Kuhlula Maluleke

Introduction: Zoonotic diseases are an increasing global health concern, especially in resource‐limited settings with frequent human–animal interaction. Professional nurses are essential in the early detection, management and prevention of primary healthcare. However, there is limited evidence on their knowledge, attitudes and awareness of these diseases in South Africa. Aim: This study aimed to assess professional nurses’ knowledge, attitudes and awareness of zoonotic diseases in selected Tshwane municipal clinics, Gauteng Province, South Africa. Methods: An exploratory qualitative descriptive design was employed, guided by the One Health approach, involving semistructured interviews with 12 professional nurses purposively selected from four municipal clinics between 10 and 24 January 2025. Data were analysed thematically using Braun and Clarke’s six‐step framework in NVivo. Results: Six key themes emerged: (1) gaps in knowledge of zoonotic diseases among nurses, (2) health system constraints in zoonotic disease management, (3) perceived zoonotic risk within community practices and transmission dynamics, (4) nurses’ knowledge as a determinant of public health protection, (5) perceived occupational vulnerability to zoonoses and (6) nurses as key actors in zoonotic disease prevention and management. Findings revealed that although participants demonstrated basic awareness of zoonotic diseases, they lacked in‐depth knowledge and confidence in recognising or managing such conditions. Limited training, inadequate intersectoral collaboration with veterinary professionals and resource constraints further hindered effective management. Conclusion: While professional nurses in Tshwane municipal clinics possess general awareness of zoonotic diseases, significant knowledge and practice gaps persist. Strengthening training programs, incorporating zoonotic disease content into nursing curricula and promoting intersectoral collaboration are essential to improve preparedness, surveillance and response to emerging zoonotic threats.

Family planning and the use of modern contraceptives are pivotal in promoting women's health, enhancing gender equality, and supporting socioeconomic development. However, in many regions, including sub‐Saharan Africa, a substantial gap remains in the utilization of modern contraceptives. This scoping review aimed to explore the reasons and factors contributing to contraceptive nonutilization among women of childbearing age in suburban areas in sub‐Saharan Africa. The review was conducted using the Arksey and O'Malley framework in accordance with the PRISMA‐ScR guidelines. The analysis identified the following reasons for contraceptive nonutilization: age‐related barriers, cultural, and social influences, gender dynamics and partner involvement, lack of knowledge and misinformation, health system barriers, fear of side effects, and the desire for more children. This review recommends that future research address gaps in understanding age‐related barriers to contraceptive use by exploring the unique needs of younger and adult women within the reproductive age group, examining the influence of cultural norms and gender dynamics, and focusing on dispelling misinformation, mitigating health system barriers, and developing interventions to reduce fears of side effects through community‐based approaches. Trial Registration: Scoping review registration identification number: Open Science Framework: osf.io/z6937

Introduction: Access to healthcare facilities in rural areas remains a major challenge, particularly during the coronavirus disease 2019 (COVID‐19) pandemic. This study investigated the spatial distribution and accessibility of COVID‐19 point‐of‐care (POC) diagnostic services in Mopani District, Limpopo province, South Africa, using a geographic information system (GIS)‐based approach. The aim was to identify areas where healthcare access requires improvement. Methods: A descriptive cross‐sectional study design was used, analysing secondary data through dasymetric mapping to disaggregate and re‐aggregate population data into analytical units. Accessibility was measured by distances from residences to the nearest primary healthcare (PHC) clinics (<5 km) and from clinics to the nearest district hospitals (<30 km). Demographic and socio‐economic data from Statistics South Africa were included for context. Results: Mopani District had an estimated population of 1,202,916, with 942,801 (78.4%) residing within 5 km of a PHC clinic. The district had 105 clinics, each serving about 11,456 people, and 72 (68.6%) of these clinics were within 30 km of a district hospital. The district contained both densely and sparsely populated areas, with high unemployment and low‐income levels, particularly in rural regions. Limited public transport further constrained access. Ba‐Phalaborwa, Maruleng, Greater Tzaneen and Greater Letaba have relatively good access, whereas Greater Giyani faces significant challenges. Discussion: Although a majority of the population lived within 5 km of a clinic, notable gaps in accessibility remain. Improving transport infrastructure, using telemedicine and mobile health units, and implementing socio‐economic support strategies, such as subsidized transport, can enhance access. Addressing geographic and structural inequalities in healthcare distribution is critical to promoting equity and improving health outcomes in rural districts like Mopani.

Public health transformation aims to instigate enduring changes in healthcare services, staff roles and patient involvement, fostering heightened satisfaction among patients and staff while bolstering financial sustainability. Public health transformation is the process of reorganizing and creating a shared vision to ensure the right mindsets, capacity, resources and workforce to deliver equitable Foundational Public Health Services and ultimately promote health, well‐being and equity. Such transformation requires a fundamental change in public health systems' structure, functioning and interactions, supported by continuous quality improvement, innovation, partnerships, community‐driven efforts and systems change.This scoping review maps evidence of public health transformation. Searches encompassed databases including EBSCOHost, Academic Search Complete, Africa‐Wide Information, Dentistry & Oral Sciences Source, Health Source–Consumer and Academic Edition, PUBMED and Scopus. Abstracts and full‐text articles were screened by two independent reviewers against predefined criteria. Inclusion criteria spanned peer‐reviewed published between 2013 and 2023. The quality of the included studies was assessed using the 2018 version of the mixed method appraisal tool. Screening results were reported following the Preferred Reporting Items for Systematic Reviews and Meta‐Analyses extension for scoping reviews (PRISMA‐ScR) guidelines. Of 9509 articles retrieved, 808 duplicates were excluded, leaving 8692 for title and abstract screening. Following title and abstract screening, 105 articles were relevant and underwent full article screening, which resulted in 20 that became eligible for data extraction.Emergent themes included (1) Transformation in Public Healthcare; (2) Evaluation of Health Transformation Programs; (3) Financial Implications; (4) Public Health Access; and (5) Job Satisfaction. Theme 4 featured a subtheme addressing healthcare access for minority groups. Overall, the review highlights a dearth of evidence guiding policymakers in decision‐making on public health transformation, oversight of vulnerable populations, financial implications, and healthcare accessibility. Solutions should prioritize a people‐centred approach in both practice and research to effectively address these gaps.

Public health transformation aims to instigate enduring changes in healthcare services, staff roles, and patient involvement, fostering heightened satisfaction among patients and staff while bolstering financial sustainability. This scoping review maps evidence of public health transformation. Searches encompassed databases including EBSCOHost, Academic Search Complete, Africa-Wide Information, Dentistry & Oral Sciences Source, Health Source - Consumer Edition, Health Source: Nursing/Academic Edition, PUBMED, and Scopus. Abstracts and full-text articles were screened by two independent reviewers against predefined criteria. Inclusion criteria spanned peer-reviewed articles in all languages published between 2013 and 2023. The quality of the included studies was assessed using the 2018 version of the mixed method appraisal tool. Screening results were reported following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for scoping reviews (PRISMA ScR) guidelines. Of 9509 articles retrieved, 808 duplicates were excluded, leaving 8692 for title and abstract screening. Following title and abstract screening, 105 articles were deemed relevant and underwent full article screening, which resulted in 20 that became eligible for data extraction. Emergent themes included: 1) Transformation in Public Healthcare; 2) Evaluation of Health Transformation Programs; 3) Financial Implications; 4) Public Health Access; and 5) Job Satisfaction. Theme 4 featured a subtheme addressing healthcare access for minority groups. Overall, the review highlights a dearth of evidence guiding policymakers in decision-making on public health transformation, oversight of vulnerable populations, financial implications, and healthcare accessibility. Solutions should prioritize a people-centered approach in both practice and research to effectively address these gaps.

Objectives To map the evidence and scope of physical rehabilitation services delivered by community health workers (CHWs) in sub-Saharan Africa (SSA). Design Scoping review Data sources PubMed, Scopus, Cochrane Central and databases within the EBSCOhost platform. We also searched other literature sources including reference lists, conference presentations and organisational websites such as WHO, Ministries of Health and non-governmental organisations in SSA. Eligibility criteria for selection of studies Articles presenting evidence on CHWs’ delivery of physical rehabilitation services in SSA from September 1978 to June 2023. Data extraction and synthesis Screening was conducted by two reviewers and was guided by the inclusion criteria. Thematic content analysis of data was employed. The results are presented according to the Preferred Reporting Items for Systematic Review and Meta-Analysis extension for scoping reviews. Results A total of 6996 articles were identified through various databases, with only 20 studies qualifying for data extraction. Evidence was presented by Eritrea, Ethiopia, Malawi, Mauritius, Namibia, South Africa and Uganda. Assessments, case management, health education, community liaison with support, health systems linkage and administration were the CHWs’ scope of practice identified. The review identified home-based, community-based, community and facility-based, home and community-based and facility-based as modes of delivery. The barriers experienced are resources, societal and community attitudes, governance, geographical barriers and delivery capacity, while proximity to the community, positive job attitude and support with collaboration facilitated service delivery. Conclusion Training and integrating CHWs in national health care systems, with careful selection of existing CHWs, would minimise the barriers faced.

Introduction: Effective supply chain management (SCM) of point-of-care (POC) tests for diseases like severe acute respiratory syndrome coronavirus type 2 (SARS-CoV-2) requires active participation from diverse stakeholders, government entities, and regulatory bodies. The responsibility for overseeing various aspects of POC tests, including procurement, quality assurance, storage, inventory management, distribution, and human resource capacity, lies with national, provincial, and local levels of government. This study aimed to collaboratively develop an innovative approach to enhance SCM for SARS-CoV-2 POC diagnostic services in resource-limited settings, using the Mopani District in Limpopo province, South Africa, as a case study.Methods: Key stakeholders were invited to participate in an online workshop using purposive sampling. The study employed the nominal group technique (NGT) for data collection, which consisted of two phases. Phase 1 focused on identifying barriers in the supply chain of COVID-19 rapid tests, while phase 2 aimed to devise strategies to overcome the priority barriers identified in phase 1. Participants used a Likert scale of 1–5 to rank barriers and strategies, and an overall ranking score was calculated for each. The participants were provided with the results of the ranking exercise for their feedback.Results: Eleven key stakeholders from national (n = 1), provincial (n = 4), and local government (n = 2) levels, research entities (n = 3), and non-governmental organizations (n = 1) took part in the study. Participants identified significant barriers in the supply chain, such as the availability of testing kits, unknown demand, information on SCM during a pandemic, methods of controlling stock, and procurement processes. Strategies suggested by key stakeholders included monitoring stock levels and optimizing stock visibility systems to improve test availability, enhancing information visibility and consistent data updates to address unknown demand and improve SCM during a pandemic, employing data capturing and digitization for effective stock control, and implementing demand planning and standardized procurement processes at the national level to enhance stock procurement.Discussion: The successful collaboration with key stakeholders, facilitated by the NGT, resulted in the co-creation of a novel approach to enhance SCM for COVID-19 diagnostic services in resource-limited settings. This study holds the potential to support the provision of COVID-19 diagnostic services in such settings. A recommended follow-up study would assess the feasibility of implementing this approach.

Access to point-of-care (POC) diagnostics in resource-limited settings, where laboratory-based diagnostics are limited, depends on efficient supply chain management (SCM). This study evaluated the SCM for SARS-CoV-2 POC diagnostic services in resource-limited settings to determine the effect of SCM on accessibility to SARS-CoV-2 POC tests and to identify barriers and enablers of accessibility to SARS-CoV-2 diagnostic services in Mopani District, Limpopo Province, South Africa. We purposively assessed 47 clinics providing POC diagnostic services between June and September 2022. One participant per clinic completed an audit tool developed by the authors with guidance from the World Health Organization and the Management Sciences for Health guidelines. The audit tool evaluated the following SCM parameters: selection, quantification, storage, procurement, quality assurance, distribution, redistribution, inventory management, and human resource capacity. Percentage rating scores between 90–100% indicated that the facility was compliant with SCM guidelines, while rating scores < 90% indicated non-compliance. The clinic audit scores were summarized and compared across clinics and sub-districts. Clinics had compliance scores ranging from 60.5% to 89.2%. Compliance scores were the highest for procurement, redistribution, and quality assurance (all 100%), followed by storage (mean = 95.2%, 95% CI: 90.7–99.7), quantification (mean = 89.4%, 95% CI: 80.2–98.5), and selection (mean = 87.5%, 95% CI: 87.5%–87.5%). Compliance scores were the lowest for inventory management (mean = 53.2%, 95% CI: 47.9%–58.5%), distribution (mean = 48.6%, 95% CI: 44.6%–52.7%), and human resource capacity (mean = 50.6%, 95% CI: 43.3%–58.0%). A significant correlation was found between compliance score and clinic headcount (r = 0.4, p = 0.008), and compliance score and ideal clinic score (r = 0.4, p = 0.0003). Overall, the 47 clinics audited did not comply with international SCM guidelines. Of the nine SCM parameters evaluated, only procurement, redistribution, and quality assurance did not need improvement. All parameters are key in ensuring full functionality of SCM systems and equitable access to SARS-CoV-2 POC diagnostics in resource limited settings.

Introduction: Infections of the central nervous system are a considerable basis of mortality in people living with HIV, with progression to cryptococcal meningitis documented at around 15% of HIV-associated mortality globally, with nearly three-quarters occurring in the sub-Saharan Africa. Discoveries from previous studies prelude to the mortality of cryptococcal antigen positive, which persisted to be elevated than in cryptococcal antigen negative persons. One feasible interpretation of this could be due to undiagnosed cryptococcus. Laboratory investigations identify cryptococcal disease prior to cryptococcal meningitis progression. Point-of-care testing has high sensitivity and specificity as seen with the cryptococcal antigen lateral flow assay screening to expedite treatment. The aim of the study is to map and translate evidence on cryptococcal antigen infection among HIV-infected persons in sub-Saharan Africa. Methodology: The proposed scoping review will be conducted using guidelines proposed by Arksey and O’Malley methodological framework and Levac et al. advanced method. It will be guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analysis for Scoping Reviews. A comprehensive literature search of studies published from the first relevant publication to 2022 will be conducted on multiple electronic databases. Additional sources (grey literature) will also be searched. The search strategy will be generated and implemented by the principal investigator with assistance from a subject specialist, and an information specialist. Two reviewers will screen eligible studies. The screening will be guided by an inclusion and exclusion criteria. The mixed methods appraisal tool version 2018 will be used to appraise the quality of the empirical studies. Discussion: The proposed scoping review will map and translate evidence on cryptococcal antigen infection among HIV-infected persons in sub-Saharan Africa. Synthesising and sharing recent evidence in this area has potential to help guide future research and interventions aimed at improving the management of cryptococcal antigen infection among HIV-infected persons in sub-Saharan Africa and other high HIV- burdened settings.