Africa's National Research Articles

Assessing compliance with national guidelines in diabetes care: A study leveraging data from south Africa's National Health Laboratory Service (NHLS).

Diabetes is a major global health issue. We evaluated compliance to laboratory-based management guidelines for diabetes (type 1 and 2), essential for effective treatment and reducing diabetes-related morbidity and mortality. Our study utilized South Africa's National Health Laboratory Services (NHLS) data, focusing on patients from birth to age 80 years who underwent initial diabetes laboratory testing between January 1, 2012-January 1, 2016. Patients were categorized into type 1 (<30 years) or type 2 (≥30-80 years) diabetes based on age at first diabetes test. National diabetes guidelines recommend blood glucose to be checked every three-six months post laboratory-diagnosis. We employed a sharp regression discontinuity design to estimate the effect of a laboratory-diagnosis of diabetes on the likelihood of having a follow-up laboratory test 24 months post-diagnosis. Among patients with type 2 diabetes, the probability of a diabetes follow-up laboratory test within 24 months was 52.4% for patients presenting above the diabetes diagnosis threshold vs 31.1% for those presenting below. Although the likelihood of repeat testing rose with higher HbA1c and glucose levels, at the diagnostic threshold there was no clinically meaningful difference (risk difference: -2.2%, 95% CI: -3.3%, -1.2%). These results were consistent among patients with type 1 diabetes, those living with and without HIV, and healthcare setting. In a national laboratory cohort, diabetes laboratory-diagnosis did not lead to increased monitoring as recommended in national guidelines. Strategies to improve patient education, healthcare provider communication, and healthcare system support are essential to enhance guideline compliance and overall diabetes management.

Sexual and reproductive health and rights, HIV and migration in southern Africa: A rapid review.

Migration, a prevalent global phenomenon, significantly impacts health, particularly in low- to middle-income countries. This article presents a rapid review aimed at mapping projects, lessons and policies concerning sexual and reproductive health (SRH), HIV and migration in southern Africa. Utilising a population-concept-context framework, the review focuses on understanding the scope, nature and extent of interventions, identifying lessons learnt, and assessing existing policies and strategies. A comprehensive search strategy and screening process resulted in 19 studies and reports for inclusion. The review highlighted diverse projects across southern Africa, addressing SRH and HIV among migrants, refugees and asylum seekers. Projects ranged from peer-education interventions to community-based referral systems, aiming to improve knowledge, access and outcomes related to SRH and HIV. The lessons learnt emphasised the importance of community involvement, healthcare worker (HCW) training and inclusive policies to address migrants' diverse needs effectively. Additionally, projects facilitated cross-border collaborations and policy integration, enhancing access to SRH-HIV services and migrant health rights. Despite these efforts, challenges persist, including gender-based violence, financial barriers and xenophobic attitudes among HCWs. Limited access to comprehensive sexuality education and social protection for migrants underscores the need for further policy development and implementation. Nevertheless, existing policies, such as Botswana's inclusive HIV treatment policy and South Africa's National Strategic Plan for HIV, TB and STIs, demonstrate steps towards ensuring migrants' rights to healthcare.

The Effects of Education on Tobacco Consumption: A Panel Data Analysis

This study tests the hypothesis that acquiring more education improves health by reducing smoking habits. The study investigates whether higher levels of education influence smokers' behaviour or not. A panel dataset from South Africa's National Income Dynamic Survey (2008–2017) was used as a data collection source. The study employs a logistic model to conclude that people in South Africa with more education are less likely to smoke than those without education. Also noteworthy is the discovery that individuals with mental health-related behavioural disorders are more likely to smoke as a form of self-medication. Our results are particularly significant for policymakers since they demonstrate that education reduces the likelihood of smoking. These findings indicate the need for increased government support for educational opportunities in South Africa. In the long run, the population health of a country may benefit from free public education. Programs aimed at reducing smoking ought to focus on individuals with lower levels of education, younger people, and city dwellers because they are more likely to be engaged in smoking.

Unpacking the process of developing South Africa's national drug policy - lessons for universal health coverage.

South Africa's National Drug Policy (NDP) was first issued in 1996, at a time of considerable political change. To revisit the lessons learned from the process of development and initial implementation of the NDP. Six in-depth face-to-face interviews were held with purposively-selected key actors. Interviews, which followed pre-determined semi-structured questions, but were allowed to explore additional areas, were recorded and transcribed, and then subjected to abductive thematic analysis, informed by the Walt and Gilson model. Three key themes emerged, described as 'evidence', 'trust' and 'looking forward'. A paucity of evidence backed some of the key concepts in the NDP, and these have not been addressed as evidence has matured. The lack of trust which characterised the policy process impacted on the ways in which actors were able to or not able to engage, and therefore on the resultant content and the choices exercised. The coherence of the policy, its articulation with other health reforms, and its contribution to subsequent efforts to ensure universal health coverage in South Africa have all been weakened by the failure to revise the document over time. As South Africa advances its plans for universal health coverage, there is an urgent need to revisit key components of the NDP which are no longer fit for purpose.

Shortening vehicle access permitting for mobility-impaired individuals to beaches in South Africa's National Parks

Shortening vehicle access permitting for mobility-impaired individuals to beaches in South Africa's National Parks

SeqCode facilitates naming of South African rhizobia left in limbo

South Africa is well-known for the diversity of its legumes and their nitrogen-fixing bacterial symbionts. However, in contrast to their plant partners, remarkably few of these microbes (collectively referred to as rhizobia) from South Africa have been characterised and formally described. This is because the rules of the International Code of Nomenclature of Prokaryotes (ICNP) are at odds with South Africa's National Environmental Management: Biodiversity Act and its associated regulations. The ICNP requires that a culture of the proposed type strain for a novel bacterial species be deposited in two international culture collections and be made available upon request without restrictions, which is not possible under South Africa’s current national regulations. Here, we describe seven new Mesorhizobium species obtained from root nodules of Vachellia karroo, an iconic tree legume distributed across various biomes in southern Africa. For this purpose, 18 rhizobial isolates were delineated into putative species using genealogical concordance, after which their plausibility was explored with phenotypic characters and average genome relatedness. For naming these new species, we employed the rules of the recently published Code of Nomenclature of Prokaryotes described from Sequence Data (SeqCode), which utilizes genome sequences as nomenclatural types. The work presented in this study thus provides an illustrative example of how the SeqCode allows for a standardised approach for naming cultivated organisms for which the deposition of a type strain in international culture collections is currently problematic.

Frontline Citizens: Liberation Movements, Transnational Solidarity, and the Making of Anti-Imperialist Citizenship in Tanzania

AbstractThis article explores the intricate relationship between transnational solidarity and citizenship in socialist Tanzania, renowned for its extensive and enduring support of liberation movements from the 1960s to the 1980s. Termed “frontline citizenship”, this unique political subjectivity, evolving in the 1960s, was shaped not only by Tanzania's geopolitical location, nationalist struggles against colonialism, and government efforts to instil attitudes of anti-colonial solidarity in the population, but also by initiatives of hosted liberation movements, Tanzanians’ embrace of global anti-imperialist currents from Cuba to China and Vietnam, and critiques of politicians in exile. The article highlights the gendered and generational aspects of the solidarity regime, scrutinizes contested material solidarities, and discusses the partial decline of the frontline citizenship discourse. It does so by investigating the role of media, the impact of the paramilitary National Service, and the dynamics of material support practices. Drawing on multi-archival research, interviews, memoirs, and secondary literature, with a focus on South Africa's African National Congress (ANC), the analysis challenges conventional views of state-sponsored solidarity, emphasizing the dynamic interplay between state initiatives and grassroots participation as well as “external” and “internal” actors. Conceiving socialist Tanzania's solidarity regime in this way contributes to a broader understanding of the intersection between anti-imperialist world-making, nationalist state-building, and everyday performances of citizenship.

Burden of tuberculosis in underserved populations in South Africa: A systematic review and meta-analysis.

Identifying case-finding strategies to reduce tuberculosis (TB) incidence in high-burden countries requires better knowledge of the disease burden in key contributing populations and settings. To inform South Africa's National Tuberculosis Strategic Plan 2023-2028, we conducted a systematic review of active TB disease and latent TB infection (LTBI) prevalence and incidence in underserved populations, defined as those living in informal settlements, townships, or impoverished communities. We identified articles published from January 2010 to December 2023, assessed study quality, and conducted a meta-analysis to estimate pooled TB and LTBI prevalence stratified by HIV status. We calculated prevalence ratios for underserved populations compared to the overall South African population. The search yielded 726 unique citations. We identified 22 studies reporting TB prevalence (n = 12), TB incidence (n = 5), LTBI prevalence (n = 5), and/or LTBI incidence (n = 2) eligible for the review, including six high-quality studies. Meta-analysis demonstrated a high prevalence of TB disease among persons living without HIV (2.7% 95% CI 0.1 to 8.5%) and persons living with HIV (PLWH) (22.7%, 95% CI 15.8 to 30.4%), but heterogeneity was high (I2 = 95.5% and 92.3%, p-value<0.00). LTBI prevalence was high among persons living without HIV (44.8%, 95% 42.5 to 47%) with moderate heterogeneity (I2 = 14.6%, p-value = 0.31), and lower among PLWH (33%, 95% CI 22.6 to 44.4%) based on one study. Compared to the national average, underserved populations of persons living without HIV had a 4-fold higher TB prevalence and a 3.3-fold higher LTBI prevalence. Underserved PLWH had a 31-fold higher TB prevalence than the national average, but similar LTBI prevalence as measured in one study. Our findings illustrate that underserved populations in South Africa have a substantially higher TB and LTBI prevalence than the general population, making targeted TB interventions potentially beneficial. More research is needed to explore the heterogeneous TB epidemiology in South Africa.

Energy efficiency in the South African mining sector: A case study at a coal mine in Mpumalanga

Energy efficiency is a cost-effective way of both bolstering energy security and limiting the harmful effects of energy use on the environment. Mining is an inherently energy-intensive activity, and the 2008 revision of South Africa's National Energy Efficiency Strategy (NEES) set a target of a 10% reduction in energy consumption by 2015 for the mining sector. In this study, we investigate the effectiveness of the NEES in improving energy efficiency in the South African coal mining sector by surveying energy intensity at a number of operations, and analysing energy efficiency trends and energy use by process and energy carrier at an underground coal mine in Mpumalanga. Most mines surveyed exhibit an increase in energy intensity over time. At the case study mine, the increase was primarily due to increased energy use in the beneficiation and discard reclaiming processes. Trends in energy consumption are a poor reflection of trends in energy intensity, as a decline in energy consumption is most easily achieved by reducing production. A more appropriate metric for energy efficiency at coal mines is energy intensity, defined as energy use per unit of saleable product, relative to a multi-year baseline. The evidence suggests that the NEES has been ineffective in promoting energy efficiency in South African coal mines. We propose that greater success could be achieved by monitoring and reporting on energy intensity at the process level, and by incentivizing energy efficiency gains.

Using Data Tools and Systems to Drive Change in Early Childhood Education for Disadvantaged Children in South Africa.

In line with United Nations Sustainable Development Goal (SDG) 4.2, South Africa's National Development Plan commits to providing high-quality early childhood education to all children by 2030 to drive improved child outcomes. Prior to 2016, South Africa lacked reliable, locally standardised, valid, and cross-culturally fair assessment tools for measuring preschool quality and child outcomes, suitable for use at scale within a resource-constrained context. In this paper we detail the development and evolution of a suite of early learning measurement (ELOM) tools designed to address this measurement gap. The development process included reviews of literature and other relevant assessment tools; a review of local curriculum standards and expected child outcomes; extensive consultation with government officials, child development experts, and early learning practitioners, iterative user testing; and assessment of linguistic, cultural, functional, and metric equivalence across all 11 official South African languages. To support use of the ELOM tools at scale, and by users with varying levels of research expertise, administration is digitised and embedded within an end-to-end data value chain. ELOM data collected since 2016 quantify the striking socio-economic gradient in early childhood development in South Africa, demonstrate the relationship between physical stunting, socio-emotional functioning and learning outcomes, and provide evidence of the positive impact of high-quality early learning programmes on preschool child outcomes. To promote secondary analyses, data from multiple studies are regularly collated into a shared dataset, which is made open access via an online data portal. We describe the services and support that make up the ELOM data value chain, noting several key challenges and enablers of data-driven change within this context. These include deep technical expertise within a multidisciplinary and collaborative team, patient and flexible capital from mission-aligned investors, a fit-for-purpose institutional home, the appropriate use of technology, a user-centred approach to development and testing, sensitivity to children's diverse linguistic and socio-economic circumstances, careful consideration of requirements for scale, appropriate training and support for a non-professional assessor base, and a commitment to ongoing learning and continuous enhancement. Practical examples are provided of ways in which the ELOM tools and data are used for programme monitoring and enhancement purposes, to evaluate the relative effectiveness of early learning interventions, to motivate for greater budget and inform more effective resource allocation, to support the development of enabling Government systems, and to track progress towards the attainment of national and global development goals. We share lessons learnt during the development of the tools and discuss the factors that have driven their uptake in South Africa.

Editorial Introduction to the Special Issue: Evaluating the Sufficiency of the African Charter on the Rights and Welfare of the Child to Enable the Social, Economic and Cultural Rights of Children in Africa—National Experiences

Editorial Introduction to the Special Issue: Evaluating the Sufficiency of the African Charter on the Rights and Welfare of the Child to Enable the Social, Economic and Cultural Rights of Children in Africa—National Experiences

And Digitally Just and Inclusive Futures

As the BRICS (Brazil, Russia, India, China, and South Africa) countries gather for the 2023 Summit in August 2023, they are confronted with the task to deepen economic cooperation in line with the BRICS Economic Partnership Strategy. Key to this is the building of a BRICS-wide digital economy that enables inclusion and dynamism. They see themselves as committed to driving digital transformation, harnessing opportunities and mitigating challenges they face in regard to digital technologies. They recognize the importance of digital inclusion and connectivity as economic growth and social development drivers. Initiatives such as India's Digital India program, China's Belt and Road Initiative, and South Africa's National Integrated ICT Policy emphasize expanding digital infrastructure and improving access to bridge the digital divide (Kaplinsky, 2017).

The road to recovery: Financial resilience and mental health in post-apartheid South Africa

Following the post-apartheid era in South Africa, global economic hardships and financial shocks have forced most households to endure various mental and psychological stresses.. This has hindered the achievement of Sustainable Development Goal 3 (SDG-3)—good health and wellbeing—prompting policymakers and academics to search for remedies to mitigate such stresses. Highlighting resilience as a means of improving wellbeing, this paper focuses on financial resilience and constructs an index using a multidimensional framework to investigate its association with mental health disorders. Using the South Africa National Income Dynamic Study alongside several robust estimation techniques, we uncover a negative association between financial resilience and mental health disorders among South Africans. More specifically, financial resilience is associated with an approximately 37% decrease in the occurrence of mental health disorders. The results also reveal disparities in the correlation between financial resilience and mental health disorders across different subgroups. Non-Whites (especially Blacks), urban dwellers, and male household heads are shown to most strongly experience the depression-reducing effect of financial resilience. This paper also shows that life satisfaction and household expenditure mediate the relationship between financial resilience and mental wellbeing. Toward the end of this paper, we discuss the implications of our results and offer some policy recommendations.

Spatial clustering of codeine use and its association with depression: a geospatial analysis of nationally representative South African data

• We spatially identified geographical clusters of codeine use in South Africa, and investigated onset of depression overtime among depression-free individuals in communities with high concentration of codeine use. • The clusters of codeine use were found to be concentrated in the northern parts of South Africa. • Residing in a community with high concentration codeine use was associated with higher subsequent depression incidence. • Whilst opioid crisis has been believed to be epidemic in the global north particularly USA, it is also taking place in sub-Saharan Africa. There is an alarming trend in sub-Saharan Africa in the use of codeine-containing pharmaceuticals, but its risk of common comorbidities, such as mental health, remains unquantified at a national-level. We investigated the relationship between codeine use and onset of depression in South Africa at a population-level. We used nationally representative panel data from the South Africa National Income Dynamic Study to investigate the relationship between exposure to codeine use in the community (i.e. residing in a codeine hotspot) and onset of depression. Geographical hotspots of codeine use were identified using Kulldorff spatial scan statistic in SaTScan. We quantified depression onset at Wave 5 (year 2017) between individuals residing inside and outside a codeine hotspot who were depression-free at enrolment (Wave 4: 2015) using generalised estimating equation (GEE) regression models. We identified four statistically significant hotspots of codeine use, mostly located at the northern part of the country. Among 13,020 participants who were depression-free at enrolment, residing within a codeine use hotspot was significantly associated with higher subsequent onset of depression (aRR=1.21, 95% CI:1.08-1.44). Data on diagnosis of depressive disorder were not available. South Africa, a resource scarce nation with chronically limited mental health services, is not spared from the global opioid epidemic and its impact on depression. Targeted scale-up access to agonist therapy to effectively treat (opioid) addiction in communities at risk for high exposure to codeine use could reduce the risk of subsequent mental health challenges.

The effects of intimate partner violence on women's risk of HIV acquisition and engagement in the HIV treatment and care cascade: a pooled analysis of nationally representative surveys in sub-Saharan Africa

Achieving the 95-95-95 targets for HIV diagnosis, treatment, and viral load suppression to end the HIV epidemic hinges on eliminating structural inequalities, including intimate partner violence (IPV). Sub-Saharan Africa has among the highest prevalence of IPV and HIV worldwide. We aimed to examine the effects of IPV on recent HIV infection and women's engagement in the HIV care cascade in sub-Saharan Africa. We did a retrospective pooled analysis of data from nationally representative, cross-sectional surveys with information on physical or sexual IPV (or both) and HIV testing, from Jan 1, 2000, to Dec 31, 2020. Relevant surveys were identified from data catalogues and previous large-scale reviews, and included the Demographic and Health Survey, the AIDS Indicator Survey, the Population-based HIV Impact Assessment, and the South Africa National HIV Prevalence, Incidence, Behavior and Communication Survey. Individual-level data on all female respondents who were ever-partnered (currently or formerly married or cohabiting) and aged 15 years or older were included. We used Poisson regression to estimate crude and adjusted prevalence ratios (PRs) for the association between past-year experience of physical or sexual IPV (or both), as the primary exposure, and recent HIV infection (measured with recency assays), as the primary outcome. We also assessed associations of past-year IPV with self-reported HIV testing (also in the past year), and antiretroviral therapy (ART) uptake and viral load suppression at the time of surveying. Models were adjusted for participant age, age at sexual debut (HIV recency analysis), urban or rural residency, partnership status, education, and survey-level fixed effects. 57 surveys with data on self-reported HIV testing and past-year physical or sexual IPV were available from 30 countries, encompassing 280 259 ever-partnered women aged 15-64 years. 59 456 (21·2%) women had experienced physical or sexual IPV in the past year. Six surveys had information on recent HIV infection and seven had data on ART uptake and viral load suppression. The crude PR for recent HIV infection among women who had experienced past-year physical or sexual IPV, versus those who had not, was 3·51 (95% CI 1·64-7·51; n=19 179). The adjusted PR was 3·22 (1·51-6·85). Past-year physical or sexual IPV had minimal effect on self-reported HIV testing in the past year in crude analysis (PR 0·97 [0·96-0·98]; n=274 506) and adjusted analysis (adjusted PR 0·99 [0·98-1·01]). Results were inconclusive for the association of ART uptake with past-year IPV among women living with HIV (crude PR 0·90 [0·85-0·96], adjusted PR 0·96 [0·90-1·02]; n=5629). Women living with HIV who had experienced physical or sexual IPV in the past year were less likely to achieve viral load suppression than those who had not experienced past-year IPV (crude PR 0·85 [0·79-0·91], adjusted PR 0·91 [0·84-0·98], n=5627). Past-year physical or sexual IPV was associated with recent HIV acquisition and less frequent viral load suppression. Preventing IPV is inherently imperative but eliminating IPV could contribute to ending the HIV epidemic. Canadian Institutes of Health Research, the Canada Research Chairs Program, and Fonds de recherche du Québec-Santé. For the French, Spanish and Portuguese translations of the abstract see Supplementary Materials section.

Maternal Oral Health and Global Oral Health: Policy Perspective

Abstract Background and problems The findings of the last South African National Children Oral Health Survey conducted between 1999 and 2002 indicated a national prevalence of dental caries at 60% among 6-year-olds, with over 80% of untreated caries. Various studies have shown that one of the successful strategies in preventing dental caries is intervention during pregnancy by providing prenatal oral health education. Importance and opportunities To successfully mitigate the challenge of ECC, South Africa needs a holistic approach strategy that will integrate oral health services into existing general health programmes, especially into antenatal care (ANC). South Africa National Oral Health Policy and Strategy states that “Integrate oral health strategy elements and strategies into programmes and policies of all sectors that impact community health like maternal and women's health.” All government health care facilities offer free essential ANC services, identifying risk factors relating to poor maternal and birth outcomes. This existing infrastructure can be utilized to deliver oral health education and care for expecting mothers as essential ANC services. Solution The Public Oral Health Forum, a non-profit organization in South Africa, seeks to develop maternal and oral health policies that can be aligned with its research and policy development strategy. It proposes maternal oral health policy and strategies, which could be applicable in the South African context: Education of pregnant women, prenatal providers, and dental and medical students about perinatal and infant oral health, integration of oral health in primary health care services, interprofessional workforce development and research to improve oral health and access to dental care among pregnant women and new mothers. This presentation will demonstrate how such maternal oral health policy and strategy are developed, aligning with existing policy and infrastructure in South Africa.

Comparative Analysis of 2021 and 2022 West Africa Examination Council (WAEC) and National Examination Council (NECO) Chemistry Multiple Choice Questions in Enugu State, Nigeria

This study compared 2021 and 2022 WAEC and NECO Chemistry multiple choice question in Enugu State, Nigeria. The comparison covered the various levels of the cognitive domain of Bloom’s Taxonomy of Educational Objectives. The population of the study was 220 West Africa Examination Council (WAEC) and National Examination Council (NECO) Senior School Certificate Examination (SSCE) objective test items for Chemistry. There was no need for sampling since the population was manageable. Percentage was used in answering the research questions while Chi-square was used in testing the hypotheses. The result showed that for both examining bodies, most of the questions were on knowledge. When the distribution of the questions across the various levels of the cognitive domain, set by WAEC and NECO were compared, significant relationship was discovered in 2021 questions, whereas in 2022 questions, no significant relationship was observed. The conclusion therefore is that, as far as the distribution of questions across the various levels of the cognitive domain is concerned, WAEC is more consistent than NECO. Based on the finding of this study, it was recommended that authorities of National Examination Council ensure that subsequent SSCE Chemistry questions are appropriately distributed across the various levels of the cognitive domain.

Transition from computer-based testing of national benchmark tests to adaptive testing: Robust application of fourth industrial revolution tools

In 2020, the COVID-19 pandemic strongly affected all sectors, including education. Across the globe, governments enacted policies restricting people's movement, affecting the educational assessment industry. During the lockdown, South Africa's National Benchmark Tests (NBTs) were cancelled. In contrast to paper-pencil and linear tests deployed for NBTs, computer-adaptive testing (CAT) is a modern alternative. CAT technology is widely used for licensing and certification exams in most developed nations. CAT is expected to be used by many educational assessment companies in sub-Saharan Africa for their high-stakes exams due to its reduced testing time and algorithms that produce stable and reliable results. This paper aims to provide an overview of the 4IR tools that will enable creation of a comprehensive CAT, such as feasibility studies, item bank development, test-and-calibrate item banks, and specifications for the final CAT. To successfully implement CAT, these steps are essential. The importance of thorough research and documentation in each stage of the CAT cannot be overemphasized. Based on Fourth Industrial Revolution (4IR) artificial intelligence tools, we conclude that CAT is an excellent modality to adopt for ensuring accurate evaluations of examinees' abilities within high-stakes exams. Keywords: CAT framework, Computerised adaptive testing, Fourth industrial revolution, Linear testing, National benchmark tests

Application of a trait‐based climate change vulnerability assessment to determine management priorities at protected area scale

AbstractEstimating and planning for the impacts of climate change on the biodiversity of protected areas is a major challenge for conservation managers. When these areas are topographically heterogenous and contain species' entire ranges, this challenge is exacerbated because the coarse spatial scales of Global Circulation Model projections provide limited information for within‐park management. South Africa's Table Mountain National Park, home to three endemic amphibian species in just ~24,500 hectares, provides a case study for identifying conservation needs under climate change. Selecting the park's herpetofauna as pilot taxa, we identified life history and demographic characteristics believed to make species more sensitive and less able to adapt to climate change. We organized these into assessment frameworks and, through a combination of literature review and expert elicitation, reviewed and used them to assess climate change vulnerability of 18 amphibian and 41 reptile species. The assessment highlighted that 73% and 67% of the park's reptile and amphibian species, respectively, had at least one high‐sensitivity and low‐adaptive capacity trait. Using ordinal and additive scoring methods, we identified the species most vulnerable to climate change and highlight the park areas containing their highest concentrations. These areas will be used to inform landscape‐scale management priorities and park use zones. The current IUCN Red List assessments for these species do not incorporate climate change vulnerability. Considering some species appear to be threatened by climate change, their conservation needs might be underestimated. Identifying the most vulnerable species and the mechanisms underpinning their vulnerability can guide the identification and prioritization of conservation needs, while the highlighted knowledge gaps inform priorities for monitoring and research. While comprehensive climate change adaptation planning for Table Mountain National Park requires additional assessment of other taxonomic groups, this trait‐based assessment example highlights a viable tool for assessing climate change vulnerability in protected areas.

Food-to-Food Fortification of Ready-to-Eat Cereal-Based Porridges: A Potential Sustainable Food-Based Strategy to Improve Bioavailable Iron and Zinc in Plant-Based Diets

Abstract Objectives Iron and zinc deficiencies are prevalent in Africa, including urban populations, often due to monotonous plant-based diets low in bioavailable minerals. Food-to-food fortification (FtFF) is an emerging tool in the fight against mineral deficiencies. However, due to rapid urbanisation in Africa, demand for ready-to-eat (RTE) staple foods is increasing. This study investigated whether FtFF with plant foods rich in minerals (moringa leaves) and their bioavailability enhancers, organic acids (baobab fruit) and β-carotene (mango, papaya) at 2.5–14.9 g/100 g porridge with micronutrient premix (MP) can improve iron and zinc bioaccessibilities in extrusion-cooked wholegrain pearl millet-based porridges. Methods Three extrusion-cooked pearl millet-based porridges were formulated: 1) Pearl millet + carrot + mango + baobab + moringa; 2) Pearl millet + carrot + papaya + baobab; 3) Pearl millet + carrot + papaya + baobab + MP (iron (2.1 mg) zinc (1.65 mg), vitamin A (840 IU)). Raw pearl millet served as the control. Porridge mineral, phytate and total phenolics contents were determined. In vitro equilibrium dialysability assay was performed to predict mineral bioavailability. Results The RTE FtFF-porridges had higher bioaccessible iron than pearl millet (p &amp;lt; 0.05), in terms of percentage and amount, by up to 23-fold. However, the porridges were unnaturally high in iron due to contamination from the extruder cooker parts. FtFF with combinations of carrot, papaya, baobab plus MP or with carrot, mango, baobab plus moringa leaves increased bioaccessible zinc (p &amp;lt; 0.05), in terms of percentage and amount, by up to 4-fold, with the porridge containing MP enhancing iron and zinc bioaccessibility the most. The organic acids and β-carotene contents plus the low pH (3.0–5.2) of the food fortificants likely enhanced the solubility of the contaminating iron and the intrinsic iron and zinc in the porridges. Extrusion cooking reduced the porridges’ phytate contents, by 35–50%, hence, likely contributed to the increased mineral bioaccessibilities. Conclusions Thus, such ready-to-eat food-to-food fortified wholegrain cereal-based porridges may be a sustainable food-based strategy to improve bioavailable iron and zinc in the diet of at-risk urban populations in Africa. Funding Sources USAID, South Africa National Research Foundation/TWAS.