School of Public Health (Journal Articles)
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Item Alcohol industry involvement in the delayed South Africa Draft Liquor Amendment Bill 2016: a case study based on freedom of information requests(BioMed Central, 2025-03) Goldstein, Susan; Mitchell, Gemma; Siwela, Pfumelani; Diedericks, Aadielah MakerBackground South Africa is reported to have one of the highest per capita rates of alcohol consumption among drinkers globally, with alcohol harms exacerbating socio-economic inequalities in the country. The Draft Liquor Amendment Bill 2016 proposed new restrictions on alcohol advertising, availability, and liability of retailers and manufacturers for harm related to any contravention of the regulations. To date, the Bill has not progressed through the legislative process. The alcohol industry is known to use a diverse set of strategies to delay evidence-based policies globally. Methods We aimed to explore Bill-related activity by industry within the National Economic and Development Labour Council, a multi-stakeholder forum that assesses socio-economic policies before they reach parliament. On 06 July 2023 we made a Request for Access to Record, using form two of the Promotion of Access to Information Act (PAIA), no. 2 of 2000 to the National Economic and Development Labour Council for access to minutes of all meetings, reports, and any other publications related to the Bill between January 2016 and December 2022. Informed by Ulucanlar et al’s (2023) model and taxonomies of corporate political activity, we extracted data on industry Bill-related activity and thematically analysed key events, presented here as a narrative synthesis. Results We identified activity by 14 alcohol industry organisations related to the Bill between 2016 and 2022. Industry representation on five National Economic and Development Labour Council-related committees identified between 2017 and 2021 facilitated their involvement in Bill-related discussions and supported access to other government departments. Community representation was low in all committees compared to industry, labour, and government. Industry funded two socio-economic assessments of the Bill in 2017 and 2022, despite an independent socio-economic impact assessment having already been completed. The 2017 report delayed progress of the Bill, and the 2022 ‘re-evaluation’ was more critical of the proposed measures, with the differing conclusions attributed to different methodologies. During the covid-19 pandemic, industry used a ‘carrot and stick’ approach of legal threats and donations to attempt to move towards self-regulation via a social compact. The National Economic and Development Labour Council confirmed in 2023 that the social compact was unsuccessful. Conclusions Early ‘regulatory capture’ gave the alcohol industry the opportunity to shape assessment of the Bill within the National Economic and Development Labour Council. Our findings are in line with previous studies on corporate influence on policy globally, and support calls for a reassessment of the role and proportion of industry representation within the National Economic and Development Labour Council locally.Item Current evidence on improving influenza vaccine uptake in low- and middle-income countries: a scoping review of determinants and interventions(Elsevier, 2025-03) Tsotetsi, Lerato; Msibi, Tshepiso; Mashamba, Mulalo; Dietrich, Janan; Alam, PrimaInfluenza is a vaccine-preventable disease affecting three to five million individuals across the globe annually. Low- and middle-income countries (LMICs) bear substantial health and economic consequences of influenza- related mortality. Despite this disproportionate burden, influenza vaccinations are seldom used across LMICs. In this article, we reviewed current evidence on improving influenza vaccine uptake within LMICs by examining key determinants and interventions. We conducted a scoping review of peer-reviewed studies pertaining to influenza vaccine uptake in LMICs. We searched five electronic databases for articles published 2014–2024, using terms relating to influenza vaccines, interventions, and context. Twenty-four articles met the inclusion criteria with sample sizes ranging from 38 to 9420. The authors followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews guidelines and synthesized the included articles using thematic analysis. All studies included in this review were cross-sectional and primarily used quantitative surveys. Most of the included studies were conducted in Sub-Saharan Africa (South Africa, Kenya, Malawi, and Sierra Leone) and the Middle East and North Africa (Tunisia, Jordan, Lebanon, and Egypt). Articles predominantly targeted vulnerable populations including elderly, pregnant women, and young children as well as healthcare workers. Participants across the included studies reported high levels of willingness to receive the influenza vaccination but lower levels of uptake. Having positive perceptions and attitudes towards the efficacy and safety of the vaccine, greater belief in disease susceptibility, physician recommendations, and a history of being vaccinated were associated with greater willingness to receive the influenza vaccine. Six articles explored national campaigns or researcher- led interventions to improve influenza vaccine uptake with educational campaigns positively changing attitudes towards influenza vaccination and integration of year-round vaccination campaigns with routine services as an effective vaccine delivery method.Item Trends in national and ethnic burden of ovarian cancer mortality in South Africa (1999–2018): a population based, age-period-cohort and join point regression analyses(BioMed Central, 2025-03) Olorunfemi, Gbenga; Libhaber, Elena; Musenge, Eustasius; Ezechi, Oliver C.Ovarian cancer is the most lethal and third leading cause of gynaecological cancers globally and in South Africa (SA). However, its current mortality trends have not been evaluated in most sub-Saharan African Countries including South Africa that is currently undergoing epidemiological and health transitions. We evaluate the trends in the ovarian cancer mortality rates in SA over 20 years (1999–2018). Methods: Crude (CMR) and age standardised mortality rates (ASMR) of ovarian cancer was calculated based on national mortality data of South Africa. The overall and ethnic trends of ovarian cancer mortality among women aged 15 years and older from 1999 to 2018 was assessed using the Join point regression model, while Age-period-cohort regression analysis was conducted to evaluate the underlying impact of age, period and cohort on ovarian cancer mortality. Results: In all, 12,721 ovarian cancer deaths were reported in South Africa from 1999 to 2018 and the mortality rates increased from 2.34 to 3.21 per 100,00 women at 1.8% per annum. In 2018, the overall mean age at ovarian cancer death in South Africa was 62.30±14.96 years while the mean age at death among Black women (58.07±15.56 years), was about 11 years earlier than among White women (69.48±11.71 years). In 2018, the White ethnic group (4.93 deaths per 100,000 women) had about doubled the ovarian cancer ASMR for the non-Whites (Indian/Asians, 2.92/100,000 women, mixed race, 2.49/100,000 women and Black women (2.36/ 100,000 women). All the ethnic groups had increased ASMR with Black women (Average annual percent change, [AAPC]: 4.7%, P-value<0.001) and Indian/Asian women (AAPC: 2.5%, P-value<0.001) having the highest rise. Cohort mortality risk ratio of ovarian cancer increased with successive birth cohort from 0.35 among 1924–1928 birth cohorts to 3.04 among 1999–2003 cohort and the period mortality risk increased by about 13% and 7.5% from 1999 to 2003 to 2004–2008 (RR: 0.87, 95% CI: 0.80–0.94), and from 2004 to 2008 to 2009–2013 (RR: 1.075, 95% CI:1.004–1.152) respectively. The longitudinal age analysis revealed that ovarian cancer increased with age, but there was an exponential increase from 55 years. Conclusions: Our study showed that there was increasing trends in ovarian cancer mortality among all the South African ethnic groups, driven partly by increasing cohort and period mortality risks. We therefore highlight the huge burden of ovarian cancer in SA and the need for targeted intervention. Public health interventions geared towards reducing ovarian cancer mortality should be instituted and ethnic disparity should be incorporated in the cancer control policyItem ‘We do not like talking about our problems’: socialization and idealized masculinity as drivers of help-seeking avoidance among college men in South Africa(BioMed Central, 2025-03) Sikweyiya, Yandisa; Jewkes, Rachel; Machisa, Mercilene; Mahlangu, Pinky; Brooke-Sumner, Carrie; Gibbs, Andrew; Dartnall, Elizabeth; Pillay, ManagaBackground: This article explores how identities and contexts influence help-seeking avoidance behaviour among college men. Methods: This exploratory qualitative study purposively selected 88 male students (aged 18–30) from some universities and Technical and Vocational Training colleges (TVETs) in South Africa. Data were collected through focus group discussions (FGDs). Eight FGDs were conducted, one in each selected university (n = 2) and TVETs (n = 6) in 2018–2019. Data were analyzed using a thematic analysis approach. Results: We found that college men’s early life experiences and socialisation strongly influenced their ability to express emotion and access services when in need of help. The data also revealed a masculinity that men aspired to and wanted to be seen as embracing or personifying while on campus. Most men ascribed to an ideal of masculinity that made it difficult for them to share their feelings (e.g., emotional pain, sadness; and bottle their emotions) and seek help from campus-based counselors or peers. The few men who reported using campus mental health support services appraised them as unsuitable and unhelpful for them, and indicated a preference for services that were more culturally relevant. Most men indicated a preference for male counselors, of which there were very few. Conclusions: These findings may be useful for the formulation of evidence-based context-specific and culturally sensitive approaches for increasing men’s access to mental health and psychological support services on South African college campuses.Item Refusal of male partner responsibility and pregnancy support: prevalence, associated factors and health outcomes in a cross sectional study in Harare, Zimbabwe(BioMed Central, 2025-03) Shamu, Simukai; Machisa, Mercilene Tanyaradzwa; Shamu, PatienceBackground The phenomenon of fathers refusing responsibility during pregnancy has not received adequate attention in African studies. This paper assesses associated factors and pregnancy-related outcomes when fathers refuse to support partners’ pregnancies and undertake parental responsibilities. Methods A cross-sectional survey of 15–49-year-old postnatal (1–6 weeks) women was conducted at six urban health facilities in Harare. Participants were interviewed about their male partners’ refusal to support their pregnancies and parenting, bride price payments (indicating marriage commitment), partner violence and control, alcohol abuse and family planning decision-making. Pregnancy health outcome data including antenatal care attendance, low birth weight (LBW)(<2500 g) and postnatal depression were collected through interviews and clinic records. Multiple regression models were built to assess gender-related factors and health outcomes associated with male partners’ refusal of parenting responsibilities. Results Of the 2042 women interviewed, 6.4% reported partner refusal to support the pregnancy or parenting. Higher odds of partner refusal of fathering responsibility were associated with partners not paying bride price (aOR 9.31; 95% CI 1.16–74.59), violence perpetration during pregnancy (aOR 2.84; 1.28–6.23), highly controlling behaviours (aOR 4.96; 2.83–8.69), alcohol abuse (aOR 1.78; 1.05–3.02), unintended pregnancy (aOR 3.72; 1.84–7.53) and partner refusal to use contraceptives (aOR 3.64; 1.86–7.14). Women who used contraceptives (aOR 0.40; 0.23–0.71), made joint (aOR 0.30; 0.14–0.67) or individual (aOR 0.25; 0.07–0.94) pregnancy decisions were protected from partner refusal of parenting responsibility. Women’s depressive symptomatology (aOR2.64; 1.52–4.59), LBW (aOR5.30; 1.18–23.74) and partner discouragement of antenatal care attendance (aOR 3.86; 1.13–13.17) were pregnancy outcomes associated with partner refusal of parenting responsibility. Conclusions Male partners’ refusal to acknowledge parenting responsibility was associated with men’s abusiveness, absence of commitment to long-term relationship/marriage, gender unequal practices and negative maternal and child health outcomes. Parenting programmes must be instituted and prioritise transforming traditional gender norms to improve fathering responsibilities.Item Social influences on Moroccan and Pakistani immigrant women’s access and use of cervical cancer screening in Catalonia, Spain: a social network analysis(BioMed Central, 2025) Harling, Guy; Lurgain, Jone G.; Peremiquel-Trillas, Paula; Ouaarab-Essadek, Hakima; Mellouki, Khadija; Sarif, AndleedBackground: Participation in cervical cancer (CC) screening programs is lower among immigrants compared to native women in many Western countries, in substantial due to lower knowledge and culturally influenced attitudes regarding self-care and prevention. Education and information programs alone have limited impact on individuals’ attitudes and behaviours, but may be bolstered by social influence methods such as peer support. Methods: In this study, we combined self-reported quantitative structural social network data with qualitative narratives and graphs to describe the social context of 12 Moroccan and 10 Pakistani immigrant women living in Catalonia, Spain. We used a survey protocol and semi-structured interviews to explore how women’s contacts influence their CC screening behaviours. Results: We identified strong gender and ethnic homophily in these women’s social networks. Despite maintaining frequent remote contact with their family ties, their immigrant peers were more influential in providing health information and advice. Furthermore, the women’s husbands played two conflicting roles as health promoters and as a barrier to the use of health prevention services. Conclusion: Our findings highlight the need to incorporate tailored social influence approaches in the design of behaviour change interventions. In this case, the use of peer-based programs to increase CC screening uptake among these two immigrant communities.Item Alcohol use and optimal chronic diseases’ treatment outcomes among adults aged 40 years and above in rural South Africa(Nature Research, 2025-03) Mupfuti, Rumbidzai; Kabudula, Chodziwadziwa. W.; Francis, Joel MsafiriChronic diseases are significant problems in South Africa. Chronic diseases’ treatment outcomes are critical to the reduction of morbidity and mortality. There is limited data in South Africa on alcohol use and treatment outcomes of chronic diseases in older people. Understanding the association between alcohol use and chronic diseases treatment outcomes would inform potential interventions to address the duo. We analysed data from wave 1 of the Health and Ageing in Africa-a longitudinal Study in an INDEPTH community (HAALSI) study. We performed descriptive analysis to determine the prevalence of optimal chronic diseases’ treatment outcomes (suppressed HIV viral load, normal blood pressure and normal blood sugar- euglycemia) and applied modified Poisson regression to determine the association between alcohol use and chronic diseases’ treatment outcomes. The prevalence of optimal treatment outcomes was 87.4% suppressed viral load for those living with HIV, 42.7% normal blood pressure for hypertensives, 53.6% with euglycemia among diabetics and 52.4% with normal outcome parameters among those with multimorbidity. Alcohol use did not negatively impact the optimal treatment outcomes for HIV (aRR = 1.00, 95%CI 0.93–1.09), hypertension (aRR = 0.88, 95%CI 0.68–1.14), diabetes mellitus (aRR = 0.73, 95%CI 0.44–1.22), and multimorbidity (aRR = 1.00, 95%CI 0.93–1.09). Alcohol use was not significantly associated with treatment outcomes possibly due to underreporting of alcohol use. There is need to incorporate objective alcohol measurements and alcohol interventions in chronic diseases care settings. Furthermore, there is urgent need to strengthen the management of hypertension and diabetes, by adopting the strategies deployed for HIV management.Item Genetic therapies for movement disorders ‑ current status(Springer, 2025-02) Waddington, S. N.; Sartorelli, J.; Ng, J.; Rahim, A. A.; Kurian, M. A.Movement disorders are a group of heterogeneous neurological conditions associated with alterations of tone, posture and voluntary movement. They may either occur in isolation or as part of a multisystemic condition. More recently, the advent of next generation sequencing technologies has facilitated better understanding of the underlying causative genes and molecular pathways, thereby identifying targets for genetic therapy. In this review, we summarize the advances in genetic therapy approaches for both hyperkinetic and hypokinetic movement disorders, including Parkinson’s Disease, Huntington’s Disease and rarer monogenic conditions of childhood onset. While there have been significant advances in the field, multiple challenges remain, related to safety, toxicity, efficacy and brain biodistribution, which will need to be addressed by the next generation of genetic therapies.Item Prevalence and factors associated with caesarean section among Tanzanian women of reproductive age: evidence from the 2022 Tanzania demographic and health survey data(BioMed Central, 2025-02) Olorunfemi, Gbenga; Nahayo, Bonfils; Ndayishimye, Samuel; Nsanzabera, CharlesBackground: Caesarean Section (CS) is one of the commonest surgical procedures worldwide. It is an important medical intervention for reducing the risk of poor perinatal outcomes. However, there was increased trends in CS in sub-Saharan Africa as maternal and neonatal mortality and morbidity remains high. This study aims to determine the prevalence and factors associated with CS rates in Tanzania. Methodology: This was a secondary data analysis of 4,768 women of reproductive age (15–49) in Tanzania. The data utilized was from the Tanzania Demographic Health and Survey (TDHS) 2022. The factors associated with CS were identified using multivariable binary logistic regression. Results: Out of 4,768 women of reproductive age in Tanzania, 497 (10.4%) had CS. Attaining primary (Adjusted Odds Ratio (aOR): 1.79,95% CI 1.23–2.60), secondary (aOR:2.07,95% CI 1.36–3.14) and higher education (aOR: 2.35, 95% CI 1.08–5.12); having a husband/partner with higher education; being in richest household wealth quintile (aOR:1.98,95% CI (1.31-3.00), having a job (aOR:1.29, 95% CI: 1.05–1.58 and having attended more than 4 antenatal care (ANC) visits (aOR: 1.36, 95% CI: 1.11–1.67) were associated with a higher odds of undergoing CS compared to their respective counterparts. However, living in rural areas (aOR: 0.74, 95% CI:0.58–0.94), being multiparous women with 2–4 births (aOR: 0.67, 95% CI: 0.53–0.84) and 5 or more births (aOR: 0.44, 95% CI: 0.32–0.60) were associated with lower odds of CS. Conclusion: The overall prevalence of CS among women of reproductive age in Tanzania was 10.4%. The highest educational level, husband/partner’s educational attainment, household wealth quintile, type of residence, employment status, increased ANC number, and high parity were associated with CS. The CS prevalence is at the lower limit of the recommendation of the World Health Organisation of 10–15%. Further researches are necessary to highlight other barriers, facilitators and outcome of CSs in Tanzania to advise policy stakeholders.Item Group-based trajectory modeling to describe the geographical distribution of tuberculosis notifcations(Springer Nature, 2025-02) Martinson, Neil A.; Lebina, Limakatso; Dagnew, Alemnew F.; Hanrahan, Colleen F.; Dowdy, David W.; Nonyane, Bareng A. S.Background Tuberculosis (TB) is a major public health problem, and understanding the geographic distribution of the disease is critical in planning and evaluating intervention strategies. This manuscript illustrates the application of Group-Based Trajectory Modeling (GBTM), a statistical method that analyzes the evolution of an outcome over time to identify groups with similar trajectories. Specifically, we apply GBTM to identify the evolution of the number of TB notifications over time across various geographic locations, aiming to identify groups of locations with similar trajectories. Locations sharing the same trajectory may be considered geographic TB clusters, indicating areas with similar TB notifications. We used data abstracted from clinic records in Limpopo province, South Africa, treating the clinics as a proxy for the spatial location of their respective catchment areas. Methods Data for this analysis were obtained as part of a cluster-randomized trial involving 56 clinics to evaluate two active TB patient-funding strategies in South Africa. We utilized GBTM to identify groups of clinics with similar trajectories of the number of TB patients. Results We identified three trajectory groups: Groups 1, comprising 57.8% of clinics; Group 2, 33.9%; and Group 3, 8.3%. These groups accounted for 30.8%, 44.4%, and 24.8% of total TB-diagnosed patients, respectively. The estimated mean number of TB-diagnosed patients was highest in trajectory group 3 followed by trajectory group 2 across the 12 months, with no overlap in the corresponding 95% confidence intervals. The estimated mean number of TB-diagnosed patients over time was fairly constant for trajectory groups 1 and 2 with exponentiated slopes of 0.979 (95% CI: 0.950, 1.004) and 1.004 (95% CI: 0.977, 1.044), respectively. In contrast, there was a statistically significant 3.8% decrease in the number of TB patients per month for trajectory group 3 with an exponentiated slope of 0.962 (95% CI: 0.901, 0.985) per month. Conclusions GBTM is a powerful tool for identifying geographic clusters of varying levels of TB notification when longitudinal data on the number of TB diagnoses are available. This analysis can inform the planning and evaluation of intervention strategies.