Journal of Reproductive Health, Gender, and HIV in Africa
Journal of Reproductive Health, Gender, and HIV in Africa is a peer‑reviewed scholarly journal published under the Pan‑African Research Journals (PARJ) platform, advancing African‑centred and global research.
Bayesian Hierarchical Model Evaluation of Community Health Centre Systems in Ghana
This study evaluates community health centre systems in Ghana from to , focusing on methodological improvements and efficiency gains. A Bayesian hierarchical model was employed to evaluate community health centre systems in Ghana. This approach allows for the integration of data from multiple sources, including patient records and administrative data. The analysis revealed significant efficiency gains in certain service delivery areas, particularly in maternal healthcare where improvements were noted by a factor of 12% over the study period. This research demonstrates the effectiveness of using Bayesian hierarchical models for evaluating community health centre performance and highlights specific areas that require targeted interventions. Recommendation is made to focus on improving maternal healthcare services, especially in underserved regions, based on the findings from this study. Treatment effect was estimated with $\text{logit}(p_i)=\beta_0+\beta^\top X_i$, and uncertainty reported using confidence-interval based inference.
Copyright (c) 2011 https://creativecommons.org/licenses/by/4.0/
Methodological Evaluation of Emergency Care Units in Uganda
Emergency care units (ECUs) play a critical role in managing acute health conditions in Uganda, where access to medical services is often limited. A randomized field trial design was employed with 120 randomly selected healthcare facilities. Participants included patients presenting to these units for acute conditions over two months. Clinical data were collected using standardised forms, and the primary outcome measure was the time from presentation to initial treatment (TTIT). The average TTIT across all ECUs was reduced by 45% compared to a control group of non-randomized facilities (90 minutes vs. 160 minutes, respectively), with a 95% confidence interval. This study demonstrates the efficacy of randomized field trials in assessing clinical outcomes within emergency care units and highlights the need for further implementation studies. The findings should inform policy on resource allocation and service delivery improvements in Uganda’s healthcare system. Treatment effect was estimated with $\text{logit}(p_i)=\beta_0+\beta^\top X_i$, and uncertainty reported using confidence-interval based inference.
Impact of School-Integrated HIV/AIDS Counseling and Testing Programmes on Adolescent Sexual Health Behaviors in Rural Tanzanian High Schools
Adolescent sexual health behaviors in rural Tanzanian high schools are influenced by various factors including HIV/AIDS stigma and risk perceptions. A longitudinal study design was employed with data collected from baseline surveys in and follow-up assessments every two years until . A mixed-method approach combining quantitative survey data and qualitative interviews was used to assess changes in sexual health behaviors, knowledge, and attitudes. There was a significant decrease (p < 0.05) in the proportion of students who reported condom use during their first sexual encounter from baseline to follow-up surveys, indicating improved awareness and behavioural change towards safer sex practices. The school-integrated HIV/AIDS counseling and testing programme demonstrated effectiveness in enhancing knowledge about HIV transmission and prevention among adolescent populations in rural Tanzanian high schools. Continuation of such programmes with additional support for peer education initiatives is recommended to sustain the positive behavioural changes observed. HIV/AIDS, Adolescent Sexual Health, Counseling and Testing, Rural Tanzania, Longitudinal Study Treatment effect was estimated with $\text{logit}(p_i)=\beta_0+\beta^\top X_i$, and uncertainty reported using confidence-interval based inference.
Copyright (c) 2010 https://creativecommons.org/licenses/by/4.0/
Longitudinal Analysis of Community Health Worker Programmes' Success in Reducing Maternal Mortality Among Pregnant Women in Urban Zimbabwean Centers,Setting
Urban centers in Zimbabwe have seen an increasing maternal mortality rate (MMR), prompting a need for innovative interventions to reduce this burden. A longitudinal analysis was conducted using data from to , employing logistic regression models with robust standard errors to assess programme impact on maternal mortality reduction. During the study period, there was an observed decline in MMR by approximately 18% among participants who received community health worker services compared to those not involved. The findings suggest that community health worker programmes effectively contributed to reducing maternal mortality rates, though further research is recommended to explore sustained effects and potential areas for improvement. Continuation of these programmes with enhanced monitoring and evaluation mechanisms will be crucial for their long-term success in urban Zimbabwean settings. Treatment effect was estimated with $\text{logit}(p_i)=\beta_0+\beta^\top X_i$, and uncertainty reported using confidence-interval based inference.
Evaluating Mobile Health Clinics in Democratic Republic of Congo
Mobile health clinics have emerged as a critical tool for delivering essential healthcare services to remote communities in Democratic Republic of Congo (DRC). Despite their potential, there is limited evidence on their operational efficiency and impact. A mixed-methods approach combining quantitative data from clinic records and qualitative interviews with community members was employed to analyse 12 months' worth of clinic operations across 5 mobile health units. Patient flow rates were calculated using the standard deviation (SD) method. The analysis revealed that patient flow rates varied significantly by location, ranging from a minimum SD of 0.5 patients per hour in one area to a maximum of 2.1 patients per hour in another, indicating substantial variability in clinic throughput. While the mobile health clinics demonstrated overall positive outcomes and high levels of community satisfaction, they faced challenges related to resource allocation and infrastructure limitations that impeded consistent service efficiency across different regions. Strengthening logistical support for remote clinics, enhancing communication systems between clinics and headquarters, and investing in local healthcare workforce training are recommended to improve clinic performance. Treatment effect was estimated with $\text{logit}(p_i)=\beta_0+\beta^\top X_i$, and uncertainty reported using confidence-interval based inference.
Copyright (c) 2009 https://creativecommons.org/licenses/by/4.0/
Methodological Evaluation of Public Health Surveillance Systems in South Africa Using Quasi-Experimental Design to Assess System Reliability
Public health surveillance systems in South Africa play a crucial role in monitoring disease prevalence and guiding public health interventions. However, their reliability and effectiveness can be assessed through methodological evaluations. This study will employ a mixed-methods approach, combining quantitative data from existing surveillance databases with qualitative interviews of key stakeholders. A causal inference model will be used to estimate the impact of system operations on disease prevalence estimates. A preliminary analysis suggests that there is a significant positive correlation (p < .05) between automated reporting systems and accurate incidence rate calculations, indicating high reliability in routine surveillance activities. The findings highlight the importance of continuous system validation to maintain data integrity and public health relevance. System administrators are advised to conduct regular audits and incorporate feedback mechanisms from surveillance users to ensure ongoing accuracy and responsiveness. Public Health Surveillance, Reliability Evaluation, Quasi-Experimental Design, South Africa Treatment effect was estimated with $\text{logit}(p_i)=\beta_0+\beta^\top X_i$, and uncertainty reported using confidence-interval based inference.
Efficacy of Community Health Worker Programmes on Breastfeeding Practices among Primiparous Mothers in Nairobi, Kenya
Community health worker programmes have been implemented to improve breastfeeding practices among primiparous mothers in Nairobi, Kenya. A comprehensive search strategy was employed to identify relevant studies published between and . Studies were included if they reported outcomes related to community health worker interventions, breastfeeding practices, and primiparity in Nairobi, Kenya. Data extraction and quality assessment were conducted using standardised procedures. Findings indicate that programmes involving more frequent home visits by trained health workers significantly extended the duration of exclusive breastfeeding compared to control groups (mean difference = 2 months; CI: 0.4-3.8). Community health worker programmes appear effective in promoting longer and more exclusive breastfeeding practices among primiparous mothers. Future interventions should focus on scaling up proven community-based models with additional resources for sustaining long-term benefits.
Copyright (c) 2008 https://creativecommons.org/licenses/by/4.0/
Methodological Evaluation of Public Health Surveillance Systems in Tanzania Using Multilevel Regression Analysis to Measure Cost-Effectiveness
Public health surveillance systems in Tanzania are crucial for monitoring diseases such as HIV/AIDS, but their effectiveness varies across regions and over time. Multilevel regression analysis will be employed to assess the impact of surveillance systems at both district (level-1) and national (level-2) levels. Robust standard errors and uncertainty intervals will be used for inference. Data revealed significant variations in HIV prevalence rates between districts, with a notable difference in one district where the system was more effective in detecting cases compared to others. The multilevel regression analysis highlights cost-effective strategies that could improve surveillance systems across Tanzania. Policy recommendations will be provided based on the findings to enhance public health surveillance effectiveness and efficiency. Treatment effect was estimated with $\text{logit}(p_i)=\beta_0+\beta^\top X_i$, and uncertainty reported using confidence-interval based inference.
Methodological Evaluation of Public Health Surveillance Systems in Senegal
This study addresses a current research gap in Medicine concerning Methodological evaluation of public health surveillance systems systems in Senegal: randomized field trial for measuring risk reduction in Senegal. The objective is to formulate a rigorous model, state verifiable assumptions, and derive results with direct analytical or practical implications. A structured analytical approach was used, integrating formal modelling with domain evidence. The results establish bounded error under perturbation, a convergent estimation process under stated assumptions, and a stable link between the proposed metric and observed outcomes. The findings provide a reproducible analytical basis for subsequent theoretical and applied extensions. Stakeholders should prioritise inclusive, locally grounded strategies and improve data transparency. Methodological evaluation of public health surveillance systems systems in Senegal: randomized field trial for measuring risk reduction, Senegal, Africa, Medicine, case study This work contributes a formal specification, transparent assumptions, and mathematically interpretable claims. Treatment effect was estimated with $\text{logit}(p_i)=\beta_0+\beta^\top X_i$, and uncertainty reported using confidence-interval based inference.
Copyright (c) 2007 https://creativecommons.org/licenses/by/4.0/
Methodological Evaluation of Public Health Surveillance Systems in South Africa Using Panel Data for Efficiency Gains
Public health surveillance systems in South Africa are crucial for monitoring disease prevalence and guiding targeted interventions. However, their effectiveness can be improved through methodological evaluation. Panel-data estimation techniques will be employed to assess system performance and identify areas for improvement. Robust standard errors will account for potential heterogeneity across different geographical regions. Our analysis indicates that the average efficiency score of public health surveillance systems is 72%, with significant variability in efficiency levels between provinces, suggesting room for targeted intervention strategies. The methodological evaluation provides insights into how to enhance the operational effectiveness of surveillance systems, particularly in addressing regional disparities. Interventions should prioritise data collection methods and resource allocation to align with identified inefficiencies observed across different regions. Treatment effect was estimated with $\text{logit}(p_i)=\beta_0+\beta^\top X_i$, and uncertainty reported using confidence-interval based inference.
Methodological Evaluation of District Hospitals Systems in Senegal Using Panel Data for Yield Improvement Assessment
This study addresses a current research gap in Medicine concerning Methodological evaluation of district hospitals systems in Senegal: panel-data estimation for measuring yield improvement in Senegal. The objective is to formulate a rigorous model, state verifiable assumptions, and derive results with direct analytical or practical implications. A structured review of relevant literature was conducted, with thematic synthesis of key findings. The results establish bounded error under perturbation, a convergent estimation process under stated assumptions, and a stable link between the proposed metric and observed outcomes. The findings provide a reproducible analytical basis for subsequent theoretical and applied extensions. Stakeholders should prioritise inclusive, locally grounded strategies and improve data transparency. Methodological evaluation of district hospitals systems in Senegal: panel-data estimation for measuring yield improvement, Senegal, Africa, Medicine, meta analysis This work contributes a formal specification, transparent assumptions, and mathematically interpretable claims. Treatment effect was estimated with $\text{logit}(p_i)=\beta_0+\beta^\top X_i$, and uncertainty reported using confidence-interval based inference.
Copyright (c) 2006 https://creativecommons.org/licenses/by/4.0/
Methodological Assessment of Public Health Surveillance Systems in Ghana
Public health surveillance systems are critical for monitoring infectious diseases in Ghana. However, their effectiveness and efficiency vary. A mixed-methods design combining quantitative data analysis with qualitative interviews to evaluate system performance across different regions. In one region, an increase of 20% in disease detection rates was observed within the first six months after implementing targeted interventions. The randomized field trial demonstrated that specific intervention strategies can significantly enhance surveillance efficiency. Further trials should be conducted to validate these findings and promote broader adoption of improved surveillance systems in Ghana. Treatment effect was estimated with $\text{logit}(p_i)=\beta_0+\beta^\top X_i$, and uncertainty reported using confidence-interval based inference.
Methodological Evaluation of Community Health Centre Systems in Uganda
This study addresses a current research gap in Medicine concerning Methodological evaluation of community health centres systems in Uganda: time-series forecasting model for measuring cost-effectiveness in Uganda. The objective is to formulate a rigorous model, state verifiable assumptions, and derive results with direct analytical or practical implications. A structured review of relevant literature was conducted, with thematic synthesis of key findings. The results establish bounded error under perturbation, a convergent estimation process under stated assumptions, and a stable link between the proposed metric and observed outcomes. The findings provide a reproducible analytical basis for subsequent theoretical and applied extensions. Stakeholders should prioritise inclusive, locally grounded strategies and improve data transparency. Methodological evaluation of community health centres systems in Uganda: time-series forecasting model for measuring cost-effectiveness, Uganda, Africa, Medicine, review article This work contributes a formal specification, transparent assumptions, and mathematically interpretable claims. Treatment effect was estimated with $\text{logit}(p_i)=\beta_0+\beta^\top X_i$, and uncertainty reported using confidence-interval based inference.
Copyright (c) 2005 https://creativecommons.org/licenses/by/4.0/
Methodological Evaluation of District Hospitals Systems in Ethiopia Using Multilevel Regression Analysis to Assess System Reliability
District hospitals in Ethiopia play a critical role in healthcare delivery, particularly for reproductive health services, gender issues, and HIV prevention and treatment. A systematic review was conducted to assess the methodological rigor of studies evaluating district hospitals in Ethiopia. Multilevel regression analysis was employed to measure system reliability. Findings from the reviewed papers indicated that variability existed within and between districts, with some areas reporting higher levels of service provision than others. The multilevel regression analysis revealed significant differences in system performance across regions, highlighting the need for targeted interventions to improve reliability. District health authorities should prioritise resource allocation based on data-driven insights to enhance service delivery and reduce disparities. Treatment effect was estimated with $\text{logit}(p_i)=\beta_0+\beta^\top X_i$, and uncertainty reported using confidence-interval based inference.
Impact Analysis of School-Based Early Adolescent Sexual Health Education Programmes in Nigerian Cities
School-based early adolescent sexual health education programmes are implemented in Nigerian cities to promote knowledge and reduce risky behaviors among young people. A comprehensive search strategy was employed using databases such as PubMed, Scopus, and Web of Science. Studies meeting inclusion criteria were selected based on their methodological rigor and relevance to the study objectives. Findings from included studies suggest a modest reduction in risky sexual behaviors (OR = 0.85; 95% CI: [0.75, 0.96]) among participants who received school-based early adolescent sexual health education compared to those in control groups. School-based early adolescent sexual health education programmes appear effective in reducing risky behaviors but with modest impact. Future research should explore long-term effects and implement these programmes in various settings across Nigeria.
Copyright (c) 2004 https://creativecommons.org/licenses/by/4.0/
This study addresses a current research gap in Medicine concerning Methodological evaluation of public health surveillance systems systems in Senegal: panel-data estimation for measuring yield improvement in Senegal. The objective is to formulate a rigorous model, state verifiable assumptions, and derive results with direct analytical or practical implications. A structured review of relevant literature was conducted, with thematic synthesis of key findings. The results establish bounded error under perturbation, a convergent estimation process under stated assumptions, and a stable link between the proposed metric and observed outcomes. The findings provide a reproducible analytical basis for subsequent theoretical and applied extensions. Stakeholders should prioritise inclusive, locally grounded strategies and improve data transparency. Methodological evaluation of public health surveillance systems systems in Senegal: panel-data estimation for measuring yield improvement, Senegal, Africa, Medicine, review article This work contributes a formal specification, transparent assumptions, and mathematically interpretable claims. Treatment effect was estimated with $\text{logit}(p_i)=\beta_0+\beta^\top X_i$, and uncertainty reported using confidence-interval based inference.
School-based HIV/AIDS Prevention Interventions in Sub-Saharan African Union Member States
Sub-Saharan African Union Member States have implemented school-based HIV/AIDS prevention interventions to mitigate the spread of HIV among adolescents. A mixed-methods approach was employed, including surveys and qualitative interviews with students and educators. Data were analysed using descriptive statistics and thematic content analysis. Findings indicate that while over 80% of participants reported increased awareness about HIV transmission methods, only half demonstrated consistent condom use in their relationships. School-based interventions in Ethiopia show promise but require further customization to address specific knowledge gaps and behaviour changes among students. Interventions should incorporate more interactive sessions and peer-led activities to enhance understanding and adherence. Educators need additional training on sensitive topics such as sexual health and relationships. Treatment effect was estimated with $\text{logit}(p_i)=\beta_0+\beta^\top X_i$, and uncertainty reported using confidence-interval based inference.
Copyright (c) 2002 https://creativecommons.org/licenses/by/4.0/
Adoption and Feedback Analysis of Electronic Medical Records Systems in South African Hospitals of Eastern Cape Province
Electronic Medical Records (EMR) systems have become integral to healthcare delivery in South Africa's Eastern Cape Province, aiming to improve patient care and operational efficiency. A mixed-methods approach was employed, including a survey among healthcare professionals (n = 150) and observational analysis of EMR system usage in five randomly selected hospitals. Quantitative data were analysed using descriptive statistics and inferential tests to assess adoption rates and user satisfaction. The preliminary findings suggest an overall 72% adoption rate for EMR systems across the sampled hospitals, with a significant improvement in patient chart accuracy noted among users who have adopted these systems (p < 0.05). User feedback highlighted improvements in documentation efficiency but also identified challenges related to system complexity and training needs. The study provides insights into the current state of EMR adoption within the Eastern Cape Province healthcare sector, identifying both successes and areas for improvement. Further implementation strategies should focus on enhancing user training programmes and simplifying interface design to maximise system benefits and reduce barriers to adoption.
Methodological Evaluation of Public Health Surveillance Systems in Tanzania Using Time-Series Forecasting Models
Public health surveillance systems play a crucial role in monitoring and managing diseases such as HIV/AIDS in Tanzania. However, their effectiveness can be influenced by various factors including data collection methods and reporting processes. A comprehensive analysis was conducted, employing time-series forecasting models (e.g., ARIMA) to analyse surveillance data from multiple sources. Robust standard errors were used to account for model uncertainty. The findings indicate that there has been a gradual increase in the adoption rates of public health surveillance systems across different regions of Tanzania over the past five years, with an average adoption rate of 75%. This study highlights the positive trends in adopting and utilising surveillance systems but also underscores the need for continuous monitoring and refinement to ensure their efficacy in disease control. Recommendations include expanding training programmes for healthcare workers on data collection methods, enhancing infrastructure support for surveillance units, and promoting standardised reporting protocols across all regions. Treatment effect was estimated with $\text{logit}(p_i)=\beta_0+\beta^\top X_i$, and uncertainty reported using confidence-interval based inference.
Copyright (c) 2001 https://creativecommons.org/licenses/by/4.0/
Bayesian Hierarchical Model in Assessing Clinical Outcomes within Urban Primary Care Networks in Tanzania
Urban primary care networks in Tanzania aim to improve access to healthcare services for underserved populations. However, there is a need for robust methods to assess clinical outcomes across these networks. A Bayesian hierarchical model was employed to analyse data from multiple urban primary care clinics in Tanzania, accounting for both clinic-specific and patient-level variability. The model accounts for uncertainty through robust standard errors and provides confidence intervals on estimated outcomes. The analysis revealed significant heterogeneity in clinical outcomes across different clinics, with some clinics showing better performance than others. The Bayesian hierarchical model offers a nuanced understanding of clinic-specific factors influencing clinical outcomes, facilitating targeted interventions to enhance service quality and patient care. Clinics identified as underperforming should prioritise resource allocation and training programmes to align with best practices observed in higher-performing clinics. Bayesian Hierarchical Model, Urban Primary Care Networks, Clinical Outcomes, Tanzania Treatment effect was estimated with $\text{logit}(p_i)=\beta_0+\beta^\top X_i$, and uncertainty reported using confidence-interval based inference.
Evaluating the Operational Outcomes of a Telehealth Intervention for Post-Abortion Care Counselling in Rural Sierra Leone
Restrictive abortion laws and a high incidence of unsafe abortion contribute to significant maternal morbidity and mortality in Sierra Leone. Rural areas, in particular, face acute shortages of trained counsellors for post-abortion care (PAC), limiting access to essential psychosocial support and contraceptive guidance. This study aimed to evaluate the operational outcomes of a newly introduced telehealth service designed to provide remote PAC counselling to clients at primary health units (PHUs) in the rural Eastern Province. An intervention study was conducted across 12 PHUs. A telehealth model using tablet-based video calls with a specialist counsellor was implemented for PAC clients. Operational data were collected over a multi-month period, focusing on service uptake, technical feasibility, and user and provider acceptability via structured interviews. Service uptake was high, with 94% of eligible clients accepting telehealth counselling. Technical challenges, notably unstable internet connectivity, disrupted 22% of scheduled sessions. Clients appreciated the privacy and specialist access. Healthcare workers reported the service enhanced their role but noted increased initial consultation time. Telehealth is a feasible and highly acceptable method to deliver specialist PAC counselling in rural, resource-limited settings. It can bridge human resource gaps, though sustained success depends on reliable digital infrastructure. Investment in robust internet connectivity at PHUs is critical. Scaling up should include streamlined referral protocols and ongoing training for PHU staff to act as effective telehealth facilitators. telehealth, post-abortion care, counselling, Sierra Leone, maternal health, digital health, operational research This study provides evidence on the implementation of a PAC telehealth service in rural Africa, highlighting its potential to improve service access and the practical barriers to its delivery.
A Systematic Review of Livelihood Interventions and Sexual and Reproductive Health Agency Among Young Women Engaged in Transactional Sex in Kampala, Uganda
Transactional sex is a significant livelihood strategy for many young women in Kampala, Uganda, exposing them to heightened risks of poor sexual and reproductive health (SRH) outcomes. Livelihood interventions have been implemented to address economic vulnerability, but their specific impact on SRH agency within this population remains unclear. This systematic review aimed to synthesise evidence on the effects of livelihood interventions on the sexual and reproductive health agency of young women engaged in transactional sex in Kampala, Uganda. A systematic search of peer-reviewed literature was conducted across major electronic databases. Studies were included if they evaluated a livelihood intervention and measured SRH agency outcomes among young women in transactional sex in Kampala. Standard systematic review procedures for screening, data extraction, and quality assessment were followed. Of the initially identified records, only three studies met the full inclusion criteria. The limited evidence suggested a potential positive association between combined economic empowerment and psychosocial support interventions and increased condom negotiation self-efficacy. However, no study demonstrated a direct, significant effect on broader SRH agency metrics, such as autonomous decision-making or reduced transactional sex engagements. The evidence base on the impact of livelihood interventions on SRH agency for this specific population in Kampala is extremely limited. The available studies are insufficient to draw definitive conclusions about effectiveness. Future research should employ robust, mixed-methods designs with standardised measures of SRH agency. Programmes should integrate tailored SRH education and empowerment components within livelihood initiatives and prioritise participatory approaches to address the complex drivers of transactional sex. Transactional sex, livelihoods, sexual and reproductive health, agency, young women, Uganda, systematic review This review consolidates the scarce existing evidence and highlights a critical gap in knowledge, providing clear directions for future research and programme design aimed at enhancing SRH outcomes for a vulnerable population.
Evaluating a Multi-Level Stigma Reduction Intervention for Healthcare Workers and Community Leaders in Nigerian HIV Clinics
**Revised Abstract** HIV-related stigma within healthcare settings and communities remains a significant barrier to achieving epidemic control in sub-Saharan Africa. This study evaluated a multi-level, 12-month stigma reduction intervention in six Nigerian HIV clinics from 2023 to 2024. The intervention comprised structured participatory training for healthcare workers and facilitated dialogue sessions with community leaders. A concurrent mixed-methods design was employed. Quantitative data were collected using validated scales measuring stigmatising attitudes and behaviours at baseline (n=312) and post-intervention (n=298), analysed via paired t-tests. Qualitative data from 42 in-depth interviews and six focus group discussions with participants were thematically analysed to capture experiential changes and contextual understanding. Integration of data strands occurred during interpretation. Findings demonstrated a statistically significant reduction in stigmatising attitudes among healthcare workers (p<0.01), particularly regarding fears of casual transmission. Community leaders reported increased advocacy and proactive countering of misinformation. Qualitative analysis generated key themes of improved client-provider interactions and the catalytic role of community leadership in shifting normative beliefs. The study concludes that concurrently addressing institutional and community stigma amplifies intervention impact, providing a replicable model for integrating social and clinical HIV responses. These findings directly inform the implementation of Nigeria’s National HIV/AIDS Strategic Plan, underscoring the necessity of sustained investment in multi-level approaches to foster equitable, stigma-free healthcare environments.
Copyright (c) 2026 https://creativecommons.org/licenses/by/4.0/
Enhancing Male Partner Involvement in PMTCT
Male partner involvement is a crucial but frequently inadequate element of effective prevention of mother-to-child transmission programmes in sub-Saharan Africa. In rural Uganda, logistical and socio-cultural barriers substantially reduce men’s participation in antenatal and PMTCT services. This study aimed to evaluate the effect of a multi-component intervention on increasing male partner involvement within a PMTCT programme in rural Uganda. A quasi-experimental trial was implemented at two comparable health centres. The intervention site received a package of targeted couple counselling, appointment reminders via SMS, and a transport subsidy. The comparison site continued with standard of care. The primary outcome was the proportion of male partners attending at least one antenatal PMTCT session with their partner. The intervention significantly increased male partner involvement. At the intervention site, 68% of male partners attended at least one PMTCT session, compared to 24% at the comparison site. Qualitative feedback indicated the transport subsidy was perceived as the most enabling component. A pragmatic, multi-component intervention successfully enhanced male partner involvement in a rural PMTCT programme by addressing key practical and motivational barriers. PMTCT programmes in similar rural contexts should consider integrating tailored support, including transport subsidies and digital reminders, to facilitate male engagement. Further research should explore cost-effectiveness and long-term sustainability. Male involvement, Prevention of mother-to-child transmission, PMTCT, Uganda, Antenatal care, Sub-Saharan Africa This study provides evidence for a feasible, multi-faceted strategy to improve male partner engagement in PMTCT, a persistent challenge in rural African health systems.
Prevention of mother-to-child transmission
An Ethnographic Study of Peer-Distributed HIV Self-Testing
HIV remains a significant public health challenge in sub-Saharan Africa, with university students being a key demographic for prevention. HIV self-testing (HIVST) is a strategy to increase testing coverage, but its distribution through peer networks in university settings is under-researched. This ethnographic study aimed to explore the acceptability and feasibility of peer-distributed HIV self-testing among university students in Yaoundé, Cameroon. An ethnographic study was conducted over several months. Data collection included participant observation in student social and residential settings, and in-depth interviews with 42 university students who had received an HIVST kit from a trained peer distributor. Field notes and interview transcripts were analysed thematically. Peer distribution was highly acceptable. Students valued the confidentiality, convenience, and non-judgemental approach of peers, with a prominent theme being the reduction of anticipated clinic-based stigma. Regarding feasibility, logistical challenges included discreet kit storage and the initial cost of kits. Approximately three-quarters of interviewed participants reported using the self-test kit. Peer distribution is an acceptable and largely feasible model for delivering HIV self-testing to university students in this setting, as it addresses critical barriers such as stigma and access. Programmes should integrate peer-distributed HIVST into campus health initiatives. Training for peer distributors should include counselling skills and logistical support for kit storage and referral pathways. HIV self-testing, peer distribution, university students, Cameroon, acceptability, feasibility, ethnography This study provides an in-depth, contextual understanding of the social and logistical dimensions of peer-led HIV self-testing distribution in a West African university, informing future implementation strategies.
Evaluating the Impact of a School-Based Training Intervention on Breast Self-Examination Uptake and Accuracy Among Female Teachers in Gaborone
This study addresses a current research gap in Medicine concerning Uptake and accuracy of breast self-examination practices following a training intervention for female teachers in secondary schools in Gaborone in Ghana. The objective is to clarify key debates, identify practical implications, and outline a focused agenda for scholarship and policy. A mixed‑methods design was used, combining survey and interview data collected over the study period. The analysis indicates persistent structural constraints alongside emerging local innovations; however, evidence remains uneven across contexts and sectors. The paper argues for context‑specific approaches and stronger empirical foundations in future research. Stakeholders should prioritise inclusive, locally grounded strategies and improve data transparency. Uptake and accuracy of breast self-examination practices following a training intervention for female teachers in secondary schools in Gaborone, Ghana, Africa, Medicine, original research This structured abstract provides a standardised summary to support rapid screening, indexing, and assessment of scholarly contribution.
Men in sub-Saharan Africa, particularly in rural settings, have lower rates of HIV testing and knowledge of status compared to women. A prior study in Lesotho found community-led, door-to-door testing increased uptake. This replication study assessed the robustness of those findings for men’s knowledge of status and linkage to care in a different rural context. The purpose was to replicate the assessment of a community-led, door-to-door HIV testing campaign’s impact on men’s knowledge of HIV status and linkage to care in rural Lesotho. The objective was to determine if the previously observed positive effects could be reproduced in different rural districts. A replication study using a cross-sectional, observational design was conducted. Trained community health workers performed door-to-door HIV testing and counselling in selected rural villages. Data were collected from adult male participants on testing uptake, knowledge of HIV status, and, for those testing positive, referral and linkage to care. Analysis compared proportions before and after the campaign. The campaign increased the proportion of men who knew their HIV status. Linkage to care for men newly diagnosed with HIV was 78% within one month of diagnosis. However, the absolute increase in overall knowledge of status among the male population was more modest than reported in the original study. Community-led, door-to-door testing is an effective strategy for improving knowledge of HIV status among men in rural Lesotho and can achieve high initial care linkage. This replication confirms the core finding but indicates the population-level impact on knowledge may vary by context. Programmes should continue to invest in and scale up community-led testing to reach men. Further research should investigate contextual factors influencing uptake and develop complementary strategies to enhance impact. HIV testing, men, rural health, community health workers, Lesotho, linkage to care, replication study. This study provides replicated evidence on the effectiveness of a community-led HIV testing model for men in rural Africa, confirming its utility while highlighting contextual variations in outcome magnitude.
Copyright (c) 2000 https://creativecommons.org/licenses/by/4.0/
A Systematic Review of the Prevalence of Cervical Precancerous Lesions Among HIV-Positive Women Following HPV Vaccination in KwaZulu-Natal, South Africa
Women living with HIV (WLHIV) in sub-Saharan Africa carry a disproportionate burden of cervical cancer, which is primarily caused by persistent human papillomavirus (HPV) infection. HPV vaccination is a key preventive intervention. Evaluating its impact through demonstration projects in high-prevalence settings such as KwaZulu-Natal, South Africa, is crucial for this immunocompromised population. This systematic review aimed to synthesise evidence on the prevalence of cervical precancerous lesions among WLHIV who received HPV vaccination within a KwaZulu-Natal demonstration project. The objective was to establish a consolidated prevalence estimate and to identify gaps in the existing literature. A systematic search was performed across multiple electronic databases for peer-reviewed literature. Eligible studies reported the prevalence of histologically or cytologically confirmed cervical intraepithelial neoplasia (CIN) grade 2 or higher among vaccinated WLHIV in KwaZulu-Natal. Study screening, data extraction, and quality assessment were conducted independently by two reviewers. The search identified a limited number of eligible studies. The synthesis suggests a lower prevalence of high-grade precancerous lesions (CIN2+) among vaccinated WLHIV compared to unvaccinated WLHIV in the same region. One included study reported a CIN2+ prevalence of 5.2% in its vaccinated cohort. The available evidence, though limited, indicates a potential protective effect of HPV vaccination against high-grade cervical precancerous lesions in WLHIV in KwaZulu-Natal. This finding highlights the value of integrating vaccination into comprehensive HIV care. Further longitudinal research with larger sample sizes and extended follow-up is required. Integration of routine cervical screening with HPV vaccination programmes for WLHIV should be prioritised. Health policy should support sustained investment in both vaccination and screening within this high-risk group. human papillomavirus, HPV vaccination, HIV, women, cervical intraepithelial neoplasia, prevalence, systematic review, South Africa, KwaZulu-Natal This review consolidates initial evidence on post-vaccination cervical precancer prevalence among WLHIV in a high-burden African setting, informing clinical practice and highlighting critical research priorities for cancer prevention.
Assessing the Impact of COVID-19 Pandemic Disruptions on Vertical Transmission of HIV and Syphilis in São Tomé and Príncipe
This mixed-methods study evaluated the impact of health system disruptions related to the COVID-19 pandemic on the vertical transmission of HIV and syphilis in São Tomé and Príncipe. It aimed to quantify changes in prevention of mother-to-child transmission (PMTCT) service coverage and outcomes, while qualitatively exploring the lived experiences of pregnant women and healthcare providers. A convergent parallel design integrated a quantitative longitudinal analysis of national antenatal and PMTCT programme data (2021–2025) with a qualitative thematic analysis of 30 in-depth interviews conducted with key stakeholders in early 2026. Quantitative results demonstrated a significant initial decline in first antenatal clinic attendance and syphilis screening rates during 2021–2022, with a corresponding increase in the risk of vertical transmission for both infections. Partial service recovery was observed by 2024. Qualitative analysis revealed that disruptions were driven by community fear of infection, transport restrictions, and the redeployment of maternal health staff, which exacerbated pre-existing systemic vulnerabilities. The study concludes that the pandemic exposed and intensified structural fragilities within the West African PMTCT architecture, reversing progress towards elimination targets. These findings underscore the necessity for health systems to develop resilient, integrated antenatal care models that can withstand future shocks. Priorities include strengthening community-based service delivery and ensuring robust medical supply chains to safeguard maternal and child health.
Copyright (c) 2022 https://creativecommons.org/licenses/by/4.0/
A Qualitative Exploration of COVID-19 School Closures, Adolescent Pregnancy, and Sexual and Reproductive Health Service Access in Sierra Leone (2021–2026)
This qualitative study investigates the intersection of COVID-19 school closures, adolescent pregnancy, and sexual and reproductive health (SRH) service access in Sierra Leone from 2021 to 2026. It addresses a critical gap in understanding the pandemic’s gendered health consequences by examining how prolonged educational disruption affected girls’ vulnerability to unintended pregnancy and their capacity to utilise SRH services. Employing a phenomenological approach, the research gathered data through in-depth interviews and focus group discussions with 45 adolescent girls and young women (aged 15–20) across three districts, supplemented by key informant interviews with 15 healthcare providers and community stakeholders. The analysis reveals that school closures fostered a ‘risk environment’, wherein economic precarity, increased idleness, and reduced social protection exacerbated transactional and age-disparate sexual relationships. Simultaneously, access to youth-friendly SRH services was severely constrained by pandemic restrictions, pervasive stigma, and a documented diversion of clinical resources towards COVID-19 response, which actively deterred help-seeking. The study concludes that the pandemic acted as a profound systemic shock, intensifying pre-existing failures in safeguarding adolescent sexual health. It argues that future health emergency responses must integrate robust, accessible adolescent SRH provisions and prioritise the continuity of comprehensive sexuality education to mitigate such compounded vulnerabilities.
Copyright (c) 2025 https://creativecommons.org/licenses/by/4.0/