Shane Anthony Norris

Background: Globally, research and public health interest in preconception health is growing. Preconception health is a public health agenda aiming to intervene before people reproduce to improve current and transgenerational disease risk. One key project of preconception health agendas will be to improve sexuality and reproductive (S&R) health knowledge through health promotion and education. Sexuality and reproductive knowledge is, however, influenced by specific historical, socio-political and structural contexts. We investigate gendered inequities existing in a South African population’s S&R knowledge that preconception health strategies must address. Methods: Our research was guided by a feminist Sexual and Reproductive Justice lens. We collected qualitative data using single semi-structured interviews with Bukhali trial men ( n = 8) and women ( n = 9) in Soweto, Johannesburg. Bukhali is the South African cohort of the Healthy Life Trajectories Initiative - the flagship international consortium trial investigating the effects of a complex intervention on the life course, including the preconception period. Interviews were transcribed verbatim and de-identified and analysed using reflexive thematic analysis. Results: Based on our interpretation of the data, we generated three dominant themes that make visible gendered inequities in South African’s S&R knowledge regarding access and content. The first theme makes visible the intergenerational avoidance of open S&R communication that disproportionately affects men. The second highlights the culturally significant value around gender-aligned S&R content and communication that emphasises heteronormativity. Finally, theme three shows how clinical spaces create and reproduce inequitable gendered epistemic norms around S&R knowledge. Conclusions: We find that the content of and access to S&R knowledge amongst our participants is significantly and inequitably gendered, and influenced by historical, sociopolitical, cultural structures. Our findings show that men are more frequently excluded from S&R knowledge, and that women are disproportionately burdened with epistemic responsibilities. Based on our findings, we recommend that preconception health and life course agendas be epistemically and structurally gender-inclusive to promote sexual and reproductive justice.

Summary Background: In 2025, the Lancet Commission proposed a framework distinguishing preclinical from clinical obesity and requiring confirmation of excess adiposity beyond BMI. The Commission recommended that obesity should be classified as either clinical or preclinical based on the presence (clinical obesity) or absence (preclinical obesity) of obesity-related organ dysfunction or functional limitations. We compared BMI-derived obesity with the Lancet criteria based on waist circumference (Lancet-WC) and dual-energy X-ray absorptiometry (Lancet-DXA) and evaluated their associations with incident diabetes and hypertension in middle-aged Black South African adults.Methods:Baseline data were available for 889 women and 821 men aged 40-60 years. Obesity prevalence was compared using WHO BMI, and Lancet-WC and Lancet-DXA criteria. Participants were followed for 10-12 years to determine incident diabetes and hypertension. Multivariable logistic regression examined associations between obesity classifications and incident outcomes.Findings: Obesity prevalence differed substantially across classification methods. Among women, obesity prevalence was 65·4% by BMI, 90·0% by Lancet-WC, and 51·9% by Lancet-DXA; corresponding estimates among men were 16·7%, 37·4%, and 23·9%, respectively. Among women, only clinical obesity was associated with incident type 2 diabetes (T2D) using both Lancet-WC (AOR 7·48, 95% CI 2·28-24·51) and Lancet-DXA criteria (AOR 3·08, 95% CI 1·34-7·07). Among men, Lancet-WC preclinical obesity (AOR 2·44, 95% CI 1·37-4·37) and clinical obesity (AOR 3·45, 95% CI 1·25-9·51) were associated with incident T2D, whereas Lancet-DXA identified risk only among those with preclinical obesity (AOR 2·13, 95% CI 1·10-4·15). No obesity classification predicted incident hypertension.Interpretation: The Lancet framework revealed variation in obesity prevalence across classification methods and identified heterogeneity in T2D risk that was not captured by BMI alone. A WC-derived obesity implementation of the Lancet framework appeared to provide greater clinical utility than the DXA-derived approach and may offer a pragmatic and accessible strategy for obesity risk stratification in African populations.

Background: Heat-health evidence from sub-Saharan Africa rests mainly on mortality and hospital admissions, while the region holds decades of clinical cohort data. We asked whether those archives can be screened for testable hypotheses about who is vulnerable to heat, where HIV prevalence is high and treatment and comorbidity may alter heat sensitivity.Methods: We harmonised 14 Johannesburg cohorts (2005–2022; 9,745 adults), linked visits to daily mean ERA5-Land temperature (≈9 km), and screened 24 biomarkers across eight domains with machine-learning models over 0–30-day lags, judged by cross-validated R-squared with SHAP values for timing. Sex, HIV status and socioeconomic position were tested as modifiers, and participants grouped by response pattern.Findings: The screen retained 10 of 24 biomarkers across six domains (cross-validated R-squared 0·051 to 0·364). Haematological and cardiovascular measures responded within days, lipids over weeks; body composition marked standing traits; sex was the commonest modifier. Three profiles emerged: young and marginalised (47·1%), older and employed (13·4%), and a third (39·5%) in which 77·8% were living with HIV and several systems moved together.Interpretation: Screening pooled clinical data across many biomarkers and lags generates testable candidates for who is heat-vulnerable and which measures to watch. Here it returned a coherent multi-system signal and concentrated people living with HIV in one profile. That profile emerged from clustering, not a pre-specified test, and direct HIV-by-temperature interactions were not significant, so it needs confirmation. People living with HIV are a priority for heat-health surveillance.Funding: National Institutes of Health (U54 TW 012083, Fogarty International Center).

Plasma proteomic scores for body mass index have been derived primarily in European populations, and it is unclear whether these scores are generalizable and useful in other ancestries. Here, we show that plasma proteomic BMI scores developed in participants of European, East Asian, South Asian and African ancestries from the UK Biobank (UKBB; N=50,621) and the South African Middle-Aged Soweto Cohort (MASC; N=948) are portable across ancestries, explain up to 48.7% of trait variance and significantly predict incident obesity. We identified eight protein biomarkers common across all scores, six of which showed causal associations with BMI in Mendelian randomization analyses and were associated with BMI across the Olink (UKBB, MASC) and SomaScan platforms (Qatar Biobank; N= 2410). Discrepancy analysis between the high predicted proteomic BMI and low measured BMI revealed metabolically unhealthy normal weight (MUNW) individuals, with higher visceral fat, elevated triglycerides, and low insulin sensitivity. Thus, plasma proteomic BMI scores may enhance the precision of cardiometabolic risk stratification across diverse populations

Plasma proteomic scores for body mass index have been derived primarily in European populations, and it is unclear whether these scores are generalizable and useful in other ancestries. Here, we show that plasma proteomic BMI scores developed in participants of European, East Asian, South Asian and African ancestries from the UK Biobank (UKBB; N = 50,621) and the South African Middle-Aged Soweto Cohort (MASC; N = 948) are portable across ancestries, explain up to 48.7% of trait variance and significantly predict incident obesity. We identified eight protein biomarkers common across all scores, six of which showed causal associations with BMI in Mendelian randomization analyses and were associated with BMI across the Olink (UKBB, MASC) and SomaScan platforms (Qatar Biobank; N = 2410). Discrepancy analysis between the high predicted proteomic BMI and low measured BMI revealed metabolically unhealthy normal weight (MUNW) individuals, with higher visceral fat, elevated triglycerides, and low insulin sensitivity. Thus, plasma proteomic BMI scores may enhance the precision of cardiometabolic risk stratification across diverse populations.

Knowledge, attitudes, and behaviours (KAB) influence mental health outcomes and vary across sociodemographic groups. In South Africa, where there is a high burden of mental health conditions, it is important to understand these factors to inform public health strategies. This study examined (a) group differences in mental health KAB and diagnosis; (b) associations between sociodemographic factors, KAB, and mental health diagnosis; and (c) whether mental health literacy (MHL), self-stigma, and help-seeking mediate the relationship between socioeconomic status (SES) and diagnosis. We collected data from 1,000 South African adults (aged 18–65) using a cross-sectional online survey. Chi-square and Kruskal–Wallis tests were used to assess group differences, while logistic regression and generalised structural equation modelling (GSEM) were used to examine direct and indirect associations. Higher SES, tertiary education, and employment were associated with greater MHL, reducing stigma, and increasing help-seeking, and a dual burden of health-promoting and risk behaviours. Higher-status groups more often endorsed evidence-based risk and treatment, whereas lower-status groups and men favoured traditional or spiritual explanations. Having a mental health diagnosis was associated with chronic conditions (odds ratio [ OR ] = 2.70, p < .001), perceived stress ( OR = 3.64, p < .001), alcohol use ( OR = 1.53, p = .015), and drug use ( OR = 2.04, p = .002). Higher SES was associated with greater MHL (β = 1.48, p < .001), reducing stigma (β = −0.78, p < .001), and increasing help-seeking (β = 0.12, p = .001). Strategies focused on improving mental health outcomes should address not only MHL and stigma but also Socioeconomic conditions that shape KAB.

Purpose: We examined the psychometric properties of the Pittsburgh Sleep Quality Index (PSQI) in a large sample of young women in Soweto, South Africa, to assess its reliability and structural validity in this context. Methods: Data were collected from 7182 women enrolled in the Bukhali randomized controlled trial, part of the Healthy Life Trajectories Initiative (HeLTI). Sociodemographic information and PSQI data were collected through interviewer-administered surveys. Internal consistency was assessed using Cronbach’s alpha, McDonald’s omega and item-level correlations. Confirmatory factor analysis (CFA) evaluated the original one-factor and established two- and three-factor multidimensional models. Model fit was examined using Root Mean Square Error of Approximation (RMSEA), Comparative Fit Index (CFI), and Tucker–Lewis Index (TLI). Results: Most women (57.4%) reported good sleep quality (PSQI ≤ 5). Poor sleep quality was associated with higher household socioeconomic status (assets score), higher education, and single relationship status. Average sleep was 7.8 hours, characterized by prolonged onset latency and high fragmentation, suggesting that continuity disruptions rather than opportunity shortage drove poor sleep. The PSQI had modest internal consistency (α = .57; ω = .57; item–total r = .33 – .65). The one-factor model demonstrated poor fit (χ ² (14) = 1677.70; CFI = .65; TLI = .48; RMSEA = .13) whereas fit was good for the two-factor (χ ² (13) = 291.46; CFI = .94; TLI = .91; RMSEA = .05) and three-factor models (χ ² (11) = 285.21; CFI = .94; TLI = .89; RMSEA = .06). Conclusion: The PSQI showed a multidimensional structure in this population. While both multidimensional models performed well, the two-factor model showed slightly better fit and is recommended for use in this population. Interpreting PSQI components rather than the global score offers more meaningful insight into sleep quality and highlights the need for context-specific psychometric validation in diverse settings. Brief Summary: Current Knowledge/Study Rationale: The Pittsburgh Sleep Quality Index is widely used, but prior evidence shows its reliability and factor structure vary across populations, settings, and sex. Young women in under-resourced urban South African settings may experience sleep disruption shaped by psychosocial stress, safety concerns, caregiving demands, and environmental factors, yet the PSQI had not been evaluated in this population. Study Impact: In this large Soweto cohort, sleep problems appeared driven more by fragmented sleep and continuity disruptions than by insufficient sleep opportunity. The PSQI performed better as a multidimensional measure, particularly a parsimonious two-factor structure, than as a single global score. The findings support using component- or factor-informed PSQI interpretation and highlight the need for context-specific validation of sleep measures in diverse populations.

Non-communicable diseases (NCDs), such as cardiovascular diseases, diabetes, chronic respiratory diseases, and cancers, account for about 75% of the global deaths, with the greatest burden falling ...

Despite the rising cancer burden in Soweto, South Africa and the recognized role of Traditional Health Practitioners (THPs) in the pluralistic health system, their role in cancer care remains underexplored. This study provides novel insights into THPs' understanding of cancer and their potential contribution to community awareness and early detection within complex sociocultural and health system contexts. To explore THPs perceptions of cancer and the factors influencing their role in community cancer awareness and early detection in Soweto. An exploratory qualitative design was adopted. Purposive and snowball sampling were used to recruit 13 THPs in Soweto. Each participated in two in-depth interviews. Data were transcribed, coded, and thematically analyzed using Dedoose. Seven of the 13 THPs had encountered clients with cancer-related symptoms. The THPs described navigating cancer care with mixed certainty, drawing on experiential, spiritual, and limited biomedical knowledge. They often referred clients to biomedical facilities when symptoms appeared serious or unclear. Participants saw themselves as accessible community figures, offering psychosocial support and helping patients navigate the health system. While motivated to contribute to cancer awareness and early detection, they reported challenges related to limited recognition and legitimacy within the formal health sector. Traditional Health Practitioners play an informal but important intermediary role in community cancer care in Soweto. Their contributions are shaped by knowledge gaps, social dynamics, and systemic barriers. Strengthening their role in early detection requires interventions that improve training, build trust in biomedical services, and support integration within the health system.