Reconstructing and developing the health system - the first 1 000 days

This paper attempts to document the successes and failures of the Department of Health during the first 1 000 days of the Government of National Unity. The achievements of the Department are reflected against the backdrop of the legacies inherited by the current Ministry and Department

The impact of climate change on maternal and child health

It can be argued that there are three colliding pandemics that are currently affecting the planet and its people: COVID-19, global inequities and climate change. Regrettably, these are all the result of human action or inaction and are preventable. The United Nations Conference of the Parties (COP26), held in November 2021 in Glasgow, addressed some of these issues. Prince Charles called this meeting the ‘last chance saloon to save the planet.’ e main objective of COP26 was to reduce global heating and limit global warming to the target maximum temperature of 1.5-degree Celsius above preindustrial levels. According to the National Aeronautics and Space Administration (NASA), since the late 19th century, the earth surface temperature rose by.18 degrees Celsius, caused by increased carbon dioxide and other emissions into the atmosphere, with the years 2016 and 2020 being tied as the warmest years on record. However, many, including a group of scientists called ‘Scientist Rebellion’ were not convinced that COP26 would make any di erence to the warming of the planet. President of COP26, Alok Sharma admitted that the objective of the conference was not reached but remained cautiously optimistic: “We can now say with credibility that we have kept 1.5 degrees alive. But its pulse is weak and it will only survive if we keep our promises and translate commitments into rapid action”.https://www.obstetricsandgynaecologyforum.comam2023Obstetrics and Gynaecolog

Optimizing knowledge and behavioral intention of women and their partners in the perinatal period in South Africa : a randomized control trial study protocol in the Tshwane district, Gauteng province, South Africa

Background: Maternal knowledge that motivates improvements in critical perinatal health behaviors has the potential to significantly reduce maternal and neonatal mortality. However, evidence-based health information often fails to reach mothers and their partners. mHealth video micro-messages, which disseminate evidence-based perinatal health messages, have the potential to address this gap. Methods: The study will make use of a mixed method design, using both qualitative and quantitative methods. The study consists of two phases. During Phase 1, qualitative in-depth interviews will be used as part of a human-centered design approach to co-create 10 videos on priority perinatal behaviors. During Phase 2, quantitative methods (a randomized control trial) will be used to test the effectiveness of the videos in improving maternal knowledge and intended behavioral change. Discussion: We hypothesize that by engaging mothers and their partners through emotive, resonant narratives and visuals, we can facilitate the delivery of evidence-based health messages at the foundation of perinatal health, thereby motivating life-saving improvements in health behaviors during the perinatal period. Trial registration: This trial has been prospectively registered on the Pan African Clinical Trials Registry (PACTR), with the registration number PACTR202203673222680. Registration date: 14 March 2022. Trial registration WHO data set: Registry – Pan African Clinical Trials Registry (PACTR). Date: 14 March 2022. Secondary identification number - grant number: GCCSOAFMNH1. Source of support: Science for Africa Foundation. Primary sponsor – Clinton Health Access Initiative South Africa. Secondary sponsor - Stanford University School of Medicine and Heidelberg University. Contact for public & scientific queries: [email protected]; +27 123,426,911; 1166 Francis Baard St, Hatfield, Pretoria, 0028. Public title – Amandla Mama. Scientific title - Optimizing knowledge and behavioral intention of women and their partners in the perinatal period in South Africa. Countries of recruitment – South Africa. Health conditions – antenatal care. Intervention – Amandla Mama mHealth videos, short 2D animated health promotional videos that promote healthy behavior in expectant mothers. Inclusion and exclusion criteria - Expectant mothers and their partners must be 18 years and older. Study type – randomized control trial. Date of first enrollment – 14 March 2021. Sample size – plan to enrol 450 participants, participants enrolled 29 participants. Recruitment Status – suspended. Primary outcome – improving knowledge. Secondary outcome – intended behavioral change. Ethics review – Approved on 24 January 2022 by Pharma-Ethics, contact Mrs. Marzelle Haskins, [email protected]. Completion date – N/A. Summary results – N/A. IPD sharing statement – yes, through the publication of results in a journal article

Human resource for health policy interventions towards health sector reform in a Zimbabwean peri-urban community : a decision space approach

BACKGROUND : Human Resources for Health (HRH) are important towards attainment of the health sector reform goal of universal health coverage in resource-constrained health systems. We used the Decision Space Approach to analyse decision space, innovation, and change in HRH reform policy interventions in Epworth, a peri-urban community in Zimbabwe. METHODS : The study design was exploratory and cross-sectional. In this, we firstly explored the healthcare worker reform policy at the principal level to determine the main policy result areas. Findings enabled us to develop an HRH Decision Space Mapping Analysis Conceptual Tool consisting of six main policy result areas. We then used it to analyse decision space, innovation, and outcomes towards healthcare worker reform at the agent level in Epworth. Interpretive thematic analysis and descriptive statistics were used to facilitate analysis. FINDINGS : Narrow decision space and functional innovation in the context of moderate decision space helps not only initiate healthcare worker reform interventions but also mitigate local incapacities to sustain the process. Future research may adopt the Conceptual Tool developed to facilitate analysis of decision space, innovation, and outcomes in local health systems focusing on the six policy result areas towards the health system reform goal of universal health coverage.The African Population and Health Research Centre (APHRC) [Grant award number ADDRF 2015-2017 ADF 002].http://www.tandfonline.com/loi/yjhm20hj2019School of Health Systems and Public Health (SHSPH

Patulin triggers NRF2-mediated survival mechanisms in kidney cells

Patulin (PAT), a mycotoxin contaminant of apples and apple products, has been implicated in nephrotoxicity. PAT depletes glutathione (GSH) and elevates reactive oxygen species (ROS). The antioxidant (AO) response is activated by Nuclear erythroid 2-related factor (NRF2) and enhanced by Silent information regulator 3 (SIRT3). The effects of PAT on these molecules have yet to be examined. We investigated the effects of PAT on AO response survival pathways in human embryonic kidney cells (HEK293). PAT cytotoxicity on HEK293 cells was evaluated (MTT assay; 24 h; [0–100 μM]) to determine an IC50. GSH levels were measured using luminometry. Intracellular ROS was evaluated by flow cytometry. Protein expression of Keap1, NRF2, SIRT3 and PGC-1α was quantified by western blotting and gene expression of SOD2, CAT and GPx was evaluated by qPCR. PAT caused a dose dependent decrease in HEK293 cell viability and a significant increase in levels of intracellular ROS (p = 0.0006). A significant increase in protein expression (p = 0.029) was observed. PAT increased gene expression of SOD2 and CAT (p = 0.0043), however, gene expression of GPx was significantly reduced (p = 0.0043). These results show the up-regulation of NRF2 mediated AO mechanisms in response to PAT toxicity.National Research Foundation (Grant UID: 90102), and the UKZN College of Health Sciencehttp://www.elsevier.com/locate/toxicon2016-06-01hb201

Health personnel retention strategies in a peri-urban community : an exploratory study on Epworth, Zimbabwe

BACKGROUND : The need to retain health personnel is a policy challenge undermining health system reform of the 21st century. The need to resolve this global health workforce crisis resulted in the First Global Forum on Human Resources for Health in 2008 from which the Kampala Declaration and Agenda for Global Action was formulated. However, whilst there have been several studies exploring the retention of health personnel towards this end, available literature does not provide a detailed narrative on strategies used in peri-urban communities. The aim of this study was to explore retention strategies implemented in a Zimbabwean peri-urban community between 2009 and 2014 and implications for peri-urban communities towards the health system reform agenda. METHODS : The study was carried out in Epworth, a peri-urban community in Harare, Zimbabwe. The research design was a cross-sectional survey, in which qualitative methods were used in sampling, data collection, reporting and analysis. Qualitative tools were used to collect data through in-depth interviews with purposively selected health personnel managers at 10 local clinics and sample interviews with purposively selected healthcare workers who included registered general nurses, state-certified nurses, midwives, environmental health technicians, nurse aids and community health volunteers at each clinic. Two focus group discussions were carried out with community health volunteers. Qualitative data was subjected to thematic analysis, with coding being performed manually. RESULTS : A programme-specific strategic partnership between the government and donor community contributed towards the mobilisation of more health personnel, health facilities, worker development and remuneration. To complement this, the Ministry of Health intervened through the review and payment of salaries, support towards post-basic training and development, and protection. The local board, mission and donors contributed through the payment of top-up allowances and provision of non-monetary incentives. CONCLUSIONS : The review of salaries, engagement of international strategic partners, payment of top-up allowances, support towards post-basic training and development, mobilisation of more health personnel, non-monetary incentives and healthcare worker protection were critical towards the retention of health personnel in the Epworth peri-urban community between 2009 and 2014.We are most grateful to the African Doctoral Dissertation Research Fellowship Award (ADDRF 2015-2017 ADF 002) offered by the African Population and Health Research Centre in partnership with the International Development Research Centre which made this research possible. We are also grateful to the University of Pretoria Postgraduate Research Bursary (10443925) which also made this study possible.http://www.human-resources-health.comam2016School of Health Systems and Public Health (SHSPH

Eliminating mother to child HIV transmission in South Africa

PROBLEM: The World Health Organization has produced clear guidelines for the prevention of mother-to-child transmission (PMTCT) of the human immunodeficiency virus (HIV). However, ensuring that all PMTCT programme components are implemented to a high quality in all facilities presents challenges. APPROACH: Although South Africa initiated its PMTCT programme in 2002, later than most other countries, political support has increased since 2008. Operational research has received more attention and objective data have been used more effectively. LOCAL SETTING: In 2010, around 30% of all pregnant women in South Africa were HIV-positive and half of all deaths in children younger than 5 years were associated with the virus. RELEVANT CHANGES: Between 2008 and 2011, the estimated proportion of HIV-exposed infants younger than 2 months who underwent routine polymerase chain reaction (PCR) tests to detect early HIV transmission increased from 36.6% to 70.4%. The estimated HIV transmission rate decreased from 9.6% to 2.8%. Population-based surveys in 2010 and 2011 reported transmission rates of 3.5% and 2.7%, respectively. LESSONS LEARNT: Critical actions for improving programme outcomes included: ensuring rapid implementation of changes in PMTCT policy at the field level through training and guideline dissemination; ensuring good coordination with technical partners, such as international health agencies and international and local nongovernmental organizations; and making use of data and indicators on all aspects of the PMTCT programme. Enabling health-care staff at primary care facilities to initiate antiretroviral therapy and expanding laboratory services for measuring CD4+ T-cell counts and for PCR testing were also helpful.Department of HE and Training approved lis