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  • 1.
    Hamukoshi, Simeon Shiweda
    et al.
    Department of Chemistry, Nelson Mandela University, Port Elizabeth, South Africa.
    Mama, Neliswa
    Department of Chemistry, Nelson Mandela University, Port Elizabeth, South Africa.
    Shimanda, Panduleni Penipawa
    Centre for Research and Development, and Clara Barton School of Nursing, Welwitchia Health Training Centre, Windhoek, Namibia.
    Shafudah, Natangue Heita
    Department of Physics, Chemistry and Materials Science, Faculty of Agriculture, Engineering and Natural Sciences, University of Namibia.
    An overview of the socio-economic impacts of the green hydrogen value chain in Southern Africa2022In: Journal of Energy in Southern Africa, ISSN 1021-447X, Vol. 33, no 3, p. 12-21Article in journal (Refereed)
    Abstract [en]

    The green hydrogen economy offers synthetic green energy with significant impacts and is environmentallyfriendly compared to current fossil-based fuels. Exploration of green hydrogen energy in Southern Africa isstill in the initial stages in many low-resourced settings aiming to benefit from sustainable green energy. Atthis early stage, potential benefits to society are yet to be understood. That is why the socio-economic impactof green hydrogen energy must be explored. This paper reviews the current literatures to describe the po-tential socio-economic effects in the Southern African Development Community (SADC). The review sup-ports the view that green hydrogen will be beneficial and have great potential to revolutionise agriculturaland industrial sectors, with advanced sustainable changes for both production and processing. This paperalso examines how sustainable green hydrogen energy production in Southern Africa will provide economicvalue in the energy export sector around the world and support climate change initiatives. Further, it discussesthe impacts of the green hydrogen value addition chain and the creation of green jobs, as well as the needfor corresponding investments and policy reforms. It is also noted that the green hydrogen economy cancontribute to job losses in fossil fuel-based industries, so that the workforce there may need re-skilling to takeup green jobs. Such exchanges may deter efforts towards poverty alleviation and economic growth in SADC.

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  • 2.
    Kandjimbi, Simon Kamuhadwa
    et al.
    Clara Barton School of Nursing, Welwitchia Health Training Centre, Windhoek, Namibia.
    Shimanda, Panduleni Penipawa
    Clara Barton School of Nursing, Welwitchia Health Training Centre, Windhoek, Namibia.
    Post-surgical experiences of women living with rheumatic heart disease in Namibia2023In: Undergraduate Research in Health Journal, Vol. 1, no 1, p. 23-26Article in journal (Refereed)
    Abstract [en]

    Background: Rheumatic heart disease (RHD) remains a public health problem predominantly among women of reproductive age in low- to middle-income settings. Women living with RHD have various experiences pertaining to physical, psychological and reproductive health, before and after surgery.Objectives. To explore and describe the post-surgical experiences of women living with RHD in Namibia.

    Method: The study used a qualitative approach, using an explorative descriptive study to collect data from women living with RHD with in-depth interviews, followed by thematic analysis of the data. The final sample size was five participants.

    Results: Key themes that emerged were related to positive experiences in terms of surgical outcome; stigma, family and social relationships, and reproductive health. The findings indicated that the women had a broad range of experiences both at home and at work, and in their reproductive relationships.

    Conclusion: It is recommended that community RHD education programmes be enhanced to raise awareness and educate the communities in order to curb stigma and discrimination against women living with RHD. Programmes to support women with family planning and good maternal and child health are also recommended. The study findings have potential significance with regard to clinical practices involved in caring for women living with RHD, and efforts to improve their life experiences.

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  • 3.
    Shimanda, Panduleni Penipawa
    Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health.
    Rheumatic heart disease in Namibia: evaluating the burden and the cost-effectiveness of a preventive strategy2024Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    Background: Rheumatic Heart Disease (RHD) is a neglected public health problem, which is most prevalent in low-and middle-income countries. It affects over 460 million people and causes about 390,000 deaths annually, predominantly children, young adults, and women. This thesis aimed to assess the burden of Rheumatic Heart Disease in Namibia and to evaluate the cost-effectiveness of a preventive strategy.

    Methods: Data was obtained from primary and secondary sources in four distinct studies. The first study analysed the RHD outpatient and inpatient data from 2010-2020. The second employed a cross-sectional survey, incorporating a questionnaire with the EQ-5D-5L tool, to assess the health-related quality of life and healthcare usage pre- and post-RHD diagnosis. A systematic review was conducted in the third study synthesising preventive interventions, while the fourth study used a Markov model to evaluate the cost-effectiveness of a secondary prevention strategy in Namibia.

    Results: The clinical RHD prevalence was estimated at 28 per 100,000 cases. From the survey, 83 RHD patients participated, predominantly women (77%) and primarily young adults aged 20-29 (41%). The majority (84%) had received surgical treatment. Notably, there was a significant increase in mean QALY from 0.773 pre-diagnosis to 0.941 post-diagnosis (p<0.001). The systematic review underscored the effectiveness of school and nurse-led prevention programmes. The health economic evaluation demonstrated that echocardiographic RHD screening was cost-effective, with an Incremental Cost-Effectiveness Ratio of N$ 28,516.75 per QALY gained, which falls below Namibia’s GDP per capita.

    Conclusions: The findings highlight a significant gap in RHD data, particularly in high-endemic regions like Sub-Saharan Africa, emphasising the need for enhanced data quality and surveillance. The effectiveness of school-based and community-led programmes is apparent, but the scarcity of data from diverse regions limits a comprehensive understanding of optimal prevention strategies. Echocardiographic screening is identified as a feasible component of RHD secondary prevention in Africa, pointing towards a policy need for improved surveillance and data quality. Future research should investigate the impact of various interventions on RHD incidence and prevalence.

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  • 4.
    Shimanda, Panduleni Penipawa
    et al.
    Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health. Welwitchia Health Training Centre, Windhoek, Namibia.
    Amukugo, Hans Justus
    University of Namibia, Windhoek, Namibia.
    Norström, Fredrik
    Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health.
    Socioeconomic factors associated with anaemia among children aged 6–59 months in Namibia2020In: Journal of Public Health in Africa, ISSN 2038-9922, E-ISSN 2038-9930, Vol. 11, no 1Article in journal (Refereed)
    Abstract [en]

    Background: Anaemia remains a public health concern, and the its prevalence varies between countries as well as between age, sex and levels of poverty. This study aims at examining the association between socio-demographic factors and anaemia among children aged 6–59 months in Namibia.

    Methods: Data was extracted from the 2013 Namibian Demographic Health Survey. The association between anaemia and other factors was examined with logistic regression. Results are reported in odds ratio (OR), with 95% confidence intervals (CI).

    Results: In total, 1,383 children aged 6–59 months had complete data and included in the analyses. Our study shows that there is a statistically significantly increased risk of anaemia among children from poorer households compared with the richest quintile. Also, there was a statistically significance supporting anaemia being more common among boys than girls. There was also a statistically significant negative effect related to age.

    Discussion: Our study shows that young children, boys and children in poorer households have an increased risk of anaemia. Considering the adverse impact of anaemia on child development, policies must prioritise factors exacerbating anaemia risk.

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  • 5.
    Shimanda, Panduleni Penipawa
    et al.
    Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health.
    Lindholm, Lars
    Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health. Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine.
    Söderberg, Stefan
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Cardiology. Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Section of Medicine.
    Norström, Fredrik
    Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health.
    Rheumatic heart disease school-based echocardiographic screening: A cost-effectiveness markov modelManuscript (preprint) (Other academic)
  • 6.
    Shimanda, Panduleni Penipawa
    et al.
    Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health.
    Shumba, Tonderai W
    Department of Occupational Therapy and Physiotherapy University of Namibia Windhoek Namibia.
    Brunström, Mattias
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Cardiology.
    Iipinge, Scholastika N
    Clara Barton School of Nursing, Welwitchia Health Training Centre Windhoek Namibia.
    Söderberg, Stefan
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Cardiology.
    Lindholm, Lars
    Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health.
    Norström, Fredrik
    Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health.
    Preventive interventions to reduce the burden of rheumatic heart disease in populations at risk: a systematic review2024In: Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease, E-ISSN 2047-9980, Vol. 13, no 5, article id e032442Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Rheumatic heart disease (RHD) is a devastating yet preventable condition that disproportionately affects low-middle-income countries and indigenous populations in some high-income countries. Various preventive interventions have been implemented across the globe, but evidence for the effectiveness of these measures in reducing the incidence or prevalence of acute rheumatic fever and RHD is scattered. This systematic review aims to assess the effectiveness of preventive interventions and identify the strategies used to reduce the burden of RHD.

    METHODS AND RESULTS: A comprehensive search was conducted to identify relevant studies on RHD prevention interventions including interventions for primordial, primary, and secondary prevention. Effectiveness measures for the interventions were gathered when available. The findings indicate that school-based primary prevention services targeting the early detection and treatment of Group A Streptococcus pharyngitis infection with penicillin have the potential to reduce the incidence of Group A Streptococcus pharyngitis and acute rheumatic fever. Community-based programs using various prevention strategies also reduced the burden of RHD. However, there is limited evidence from low-middle-income countries and a lack of rigorous evaluations reporting the true impact of the interventions. Narrative synthesis was performed, and the methodological quality appraisal was done using the Joanna Briggs Institute critical appraisal tools.

    CONCLUSIONS: This systematic review underscores the importance of various preventive interventions in reducing the incidence and burden of Group A Streptococcus pharyngitis, acute rheumatic fever, and RHD. Rigorous evaluations and comprehensive analyses of interventions are necessary for guiding effective strategies and informing public health policies to prevent and reduce the burden of these diseases in diverse populations.

    REGISTRATION: URL: https://www.crd.york.ac.uk/prospero/; Unique identifier: CRD42020170503.

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  • 7.
    Shimanda, Panduleni Penipawa
    et al.
    Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health. Clara Barton School of Nursing, Welwitchia Health Training Centre, Windhoek, Namibia.
    Shumba, Tonderai Washington
    University of Namibia.
    Brunström, Mattias
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Section of Medicine.
    Söderberg, Stefan
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Section of Medicine.
    Lindholm, Lars
    Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health.
    Iipinge, Scholastika Ndatinda
    Welwitchia Health Training Centre.
    Norström, Fredrik
    Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health.
    Preventive interventions to reduce the burden of rheumatic heart disease in populations at risk: a systematic review protocol2021In: Systematic Reviews, E-ISSN 2046-4053, Vol. 10, no 1, article id 200Article in journal (Refereed)
    Abstract [en]

    Background: Rheumatic heart disease is preventable, yet associated with significant health burden, mostly in low-resourced settings. It is prevalent among children and young adults living in impoverished areas. Primordial, primary, and secondary preventive measures have been recommended through health interventions and comprehensive programmes, although most implemented interventions are the high-resourced settings. The proposed review aims to synthesise the evidence of prevention effectiveness of implemented health interventions for the prevention of rheumatic heart disease.

    Methods and design: This article describes a protocol for a systematic review. A predefined search strategy will be used to search for relevant literature published from the year 2000 to present. Electronic databases Medline, Web of Science, Scopus, and Cochrane Central Register of Controlled Trials will be searched for the studies, as well as reference lists of relevant studies included. Risk of bias and quality appraisal will be done for the included studies using ROBINS-I tool and Cochrane tool for assessing risk of bias in randomised control trials. Findings will be analysed in subgroups based on the level of intervention and prevention strategy implemented. We will present the findings in descriptive formats with tables and flow diagrams.

    Discussion: This review will provide evidence on the prevention effectiveness of interventions or strategies implemented for the prevention of RHD. The findings of this will be significant for policy, practice, and research in countries planning to implement interventions.

    Registration: PROSPERO ID: CRD42020170503.

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  • 8.
    Shimanda, Panduleni Penipawa
    et al.
    Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health. Clara Barton School of Nursing, Welwitchia Health Training Centre, Pelican Square, Windhoek, Namibia.
    Söderberg, Stefan
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Section of Medicine.
    Iipinge, Scholastika Ndatinda
    Clara Barton School of Nursing, Welwitchia Health Training Centre, Pelican Square, Windhoek, Namibia.
    Lindholm, Lars
    Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health.
    Shidhika, Fenny Fiindje
    Department of Cardiology, Windhoek Central Hospital, Windhoek, Namibia.
    Norström, Fredrik
    Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health.
    Health-related quality of life and healthcare consultations among adult patients before and after diagnosis with rheumatic heart disease in Namibia2023In: BMC Cardiovascular Disorders, ISSN 1471-2261, E-ISSN 1471-2261, Vol. 23, no 1, article id 456Article in journal (Refereed)
    Abstract [en]

    Background: Rheumatic Heart Disease (RHD) causes high morbidity and mortality rates among children and young adults, impacting negatively on their health-related quality of life (HRQoL). This study aimed to evaluate the HRQoL and healthcare consultations of adult patients with RHD in Namibia.

    Methods: From June 2019 to March 2020, a questionnaire was administered to 83 RHD patients during routine follow-ups. The EQ-5D-5L instrument was used to assess the health-related quality of life before diagnosis and at the time of the survey. The Ethiopian value set for EQ-5D-5L was used to calculate Quality-Adjusted Life Years (QALY).

    Results: Most respondents were women (77%), young adults below the age of 30 years (42%), and individuals who grew up in rural areas (87%). The mean QALY statistically significantly improved from 0.773 pre-diagnosis to 0.942 in the last 12 months (p < 0.001). Sixty-six patients who had surgery reported a better QALY. Healthcare visits statistically significantly increased from on average 1.6 pre-diagnosis to 2.7 days in the last 12 months (p < 0.001). The mean distance to the nearest facility was 55 km, mean cost of transport was N$65, and mean time spent at the clinic was 3.6 h. The median time from diagnosis to the survey was 7 years (quartiles 4 and 14 years).

    Conclusion: Treatment and surgery can improve HRQoL substantially among RHD patients. Being diagnosed with RHD affects patients living in socioeconomically disadvantaged rural areas through cost and time for healthcare visits. It would be valuable with further research to understand differences between disease severities.

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  • 9.
    Shimanda, Panduleni Penipawa
    et al.
    Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health. Welwitchia Health Training Centre, Namibia.
    Söderberg, Stefan
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Section of Medicine.
    Iipinge, Scholastika Ndatinda
    Welwitchia Health Training Centre, Namibia.
    Neliwa, Ebba Mwalundouta
    Cardiac Outpatient Clinic, Intermediate Hospital Oshakati, Oshakati, Namibia.
    Shidhika, Fenny Fiindje
    Department of Paediatric and Congenital Cardiology, Windhoek Central Hospital, Windhoek, Namibia.
    Norström, Fredrik
    Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health.
    Rheumatic heart disease prevalence in Namibia: a retrospective review of surveillance registers2022In: BMC Cardiovascular Disorders, ISSN 1471-2261, E-ISSN 1471-2261, Vol. 22, no 1, article id 266Article in journal (Refereed)
    Abstract [en]

     Background:  Rheumatic heart disease (RHD) is the most commonly acquired heart disease in children and young people in low and middle-income settings. Fragile health systems and scarcity of data persist to limit the understanding of the relative burden of this disease. The aims of this study were to estimate the prevalence of RHD and to assess the RHD-related health care systems in Namibia.

     Methods:  Data was retrieved from outpatient and inpatient registers for all patients diagnosed and treated for RHD between January 2010 to December 2020. We used descriptive statistics to estimate the prevalence of RHD. Key observations and engagement with local cardiac clinicians and patients helped to identify key areas of improvement in the systems.

     Results:  The outpatient register covered 0.032% of the adult Namibian population and combined with the cumulative incidence from the inpatient register we predict the prevalence of clinically diagnosed RHD to be between 0.05% and 0.10% in Namibia. Young people (< 18 years old) are most affected (72%), and most cases are from the north-eastern regions. Mitral heart valve impairment (58%) was the most common among patients. We identified weaknesses in care systems i.e., lack of patient unique identifiers, missing data, and clinic-based prevention activities.

    Conclusion:  The prevalence of RHD is expected to be lower than previously reported. It will be valuable to investigate latent RHD and patient follow-ups for better estimates of the true burden of disease. Surveillance systems needs improvements to enhance data quality. Plans for expansions of the clinic-based interventions must adopt the "Awareness Surveillance Advocacy Prevention" framework supported by relevant resolutions by the WHO.

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