Peter Barron

University of the Witwatersrand | wits · Division of Epidemiology and Biostatistics

Background: In a previous article on the impact of COVID-19, the authors compared access to routine health services between 2019 and 2020. While differential by province, a number of services provided, as reflected in the District Health Information System (DHIS), were significantly affected by the pandemic. In this article we explore the extent t...

Articles on teenage pregnancies have been proliferating in both the popular press and the medical media. We analysed data available in the public sector database, the District Health Information System, from 2017 to 2021. During this time, the number of births to young teenagers aged 10 - 14 years increased by 48.7% (from a baseline of 2 726, which...

Digital health solutions offer tremendous potential to enhance the reach and quality of health services and population‐level outcomes in low‐ and middle‐income countries (LMICs). While the number of programs reaching scale increases yearly, the long‐term sustainability for most remains uncertain. In this article, as researchers and implementors, we...

Background: The COVID-19 pandemic and responses by governments, including lockdowns, have had various consequences for lives and livelihoods. South Africa (SA) was one of the countries that implemented severely restrictive lockdowns to reduce transmission and limit the number of patients requiring hospitalisation. These interventions have had mixe...

Introduction New HIV infection during pre-conception and pregnancy is a significant contributor of mother–to–child transmission of HIV in South Africa. This study estimated HIV incidence (defined as new infection within the last one year from the time of the survey which included both new infections occurred during pregnancy or just before pregnanc...

Background: Global guidelines recommend exclusive breastfeeding (EBF) for the first 6 months of life. South African EBF rates have steadily increased but still only average 32% for infants below 6 months of age. Malnutrition and developmental delays continue to contribute substantially to the morbidity and mortality of South African children. MomC...

Introduction Knowledge of HIV status in South Africa (SA) is reported to be 90% among people living with HIV. National level estimates could mask population-specific levels, which are critical to monitor program coverage and potential impact. Using data from the 2017 national antenatal sentinel survey, we assessed knowledge of HIV-positive status,...

Objective: To describe viral load (VL) levels among pregnant women and factors associated with failure to achieve viral suppression (VL≤50 copies/mL) (VS) during pregnancy. Design: Between 1 October and 15 November 2017, a cross-sectional survey was conducted among 15-49 year old pregnant women attending antenatal care (ANC) in 1,595 nationally...

Objective: South Africa has used antenatal HIV surveys for HIV surveillance in pregnant women since 1990. We assessed South Africa's readiness to transition to programme data based antenatal HIV surveillance with respect to PMTCT uptake, accuracy of point-of-care rapid testing (RT) and selection bias with using programme data in the context of the...

South Africa (SA) is committed to reducing tuberculosis (TB) mortality rates in line with the World Health Organization's End TB Strategy and the Sustainable Development Goal (SDG) targets. From mortality reports released by Statistics South Africa, this study analysed reported TB mortality in SA from 2006 to 2016 to inform our understanding of TB...

Background Over the past decade, mobile health has steadily increased in low-income and middle-income countries. However, few platforms have been able to sustainably scale up like the MomConnect program in South Africa. NurseConnect was created as a capacity building component of MomConnect, aimed at supporting nurses and midwives in maternal and c...

BACKGROUND Over the past decade, mobile health (mHealth) has steadily increased in low- and middle- income countries. However, few platforms have been able to sustainably scale-up like the MomConnect programme in South Africa. NurseConnect was created as a capacity building component of MomConnect, aimed at supporting nurses and midwives in materna...

Despite calls to address broader evidence gaps in linking digital technologies to outcome and impact level health indicators, limited attention has been paid to measuring processes pertaining to the performance of programs. In this paper, we assess the program reach and message exposure of a mobile health information messaging program for mothers (...

MomConnect is a flagship programme of the South African National Department of Health that has reached over 1.5 million pregnant women. Using mobile technology, MomConnect provides pregnant and postpartum women with twice-weekly health information text messages as well as access to a helpdesk for patient queries and feedback. In just 3 years, MomCo...

Information systems designed to support health promotion in pregnancy, such as the MomConnect programme, are potential sources of clinical information which can be used to identify pregnancies prospectively and early on. In this paper we demonstrate the feasibility and value of linking records collected through the MomConnect programme, to an emerg...

In South Africa, a national-level helpdesk was established in August 2014 as a social accountability mechanism for improving governance, allowing recipients of public sector services to send complaints, compliments and questions directly to a team of National Department of Health (NDoH) staff members via text message. As demand increases, mechanism...

MomConnect was designed to provide crucial health information to mothers during pregnancy and in the early years of child rearing in South Africa. The design drew on the success of the Mobile Alliance for Maternal Action’s programme in South Africa, as well as a growing list of mobile health (mHealth) interventions implemented internationally. Serv...

MomConnect is a national initiative coordinated by the South African National Department of Health that sends text-based mobile phone messages free of charge to pregnant women who voluntarily register at any public healthcare facility in South Africa. We describe the system design and architecture of the MomConnect technical platform, planned as a...

Over the last few years, the South African (SA) National Department of Health has led the design, implementation and monitoring of key strategies to improve maternal, newborn, and child health outcomes. The strategies have resulted in the reduction of maternal, under-5 and infant mortality rates in SA. Here, we examine the strategies using a framew...

South Africa is committed to reducing under-5 mortality rates in line with the Sustainable Development Goal (SDG) targets. Policymakers and healthcare service managers require accurate and complete data on the number and causes of child deaths to plan and monitor healthcare service delivery and health outcomes. This study aimed to review nationally...

Although current levels of the neonatal mortality rate (NMR) are within reach of the Sustainable Development Goal (SDG) target of 12 per 1 000 live births, the absolute number of deaths is unacceptably high for a lower-middle-income country such as South Africa (SA). Neonatal mortality over the last decade has declined very slowly, and is not comme...

The contribution of the District Clinical Specialist Teams (DCSTs) to improving maternal and child health outcomes in South Africa, through strengthening the four pillars of clinical governance, is reflected in innovative work presented at a ‘Promising Practices’ symposium and at various conferences. Of the 24 identified DCST innovations, 21% r...

Introduction: In 2014, city leaders from around the world endorsed the Paris Declaration on Fast-Track Cities, pledging to achieve the 2020 and 2030 HIV targets championed by UNAIDS. The City of Johannesburg - one of South Africa's metropolitan municipalities and also a health district - has over 600,000 people living with HIV (PLHIV), more than a...

Figure S1. shows the model estimates of HIV prevalence in each sub‐population compared to available data. Table S1. Calculations to determine the cost of scaling up the VMMC and condom distribution programmes in Johannesburg

Background: South Africa represents the first high-burden setting to introduce routine virological testing at birth within its early infant diagnosis program, implemented in June 2015. National HIV birth testing coverage, intra-uterine transmission rates and case rates for the first year since introduction of universal birth testing are reported....

Background South Africa has utilized three independent data sources to measure the impact of its program for the prevention of mother–to–child transmission (PMTCT) of HIV. These include the South African National Health Laboratory Service (NHLS), the District Health Information System (DHIS), and South African PMTCT Evaluation (SAPMTCTE) surveys. W...

[This corrects the article DOI: 10.1371/journal.pone.0157071.].

MomConnect is an mHealth initiative giving pregnant women information via SMS. We report on an analysis of the compliments and especially complaints component of the feedback. We scrutinised the electronic databases containing information on the first seventeen months of operation of MomConnect. During this time, 583,929 pregnant women were registe...

Background: In 2012, South Africa set a goal of circumcising 4.3 million men ages 15-49 by 2016. By the end of March 2014, 1.9 million men had received voluntary medical male circumcision (VMMC). In an effort to accelerate progress, South Africa undertook a modeling exercise to determine whether circumcising specific client age groups or geographi...

South Africa DMPPT 2.0 Model Inputs, Part 1. See Methods section for data sources. (DOCX)

Number of VMMCs conducted in each South African province, by year. Indicated percentage represents the portion of VMMCs done in this province out of all provinces in each year. (DOCX)

South Africa DMPPT 2.0 Model Inputs, Part 2 (Epidemiology and Demographic Inputs). See Methods section for data sources. (XLSX)

Provincial HIV incidence is inversely related to the number of VMMCs per HIV infection averted (VMMC/IA). (a) Average HIV incidence for each province, [2013 to 2028]; (b) Projected number of VMMCs per HIV infection averted for each province, [2013 to 2028]; IA = HIV infections averted. (TIF)

Estimated number of circumcisions conducted in South Africa, by age and year. Indicated percentage represents the portion of VMMCs done in this age group out of all ages in each year. (DOCX)

After a late start and poor initial performance, the South African Prevention of Mother-To-Child Transmission (PMTCT) programme achieved rapid progress in achieving effective national-scale implementation of a complex intervention across a large number of different geographic and socioeconomic contexts. This study shows how quality-improvement meth...

For the past 25 years, South Africa has had to deal with the inexorable and monumental rise of HIV. From one or two isolated cases, in the late 1980s, South Africa now has an estimated 6.4 million people infected with HIV, with high rates of concomitant tuberculosis, which will profoundly affect the country for decades to come. For nearly 10 years,...

South Africa has made substantial progress on child and maternal mortality, yet many avoidable deaths of mothers and children still occur. This analysis identifies priority interventions to be scaled up nationally and projects the potential maternal and child lives saved. We modelled the impact of maternal, newborn and child interventions using the...

The Millennium Declaration, together with the Millennium Development Goals (MDGs), was signed by member states of the United Nations, including South Africa (SA), in September 2000. While all the MDGs are related to health, goals 4, 5 and 6 are directly related to health and the functioning of the healthcare system: goal 4 relates to reducing child...

Background: Monitoring the prevention of mother-to-child transmission (PMTCT) programme to identify gaps for early intervention is essential as South Africa progresses from prevention to elimination of HIV infection in children. Early infant diagnosis (EID) by an HIV polymerase chain reaction (PCR) test is recommended at 6 weeks of age for all HIV...

Background: South Africa (SA) is committed to achieving the goal of eliminating mother-to-child transmission (MTCT) of HIV by 2015. To achieve this, universal coverage of quality antenatal, labour, delivery and postnatal services for all women has to be attained. Over the past decade, the prevention of mother-to-child transmission (PMTCT) programm...

This article is reprinted from The Lancet, with permission from Elsevier: Coutsodis A, Goga A, Desmond C, Barron P, Black V, Coovadia H. Is Option B+ the best choice? Lancet 2013;381(9863):269-271. [http://dx/doi.org/10.1016/S0140-6736(12)61807-8] The success of prevention of mother-to-child transmission (PMTCT) programmes (Options A and B) in midd...

This article is reprinted from The Lancet, with permission from Elsevier: Coutsodis A, Goga A, Desmond C, Barron P, Black V, Coovadia H. Is Option B+ the best choice? Lancet 2013;381(9863):269-271. [http://dx/doi.org/10.1016/S0140-6736(12)61807-8] The success of prevention of mother-to-child transmission (PMTCT) programmes (Options A and B) in mid...

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. Although South Africa initiated its PMTCT programme in 2002,...

Improving health systems performance in order to achieve good health care outcomes and meet the Millennium Development Goals (MDGs) has received increased global attention. Using the World Health Organization (WHO)'s framework on health system strengthening, an overview is presented of key aspects of performance of the South African (SA) health sys...

The roots of a dysfunctional health system and the collision of the epidemics of communicable and non-communicable diseases in South Africa can be found in policies from periods of the country's history, from colonial subjugation, apartheid dispossession, to the post-apartheid period. Racial and gender discrimination, the migrant labour system, the...

15 years after liberation from apartheid, South Africans are facing new challenges for which the highest calibre of leadership, vision, and commitment is needed. The effect of the unprecedented HIV/AIDS epidemic has been immense. Substantial increases in mortality and morbidity are threatening to overwhelm the health system and undermine the potent...

This chapter reviews South Africa's response to its HIV epidemic. Within the current macroeconomic context, the public sector will find itself increasingly constrained in its ability to meet existing needs, let alone new demands generated by the HIV epidemic. There is a need to increase the portion of GDP spent on health, social and other support s...

A decentralised District Health System, based on Primary Health Care, is the vision for health services in South Africa. This is established in the National Health Act of 2003. Structures and systems for a district health system have been established; the impact of these structures and systems on human resources has not always been adequately consi...

Long waits at large urban clinics obstruct primary care delivery, imposing time costs on patients, deterring appropriate utilization and causing patient dissatisfaction. This paper reports on an innovative attempt by staff in a large South African urban health centre to analyse a system of queues and preventive and curative services for pre-school...

Cape Town is undergoing rapid urbanization. South African vital statistics have routinely been stratified by racial categories but intra-urban and peri-urban geographical variations have been neglected. To examine variations in infant mortality rates (IMR) and proportional infant mortality between urban, rural and informally settled areas, stratifi...

This article summarizes key findings from a survey of access to facilities during 1994-95, among environmental health offices in Greater Metropolitan Cape Town, South Africa. The offices were situated in Parow, Goodwood, Elsies River, Constantia, Grassy Park, Durbanville, Atlantis, Bellville, Paarl, Stellenbosch, Belhar, Khanya, and Milnerton. Samp...

To compare prevalences of missed opportunities for immunisation between preventative and curative clinic patients and to evaluate changes 13 months later. Repeat cross-sectional survey of patients' Road to Health cards. A large community health centre in Khayelitsha, South Africa. Patients under 6 years of age. Proportion of children needing immuni...

The effects of measles immunization on immune responses in infants and the roles of vaccine strain and age of immunization are not known. Eighty-eight children were immunized at 6 or 9 months of age with the Edmonston-Zagreb (EZ) or Schwarz (SW6, SW9) strain of measles vaccine. Children were studied before and 2 weeks and 3 months after immunizatio...

In 1988 the Western Cape Regional Services Council (RSC) initiated a community health worker (CHW) project in Khayelitsha in order to extend its preventive services to people in the community and promote 'community upliftment'. An evaluation of this project was undertaken in 1991 and 1992 in order to examine the potential of this local health autho...

The mobile nature of the population of Khayelitsha makes it imperative that opportunities for immunisation of children are exploited at every visit to health services. Previous studies have demonstrated a high incidence of missed opportunities for immunisation at curative health services. The occurrence of undetected opportunities for immunisation...

This community-based survey evaluates vaccination coverage of small children and socio-economic status of their households in a randomly selected sample of a black South African township. It reveals a poverty-stricken community, where only 19% of the children surveyed were fully vaccinated. It is suggested that expansion of health infrastructures t...

This article reports on some aspects of the physical environment and on environmental health services at Oukasie. The data were collected over a weekend in August 1987 by an interview and by direct inspection of the environment using a standard schedule. We had a 100% response rate on the interviews. There was a mean of 2.2 +/- 1.6 persons per room...

A series of surveys were conducted at the request of the community of Oukasie to determine certain public health information in the township, a peri-urban black community. This article describes two of these surveys. The first, a census and partial demographic survey, showed that the total black population was around 6,300 with a mean household occ...

Questionnaires were posted to 760 manufacturing organisations sampled from the 1986 Workmen's Compensation tape in the Johannesburg and Randburg areas. A response rate of 51% was obtained. The results indicate a general deficiency in the quantity of occupational health services offered. For example, only 57 factories (18%) offered a medical service...

The process by which mortality statistics are compiled in the RSA and the potential impact on public health are discussed. The use of the international death certificate is outlined; this is compared with the South African death certificate to illustrate the importance of establishing the chain of events leading to death. The distinction between un...