Background: Because of low utilisation of cervical cancer screening (CCS) services, Senegal ranks 17th in the world for cervical cancer incidence. Aim: The aim was to investigate health facility factors associated with CCS. Setting: The study was conducted in six Senegalese health districts (Keur Massar, Yeumbeul, Diamniadio, Kédougou, Saraya and Salémata). Methods: This was a descriptive and analytical cross-sectional study of women aged 25–69 years. A two-stage cluster survey was carried out, with a selection of census districts (CDs) followed by households. The data were collected with collection tools during individual interviews. Data were analysed using R 4.2.3 software. Univariate, bivariate analysis and logistic regression were performed. Results: The study involved 360 women. The average age was 40.2 (± 11.5) years. A proportion of 46.5% (334 individuals) regularly went to the health facility for treatment. 18.8% of women had been screened for cervical cancer. Factors associated with screening were hearing about a CCS or the human papillomavirus vaccine, regular attendance at a traditional healer for care, regular attendance at a healthcare facility to receive care and professionalism of healthcare facility workers. Other significantly related factors were age, marital status and level of education. Conclusion: Improving the uptake of CCS services requires a multifactorial approach, including taking into account obstacles linked to health facilities. It will involve improving attendance at health facilities through information, education and communication strategies aimed at women and health workers to contribute to maternal health. Contribution: This study will help remove the barriers faced by healthcare facilities that limit screening, including a lack of information, reliance on traditional medicine, irregular visits to healthcare facilities, and a lack of professionalism among healthcare workers. As a result, an improvement will be observed in the utilisation of cervical cancer screening services. Policy makers will be able to use the results to implement appropriate strategies that will increase screening rates and ensure adequate care for women who test positive. This study makes a positive contribution to science and opens up avenues for further research, such as on the implementation of cervical cancer screening services.
Background: Health workforce challenges in Africa are exacerbated by fragmented and underdeveloped Human Resources for Health Information Systems (HRH-IS). While digital health maturity models exist, their applicability to HRH-IS in low- and middle-income countries (LMICs) remains unclear, with limited evidence of context-specific frameworks. Aim: This scoping review aimed to (1) map digital health and health information system (HIS) maturity models, frameworks, tools and guidelines relevant to HRH-IS, and (2) synthesise key domains to inform the development of a context-appropriate HRH-IS maturity model for African LMICs. Setting: The study was conducted in low- and middle-income countries in Africa. Methods: A scoping review was conducted following the Arksey and O’Malley framework and Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews guidelines. PubMed, EBSCO-hosted databases, Google Scholar and grey literature sources, including institutional repositories and global health agency publications were searched. Data were extracted using a structured form and analysed descriptively, with thematic synthesis used to identify transferable domains. Results: A total of 3128 records were screened, and 41 were included. Only one tool targeted HRH-IS. Most identified frameworks addressed broader digital health or HIS. Six cross-cutting domains were synthesised: (1) governance and leadership; (2) workforce and organisational capacity; (3) financing and sustainability; (4) data architecture and interoperability; (5) data quality and analytics; and (6) equity, trust and system adoption. Conclusion: There is limited evidence of dedicated HRH-IS maturity models in African LMICs. However, existing digital health and HIS frameworks provide a strong foundation for adaptation. Contribution: The six synthesised domains offer a preliminary basis for developing and validating a context-specific HRH-IS maturity model to strengthen workforce data systems and support evidence-informed policy.
On 17 May 2026, the Director-General of the World Health Organization determined that Ebola disease caused by Bundibugyo virus in the Democratic Republic of the Congo (DRC) and Uganda constituted a Public Health Emergency of International Concern. Ten days separated the initial alert (05 May) from laboratory confirmation (15 May) although multiple non-laboratory signals were already active. Using this outbreak, we argue that Africa's principal detection challenge is often not signal availability but the timely interpretive integration of concurrent multi-source signals, and we outline how a reproducible analytical layer - the Pan-African Real-time Epidemiological Intelligence System (PREIS) framework - might support it.
Background: Cardiovascular disease (CVD) is the leading cause of death globally, with a disproportionate burden in low- and middle-income countries (LMIC). Cardiovascular (CV) polypills, combining a statin with two or three antihypertensive agents, improve adherence, risk-factor control and outcomes, but uptake remains limited. In South Africa, they are unavailable in the public sector and rarely used privately. Aim: To explore stakeholder perspectives on the feasibility, acceptability and potential uptake of CV polypills in South African primary care. Setting: Primary healthcare and health-system contexts in South Africa. Methods: We conducted semi-structured interviews with 15 purposively sampled stakeholders from clinical, policy, regulatory, industry and advocacy sectors. Data were analysed thematically using ATLAS.ti, with reflexivity, peer debriefing and participant validation to enhance rigour. Results: Stakeholders viewed polypills as a promising strategy to simplify treatment, improve adherence and strengthen cardiovascular prevention. Barriers included formulation constraints, weak commercial incentives, regulatory complexity, inequitable access and limited local evidence. Pharmacological prevention was seen as complementary to risk screening and lifestyle interventions. Participants called for context-specific research, coordinated policy action, streamlined regulation, equitable procurement, advocacy-led demand generation and strong government leadership. Conclusion: Cardiovascular polypills could improve prevention and outcomes in South Africa and similar LMIC settings, but scale-up will require local evidence and coordinated multisectoral action to overcome regulatory, procurement, access and health-system barriers. Contribution: This study identifies clinical, behavioural and health system factors influencing CV polypill adoption in South Africa, offering actionable insights to inform research, policy and scalable CVD prevention strategies in LMICs.
Background: Rhodesiense human African trypanosomiasis (rHAT) is an acute zoonotic infection that can rapidly progress to central nervous system (CNS) disease. As lumbar puncture is no longer routinely required for treatment selection, district hospitals need accessible measures associated with CNS inflammatory burden. Aim: This study aimed to evaluate routine admission clinical and laboratory measures as correlates of cerebrospinal-fluid white-cell count and to describe changes in this count during early hospital care. Setting: The study was conducted at Rumphi District Hospital, a public secondary-level treatment facility serving rural communities in the Vwaza Marsh focus of northern Malawi. Methods: We retrospectively studied patients aged ≥ 6 years with parasitological confirmed rHAT from 2012–2024. Cerebrospinal-fluid white-cell counts at admission and Day 11 were analysed using mixed-effects negative binomial regression, reporting adjusted incidence rate ratios (aIRRs) with 95% confidence intervals (CIs). Results: Forty-three patients met the eligibility criteria; 43 contributed admission counts, and 42 contributed Day-11 counts. Day-11 cerebrospinal-fluid white-cell counts were 75% lower than admission counts (aIRR = 0.25, 95% CI: 0.14–0.45; p < 0.001). Stage 2 disease was associated with a higher count than Stage 1 disease (aIRR = 4.23, 95% CI: 1.35–13.30; p = 0.013). Each 1 g/dL increase in haemoglobin and albumin was associated with lower expected counts (haemoglobin aIRR = 0.83, 95% CI: 0.78–0.89; p < 0.001; albumin aIRR = 0.70, 95% CI: 0.54–0.92; p = 0. 009). Conclusion: Lower haemoglobin and albumin were associated with greater cerebrospinal-fluid inflammation, which declined during early care. As accessible admission measures, they may support recognition, triage and monitoring of CNS burden in rHAT, pending prospective diagnostic-accuracy validation before implementation. Contribution: This study links routine blood measures to cerebrospinal-fluid inflammation in rHAT, informing prospective validation priorities.
Background: In South Africa, infectious disease outbreaks are common and pose severe public health threats. To mitigate outbreaks, health promotion plays a significant role. However, the role of health promotion practitioners remains obscure. Aim: To describe the role of health promotion practitioners during outbreaks in the OR Tambo District. Setting: The study was conducted in the Oliver Reginald (OR) Tambo District, a predominantly rural area in the Eastern Cape province of South Africa. Methods: The study used a qualitative descriptive-phenomenological design. The population comprised health promotion practitioners with a tertiary qualification. These were selected using snowball sampling until data saturation. Data were collected using individual face-to-face and telephonic interviews. Thematic analysis was used to analyse data. Results: The sample consisted of 14 participants, with the majority (57.1%, n = 8) being female. Three themes were identified. Firstly, the implementation role in planning and health education. This was supported by three subthemes: (1) planning and organising, (2) health education collaboration with government departments and (3) multidisciplinary collaborative health education. Secondly, the theme was research, monitoring and evaluation, supported by two subthemes: (1) surveillance and assessment and (2) monitoring and evaluation. Thirdly, the theme, advocacy, was supported by the subtheme advocacy for health services. Conclusion: The roles of health promotion practitioners during outbreaks were aligned with the national strategy and could be optimised by inclusion in training and planning activities. Contribution: The study contributes to the efficient management of infectious disease outbreaks by clarifying the role of health promotion practitioners.
Background: Cholera is a major public health challenge in Nigeria. On 09 September 2021, the Adamawa State Ministry of Health confirmed an outbreak affecting 12 local government areas (LGAs). Aim: To describe the outbreak and identify risk factors. Setting: Community-based in Adamawa State, Nigeria (30 June 2021 – 01 December 2021). Methods: We described the State cholera line list (30 June 2021 – 01 December 2021) and estimated case fatality and attack rates. We conducted an unmatched case-control study in seven LGAs, involving 66 laboratory-confirmed cases and 120 asymptomatic neighbourhood controls. We collected data on demographics, clinical history, practices and risk factors using interviewer-administered questionnaires. We executed univariate, bivariate and multivariate analyses to estimate adjusted odds ratios (aORs) and 95% confidence intervals (CIs). Results: Of 1332 cases reported across 12 LGAs, we recorded an overall case fatality rate (CFR) of 3.6%. We recorded the highest CFR (16.7%) in Song and the attack rate (N = 239.6/100 000) in Numan. Children aged 5–14 years were most affected. The median age was 24 years for cases (range: 1–76) and 32 years for controls (range: 5–70). Males accounted for 54.5% (cases) and 53.3% (controls). Independent risk factors were age < 10 years (aOR = 9.7; 95% CI: 2.6–34.9) and consumption of street-vended noodles (aOR = 7.0; 95% CI: 1.4–34.8). Conclusion: The outbreak disproportionately affected children with unregulated food sources, contributing significantly. Public health interventions included hygiene education and chlorine distribution. Strengthening food safety regulations and sustaining hygiene promotion were recommended to mitigate future outbreaks. Contribution: The study supports Nigeria’s Cholera Control Programme in refining hygiene strategies, regulating street food safety and targeting high-risk groups, such as young children.
Background: Road crashes continue to cause morbidity and mortality in South Africa, with motorbike accidents causing serious musculoskeletal injuries. The rapid growth of e-hailing delivery services has increased the number of motorbike drivers on congested urban roads, increasing their vulnerability to crashes. Aim: This scoping review examined South African motorbike delivery driver road traffic crashes, injury patterns, economic implications, and related regulatory gaps. Setting: South African public healthcare and trauma systems. Methods: A systematic search of PubMed, Scopus, and Web of Science was performed for studies published between 2020 and 2025. The search strategy combined Medical Subject Headings and Emtree terms pertaining to motorbikes, delivery services, and injury-related outcomes. Eligible English-language studies were included, with data extracted using a standardised collection sheet and synthesised descriptively. Result: The review comprised three studies with 133 participants with 161 orthopaedic injuries. The studies conducted in Cape Town, Tembisa, and Pretoria consistently reported that delivery motorbike crashes result in high-energy trauma predominantly affecting young, male riders. The predominant injuries consisted of severe long-bone fractures and polytrauma in patients. Across sites, most patients required surgical intervention, and intensive care unit (ICU) admissions were necessary in the most severe cases. The treatment of these patients incurred substantial costs. Expenses were predominantly influenced by surgical procedures, prolonged hospitalisation, ICU treatment, and implants. Conclusion: Motorbike delivery drivers in South Africa face disproportionate health risks and financial insecurity because of traffic-related injuries. Contribution: This review highlights important policy and legislative gaps and supports reforms aimed at improving occupational protection and road safety for delivery drivers.
Background: Timely reporting of human immunodeficiency virus (HIV) commodity stock status is critical for effective supply chain management. However, only four (12%) of 31 HIV-accredited sites in the region submitted all weekly reports in quarter one 2024 using the Real-time Antiretrovirals (ARV) Stock Status Monitoring (RASS) tool. Aim: To improve weekly reporting from 0% to 100% by August 2024 at a non-reporting HIV-accredited regional referral hospital using a continuous quality improvement (CQI) approach. Setting: The project was conducted at a regional referral hospital in Kampala, Uganda, an HIV-accredited facility serving approximately 1354 HIV patients as of March 2024. Methods: A CQI team conducted a baseline assessment in March 2024 using RASS dashboard data and identified non-reporting causes using fishbone and 5 Whys techniques. Interventions, implemented from April 2024 to July 2024, included orienting new staff and introducing WhatsApp reminders. Progress was monitored weekly using the Plan–Do–Check–Act (PDCA) cycle, with data analysed monthly to assess trends. Results: Baseline reporting was 0% in March 2024 because of a lack of staff orientation. Orientation of two RASS users in April 2024 increased reporting to 80% by May 2024, and with WhatsApp reminders in June 2024, it reached 100% and was sustained through August 2024. Conclusion: Staff orientation and WhatsApp reminders were associated with improved HIV commodity reporting at the study site. While these interventions appear promising, further evaluation across multiple sites and under controlled conditions is needed to confirm their effectiveness. Institutionalising such low-cost strategies may offer potential benefits for strengthening HIV commodity stock management. Contribution: These low-cost, scalable interventions can enhance HIV commodity management across HIV-accredited sites, thus supporting 95-95-95 HIV targets.
Background:Northwest Nigeria is highly vulnerable to climate variability and heavily dependent on rain-fed agriculture, which exacerbates existing socioeconomic vulnerabilities. Aim:This study aimed to explore the link among climate-induced stress, poverty, and mental health outcomes, particularly substance use as a maladaptive coping mechanism, in this region. Setting:The study was conducted in Kano, Kaduna, and Katsina in Northwest Nigeria. Methods:A cross-sectional study was conducted among 20 000 adults aged ≥ 18 years from 40 randomly selected communities. Data were collected using validated instruments: The Alcohol, Smoking and Substance Involvement Screening Test (ASSIST), the Kessler Psychological Distress Scale (K10), the Coping Strategies Inventory-Short Form (CSI-SF), and a Multidimensional Poverty Index Questionnaire. Robust statistical analyses, including multivariable logistic regression with cluster-robust standard errors, were employed. Results:The prevalence of high-risk substance use (ASSIST ≥ 27) was 18.5% (n = 3700). Cannabis was the most commonly misused substance (12.4%, n = 2480), followed by prescription opioids (9.1%, n = 1820) and alcohol (7.8%, n = 1560). High psychological distress (K10 ≥ 20) was identified in 45.2% (n = 9040). Over 85% (n = 17 000) were multidimensionally poor. Maladaptive coping strategies were strongly correlated with both poverty (odds ratio [OR]: 3.12, 95% confidence interval [CI]: 2.85-3.42) and high psychological distress (OR: 4.85, 95% CI: 4.48-5.25). Conclusion:This study reveals a concerning syndemic of climate-related stress, profound poverty, poor mental health, and substance use in Northwest Nigeria. Associations suggest substance use may function as a maladaptive coping mechanism in the context of climate-induced economic hardship, though causal inference is limited by the cross-sectional design. Contribution:Findings underscore the critical need for integrated public health interventions that address mental health and substance use disorders within the context of climate adaptation and poverty reduction strategies.
Background: Adolescent girls in sub-Saharan Africa (SSA) are at higher risk of maternal death as they tend to underuse maternal health services during pregnancy. Aim: This study aimed to identify the factors associated with dropouts along the continuum of maternal care (CoC) among adolescent girls. Setting: The analysis included 15 countries in SSA with high maternal mortality. Methods: We conducted a secondary data analysis using Demographic and Health Surveys data from 15 countries across SSA. All adolescent girls aged 15–19 years who reported a live birth in the 5 years preceding data each collection were included in the study. A multilevel logistic regression models were fitted to the data to identify the factors associated with dropouts. Results: Only 27.3% received all components of the CoC. Dropouts were highest between one and four antenatal care (ANC) visits (42.0%) and between childbirth and 48-h postnatal care (PNC) (37.4%). The odds of dropout between ANC1 and ANC4 visits were higher for adolescents living in rural areas, without formal education, from poor households and with poor ANC content (adjusted odds ratio: 1.68; 95% confidence interval: 1.51–1.86). Regarding 48-h PNC, the distance between home and health facility, the educational attainment and the content of ANC were associated with dropouts. Conclusion: Beside well-known socio-demographic factors, the study shows that poor quality of ANC services was a key driver of dropouts. Contribution: This study, which strengthens the body of evidence on maternal health among adolescent girls in SSA, could help in designing more efficient interventions.
Mpox, caused by the mpox virus, has evolved from isolated cases in endemic regions to widespread outbreaks affecting multiple countries in Africa. The Research and Innovation pillar of the Continental Incident Management Support Team (IMST) was established to generate evidence that supports response efforts, including analysing the efficiency and effectiveness of clinical trials and health research on mpox across Africa. This article describes the achievements, challenges faced and lessons learned from mpox research efforts. The contributions of research to the mpox response by the Africa Centres for Disease Control and Prevention (Africa CDC) are crucial to managing infectious disease outbreaks across the continent. Multiple research initiatives were coordinated across Member States, including socio-behavioural, epidemiological, diagnostic, vaccine and therapeutic studies. Key achievements included the establishment of a coordinated continental research platform, initiation of multi-country studies and mapping of ongoing mpox research activities across Africa. Challenges included bureaucratic procedures, delays in funding disbursement, ethical approval bottlenecks, coordination complexities and surveillance gaps that affected timely research implementation. Addressing these gaps has the potential to enhance evidence-based decision-making and provide valuable lessons for improving future epidemic preparedness and response in Africa. Contribution: The mpox research demonstrated the vitality of collaborative research efforts, the need for continuous, systematic monitoring of its progress and the need for real-time dissemination of research findings to inform practices that ensure an effective response to mpox. Real-time dissemination of research findings, starting with early community engagement, is critical to ensure that research findings are translated into action.
Background: Globally, there has been an increase in neurological disorders such as stroke and spinal cord impairments, which often result in permanent disability and require long-term care. However, there is limited evidence on factors influencing the continued care journey for people with neurological disabilities. Aim: This study aimed to explore the barriers and facilitators experienced by people with neurological disabilities throughout their care journey. Setting: This study was conducted in a specialised rehabilitation hospital. Methods: An explorative qualitative design was used. Semi-structured interviews were conducted with 26 patients with neurological disabilities and 15 health professionals. MAXQDA (2024) software was utilised for thematic data analysis. Results: Key environmental barriers influencing the care journey included limited or delayed access to care, inaccessible infrastructure and transport, a lack of health resources, financial and employment challenges, and poor support and attitudes. Personal factors were identified as the impact of limitations or restrictions on physical function, the patient’s own beliefs, and self-motivation. Conclusion: People with neurological disabilities experience numerous barriers that suggest gaps in the health system. Throughout the care journey, there is a need to improve health system responsiveness, service accessibility, treatment quality, and health system governance. Contribution: Specialised health services and system improvements are recommended for people with neurological disabilities, particularly in rehabilitation care and community integration.
Background: Oral health conditions are preventable, but frequently neglected because of limited knowledge, negative attitudes, and misconceptions within communities. Aim: This study aimed to determine the oral health knowledge, attitudes, and practices and factors associated with these outcomes and self-reported oral pain among community members across four communities (two urban and two semi-rural) in the Western Cape, South Africa. Setting: Two urban and two semi-rural communities in the Western Cape, South Africa. Methods: A cross-sectional survey using a researcher-administered questionnaire with validated instruments (The World Health Organization [WHO] Oral Health Assessment and the Rustvold Scale) was conducted among 776 adults, with knowledge, attitudes, and practices measured using composite scores. Data were analysed using descriptive and multivariable analyses to identify socio-demographic factors associated with knowledge, attitudes, and practices, as well as factors associated with self-reported oral pain. Results: Most respondents were female (n = 567, 73.1%) with a mean age of 42.3 ± 14.2 years. Overall knowledge was moderate (mean score: 68.4%, 6.84, ± 1.4). While most respondents reported daily toothbrushing and using fluoride toothpaste, only 13.8% used dental floss, and fewer than 20% had visited a dentist in the past year, primarily for pain. In multivariable logistic regression analysis, semi-rural residence (adjusted odds ratio [aOR]: 2.1; 95% confidence interval [CI]: 1.4–3.1), female gender (aOR: 1.6; 95% CI: 1.2–2.3), and poor self-reported health status aOR: 1.8; 95% CI: 1.2–2.7 were associated with higher odds of self-reported oral pain. Conclusion: Despite moderate knowledge and positive attitudes, gaps in oral health practices persist, with higher odds of oral pain among semi-rural residents and those with poorer health. Contribution: Findings support targeted oral health promotion and improved access to preventive care in semi-rural communities.
Snakebite envenomation remains one of the most neglected tropical diseases (NTDs), with clinical management primarily focused on survival and acute complications. While mortality and limb-related disability have been well documented, potential auditory and vestibular sequelae remain underexplored, particularly within African health systems. Emerging evidence, primarily from non-African settings, suggests that snakebite survivors may experience hearing loss and vestibular dysfunction; however, these outcomes are not routinely recognised or integrated into rehabilitation pathways. This article provides a conceptual public health perspective informed by existing literature and implementation considerations for hearing healthcare in snakebite management. It examines potential mechanisms of snakebite-associated audiological dysfunction and identifies gaps in surveillance, research and post-acute care within sub-Saharan Africa. We propose the integration of task-shifted and technology-supported audiological screening, referral pathways and rehabilitation services into snakebite care frameworks. Strengthening surveillance and incorporating functional outcomes into national NTD strategies may improve post-snakebite disability prevention and rehabilitation outcomes across African health systems.
Background: Access to high-quality family planning (FP) services is crucial for addressing unintended pregnancies and maternal mortality. There is uncertainty about health expenditures, especially FP services, by financing sources. Aim: The study aims to conduct key analyses on health and reproductive health expenditures in the West African Economic and Monetary Union (WAEMU). Setting: This analysis was performed across the eight WAEMU countries (Benin, Burkina Faso, Côte d’Ivoire, Guinea-Bissau, Mali, Niger, Senegal and Togo) from 2013 to 2021. Methods: We conducted a secondary data analysis using the Global Health Expenditures Database. The variables were the current health expenditures, reproductive health expenditures, and FP expenditures by funding source (National General Government, External Funding Sources, and National Private Sector). We performed a trend and funding-source analysis in purchasing power parity in United States dollars. Results: Current expenditures allocated to health, reproductive, and FP services increased in recent years, growing by 4.6%, 5.9%, and 2.7% per year, respectively, in the region. The evidence is strong that countries have commitments to improving health and strengthening access to reproductive health services, especially modern contraceptives. However, FP funding is still dependent on external resources. In most countries, including Benin, Burkina Faso, Guinea- Bissau, Mali, and Senegal, more than half of FP expenditures are funded by external resources, whereas Côte d’Ivoire and Niger rely heavily on government resources. In Togo, the main FP funding sources are the domestic private resources. Conclusion: The significant dependence of Public Finance management systems on external funding, with the government’s low contribution, may undermine the sustainability of FP programmes in these countries. Contribution: The evidence suggests increasing domestic resource mobilisation for FP through integrated co-financing mechanisms and advocacy for FP reprioritisation within governments’ health budgets, and ensuring efficient and equitable allocation of existing resources through resource reprogramming based on the country background, national priorities, and high-impact interventions.
Background: Hearing impairment affects speech-language and academic development, creating substantial lifelong public health and economic burdens. In South Africa, early intervention typically follows either the Listening and Spoken Language–South Africa (LSL-SA) or Traditional Speech-Language Therapy (TSLT) model. Although LSL-SA demonstrates promising outcomes, limited evidence compares its costs with TSLT in low- and middle-income countries (LMICs). Such evidence is needed to inform equitable health financing and disability-inclusion policies. Aim: This study aimed to compare the total and component costs of LSL-SA and TSLT; describe cost distribution across healthcare, education and family domains and identify barriers to accessibility and scalability. Setting: This study was conducted in South Africa and examined intervention pathways for children with hearing impairment. Methods: A comparative costing approach was used to estimate expenditures across healthcare, education, and family sectors and compare the economic implications of LSL-SA and TSLT. Results: Listening and Spoken Language–South Africa incurred higher upfront therapy and rehabilitation costs but achieved superior outcomes, with 78% of children placed in mainstream schools compared with 42% in the TSLT group. The average total cost per child was ZAR 1.08 million for LSL-SA and ZAR 1.02 million for TSLT. Healthcare accounted for 65% of LSL-SA expenditure, whereas TSLT incurred higher education costs (35%) because of greater reliance on special schooling. Overall, LSL-SA demonstrated a more favourable cost-outcome profile despite its higher initial investment. Conclusion: Despite greater upfront investment, LSL-SA produced better educational outcomes and a more favourable cost-outcome profile than TSLT. Contribution: This study provides LMIC-specific economic evidence to inform resource allocation, disability-inclusive policies, and investment in early hearing intervention.
Background: South Africa faces significant health challenges due to a combination of infectious diseases, non-communicable diseases, malnutrition and underdevelopment among children. While policies aimed at improving child health and development have sought to address these issues by focusing on improving healthcare access, nutrition, education and equitable service delivery, gaps in implementation persist. Aim: To map available literature and policy documents regarding child health and development in South Africa over the last 15 years. Setting: The review was conducted in South Africa. Method: The scoping review was conducted using the Joanna Briggs Institute methodology and reported following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews. We searched using academic databases (MEDLINE, Google Scholar, African Journals Online [AJOL]), government reports (South African Department of Health, National Planning Commission) and grey literature from 2008 to 2023. All authors were involved in the study selection and data extraction, and over 90% agreement was reached to include relevant articles. Records were screened using predefined inclusion criteria. Data were charted and synthesised thematically to map policy domains and identify implementation patterns and evidence gaps. Results: Policy attention was highly concentrated in food provision; maternal and child health; child growth and development; economic well-being; and access to resources, though these themes showed uneven articulation and poor-to-moderate implementation. The policy landscape also reflected poor prioritisation and weak articulation in practice for caregiver mental health and child psychosocial well-being. Major barriers include inequitable resource allocation and service delivery across provinces, limited intersectoral collaboration and incomplete monitoring data. Conclusion: South Africa has developed comprehensive child health and development policies; however, gaps in implementation continue to hinder progress. Contribution: The findings can help address gaps in the implementation of child health and development policies in South Africa through policy integration, equitable resource distribution and improved data monitoring to meet child health and development goals.
Background: Schools in rural Namibia face severe health challenges (malnutrition, infectious diseases, poor sanitation), leading to high learner absenteeism and poor academic performance. Current school health policies are often fragmented and insufficient to address these issues comprehensively. Aim: This study aimed to develop an evidence-based, contextually relevant conceptual framework to enhance school health policies in Namibia and similar resource-limited Southern African settings. Setting: The problem context is rural areas across Southern Africa. The resulting framework is specifically tailored for implementation in Namibia. Methods: This study employed a convergent mixed-methods design. A systematic review (following Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 guidelines) synthesised evidence on African school health policy. Qualitative data were collected through 15 key informant interviews and 3 focus groups (n = 30) with key stakeholders, including educators, healthcare professionals and community members, using purposive sampling and thematic analysis. Results: The study developed a conceptual framework for Namibia. It integrates key components: evidence-based policy development, equitable resource allocation, capacity building and robust monitoring and evaluation. The framework emphasises stakeholder collaboration and addresses specific rural challenges, such as infrastructure gaps and inconsistent implementation. Conclusion: The proposed framework provides an evidence-based, contextually relevant approach to significantly improve school health policies in Namibia. It directly addresses the unique challenges of resource-limited Southern African settings. Contribution: The framework fills a crucial policy gap and offers a differentiated model focused on improving learners' health and educational outcomes, moving beyond generic global approaches.
