Determination of birth prevalence of sickle cell disease using point of care test HemotypeSC™ at Rundu Hospital, Namibia.

BACKGROUND: Sickle cell disease (SCD), a noncommunicable disease, has the greatest burden in sub-Saharan Africa. The majority of children (50-90%) with SCD die before their 5th birthday, with approximately 150,000-300,000 annual SCD child deaths in Africa. In developed countries, newborn screening (NBS) has been shown to improve the survival of children with sickle cell disease, with under5 childhood mortality reduced tenfold due to interventions performed before the development of complications. Point -of-care tests have been developed for resource limited settings to expand NBS. The aim of this study was to determine the birth prevalence of sickle cell disease in Namibia using the HemoTypeSC™ point-of-care test. METHODS: A cross-sectional descriptive study was carried out at Rundu Intermediate Hospital in the Kavango East Region. Two hundred and two (202) well newborns within 72 h of birth were recruited for the study from 22 February to the 23th March 2023. Descriptive statistics were used to compute the haemoglobin types of the study participants. RESULTS: The majority of the participants (n = 105, 52%) were females, and (n = 97,48%) were males. The median age of the participants was 23 h (Q1, Q3; 11; 33),) with an age range of 2-98 h. Sickle cell trait was present in 9.4% of the screened newborns, no homozygous disease was detected, and 90.6% had Hb AA. CONCLUSIONS: This study is the first to measure HbS gene carriage at birth using HemotypeSC point-of-care testing in Namibia. There was a moderate prevalence of sickle cell traits but no SCD. This baseline study may provide the foundation for larger epidemiological surveys to map HbS gene carriage in Namibia to provide evidence for policy makers to fashion appropriate SCD newborn screening services.

Medical mistrust, discrimination and healthcare experiences in a rural Namibian community.

Substantial evidence indicates that medical mistrust, resulting from experiences with discrimination and marginalisation, is a determinant of health disparities in minority populations. However, this research is largely limited to the US and other industrialised countries. To broaden our understanding of the role of medical mistrust on health-care decision making, we conducted a study on healthcare experiences and perceptions in a rural, underserved indigenous community in northwest Namibia (n = 86). Mixing semi-structured interview questions with the medical mistrust index (MMI), we aim to determine the relevance of the MMI in a non-industrialised population and compare index scores with reports of healthcare experiences. We find that medical mistrust is a salient concept in this community, mapping onto negative healthcare experiences and perceptions of discrimination. Reported healthcare experiences indicate that perceived incompetence, maltreatment and discrimination drive mistrust of medical personnel. However, reporting of recent healthcare experiences are generally positive. Our results indicate that the concept of medical mistrust can be usefully applied to communities in the Global South. These populations, like minority communities in the US, translate experiences of discrimination and marginalisation into medical mistrust. Understanding these processes can help address health disparities and aid in effective public health outreach in underserved populations.

Experiences and challenges of enrolled nurses undertaking a Bachelor of Nursing Science programme in Namibia.

BACKGROUND:  Globally, enrolled nurses (ENs) are embarking on an educational journey to become registered nurses (RNs) in order to enhance their knowledge and career opportunities. However, their aspiration is not without challenges. In Namibia, the experiences of these nurses have not been extensively researched. OBJECTIVES:  This study aims to explore and describe the experiences and challenges of ENs undertaking a Bachelor of Nursing Science at the University of Namibia. METHOD:  A qualitative, exploratory, descriptive and contextual research strategy was followed as the basis of conducting the study. A sample of 15 nursing students was purposively selected from the target population of 73 nursing students. This sample size was determined by the saturation of data as reflected in repeating themes. The collected data were analysed thematically using an inductive approach. RESULTS:  Three main themes subsequently emerged from the study: ENs' positive experiences advancing in the Bachelor of Nursing Science (BNSc) programme; nurses' negative experiences advancing in the BNSc programme; and recommendations to ensure effective advancement in the BNSc programmeConclusion: The findings of this study revealed that ENs positively experience becoming a RN when it comes to self-development; however, they have negative experiences such as not receiving exemptions for prior learning and having to learn a new curriculum.Contribution: These findings may be used by the Faculty of Health Sciences, School of Nursing and Public Health management in order to develop targeted interventions and ongoing strategies during their curriculum review cycles to ensure positive student experiences and success within the programme.

Ecotoxicological evaluation of surface waters in Northern Namibia.

The increasing pressure on freshwater systems due to intensive anthropogenic use is a big challenge in central-northern Namibia and its catchment areas, the Kunene and the Kavango Rivers, and the Cuvelai-Etosha Basin, that provide water for more than 1 million people. So far, there is no comprehensive knowledge about the ecological status and only few knowledge about the water quality. Therefore, it is crucial to learn about the state of the ecosystem and the ecological effects of pollutants to ensure the safe use of these resources. The surface waters of the three systems were sampled, and three bioassays were applied on three trophic levels: algae, daphnia, and zebrafish embryos. Additionally, in vitro assays were performed to analyze mutagenicity (Ames fluctuation), dioxin-like potential (micro-EROD), and estrogenicity (YES) by mechanism-specific effects. The results show that acute toxicity to fish embryos and daphnia has mainly been detected at all sites in the three catchment areas. The systems differ significantly from each other, with the sites in the Iishana system showing the highest acute toxicity. At the cellular level, only weak effects were identified, although these were stronger in the Iishana system than in the two perennial systems. Algae growth was not inhibited, and no cytotoxic effects could be detected in any of the samples. Mutagenic effects and an estrogenic potential were detected at three sites in the Iishana system. These findings are critical in water resource management as the effects can adversely impact the health of aquatic ecosystems and the organisms within them.

Leveraging Routinely Collected Program Data to Inform Extrapolated Size Estimates for Key Populations in Namibia: Small Area Estimation Study.

BACKGROUND: Estimating the size of key populations, including female sex workers (FSW) and men who have sex with men (MSM), can inform planning and resource allocation for HIV programs at local and national levels. In geographic areas where direct population size estimates (PSEs) for key populations have not been collected, small area estimation (SAE) can help fill in gaps using supplemental data sources known as auxiliary data. However, routinely collected program data have not historically been used as auxiliary data to generate subnational estimates for key populations, including in Namibia. OBJECTIVE: To systematically generate regional size estimates for FSW and MSM in Namibia, we used a consensus-informed estimation approach with local stakeholders that included the integration of routinely collected HIV program data provided by key populations' HIV service providers. METHODS: We used quarterly program data reported by key population implementing partners, including counts of the number of individuals accessing HIV services over time, to weight existing PSEs collected through bio-behavioral surveys using a Bayesian triangulation approach. SAEs were generated through simple imputation, stratified imputation, and multivariable Poisson regression models. We selected final estimates using an iterative qualitative ranking process with local key population implementing partners. RESULTS: Extrapolated national estimates for FSW ranged from 4777 to 13,148 across Namibia, comprising 1.5% to 3.6% of female individuals aged between 15 and 49 years. For MSM, estimates ranged from 4611 to 10,171, comprising 0.7% to 1.5% of male individuals aged between 15 and 49 years. After the inclusion of program data as priors, the estimated proportion of FSW derived from simple imputation increased from 1.9% to 2.8%, and the proportion of MSM decreased from 1.5% to 0.75%. When stratified imputation was implemented using HIV prevalence to inform strata, the inclusion of program data increased the proportion of FSW from 2.6% to 4.0% in regions with high prevalence and decreased the proportion from 1.4% to 1.2% in regions with low prevalence. When population density was used to inform strata, the inclusion of program data also increased the proportion of FSW in high-density regions (from 1.1% to 3.4%) and decreased the proportion of MSM in all regions. CONCLUSIONS: Using SAE approaches, we combined epidemiologic and program data to generate subnational size estimates for key populations in Namibia. Overall, estimates were highly sensitive to the inclusion of program data. Program data represent a supplemental source of information that can be used to align PSEs with real-world HIV programs, particularly in regions where population-based data collection methods are challenging to implement. Future work is needed to determine how best to include and validate program data in target settings and in key population size estimation studies, ultimately bridging research with practice to support a more comprehensive HIV response.

DESCRIPTION OF FEMALE DENDRITOBILHARZIA PULVERULENTA (BRAUN, 1901) SKRJABIN, 1924 FROM TWO NEW AVIAN HOSTS IN NAMIBIA WITH PHYLOGENETIC ANALYSES AND COMMENTS ON SEVERAL TAXONOMICALLY UNCERTAIN AVIAN SCHISTOSOME SEQUENCES.

During a 2021 parasitological survey of birds in the Nyae Nyae-Khaudum Dispersal Area (Kavango-Zambezi Transfrontier Conservation Area, Namibia), we collected 9 specimens of Dendritobilharzia pulverulenta (Braun, 1901) Skrjabin, 1924 infecting the blood (heart lumen) of a white-backed duck, Thalassornis leuconotus (Eyton, 1838) (Anseriformes: Anatidae), and a fulvous whistling duck, Dendrocygna bicolor (Vieillot, 1816) (Anatidae). These flukes were fixed for morphology and preserved for DNA extraction. We assigned our specimens to DendritobilharziaSkrjabin and Zakharow, 1920 because they were strongly dorso-ventrally flattened in both sexes and had an intestinal cyclocoel with a zig-zag common cecum with lateral dendritic ramifications, numerous testes posterior to the cyclocoel and flanking the dendritic ramifications, and a tightly compacted convoluted ovary as well as lacking an oral sucker, ventral sucker, and gynaecophoric canal. Further, our specimens were morphologically identical to previously published descriptions of D. pulverulenta. Sequences of the 28S from our specimens were nearly identical to those identified as D. pulverulenta from North America (New Mexico), and our 28S phylogenetic analysis recovered D. pulverulenta within a polytomy of other Gigantobilharziinae spp. The CO1 phylogenetic analysis recovered a monophyletic Dendritobilharzia and, with low taxon sampling, a monophyletic Gigantobilharzia. This is the first record of a species of Dendritobilharzia infecting these ducks as well as the first record of an adult Dendritobilharzia from sub-Saharan Africa. The original description of adult D. pulverulenta (type locality: northern Sudan) was based on 2 males only, and hence the present study is the first description of female D. pulverulenta from Africa (the continent of the type locality). We reassign 2 Gigantobilharziinae spp. based on morphology and nucleotide evidence: Gigantobilharzia ensenadense (Lorenti, Brant, Gilardoni, Diaz, and Cremonte, 2022) Dutton and Bullard, n. comb., and Gigantobilharzia patagonense (Lorenti, Brant, Gilardoni, Diaz, and Cremonte, 2022) Dutton and Bullard, n. comb. We also comment on several avian schistosome sequences whose identities need confirmation or that likely have been misidentified.

Association between Physical Activity and Health Outcomes (High Body Fatness, High Blood Pressure) in Namibian Adolescents and Adult women.

Regular physical activity (PA) is known to promote the physical and mental health of children and adolescents and further prevent the development of health problems in adulthood. Information on body composition and PA is crucial for health promotion strategies and for epidemiological studies informing policies. However, there is limited data on the association between body composition and PA in Namibia. This dearth of published data is a significant shortcoming in the development of strategies and policies to promote PA in Namibia. Therefore, this cross-sectional study was conducted to determine the association between PA as a dependent variable and independent variables such as high blood pressure and body fatness as measured by different methods (gold standard deuterium dilution, body mass index, mid upper arm circumference, and waist circumference). The study included 206 healthy adolescent girls aged 13-19 years and 207 young adult females aged 20-40 years from Windhoek, Namibia. PA was measured using the PACE+ questionnaire in adolescents, and the GPAQ questionnaire was used for adults. In adolescents, only 33% of the participants met the recommended guidelines for PA, compared to only 2% for adults. Nevertheless, the study found no statistically significant association between PA and blood pressure indices (p-value < 0.05) among adolescents and adults. However, there was a significant association between PA and high body fatness (p-value < 0.001) and waist circumference (p-value = 0.014) in adolescents. Among adults, PA was significantly related to waist circumference only. In conclusion, failure to meet recommended PA guidelines is strongly associated with abdominal obesity and high body fatness. The knowledge gained from this study may be used by policymakers in the development of strategic policies and interventions aimed at promoting PA as a public priority and improving health outcomes.

Patterns of availability and accuracy of risk factor data for cardiovascular diseases among people initiated on antiretroviral therapy at selected health facilities in Khomas region, Namibia: a retrospective, cross-sectional, quantitative study.

Introduction: quality data is a prerequisite for timely decision-making and measuring health outcomes in public health settings. Comorbidities such as cardiovascular diseases (CVDs) among people living with HIV (PLHIV), require a robust system that ensures credible data at all data-producing levels. The study at determining the level of availability and completeness of CVDs risk factors data of PLHIV. Methods: a quantitative study was conducted to extract CVDs risk factors data retrospectively from 529 patient care booklets (PCBs) between 2004 and 2017. The analysis was done with the Statistical Package for Social Sciences (SPSS) version 25. Pearson Chi-Square was used to test for associations. The level of significance was at p ≤ 0.05. Results: the study revealed that 72.8% of patients are at risk of CVDs due to incomplete demographics (73.72%) and other systemic data (41.18%). A significant association was found (Pearson Chi-Square test 19.907; p-value of 0.001) between average visits per year, accurate data recording, and active status of the patient. Lost to follow-up (15%) and true retention (27.2%) was significantly associated with the last Antiretroviral Therapy (ART) status of a patient (Pearson Chi-Square test 87.754; p-value of 0.001). Conclusion: the study that despite concerted efforts to improve data quality, the availability and completeness of data remain unsatisfactory. Lack of harmonised data screening and analysis efforts for CVDs risk factors is found to be a significant risk factor in ensuring integrated routine measuring of CVDs health outcomes for PLHIV.

Healthcare worker burnout: exploring the experiences of doctors working in a maternity unit in Namibia.

BACKGROUND: Globally, healthcare workers (HCWs) in maternity units are at high risk of developing burnout. Burnout can lead to multiple harmful impacts on HCWs, their patients, and the broader healthcare system. Little is known about the burden of burnout among sub-Saharan African HCWs. Although evidence suggests that maternity unit doctors in a hospital complex in Namibia are at risk of developing burnout, no studies have been conducted on doctors in this department yet. METHODS: Through participant observation and a mixed-methods needs assessment, this study aimed to explore the drivers, experiences, and impact of burnout symptoms among doctors in this department, and current support mechanisms in place. Survey data was collected from 18 participants and seven in-depth interviews were conducted. Burnout risk was assessed using the Burnout Assessment Tool. RESULTS: Seven out of 18 participants were at very high risk for burnout and three were at risk, showing a high prevalence of burnout risk. Burnout risk remained similar between levels of staff, while gender qualitatively impacted burnout-related experiences. Drivers of burnout were identified at personal, occupational, and systemic levels. CONCLUSIONS: Over half of participants were at risk or at very high risk of burnout. Results highlighted a need for support and identified areas for intervention and further research. Such areas include blame culture, lack of trust between colleagues, and systemic drivers of burnout. This study contributes to the understanding of burnout among HCWs in sub-Saharan Africa.

Estimating the size of populations at risk for malaria: a case study in cattle herders and agricultural workers in Northern Namibia.

Cattle herders and agricultural workers have been identified has key high-risk populations for malaria in northern Namibia. Population size estimates for these groups are lacking but are important for planning, monitoring and evaluating the effectiveness of targeted strategies towards malaria elimination in the region. In this analysis, we extend population size estimation methods routinely used in HIV research, specifically social mapping and multiple source capture-recapture, to the context of malaria to estimate how many cattle herders and agricultural workers lived in two regions of northern Namibia over the course of the 2019-2020 malaria season. Both methods estimated two to three times more agricultural workers than cattle herders but size estimates based on the multiple source capture-recapture method were two to three times greater than the mapping-based, highlighting important methodological considerations to apply such methods to these highly mobile populations. In particular, we compared open versus closed populations assumptions for the capture-recapture method and assessed the impact of sensitivity analyses on the procedure to link records across multiple data sources on population size estimates. Our results are important for national control programs to target their resources and consider integrating routine population size estimation of high risk populations in their surveillance activities.

Insecticide susceptibility status of Anopheles gambiae mosquitoes and the effect of pre-exposure to a piperonyl butoxide (PBO) synergist on resistance to deltamethrin in northern Namibia.

BACKGROUND: Pyrethroid-based indoor residual spraying (IRS) and long-lasting insecticidal nets (LLINs) have been employed as key vector control measures against malaria in Namibia. However, pyrethroid resistance in Anopheles mosquitoes may compromise the efficacy of these interventions. To address this challenge, the World Health Organization (WHO) recommends the use of piperonyl butoxide (PBO) LLINs in areas where pyrethroid resistance is confirmed to be mediated by mixed function oxidase (MFO). METHODS: This study assessed the susceptibility of Anopheles gambiae sensu lato (s.l.) mosquitoes to WHO tube bioassays with 4% DDT and 0.05% deltamethrin insecticides. Additionally, the study explored the effect of piperonyl butoxide (PBO) synergist by sequentially exposing mosquitoes to deltamethrin (0.05%) alone, PBO (4%) + deltamethrin (0.05%), and PBO alone. The Anopheles mosquitoes were further identified morphologically and molecularly. RESULTS: The findings revealed that An. gambiae sensu stricto (s.s.) (62%) was more prevalent than Anopheles arabiensis (38%). The WHO tube bioassays confirmed resistance to deltamethrin 0.05% in the Oshikoto, Kunene, and Kavango West regions, with mortality rates of 79, 86, and 67%, respectively. In contrast, An. arabiensis displayed resistance to deltamethrin 0.05% in Oshikoto (82% mortality) and reduced susceptibility in Kavango West (96% mortality). Notably, there was reduced susceptibility to DDT 4% in both An. gambiae s.s. and An. arabiensis from the Kavango West region. Subsequently, a subsample from PBO synergist assays in 2020 demonstrated a high proportion of An. arabiensis in Oshana (84.4%) and Oshikoto (73.6%), and 0.42% of Anopheles quadriannulatus in Oshana. Non-amplifiers were also present (15.2% in Oshana; 26.4% in Oshikoto). Deltamethrin resistance with less than 95% mortality, was consistently observed in An. gambiae s.l. populations across all sites in both 2020 and 2021. Following pre-exposure to the PBO synergist, susceptibility to deltamethrin was fully restored with 100.0% mortality at all sites in 2020 and 2021. CONCLUSIONS: Pyrethroid resistance has been identified in An. gambiae s.s. and An. arabiensis in the Kavango West, Kunene, and Oshikoto regions, indicating potential challenges for pyrethroid-based IRS and LLINs. Consequently, the data highlights the promise of pyrethroid-PBO LLINs in addressing resistance issues in the region.

Exploring challenges and improvement strategies of adolescent-friendly health services in the northwest region of Namibia: A qualitative descriptive study.

Despite global agreements on adolescents' sexual and reproductive health and rights, access to and the utilisation of these services by the adolescents remain underutilised in low and middle-income countries. The aim of the study was to explore challenges and improvement strategies of adolescent-friendly health services in the northwest of Namibia. This study employed a qualitative approach utilising an explorative strategy. Semi-structured interviews were used to collect the data. Fifteen nurses were selected using a convenience sampling technique. The interviews were audio recorded, transcribed verbatim and the data were analysed using thematic analysis. The data analysis led to the emergence of the following three themes: Challenges affecting the delivery of Adolescent Friendly Health Services, Challenges affecting participation of adolescent to AFHS and strategies to improve the provision of adolescent-friendly health services. Findings from this study revealed several barriers reportedly faced by adolescents in accessing AFHS as including a lack of comprehensive sexual reproductive health (SRH) services in many healthcare facilities, a lack of trained staff, unfavourable environments for adolescents, a lack of information about the services provided, and recruitment of providers who are not friendly to young people and adolescents. This study findings may lead to an improvement in the provision of such services in healthcare settings. The study can lead to an improvement in the provision of adolescent-friendly services in health care settings. It can help the Ministry of Health and Social Services, along with its agencies, to formulate strategies that can be used to mitigate the challenges d in the provision of adolescent-friendly services.

Malgré les accords mondiaux sur la santé et les droits sexuels et reproductifs des adolescents, l'accès et l'utilisation de ces services par les adolescents restent sous-utilisés dans les pays à revenu faible ou intermédiaire. Le but de l'étude était d'explorer les défis et les stratégies d'amélioration des services de santé adaptés aux adolescents dans le nord-ouest de la Namibie. Cette étude a utilisé une approche qualitative utilisant une stratégie exploratoire. Des entretiens semi-structurés ont été utilisés pour collecter les données. Quinze infirmières ont été sélectionnées à l'aide d'une technique d'échantillonnage de convenance. Les entretiens ont été enregistrés audio, transcrits textuellement et les données ont été analysées par analyse thématique. L'analyse des données a conduit à l'émergence des trois thèmes suivants : les défis affectant la prestation de services de santé adaptés aux adolescents, les défis affectant la participation des adolescents à l'AFHS et les stratégies visant à améliorer la fourniture de services de santé adaptés aux adolescents. Les résultats de cette étude ont révélé plusieurs obstacles auxquels les adolescents seraient confrontés pour accéder à l'AFHS, notamment le manque de services complets de santé sexuelle et reproductive (SSR) dans de nombreux établissements de santé, le manque de personnel qualifié, les environnements défavorables pour les adolescents, le manque d'informations sur les services. Fournis et le recrutement de prestataires peu amicaux envers les jeunes et les adolescents. Les résultats de cette étude pourraient conduire à une amélioration de la fourniture de tels services dans les établissements de soins de santé. L'étude peut conduire à une amélioration de la fourniture de services adaptés aux adolescents dans les établissements de soins de santé. Il peut aider le ministère de la Santé et des Services sociaux, ainsi que ses agences, à formuler des stratégies pouvant être utilisées pour atténuer les défis liés à la fourniture de services adaptés aux adolescents.

Policy and Programming Towards Addressing Treatment Gaps in Adolescents Living with HIV: A Content Analysis of Policy and Programme Documents in Namibia.

Adolescents living with HIV (ALHIV) face unique challenges resulting in persistent treatment gaps, particularly viral non-suppression. Country programs adopt policies, guidelines, and innovations, based on WHO recommendations and best practices from elsewhere. However, it is unclear to what extent these tools address the management of adolescents with viral non-suppression. We report on a review of guidelines for the provision of HIV services to ALHIV in Namibia. We conducted a systematic document review using Content Analysis and Thematic Analysis methodology, and the READ approach. We identified seven relevant policy documents, four of which somewhat addressed viral non-suppression (treatment gap) in ALHIV and outlined interventions to improve treatment outcomes in adolescents considering their lived experience and unique challenges. The persistent treatment gap may reflect policy implementation gaps in specifically addressing viral non-suppression. It may be worthwhile to leverage existing documents to develop specific operational guidance for ALHIV with unsuppressed viral loads.

Study analysing the potential gaps in the contents of policies and programme documents meant to address management of adolescents living with HIV with high viral load Viral load suppression is a huge challenge in adolescents living with HIV (ALHIV). Globally, adolescents lag when compared to children and adults in achieving viral suppression levels set for achieving HIV epidemic control. The WHO and global HIV program initiatives recommend evidence-based interventions to be included in policies and guidelines to address unique barriers adolescents face that prevent them from staying in HIV care and adhering to their medication. The extent to which country policies guide service providers in managing high viral load cases among adolescents is important in identifying and addressing the persistent gaps. We reviewed the contents of policies, guidelines and other programmatic documents that address HIV management in adolescents in Namibia to assess the extent to which the documents guide management of ALHIV who have high viral load. Seven documents addressing management of ALHIV in Namibia were identified. Four documents address viral suppression among adolescents and recommend some interventions to improve treatment outcomes in adolescents in general. The documents acknowledge the uniqueness of the adolescence, with unique experiences and challenges. However, the documents fall short in providing comprehensive and specific guidance in managing adolescents with high viral loads, for program implementers and direct service providers for ALHIV. The fragmented guidance on managing adolescents with unsuppressed viral loads may be leading to implementation gaps or uncertainties among service providers on how to manage unique cases. It would be essential to focus future efforts on consolidation or development of comprehensive guidance on management of adolescents with high viral load, and capacitating the healthcare providers and stakeholders engaged in addressing social determinants of health affecting these adolescents. A multisectoral approach may provide a pathway to improved viral suppression among ALHIV.

Enhanced active case finding of drug-resistant tuberculosis in Namibia: a protocol for the hotspots, hospitals, and households (H3TB) study.

INTRODUCTION: Namibia is a high tuberculosis (TB)-burden country with an estimated incidence of 460/100 000 (around 12 000 cases) per year. Approximately 4.5% of new cases and 7.9% of previously treated TB cases are multidrug resistant (MDR) and 47% of patients with MDR-TB are HIV coinfected. Published data suggest a clustering of MDR-TB transmission in specific areas. Identifying transmission clusters is key to implementing high-yield and cost-effective interventions. This includes knowing the yield of finding TB cases in high-transmission zones (eg, community hotspots, hospitals or households) to deliver community-based interventions. We aim to identify such transmission zones for enhanced case finding and evaluate the effectiveness of this approach. METHODS AND ANALYSIS: H3TB is an observational cross-sectional study evaluating MDR-TB active case finding strategies. Sputum samples from MDR-TB cases in three regions of Namibia will be evaluated by whole genome sequencing (WGS) in addition to routine sputum investigations (Xpert MTB/RIF, culture and drug susceptibility testing). We will collect information on household contacts, use of community spaces and geographical map intersections between participants, synthesising these data to identify transmission hotspots. We will look at the feasibility, acceptability, yield and cost of case finding strategies in these hotspots, and in households of patients with MDR-TB and visitors of hospitalised patients with MDR-TB. A compartmental transmission dynamic model will be constructed to evaluate the impact and cost-effectiveness of the strategies if scaled. ETHICS AND DISSEMINATION: Ethics approval was obtained. Participants will give informed consent. H3TB will capitalise on a partnership with the Ministry of Health and Social Services to follow up individuals diagnosed with MDR-TB and integrate WGS data with innovative contact network mapping, to allow enhanced case finding. Study data will contribute towards a systems approach to TB control. Equally important, it will serve as a role model for similar studies in other high-incidence settings.

Assisted Partner Notification Services in Namibia: Comparison of Case-Finding in Persons With New and Previously Diagnosed Human Immunodeficiency Virus, and Success as a Platform for PrEP Referral.

BACKGROUND: Assisted partner notification services (APS) are widely implemented throughout sub-Saharan Africa. The effectiveness of APS among persons with previously diagnosed human immunodeficiency virus (HIV) infection is uncertain, and there are few published data on the success of integrating referrals for HIV preexposure prophylaxis (PrEP) into APS. METHODS: Staff in 22 Namibian Ministry of Health and Social Service clinics offered APS to patients newly and previously diagnosed with HIV (index cases [ICs]) between October 2019 and June 2021. Counselors used a structured interview guide to elicit ICs' sex partners and biological children and assisted ICs to arrange testing of contacts. Contacts testing HIV-positive were linked to HIV services and those 14 years or older testing negative were offered PrEP. The primary outcome was the case-finding index (contacts testing HIV-positive ÷ ICs receiving APS). RESULTS: Staff provided APS to 1222 (78%) of 1557 newly diagnosed ICs eliciting 1155 sex partners and 649 biological children. Among 280 previously diagnosed ICs, 279 sex partners and 158 biological children were elicited. The case-finding index was higher among ICs with newly diagnosed HIV compared with previously diagnosed HIV (0.14 vs 0.09, P = 0.46), though this difference was not statistically significant. Most sex partners testing HIV-negative were initiated on PrEP (67% in sex partners from newly diagnosed ICs; 74% in sex partners from previously diagnosed ICs). CONCLUSIONS: Assisted partner notification services successfully identified sex partners and biological children with undiagnosed HIV infection when provided to both newly and previously diagnosed ICs. Integration of referral to PrEP resulted in many HIV-negative partners initiating PrEP.

Bedaquiline Resistance after Effective Treatment of Multidrug-Resistant Tuberculosis, Namibia.

Bedaquiline is currently a key drug for treating multidrug-resistant or rifampin-resistant tuberculosis. We report and discuss the unusual development of resistance to bedaquiline in a teenager in Namibia, despite an optimal background regimen and adherence. The report highlights the risk for bedaquiline resistance development and the need for rapid drug-resistance testing.

Dog ecology and rabies knowledge, attitude and practice (KAP) in the Northern Communal Areas of Namibia.

In 2021, a comprehensive dog demographic questionnaire combined with a KAP survey were conducted in the northern communal areas (NCAs) of Namibia with the aim of gaining a better understanding of dog populations, owner behaviour, and knowledge, attitudes and practices (KAP) relating to rabies. The survey of 3,726 households across the eight regions of the NCAs provided insights that will inform interventions in order to improve human rabies prevention and Namibia's dog rabies control strategy. The results showed a relatively low average human/dog ratio (HDR) of 5.4:1 indicating a surprisingly high dog population of at least 272,000 dogs in the NCAs, 93% of which appear to be owned but are free-roaming. Data analysis revealed opportunities but also highlighted needs for improvements in rabies surveillance and mass dog vaccinations. Although knowledge, attitude, and practice scores towards epidemiologic and clinical aspects, human rabies prevention, and dog rabies vaccination were deemed to be acceptable, the survey nevertheless revealed deficiencies in certain aspects in some of the population. Interestingly, data seemed to indicate relatively high dog bite incidences per 100,000 people, ranging between 262 and 1,369 and a certain number of unreported human rabies cases. Despite the very high number of dogs, only 50% of dog-owning households reported having vaccinated their dogs. In order to address these issues, the planning, announcement, and implementation of mass dog vaccination campaigns needs to be adapted to achieve adequate vaccination coverage. Another focus needs to be on rabies awareness and education if Namibia is to be significantly contributing to the global goal of "Zero by 30".

Molecular epidemiology and antimicrobial resistance of vaginal Candida glabrata isolates in Namibia.

Candida glabrata is the most common non-albicans Candida species that causes vulvovaginal candidiasis (VVC). Given the intrinsically low susceptibility of C. glabrata to azole drugs, investigations into C. glabrata prevalence, fungal susceptibility profile, and molecular epidemiology are necessary to optimise the treatment of VVC. This molecular epidemiological study was conducted to determine antifungal drug profile, single nucleotide polymorphisms (SNPs) associated with phenotypic antifungal resistance and epidemic diversity of C. glabrata isolates from women with VVC in Namibia. Candida glabrata isolates were identified using phenotypic and molecular methods. Antifungal susceptibility of strains was determined for fluconazole, itraconazole, amphotericin B, and anidulafungin. Whole genome sequencing was used to determine SNPs in antifungal resistance genes and sequence type (ST) allocation. Among C. glabrata isolates, all (20/20; 100%) exhibited phenotypic resistance to the azole class antifungal drug, (fluconazole), and phenotypic susceptibility to the polyene class (amphotericin B), and the echinocandins (anidulafungin). Non-synonymous SNPs were identified in antifungal resistance genes of all fluconazole-resistant C. glabrata isolates including ERG6 (15%), ERG7 (15%), CgCDR1 (25%), CgPDR1 (60%), SNQ2 (10%), FKS1 (5.0%), FKS2 (5.0%), CgFPS1 (5.0%), and MSH2 (15%). ST15 (n = 8/20, 40%) was predominant. This study provides important insight into phenotypic and genotypic antifungal resistance across C. glabrata isolates from women with VVC in Namibia. In this study, azole resistance is determined by an extensive range of SNPs, while the observed polyene and echinocandin resistance-associated SNPs despite phenotypic susceptibility require further investigation.

Candida glabrata is inherently resistant to azole drugs. In this study, we identified a clone that was predominant in women with vulvovaginal candidiasis in Namibia, and that harboured various mutations in resistance-associated genes. This study provides important insight into antifungal resistance across C. glabrata isolates in a sub-Sahara African setting.

First report of a fish blood fluke from sub-Saharan Africa: Nomasanguinicola dentata (Paperna, 1964) Warren and Bullard, 2023 infecting African sharptooth catfish, Clarias gariepinus (Burchell, 1822) Teugles, 1982 in the Kavango River, Namibia, and a revised phylogeny for Sanguinicolidae Poche, 1926.

We herein provide a supplemental description of Nomasanguinicola dentata (Paperna, 1964) Warren and Bullard, 2023 (Digenea: Sanguinicolidae) and provide a revised 28S phylogeny to test relationships among freshwater fish blood flukes. We examined the heart of three African sharptooth catfish, Clarias gariepinus (Burchell, 1822) Teugles, 1982 from the Kavango River (northeastern Namibia) that was infected with adults of N. dentata. This blood fluke differs from N. canthoensis by having a body 5.3-6.7 longer than wide (vs. 3.5-4.6), an anterior esophageal swelling 7-8% (vs. 14-24%) of total esophageal length, a posterior esophageal swelling 3-5% (vs. 8-10%) of total esophageal length, a pre-cecal (vs. wholly post-cecal) testis, and an ovary that does not extend laterally beyond the nerve cords. The 28S sequence for N. dentata differed from that of N. canthoensis by 144 bp (9% difference). The phylogenetic analysis recovered these species as sister taxa and Sanguinicolidae as monophyletic. This is the first report of a fish blood fluke from sub-Saharan Africa, and the first report of a species of Nomasanguinicola from Africa in ∼40 yrs.

Caregiver-child communication on parental loss in the context of the AIDS epidemic in Namibia.

Personal grief takes place in a social context, such as the family setting. This study aimed to understand how Namibian caregivers and children/adolescents communicate parental loss, in the context of the HIV/AIDS epidemic. An ethnographic design was used, in which 38 children, adolescents, and their caregivers were interviewed. The results show that caregivers shared few memories and provided minimal information about the deceased parents. However, the majority of adolescents and children wished for information. A relational Sender-Message-Channel-Receiver model was used to map the reasons for this silence. This model is useful for grief interventions that aim to strengthen communication.