South Africa Research Articles

Dynamics of Amaranthus in Urban and Rural Value Chains in Communities of KwaZulu-Natal Province, South Africa

Sub-Saharan Africa falls among the developing countries with poor standards of living contributing to the high prevalence of malnutrition. Interventions have been conducted, but malnutrition continues to linger, with devastating impacts on vulnerable groups. In Africa, 90% of its children cannot access the minimum balanced diet. Also, 60% of the people in this region do not access daily meals for dietary needs. Traditional vegetables like Amaranthus are identified to have great potential to combat malnutrition; however, Amaranthus is underutilized due to limited awareness of its potential and poor post-harvest practices along the value chain. This study evaluates the dynamics of Amaranthus along its value chain in the urban and rural communities of KwaZulu-Natal. South Africa. Mixed-design research and a purposive convenient random sampling approach were explored. Semi-structured questionnaires were used to collect data for the survey, and this was strengthened by a series of five n = (30) face-to-face interviews with six key informants from urban and rural formal and informal markets. The findings revealed that eleven species of Amaranthus have been identified in South Africa such as Amaranthus spinosus varieties, including A. dubius, and A. cruentus, which are the most sold and consumed, mostly being sold by street vendors. Thus, poor perception and attitudes along with limited access to Amaranthus in some upper-class markets contribute to underutilization. Promoting Amaranthus at all levels of markets might create better awareness of its utilization.

Persistence and Emergence of Literacy Skills: Long-Term Impacts of an Effective Early Grade Reading Intervention in South Africa

Many countries strongly emphasize enhancing foundational reading skills, with the expectation that such improvements will catalyze the development of new cognitive abilities and lead to improved life outcomes. However, the relationship between early educational gains and later-life achievements remains theoretically complex and evidence is lacking, particularly from low- and middle-income countries (LMICs). This paper examines the long-term impacts of an early grade literacy intervention that was implemented in South Africa in Setswana language from 2015 to 2017. A unique feature of our study is the longitudinal tracking and assessment of the same group of students over a 7-year period, extending up to 4 years post-intervention. We found sustained improvements in Setswana oral reading fluency, indicating a lasting impact of the intervention. Moreover, treated students exhibited enhanced Setswana and English written comprehension skills, signifying the emergence of new skills. Grade progression also improved, potentially reducing dropout rates, and facilitating transitions to secondary education. This study contributes to the limited literature on the long-term causal impacts of early literacy investments in LMICs, suggesting potential for enduring educational benefits and improved later-life outcomes.

Tuberculosis Preventive Treatment for Pregnant People With Human Immunodeficiency Virus in South Africa: A Modeling Analysis of Clinical Benefits and Risks.

Although prior studies of tuberculosis-preventive treatment (TPT) for pregnant people with human immunodeficiency virus (PPWH) report conflicting adverse pregnancy outcome (APO) risks, international guidelines recommend TPT for PPWH. We used a microsimulation model to evaluate 5 TPT strategies among PPWH receiving antiretroviral therapy in South Africa: No TPT; 6 months of isoniazid (6H) or 3 months of isoniazid-rifapentine (3HP) during pregnancy (Immediate 6H or Immediate 3HP) or post partum (Deferred 6H or Deferred 3HP). The primary outcomes were maternal, fetal/infant, and combined deaths from causes potentially influenced by TPT (maternal tuberculosis, maternal hepatotoxicity, stillbirth, low birth weight [LBW], and infant tuberculosis). Tuberculosis during pregnancy confers 250% and 81% higher modeled risks of stillbirth and LBW, respectively. In lower-risk or higher-risk scenarios, immediate TPT confers 38% lower or 92% higher risks of stillbirth and 16% lower or 35% higher risks of LBW. Immediate TPT would minimize deaths among PPWH. When TPT confers higher stillbirth and LBW risks, immediate TPT would produce the most combined maternal and fetal/infant deaths, even with low maternal CD4 cell count and high tuberculosis incidence. If immediate TPT yields a <4% or <20% increase in stillbirth or LBW, immediate TPT would produce fewer combined deaths than deferred TPT (sensitivity analysis range, <2%-22% and <11%-120%, respectively). If APO risks are below identifiable thresholds, TPT during pregnancy could decrease combined maternal and fetal/infant deaths. Given uncertainty around isoniazid's risks, and the low threshold at which APO risks could outweigh benefits from tuberculosis deaths averted, studies of newer TPT regimens among PPWH are warranted to inform guidelines.

Nurse training to enhance adherence counselling for HIV-tuberculosis coinfection in South Africa: Integrative review

Background: South Africa has seen strides in reducing HIV and tuberculosis (TB); however, adherence counselling for people living with HIV (PLHIV) coinfected with TB remains a challenge, particularly in specific sub-districts like Cape Town. Understanding the attributes of existing training programmes is crucial.Objectives: This study explored attributes of training programme development for nurses and other health professionals to enhance adherence counselling for PLHIV coinfected with TB in Cape Town.Method: An integrative literature review was conducted in five steps following PRISMA guidelines. Electronic searches encompassed multiple databases: COCHRANE, PsycINFO, PUBMED, ENMBASE, Science Direct, SCOPUS, SocINDEX, Academic Search Complete, Eric, SABINET, Health Resources and World Health Organization Global Health Library Regional Indexes. Inclusion criteria encompassed English language, peer-reviewed full-text studies on training programme development, qualitative and quantitative, published between January 2012 and May 2021. Exclusion criteria included non-English articles, conference proceedings and irrelevant studies. Thematic data analysis synthesised findings.Results: Three main themes emerged: participant identification, key programme content and programme implementation process, crucial for effective training programme development.Conclusion: Identifying participants, defining programme content and outlining implementation processes are pivotal in enhancing nurses’ adherence counselling skills. This approach could stabilise patient treatment adherence, potentially reducing treatment default, loss to follow-up and mortality rates.Contribution: These findings lay the groundwork for developing effective training programmes aimed at improving adherence counselling among nurses.

Promoting collaborative care of the human body after cessation of life: Ubuntu beyond death

Background: South Africa is a diverse country that promises equality, dignity, linguistic and cultural rights to all its citizens. Therefore, understanding the cultural, religious and nursing practices in caring for the deceased body is crucial to ensure meaningful integrated care of the deceased body and collective mourning and support within a community.Objectives: This study aimed to strengthen multidisciplinary collaboration and knowledge sharing on caring for the human body at all stages of life and beyond death using Ubuntu principles.Method: A qualitative exploratory-descriptive design was used to understand the meaning of the human body after cessation of life within African, Christian and nursing practice. The study was conducted in three countries in Southern Africa (eSwatini, South Africa and Zimbabwe). Snowball and purposive sampling techniques were used to recruit participants. In-depth telephonic and face-to-face interviews were conducted. The data were analysed thematically.Results: To provide comprehensive insights, themes from the three population groups were integrated. Four main themes emerged from the thematic analysis: (1) death as an end to physical life, (2) cleanliness of the deceased body, (3) ritualisation of death and (4) beyond death and burial.Conclusion: Strengthening multidisciplinary collaboration is vital to providing comprehensive care for the body and spirit of the deceased. Understanding cultural and religious rituals helps with collective mourning and support in the community.Contribution: Reflecting on the meaning of the deceased body and the respect given to it during the process of transition into the spiritual world through ritualisation.

Professional development of teachers: Perceptions and challenges of foundation phase teachers

Background: South Africa’s teacher retention crisis calls for policy makers, school leaders and teachers to explore ways for professional growth. This study examined six novice teachers’ experiences and views on continuous professional development (CPD) and how it benefits teachers as they transition from mentees to mentors.Aim: The study aimed to explore novice teachers’ engagement with CPD within the context of foundation phase (FP) teaching. It specifically investigated their understanding of CPD in communities of practice and how they preferred to be inducted, mentored and coached.Setting: This qualitative case study was conducted in six inner-city public primary schools in urban Johannesburg, South Africa.Methods: The research followed a case study design, using semi-structured interviews with six novice teachers to gather data.Results: The findings revealed the significance of informal mentorship, offering support despite the absence of formal structures in FP settings. This highlights the need for educational institutions to establish formal mentorship opportunities to promote professional development and well-being of teachers.Conclusion: CPD goes beyond fulfilling professional requirements – it empowers teachers. By upskilling and reskilling, CPD prepares teachers to meet modern teaching challenges.Contributions: This research adds to the limited literature on novice teachers’ experiences with CPD in FP. It highlights CPD’s crucial role in enhancing pedagogical strategies, supporting diverse learners, improving teacher wellness, and informing educational policy and leadership decisions.

Famine and food security: new trends and systems or politics as usual? An introduction.

Over the past decade, famine and food insecurity have increased, yet there have been few articles with a critical analysis of their social and political dynamics. This special issue of Disasters aims to revive such analysis and to provide new insights. The special issue contains eight articles, with topics ranging from the role of global politics and neoliberal strategies, to sanctions, war, settler-colonialism, elite capture and inequalities, actions of resistance and resilience, and the challenges of famine prevention in today's global political context. The papers provide both global and local analysis, with the latter covering Kashmir, South Africa, South Sudan, Sudan, and Syria.

Intermediate Phase English First Additional Language Teachers’ Use of Technology in Rural Schools of Limpopo

&lt;p style="text-align:justify"&gt;Teachers’ access to technology in this day and age could have a positive effect on the teaching and learning of English first additional language (EFAL). This qualitative interpretive case study explored how limited access to technology resources affects the teaching practices of Intermediate Phase EFAL teachers in rural schools in Limpopo, South Africa. This study, underpinned by the Technology Acceptance Model (TAM), conducted semi-structured interviews to collect data from ten EFAL teachers who were purposively sampled. Thematic analysis was used to analyse the data. The study revealed that three of the ten EFAL teachers sampled integrated technology into their teaching despite challenges such as insufficient projectors, lack of learners’ smartphones and data bundles, and Internet connectivity. However, the other seven sampled participants did not use technology, citing a lack of digital tools and knowledge as a contributing factor. The study concludes that the lack of resources contributed to limited or no use of technology and the motivation to integrate technology into their lessons. Based on these findings, it is recommended that technological resources that can help EFAL teachers with digital teaching be made available so that they can integrate them to assist learners in developing language skills. Furthermore, in-service training and ongoing support should be provided to EFAL teachers to give them knowledge and skill to use available technology resources effectively.&lt;/p&gt;

Rural livelihoods sustainability in South Asia and Africa: a systematic review with bibliometric analysis

Rural livelihoods sustainability in South Asia and Africa: a systematic review with bibliometric analysis

A Reflective Thematic Analysis Into the Perceptions of Pregnant Radiographers Regarding the Usefulness of the PregiDose Mobile App to Enhance Fetal Dosimetry and Well-Being: Qualitative Exploration.

Pregnancy apps are widely used by pregnant women, who benefit from self-tracking features to support their health goals. Pregnant radiographers are considered a high-risk group of health workers practicing in ionizing radiation environments. Radiation exposure above threshold limits can cause harmful genetic effects on a fetus. Accordingly, pregnant radiographers are required to wear special fetal dosimeters, which provide real-time readings of radiation dose exposure to the fetus. Pregnant radiographers have the responsibility to self-track their fetal doses to ensure that the threshold limit of 1 mGy is not exceeded. The traditional method used to track doses includes a written log of doses in a notebook. Thus, PregiDose, a unique offering in the context of pregnancy apps, was developed to enhance fetal dose tracking and monitoring using technological methods. This study aims to describe the users' perceptions of the app's usefulness using PregiDose in a natural setting. The overarching framework adopted for the study was a design science research (DSR) methodology encompassing five steps, namely (1) problem awareness, (2) suggestion, (3) development, (4) evaluation, and (5) conclusion. This paper presents the evaluation step of DSR. DSR step 4 included a qualitative approach to explore users' perceptions regarding the app. Data were collected using a semistructured interview guide. Open-ended questions were guided by the app's core features, namely dose tracking, education, and wellness. In total, 17 pregnant radiographers in South Africa enrolled to use the app, 9 (53%) engaged with the app, and 4 (24%) agreed to participate in the feedback interviews. The data were collected from October 2023 to March 2024 and analyzed using a reflective thematic data analysis method. Three overarching themes emerged from the data, namely (1) usefulness of PregiDose, (2) barriers to PregiDose adoption and use, and (3) recommendations for the advancement of PregiDose. Users labeled the app's usefulness as positive and perceived it as a modern approach to traditional dose-tracking methods. They perceived the graph output of the dose-tracking feature to be useful for viewing their accumulative doses. They did not fully engage with the journaling feature, indicating that it was a personal preference and not a practice they would usually engage in. Physiological barriers, such as fatigue and "pregnancy brain," were contributors to decreased engagement. Finally, because of the demanding workload and fast-paced nature of the radiography department, users recommended the automation of fetal dosimetry through the Internet of Things. PregiDose is an occupational health and safety mobile app developed for pregnant radiographers through a DSR approach. The app offers a modern method of dose tracking consistent with technological advancements in the context of self-tracking. However, future implementation would require using Internet of Things to make fetal dose tracking more effective.

Survival rate of diabetic-related lower extremity amputees in hospitals in the Eastern Cape

Background: Diabetes mellitus (DM) is a global health concern that has greatly affected South Africa. The gap in the current management of DM has resulted in complications such as lower extremity amputations (LEAs) and death. Eastern Cape province reflects this struggle, with disparities in access to healthcare and poor health outcomes. Understanding survival rates and associated factors between the urban Livingstone Hospital and the rural Nelson Mandela Academic Hospital can improve health interventions and outcomes.Objectives: This study compared the survival rate of patients in urban areas and those in rural areas.Method: This retrospective cohort study was conducted in an urban and a rural hospital by reviewing existing medical records of diabetic patients who underwent an LEA between 2016 and 2019.Results: The retrospective cohort study examined 439 diabetic-related LEA cases. This study found that residing in rural areas significantly decreased the risk of mortality by 62% compared with living in the urban areas. Factors such as haemoglobin A1c (HbA1c) levels, nephropathy, cardiovascular disease, human immunodeficiency virus (HIV), other comorbidities and level of amputation significantly influenced survival probabilities.Conclusion: Survival analysis indicated a significant difference in the 3-year survival probabilities of the two groups, favouring rural residency (p = 0.001). The biggest cause for concern between the two regions was uncontrolled blood glucose levels as this resulted in high mortality rates.Contribution: Insights from this study have shown that introducing podiatry and orthotics at primary healthcare (PHC) could improve foot care and reduce diabetic-related LEAs and mortality.

Different regimens for eradication of Helicobacter pylori infection in children: a randomized controlled trial.

As an empirical treatment for children with H. pylori infection, CTT is safe and provides the highest eradication rate. HT, ST, and CT might not be superior to TT. This study was registered at the Pan African Clinical Trials Registry, Cochrane South Africa, under the identifier PACTR202201686010590. Date of registration: 04 January 2022. • Triple therapy has been the standard eradication regimen for pediatric H. pylori infection. The efficacy of triple therapy has decreased in many countries due to increased antibiotic resistance. • This randomized controlled trial is the first to compare triple therapy, sequential therapy, hybrid therapy, concomitant therapy, and ciprofloxacin-based triple therapy for the eradication of pediatric H. pylori infection. Triple therapy exhibited the lowest eradication rate among the studied regimens, suggesting it may not be an adequate therapeutic option for infected children. Ciprofloxacin-based triple therapy appears to be a safe and effective therapeutic choice for pediatric H. pylori infection. Additionally, this study provides the first reported eradication rate of hybrid therapy in pediatric H. pylori infection.

The work of repair: Capacity after colonialism in the timber plantations of South Africa By ThomasCousins, New York: Fordham University Press. 2023. 320 pp.

The work of repair: Capacity after colonialism in the timber plantations of South Africa By ThomasCousins, New York: Fordham University Press. 2023. 320 pp.

Financing white rule: How Luxembourg became a banker for the Belgian Congo and Apartheid South Africa

Abstract In this article, I offer a historical analysis of how bankers in Luxembourg came to be important service providers to borrowers in the Belgian Congo and Apartheid South Africa. I demonstrate how a series of unique political and cultural factors linking Luxembourg and these two (neo)colonial regimes account for the financial activities that developed between the three jurisdictions. As such, I show that officials in the Belgian Congo and Apartheid South Africa were able to count on their Luxembourg-based bankers for a variety of finance-related services, including the provision of Eurocurrency loans and the formation of offshore companies. In doing so, the article contributes to a body of literature in the social sciences of finance that has grown significantly in recent years: on the imperial and neocolonial basis of the contemporary global financial system.

Waste-to-energy: exploring the roadmap for energy generation from commercial waste in South Africa

Purpose This study aims to investigate the adoption of waste-to-energy (WtE) technologies in South Africa (SA), focusing on identifying the key drivers, barriers and potential solutions for commercial uptake. The ultimate aim is to propose an implementation framework that promotes renewable energy while reducing landfill reliance. Design/methodology/approach A systematic literature review (SLR) of papers published between 2020 and 2023 was conducted to identify factors impacting WtE adoption in SA. The conceptual model developed from the SLR was tested using a qualitative case study approach. Data was collected through 15 semi-structured interviews with commercial entities and WtE experts from four regions of SA. Findings Anaerobic digestion and pyrolysis are identified as the most suitable waste-to-energy technologies in the South African context. Among the financial challenges of WtE in SA, the availability of cheap coal, low landfill tariffs, high capital costs, funding constraints and regressive economic incentives are critical. The lack of government support, insufficient incentives, regulatory burdens, weak policies and limited innovation capacity are considerable non-financial barriers hindering WtE technologies’ growth. The successful adoption of renewable energy also requires adequate infrastructure, increased sustainability awareness and technical expertise. Research limitations/implications Although the sample size is diverse and consists of a range of organisations, it may not capture the thoughts and experiences of other SA businesses in their entirety. It is important to note that the lack of existing research on the implementation, benefits and impacts of WtE technologies limits the authors’ ability to interpret and benchmark the findings of this study. Yet, this study contributes by developing an implementation framework to encourage WtE adoption, recommending policy actions such as regressive taxation on fossil fuels and landfills and promoting renewable energy through subsidies, awareness and energy credits. Practical implications This study provides a practical framework for businesses and policymakers to adopt WtE technologies by addressing key barriers. The research suggests that businesses could reduce waste management costs and generate new revenue streams by adopting anaerobic digestion and pyrolysis. Policymakers are encouraged to disincentivize landfills and promote WtE through financial incentives such as subsidies and energy credits. The implementation framework offers clear recommendations for integrating WtE into SA’s energy and waste management strategies, supporting both sustainability and economic goals. Social implications The main social contribution is the potential for WtE adoption to improve waste management practices and generate new job opportunities within the renewable energy and waste sectors. Originality/value This study provides a novel contribution by developing an implementation framework tailored to SA’s unique regulatory, economic and social contexts. The research highlights the importance of aligning WtE adoption with sustainability goals, reducing reliance on fossil fuels and promoting renewable energy. The framework serves as a practical guide for policymakers, businesses and industry leaders seeking to implement sustainable waste management solutions in SA.

The nutritional composition and in-store marketing of processed and packaged snack foods available at supermarkets in South Africa.

Over recent decades, the commercial ultra-processed food industry has grown, making snacks high in energy, added sugar, saturated fat and sodium affordable and accessible to consumers. Dietary patterns high in ultra-processed snacks are concerning as this can result in negative health outcomes. This study aims to provide insight on available snack products in South African supermarkets, and the marketing thereof, which can be used to support policy development aimed at improving the healthfulness of the food supply and consumption patterns. This was an observational cross-sectional, mixed-method study. Secondary data from six major supermarket chains (eight stores) in three different suburbs in Cape Town, South Africa was analysed to evaluate the nutritional composition of snack products (n=3837). The same eight supermarkets were revisited to obtain information on marketing via an observational checklist. Qualitative interviews were also conducted with store managers. Majority (89%) of the products assessed either contained non-sugar sweeteners or were high in sugar, saturated fat, or sodium. These snack items that are high in nutrients of concern to limit were available at checkout areas in all stores, were found in high traffic areas and several in-store promotional strategies such as branded displays, special offers and combo-deals were commonly found. The current South African supermarket environment encourages consumers to purchase unhealthy snacks. Most snacks assessed in this study cannot be recommended for regular consumption due to the nutritional composition being high in nutrients linked to poor health outcomes. There is a need for regulation of the in-store marketing of unhealthy snacks in South Africa. Retail settings are potential intervention points for limiting exposure to these unhealthy products.

Essay review: technopolitics, development and the residues of the South African state.

It has been thirty years since the end of political apartheid in South Africa in 1994. Those decades have been marked by single-party dominance under the African National Congress (ANC), and the expansion of democratic rights and public goods like education, as well as neoliberal economic policies, growing inequality and, in recent years, corruption and maladministration scandals. On the heels of a historic election in May 2024, one which marked the end of the ANC's electoral dominance and was shaped, in part, by government mismanagement of the energy sector and extensive infrastructural decline, it is a timely moment to consider the history of South Africa's state and its relation to industries of extraction and energy production. Two new books do just that. Residual Governance: How South Africa Foretells Planetary Futures, by Gabrielle Hecht, takes a long view of the impact of extractive industries, arguing that contemporary South Africa may offer a cautionary tale of the devastating impacts of the Anthropocene, one that 'foretells planetary futures' in the way that the state has failed to reckon with the enduring communal and environmental impacts of the mining industry. Apartheid's Leviathan: Electricity and the Power of Technological Ambivalence, by Faeeza Ballim, historicizes the development of South Africa's electricity sector under the apartheid state and traces the roots of the current energy crisis back to the pursuit of authoritarian high modernism in the mid-twentieth century.

Incidence of injury among male Varsity Cup Young Guns rugby players in South Africa.

The physical nature of the sport of rugby results in a high incidence of injury, even in university rugby, compared to other contact sport codes. Rugby Union lacks injury data focusing on university student-athletes, specifically in South Africa. The aim of the study was to determine the incidence of injury among male rugby players participating in the Varsity Cup Young Guns national rugby tournament. The study used a quantitative, cross-sectional, and correlational research design. A total of 252 rugby players, males aged 18 to 20 years, who played for their university rugby team in the 2022 Varsity Cup Young Guns national tournament were conveniently recruited to determine the incidence of overall, match, and training injuries (number of injuries/1000 hours) for the 2022 tournament. The overall injury incidence for all players was 9.5 injuries/1000 player-hours. The injury incidence for all players during matches was 136.5 injuries/1000 match-hours, whereas during training it was 0.6 injuries/1000 training-hours. The injury incidence was greater for backs than forwards (150.6 injuries/1000 match-hours vs. 124.1 injuries/1000 match-hours, respectively). The lower limb was the most commonly injured anatomical site with 36.6% (95% CI: 27.7-48.3%), while the common types of injuries were the joints (41.6%, 95% CI: 29.9-49.9%) and muscles (28.7%, 95% CI: 20.8-38.0%). A statistically significant association was found between the playing position and the phase of play in which injury occurred (χ2<inf>(1)</inf>=160.2; P=0.021). This study reported a high injury incidence, especially during matches, in the Varsity Cup Young Guns tournament. It is recommended that prospective, incidence-based studies be used to precisely determine the incidence, nature, severity and mechanisms of injury. An injury surveillance system should be implemented, specifically within Varsity Cup rugby to inform, support, and improve current injury prevention strategies.

Illustrations of Coping and Mental Well-Being of Adolescents Living with HIV in Cape Town, South Africa During COVID: A Photovoice Study

Adolescents living with HIV (ALHIV) are the fastest-growing population living with HIV globally. The COVID-19 pandemic disrupted health systems, thereby negatively affecting the quality and availability of HIV care and support services. This study describes the challenges and treatment experiences of ALHIV on ART at a public primary healthcare facility in a low-socioeconomic community in Cape Town, South Africa during the COVID-19 pandemic. A qualitative photovoice study was conducted with 21 adolescents (aged 14–19 years; 13 females and 8 males). Participants shared pictures illustrating their experiences during the COVID-19 pandemic in groups. Group discussions were audio-recorded and transcribed in full and subjected to content analysis. Seven themes emerged describing ALHIV’s personal, social, and economic challenges, their means of coping, and feelings of vulnerability. Challenges included the loss of significant others, lack of social support and opportunities, experiences of HIV-related stigma and discrimination in the household, loneliness, and isolation. In spite of difficulties, some ALHIV displayed resilience by continuing their medication routines during lockdown periods. After the COVID-19 pandemic, there is a need for the restoration of the health system and services, including psychosocial support to re-engage ALHIV in care and treatment.

Identification and outcomes of acute kidney disease in patients presenting in Bolivia, Brazil, South Africa, and Nepal.

The International Society of Nephrology proposes an acute kidney disease (AKD) management strategy that includes a risk score to aid AKD identification in low- and low-middle-income countries (LLMICs). We investigated the performance of the risk score and determined kidney and patient outcomes from AKD at multiple LLMIC sites. Adult patients presenting to healthcare facilities in Bolivia, Brazil, South Africa, and Nepal were screened using a symptom-based risk score and clinical judgment. Those at AKD risk underwent serum creatinine testing, predominantly with a point-of-care (POC) device. Clinical data were collected prospectively between September 2018 and November 2020. We analyzed risk score performance and determined AKD outcomes at discharge and over follow-up of 90 days. A total of 4,311 patients were at increased risk of AKD, and 2,922 (67.8%) had AKD confirmed. AKD prevalence was 80.2% in patients enrolled based on the risk score and 32.5% when enrolled on clinical judgment alone (p < 0.0001). The area under the receiver operating characteristic curve was 0.73 for the risk score to detect AKD. Death during admission occurred in 84 (2.9%) patients with AKD and 3 (0.2%) patients without kidney disease (p < 0.0001). Death after discharge occurred in 206 (9.7%) AKD patients, and 1865 AKD patients underwent reassessment of kidney function after discharge; 902 (48.4%) patients had persistent kidney disease including 740 (39.7%) patients reclassified with de novo or previously undiagnosed chronic kidney disease (CKD). The study was pragmatically designed to assess outcomes as part of routine healthcare, and there was heterogeneity in clinical practice and outcomes between sites, in addition to selection bias during cohort identification. The use of a risk score can aid AKD identification in LLMICs. High rates of persistent kidney disease and mortality after discharge highlight the importance of AKD follow-up in low-resource settings.