Thandi Kapwata’s research while affiliated with South African Medical Research Council and other places

Youth depression is a global emergency. Redressing this emergency requires a sophisticated understanding of the multisystemic risks and biopsychosocial, economic, and environmental resources associated with young people's experiences of no/limited versus severe depression. Too often, however, personal risks and a focus on individual-level protective resources dominate accounts of young people's trajectories towards depression. Further, studies of depression in high-income countries (i.e., “western”) typically inform these accounts. This article corrects these oversights. It reports on the methodology of the Wellcome-funded R-NEET study: a multidisciplinary, multisystemic, mixed method longitudinal study of resilience among African youth whose status as “not in education, employment or training” (NEET) makes them disproportionately vulnerable to depression. Co-designed by academics, community-based service providers and youth in South Africa and Nigeria, with partnerships in the United Kingdom, Canada and the United States, the R-NEET study is identifying the physiological, psychological, social, economic, institutional, and environmental risks and resources associated with distinct trajectories of depression. Using the methodology of the R-NEET study as exemplar, this article advances an argument for understanding resilience as a contextually and culturally rooted capacity that draws on the multiple, co-occurring systems that young people depend upon to support their wellbeing. Acknowledging and harnessing the multiple systems implicated in resilience is critical to researchers and mental health providers who seek to support young people to thrive, and to young people themselves when protecting or promoting their mental wellbeing.

Communities living in proximity to coal-fired power plants (CFPPs) may be at greater risk of negative health impacts from exposure to air pollution than communities living further away. The aim of this scoping review was to provide an update on the evidence of the health risks of air pollution exposure associated with living in proximity to CFPPs and to evaluate the relationship between residential proximity and the extent of the health burden. We followed the PRISMA-ScR guidelines and searched Google Scholar, PubMed, ScienceDirect, Scopus and Web of Science for relevant studies from inception up to 31 January 2024. Fifty-six studies were included with most articles published from 2016 to 2023 (n=33, 59 %) and 35 were in high income countries (63 %). Living close to CFPPs was frequently associated with increased odds or likelihood of respiratory disorders, adverse birth outcomes and child developmental issues. Interventions such as emission control systems or total shutdown of CFPPs led to improved health among communities living near CFPPs. The review highlights the health impacts from air pollution associated with living in proximity to CFPPs and the need for policy measures to reduce air pollution by installing emission control technologies or transitioning to cleaner energy sources.

Africa is grappling with severe food security challenges driven by population growth, climate change, land degradation, water scarcity, and socio-economic factors such as poverty and inequality. Climate variability and extreme weather events, including droughts, floods, and heatwaves, are intensifying food insecurity by reducing agricultural productivity, water availability, and livelihoods. This study examines the projected threats to food security in Africa, focusing on changes in temperature, precipitation patterns, and the frequency of extreme weather events. Using an Exponential Growth Model, we estimated the population from 2020 to 2050 across Africa’s five sub-regions. The analysis assumes a 5% reduction in crop yields for every degree of warming above historical levels, with a minimum requirement of 225 kg of cereals per person per year. Climate change is a critical factor in Africa’s food systems, with an average temperature increase of approximately +0.3 °C per decade. By 2050, the total food required to meet the 2100-kilocalorie per adult equivalent per day will rise to 558.7 million tons annually, up from 438.3 million tons in 2020. We conclude that Africa’s current food systems are unsustainable, lacking resilience to climate shocks and relying heavily on rain-fed agriculture with inadequate infrastructure and technology. We call for a transformation in food systems through policy reform, technological and structural changes, solutions to land degradation, and proven methods of increasing crop yields that take the needs of communities into account.

Objective Prior research has shown strong evidence of spatial clustering of tuberculosis across a range of contexts. Identifying the spatial patterning of infectious diseases such as tuberculosis is crucial as it allows for targeted intervention strategies, directing healthcare resources efficiently to areas where tuberculosis incidence is concentrated. This is especially true for low- and middle-income countries that typically experience greater resource constraints relative to their Global North counterparts. In this study, we extend existing literature by investigating the spatial patterning of tuberculosis among vulnerable communities in South Africa, notably in the relatively under-researched provinces of the North-West and Gauteng. Results Data for this study were collected from several locations implementing community-oriented primary care in the country. Community health workers used AitaHealth™, a custom-built mobile information management application, to obtain data on tuberculosis status and environmental conditions of households. We find notable clusters of tuberculosis in these provinces which we speculate could be associated with urban formal and informal settlement densification and overcrowding, the incidence of mining activities prevalent in sampled locations and poor access to healthcare.

Introduction: Despite the broad improvement in air quality, air pollution remains a major leading global risk factor for ill health and deaths each year. Air pollution has a significant impact on both health and economic growth in Africa. This paper reviews the health impacts of air pollution and the benefits of air pollution mitigation and prevention on climate change. Methods: We conducted a narrative review and synthesized current literature on the health impact of air pollution in the context of changing climate in Africa. Results: Particulate matter (PM2.5) concentrations in Africa pose significant health risks due to various sources, including household fuels and industrial emissions. Limited air quality monitoring hampers accurate assessment and public health planning. Africa’s rapid urbanization exacerbates air pollution, impacting vulnerable populations disproportionately. Renewable energy adoption and improved monitoring infrastructure are crucial for mitigating air pollution’s economic and health impacts. Recommendations include adopting air quality standards, identifying pollution sources, and prioritizing interventions for vulnerable groups. Integrating renewable energy into development plans is essential for sustainable growth. African leaders must prioritize environmental policies to safeguard public health amid ongoing industrialization. Conclusions: Air pollution prevention remains a vital concern that requires leaders to engage stakeholders, and other opinion leaders in society. African leaders should proactively explore new avenues to integrate non‑polluting renewable energy sources such as solar power, wind and hydropower into their national development plans.

Global warming, the increase in heatwaves and periods of intense heat, is a major problem across the world, including in South Africa. Heat exposure has adverse health impacts, ranging from dehydration and heat stroke to death. The transport sector and its users are vulnerable to heat exposure both in vehicles and in places where they wait for transport. We investigated the heat perceptions and experiences of minibus commuters and the minibus taxi industry in minibus taxis and minibus taxi ranks to inform an intervention to prevent adverse health impacts from heat exposure in the City of Tshwane. Commuters (n = 279), drivers and marshals (n = 46) reported feeling hot in minibus taxis and minibus taxi ranks, experiencing sweating, headaches, exhaustion and dizziness. Some participants reported opening windows and doors, drinking water/cold drinks, removing a jersey and fanning themselves to try and cool down. All participants suggested solutions to address heat exposure in minibus taxis and minibus taxi ranks, including more shelters and trees for shade, the provision of water, benches and potentially an air-conditioned building for waiting/holding periods between trips. In consultation with our stakeholders, we prepared educational awareness materials about heat risks to health and actions to take when it is hot, and these were distributed through the minibus taxi sector in the City of Tshwane. Future research needs include measuring temperatures in these settings and rolling out large-scale interventions to protect health and well-being in a changing climate.

Background Outdoor and indoor air temperature affects human health and wellbeing. Climate change projections suggest that global temperatures will continue to increase, and this poses a threat to health. Buildings (for housing and business purposes) that can protect humans from the adverse effects of temperature are essential, especially in the context of climate change. Method In this cross-sectional study, we measured the indoor temperature inside shipping containers comprising a seven-storey block of apartments and businesses in Johannesburg, South Africa for 14 days. We assessed indoor temperature and relative humidity; evaluated measured temperatures in relation to thresholds known to be associated with adverse health risks; and sought to understand heat-health perceptions and symptoms of people living and working in shipping container units. Results Median indoor apparent temperature (AT) (a combination of temperature and relative humidity) was 16°C with values ranging from 6°C (observed at 8:00) to 42°C (observed at 17:00). Insulated units had temperatures between 2°C and 9°C cooler than the uninsulated unit. Heat-health risks from AT exposure were likely in all units, although there was variation in the number of occurrences that AT measurements exceeded the four symptom bands of caution, extreme caution, danger and extreme danger. Indoor AT was found to be 7°C higher on average when compared to outdoor AT. Some participants believed that their units were hot during hot weather and most people opened windows or did nothing during hot weather. Few participants reported experiencing adverse heat-health impacts, except for experiencing headaches (58%) and feeling tired or weak (40%). Conclusion Residents, tenants, or business owners using shipping containers should consider insulation installation and adequate windows/air conditioning for ventilation, especially in hot climates. Further research and awareness regarding heat-health risks of living or working in these spaces is needed.

Background Temperatures across Africa are expected to rise at up to twice the rate of mean global temperatures, posing significant health threats to vulnerable communities. Prolonged exposure to high day- and night-time temperatures has been implicated in a myriad of adverse health outcomes. The built environment and inadequate housing can exacerbate these consequences, prompting the need to evaluate heat adaptation interventions as a sustainable adaptation strategy for low-income and informal settlement dwellers. The HABVIA: heat adaptation benefits for vulnerable groups in Africa study aims to assess the impact of passive cooling interventions in homes on several key physiologic and mental health outcomes, as well as building internal thermal conditions. Methods HABIVA is a 3-year prospective controlled study to identify, implement and assess heat adaptation solutions in four low-income communities in one urban and one rural site in Ghana and South Africa, respectively. In each site, N = 240 participants (N = 60 per site) will be assigned to intervention or control groups. The intervention is focused on lowering the nighttime temperature of the home environment. Health and biometric data will be collected through a combination of physiological measurements, questionnaires, and biochemical measures taken at 3 time points during the hot season. Clinical outcomes include objective sleep behaviour, core body temperature, physical activity, blood pressure, blood glucose, anthropometrics and body composition. Indoor and outdoor environmental data will be collected continuously using fixed indoor sensors and automatic weather stations. Housing and community characteristics, and socio-economic information will be collected. Quantitative comparisons will be made between intervention and control conditions using generalised linear mixed models. Qualitative data from consultive workshops will be used to assess the acceptability and feasibility of the adaptations. Discussion Robust evaluation of the environmental and health outcomes of heat adaptations are limited for Africa, despite high climate vulnerability. HABVIA will address some of these gaps by assessing low-cost passive cooling interventions to promote heat resilience and improve health outcomes, providing real-world evidence for the feasibility of readily implementable and scalable adaptations in local contexts. Trial registration Pan African Clinical Trials Registry (PACTR) PACTR202401521630856, version 1. Retrospectively registered on January 12, 2024.