Namibia Institute of Pathology

Abstract Purpose: To provide estimates of breast cancer survival and investigate its determinants at five years and beyond in Sub-Saharan Africa (SSA). Methods: The prospective African Breast Cancer-Disparities in Outcomes (ABC-DO) cohort study recruited women ≥18 years with a new clinical or histological diagnosis of breast cancer at eight major hospitals in Namibia, South Africa, Uganda, Zambia, and Nigeria. Vital status was updated telephonically trimonthly for seven years. We estimated age-standardized net survival (ASNS), conditional survival and predicted survival gains if there were favourable shifts in the distribution of prognostic factors aligned with WHO’s Global Breast Cancer Initiative (GBCI). Results: Between September 8, 2014, and December 31, 2017, 2313 women were recruited and followed to January 1, 2022, and for a further year in South Africa, 2153 of whom were eligible. Of these, 1323 (61·4%) died, 672 (31·1%) remained alive, and 158 (7·3%) were lost to follow-up, giving overall survival at 3, 5 and 7 years of 51%, 40% and 33% respectively. Large between-country variations in 5-year ASNS were observed: 35–42% in Zambia and Nigeria, 52–58% in Black women in Uganda, South Africa and Namibia, and over 84% in mixed race and White Namibian women. The annual probability of death (1- NS, censored prior to Covid) declined generally from 2 to 3 years post-diagnosis, but remained at 8–21% for Black women in Namibia, Uganda and Nigeria during the fifth year post-diagnosis. Reaching the GBCI 60% stage I/II target, and accessing treatment would lead to an approximate one-third reduction in deaths amongst Black women. Conclusion: At present, survival in breast cancer patients is low in several SSA countries, with the risk of dying remaining substantial even amongst women who have survived over 3 years. Understanding and preventing deaths among longer-term survivors needs addressing. Citation Format: Tingting Mo, Maureen Joffe, Moses Galukande, Groesbeck Parham, Annelle Zietsman, Isabel dos- Santos-Silva, Valerie McCormack. Breast Cancer Overall Survival, Annual Risks of Death, and Survival Gap Apportionment in Sub-Saharan Africa (ABC-DO): 7-Year Follow-Up of a Prospective Cohort Study [abstract]. In: Proceedings of the 13th Annual Symposium on Global Cancer Research; 2025 Sep 16. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2025;34(12_Suppl):Abstract nr 51.

Cold agglutinin syndrome (CAS) is a rare form of autoimmune haemolytic anaemia mediated by cold agglutinins and characterized by an identifiable underlying cause. This case series presents three patients with CAS, each having a different secondary cause: neoplastic, autoimmune, and infection-related. Each case highlights the clinical presentation, diagnostic challenges, and therapeutic approaches specifically tailored to the underlying cause. The series underscores the importance of identifying secondary causes of CAS to guide treatment decisions. Management varies from immunosuppressive therapy and infection control to targeted treatments for underlying malignancies. These cases emphasise the need for a high index of suspicion in patients with haemolytic anaemia and cold agglutinin activity.

Fairy circles are rings of grass (2-12 m diameter) with centers of bare soil that are found in some arid grasslands. Above- and belowground chemical and biological processes have been explored in an ongoing debate about the ultimate causes of this pattern. Belowground biota, including beneficial and pathogenic nematodes in the soil food web, may both influence and respond to the formation of fairy circles. For example, root-feeding nematodes have the potential to enhance plant water stress, promoting the spatial organization into rings to minimize competition. We studied the soil nematode communities associated with Stipagrostis fairy circles along a 900-km range in the Namib Desert of Namibia in southern Africa. Nematode abundance and diversity were highest in soils beneath the vegetation rings that define fairy circles and in soils in the vegetated matrix surrounding the rings, demonstrating the positive impact of plant-derived resources (i.e., roots and organic matter) on nematode communities. Network analysis of nematode communities showed that in many ring soils, fungal or root hair-feeding Aphelenchoides, Ditylenchus, and Hexatylus frequently co-occurred among other plant-parasitic taxa. In contrast, soils from the bare centers of fairy circles had lower organic matter content and were nearly defaunated. Fairy circle centers appear to be a hostile environment for soil nematodes, reflecting a resource-limited soil food web that may contribute to the persistent absence of vegetation. Bacterial-feeding Acrobeloides were over-represented in communities in the centers, which could reflect an association with termites or ants, whose activity has been proposed to play a role in fairy circle formation. These findings show that nematode communities respond to the unique environmental conditions created by fairy circles, and nematode assemblages found in center, ring, and matrix soils also may contribute to sustaining the pattern.

South Africa is one of 25 countries identified by the World Health Organization as having the potential to eliminate malaria in the near future. In response to the emerging threat of antimalarial resistance, South Africa enhanced its surveillance programs to enable the mapping of resistance markers prevalence down to the facility level. A total of 4 471 samples, collected between January 2022 and August 2024 from healthcare facilities, and during active surveillance in malaria-eliminating districts in KwaZulu-Natal and Mpumalanga provinces, were assessed for drug (mutations in the kelch13, crt, mdr1, dhfr, and dhps genes) and diagnostic (hrp2/3 gene deletions) resistance markers using PCR and sequencing (Sanger and/or targeted amplicon) protocols. Validated markers of artemisinin partial resistance were rare, with the P574L mutation detected as a minor allele in two samples and the P553L mutation present in one sample. Of the 60 additional non-synonymous mutations detected, the A578S (30/999) and the I494V (13/951) mutations were most prevalent. Almost all parasites assessed carried the crtK76 (99.8%) and mdr1N86 (99.0%) alleles, suggesting susceptibility to chloroquine. The dhfr triple (99.9%) and dhps double (98.2%) mutations associated with pyrimethamine and sulfadoxine resistance, respectively, were close to fixation. No double hrp2/3 gene deletions were detected. These findings suggest that the recommended treatments and diagnostics in South Africa are effective. However, the strong selection for antimalarial drug resistance markers across southern Africa combined with high regional interconnectedness, emphasizes the need for sustained malaria molecular surveillance to support South and southern Africa achieve their elimination goals.

Human-induced habitat loss, fragmentation and degradation are among the leading causes of species decline worldwide. This is particularly true in tropical forests, where unique, often highly specialized fauna is under threat. By altering resource availability, anthropogenic habitat change can impose resource constraints on animals and may influence their allocation of resources to competing life history traits. In this study, we investigated whether nestlings and adults differently invest in self-maintenance depending on habitat degradation in the placid greenbul (Phyllastrephus cabanisi placidus), a cooperative breeder native to the cloud forests of Eastern Africa. We quantified investment in self-maintenance by measuring innate immune function using bacteria killing assays (BKAs) in adult breeders and their nestlings along a gradient of fragmented and degraded forests of the Kenyan Taita Hills. While innate immune function is an important defence against pathogens, resources needed to maintain it may come at a cost to other processes such as nestling development. We show that while forest degradation did not affect adult innate immune function, nestlings bear the cost of growing up in degraded habitats, as their ability to clear bacteria from blood plasma was lower in areas with degraded vegetation. These findings highlight the importance of studying the effects of habitat fragmentation and degradation in the tropics, where most of the global biodiversity occurs, and where long-lived species may respond differently from short-lived temperate ones, for example by prioritising self-preservation over reproduction.Supplementary InformationThe online version contains supplementary material available at 10.1007/s00114-025-02046-3.

To ensure a sustainable and economically sound hydrogen supply, the ramp-up of hydrogen production in regions with large incident solar radiation is critically needed. Plans of the Republic of Namibia to set up a new infrastructure from scratch aiming at the export of ammonia as hydrogen carrier co-address questions with respect to the associated quality infrastructure (QI). Here, a regulatory framework is envisaged to define safety requirements and quality objectives for hydrogen generation, operating conditions of production facilities, and subsequent transportation. Standardization should secure access to the current level of technology and cover dynamic technological developments at the national and international level. New capacities will be required for services in metrology and accreditation, testing, certification, inspection and for monitoring the environmental impact. We present an overview of the essential components of a QI cooperation aimed at sustainable hydrogen production and export with project partner countries Namibia and Germany providing a case study. This article tackles technical requirements in the context of QI and showcases the cooperation between Namibia and Germany demonstrating how metrology supports both countries achieving their technical and economic goals.

Clinical laboratory is the epicenter of health care sector and because patient management depends on the laboratory services, it is significant that the quality of these services is guaranteed.However, in the laboratory setting, blood specimens may be rejected for a variety of reasons, which may have substantial clinical consequences for the patient safety.The pre-analytical phase which is outside of the laboratory and beyond the control of the laboratory professionals has been highlighted as the leading contributor of diagnostics errors rates, accounting for 70% of errors in the laboratory.This study aimed to determine the major causes of preanalytical errors because of sample collection among clinicians in Erongo Region.The cross-sectional quantitative study was conducted among the state doctors and nurses at district hospitals in Erongo Region with a sample size of 14 doctors and 153 Nurses.The study further assessed the data of sample rejections recorded at the four of the Namibia Institute of Pathology (NIP) laboratories within the Erongo region, in 2020 and 2021.The data was collected and analyzed using Statistical Package for Social Science (SPSS) 25.0 program.During the two year period (2020-2021), NIP Walvis Bay had a significant improvement (38.4%) of sample rejections in 2021 as compared to 2020, however, the laboratory recorded the highest rejection rates in comparison to the other laboratories in the region.Missing specimen/ no specimen received had been the most predominant reason for sample rejections among the laboratories in the region accounting for 21.2% and 28.5% of rejected samples in 2020 and 2021 respectively.Lack of specimen collecting materials had an influence on the sample rejections.To reduce the sample rejections, NIP need to focus on strengthening the relationship with the clinicians by constantly providing adequate training and education and ensure the availability of sufficient materials required in the collection of patients' samples by the district clinicians.It is further recommended that the clinicians engage or consult with the laboratories to seek clarity on the collection and handling of samples to avoid more sample rejections.

Petalidium (Acanthaceae) is a speciose genus of woody shrubs with its diversity centred in arid regions of central to northwestern Namibia and southwestern Angola. Here, we compiled distribution information for all accepted species in the genus from herbarium specimens and our own fieldwork to determine the number of endemics and near-endemic species in the highlands and escarpments of Angola and Namibia (HEAN). In the process, we provide an informal overview of all accepted species of Petalidium, which we hope will facilitate further research on the genus. We found that 22 of 36 species are endemic or near-endemic to the HEAN, clearly indicating the importance of this area for plant conservation. Furthermore, our results presented here, coupled with evolutionary studies that show the genus to be rapidly diversifying, suggest that the highlands and escarpments have played a significant role in plant speciation. We conclude by highlighting the advantages of studying this genus further as a model system for plant ecology and evolution in arid environments.

COVID-19-related complications can last for years, even in patients who are asymptomatic during the acute phase, a phenomenon referred to as long COVID. This scoping review aimed to summarize the risk factors and clinical symptoms of long COVID in Africa between 2020 and 2022. Five studies were included. Three of the studies used in this review were retrospective cross-sectional studies, one was a prospective cohort study while another one was a case-control study. The review identified several risk factors for long COVID, including being female, being older than 40 years, having more than four acute COVID-19 symptoms, and having concomitant conditions such as asthma, hypertension, and depression. General, respiratory, cardiovascular, otolaryngological, gastrointestinal, and neurological symptoms were among the reported long COVID symptoms. To ensure that patients with long COVID are diagnosed and treated early, the risk factors and clinical symptoms of long COVID need to be identified for different population groups.

BackgroundPreventable adverse drug reactions (ADR) and adverse events following immunization (AEFI) are more prevalent in patients of low- and middle-income nations compared to high-income countries. Sub-Saharan Africa (SSA) experiences more ADR and AEFI for many reasons, including poor quality control of drug products, extensive use of substandard traditional and herbal medicines, environmental influences, and genetic factors. This scoping review aimed to explore the challenges to ADR and AEFI reporting by healthcare providers in SSA and strategies that can be used to address these challenges. MethodsIn this scoping review, articles reporting on primary research conducted in SSA to identify challenges to ADR and AEFI reporting and strategies to address these challenges, and published in English, were retrieved from three databases (Google Scholar, ScienceDirect, and PubMed). The quality of the selected quantitative studies was evaluated utilizing the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) 22-item checklist. In contrast, qualitative studies were evaluated for credibility, confirmability, dependability, and transferability. The guidelines specified in the Preferred Reporting Items for Systematic Reviews and Meta-Analysis Protocols (PRISMA-P) statement were followed in this scoping review. ResultsThis review revealed several challenges to ADR and AEFI reporting in SSA. The challenges were categorized into healthcare provider-related, work-related, material/tools-related, and national pharmacovigilance activities-related challenges. Several strategies to address the challenges were also revealed and categorized into healthcare providers, reporting material/tools and mechanisms strategies, national or institutional pharmacovigilance, and community engagement strategies. ConclusionCountries in SSA face several challenges to ADR and AEFI reporting. Strategies identified to improve the reporting of ADR and AEFI should be prioritized so that unnecessary morbidity and mortality are avoided in the region.