Public Health
  topic: disciplines
creator: C de Kock
creator: G N Hudson
rights: Copyright (c) 2025 C de Kock, G N Hudson https://creativecommons.org/licenses/by-nc/4.0
date: 2025-11-14
publication date: 2025-11-14
starting page: e2946
ending page: e2946
doi: 10.7196/SHS.2025.v8i2.2946

CPD
type: item
description: -
subject: CPD
  topic: section
subject: cpd
  topic: keywords
creator: D Basu
rights: Copyright (c) 2024 https://creativecommons.org/licenses/by-nc/4.0
date: 2024-12-03
publication date: 2024-12-03
doi: 10.7196/

Factors influencing stroke outcomes and the experiences of healthcare workers managing stroke patients in a South African hospital: A protocol for a mixed‐methods study
type: item
description: Background. Stroke, also known as cerebrovascular accident, is the second leading cause of death and a significant contributor to disability on a global scale. Stroke presents an important healthcare challenge in South Africa (SA), standing as the second most common cause of death after HIV/AIDS. However, there is a lack of comprehensive epidemiological data and research on the experiences of healthcare professionals in managing stroke patients in low- and middle-income countries such as SA. Objectives. To describe the profiles of and factors affecting outcomes for stroke patients admitted to Steve Biko Academic Hospital, Pretoria, SA, and explore the experiences of healthcare professionals managing these patients. Methods. The study will employ a mixed-methods approach, combining quantitative and qualitative methods. It will describe factors influencing outcomes for stroke patients at the hospital, utilising quantitative data analysis. Additionally, it will capture healthcare workers’ experiences through qualitative insights into their challenges and successes. Data will be gathered via REDCap forms for quantitative measures and through semi-structured interviews for qualitative information. Analysis will include descriptive statistics, logistic regression for variable relationships, and thematic analysis for qualitative patterns. Conclusions. This research aims to improve understanding of stroke management and the impact of a stroke unit at a central hospital.
subject: Postgraduate studies
  topic: section
subject: Stroke management, Stroke Epidemiology, Stroke Unit, Central Hospital, Clinical governance
  topic: keywords
subject: Stroke management, Stroke Epidemiology, Stroke Unit, Central Hospital
  topic: subjects
subject: Clinical Governance
  topic: subjects
subject: Neurology, Internal Medicine, Public Health Medicine
  topic: disciplines
creator: L Mpuku
creator: M Kakaza
creator: D Basu
creator: T Phashe
rights: Copyright (c) 2025 L Mpuku, M Kakaza, D Basu, T Phashe https://creativecommons.org/licenses/by-nc/4.0
date: 2025-11-14
publication date: 2025-11-14
starting page: e2911
ending page: e2911
doi: 10.7196/SHS.2025.v8i2.2911

47th World Hospital Congress, International Hospital Federation, Rio de Janeiro 09 - 12 September 2024
type: item
description: -
subject: Correspondence
  topic: section
subject: Young Executive Leaders Program
  topic: keywords
subject: World Hospital Congress;
  topic: keywords
subject: International Hospital Federation
  topic: keywords
subject: Young Executive Leaders Program;
  topic: subjects
subject: World Hospital Federation;
  topic: subjects
subject: International Hospital Federation
  topic: subjects
subject: Hospital management;
  topic: disciplines
creator: M C Chisale-Mabotja
creator: M J Mathabathe
rights: Copyright (c) 2025 M C Chisale-Mabotja, M J Mathabathe https://creativecommons.org/licenses/by-nc/4.0
date: 2025-06-04
publication date: 2025-06-04
starting page: e2829
ending page: e2829
doi: 10.7196/SHS.2025.v8i1.2829

Oxford University Government Outcomes Lab 2024 Social Outcomes Conference, 5 – 6 September 2024
type: item
description: -
subject: Correspondence
  topic: section
subject: Outcomes Based Finance. Government Outcomes Lab. South Africa
  topic: keywords
subject: Outcomes based contracting.
  topic: subjects
subject: Oxford Government Outcomes Lab Conference
  topic: subjects
subject: South Africa
  topic: subjects
subject: Public Health
  topic: disciplines
creator: L-A C Davids
creator: P Rousseau
creator: N Slingers
rights: Copyright (c) 2025 L-A C Davids, P Rousseau, N Slingers https://creativecommons.org/licenses/by-nc/4.0
date: 2025-11-14
publication date: 2025-11-14
starting page: e2730
ending page: e2730
doi: 10.7196/

Determinants of TB data quality in completeness, accuracy, and timeliness for TB programme decision-making in Tshwane District : A protocol for a cross-sec tional analytical study
type: item
description: Background. The quality of health information is crucial for TB programme monitoring and decision -making. South Africa faces challenges in the quality of reported TB data as evidenced in discrepancies reported between different sources. This poses a need to systematically assess the quality of TB data from districts to understand factors that contribute to TB data quality for use in decision-making. Objective. To determine factors influencing TB data quality for decision-making in the TB programme at a district level in South Africa. Methods. The study will follow a cross-sectional mixed methods design using an explanatory sequential method to achieve triangulation between the two research methods. The study setting is the Tshwane Health District (THD). Data will be collected from multiple TB data sources in selected clinics and multilevel TB programme personnel. Data collection will be conducted over six months from July 2024 to December 2024. A process flow framework will be used to document the current TB data recording systems in THD. Validated data quality assessment tools (DAQs) will be used for data auditing purposes. Furthermore, a self-administered questionnaire, and one-to-one semi-structured interviews will be used for qualitative data collection. Triangulation will be achieved by integrating both research method findings. The study will be initiated after obtaining approvals from relevant authorities. Conclusion. This research aims to gain insight and understanding of behavioural, systemic, organisational and technical factors that influence health data quality using TB programme data as a lens. This will enable quantifying of data quality elements and contribute to the body of research with regards to data quality in health.
subject: Postgraduate studies
  topic: section
subject: Health data , data quality , Tuberculosis , programme decision-making
  topic: keywords
subject: Data completeness , transparency , data reporting , timeliness
  topic: keywords
subject: District health information system, Electronic database, source documents ,Health district ,Public health facility
  topic: keywords
subject:
  topic: subjects
  value: Health data , data quality , Tuberculosis , programme decision-making, Data completeness , transparency , data reporting , timeliness, District health information system, Electronic database, source documents ,Health district ,Public health facility
subject: Public Health Medicine
  topic: disciplines
subject: Health information systems
  topic: disciplines
creator: L Motimele
creator: T Maimela
creator: D Basu
rights: Copyright (c) 2025 L Motimele, T Maimela, D Basu https://creativecommons.org/licenses/by-nc/4.0
date: 2025-06-04
publication date: 2025-06-04
starting page: e2698
ending page: e2698
doi: 10.7196/SHS.2025.v8i1.2698

A complex tapestry of urban health in South Africa
type: item
subject: Editorial
  topic: section
subject: urban health; South Africa;
  topic: keywords
subject: urban health
  topic: subjects
creator: D Basu
rights: Copyright (c) 2024 D Basu https://creativecommons.org/licenses/by-nc/4.0
date: 2024-12-03
publication date: 2024-12-03
starting page: e2600
ending page: e2600
doi: 10.7196/

A cross-sectional study of the factors associated with the acceptance of oral HIV self-testing among medical students at Joseph Ki-Zerbo University in Ouagadougou in 2021
type: item
description: Background. New screening techniques are being used to diagnose HIV infection. Objective. To identify factors associated with the acceptance of oral HIV self-testing among medical students using the socio-ecological model. Method. We conducted a descriptive, analytical cross-sectional study among medical students from October 2020 to September 2021, with data collection carried out from 10 to 25 March 2021. Results. A total of 508 students participated, of whom 15.75% (n=80) had heard of oral HIV self-testing. The acceptance rate was 92.52% (n=470). Additionally, 76.52% (n=345) were willing to buy the self-test at a preferential price of less than Franc African Financial Community (FCFA) 1 000. Logistic regression analysis revealed a statistically significant relationship between acceptance of oral HIV self-testing and the importance placed on pre-test counselling (odds ratio (OR) 6.45, 95% CI 0.93 - 40.33; p=0.049). Conclusion. Oral HIV self-testing is widely accepted among medical students. However, pre-test counselling could further increase its use and help achieve the first 95 of the United Nations’ ambitious targets.
subject: Original Articles
  topic: section
subject: oral HIV self-test
  topic: keywords
subject: associated factors
  topic: keywords
subject: students,
  topic: keywords
subject: socio-ecological model
  topic: keywords
creator: A Kabore
creator: O Gouwendmanégré Bérékia
creator: J Johns
creator: H Tognon
creator: L Sènami Akoyi
creator: T S Hema Tiemoko
creator: N Meda
rights: Copyright (c) 2025 A Kabore, O Gouwendmanégré Bérékia, J Johns, H Tognon, L Sènami Akoyi, T S Hema Tiemoko, N Meda https://creativecommons.org/licenses/by-nc/4.0
date: 2025-06-04
publication date: 2025-06-04
starting page: e2365
ending page: e2365
doi: 10.7196/SHS.2025.v8i1.2365

Annual district research conferences organised in the Gauteng Province
type: item
description: -
subject: Correspondence
  topic: section
subject: District research conference; Ekurhuleni; Gauteng; Johannesburg; Primary health care; Tshwane;
  topic: keywords
creator: L Mpuku
creator: G Tesema
rights: Copyright (c) 2024 L Mpuku, G Tesema https://creativecommons.org/licenses/by-nc/4.0
date: 2024-12-03
publication date: 2024-12-03
starting page: e2574
ending page: e2574
doi: 10.7196/

Effects of sociodemographic status, HIV disclosure, and self-reported adherence on treatment outcome among HIV/AIDS patients in south-western Nigeria
type: item
description: Background. HIV/AIDS is still a leading cause of death and a health threat to millions worldwide. Objectives. To assess the effects of sociodemographic status, HIV disclosure, and self-reported adherence on treatment outcome among patients living with HIV in south-western Nigeria. Methods. Four hundred and forty participants were recruited from six secondary health facilities offering antiretroviral therapy (ART) services in Osun State. A multistage sampling technique was used to select eligible participants. The level of significance was set at p<0.05. Results. Of the participants, less than half (42.0%) had good knowledge on HIV and ART services, while 73.0% had good treatment adherence, about one-quarter (20.7%) had been stigmatised or discriminated against, and 58.4% had disclosed their status to their sexual partner; 75.5% of the partners were supportive afterwards. Treatment outcome was favourable for 86.4% of the participants, and there was a significant relationship between marital status and viral load suppression (p=0.003) and between adherence and viral load suppression (p=0.001). Participants with good adherence were 2.6 times more likely to have a favourable treatment outcome than those with poor adherence. Conclusion. Adherence and marital status were found to be significantly associated with suppressed viral loads among people living with HIV.
subject: Preventive Medicine
  topic: section
subject: Socio-demographic Status
  topic: keywords
subject: Self-Reported Adherence
  topic: keywords
subject: HIV/AIDS
  topic: keywords
subject: Treatment Outcome
  topic: keywords
creator: S O Olarewaju
creator: C A Akinleye
creator: S B Bola-Oyebamiji
creator: O O Olusola
creator: O K Israel
creator: N E Anegbe
creator: G M Israel
creator: A O Fasanu
creator: S C Adeyemo
creator: E M Ogba
creator: O O Kayode
creator: T M Jacob
creator: E O Ewenyi
creator: N A Emeribe
creator: E M Farinloye
rights: Copyright (c) 2025 S O Olarewaju, C A Akinleye , S B Bola-Oyebamiji , O O Olusola, O K Israel, N E Anegbe , G M Israel, A O Fasanu, S C Adeyemo , E M Ogba, O O Kayode, T M Jacob, E O Ewenyi, N A Emeribe, E M Farinloye https://creativecommons.org/licenses/by-nc/4.0
date: 2025-11-14
publication date: 2025-11-14
starting page: e2406
ending page: e2406
doi: 10.7196/SHS.2025.v8i2.2406

https://samajournals.co.za/index.php/sajph/article/view/2007
type: item
title: Experiences of the use of the levonorgestrel intrauterine device for heavy menstrual bleeding: Device discontinuation rates and reasons for discontinuation among users at a regional hospital in the Western Cape - A seven-year review
description: Background. Medical management for heavy menstrual bleeding (HMB) in low- and middle-income countries is limited. The National Institute for Health and Care Excellence recommends the levonorgestrel intrauterine device (LNG-IUD) as first-line management for HMB. However, since 2019, South Africa’s (SA) Essential Medicines List (EML) guidelines have listed it as the last medical treatment option in the public health sector. An economic analysis conducted from a payer’s perspective found the LNG-IUD dominant at 5 years and more cost-effective at 1 year than other medical treatment options. However, it would no longer be dominant if the 5-year discontinuation rate exceeded 40%. Assumptions about continuation rates of the LNG-IUD for HMB were made, as no local SA data are available. Objectives. To assess the discontinuation rate of the LNG-IUD for HMB after 1 year and explore the reasons for discontinuation. Methods. This was a retrospective, folder-based study of patients who received the LNG-IUD for HMB at Tygerberg Hospital, Cape Town, SA between 2014 and 2020. Results. The hospital records of all women who received the LNG-IUD were reviewed. Incomplete records, duplications or prescriptions for contraception were excluded. Complete records were available for 100 patients, of whom 68 reported symptom improvement after 1 year and continued use. Thirty-two patients discontinued use, of whom eight experienced spontaneous expulsions and 24 requested removals. Reasons for discontinuation included ongoing symptoms (n=18), adverse effects (n=4) and the desire for fertility (n=2). Fourteen of the 24 patients who requested removal had a hysterectomy. The study showed a 68% continuation rate for the LNG-IUD, which is lower than in higher-income countries (82 - 88%). This rate is considered sufficient to endorse the affordability of LNG-IUD for HMB over 5 years. Conclusion. Offering LNG-IUD as the primary treatment may potentially improve the continuation rate. Further research …
subject: Original Articles
  topic: section
subject: heavy menstrual bleeding
  topic: keywords
subject: levonorgestrel intrauterine device
  topic: keywords
subject: discontinuation rate
  topic: keywords
subject: Public health
  topic: subjects
subject: Public health implementation
  topic: subjects
subject: real world experience
  topic: subjects
subject: Women's health
  topic: disciplines
creator: A Swanepoel
creator: T D Leong
creator: T Esterhuizen
creator: G S Gebhardt
rights: Copyright (c) 2024 A Swanepoel, T D Leong, T Esterhuizen, G S Gebhardt https://creativecommons.org/licenses/by-nc/4.0
date: 2024-12-03
publication date: 2024-12-03
starting page: e2007
ending page: e2007
doi: 10.7196/shs.2024.v7.i3.2007

Role of the patient and citizen in health technology assessment and decision-making in South Africa
type: item
description: -
subject: Forum
  topic: section
subject: HTA, patient involvement, decision-making, South Africa
  topic: keywords
subject: Healthcare
  topic: disciplines
subject: Health Technology Assessment
  topic: disciplines
creator: D Mueller
creator: L Pretorius
rights: Copyright (c) 2025 D Mueller, L Pretorius https://creativecommons.org/licenses/by-nc/4.0
date: 2025-06-04
publication date: 2025-06-04
starting page: e2594
ending page: e2594
doi: 10.7196/SHS.2025.v8i1.2594

Factors associated with advanced HIV in the Tshwane District drainage area: A protocol for a cross-sectional analytical study
type: item
description: Background. HIV continues to be a global pandemic. Despite significant achievements in reaching the global 95-95-95 targets, advanced HIV disease (AHD) continues to contribute to substantial morbidity and mortality, with 600 000 deaths worldwide in 2022 including 51 000 in South Africa (SA). The patient demographic has shifted from antiretroviral therapy (ART)-naïve individuals to those facing treatment interruptions or non-adherence. Objective. To explore the factors associated with AHD in patients within the Tshwane District drainage area, SA, where high treatment coverage has not fully curbed mortality rates. Method. This cross-sectional analytical study employs both quantitative and qualitative methods, utilising structured questionnaires and blood samples to assess ART levels, specifically dolutegravir. A minimum of 10 participants will undergo semi-structured interviews to explore their treatment experiences. Quantitative data will be analysed using descriptive and inferential statistics, while qualitative data will be examined through thematic analysis. Conclusion. This research aims to enhance the understanding of AHD-related factors to inform effective interventions and policies for HIV care.
subject: Original Articles
  topic: section
subject: Advanced HIV
  topic: keywords
subject: Antiretroviral treatment
  topic: keywords
subject: Dolutegravir
  topic: keywords
subject: Antiretroviral naive
  topic: keywords
subject: Antiretroviral experienced
  topic: keywords
subject: Advanced HIV
  topic: subjects
subject: Antiretroviral treatment
  topic: subjects
subject: Antiretroviral naive
  topic: subjects
subject: Antiretroviral experienced
  topic: subjects
subject: Public Health Medicine
  topic: disciplines
creator: S Nair
creator: K M Tshabalala
creator: F Abdullah
rights: Copyright (c) 2024 S Nair, K M Tshabalala , F Abdullah https://creativecommons.org/licenses/by-nc/4.0
date: 2024-12-03
publication date: 2024-12-03
starting page: e2564
ending page: e2564
doi: 10.7196/shs.2024.v7.i3.2564

Global surgery in Africa: Access to surgery, an opportunity to adopt a participatory community-based approach
type: item
description: -
subject: Original Articles
  topic: section
subject: Global Surgery
  topic: keywords
subject: Community-based participatory research
  topic: keywords
subject: Collaborative Citizen Science
  topic: keywords
subject: Access to surgery
  topic: keywords
subject: Global Surgery
  topic: subjects
subject: participatory community-based approaches
  topic: subjects
subject: Citizen science
  topic: subjects
subject: Global surgery
  topic: disciplines
subject: Public Health
  topic: disciplines
subject: Community Medicine
  topic: disciplines
subject: Social medicine
  topic: disciplines
creator: M Isiagi
creator: S Maswime
creator: K J Okop
rights: Copyright (c) 2025 M Isiagi, S Maswime, K J Okop https://creativecommons.org/licenses/by-nc/4.0
date: 2025-06-04
publication date: 2025-06-04
starting page: e2539
ending page: e2539
doi: 10.7196/SHS.2025.v8i1.2539