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Background/Aims: Extensive research focuses on the advantages and disadvantages of various positions throughout active second stage labour, but there is limited focus on midwives' practice. This study aimed to explore midwives' practice of maternal positions throughout the active phase of second stage labour. Methods: An integrative review of three databases was carried out for research papers published between 2015 and 2022. Thematic analysis was used for data analysis and synthesis. Results: Five eligible research papers were included. There were four key findings: maternal positions practised by midwives, midwives as the prime decision maker, midwives' personal convenience and comfort, and barriers to practising maternal positions. Conclusions: Midwives were seen as prime decision makers, who hindered informed decision making on maternal positions during active second stage labour. Inadequate knowledge, skills and confidence were barriers to practice and attributed to midwives adopting positions that were convenient and comfortable for themselves. Strategies are needed to enhance practice through review and evaluation of current clinical settings, regular updates to evidence-based practice and refreshing essential midwifery skills. [ABSTRACT FROM AUTHOR]

This paper uses the concept of epistemic injustice to shed light on the discriminatory treatment of experts in and by development aid. While the literature on epistemic justice is largely based on philosophical reasoning, I provide an empirical case study which substantiates theoretical claims with findings from social science research. Drawing on expert interviews conducted in South Africa and Tanzania, I reveal how epistemic injustice is experienced, practiced and institutionalised in a field which claims to work towards global justice. Focusing on aid-related advisory processes, the paper highlights how epistemic authority therein is tied to identity-based prejudice. The systematic credibility deficit policy experts from aid-receiving countries suffer is closely interrelated with the credibility excess so-called 'international' experts profit from. Their privilege is backed by an imaginary that maintains the idea of Northern epistemic superiority and sustained by prevailing employment and procurement practices of donor organisations. The paper suggests that the concurrence of testimonial and hermeneutical injustice prevents experts from the Global South from taking the lead in interpreting their own societies' realities. This, I argue, is not only detrimental to the countries whose knowers are marginalised but also a root cause of persisting global inequality. [ABSTRACT FROM AUTHOR]

Intercultural philosophy and critical development theories have so far rarely entered into exchange, although they share central concerns: they criticize epistemic eurocentrism and call for a diversification of science and knowledge alike. In this paper, I illustrate how the conjunction of philosophical concepts and insights from decolonial and postcolonial scholars can lead to a deeper understanding of empirical phenomena - such as unequal relations of knowers in the context of development cooperation. Drawing on empirical material generated by social science research in South Africa and Tanzania, I highlight how experts from the Global South experience epistemic injustice in aid-related advisory processes, and how this is fostered by a social imaginary of Northern epistemic superiority institutionalized in development practice. The paper ends with a critical reflection on the interdisciplinary research journey, pointing out its drawbacks but also its potential for opening up new thinking spaces and generating questions that demand further exploration. [ABSTRACT FROM AUTHOR]

The study aims to understand the foremost challenges in the transition to online teaching and learning during the COVID-19 pandemic. The study adopts the PRISMA approach to screening the selection of journal articles and review papers according to the research aims and the inclusion criteria. The journal articles and review papers were extracted and stored in Microsoft Excel and Google Scholar, Academic. Microsoft, Semantic Scholar, Elsevier, and Emerald Insight databases searched relevant documents using formulated keywords. A statistical technique was applied using the M.S. Excel analysis tool (PivotTable and an independent t-Test) to analyze data and determine the differences between teachers and students. The review revealed the evidence that the majority of the studies were primarily focused on the individual developing countries and results from other developing countries were not considered. In addition, the foremost challenges in the transition to online teaching and learning during the COVID-19 pandemic were inadequate skills and training, inadequate Internet/Infrastructure, lack of supporting resources and lack of online student engagement and feedback. Finally, the independent t-test reveals there is no statistically significant difference in challenges in the transition to online teaching and learning during the COVID-19 pandemic. Both teachers and students encounter similar challenges. The systematic review raised concerns that higher learning needs to effectively implement long term strategies and support teachers and students in getting into online teaching and learning.

Background: Sub-Saharan Africa (SSA) countries are facing an epidemiological shift from infectious disease to chronic diseases, such as cardiovascular diseases (CVDs). CVDs incidence in SSA are frequently attributed to the prevalence of hypertension, diabetes, and overweight/obesity. Nevertheless, some researchers contend that CVDs are not a priority public health problem in SSA. Method: This paper systematically reviews the evidence on CVDs and their relation with hypertension, diabetes mellitus and obesity/overweight in Ghana, Nigeria, South Africa, Sudan and Tanzania. The publication's content was analyzed qualitatively using the directed content analysis method and the results were presented in a tabular format. Result: The paper illustrates the rising prevalence of CVDs as well as the three related risk conditions in the selected SSA countries. Conclusion: The review indicates a poor health system response to the increasing risk of CVDs in SSA. The conditions and major drivers that contribute to this underlying increasing trend need to be further studied. [ABSTRACT FROM AUTHOR]

Purpose: This paper aims to explore the effects of the customer-to-customer co-creation experiences of savings/credit groups in the African context and how savings/credit groups influence financial capability and enhance financial well-being. Design/methodology/approach: Using purposive sampling, a study of a total of 18 focus groups was conducted in sub-Saharan Africa. Nine urban-based savings/credit groups were drawn from across South Africa and additional nine, rural-based savings/credit groups were studied in the Monduli district of Tanzania. Findings: Findings demonstrate that the African philosophy of Ubuntu, which promotes customer-to-customer interaction, is the cornerstone of the customer-to-customer co-creation experience. Ubuntu philosophical principles were found to influence the dialogue, access, risk and transparency model of co-creation and customer-dominant logic. The results show further that customer-to-customer co-creation experience positively influences the cognitive, financial, personal and social experiences of members. Specifically, it was found that cognitive and financial experiences positively influence financial satisfaction, financial self-esteem, financial self-efficacy and financial capability, all of which enhance financial well-being. In addition, personal and social experiences positively influence equality, self-confidence, entrepreneurial skills and motivation that in turn enhance social well-being. Research limitations/implications: This study has implications for many different stakeholders concerned with the financial inclusion of low-income consumers, particularly in the southern part of Africa. Originality/value: To the authors' knowledge, this is the first study to explore the effects of customer-to-customer co-creation experiences in traditional financial services settings in order to understand how these indigenous financial services influence the financial capability and financial well-being of co-creation members. [ABSTRACT FROM AUTHOR]

This article seeks to ascertain whether refugees who are victims of sexual violence in contracting states enjoy access to courts per Article 16 of the United Nations (UN) Convention Relating to the Status of Refugees (1951 Refugee Convention). It does so by comparing the situation of urban refugees in South Africa with that of refugees in camps in Tanzania and settlements in Uganda, beginning with a description of what "accessing courts" entails in the respective domestic criminal justice systems and of what mechanisms are in place for addressing sexual offences. It further uses the qualitative analysis of documented prosecuted cases of sexual violence in South African, Tanzanian and Ugandan courts between 2013-2017, 2009-2016 and 2013-2017 respectively to establish if these countries prosecute cases of sexual violence suffered by their citizens and whether claims of such violations affecting refugees also enjoy the same treatment. The enquiry found that of 328 documented prosecuted cases of sexual offences in South Africa, victims who were citizens were a majority in number. In Tanzania there appeared to be few prosecuted cases of sexual violence against refugees, but given that limited documentation is available, it is difficult to assess the actual figures. In Uganda the 187 recorded prosecuted cases of sexual offences in the years of investigation all related to citizens, despite the introduction of a mobile court to refugee settlements. Overall, this paper recommends that the countries under review adopt measures to ensure the prompt prosecution of cases of sexual violence against refugees and thereby enable them to access courts and testify against their assailants. [ABSTRACT FROM AUTHOR]

Medical education in Africa is in desperate need of reforms, evident in widespread diseases, and an inability to mobilise and train the required medical workforce to deal with these health issues. However, the exponential rise in the use of mobile technologies due to the spread of the Internet and increased telecommunication networks offer an opportunity for the transformation of medical education and practice through the deployment of mobile devices as a medium for learning and conveying health care services to the remote and resource-constrained locations of Sub-Saharan Africa (SSA). This paper reviewed articles on the affordances of m-learning for distributed medical education in SSA published between 2010-2018. Results from 18 articles identified in the review revealed a slow-paced ascendancy of practice and research in the field; it further exposed competing priorities, infrastructural deficit, and chronic workforce shortages as the bane of m-learning implementation in the subregion. This paper makes recommendations that will enhance the growth of mobile-based distance medical education and practice in SSA.

The HIV response is hampered by many obstacles to progression along the HIV care cascade, with men, in particular, experiencing different forms of disruption. One group of men, whose stories remain untold, are those who have succumbed to HIV-related illness. In this paper, we explore how next-of-kin account for the death of a male relative. We conducted 26 qualitative after-death interviews with family members of male PLHIV who had recently died from HIV in health and demographic surveillance sites in Malawi, Tanzania, Kenya, Uganda, Zimbabwe and South Africa. The next-of-kin expressed frustration about the defiance of their male relative to disclose his HIV status and ask for support, and attributed this to shame, fear and a lack of self-acceptance of HIV diagnosis. Next-of-kin painted a picture of their male relative as rebellious. Some claimed that their deceased relative deliberately ignored instructions received by the health worker. Others described their male relatives as unable to maintain caring relationships that would avail day-to-day treatment partners, and give purpose to their lives. Through these accounts, next-of-kin vocalised the perceived rebellious behaviour of these men, and in the process of doing so neutralised their responsibility for the premature death of their relative. [ABSTRACT FROM AUTHOR]

In sub-Saharan Africa over 52 million children are living with the death of one or both parents. Drivers of this parental mortality include afflictions at levels endemic to the region, including: HIV; malaria and other parasites; lower respiratory infections; diarrhoeal illnesses; and road accidents, among others. This paper examines the impact of orphanhood on learning outcomes among girls and boys in sub-Saharan Africa, conditional on school enrolment. By analysing test scores for approximately 60,000 pupils in 12 countries, we estimate the effect on student test scores by comparing paternal, maternal, and double orphans to non-orphans in the sample, specifically for the subjects of reading, mathematics, and HIV-AIDS knowledge. No previous study has analysed how orphanhood might influence learning by using student test score data, making this paper's approach unique in the literature. This study employs two estimation techniques: Coarsened exact matching calculates the sample average treatment effect on the treated, while matching on students' family structure, household wealth, school resources, and geographic location; and double lasso (DL) regression applies applying machine-learning for variable selection with high-dimensional controls for regional and school identifiers, school location, and student age. Our results show both CEM and DL consistently report a significant negative impact of orphanhood on test scores among specific countries, especially those which faltered in addressing the HIV-AIDS crisis.

The drives to internationalise the UK curriculum and psychology students' desires to work in communities are brought together in this paper. International community-based learning (ICBL) links with many psychology students' motivations to make contributions to others; with the potential to enhance students' learning and cultural sensitivities. The recently-developed literature on international service learning highlights multiple benefits for students (and sometimes community hosts), as well as the potential tensions that need to be negotiated. With the intentions of creating global citizens interested in social justice, community-based engagement can sometimes reinforce preconceived notions. In addition, benefits to the host communities may only be short-term or questionable, with less research on community partners' perspectives than on those of the students. This paper describes work with UK psychology students who undertook CBL in four different international settings (2008--2015); illustrating the complexities of setting up, facilitating and supporting students' CBL. It will then focus on two African settings (South Africa and Tanzania), with data drawn from group discussions with students, post-experience reflections, observations by the accompanying tutor and feedback from community partners. The findings show the richness of students' learning through CBL in both settings, including deeper insight into applications of psychological theory, the skills they enhanced and the emotional impacts of the work. Students reported changed perspectives, including greater awareness of social issues that impacted on their attitudes. The findings are explored and compared, using tools from Activity Theory, to illustrate points of confluence and tensions in such initiatives, when students, community partners and academic staff members interact. The discussion will reflect on what might guide the integration and optimising of ICBL to benefit both students and community partners.

This paper explores the thesis of de-globalisation in relation to international education. Through interrogating accounts of international school leadership during the COVID-19 crisis, the tension between international expectations and localised realities is charted, with four central tenets of internationalism undermined by the pandemic experience. It is argued that the COVID-19 crisis, ostensibly a single global event, resulted in the fractalisation of international education; the conceptualisation of unified internationalism was undermined by the inherently localised material effects of the pandemic. In place of an internationalism that is unified, transcendent, inclusive and connected, international school leaders' accounts of leading through the pandemic focused on their sense that their schools were fractured, rooted, privileged and isolated. It is suggested that this international crisis demonstrates the precarious nature of the respatialising of the global that is intrinsic to international schooling.

Small pelagic fish, including anchovies, sardines and sardinellas, mackerels, capelin, hilsa, sprats and herrings, are distributed widely, from the tropics to the far north Atlantic Ocean and to the southern oceans off Chile and South Africa. They are most abundant in the highly productive major eastern boundary upwelling systems and are characterised by significant natural variations in biomass. Overall, small pelagic fisheries represent about one third of global fish landings although a large proportion of the catch is processed into animal feeds. Nonetheless, in some developing countries in addition to their economic value, small pelagic fisheries also make an important contribution to human diets and the food security of many low-income households. Such is the case for many communities in the Zanzibar Archipelago and on mainland Tanzania in the Western Indian Ocean. Of great concern in this region, as elsewhere, is the potential impact of climate change on marine and coastal ecosystems in general, and on small pelagic fisheries in particular. This paper describes data and information available on Tanzania's small pelagic fisheries, including catch and effort, management protocols and socio-economic significance. Then, incorporating the rapidly improving understanding of the region's oceanography resulting from the application of remote sensing and oceanographic modelling, the paper undertakes the most complete assessment to date of the potential impacts of climate change on the small pelagic fishery of the Pemba Channel. Pathways of climate change impact are explored and crucial knowledge gaps, both in terms of the fishery itself and the wider ecosystem, are identified in order to guide future research activities. Although we analyse small pelagics in the specific context of the Pemba Channel, the key challenges identified in the analysis are likely to be relevant to many small pelagic fisheries in coastal nations heavily dependent on living marine resources. Image 1 • Small pelagic fishery provides critical contribution to the food security of the Tanzanian coastal population. • Pemba Channel is a complex dynamics environment, with coastal population heavily reliant on small pelagics for livelihood and food security. • Potential impact of climate change on marine and coastal ecosystems in general, and on small pelagic fisheries in particular is of great concern to the region. • The key research gaps in understanding of the climate change impacts on the future of the small pelagic fishery are identified. [ABSTRACT FROM AUTHOR]

Undetected and unmonitored hypertension carries substantial mortality and morbidity, especially during pregnancy. We assessed the accuracy of OptiBPTM, a smartphone application for estimating blood pressure (BP), across diverse settings. The study was conducted in community settings: Gaibandha, Bangladesh and Ifakara, Tanzania for general populations, and Kalafong Provincial Tertiary Hospital, South Africa for pregnant populations. Based on guidance from the International Organization for Standardization (ISO) 81,060–2:2018 for non-invasive BP devices and global consensus statement, we compared BP measurements taken by two independent trained nurses on a standard auscultatory cuff to the BP measurements taken by a research version of OptiBPTM called CamBP. For ISO criterion 1, the mean error was 0.5 ± 5.8 mm Hg for the systolic blood pressure (SBP) and 0.1 ± 3.9 mmHg for the diastolic blood pressure (DBP) in South Africa; 0.8 ± 7.0 mmHg for the SBP and −0.4 ± 4.0 mmHg for the DBP in Tanzania; 3.3 ± 7.4 mmHg for the SBP and −0.4 ± 4.3 mmHg for the DBP in Bangladesh. For ISO criterion 2, the average standard deviation of the mean error per subject was 4.9 mmHg for the SBP and 3.4 mmHg for the DBP in South Africa; 6.3 mmHg for the SBP and 3.6 mmHg for the DBP in Tanzania; 6.4 mmHg for the SBP and 3.8 mmHg for the DBP in Bangladesh. OptiBPTM demonstrated accuracy against ISO standards in study populations, including pregnant populations, except in Bangladesh for SBP (criterion 2). Further research is needed to improve performance across different populations and integration within health systems. [ABSTRACT FROM AUTHOR]

This paper reports a phenomenographic study exploring diverse understandings and experiences of teacher leadership among 12 members of the International Study of Teacher Leadership research team comprised of 20 academics located in 10 countries. Mind mapping and semi-structured, online interviews were used to explore the ways that the participants related with the phenomenon of interest: 'teacher leadership'. Phenomenographic analysis of interview artefacts revealed nine qualitatively different conceptions of teacher leadership in the study's outcome space across three broad domains: A: The school, school community and formal education system; B: The teacher leader's professional self; C: The broader historical, socio-political and global contexts of teacher leadership. In addition to providing a 'touchstone' for the team's ongoing research, these findings serve as an experiential framework for thinking about teacher leadership, potentially encouraging more inclusive, more complete and richer understandings of the phenomenon.

The Burgersdorp Formation of South Africa is a richly fossiliferous rock sequence at the top of the Permian-Triassic Beaufort Group and is known for its abundance of Early-Middle Triassic vertebrate remains, particularly cynodonts. Fossils from the Burgersdorp Formation are referred biostratigraphically to the Cynognathus Assemblage Zone (CAZ), which is further divided into three subzones: Langbergia-Garjainia, Trirachodon-Kannemeyeria, and Cricodon-Ufudocyclops. Each subzone is characterised by the presence of a distinct species of trirachodontid, a group of gomphodont cynodonts found relatively abundantly throughout the CAZ, with the lower two subzones characterised by the medium-sized trirachodontids Langbergia and Trirachodon. The uppermost part of the formation, the Cricodon-Ufudocyclops subzone, yields trirachodontids of larger size. The majority of these trirachodontid specimens have previously been referred to Cricodon metabolus, a taxon also known from the Manda Beds of Tanzania and the Ntawere Formation of Zambia. Here we identify one of the specimens (BP/1/5538) previously referred to Cricodon as a new taxon, Guttigomphus avilionis. Guttigomphus can be distinguished from other gomphodont cynodonts by features of the upper postcanine teeth, such as an asymmetric crown in occlusal view (crown narrower along the lingual margin than the labial). Our phylogenetic analysis recovers Guttigomphus as a basal member of Trirachodontidae, outside of the clade including Cricodon, Langbergia and Trirachodon. [ABSTRACT FROM AUTHOR]

Background Whilst cleaning agents are commonly used in workplaces and homes, health workers (HWs) are at increased risk of exposure to significantly higher concentrations used to prevent healthcare-associated infections. Exposure assessment has been challenging partly because many are used simultaneously resulting in complex airborne exposures with various chemicals requiring different sampling techniques. The main objective of this study was to characterize exposures of HWs to various cleaning agents in two tertiary academic hospitals in Southern Africa. Methods A cross-sectional study of HWs was conducted in two tertiary hospitals in South Africa (SAH) and Tanzania (TAH). Exposure assessment involved systematic workplace observations, interviews with key personnel, passive personal environmental sampling for aldehydes (ortho -phthalaldehyde—OPA, glutaraldehyde and formaldehyde), and biomonitoring for chlorhexidine. Results Overall, 269 samples were collected from SAH, with 62 (23%) collected from HWs that used OPA on the day of monitoring. OPA was detectable in 6 (2%) of all samples analysed, all of which were collected in the gastrointestinal unit of the SAH. Overall, department, job title, individual HW use of OPA and duration of OPA use were the important predictors of OPA exposure. Formaldehyde was detectable in 103 (38%) samples (GM = 0.0025 ppm; range: <0.0030 to 0.0270). Formaldehyde levels were below the ACGIH TLV-TWA (0.1 ppm). While individual HW use and duration of formaldehyde use were not associated with formaldehyde exposure, working in an ear, nose, and throat ward was positively associated with detectable exposures (P -value = 0.002). Glutaraldehyde was not detected in samples from the SAH. In the preliminary sampling conducted in the TAH, glutaraldehyde was detectable in 8 (73%) of the 11 samples collected (GM = 0.003 ppm; range: <0.002 to 0.028). Glutaraldehyde levels were lower than the ACGIH's TLV-Ceiling Limit of 0.05 ppm. p -chloroaniline was detectable in 13 (4%) of the 336 urine samples (GM = 0.02 ng/ml range: <1.00 to 25.80). Conclusion The study concluded that detectable exposures to OPA were isolated to certain departments and were dependent on the dedicated use of OPA by the HW being monitored. In contrast, low-level formaldehyde exposures were present throughout the hospital. There is a need for more sensitive exposure assessment techniques for chlorhexidine given its widespread use in the health sector. [ABSTRACT FROM AUTHOR]

Summary: The tribe Diosmeae (Rutaceae) encompasses circa 278 species classified in 11 genera: ten of them are shrubs endemic to the Cape Floristic Region (South Africa), while the only arborescent genus (two species) extends from South Africa to Tanzania. We examined the wood structure of 21 species representing nine genera of Diosmeae and analysed it with respect to their life form and climatic niches. Studied taxa share a suite of traits typical for the whole family: radial vessel multiples, simple perforation plates, minute alternate intervessel pits, distinctly bordered vessel-ray pits, non-septate libriform fibres, and — except for Empleurum — marginal axial parenchyma. However, unlike most Rutaceae, they also occasionally feature vessel-ray pits with reduced borders. Most of the studied species are very similar to each other in their wood structure and habit. The two exceptions are Calodendrum capense (the only canopy tree under study) and Empleurum unicapsulare (a large riparian shrub). The first differs from other species in having wider vessels, longer libriform fibres, prismatic crystals in ray cells and winged-aliform axial parenchyma (which may be plesiomorphic for the tribe); the latter is distinctive because it lacks growth rings and banded axial parenchyma. Analysing anatomy–climate relationship, we found that wood anatomy among shrubby Diosmeae relates to their size and environmental factors, rather than taxonomy. Particularly, the vessel grouping weakly increases with stricter water limitation along the gradient from a semi-arid winter-dry climate to a Mediterranean winter-wet climate. [ABSTRACT FROM AUTHOR]

As scholarship on episodic volunteering expands, researchers question if episodic volunteering is similar to, and/or different from, long-term, membership-based volunteering. This article examines the motivations of Ghanaians, South Africans, and Tanzanians to engage in event-based, episodic volunteering. Based on surveys collected from over 1000 participants in 2018, we use logistic regression models to distinguish differences in motivations between novice, occasional, and regular episodic volunteers. The results show that age and student status are influential in distinguishing novice volunteers from regular volunteers, but more importantly that novices are motivated for primarily social reasons, while regular volunteers are motivated by more altruistic reasons. Our study reinforces established knowledge that people are motivated to volunteer for many reasons that may overlap or occur simultaneously, and that these motivations differ by stage of life. [ABSTRACT FROM AUTHOR]

Background: Health workers (HWs) are exposed to diverse cleaning agents in large hospitals. This study determined the prevalence of work‐related symptoms, allergic sensitization, and lung function abnormalities in HWs of two tertiary hospitals in Southern Africa. Methods: A cross‐sectional study of 699 HWs (South Africa: SAH, n = 346; Tanzania: TAH, n = 353) was conducted. Health outcomes were assessed using a standardized ECRHS questionnaire, immunological tests (specific IgE antibody to common aero‐allergens and to occupational allergens: natural rubber latex [NRL] Hev b5 and Hev b6.02, chlorhexidine, and ortho‐phthalaldehyde [OPA]), spirometry [pre‐and post‐ bronchodilator], methacholine challenge, and fractional exhaled nitric oxide (FeNO). Results: A large proportion of participants (78%) were women. Median age was 42 years, with 76% nurses, 12% cleaners, and 5% administrative workers. Current smoking was more common in SAHWs (12%) than TAHWs (1%). The overall prevalence of doctor‐diagnosed asthma was 7%. Atopy was present in 43% of HWs, while 4% were sensitized to OPA, 2% to NRL, and 1% to chlorhexidine. Prevalence of work‐related ocular‐nasal symptoms (16%) was higher than skin (12%) and chest (7%) symptoms. TAHWs had significantly lower mean lung volumes, higher degrees of significant airflow obstruction and impaired lung function. The prevalence of bronchial hyperresponsiveness in SAHWs (14%) was high. Overall, 23% of HWs had abnormal FeNO; 6% having high (>50 ppb) levels. FeNO was positively associated with sensitization to occupational allergens, primarily OPA and NRL. Conclusions: HWs from both hospitals had similar prevalence of work‐related respiratory symptoms. Sensitization to OPA and NRL appears to be contributing to allergic airway inflammation in these HWs. [ABSTRACT FROM AUTHOR]

This paper examines three interrelated factors outside of formal provision of technical and vocational education and training (TVET) in sub-Saharan Africa that have undermined TVET systems. The first is the process, pace, and levels of industrialisation, which has had a direct effect on TVET provision: low numbers of well-paying jobs requiring technical expertise. This has an indirect effect, which is the second crucial factor: lack of economic development and change in labour markets. There are very few jobs that would be considered 'middle class' or 'mid-level' in wealthy countries. Most people are in survivalist work. An international consensus since the 2000s on palliative approaches to development which address the effects but not the causes of the lack of economic development in Africa has resulted in mass poor quality provision of education--the third factor. Education systems are rapidly expanding and achievement levels rising, in the context of very little possibility of labour market rewards for most people, and substantial labour market rewards confined mainly to graduates. This reinforces deeply embedded cultural preferences for general education, which originate in the type of education systems established by colonial powers, as well as the relationships between educational credentials and elite jobs.

Sub-Saharan Africa secondary school science curricula recognise language as the most important communication tool for learners' biology learning outcomes. Despite this prominent goal, learners' scientific literacy at secondary school appears to be insufficient to cope with classroom teaching and learning of biology. This paper presents a review of literature regarding the way English as the language of instruction and inquiry-based learning strategies affect biology learning in Sub-Saharan Africa secondary schools. The scope of the review included journal articles, books and book chapters published in the period from 2005 to 2020 on the English language of instruction in biology education in Sub-Saharan Africa. We established criteria for first article searches indexed in Scopus, African Journals Online, the Education Resources Information Center, Web of Science and Psych Info as recognised index systems for science education. We considered studies related to the understanding of learners' language backgrounds, language-in-education policy and pedagogical language strategies (practice) that mediate learning. In this case, 53 studies were identified after removing redundancies; 27 studies satisfied the inclusion criteria when screened by key words and abstract and reviewed for eligibility; and only nine were selected after evaluating the full texts. The review analysis suggests that there is a gap in the corpus of literature on what and how pedagogical language strategies should be utilised to support meaningful learning of biology in multilingual settings. Poor learners' academic achievement and conceptual engagement in biology at secondary school level were the main effects reported by the reviewed literature. Less is still known about the effect of the use of inquiry-based learning strategies on learners' conceptual engagement in multilingual biology classrooms. We recommend formulating a clear policy articulation on the use of bilingual instructions in teaching and learning of biology at the secondary school level; assessing teacher and learner performance over pedagogical language strategies; and evaluating the contribution of IBL strategies in addressing language barriers in biology learning for higher order thinking skills in Sub-Saharan Africa secondary schools.

This paper summarises experiences of efforts made by twenty individuals when implementing small-scale ICT development projects in their organizations located in seven developing countries. The main focus of these projects was the use of ICT in educational settings. Challenges encountered and the contributing factors for implementation success of the projects are systematically investigated using interviews and follow up surveys. Results show that the typical limitations of technology and infrastructure were the key obstacles. The commitment of individual project managers in the role of "change agents" and organizational support in the were the strengths behind the success of the projects. Based on the outcome of this study, professional development of the change agents is a key factor for the success of projects. IT and infrastructure limitations contributed to the failure of the majority of the ICT related projects.

Low intake of diverse complementary foods causes critical nutrient gaps in the diets of young children. Inadequate nutrient intake in the first 2 years of life can lead to poor health, educational, and economic outcomes. In this study, the extent to which food affordability is a barrier to consumption of several nutrients critical for child growth and development was examined in Ethiopia, Mozambique, South Africa, Tanzania, Uganda, and Zambia. Drawing upon data from nutrient gap assessments, household surveys, and food composition tables, current consumption levels were assessed, the cost of purchasing key nutritious foods that could fill likely nutrient gaps was calculated, and these costs were compared with current household food expenditure. Vitamin A is affordable for most households (via dark leafy greens, orange-fleshed vegetables, and liver) but only a few foods (fish, legumes, dairy, dark leafy greens, liver) are affordable sources of iron, animal-source protein, or calcium, and only in some countries. Zinc is ubiquitously unaffordable. For unaffordable nutrients, approaches to reduce prices, enhance household production, or increase household resources for nutritious foods are needed. [ABSTRACT FROM AUTHOR]

Little is known about how CD4 and viral load testing have evolved following implementation of universal test and treat (UTT) in African settings. We reviewed World Health Organization (WHO) guidance from 2013 to 2018, and compared it against national HIV policies in Malawi, Tanzania and South Africa. Three surveys rounds were conducted in 2013, 2016 and 2017–2018 in 33 health facilities across the three settings to assess implementation of national policies on the use of biological markers. Qualitative interviews were conducted with 26 HIV policymakers or programme managers, 21 providers and 66 people living with HIV to explore understandings and experiences of these tests. Various factors influenced adoption and implementation of WHO guidance, including historical policies on CD4 counts, governance issues, supply chain challenges and funding mechanisms. Facility-level practices relating to the use of these tests often diverged from national policies. Patients and providers valued both tests, but did not always understand their roles. In addition to continued support for scaling-up viral load testing, renewed focus should be placed on the ongoing value of point-of-care CD4 tests in the UTT era, including its role in assessing disease progression and informing clinical management of cases to reduce HIV-related mortality. [ABSTRACT FROM AUTHOR]

Universal antiretroviral therapy (ART) for pregnant and postpartum women in sub-Saharan Africa has required adaptations to service delivery. We compared national policies on differentiated HIV service delivery with facility-level implementation, and explored provider and user experiences in rural Malawi, Tanzania and South Africa. Four national policies and two World Health Organization guidelines on HIV treatment for pregnant and postpartum women published between 2013 and 2017 were reviewed and summarised. Results were compared with implementation data from surveys undertaken in 34 health facilities. Eighty-seven in-depth interviews were conducted with pregnant and post-partum women living with HIV, their partners and providers. In 2018, differentiated service policies varied across countries. None specifically accounted for pregnant or postpartum women. Malawian policies endorsed facility-based multi-month scripting for clinically-stable adult ART patients, excluding pregnant or breastfeeding women. In Tanzania and South Africa, national policies proposed community-based and facility-based approaches, for which pregnant women were not eligible. Interview data suggested some implementation of differentiated services for pregnant and postpartum women beyond stipulated policies in all settings. Although these adaptations were appreciated by pregnant and postpartum women, they could lead to frustrations among other users when criteria for fast-track services or multi-month prescriptions were not clear. [ABSTRACT FROM AUTHOR]

National HIV testing policies aim to increase the proportion of people living with HIV who know their status. National HIV testing policies were reviewed for each country from 2013 to 2018, and compared with WHO guidance. Three rounds of health facility surveys were conducted to assess facility level policy implementation in Karonga (Malawi), uMkhanyakude (South Africa), and Ifakara (Tanzania). A policy 'implementation' score was developed and applied to each facility by site for each round. Most HIV testing policies were explicit and aligned with WHO recommendations. Policies about service coverage, access, and quality of care were implemented in >80% of facilities per site and per round. However, linkage to care and the provision of outreach HIV testing for key populations were poorly implemented. The proportion of facilities reporting HIV test kit stock-outs in the past year reduced over the study period in all sites, but still occurred in ≥17% of facilities per site by 2017. The implementation score improved over time in Karonga and Ifakara and declined slightly in uMkhanyakude. Efforts are needed to address HIV test kit stock-outs and to improve linkage to care among people testing positive in order to reach the 90-90-90 targets. [ABSTRACT FROM AUTHOR]

Investigating how young women disclose oral pre-exposure prophylaxis (PrEP) use is important given evidence that disclosure is associated with higher adherence. We report qualitative results on PrEP disclosure among young women in South Africa and Tanzania who participated in a PrEP demonstration project (EMPOWER). In total, 81 in-depth interviews were conducted with 39 young women aged 16–24 years—25 from Johannesburg and 14 from Mwanza—at approximately 3, 6 and/or 9 months post-enrolment. Analysis of data was thematic and inductive. Most Johannesburg participants were students in the inner-city; in Mwanza, all worked in recreational venues, occasionally engaging in sexual transactions with customers. A continuum of approaches was evident. Partner disclosure was common in Johannesburg but less so in Mwanza, where many partners were feared as judgemental and potentially violent. In both sites, participants commonly disclosed to family to secure support, and to friends and work colleagues to advocate about PrEP and encourage uptake among at-risk peers. Adherence clubs appeared helpful in building participants' skills and confidence to disclose, particularly in gender-inequitable sexual relationships. PrEP counselling for young women should focus on strengthening communication skills and helping develop strategies for safe disclosure. [ABSTRACT FROM AUTHOR]

Many nations have attempted to create different language-in-education policies that would cater not only to the needs of learners but also to the demands of preserving a country's native languages. The emergence of multilingual education has led to a proliferation of research that shows the benefits of using a learner's first language. These issues have led the authors to investigate the different language-in-education policies of Brunei, Cambodia, Malaysia, Thailand, the Philippines, Botswana, Kenya, Rwanda, South Africa, Tanzania, and Uganda, and how they establish students' first languages as a medium of instruction. This paper examined 30 research articles with the goal of providing an in-depth understanding of each country's policies and implementation practices. The study also explored the different challenges and pedagogical implications of these policies to better understand emerging issues and insights. An identified issue is the devaluation of one's first language due to people's negative perspectives and poor policy planning. It was also not surprising that most of these developing communities understand the importance of English as a language of globalization. Thus, emphasizing the importance of establishing one's first language and strengthening the use of the English language in educational systems are two important considerations for policy planning.

Background: In low- and middle-income countries, infectious diseases remain a key public health issue. Additionally, non-communicable diseases are a rapidly growing public health problem that impose a considerable burden on population health. One way to address this dual disease burden, is to incorporate (lifestyle) health promotion measures within the education sector. In the planned study, we will (i) assess and compare physical activity, physical fitness, micronutrient status, body composition, infections with soil-transmitted helminths, Schistosoma mansoni, malaria, inflammatory and cardiovascular health risk markers, cognitive function, health-related quality of life, and sleep in schoolchildren in Côte d'Ivoire, South Africa and Tanzania. We will (ii) determine the bi- and multivariate associations between these variables and (iii) examine the effects of a school-based health intervention that consists of physical activity, multi-micronutrient supplementation, or both.Methods: Assuming that no interaction occurs between the two interventions (physical activity and multi-micronutrient supplementation), the study is designed as a cluster-randomised, placebo-controlled trial with a 2 × 2 factorial design. Data will be obtained at three time points: at baseline and at 9 months and 21 months after the baseline assessment. In each country, 1320 primary schoolchildren from grades 1-4 will be recruited. In each school, classes will be randomly assigned to one of four interventions: (i) physical activity; (ii) multi-micronutrient supplementation; (iii) physical activity plus multi-micronutrient supplementation; and (iv) no intervention, which will serve as the control. A placebo product will be given to all children who do not receive multi-micronutrient supplementation. After obtaining written informed consent from the parents/guardians, the children will be subjected to anthropometric, clinical, parasitological and physiological assessments. Additionally, fitness tests will be performed, and children will be invited to wear an accelerometer device for 7 days to objectively assess their physical activity. Children infected with S. mansoni and soil-transmitted helminths will receive deworming drugs according to national policies. Health and nutrition education will be provided to the whole study population independently of the study arm allocation.Discussion: The study builds on the experience and lessons of a previous study conducted in South Africa. It involves three African countries with different social-ecological contexts to investigate whether results are generalisable across the continent.Trial Registration: The study was registered on August 9, 2018, with ISRCTN. https://doi.org/10.1186/ISRCTN29534081. [ABSTRACT FROM AUTHOR]

Inquiry-based instruction (IBI) is widely renowned as one of the best approaches to teaching school science. Nonetheless, while science teachers in Tanzania might involve in teaching activities consistent with inquiry, IBI is not yet recognised as a formal approach to teaching science. Hence, this study investigated the extent to which IBI is promoted in Tanzanian secondary science curriculum documents. Additionally, it proposed suggestions on how to adopt IBI in the context of Tanzania. Using document analysis as a method of inquiry, six syllabi for secondary school science subjects in Tanzania were analysed to assess the extent to which they support the IBI practice. Further, curriculum documents for secondary school science from South Africa and the United States were also analysed. This was done to compare between education systems that have recognised IBI as a formal approach to teaching science with that of Tanzania. Results indicated that while teaching methods, goals and objectives of education support the practice of IBI, a few aspects such as the time allocated and resources suggested for accomplishing investigative learning activities are the barriers to practising IBI. By reflecting on these results and lessons learned from the US and South Africa, the study provides recommendations such as allocating enough time for carrying out scientific investigations, changing teachers' beliefs, revision of some learning objectives, and promoting teacher professional development in case Tanzania wishes to adopt IBI. [ABSTRACT FROM AUTHOR]

The 20 facilities were selected in collaboration with the Department of Health, Western Cape, South Africa (SA), and Ministry of Health, Community Development, Gender, Elderly & Children (MoHCDGEC) in Tanzania (TZ), as high volume delivery sites. In South Africa to embed changes into the regional training structures and curriculum, and in Tanzania to institutionalise PPFP within facilities, supported by facility management and regional and district health management teams. The proportion of women receiving postpartum contraception, particularly LARCs, increased in both Tanzania and South Africa, but was especially striking in Tanzania, which started from a lower base. [Extracted from the article]

BACKGROUND: Household air pollution (HAP) from solid fuel use for cooking affects 2.5 billion individuals globally and may contribute substantially to disease burden. However, few prospective studies have assessed the impact of HAP on mortality and cardiorespiratory disease. OBJECTIVES: Our goal was to evaluate associations between HAP and mortality, cardiovascular disease (CVD), and respiratory disease in the prospective urban and rural epidemiology (PURE) study. METHODS: We studied 91,350 adults 35-70 y of age from 467 urban and rural communities in 11 countries (Bangladesh, Brazil, Chile, China, Colombia, India, Pakistan, Philippines, South Africa, Tanzania, and Zimbabwe). After a median follow-up period of 9.1 y, we recorded 6,595 deaths, 5,472 incident cases of CVD (CVD death or nonfatal myocardial infarction, stroke, or heart failure), and 2,436 incident cases of respiratory disease (respiratory death or nonfatal chronic obstructive pulmonary disease, pulmonary tuberculosis, pneumonia, or lung cancer). We used Cox proportional hazards models adjusted for individual, household, and community-level characteristics to compare events for individuals living in households that used solid fuels for cooking to those using electricity or gas. RESULTS: We found that 41.8% of participants lived in households using solid fuels as their primary cooking fuel. Compared with electricity or gas, solid fuel use was associated with fully adjusted hazard ratios of 1.12 (95% CI: 1.04, 1.21) for all-cause mortality, 1.08 (95% CI: 0.99, 1.17) for fatal or nonfatal CVD, 1.14 (95% CI: 1.00, 1.30) for fatal or nonfatal respiratory disease, and 1.12 (95% CI: 1.06, 1.19) for mortality from any cause or the first incidence of a nonfatal cardiorespiratory outcome. Associations persisted in extensive sensitivity analyses, but small differences were observed across study regions and across individual and household characteristics. DISCUSSION: Use of solid fuels for cooking is a risk factor for mortality and cardiorespiratory disease. Continued efforts to replace solid fuels with cleaner alternatives are needed to reduce premature mortality and morbidity in developing countries. [ABSTRACT FROM AUTHOR]

Copyright of Cybium: International Journal of Ichthyology is the property of Societe Francaise d'Ichtyologie (SFI) and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

This paper presents an update on some of the activities that have taken place since a World Bank report; "Guidelines for Education and Training in Environmental Information Systems in Sub-Saharan Africa: Some Key Issues" was published and provides details on the current situation. It shows how organizations such as the African Association on Remote Sensing of Environment, International Society of Photogrammetry and Remote Sensing, European Association of Remote Sensing Companies, Group on Earth Observation, and several others have helped to increase manpower resources in the region and strengthened institutional capacity in the field of geoinformatics, through capacity building, technology transfer, international cooperation and the provision of internal African resources. After reviewing what has happened in the field of geoinformatics education and training, we focused on current initiatives taken and challenges in five Sub-Saharan countries: Ethiopia, Nigeria, South Africa, Tanzania, and Zimbabwe. We reviewed GIS education and training in the private sector, government, information communications technology in higher education institutions, GIS application areas and challenges facing GIS education and training. Findings show that; change should involve education stakeholders in all levels of education and curriculum quality, regional and international cooperation through exchange programs, should be a priority for Sub-Saharan Africa countries.

Background: Use of a reliable contraception method has become an inclusion criterion in prevention trials to minimize time off product. We report on hormonal contraceptive prevalence, uptake, sustained use and correlates of use in the Microbicides Development Programme (MDP 301) trial at the Masaka Centre in Uganda. Methods: HIV negative women in sero-discordant relationships were enrolled and followed-up for 52 to 104 weeks from 2005 to 2009. Contraceptive use data was collected through self-report at baseline and dispensing records during follow-up. Hormonal contraceptives were promoted and provided to women that were not using a reliable method at enrolment. Baseline contraceptive prevalence, uptake and sustained use were calculated. Uptake was defined as a participant who reported not using a reliable method at enrolment and started using a hormonal method at any time after. Logistic regression models were fitted to investigate predictors of hormonal contraceptive uptake. Results: A total of 840 women were enrolled of whom 21 aged ≥50 years and 12 without follow-up data were excluded; leaving 807 (median age 31 IQR 26-38) in this analysis. At baseline, 228 (28%) reported using a reliable contraceptive; 197 hormonal, 28 female-sterilisation, two IUCD and one hysterectomy. As such 579 were not using a reliable contraceptive at enrolment, of whom 296 (51%) subsequently started using a hormonal contraceptive method; 253 DMPA, four oral pills, and two norplant. Overall 193 (98%) existing users and 262 (88%) new users sustained use throughout follow-up. Independent correlates of hormonal contraceptive uptake were: younger women ≤30 years, aOR = 2.5, 95% CI: 1.7-3.6 and reporting not using contraceptives at baseline due to lack of access or money, breastfeeding or other reasons, in comparison to women who reported using unreliable method. Conclusion: Promotion and provision of hormonal contraception doubled the proportion of women using a reliable method of contraception. Uptake was pronounced among younger women and those not previously using a reliable method because of lack of access or money, and breastfeeding. Promotion and provision of hormonal contraceptives in trials that require the interruption or discontinuation of investigational products during pregnancy is important to reduce the time off product. Trial registration: Protocol Number ISRCTN64716212. [ABSTRACT FROM AUTHOR]

The duration of exclusive breastfeeding (EBF) is often defined as the time from birth to the first non‐breast milk food/liquid fed (EBFLONG), or it is estimated by calculating the proportion of women at a given infant age who EBF in the previous 24 h (EBFDHS). Others have measured the total days or personal prevalence of EBF (EBFPREV), recognizing that although non‐EBF days may occur, EBF can be re‐initiated for extended periods. We compared breastfeeding metrics in the MAL‐ED study; infants' breastfeeding trajectories were characterized from enrollment (median 7 days, IQR: 4, 12) to 180 days at eight sites. During twice‐weekly surveillance, caretakers were queried about infant feeding the prior day. Overall, 101 833 visits and 356 764 child days of data were collected from 1957 infants. Median duration of EBFLONG was 33 days (95% CI: 32–36), compared to 49 days based on the EBFDHS. Median EBFPREV was 66 days (95% CI: 62–70). Differences were because of the return to EBF after a non‐EBF period. The median number of returns to EBF was 2 (IQR: 1, 3). When mothers re‐initiated EBF (second episode), infants gained an additional 18.8 days (SD: 25.1) of EBF, and gained 13.7 days (SD: 18.1) (third episode). In settings where women report short gaps in EBF, programmes should work with women to return to EBF. Interventions could positively influence the duration of these additional periods of EBF and their quantification should be considered in impact evaluation studies. © 2016 John Wiley & Sons Ltd [ABSTRACT FROM AUTHOR]

Copyright of Review of African Political Economy is the property of Review of Political Economy (ROAPE) and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

This article studies the transformative nature of 'artisanal frontier mining' in view of sub-Saharan Africa's mining history. Artisanal gold production has generated livelihood earnings for millions of people in sub-Saharan Africa. Yet we must go beyond a study of artisanal mining as an individual livelihood choice and consider the sector's internal dynamics. In this sense, the concept of 'labour transformation' is helpful. It refers to a process in which individuals' skill acquisition, economic exchange, psychological reorientation, and social positioning evolve towards a shared occupational identity and collective professional norms, leaving considerable scope for self-governance amongst artisanal miners. This process is captured in the notion of the 'frontier', which in our case refers to occupational rather than geographic locational change. However, the frontier is necessarily of limited temporal duration given the existence of gold as a non-renewable resource, the depth of the gold supply sinking beyond the exploratory and extractive reach of artisanal miners, and the expanding interests of foreign mining corporations and the state. Our argument is illustrated through a comparison of the artisanal mining experiences of two neighbouring countries, Tanzania and the Democratic Republic of Congo (DRC), whose artisanal labour patterns are remarkably similar to each other despite their very different national political contexts and the DRC's recent experience of conflict mineral production. [ABSTRACT FROM AUTHOR]

Many HIV intervention programs in sub-Saharan Africa have applied social cognitive theories such as the theory of planned behavior. However, a recent sub-Saharan African review was unable to show increased effectiveness for theory-based interventions. This study assessed whether the predictive value of attitudes, subjective norms, self-efficacy, and intention was similar to studies in Europe and the U.S., and whether there were differences between three sub-Saharan sites. Longitudinal multigroup structural equation modeling was used to assess whether attitudes, subjective norms, and self-efficacy predicted condom use intentions and condom use (after 6 months) among adolescents in three sites, namely Cape Town (South Africa; N = 625), Dar es Salaam (Tanzania; N = 271), and Mankweng (South Africa; N = 404). Condom use intentions were predicted by subjective norms and self-efficacy in all three sites. Attitudes were not related to intentions in Dar es Salaam and were moderately related to intentions in Cape Town and Mankweng. The proportions of explained variance in intentions and behavior were decent (37-52 and 9-19%, respectively). Although significant differences in predictive value were found between sites and in comparison to European and U.S. studies, intentions could adequately be explained by attitudes, subjective norms, and self-efficacy. However, the limited proportions of variance in behavior explained by intentions could signify the importance of contextual and environmental factors. Future studies are recommended to use an integrative approach that takes into account both individual and contextual factors, as well as social and environmental differences. [ABSTRACT FROM AUTHOR]

Early sexual debut is common in South Africa and Tanzania, with potentially negative reproductive health outcomes. The role of violence as a predictor of sexual debut was studied, in a context of predictors borrowed from social cognition models. Data were taken from cluster-randomized trials of school-based HIV prevention interventions in three sites in South Africa and Tanzania. Analyses consisted of descriptive statistics and multi-group structural equation modelling. The basic model functioned fairly well for Cape Town, but less well for Mankweng and Dar es Salaam (low R values). Attitudes were the strongest predictor of intention. Adding socio-demographic variables to the model did not reduce the associations much and neither did subsequent inclusion of violence. Sexual debut was strongly associated with victimization; adding violence also substantially increased R for sexual debut. Besides social cognition factors, intimate partner violence should be addressed in future research on reproductive health interventions for adolescents. [ABSTRACT FROM AUTHOR]

Cluster-randomized controlled trials were carried out to examine effects on sexual practices of school-based interventions among adolescents in three sites in sub-Saharan Africa. In this publication, effects on communication about sexuality with significant adults (including parents) and such communication as a mediator of other outcomes were examined. Belonging to the intervention group was significantly associated with fewer reported sexual debuts in Dar es Salaam only (OR 0.648). Effects on communication with adults about sexuality issues were stronger for Dar es Salaam than for the other sites. In Dar, increase in communication with adults proved to partially mediate associations between intervention and a number of social cognition outcomes. The hypothesized mediational effect of communication on sexual debut was not confirmed. Promoting intergenerational communication on sexuality issues is associated with several positive outcomes and therefore important. Future research should search for mediating factors influencing behavior beyond those examined in the present study. [ABSTRACT FROM AUTHOR]

This article discusses the potential factors for the development of international terrorism in southern Africa. While the region has seemingly been spared the terror attacks that have ravaged most other parts of the continent, and the globe at large, it is not immune to these attacks. Using a survey of the Southern African Development Community (SADC) countries, particularly the Democratic Republic of the Congo, Mozambique, South Africa, Mauritius, Zimbabwe, and Tanzania, which illuminate some of the permissive factors, the article asks, largely, first, to what extent is southern Africa at risk of global terrorism? And, second, in what ways can southern African states reduce the risk of terrorism in the region? Broadly, the article contends that, like most developing countries, including those from other parts of Africa, there exist permissive, both root and trigger, factors including insecure borders, democratization challenges, poverty, urban centers and variegated forms of both sub-state and state terrorism, that could provide useful platforms for the growth of international terrorism. [ABSTRACT FROM AUTHOR]

The death of a woman in pregnancy and childbirth is globally considered an individual tragedy and a human rights violation. Given the inequities in death that occur to marginalized, poor, and vulnerable women in low and middle income countries, there is no doubt that maternal death is a horrific injustice. However, the long term global burden of disease goes far beyond this tragedy. Recent research is demonstrating that there are disastrous consequences in infant and child mortality, loss of economic opportunities, spiraling cycles of poverty in the families and communities where women die giving birth. The journal has published a supplement "The True Cost of Maternal Death," Reproductive Health which includes original research from two major study groups. Harvard's Francois-Xavier Bagnoud (FXB) Center for Health and Human Rights conducted a multi-country, mixed methods study of the impact of maternal mortality on newborn health and survival, family functioning, interrupted education and economic degradation in four high maternal mortality countries, Tanzania, South Africa, Malawi, and Ethiopia. A collaborative group from Family Care International (FCI), the International Center of Research on Women (ICRW), and the Kenya Medical Research Institute (KEMRI)-Center for Disease Control (CDC)-Research Collaboration conducted research into true costs of maternal death in Kenya. These articles demonstrate the enormous costs that ripple out from the maternal death, and the intergenerational and multi-sectorial disruptions related to maternal mortality. It is important in this period of post-MDG strategy planning period that donors, governments, and NGOs be aware not only of the individual level tragedy of the loss of a mother's life, but also the financial and health costs associated with maternal mortality, and to keep the focus on maternal health as a key issue in all aspects of development, not just health. [ABSTRACT FROM AUTHOR]

This is the 13th in a series of articles exploring international trends in health science librarianship in the 21st century. It is the first devoted to four different regions in the African continent. The present issue focuses on countries in Southern Africa - South Africa and Zimbabwe. The next issue will examine East Africa. [ABSTRACT FROM AUTHOR]