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Integrity and adherence to appropriate ethical standards are important elements of research. These standards are key to protecting research participants' rights as well as ensuring the reliability and quality of research outputs. Although empirical evidence is scanty, several authors have alluded to the fact that violation of research integrity standards could be common in low- and middle-income countries including sub-Saharan Africa (SSA). Understanding the issues, challenges, and opportunities of research integrity and ethics in SSA is key to promoting the responsible conduct of research and the protection of research participants. This paper presents the authors' critical views and recommendations on the current state of research integrity in SSA. We argue that understanding the current research integrity architecture in SSA has the potential to identify opportunities to promote responsible conduct of research in SSA. Such opportunities include, but are not limited to transparency, accountability, and reproducibility of research, which collectively lead to enhanced public trust in the research enterprise. We highlight the need to embrace equity, fairness, diversity, and inclusivity in the research cycle from conception (priority setting), funding, implementation, dissemination of findings, and scale up. We move on to provide a rationale for understanding the differences and similarities between research ethics and research integrity. Governments, research, and academic institutions must develop multifaceted approaches to promote compliance with principles of research integrity by developing and implementing clear research integrity policies and guidelines that foster responsible conduct of research and prioritize capacity building and empowerment of early career researchers, students, and other targeted key stakeholders. [ABSTRACT FROM AUTHOR]

One-third of the global burden of disease is attributed to surgical conditions yet, 5 billion people globally, lack access to surgery. The Lancet Commission on Global Surgery, Obstetrics, and Anesthesia (LCOGS) published guidelines for improving access by reducing catastrophic health expenditures (CHEs) by 2030. This is especially important in sub-Saharan Africa (SSA) where 90% of the extreme poor reside. In this paper, we provide a narrative review of four studies on CHEs for surgical care in SSA published since 2015. We discuss healthcare financing in the countries and summarize the authors’ key findings of out-ofpocket payments (OOP) and CHEs. Briefly, the studies enrolled 130 to 300 patients and collected direct OOPs via chart review of health costs or patient interviews. Indirect costs were calculated from lost wages and transportation costs. CHEs were defined as health costs exceeding 10% of the GDP per capita or the household income. Despite healthcare being reported as free in all studies, 60%-90% of surgical patients had CHEs with all costs considered. OOPs persists for medicines and anesthesia that should be covered under any health insurance scheme. In some cases, indirect costs associated with transportation and wages were major drivers of CHEs for surgery. Without addressing these gaps in coverage, more people will risk impoverishment in seeking surgical care in SSA. [ABSTRACT FROM AUTHOR]

COVID-19 is a rapidly growing pandemic that has grown from a few cases in Wuhan, China to millions of infections and hundreds of thousands of deaths worldwide within a few months. Sub-Saharan Africa is not spared. Radiology has a key role to play in the diagnosis and management of COVID-19 as literature from Wuhan and Italy demonstrates. We therefore share some critical knowledge and practice areas for radiological suspicion and diagnosis. In addition, emphasis on how guarding against healthcare acquired infections (HAIs) by applying "red" and "green" principle is addressed. Given that pandemics such as COVID-19 can worsen the strain on the scantily available radiological resources in this region, we share some practical points that can be applied to manage these precious resources also needed for other essential services. We have noted that radiology does not feature in many main COVID-19 guidelines, regionally and internationally. This paper therefore suggests areas of collaboration for radiology with other clinical and management teams. We note from our local experience that radiology can play a role in COVID-19 surveillance. [ABSTRACT FROM AUTHOR]

The African Program for Onchocerciasis Control (APOC) was launched in 1995 with the main goal being to boost the fight against onchocerciasis in Africa. In 2011, over 80 million people benefited from this intervention thanks to the contribution of 268.718 Community-Directed Distributors (CDD). These significant results obscure the role of women CDD in this fight. Indeed, the insufficient involvement of female CDD has been identified as a concern by the APOC partners early in the program. The present study aims to assess the contribution and performance of women involved in a strategy to control onchocerciasis by community-directed treatment with ivermectin in sub Saharan Africa. We searched the following electronic databases from January 1995 to July 2013: Medline, Embase (Excerpta Medica Database), CINAHL (Cumulative Index to Nursing and Allied Health Literature), LILAS (Latin American and Caribbean Literature on Health Sciences), International Bibliography of Social Sciences, Social Services Abstracts, and Sociological Abstracts. Two research team members independently conducted data extraction from the final sample of articles by using a pre-established data extraction sheet. The primary outcome was the contribution of female CDD in the control of onchocerciasis by community-directed treatment with Ivermectin. Of 25 hits, 7 papers met the inclusion criteria. For the management of onchocerciasis, female CDDs are elected by the health committee from the communities they will serve. The significant proportion of those treated (about 61%) were women, although only 24% of CDDs were women. Many community members reported that women were more committed, persuasive and more patient than men in the distribution of ivermectin. Some studies have identified underutilization of female CDD as one reason for the limited effectiveness or, in some cases, pure failure related to the distribution of Ivermectin interventions in the fight against onchocerciasis in sub- Saharan Africa. Evidence from this review suggests that female CDD contribute to the treatment of onchocerciasis with Ivermectine in sub-Saharan Africa. Large-scale rigorous studies including Randomized controlled trials (RCTs) are needed to compare Community-Directed intervention involving men and women CDDs. [ABSTRACT FROM AUTHOR]

The World Health Organization (WHO) estimated in 2012 that 287,000 maternal deaths occurred in 2010; sub-Saharan Africa (56%) and Southern Asia (29%) accounted for the global burden of maternal deaths. Men are also recognized to be responsible for the large proportion of ill reproductive health suffered by their female partners. Male involvement helps not only in accepting a contraceptive but also in its effective use and continuation. The objectives were to assess men's knowledge, attitude, and practice of modern contraceptive methods; determine the level of spousal communication about family planning decision making; and investigate the correlates of men's opinion about their roles in family planning decision making. We searched the following electronic databases from January 1995 to December 2013: Medline, Embase, CINAHL, LILAS, International Bibliography of Social Sciences, Social Services Abstracts, and Sociological Abstracts. Along with MeSH terms and relevant keywords, we used the Cochrane Highly Sensitive Search Strategy for identifying reports of articles in PubMed. There were no restrictions to language or publication status. Of 137 hits, 7 papers met the inclusion criteria. The concept of family planning was well known to men. In the Nigerian study, almost (99 %) men were aware of the existence of modern contraceptives, and most of them were aware of at least two modern methods. Awareness of the condom was highest (98 %). In the Malawi study, all of the participants reported that they were not using contraception before the intervention. In Ethiopia, above 90% of male respondents have supported and approved using and choosing family planning methods, but none of them practiced terminal methods. Generally, more male respondents disagreed than agreed that men should make decisions about selected family planning issues in the family. Decision-making dynamics around method choice followed a slightly different pattern. According to female participants, decisions regarding method choice were equally made by women or jointly, with male-dominated decisions falling last. There are many challenges to increase male involvement in family planning services. So far very few interventions addressing these challenges have been evaluated scientifically. Health education campaigns to improve beliefs and attitudes of men are absolutely needed. Additionally, improving accessibility, affordability, availability, accommodation and acceptability of family planning service venues will make them more attractive for male partners. [ABSTRACT FROM AUTHOR]

In sub-Saharan Africa, HIV/AIDS and tuberculosis are major public health problems. In 2010, 64% of the 34 million of people infected with HIV were reported to be living in sub-Saharan Africa. Only 41% of eligible HIV-positive people had access to antiretroviral therapy (ART). Regarding tuberculosis, in 2010, the region had 12% of the world's population but reported 26% of the 8.8 million incident cases and 254000 tuberculosisrelated deaths. This paper aims to review missed opportunities for improving HIV/AIDS and tuberculosis prevention and care. We conducted a systematic review in PubMed using the terms 'missed'(Title) AND 'opportunities'(Title). We included systematic review and original research articles done in sub-Saharan Africa on missed opportunities in HIV/AIDS and/or tuberculosis care. Missed opportunities for improving HIV/AIDS and/or tuberculosis care can be classified into five categories: i) patient and community; ii) health professional; iii) health facility; iv) local health system; and v) vertical programme (HIV/AIDS and/or tuberculosis control programmes). None of the reviewed studies identified any missed opportunities related to health system strengthening. Opportunities that are missed hamper tuberculosis and/or HIV/AIDS care in sub-Saharan Africa where health systems remain weak. What is still missing in the analysis of health experts is the acknowledgement that opportunities that are missed to strengthen health systems also undermine tuberculosis and HIV/AIDS prevention and care. Studying why these opportunities are missed will help to understand the rationales behind the missed opportunities, and customize adequate strategies to seize them and for effective diseases control. [ABSTRACT FROM AUTHOR]

Buruli ulcer (BU) is a cutaneous neglected tropical disease caused by Mycobacterium ulcerans. Participation of Community Health Workers (CHWs) is an integral part of the management of BU, yet their impact has not been systematically evaluated in sub-Saharan Africa. METHODS: Our objectives were to summarize the evidence on the impact of CHWs on the control of BU in sub-Saharan Africa by looking at their recruitment, training, non-governmental support and performance. We searched the following electronic databases from January 1998 to July 2012: Medline, EMBASE (Excerpta Medica Database), The Cochrane Library, Google Scholar, CINAHL (Cumulative Index to Nursing and Allied Health Literature), WHOLIS (World Health Organization Library Database), LILACS (Latin American and Caribbean Literature on Health Sciences) and contacted experts in the field. There were no restrictions to language or publication status. All study designs that could provide the information we sought were eligible, provided the studies were conducted in sub-Saharan Africa. Critical appraisal of all identified citations was done independently by two authors to establish the possible relevance of the articles for inclusion in the review. Of 195 hits, 17 papers met the inclusion criteria. For the management of Buruli Ulcer, CHWs are often recruited from the communities they will serve. Communities play a role in CHW selection. Larger numbers of CHWs are needed in order to improve the detection and management of cases. One of the major obstacles to the control of BU is inadequate and poorly-equipped health facilities in the affected areas. Evidence from this review suggests that CHW programmes can have large impacts on the control of BU in sub-Saharan Africa. Large-scale rigorous studies, including RCTs, are needed to assess whether the CHWs programs promote equity and access. [ABSTRACT FROM AUTHOR]

Despite the enormous victory that has been recorded in decreasing significantly HIV-TB related mortality and morbidity in Sub-Saharan Africa, enormous challenges continue to obstruct proper and enviable control of these conditions. These range from prioritization, ethics, funding, drug resistance and research gaps. Resistance to these diseases could constitute key treatment and prevention challenges to health care systems and the international community if not handled appropriately and promptly. This paper presents key shortcomings of the current funding, management and research policies and highlights possible action areas to remedy this situation. [ABSTRACT FROM AUTHOR]