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Multispecies studies are known for tackling human exceptionalism. Whilst the field has seen a remarkable increase in popularity amongst scholars in the humanities and social sciences, critiques argue that it neglects inequalities and consequential differences amongst humans and between humans and other-than-humans. These critiques are especially relevant in the context of Southern Africa, where extreme inequalities amongst humans persist whilst wildlife is often perceived to enjoy a favoured position in the region's prominent conservation industries. As four researchers working in a multispecies study project focusing on the Kavango-Zambezi Transfrontier Conservation Area in Southern Africa, we pose the question of what a politicised multispecies studies might look like. In this article, we share our thoughts and reflections on working in this complex political landscape. Using insights from our own fields, we share some of the persistent concerns encountered during fieldwork and discuss and contextualise these by drawing on multispecies literature that deals with similar concerns. We identify three salient themes that should inform and politicise multispecies work in postcolonial conservation landscapes: historical legacies, reflexive positionalities and marginalised subjects.

Os estudos multiespécies são conhecidos por enfrentar a questão do excepcionalismo humano. Embora o campo tenha registrado um aumento notável em popularidade entre os estudiosos das ciências humanas e sociais, os críticos argumentam que ele negligencia as desigualdades e as consequentes diferenças entre os humanos e entre humanos e não humanos. Estas críticas são especialmente relevantes no contexto da África Austral, onde desigualdades extremas entre os seres humanos persistem, enquanto a vida selvagem é frequentemente entendida como tendo uma posição privilegiada nas proeminentes indústrias de conservação da região. Como quatro investigadores que trabalham em um projeto de estudo multiespécies com foco na Área deConservação Transfronteiriça Cubango-Zambeze, na África Austral, colocamos a questão de como seria um estudo multiespécies politizado. Neste artigo, compartilhamos nossas ideias e reflexões sobre o trabalho neste cenário político complexo. Utilizando observações oriundas de nossas próprias pesquisas, partilhamos algumas das persistentes inquietações encontradas durante o trabalho de campo, bem como discutimos e contextualizamos estas questões recorrendo à literatura multiespécies que trata de preocupações semelhantes. Identificamos três temas de relevo que devem informar e politizar o trabalho multiespécies em cenários pós-coloniais de conservação: os legados históricos, as posicionalidades reflexivas e os sujeitos marginalizados.

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BACKGROUND: The PedsQL™ 4.0 Generic Core Scales (GSC) have been translated into over 60 languages, but use in the sub-Saharan African region is limited. This study aimed to cross-culturally adapt and validate the PedsQL™ 4.0 GCS child self-report and teen self-report versions into the Chichewa language for Malawi. METHODS: The English (USA) versions were adapted (translation, back translation and cognitive interviews to evaluate conceptual equivalence) into Chichewa. We recruited 289 children (8-17 years) in Blantyre, Malawi. Classical psychometrics at the item level (missing data, endorsement frequencies, item redundancy) and scale level (internal consistency, convergent, discriminant and known groups validity) was used to evaluate the new Chichewa versions. RESULTS: Six items were found to need cultural adaptation for Malawi. There were problems with missing data (< 5%) and adjacent endorsement frequency (< 10%) among younger children. Internal consistency reliability was acceptable (Cronbach α > 0.7). Convergent validity was generally strong (correlations > 0.4). Discriminant validity (p > 0.05) was evident with respect to gender and age, but not for school grade (p < 0.05). Effect sizes indicating known groups validity were in the expected direction but of variable magnitude. CONCLUSION: We have successfully adapted the PedsQL™ 4.0 GCS child self-report and teen self-report into Chichewa for use in Malawi. Many aspects of the psychometric evaluation were promising, though some elements were more mixed and we have not yet been able to evaluate test-retest reliability or responsiveness. We suggest that the PedsQL™4.0 GCS child and teen self-reports should be used with caution among children and adolescents in Malawi.

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Microplastics are increasingly recognised as posing a significant environmental threat across systems. Their pervasive presence in freshwater poses a serious concern, given the heavy reliance of both humans and biodiversity on healthy, functioning freshwater ecosystems. Acknowledgment of the potential risks led the transboundary Orange-Senqu River Commission (ORASECOM) to include sampling for microlitter (primarily microplastics) in riverine sediment, surface water, and fishes, across Southern Africa as part of the third Joint Basin Survey (JBS3) in 2021. The aim was to establish a first, basin-wide estimate of microlitter contamination across compartments, setting a baseline for further monitoring. The survey showed that the abundance of microlitter in riverine sediment (0 - 4000 particles.kg-1 dry weight (dw)) and riverine water (1.00 ± 0.71 - 69.75 ± 68.55 SD items.L-1) varied considerably between sample sites, with no correlation between the two. The abundance of microlitter in fishes was low (average of 0.7 ± 0.4 items.individual-1). Course resolution analyses suggested that microlitter concentrations in riverine sediment and riverine water at each site did not correlate with land use directly upstream, though variation in microlitter abundance did isolate some hotspots of contamination. Discharge data collected from nine gauging stations near sampling sites confirmed that low flows prevailed in the system during the study, with high flows occurring approximately 5 months prior during the summer months. There is some variation in river flow across the catchment which is a likely driver of microlitter transport. This was evident in the polymer composition for sediment and water samples. Based on the average discharge at each gauging station and microlitter concentrations measured in riverine water, the estimated microlitter load ranged from ∼889 particles.s-1 to ∼17.9 million particles.s-1, with a substantial amount ending likely up in the mudbelt adjacent to the Orange River mouth. This assessment provides a first insight into the characterisation and distribution of microlitter in multiple compartments across the Orange-Senqu River basin. Overall, the findings highlight the need for continued monitoring across compartments at catchment scales to improve our understanding of microplastic pathways into and within riverine systems.

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Background: Disturbed sleep during infancy and early childhood can have a detrimental effect on parental sleep and consequently parental well-being. However, there is a paucity of research on how perceived child sleep problems and behavioural sleep interventions as treatment influence maternal subjective well-being. Aim: This study aimed to explore the incidence of subjective well-being in mothers of children with sleep problems and whether implementing two behavioural sleep interventions changed their well-being. Setting: The research was conducted in a community setting, with parents voluntarily approaching a sleep consultancy based in South Africa. Method: Using data from 119 mothers voluntarily approaching a sleep consultancy in South Africa, a pre-test-post-test design was employed to investigate changes in life satisfaction, affect, couple satisfaction, perceived stress and depression approximately 3 weeks after implementation of a sleep intervention. Results: Results indicate that mothers of children with sleep problems experienced moderate to high life satisfaction and positive affect although the presence of moderate negative affect, couple satisfaction and stress and mild depression suggest possible decreased subjective well-being. Conclusion: Findings suggest implementation of graduated extinction and extinction with parental presence sleep interventions may improve life satisfaction, affect, stress and depression but not couple satisfaction in the short-term. Contribution: This study contributes towards understanding the effect of sleep loss on the subjective well-being of mothers and provides preliminary evidence regarding the benefits of two sleep interventions for improving maternal subjective well-being.

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The Southern African region suffers from drought and food system uncertainty with increased risks due to climate change, natural disasters, and global catastrophes. Increasing crop diversity with more appropriate and resilient crops is an effective way of increasing food system resilience. We focus on crop species that are native or naturalized to an area because of their increased resilience than those that are not naturally occurring. Additionally, crops that are easily stored are more useful in times of drought and disaster. In this systematic review, we use scientific interest in neglected and underutilized species (NUS) from Southern Africa to help define next steps toward their cultivation and development as a marketable crop. We found that although scientific interest is minimal for storable Southern African NUS, these crops are worth scaling up due to their economic and nutritional value. We outline next actionable steps and specific NUS for production in a more agrobiodiverse and resilient agriculture system.

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Female genital schistosomiasis (FGS) and male genital schistosomiasis (MGS) are gender-specific manifestations of urogenital schistosomiasis. Morbidity is a consequence of prolonged inflammation in the human genital tract caused by the entrapped eggs of the waterborne parasite, Schistosoma (S.) haematobium. Both diseases affect the sexual and reproductive health (SRH) of millions of people globally, especially in sub-Sahara Africa (SSA). Awareness and knowledge of these diseases is largely absent among affected communities and healthcare workers in endemic countries. Accurate burden of FGS and MGS disease estimates, single and combined, are absent, mostly due to the absence of standardized methods for individual or population-based screening and diagnosis. In addition, there are disparities in country-specific FGS and MGS knowledge, research and implementation approaches, and diagnosis and treatment. There are currently no WHO guidelines to inform practice. The BILGENSA (Genital Bilharzia in Southern Africa) Research Network aimed to create a collaborative multidisciplinary network to advance clinical research of FGS and MGS across Southern African endemic countries. The workshop was held in Lusaka, Zambia over two days in November 2022. Over 150 researchers and stakeholders from different schistosomiasis endemic settings attended. Attendees identified challenges and research priorities around FGS and MGS from their respective countries. Key research themes identified across settings included: 1) To increase the knowledge about the local burden of FGS and MGS; 2) To raise awareness among local communities and healthcare workers; 3) To develop effective and scalable guidelines for disease diagnosis and management; 4) To understand the effect of treatment interventions on disease progression, and 5) To integrate FGS and MGS within other existing sexual and reproductive health (SRH) services. In its first meeting, the BILGENSA Network set forth a common research agenda across S. haematobium endemic countries for the control of FGS and MGS.

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BACKGROUND: Amblyomma spp. ticks, known for their long mouthparts, bright ornate appearance and aggressive hunting behaviour, are vectors of a number of important pathogens. In southern Africa, 17 Amblyomma spp. are currently documented. Of these species, Amblyomma hebraeum and Amblyomma variegatum have been well studied due to their wide geographical range and their status as competent vectors of pathogens that are of veterinary and medical importance. Studies on other Amblyomma spp. in southern Africa have been neglected, fostering ongoing debates on the validity of certain species such as Amblyomma pomposum. This study investigated the inter- and intra-species variation of Amblyomma ticks collected in southern Africa, focusing on resolving the dispute about A. pomposum and A. variegatum being distinct species. METHODS: Four Amblyomma tick species were collected from Angola, Mozambique, South Africa, Zambia and Zimbabwe, and were identified morphologically as Amblyomma eburneum (208), A. hebraeum (4758), A. pomposum (191) and A. variegatum (2577) using identification keys. Gene amplification targeting the 12S and 16S rRNA, cytochrome oxidase I, cytochrome B and internal transcribed spacer-2 genes was conducted for 204 ticks, for which varying success was achieved during amplification for each of the markers. Maximum likelihood analyses were performed in IQ-TREE. RESULTS: The phylogenetic topologies and ABGD analyses of each individual gene clustered A. pomposum within the A. variegatum clade, while clearly separating A. eburneum and A. hebraeum from all other species. None of the genetic markers indicated intraspecific structuring on the basis of geographical origin, despite great distances between sampling sites. CONCLUSION: Our study concludes that there is insufficient molecular evidence to differentiate A. pomposum and A. variegatum from each other. We highlight the need for whole mitochondrial genome sequencing of these two species to resolve the ongoing controversies. Furthermore, we propose mating and hybrid viability studies between the two species to confirm their reproductive isolation.

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ETHNOPHARMACOLOGICAL RELEVANCE: Angola has an extraordinary plant diversity and a great ethnobotanical potential. However, there is a general lack of information about the first botanical explorations in the country and their contribution to the knowledge of the medicinal flora. AIM OF THE STUDY: The main aim of this study was to unveil the ethnobotanical legacy of José Maria Antunes and Eugène Dekindt, priests of the first Catholic mission in Huíla (Angola) and shed light on their contribution to the knowledge of medicinal wild plants of the country, including information on the uses, plant parts used, and preparation methods documented in the late 19th century. The findings are discussed considering recent ethnobotanical studies to offer a more comprehensive understanding of the historical and traditional uses of plants in Angola over the last two centuries. MATERIALS AND METHODS: Based on the information available in manuscripts and on the study of botanical collections preserved in herbaria of Portugal and Angola, we extracted relevant information about the species used in traditional medicine by the rural population of Huíla, the health conditions treated, and the mode of preparation and application. RESULTS: Our results revealed that Antunes and Dekindt conducted the first ethnobotanical study in Huíla, and documented a large number of medicinal wild plants. From these, we report 191 medicinal species, including 25 endemic and four introduced species, belonging to 56 plant families and 146 genera. Fabaceae family presents the highest richness of medicinal plants (39 taxa), followed by Rubiaceae (13), Asteraceae (10), and Apocynaceae (9). The illnesses reported were classified into 15 different categories, with the highest number of species (49) corresponding to unspecific conditions, such as general pains, chills, and fever. Thirty-seven species were reported for respiratory diseases, 31 for musculoskeletal problems, and 30 for digestive issues. Leaves were the most used plant part for medicinal purposes (84 species). Infusion was the most frequently described preparation method (40 species), followed by maceration (24 species), and powdering (36 species). CONCLUSIONS: The legacy of Antunes and Dekindt's work improves our understanding of Angola's botanical richness and traditional uses of plant resources. Our findings highlight the presence of unique medicinal resources in Angola, especially among endemic species, which hold the potential to improve the quality of life of rural communities. Moreover, our research underscores the lack of knowledge of medicinal species, emphasizing the risk of losing valuable historical information.

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Pregnant and lactating persons in sub-Saharan Africa face a heightened risk of HIV acquisition, due to biological and behavioral factors, combined with limited access to prevention and treatment services. Oral pre-exposure prophylaxis (PrEP) and the dapivirine vaginal ring are promising tools for HIV prevention, and the ring's recent approval in multiple African countries represents a significant advancement in expanding access to HIV prevention. In a nested qualitative study within the MTN-042 trial, we explored the acceptability of study products among pregnant persons in the second and early third trimesters. Interviews were conducted privately, using a semi-structured guide with 77 participants, in participants' preferred language. Topics explored included product acceptability (using the theoretical framework of acceptability), user experience, satisfaction, disclosure, community attitudes, and sexual activity during pregnancy. Interview transcripts were analyzed using Dedoose software. We observed positive attitudes among participants towards the study products, which they found generally user-friendly, despite the added complexities of using them during pregnancy. Participants recognized that consistent and correct use would provide protection for both them and their unborn children. Although initial concerns existed, most of these worries dissipated over time, with study staff support and increased product use experience. These findings emphasize the importance of continued surveillance, support, and education to ensure the successful rollout of new HIV prevention measures during pregnancy.

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BACKGROUND: Multipurpose prevention technologies (MPTs) are products capable of simultaneously addressing multiple sexual and reproductive health needs such as unwanted pregnancy, STIs including HIV-1, and other reproductive tract infections. MPTs are urgently needed to address the double burden of unplanned pregnancy and HIV. While condoms are currently the only accessible MPTs, they are not solely under a woman's control, and female condoms face limitations due to poor acceptability and high cost. METHODS: We conducted a sub-analysis of qualitative data from 39 couples participating in the MTN 045 study to examine the perception of couples on choice and acceptability of a "2 in 1" MPT that combines HIV and pregnancy prevention. RESULTS: Couples recognized the benefits of MPTs for HIV and pregnancy prevention but perceptions tied to each indication and a novel prevention technology tool raised important concerns relevant to use of future MPTs. In the study, participants' perceptions of MPT use were influenced by pregnancy planning. When the timing was less critical, they prioritized HIV prevention. Misinformation about family planning methods, including MPTs, affected decision-making with potential to hinder uptake of future MPTs. Concerns about side effects, such as weight gain and hormonal imbalances, influenced willingness to use MPTs. CONCLUSION: Addressing the myths and misconceptions surrounding the use of contraceptives is crucial in promoting their acceptance and ultimate use. Strategies for addressing the drawbacks women might experience while using a particular product should be in place as new MPTs progress through the development pipeline and approach roll-out.

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BACKGROUND: The College of Surgeons of East, Central, and Southern Africa (COSECSA) comprises 14 countries, many of which currently grapple with an increasing burden of cardiothoracic surgical (CTS) diseases. Health and economic implications of unaddressed CTS conditions are profound and require a robust regional response. This study aimed to define the status of CTS specialist training in the region (including the density of specialists, facilities, and active training posts), examine implications, and proffer recommendations. METHODS: A desk review of COSECSA secretariat documents and program accreditation records triangulated with information from surgical societies was performed in May 2022 and September 2023 as part of education quality improvement. A modified nominal group process involving contextual experts was used to develop a relevant action framework. RESULTS: Only 6 of 14 (43%) of COSECSA countries offered active training programs with annual intake of only 18 trainees. Significant training gaps existed in Burundi, Botswana, Malawi, Rwanda, South Sudan, Zambia, and Zimbabwe. Country specialist density ranged from 1 per 400,000 (Namibia) to 1 per 8,000,000 (Ethiopia). Overall, the region had 0.2 CTS specialists per million population as compared with 7.15 surgeons per million in High-Income Countries. Surgical education experts proposed an action framework to address the training crisis including increasing investments in CTS education, establishing regional centers of excellence, retention incentives and opportunities for women, and leveraging international partnerships. CONCLUSION: Proactive investments in infrastructure, human resources, training, and collaborative efforts by national governments, regional intergovernmental organizations, and international partners are critical to expanding regional CTS training.

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Data collection was implemented through an initiative by the Child Health and Mortality Prevention Surveillance (CHAMPS) Network to assess whether lockdowns and other social distancing policies during COVID-19 had implications for household economic status, maternal and child health, and healthcare accessibility for pregnant women and children. The data were collected from April 2021 until February 2022 from a population living in a rural community of Mozambique. This rural community is located within a Health and Demographic Surveillance System (HDSS) that operates in the Manhiça district of Maputo province. The survey instrument used for data collection was specifically designed to examine household awareness, knowledge, and prevalence of COVID-19; it was also designed to document hardships experienced by households during the pandemic period such as food insecurity, job losses and/or business closures of household members, and access to healthcare. The data are generalizable to a contiguous community in Manhiça, Mozambique of approximately 200,000 inhabitants.

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Gut bacterial communities provide flexibility to hosts during dietary changes. Despite the increasing number of studies exploring the associations between broader dietary guilds of mammalian hosts and their gut bacteria, it is generally unclear how diversity and variability in consumed diets link to gut bacterial taxa in wild non-primate mammals, particularly in omnivores. Here, we contribute to filling this gap by exploring consumed diets and gut bacterial community compositions with metabarcoding of faecal samples for two African mammals, Civettictis civetta and Genetta spp., from the family Viverridae. For each individual sample, we characterised bacterial communities and identified dietary taxa by sequencing vertebrate, invertebrate and plant markers. This led us to establish diet compositions that diverged from what has previously been found from visual identification methods. Specifically, while the two genera have been categorised into the same dietary guild, we detected more animal dietary items than plant items in C. civetta, while in Genetta spp., we observed the opposite. We further found that individuals with similar diets have similar gut bacterial communities within both genera. This association tended to be driven by specific links between dietary items and gut bacterial genera, rather than communities as a whole, implying diet-driven selection for specific gut microbes in individual wild hosts. Our findings underline the importance of molecular tools for improving characterisations of omnivorous mammalian diets and highlight the opportunities for simultaneously disentangling links between diets and gut symbionts. Such insights can inform robustness and flexibility in host-microbe symbioses to dietary change associated with seasonal and habitat changes.

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Avian species diversity in Southern Africa is remarkably high, yet the mechanisms responsible for that diversity are poorly understood. While this is particularly true with respect to species endemic to the subregion, it is unclear as to how more broadly distributed African species may have colonized southern Africa. One process that may in part account for the high bird species diversity in southern Africa is a "species pump" model, wherein the region was repeatedly colonized by lineages from areas further north: a pattern related to climate cycling and the eastern African arid corridor. Once occupying southern Africa, with its many varied biomes, it is possible that climate cycling further affected lineages by generating genetic diversity in multiple refugia, a pattern recently shown for several southern African bird species. Here, we used mtDNA to address these questions in a widespread, sedentary habitat generalist bird species, the familiar chat (Oenanthe familiaris). The phylogenetic structure suggests a north-to-south colonization pattern, supporting the "species pump" model. Haplotype diversity was partitioned into two distinct clusters: southern Africa and Malawi (East Africa). Southern African haplotypes were not geographically partitioned, and we hypothesize that this pattern has arisen because this species is a habitat generalist, and as such resilient to habitat-altering climate perturbations. Based on our phylogenetic results, we discuss the validity of currently recognized subspecies.

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Background: Novel HIV pre-exposure prophylaxis (PrEP) methods including a potential future HIV vaccine, will increase prevention options for adolescent girls and young women (AGYW) at high risk of HIV infection in Eastern and Southern Africa, yet data on AGYW's preferences for various PrEP methods is limited. We investigated preferences for five biomedical PrEP methods (oral, injectable, vaginal ring, implant, HIV vaccine) among 14-24-years-old AGYW in Kampala, Uganda. Methods: From January to December 2019, we conducted a mixed methods study including 265 high-risk AGYW. After receiving two education sessions on the five PrEP methods, participants were asked about their "most preferred PrEP method." Multinomial logistic regression (oral PrEP as reference category) was used to determine participant characteristics associated with method preference. Results are presented as adjusted relative risk ratios (aRRR) with 95% confidence intervals (CI). In-depth interviews were conducted with 20 selected participants to examine reasons influencing PrEP preferences and suggestions for method improvements. Transcripts were analyzed thematically. Results: Participants preferred methods were: HIV vaccine (34.7%), oral PrEP (25.7%), injectable PrEP (24.9%), PrEP implant (13.6%), and vaginal ring (1.1%). Preference for injectable PrEP increased with every year of age (aRRR 1.22; 95% CI 1.04-1.44) and among participants with chlamydia or gonorrhoea (aRRR 2.53; 95% CI 1.08-5.90), while it was lower among participants having sexual partner(s) living with HIV or of unknown HIV status (aRRR 0.30; 95% CI 0.10-0.91). Preference for PrEP implants also increased with age (aRRR 1.42; 95% CI 1.14-1.77) and was strong among participants having ≥10 sexual partners in the past 3 months (aRRR 3.14; 95% CI 1.16-8.55), while it was lower among those with sexual partner(s) living with HIV or of unknown HIV status (aRRR 0.25; 95% CI 0.07-0.92). PrEP method preference was influenced by product attributes and prior experiences with similar product forms commonly used in health care. Conclusion: AGYW have varied preferences for biomedical PrEP method and those with higher sexual behavioral risk prefer long-acting methods. As we anticipate more available PrEP options, oral PrEP use should be supported among AGYW, especially for those with sexual partners living with HIV or of unknown HIV status.

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Data collection was implemented through an initiative by the Child Health and Mortality Prevention Surveillance (CHAMPS) Network to assess whether lockdowns and other social distancing policies during COVID-19 had implications for household economic status, maternal and child health, and healthcare accessibility for pregnant women and children. The data were collected from April 2021 until February 2022 from a population living in a rural community of Mozambique. This rural community is located within a Health and Demographic Surveillance System (HDSS) that operates in the Manhiça district of Maputo province. The survey instrument used for data collection was specifically designed to examine household awareness, knowledge, and prevalence of COVID-19; it was also designed to document hardships experienced by households during the pandemic period such as food insecurity, job losses and/or business closures of household members, and access to healthcare. The data are generalizable to a contiguous community in Manhiça, Mozambique of approximately 200,000 inhabitants.

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BACKGROUND: While ear, nose, and throat (ENT) diseases are a substantial threat to global health, comprehensive reviews of ENT services in Southern Africa remain scarce. OBJECTIVE: This scoping review provides a decade-long overview of ENT services in Southern Africa and identifies gaps in healthcare provision. From the current literature, we hope to provide evidence-based recommendations to mitigate the challenges faced by the resource-limited ENT service. DATA SOURCES: PubMed, Web of Science, EBSCOhost, Cochrane Library, Cochrane Library, and Scopus. REVIEW METHODS: On several databases, we conducted a comprehensive literature search on both quantitative and qualitative studies on ENT services in Southern Africa, published between 1 January 2014 and 27 February 2024. The extracted data from the analyzed studies was summarized into themes. RESULTS: Four themes in the fourteen studies included in the final analysis described the existing ENT services in Southern Africa: 1. Workforce scarcity and knowledge inadequacies, 2. Deficiencies in ENT infrastructure, equipment, and medication, 3. Inadequate ENT disease screening, management, and rehabilitation and 4. A lack of telehealth technology. CONCLUSION: The Southern African ENT health service faces many disease screening, treatment, and rehabilitation challenges, including critical shortages of workforce, equipment, and medication. These challenges, impeding patient access to ENT healthcare, could be effectively addressed by implementing deliberate policies to train a larger workforce, increase ENT funding for equipment and medication, promote telehealth, and reduce the patient cost of care.

Main findings: Ear, nose and throat (ENT) healthcare in Southern Africa faces critical shortages of workforce, equipment, and medication for disease screening, treatment and rehabilitation.Added knowledge: In this review, we identify challenges in the resource-limited Southern African ENT healthcare provision and provide evidence-based recommendations to mitigate these challenges.Global health impact for policy and action: Improving ENT service delivery in the resource-limited world requires deliberate policies that improve health worker training, expand financing and resource availability, incorporate new technology, and lower patient costs of care.

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This paper provides an overview of the HEAT (Healthy Environments for AthleTes) project, which aims to understand the impact of environmental conditions on athlete health and performance during major sporting events such as long-distance running, cycling, and triathlons. In collaboration with the SAFER (Strategies to reduce Adverse medical events For the ExerciseR) initiative, the HEAT project carried out a field campaign at the 2022 Comrades Marathon in the KwaZulu-Natal province of South Africa. The measurement campaign deployed seven weather stations, seven PM2.5 monitors and one spore trap along the 90 km route to capture spatially representative measurements of complex micro-climates, allergenic aerospora, and particulate matter exposure. The results indicate that runners were exposed to moderate risk heat stress conditions. Novel findings from this initial campaign shows elevated and potentially harmful PM2.5 levels at spectator areas, possibly coinciding with small fire events around the race day festivities. Our findings show values PM2.5 levels over the WHO 24-h guidelines at all stations, while 2000 µg/m3 at two stations. However, the lack of an acute exposure standard means direct health impacts cannot be quantified in the context of a sport event. The HEAT project highlights important aspects of race day monitoring; regional scale climatology has an impact on the race day conditions, the microclimatic conditions (pollution and meteorology) are not necessarily captured by proximity instruments and direct environmental measurements are required to accurately capture conditions along the route.

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BACKGROUND: People with human immunodeficiency virus (PWH) on first-line, nonnucleoside reverse-transcriptase inhibitor-based antiretroviral therapy (ART) were routinely switched to tenofovir-lamivudine-dolutegravir. We examined virologic outcomes and drug resistance in ART programs in Malawi, where switching was irrespective of viral load, and Zambia, where switching depended on a viral load <1000 copies/mL in the past year. METHODS: We compared the risk of viremia (≥400 copies/mL) at 1 and 2 years by viral load at switch and between countries using exact methods and logistic regression adjusted for age and sex. We performed HIV-1 pol Sanger sequencing on plasma samples with viral load ≥1000 copies/mL. RESULTS: A total of 2832 PWH were eligible (Malawi 1422, Zambia 1410); the median age was 37 years, and 2578 (91.0%) were women. At switch, 77 (5.4%) were viremic in Malawi and 42 (3.0%) in Zambia (P = .001). Viremia at switch was associated with viremia at 1 year (adjusted odds ratio (OR), 6.15; 95% confidence interval [CI], 3.13-11.4) and 2 years (7.0; 95% CI, 3.73-12.6). Viremia was less likely in Zambia than in Malawi at 1 year (OR, 0.55; 0.32-0.94) and 2 years (OR, 0.33; 0.18-0.57). Integrase sequencing was successful for 79 of 113 eligible samples. Drug resistance mutations were found in 5 PWH (Malawi 4, Zambia 1); 2 had major mutations (G118R, E138K, T66A and G118R, E138K) leading to high-level dolutegravir resistance. CONCLUSIONS: Restricting switching to dolutegravir-based ART to PWH with a viral load <1000 copies/mL may reduce subsequent viremia and, consequently, the emergence of dolutegravir drug resistance mutations. CLINICAL TRIALS REGISTRATION: Clinicaltrials.gov (NCT04612452).

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Two articles by Garenne (2023a,b) argue that voluntary medical male circumcision does not reduce human immunodeficiency virus transmission in Africa. Here we point out key evidence and analytical flaws that call into question this conclusion.