Sean Mark Patrick

School mental health care in South Africa forms part of the primary health care package in the form of an integrated programme for the promotion of school health. However, there appears to be a limitation in teacher mental health literacy, which may not meet the needs of South African secondary school youth in terms of coverage and uptake. The aim with the study reported on here was to explore secondary school teachers’ mental health literacy in the City of Ekurhuleni, using a cross‐sectional descriptive design. In total, 132 secondary school teachers participated in this study. A mental health literacy assessment was conducted using 4 vignettes, each scoring 1 for a total of 4, with a mean score of 1.23 (SD = 0.96) obtained. For the assessment of depression literacy, a 22-item questionnaire scored out of 22 was used, with a mean score of 10.65 (SD = 3.21) observed. Overall, the study results reveal a low mental health literacy level and a poor ability to identify the clinical features of depression among secondary school teachers in the City of Ekurhuleni. It is imperative that teachers become more aware of the mental health of their learners. We propose that the pre-service and in-service training curriculum of teachers include training on the identification of mental health systems.

Background to the Study: As fully online postgraduate programmes expand, questions remain regarding whether sufficient student engagement is achieved and how such sufficiency can be measured. This study examined the types and levels of engagement within a fully online postgraduate module and explored how engagement can be operationalised using learning management system (LMS) analytics. Objective: To explore whether there is sufficient student engagement in an online module, and the types and levels of online engagement. Methods: A quantitative single‐case study analysed LMS trace data from 773 students. Data were analysed using the Online Engagement Framework and Moore's interaction typology. Engagement was operationalised using four behavioural indicators: submissions, interactions, time‐on‐platform and Grade Center access. Cluster analysis was applied to identify engagement profiles. Results: Findings indicate high levels of social, cognitive, behavioural and collaborative engagement, with participation substantially exceeding minimum requirements. In contrast, structured opportunities for emotional engagement were absent. Frequent Grade Centre access (mean = 68 views per student) suggests a digitally observable form of performance engagement characterised by academic self‐monitoring behaviour Cluster analysis revealed four distinct engagement profiles, highlighting heterogeneity in student interaction patterns. Conclusion: The findings suggest that high‐density programmatic assessment is associated with sustained engagement behaviours in online contexts. This study contributes to the literature by proposing a trace‐based operationalisation of performance engagement and offering a practical framework for examining engagement sufficiency in fully online programmes.

Background. Hypertension is a leading cause of cardiovascular disease. There are limited longitudinal data on temporal trends in hypertension prevalence in rural South Africa (SA). Objectives. To analyse trends in hypertension prevalence and investigate its associated factors among adults aged ≥40 years in SA. Methods. A retrospective observational secondary quantitative analysis of a sample from the Health and Aging in Africa: A Longitudinal Study of an INDEPTH Community in South Africa (HAALSI) was conducted. Data for the HAALSI study were collected over three waves during 2014, 2018 and 2021 from the existing Agincourt Health and Socio-demographic Surveillance System (AHDSS) framework, with a total sample of 3 707 participants in the present study. Descriptive statistics were used to summarise sociodemographic data. A bivariate analysis and multivariable generalised estimating equation (GEE) model was applied to determine factors associated with hypertension prevalence, with significance set at p<0.05. Results. The overall prevalence of hypertension declined from 58% (95% confidence interval (CI) 56.42 - 59.58) in wave 1 to 42% (95% CI 40.42 - 43.58) in wave 2, and further decreased to 30% (95% CI 28.58 - 31.42) in wave 3. Transitions between hypertensive and normotensive status were observed, with 1 018 individuals transitioning to normotensive from wave 1 to wave 2, and 1 167 individuals from wave 2 to wave 3. The GEE analysis identified significant predictors of hypertension. High body mass index (BMI) was associated with increased odds in wave 2 (adjusted odds ratio (aOR) 1.11; 95% CI 1.02 - 1.21; p=0.014). Frequent alcohol consumption increased the odds of hypertension in wave 3 (aOR 1.19; 95% CI 1.04 - 1.37; p=0.009). No formal education was associated with higher hypertension prevalence (aOR 1.07; 95% CI:1.00 - 1.14; p=0.0026). Younger age (40 - 49 years) was protective, with decreased odds of hypertension in wave 2 (aOR 0.64; 95% CI 0.48 - 0.84; p=0.014), as was employment (aOR 0.82; 95% CI 0.69 - 0.96; p=0.020) and fruit consumption in wave 3 (aOR 0.95; 95% CI 0.91 - 0.99; p=0.037). Conclusion. The study found that the prevalence of hypertension in Agincourt decreased from 58 to 30% between waves 1 and 3. High BMI, high alcohol use frequency and no formal education were key predators of hypertension. The study highlights the need for targeted public health interventions, including regular hypertension screening, lifestyle modification and better management of associated factors. These efforts will be crucial in reducing hypertension-related morbidity and mortality in rural SA.

African men are disproportionately impacted by aggressive prostate cancer (PCa). The key to this disparity is both genetic and environmental factors, alluding to epigenetic modifications. However, African-inclusive prostate tumour DNA methylation studies are lacking. Assembling a multi-geo-ancestral prostate tissue cohort, including men with (57 African, 48 European, 23 Asian) or without (65 African) PCa, we interrogate for genome-wide differential methylation. Overall, methylation appears to be driven by ancestry over geography (152 southern Africa, 41 Australia). African tumours show substantial heterogeneity, with universal hypermethylation indicating more pervasive epigenetic silencing, encompassing PCa suppressor genes and enhancer-targeted binding motifs. Conversely, African tumour-associated heterochromatic hypomethylation suggests chromatin relaxation and developmental pathway activation via enhancer targets. Notably, non-prostate lineage elements appeared preferentially exploited in African tumorigenesis, with ancestry potentially influencing the extent of lineage-inappropriate activation, and tumour progression marked by repression of developmental regulators. Together, these findings point to extensive epigenetic plasticity in African tumours, with intergenic regulatory remodelling promoting genomic instability, metastatic potential and aggressive disease phenotypes.

Background: Prostate cancer (PCa) awareness and knowledge among men in Vhembe District, Limpopo Province, South Africa, remain inadequately studied despite the high local burden of the disease. This study investigates the knowledge, attitudes, practices, cultural beliefs, and perceived risk of PCa among men aged 40 and above in selected villages under the Mphaphuli and Niani tribal authorities. Methods: A quantitative survey was conducted with 431 men, utilizing a questionnaire adapted from the African Women Awareness of Cancer (AWACAN) tool. The questionnaire, translated into Tshivenda, assessed socio-demographic data, awareness, knowledge of risk factors and symptoms, health-seeking behavior, and barriers to seeking medical help. Results: The study revealed that 51.3% of participants had heard of PCa, while 48.7% had not. Awareness varied significantly with age, relationship status, education level, and language. Older men and those with higher education levels were more knowledgeable about PCa. Clinics, hospitals, and media were the primary sources of information. Misconceptions about risk factors were prevalent, with 24.0% of men indicating a preference for traditional healers for PCa symptoms. Barriers to medical help included fear of the disease, procedural fears, and cultural taboos. Multivariate analysis identified significant factors associated with PCa knowledge, including age, language, access to tap water, and cell phone ownership. Conclusion: These findings underscore the importance of targeted educational interventions considering sociodemographic and cultural contexts. Future public health initiatives should focus on bridging the gap between traditional and modern medical practices to enhance health outcomes in the Vhembe District and similar settings.

The landscape of public health education is transforming, and online learning technologies are rapidly being adopted. This narrative review examines how public health education has evolved by comparing traditional and online learning environments, focusing on how smart learning environments can enhance educational outcomes. The analysis is grounded in the community of inquiry framework, Gardner’s theory on multiple intelligences, and the theory of self-regulated learning. This review first outlines the key competencies required by public health professionals, including epidemiology, health policy, and biostatistics, and then discusses how these competencies are taught traditionally. This description is followed by an exploration of online learning environments and the unique challenges faced by learners, such as the need for self-regulation and motivation. Smart learning environments should integrate adaptive learning technologies and personalized learning pathways to address these challenges and provide a more engaging and supportive learning experience. These technologies enable real-time feedback and customization of learning materials, allowing students to monitor their progress and adjust their learning strategies. Smart learning environments can also contribute to community and collaborative learning in online environments. Integrating smart learning environments into public health curricula can enhance student learning outcomes and prepare future public health professionals to navigate a rapidly changing digital world. The purpose of this review is to contribute to the ongoing discourse on the modernization of public health education by proposing a conceptual community of inquiry framework for smart learning environments, suggesting a balanced approach that leverages the strengths of traditional and online learning methods.

Prostate cancer is the leading cause of cancer-associated death among men across Sub-Saharan Africa, with Southern and East Africa ranking first and fifth globally. However, lack of coordinated national cancer registries has biased data toward single-sourced, averaged, or model estimates. Here, our retrospective study included 8634 South-East African patients diagnosed between 2010 and 2019, which when compared with 71 694 Black and 322 356 White period-matched American men, were over threefold more likely to present with aggressive disease (International Society of Urological Pathology grade groups ≥4: 45.38% vs 21.22% and 21.05%; prostate-specific antigen ≥20 ng/mL: 62.04% vs 17.29% and 11.17%, respectively; all 2-sided P < .0001). East over Southern African men are 1.5 times more likely to present with advanced disease, however, age was not a confounder. Supporting prostate cancer as a major health concern for Africa, our data suggest underestimation in East Africa, while highlighting the need for accurate monitoring, increased awareness, and tailored screening criteria.

Background: The rise of asthma prevalence in recent decades has been attributed to changes in dietary patterns, especially in developing countries. Studies have also suggested that dietary patterns play an important role in both asthma development and management. This study aimed to investigate the association between consumption of various foods and environmental factors with asthma and wheeze among adolescents. Methods: A self-administered standardized International Study of Asthma and Allergies in Childhood (ISAAC) questionnaire was used to collect data on demographics, respiratory health, exposure to air pollution, and diet on n = 2855 adolescents residing in Vhembe District, South Africa. Results: The prevalence of asthma and wheeze were 18.91% and 37.69%, respectively. Consuming various foods such as fast foods (OR = 1.41; 95% CI: 1.06–1.88), bread (OR = 0.60; 95% CI: 0.45–1.81), pasta (OR = 1.39; 95% CI: 1.06–1.84), seafood (OR = 1.79; 95% CI: 0.65–1.24), and nuts (OR = 0.85; 95% CI: 0.65–1.12) were significantly associated with asthma in the crude logistic regression analysis. Further analysis in the multiple regression model indicated a strong association of asthma with consumption of nuts (OR = 1.55; 95% CI: 1.11–2.17), seafood (OR = 1.60; 95% CI: 1.03–2.49), and cereal (OR = 0.67; 95% CI: 0.45–0.99). In relation to wheeze, consumption of meat (red) (OR = 0.77; 95% CI: 0.60–0.99) was a protective factor in the crude analysis. The multiple logistic regression model showed that, seafood (OR = 0.76; 95% CI: 0.59–0.96), fruit (OR = 0.55; 95% CI: 0.32–0.94), nuts (OR = 1.88; 95% CI: 1.50–2.66), and olive oil (OR = 1.48; 95% CI: 1.09–2.00) were significantly associated with wheeze. Conclusion: Diet plays a major role in respiratory health, especially in asthma and wheeze. Dietary changes may play a role in reducing the burden of asthma and other respiratory symptoms in adolescents.

This study investigated the prevalence of childhood asthma and respiratory symptoms with their associated air pollution sources among adolescents aged 13–14 years residing in a Malaria-endemic region. Methods: A cross-sectional survey was conducted with 2855 adolescents from fourteen (14) selected schools in communities exposed to high levels of air pollution from indoor residual spraying (IRS) that is used for malaria vector control in the Vhembe region. Data were collected using a self-administered standardized International Study of Asthma and Allergies in Childhood (ISAAC) questionnaire. Statistical software STATA version 17 was used to analyze the data. Binary logistic regression was used to determine the relationship between air pollution sources and childhood asthma/symptoms. Results: The prevalences of asthma, ‘wheeze ever’ and ‘wheeze in the past’ were 18.91%, 37.69% and 24.69%, respectively. The results from the adjusted binary logistic regression model indicated that exposure to tobacco smoke (OR = 1.84; 95% CI: 1.08–3.16), smoking a water pipe (OR = 1.65; 95% CI: 1.16–2.36) and the use of paraffin as fuel for heating (OR = 1.70; 95% CI: 0.97–2.88) and cooking (OR = 0.48; 95% CI: 0.29–1.00) were significant risk factors for asthma. Trucks passing through the streets, having a cat at home and using open fires were significantly associated with ‘wheeze in the past’. Finally, using gas for cooking (OR = 0.72; 95% CI: 0.53–0.99), open fires for heating (OR = 0.53; 95% CI: 0.35–0.80) and smoking a water pipe (OR = 2.47; 95% CI: 1.78–3.44) were associated with ‘wheeze ever’. Conclusions: School children living in these communities had an increased risk of developing asthma and presenting with wheezing due to exposure to environmental air pollution sources.