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Background: In mid-November, 2021, the SARS-CoV-2 omicron variant (B.1.1.529; BA.1 sublineage) was detected in southern Africa, prompting international travel restrictions. We aimed to investigate the spread of omicron BA.1 in Africa., Methods: In this observational study, samples from patients infected with SARS-CoV-2 from 27 laboratories in 24 African countries, collected between June 1, 2021 and April 14, 2022, were tested for omicron BA.1 and delta (B.1.617.2) variants using real-time RT-PCR. Samples that tested positive for BA.1 by RT-PCR and were collected before estimated BA.1 emergence according to epidemiological properties were excluded from downstream analyses. The diagnostic precision of the assays was evaluated by high-throughput sequencing of samples from four countries. The observed spread of BA.1 was compared with mobility-based mathematical simulations and entries for SARS-CoV-2 in the Global Initiative on Sharing All Influenza Data (GISAID) genomic database. We estimated the effective reproduction number (R t ) at the country level considering the BA.1 fraction and the reported numbers of infections. Phylogeographical analyses were done in a Bayesian framework., Findings: Through testing of 13 294 samples from patients infected with SARS-CoV-2, we established that, by November-December, 2021, omicron BA.1 had replaced the delta variant of SARS-CoV-2 in all African subregions, following a south-north gradient, with a median R t of 2·60 (95% CI 2·46-2·71). This south-north spread, established on the basis of PCR data, was substantiated by phylogeographical reconstructions, ancestral state reconstructions, and GISAID data. PCR-based reconstructions of country-level BA.1 predominance and the availability of BA.1 genomic sequences in GISAID correlated significantly in time (p=0·0002, r=0·78). The first detections of BA.1 in high-income settings beyond Africa were predicted accurately in time by mobility-based mathematical simulations (p<0·0001). Comparing PCR-based reconstructions with mobility-based mathematical simulations suggested that SARS-CoV-2 infections in Africa were under-reported by approximately ten times. Inbound travellers infected with BA.1, departing from five continents, were identified in six African countries by early December, 2021., Interpretation: Omicron BA.1 was widespread in Africa when travel bans were implemented, limiting their effectiveness. Combined with genomic surveillance and mobility-based mathematical modelling, PCR-based strategies can inform R t and the geographical spread of emerging pathogens in a cost-effective and timely manner, and can guide evidence-based, non-pharmaceutical interventions such as travel restrictions or physical distancing., Funding: Bill & Melinda Gates Foundation., Translations: For the French, Portugese and Spanish translations of the abstract see Supplementary Materials section., Competing Interests: Declaration of interests OL is the former owner of TIB Molbiol, the company that produced the kits provided to African partner laboratories in this study. The kits are not commercially available. All other authors declare no competing interests., (Copyright © 2025 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license. Published by Elsevier Ltd.. All rights reserved.)

Mycotoxin exposure from contaminated food is a significant global health issue, particularly among vulnerable children. Given limited data on mycotoxin exposure among Namibian children, this study investigated mycotoxin types and levels in foods, evaluated dietary mycotoxin exposure from processed cereal foods in children under age five from rural households in Oshana region, Namibia. Mycotoxins in cereal-based food samples (n = 162) (mahangu flour (n = 35), sorghum flour (n = 13), mahangu thin/thick porridge (n = 54), oshikundu (n = 56), and omungome (n = 4)) were determined by liquid chromatography-tandem mass spectrometry. Aflatoxin B 1 (AFB 1 , 35.8%), zearalenone (27.2%), fumonisin B 1 (FB 1 , 24.1%), citrinin (CIT, 12.4%) and deoxynivalenol (10.5%) were the major mycotoxins quantified. Food samples (35.8% (n = 58) and 6.2% (n = 10)) exceeded the 0.1 µg/kg AFB 1 and 200 µg/kg FB 1 EU limit for children's food, respectively. Several emerging mycotoxins including the neurotoxic 3-nitropropionic acid, moniliformin (MON), and tenuazonic acid were quantified in over 50% of all samples. Co-occurrence of AFB 1 , CIT, and FB 1 detected in 4.9% (n = 8) samples, which could heighten food safety concerns. Regarding exposure assessment and risk characterization, average probable dietary intake for AFB 1 from all ready-to-eat-foods was 0.036 µg/kg bw/day, which resulted in margin of exposures (MOE) of 11 and 0.65 risk cancer cases/year/100,000 people, indicating a risk of chronic aflatoxicosis. High tolerable daily intake values for FB 1 , and MOE for beauvericin and MON exceeded reference values. Consumption of a diversified diet and interventions including timely planting and harvesting, best grain storage, and other standard postharvest food handling practices are needed to mitigate mycotoxin exposure through contaminated cereal foods and to safeguard the health of the rural children in Namibia., Competing Interests: Declarations. Competing interest: The authors declare no competing interests., (© 2025. The Author(s).)

Abstract: Background: In operating theatres, diagnostic radiography is used to capture images during surgical operations. With the growing use of fluoroscopy, there are concerns about increased radiation exposure to healthcare workers such as doctors and nurses. Thus, assessing HCWs' knowledge and adherence to radiation protection is crucial to prevent overexposure, radiation-related health issues, and ensure patient safety. Objective: The study aimed to assess the knowledge of non-radiation HCWs regarding radiation protection and determine the level of adherence to radiation protection in two theaters. Methods: A quantitative descriptive research methodology was used. Data collection involved a questionnaire, and participants were selected through a simple random sampling method. Data were analyzed using SPSS version 26. Results: Fifty-eight non-radiation HCWs participated. Most (77.6%) were female with nurses comprising the largest demographic (62.1%). Most participants (53.4%) lacked prior education in radiation protection. Concerningly, 70.7% did not use dosimeters during theater radiography, which is a requirement for radiation protection. No significant association was found between participants' allocated hospital and the level of knowledge, but a significant association (p = 0.027) was found between participants' allocated hospital and adherence levels. Conclusion: The findings suggest inadequate knowledge and adherence to radiation protection. Therefore, education on radiation protection must be mandated, and measures should be taken to enforce adherence., (Copyright © 2024 Health Physics Society.)

Objectives: To examine if point-of-care (POC) urine tenofovir testing-informed counseling could be used to improve virologic suppression (VS) among participants with virologic failure (VF) after ≥1 prior round of enhanced adherence counseling (EAC)., Methods: Participants were enrolled from 42 clinics across Namibia. At each monthly medication pick-up, participants completed the POC urine test and received EAC informed by this testing (EAC+). If VS was not achieved after 3 months of EAC+, up to 3 additional rounds of EAC+ were provided, with resistance testing at month (M)9., Results: Of 310 potentially eligible participants across 42 clinics in Namibia, we enrolled 211 participants with VF (median age 33 years, 61% female); 195 reached M3 defined as receiving EAC+ and follow-up viral load testing; 169 achieved VS within M3 (87%, P < 0 . 001) and 97% by M9 (181/186) compared to 40% (22/55) prior to the intervention (P < 0.001). Resistance testing was performed in five remaining participants with VF at M9, of whom 1/5 (20%) developed dolutegravir resistance., Conclusion: The urine tenofovir assay when incorporated into adherence counseling has potential to be a cost-effective intervention among participants failing tenofovir-based regimens, increasing VS to 97% in those failing Tenofovir-Lamivudine-Dolutegravir. Encouraging results of this pre-post intervention will be rigorously tested in a randomized trial., Competing Interests: Declarations of competing interest The authors report no conflicts of interest., (Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Background: Long-lasting insecticidal nets (LLINs) were once fully effective for the prevention of malaria; however, mosquitoes have developed resistance to pyrethroids, the main class of insecticides used on nets. Dual active ingredient LLINs (dual-AI LLINs) have been rolled out as an alternative to pyrethroid (PY)-only LLINs to counteract this. Understanding the minimum community usage at which these LLINs elicit an effect that also benefits non-users against malaria infection is important., Methods: We conducted a secondary analysis of a 3-year randomized controlled trial (RCT) in 84 clusters in North-western Tanzania to evaluate the effectiveness of three dual-AI LLINs: pyriproxyfen and alpha(α)-cypermethrin, chlorfenapyr and α-cypermethrin, and the piperonyl-butoxide (PBO) and permethrin compared to α-cypermethrin only LLINs. We measured malaria infection prevalence using 5 cross-sectional surveys between 2020 and 2022. We assessed net usage at the cluster level and malaria infection in children aged from 6 months to 14 years in 45 households per cluster. The trial was registered as a clinical trial on www., Clinicaltrials: gov : ClinicalTrials.gov (NCT03554616) on 2018-06-13., Results: A total of 22,479 children from 12,654 households were tested for malaria using rapid diagnostic tests in January 2020, 2021, & 2022 and July 2020 & 2021. Among non-users, community-level usage of > 40% of dual-AI LLIN was significantly associated with protection against malaria infection: chlorfenapyr arm (OR: 0.44 (95% CI: 0.27-0.71), p = 0.0009), PBO arm (OR: 0.55 (95% CI: 0.33-0.94), p = 0.0277) and pyriproxyfen arm (OR: 0.61 (95% CI: 0.37-0.99), p = 0.0470) compared with non-users in clusters with > 40% usage of pyrethroid-only LLINs. There were indications of some protection against malaria infection to non-users in the chlorfenapyr arm when community-level usage was ≤ 40% (OR: 0.65 (95% CI: 0.42-1.01), p = 0.0528) compared to those living in clusters with > 40% usage of pyrethroid-only LLINs., Conclusion: Our study demonstrated that at a community usage of 40% or more of dual-AI LLINs non-users benefited from the presence of these nets. Noticeably, even when usage was ≤ 40% in the chlorfenapyr arm, non-users were better protected than non-users in the higher coverage pyrethroid-only arm. The greater difference in malaria risk observed between users and non-users indicates that LLINs play a crucial role in providing personal protection against malaria infection for the people using the net., Competing Interests: Declarations. Ethics approval and consent to participate: Ethical approval for the RCT was obtained from the institutional review boards of the Tanzanian National Institute for Medical Research (reference number: NIMR/HQ/R.8a/Vol.IX/2743), Kilimanjaro Christian Medical University College (2267), London School of Hygiene and Tropical Medicine (14952), and University of Ottawa (H-05-19-4411). A written informed consent was obtained from an adult guardian in each household interviewed and for selected children. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests., (© 2025. The Author(s).)

Introduction: Patient-centred care (PCC) is essential in radiography for polytrauma patients emphasising empathy, clear communication, and patient well-being. Polytrauma patients require tailored imaging approaches, often involving multiple modalities. Managing and handling these patients during imaging are key components of radiography training to develop the necessary competencies. This study aimed to explore the experiences of third- and fourth-year radiography students in applying PCC during the imaging of polytrauma patients., Methods: A qualitative interpretive phenomenological design was employed to capture the in-depth experiences of third and fourth-year radiography students at the University of Namibia. The study utilised purposive sampling to select participants. Data were collected through face-to-face semi-structured interviews, recorded and transcribed for interpretive phenomenological analysis. Trustworthiness was ensured through credibility, dependability, confirmability, and transferability measures., Results: Twenty-one students (3 males, 18 females; 10 third-year, 11 final-year) participated. Three interpretive themes shaped the findings: Compassionate Patient Care, reflecting students' commitment to balancing technical accuracy with empathy while managing personal fears; Professional Challenges in Polytrauma Imaging, highlighting emotional trauma, technical challenges, and communication barriers as central obstacles; and Professional Transformation Through Collaboration, illustrating how teamwork and reflective practice fostered growth, confidence, and resilience. The findings highlight the human and transformative nature of students' experiences in imaging polytrauma patients., Conclusions: This study highlights radiography students' experiences imaging polytrauma patients, emphasizing compassionate care, professional challenges, and collaborative growth. The interplay between technical skills, emotional resilience, and relational competence underscores the need for curricula that address patient-centred care, adaptive problem-solving, and emotional resilience to prepare students for clinical challenges., Implications for Practice: Radiography curricula should incorporate emotional resilience training, patient-centred care principles, and adaptive problem-solving to enhance students' preparedness for real-world clinical challenges., Competing Interests: Conflict of interest statement None., (Copyright © 2025 The College of Radiographers. Published by Elsevier Ltd. All rights reserved.)

Members of the RNA virus order Nidovirales infect hosts ranging from marine invertebrates to terrestrial mammals. As such, understanding the determinants of host range in this group of viruses, as well as their patterns of emergence and disease potential, is of clear importance. The Mesoniviridae are a recently documented family within the Nidovirales . To date, mesoniviruses have only been associated with the infection of arthropod species, particularly mosquitoes, and hence are regarded as insect-specific viruses (ISVs). Herein, we report the first detection of a mesonivirus-Alphamesonivirus-1 -in mammals. Specifically, we utilized genomic and histological techniques to identify Alphamesonivirus-1 in lung and lymph node tissues of two horses (a mare and its foal) from Italy that succumbed to an acute respiratory syndrome. The genome sequences of Alphamesonivirus-1 obtained from the two horses were closely related to each other and to those from a local Culex mosquito pool and an Alphamesonivirus-1 previously identified in Italy, indicative of ongoing local transmission. The discovery of Alphamesonivirus-1 in horse tissues prompts further investigation into the host range of mesoniviruses, the possible role of insect-specific viruses in mammalian disease processes, the determinants of and barriers to cross-species virus transmission, and the potential epizootic threats posed by understudied viral families., Importance: Alphamesoniviruses, members of the family Mesoniviridaeare, are considered insect-specific RNA viruses with no known association with vertebrate hosts. Herein, we report the identification of Alphamesonivirus-1 in mammals. Using detailed molecular and histological analyses, we identified Alphamesonivirus-1 in lung and lymph node tissues of two horses that presented with an acute respiratory syndrome and that was phylogenetically related to virus sequences found in local Culex mosquitoes. Hence, Alphamesoniviruses may possess a broader host range than previously believed, prompting the investigation of their possible role in mammalian disease. This work highlights the need for increased surveillance of atypical viruses in association with unexplained respiratory illness, including those commonly assumed to be insect-specific, and may have implications for epizootic disease emergence.

This qualitative research study explores stakeholders' perspectives on the challenges of implementing Namibia's National School Health Policy (NSHP) in schools. The interview guide used for this study was specifically developed to address the research objectives and themes. A total of 20 stakeholders participated, including educators, nurses, principals, and health program administrators from three regions in Namibia. The study identifies significant barriers to effectively implementing the school health policy. These barriers include staffing shortages, inadequate resources, limited learner awareness of health rights, and insufficient teacher well-being. Additional challenges involve resource constraints, a lack of monitoring and evaluation, and limited coordination between the education and health sectors. The thematic analysis reveals recurring patterns and emphasizes the need for increased resource allocation, comprehensive training, collaborative policy development, and initiatives to improve teacher well-being. These findings provide valuable insights for refining future implementation strategies for school health programs in Namibia, highlighting the importance of strong leadership, stakeholder involvement, and adequate funding to support the goals of the NSHP., Competing Interests: Declarations. Ethics approval and consent to paricipate: The study was carried out by the Declaration of Helsinki and Ethics approval was secured from the University of South Africa Ethical Committee, Ministry of Education, Sport and Culture, and Namibia Ministry of Health and Social Services Research Ethics Committees. All participants provided voluntary informed consent before engaging in the research. The study's objectives, the nature of voluntary participation, and the measures implemented to ensure confidentiality were communicated to all participants. Consent for publication: All participants provided their written consent to include anonymized quotes from their interviews in published materials. It should be emphasized that no personal or identifiable information has been incorporated into any of the publications. Competing interests: The authors declare no competing interests., (© 2025. The Author(s).)

The assessment of research performance is widely seen as a vital tool in upholding the highest standards of quality, with selection and competition believed to drive progress. Academic institutions need to take critical decisions on hiring and promotion, while facing external pressure by also being subject to research assessment 1-4 . Here we present an outlook on research assessment for career progression with specific focus on promotion to full professorship, based on 314 policies from 190 academic institutions and 218 policies from 58 government agencies, covering 32 countries in the Global North and 89 countries in the Global South. We investigated how frequently various promotion criteria are mentioned and carried out a statistical analysis to infer commonalities and differences across policies. Although quantitative methods of assessment remain popular, in agreement with what is found in more geographically restricted studies 5-9 , they are not omnipresent. We find differences between the Global North and the Global South as well as between institutional and national policies, but less so between disciplines. A preference for bibliometric indicators is more marked in upper-middle-income countries. Although we see some variation, many promotion policies are based on the assumption of specific career paths that become normative rather than embracing diversity. In turn, this restricts opportunities for researchers. These results challenge current practice and have strategic implications for researchers, research managers and national governments., Competing Interests: Competing interests: The authors declare no competing interests., (© 2025. The Author(s).)

Groundnut (Arachis hypogaea L.) is a popular nutritious food crop in the world. In Namibia, groundnut varieties are limited and characterized by low yields of 0.4 t/ha. Its production is challenged by biotic and abiotic stresses and low genetic variability in the agroecological zones of Namibia. Gamma-irradiation mutagenesis is a technique applied to generate genetic variation based on the genotype's sensitivity to the mutagenic agent for the selection of traits of economic importance that fulfill the user's requirements. This study aimed to determine the optimal lethal doses (LD 50 ) of mutagens producing maximum mutations with minimum damage for mass gamma-irradiation on Namibian landraces of groundnut in preparation for mutation breeding programs. Seeds of three groundnut varieties ('NAM 4433', 'NAM 888/2', 'NAM 1747/1') were subjected to six gamma radiation doses [0, 50, 75, 100, 125, and 150 Gy (Gy)]. The radiation source was Cobalt-60, with an irradiation rate of 28.81 Gy/min. Irradiated and non-irradiated (control) seeds were sown in plastic pots, using a factorial experiment with a randomized complete block design. Data were collected on parameters relating to seed germination, seedling growth, and plant survival of the varieties. A linear regression model was developed to determine the mean lethal dose (LD 50 ) and reduction dose (RD 50 ) of the varieties. Combined analysis of variance showed significant responses (p < 0.001) to seedling emergence, shoot, and root traits. Genotype NAM 4433 was most sensitive to gamma radiation doses ranging from 106 to 150 Gy. The doses could be used in mutation breeding programs to select mutants with desirable agronomic and nutritional traits for farmers and consumers. Genotypes NAM 1747/1 and NAM 888/2 did not respond to the doses applied. Further research using high radiation doses for NAM 1747/1 and NAM 888/2 is recommended., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2025 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Introduction: Congenital colour vision deficiency (CVD), known as colour blindness, is a common visual problem affecting around 1 in 12 men and 1 in 200 women. It is known that people who have red-green CVD, the most common phenotype, can have difficulty differentiating colours and this can impact the ability to perform clinical tasks related to patient care. The objective of this scoping review is to understand the extent and type of evidence and the impact on clinical practice and patient safety arising from congenital CVD in healthcare professionals., Methods and Analysis: The scoping review will follow the methodological framework outlined by the Joanna Briggs Institute and by Arksey and O'Malley and we will adhere to the Preferred Reporting Items for Systematic reviews and Meta-Analyses Scoping Reviews checklist. The following databases will be searched: PubMed, MEDLINE, Web of Science, Scopus, Lens.org and the Trip medical database (filtered for low-income countries) with no limit on earliest date and up to 30 November 2024. Grey literature will be identified by planned searches in the Overton Index. All articles related to 'CVD in healthcare professionals in clinical practice or in training' will be included. The study will also include other professionals who may be involved in healthcare but are not involved in direct patient-facing activities. It will be limited to congenital CVD and will exclude the impact of visual impairment and acquired CVD.There will be an initial search to validate the search strategy. Titles and abstracts will be screened to determine eligibility, and the full text will be reviewed using a data extraction framework. Data will be extracted, collated and then mapped and summarised to present the relevant key findings and outcomes from the papers in tabular and visualised form with a narrative synthesis., Ethics and Dissemination: The scoping review does not need ethical approval and will provide an overview of the impact of congenital CVD on clinical practice and patient safety. This will determine the future need and direction of research in this area and identify methodological challenges and opportunities. The results will be published open access in a peer-reviewed journal., Registration: INPLASY (DOI: 10.37766/inplasy2024.11.0099)., Competing Interests: Competing interests: EL is colour vision deficient, known to have protanopia, and is a fully licensed medical practitioner in the UK. AT, AK and QW have no conflict of interest in this project and are not colour vision deficient., (© Author(s) (or their employer(s)) 2025. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ Group.)

Sub-Saharan Africa continues to bear a disproportionate burden of the global HIV epidemic. Integrating HIV services into primary healthcare is a crucial strategy to accelerate progress towards ending the epidemic. However, several challenges hinder effective integration, including underfunding, human resource shortages, infrastructure limitations, weak health systems, and sociocultural factors. With this perspective, we discuss strategies to address these challenges. A comprehensive, multi-faceted approach is necessary to overcome these barriers. Investing in human resources, improving infrastructure, and strengthening health information systems are essential for strengthening the health system. Implementing patient-centered care, integrated service delivery models, and community engagement can optimize service delivery. Utilizing digital health tools, such as mobile health applications and electronic health records, can enhance service delivery and data management. Mobilizing for an increase in domestic resources, aligning donor funding, and using cost-effective approaches are crucial for effective financing. Finally, robust monitoring and evaluation systems are necessary to track progress, identify challenges, and inform decision-making. With these strategies, among many others, sub-Saharan African countries can significantly improve the integration of HIV services into primary healthcare, leading to better health outcomes for people living with HIV and more sustainable HIV programs.

It is observed that the global burden of diseases had shifted from infectious diseases to Non-Communicable Diseases (NCDs), with an accumulative trend in developing countries. NCDs share key modifiable behavioral risk factors like unhealthy diet and lack of physical activity that are typically established during adolescence or young adulthood and will set the stage for NCDs development later in life. Therefore, this paper aimed to explore factors contributing to the co-occurrence of risk factors for NCDs among persons aged 30 years and above in selected urban areas of Namibia. Specifically, the paper focused on examining the social, economic and behavior characteristics of people living with NCDs and how they contribute to the relative risk of the co-occurrence of NCDs. The study is based on secondary data and analysis is based on a total sample of 1527 which was successfully interviewed. The dependent variable was co-occurrence of NCD risk factors per respondent with the following groups: No co-occurrence, at most two risk factors, 3-4 risk factors, and 5-6 risk factors. The risk factors included excessive alcohol consumption, smoking of tobacco, insufficient physical activeness, insufficient intake of fruits, and insufficient intake of vegetable and unhealthy dietary pattern. Descriptive statistics were obtained using frequencies and averages. Pearson Chi-square was used to assess the association between co-occurrence of risk factors and socio-economic and behavioural variables using cross-tabulation. A multinomial regression model was also used to predict the effects of factors contributing to the co-occurrence of risk factors. The significance of variables was tested using 5% level. The results showed that overall, co-occurrence of risks was more prevalent among respondents with HBP than those with diabetes or HRD. Notably, age and education level positively contribute to co-occurrence of risk factors of NCDs. Increased co-occurrence of risks was also relatively high among respondents with NCD who did not take medication and those who did not go for follow up. The paper concluded that taking medication, regular check-up and following healthy diet significantly reduce the risk of co-occurrence of NCD risk factors. The study recommends for infrastructural developments in urban areas that promotes health lifestyles including provision for cycling, walking paths and participation in urban agriculture., Competing Interests: Declarations. Ethics approval and consent to participate: Since the research involved secondary data analysis and exclusively utilized anonymized data, the University of Namibia MRS Decentralised Ethics Committee granted a waiver of ethics approval and informed consent. Data was analysed in accordance with ethical principles of the Declaration of Helsinki. The research did not interact with respondents, however all individuals who participated in the initial study were initially informed about the study purpose and consented to participate. The data used were available with no personal identifier. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests., (© 2025. The Author(s).)

Crimean-Congo haemorrhagic fever (CCHF) is a viral zoonotic disease endemic to regions of Africa, the Balkans, the Middle East, and Asia, with increasing reports of cases in southern Europe. Human transmission occurs primarily through the bite of infected ticks and by body fluids from infected human. Crimean-Congo haemorrhagic fever virus (CCHFV) affects a broad host range, including both domestic and wild vertebrates. Recent studies have suggested a potential susceptibility of companion animals, posing an additional threat to public health. In the present study, the presence of CCHFV antibodies was evaluated by screening 374 dog and 238 cat serum samples collected from eight Namibian regions using a commercial enzyme-linked immunosorbent assay. Overall, dogs (11.50 %) showed significantly higher odds of seropositivity (OR = 7.60; 95 % CI = 3.02 - 25.51; p-value < 0.001) compared to cats (1.68 %). Most of the positive dogs and all positive cats originated from the Kunene and Hardap regions. No other factors were found to affect seroprevalence. The limited development of farming systems in these regions, combined with the higher roaming activity of dogs, may suggest a greater exposure risk to wild animals or infected ticks. Tick species of the genus Hyalomma are not commonly reported to infest dogs in Namibia, and other tick species may also be involved in transmission. The detection of CCHFV antibodies in dogs and cats in Namibia should be considered by public health authorities as a potential threat, warranting further investigation to identify infection sources and risk factors. While the level and duration of viremia in companion animals, as well as their actual infectivity, remain unknown, efforts should focus on reducing contact between domestic pets, livestock, and wild animals, as well as regular prophylactic tick treatment of pets to prevent or minimise tick infestations., Competing Interests: Declaration of competing interest The authors declare no competing interests., (Copyright © 2025. Published by Elsevier B.V.)

Background and Aim: Data are scarce regarding Wolf-Parkinson White Syndrome (WPW) syndrome and asymptomatic pre-excitation in Africa. This study tried to understand the current approaches utilized in Africa for the diagnosis and management of both symptomatic and asymptomatic ventricular pre-excitation., Methods: The current prospective study was conducted in 20 centers located in 17 countries spanning all areas of Africa. Participants included had ventricular pre-excitation patterns. The data collected included symptoms, locations of accessory pathways (AP) and tachyarrhythmia, risk stratification, as well as acute and long-term management. In addition, we assessed the clinical effectiveness of the centers and the impact of socioeconomic and health metrics on these treatment approaches., Results: Among 541 participants, 93% were diagnosed with WPW syndrome, with orthodromic atrioventricular reciprocating tachycardia (AVRT) being the most prevalent arrhythmia, affecting 55% of the cases. Approximately 30% of patients in Africa, except for the southern region, received intravenous amiodarone as the first-choice drug for orthodromic AVRT while adenosine was the drug of choice in the Southern region. Electrical cardioversion was the first-line treatment for pre-excited atrial fibrillation and antidromic AVRT across all of Africa. Radiofrequency ablation (RF) was the first long-term therapy option for 88% of patients in all African regions, unlike western and central Africa where it was implemented for less than 30% of patients (p < 0.001). The rates of RF success, long-term recurrence, and complications were 93%, 4.1%, and 3.8%, respectively., Conclusion: There are significant variations between African regions in terms of diagnostic workup, accessory pathway localizations, and volume of invasive treatment. Countries in Northern and Southern Africa are more advanced than other African countries in terms of modern management strategy. Additional government investments are necessary to enhance diagnostic likelihood and curative treatments as well as to reduce the gap between different regions in Africa., (© 2025 Wiley Periodicals LLC.)

Kenya is committed to achieving Universal Health Coverage (UHC) within its devolved health system in which significant investments have been made in health infrastructure, workforce development, and service delivery. Despite these efforts, the country faces considerable health workforce challenges. To address these, the Ministry of Health undertook a comprehensive Health Labour Market Analysis (HLMA) in 2022 to generate evidence supporting the development of responsive health workforce policies. This paper presents findings of a modelling exercise to understand the health labour market outlook. As part of a comprehensive HLMA, a validated needs-based health workforce modelling framework was applied to project the supply, needs, and investment requirements. Data was triangulated from multiple sources through desk reviews and group modelling by an expert technical working group constituted to undertake the study. The analysis considered disease burden, population growth, service delivery models, and health worker productivity, to assess the future health workforce needed. Kenya's health workforce is growing, with approximately 7,650 new workers added annually, resulting in an estimated 3.4% annual growth. By 2025, the health workforce is projected to reach 226,434, increasing to 263,700 by 2030. However, Kenya required a minimum of 254,220 health workers in 2021 to make substantial progress toward UHC. The cumulative need could rise to 476,278 by 2035. In 2021, Kenya had a needs-based shortage of nearly 60,000 health professionals, which could increase to 114,352 by 2030. The financial space for health workforce was estimated at US$2.29 billion in 2021 and is projected to rise to US$3.58 billion by 2030, but the required wage bill potentially reaching US$3.9 billion. Kenya must significantly increase investments in its health workforce to meet UHC goals. Both public and private sectors need to contribute more, with the public sector requiring a health workforce budget increase of 10.5% annually to bridge the projected funding gap., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2025 Asamani et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Competing Interests: DSI is a member of the PMI-supported Partnership for Antimalarial Resistance Monitoring in Africa Network (PARMA), the Genomic Epidemiology of Malaria Network (MalariaGEN), and the Pathogen Diversity Network Africa and is partly supported by the Bill & Melinda Gates Foundation (grant number INV 067322). RG reports support of salary from Unitaid as technical director of Plus Project, consulting fees from Population Services International and the University of California San Francisco, is a DSMB member of the mass R21 vaccine in Bangladesh for malaria elimination and multicentre study of ivermectin for scabies treatment (Mahidol Oxford Research Unit) and the TADORE dose finding study of tafenoquine for vivax malaria (Menzies University), and is the Director of the non-profit LEAD Ubuntu Global Foundation. PJR is a member of the World Health Organization Guideline Development Group for Malaria Chemotherapy. AD is the Chair of the Regional Steering Committee for the Regional Artemisinin-resistance Initiative from the Global Fund. KIB reports a grant paid to her institution from the European Union under the Global Health EDCTP3 Joint Undertaking (grant agreement no 101103076) as the Coordinator of Mitigating Antimalarial Resistance Consortium for SE-Africa (MARC SE-Africa). JC is the Executive Director of the SADC Malaria Elimination 8 Initiative. WFM and MRK are members of the PMI-supported Partnership for Antimalarial Resistance Monitoring in Africa Network (PARMA). DAF reports grants from the NIAID/NIH (R01 AI109023, R01 AI185559), and is a member of the Malaria Policy Advisory Group that advises to the Global Malaria Programme at the WHO. RK is the Chief Executive Officer of Navigo Partners, a consulting company currently conducting a review of ASEAN's 5 year health plan but with no engagement in the topic discussed in this Comment and was employed by the Global Fund before March, 2023. All other authors declare no competing interests. KIB coordinates the Mitigating Antimalarial Resistance Consortium in South-East Africa (MARC SE-Africa), funded by the EU under the Global Health EDCTP3 Joint Undertaking (grant agreement 101103076). The views and opinions expressed in this Comment are, however, those of the authors only and do not necessarily reflect those of the Global Health EDCTP3 Joint Undertaking nor its members; neither of the aforementioned parties can be held responsible for them. During the preparation of this Comment the authors used ChatGPT to reduce the character count in the title and the word count in the first paragraph. After using this tool/service, the authors reviewed and edited the content as needed and take full responsibility for the content of the publication.

Background: Despite Naja nigricincta nigricincta being responsible for most snake envenomation in remote Namibian regions, an effective intervention against its venom remains undiscovered. This study aimed to scientifically validate Namibian folklore claims about Senegalia mellifera extract's efficacy against snake envenomation., Methods: In vitro assays were conducted to assess the inhibitory potential of S. mellifera stem bark extract on snake venom phospholipase A2 (svPLA2) activity from N. n. nigricincta venom. Gas chromatography-mass spectrometry (GC-MS) and molecular docking predicted phytochemicals responsible for inhibitory effects on venom proteins., Results: The svPLA2 activity assay demonstrated significant inhibitory potential of the extract, reducing enzyme activity from 100% to as low as 66.99%. GC-MS analysis indicated an abundant presence of terpenes having antisnake venom activity. Molecular docking identified phytochemicals of S. mellifera capable of neutralizing prevalent cobra toxins, that is, stigmasterol acetate, beta-Sitosterol acetate, vitamin E, kaur-15-ene, squalene and 4,6-Cholestadien-3beta-ol., Conclusions: This plant extract cannot be considered as a discrete treatment against venom. It may serve as a transient remedy to impede the toxic effects or supplement the action of antivenoms. Future research should be aimed at finding other plants with greater antivenom potential to increase the prospect of using ethnobotanicals to manage snakebites in a cost-effective manner., (© The Author(s) 2024. Published by Oxford University Press on behalf of Royal Society of Tropical Medicine and Hygiene.)

Background: To assess population-based quality of cancer care in sub-Saharan Africa and to identify specific gaps and joint opportunities, we assessed concordance of diagnostics and treatments with National Comprehensive Cancer Network Harmonized Guidelines for leading cancer types in 10 countries., Methods: Adult patients with female breast cancer, cervical cancer, colorectal cancer, non-Hodgkin lymphoma, and prostate cancer were randomly drawn from 11 population-based cancer registries. Guideline concordance of diagnostics and treatment was assessed using clinical records. In a subcohort of 906 patients with potentially curable cancer (stage I-III breast cancer, cervical cancer, colorectal cancer, prostate cancer, aggressive non-Hodgkin lymphoma [any stage]) and documentation for more than 1 month after diagnosis, we estimated factors associated with guideline-concordant treatment or minor deviations., Results: Diagnostic information based on guidelines was complete for 1030 (31.7%) of a total of 3246 patients included. In the subcohort with curable cancer, guideline-concordant treatment was documented in 374 (41.3%, corresponding to 11.7% of 3246 patients included in the population-based cohort): aggressive non-Hodgkin lymphoma (59.8%/9.1% population based), breast cancer (54.5%/19.0%), prostate cancer (39.0%/6.1%), colorectal cancer (33.9%/9.5%), and cervical cancer (27.8%/11.6%). Guideline-concordant treatment was most frequent in Namibia (73.1% of the curable cancer subcohort/32.8% population based) and lowest in Kampala, Uganda (13.5%/3.1%). Guideline-concordant treatment was negatively associated with poor ECOG-ACRIN performance status, locally advanced disease stage, origin from low Human Development Index countries, and a diagnosis of colorectal cancer or cervical cancer., Conclusions: The quality of diagnostic workup and treatment showed major deficits, with considerable disparities among countries and cancer types. Improved diagnostic services are necessary to increase the share of curable cancer in sub-Saharan Africa. Treatment components within National Comprehensive Cancer Network Guidelines for several cancers should be prioritized., (© The Author(s) 2024. Published by Oxford University Press.)

Caring for newborn offspring hampers resource acquisition of mammalian females, curbing their ability to meet the high energy expenditure of early lactation. Newborns are particularly vulnerable, and, among the large herbivores, ungulates have evolved a continuum of neonatal antipredator tactics, ranging from immobile hider (such as roe deer fawns or impala calves) to highly mobile follower offspring (such as reindeer calves or chamois kids). How these tactics constrain female movements around parturition is unknown, particularly within the current context of increasing habitat fragmentation and earlier plant phenology caused by global warming. Here, using a comparative analysis across 54 populations of 23 species of large herbivores from 5 ungulate families (Bovidae, Cervidae, Equidae, Antilocapridae and Giraffidae), we show that mothers adjust their movements to variation in resource productivity and heterogeneity according to their offspring's neonatal tactic. Mothers with hider offspring are unable to exploit environments where the variability of resources occurs at a broad scale, which might alter resource allocation compared with mothers with follower offspring. Our findings reveal that the overlooked neonatal tactic plays a key role for predicting how species are coping with environmental variation., Competing Interests: Competing interests: The authors declare no competing interests., (© 2024. The Author(s), under exclusive licence to Springer Nature Limited.)

Background: The standard malaria rapid diagnostic test (RDT) and newer ultra-sensitive RDT (uRDT) target Plasmodium falciparum histidine rich protein-2 (HRP2), which persists post-treatment. The duration of test positivity has not previously been studied in a low transmission setting., Methods: We conducted a longitudinal cohort study in a low transmission setting in Namibia. RDT-positive individuals identified through passive and active case detection were treated and followed weekly for testing by RDT and uRDT, HRP2 quantification, quantitative PCR (qPCR) of parasitemia, and quantitative reverse transcriptase PCR (RT-PCR) of gametocytemia, until RDT and uRDT were negative for two consecutive weeks. Determinants of persistent positivity were identified using Cox proportional hazards models., Findings: Among 137 participants with complete follow-up and no evidence of resurgence during follow-up, median duration of positivity was 42 days (range: 3-98 range) for RDT, compared to 67 days (range 12-105) for uRDT. In a sub-analysis of those with laboratory data before treatment (n = 60), drug resistance did not explain persistent positivity. Younger age (<15 years versus ≥15 years: aHR: 1.85, 95% CI 1.04-3.30, and 1.67, 95% CI 0.96-2.89, for RDT and uRDT, respectively), higher initial parasite density (highest versus lowest tertile: aHR 0.11, 95% CI 0.04-0.32 and 0.19, 95% CI 0.07-0.48 for RDT and uRDT, respectively), and persistent parasitemia (≥7 days versus reference of <7 days, aHR 0.39, 95% CI 0.20-0.76, and 0.40, 95% CI 0.21-0.76 for RDT and uRDT, respectively) were associated with longer duration of positivity., Interpretation: Duration of RDT/uRDT positivity was more than double compared to reports from higher endemic settings, potentially due to lower population immunity to clear parasite DNA and antigen. Prolonged duration of positivity compromises their use to detect current infection, but increased detection of recent infection can facilitate surveillance and inform elimination efforts., Funding: The project was funded by the Bill and Melinda Gates Foundation (A128488 and INV1135840), Horchow Family Fund (5300375400), and Chan Zuckerberg Biohub., Competing Interests: Declaration of interests All authors declare no competing interests., (Copyright © 2024 The Authors. Published by Elsevier B.V. All rights reserved.)

Background: The actions required to achieve higher-quality and harmonised global surveillance of child and adolescent movement behaviours (physical activity, sedentary behaviour including screen time, sleep) are unclear., Objective: To identify how to improve surveillance of movement behaviours, from the perspective of experts., Methods: This Delphi Study involved 62 experts from the SUNRISE International Study of Movement Behaviours in the Early Years and Active Healthy Kids Global Alliance (AHKGA). Two survey rounds were used, with items categorised under: (1) funding, (2) capacity building, (3) methods, and (4) other issues (e.g., policymaker awareness of relevant WHO Guidelines and Strategies). Expert participants ranked 40 items on a five-point Likert scale from 'extremely' to 'not at all' important. Consensus was defined as > 70% rating of 'extremely' or 'very' important., Results: We received 62 responses to round 1 of the survey and 59 to round 2. There was consensus for most items. The two highest rated round 2 items in each category were the following; for funding (1) it was greater funding for surveillance and public funding of surveillance; for capacity building (2) it was increased human capacity for surveillance (e.g. knowledge, skills) and regional or global partnerships to support national surveillance; for methods (3) it was standard protocols for surveillance measures and improved measurement method for screen time; and for other issues (4) it was greater awareness of physical activity guidelines and strategies from WHO and greater awareness of the importance of surveillance for NCD prevention. We generally found no significant differences in priorities between low-middle-income (n = 29) and high-income countries (n = 30) or between SUNRISE (n = 20), AHKGA (n = 26) or both (n = 13) initiatives. There was a lack of agreement on using private funding for surveillance or surveillance research., Conclusions: This study provides a prioritised and international consensus list of actions required to improve surveillance of movement behaviours in children and adolescents globally., Competing Interests: Declarations. Author Contributions: J.J.R. and S.A. were responsible for the original concept and study design. Original concept/ design/ methods were developed by the study leadership group (J.J.R., S.A., C.A., R.A., J.Y.C., R.L., S.K.L., N.M., A.D.O., C.T., M.T., D.A.W.). The replies from all the participants in the first round of the Delphi determined the content and format of the second round of the survey. J.J.R. and R.A. led the analysis and take responsibility for the integrity of the data. J.J.R. and S.A. drafted the manuscript. All authors: completed both rounds of the Delphi survey, reviewed and contributed significantly to the editing and critical reviewing of the manuscript, contributed significantly to interpretation of results, stated their formal approval of the manuscript, and stated their formal agreement to be accountable for all aspects of the work. All authors met al ICMJE authorship criteria. Funding: This study had no specific funding. Reilly and Andrew were funded by the Scottish Funding Council at the time the study was carried out. Conflicts of Interest: The authors have no conflicts of interest to declare. Availability of Data: The anonymised data from survey rounds 1 and 2 are available from the corresponding author upon reasonable request. Consent for Publication: Not applicable. Consent to Participate: All participants gave electronic informed written consent and were aware that participation was voluntary, and they could withdraw at any point during the survey without any consequences. Ethics Approval: The study was approved by the University of Strathclyde, Glasgow Scotland, School of Psychological Sciences and Health Research Ethics Committee (reference 03.05.10.2022)., (© 2024. The Author(s).)

Campaigns to scale up Voluntary Medical Male Circumcision (VMMC) for the prevention of HIV transmission has been going on for years in selected Southern African countries, following recommendations from the World Health Organisations. Despite significant strides made in the initiative and its proven benefits, controversies surrounding the strategy have never ceased, and its future remains uncertain especially as some countries near their initial targets. Over the years, as the campaigns unfolded, a lot of insights have been generated in favour of continuing the VMMC campaigns, although some insights portray the impression that the strategy is not worthy of the risks and effort required, or that enough has been done, as the targets have now been achieved. This article proposes a scoping review that aims at synthesizing and consolidating that evidence into a baseline for a further systematic review aimed at developing sound recommendations for the future of the VMMC strategy for HIV prevention. The scoping review will target all scientific literature published on the Web of Science, Cochrane Library, Scopus, Science Direct, PubMed as well as grey literature from Google Scholar and WHO Institutional Repository for Information Sharing (IRIS) from the inception of the campaigns. The review shall be guided by Arksey and O'Malley's (2005) framework for scoping reviews, and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR) checklist shall be followed. Discussion of the findings is envisioned to yield evidence that can be further analysed to give insights about risk/cost-benefits ratios of the strategy at this point in time as well as best clinical practices for the VMMC procedure, to inform the future of the strategy. This protocol is registered with the Open Science Framework, registration ID https://doi.org/10.17605/OSF.IO/SFZC9., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2024 Maibvise et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Background: Infectious disease agents pose significant threats to humans, wildlife, and livestock, with rodents carrying a third of these agents, many linked to human diseases. However, the range of pathogens in rodents and the hotspots for disease remain poorly understood., Aim: This study evaluated the prevalence of viral, bacterial, and parasitic pathogens in Mastomys natalensis rodents in riverine and non-riverine areas in selected districts in Zambia., Methods: The study applied metagenomic next generation sequencing (mNGS). Tissues analysed included semen, foetal tissues, and blood-rich organs (liver, spleen, kidneys, and lungs). A multivariate logistic regression model explored the relationship between pathogen presence and host or ecological factors., Results: A total of 182 rodents were captured, and 14 pathogens were detected in 10.4% of the samples (19/182). Detected organisms included zoonoses ( Klebsiella michiganensis , Klebsiella pneumoniae , Salmonella enterica , and Bartonella elizabethae ); Emerging zoonoses ( Elizabethkingia miricola , Klebsiella variicola , Bartonella tribocorum, and Cardiovirus B); among others ( Eimeria papillata etc). Riverine areas showed higher odds of pathogen presence (OR = 8.45; p < 0.001; 95% CI: 3.07-23.26)., Conclusion: These results suggest that M. natalensis harbours multiple infectious agents with zoonotic potential, and riverine regions may be key hotspots for rodent-borne pathogens in Zambia., Competing Interests: No potential conflict of interest was reported by the author(s)., (© 2024 The Author(s). Published by Informa UK Limited, trading as Taylor & Francis Group.)

Introduction: Clinical training is crucial for diagnostic radiography students, bridging theoretical knowledge with practical skills. In resource-constrained settings, this training may face unique challenges that might significantly impact learning outcomes and future practice. Despite its importance, the experiences of diagnostic radiography students during clinical placements remain understudied, particularly in Sub-Saharan Africa. This study aimed to explore and describe the experiences of diagnostic radiography students during clinical training at two resource-constrained Sub-Saharan public hospitals., Methods: A qualitative phenomenological study was conducted using face-to-face, semi-structured interviews with 18 diagnostic radiography students (six each from years 2 to 4) from one participating university. Interviews were audio-recorded, transcribed and analysed using thematic analysis. Trustworthiness was ensured through prolonged engagement, member checking, and researchers' reflexivity. Ethical approval was obtained before data collection commenced., Results: Three main themes were generated: (1) Clinical Environment Challenges, including equipment shortages and understaffing; (2) Independent Learning and Development, highlighting students' resilience and self-directed learning; and (3) Patient Care Impact, demonstrating students' commitment to quality care despite constraints. Students reported increased confidence and adaptability but also noted negative interactions with healthcare workers and supervision inconsistencies., Conclusions: Despite significant challenges, diagnostic radiography students demonstrated remarkable resilience and commitment to patient care. However, resource limitations and interprofessional issues pose substantial barriers to optimal learning experiences. These findings highlighted the need for targeted interventions in diagnostic radiography education within resource-constrained settings, including increased investment in equipment and staffing, enhanced interprofessional education, improved supervision models and curriculum enhancements fostering self-directed learning and resilience., (© 2024 The Author(s). Journal of Medical Radiation Sciences published by John Wiley & Sons Australia, Ltd on behalf of Australian Society of Medical Imaging and Radiation Therapy and New Zealand Institute of Medical Radiation Technology.)

Background: The use of medical abortion using either a combination of mifepristone and misoprostol, or misoprostol alone has contributed to increased safety and decreased mortality and morbidity. The availability of quality medical abortion medicines is an essential component in the provision of quality abortion care. Understanding the factors that influence the availability of medical abortion medicines is important to help in-country policymakers, program planners, and providers improve availability and use of medical abortion., Methods: Using a national assessment protocol and an availability framework, we assessed the availability of medical abortion medicines across five elements (Registration & Quality Assurance, Policy & Financing, Procurement & Distribution, Provider Knowledge, and End-user Knowledge) in eight countries: Botswana, Burkina Faso, Central African Republic, Democratic Republic of the Congo, Eswatini, Lesotho, Namibia and Uganda between November 2020 and November 2021. The assessment included an online desk review and virtual or telephone-based key informant interviews., Results: Registration of medical abortion medicines-misoprostol or co-packaged mifepristone and misoprostol products (combi-pack)-was established in all countries, except the Central African Republic. In Lesotho and Eswatini, the national regulatory agency is still in development and importation of Cytotec™ misoprostol is permitted for off-label use in obstetrics/gynecology. Misoprostol was included in all countries' essential medicines lists, except Botswana. Burkina Faso and Democratic Republic of the Congo also include mifepristone on their essential medicines list and medical abortion regimens in national abortion care service and delivery guidelines. Additionally, guidelines clarified health worker roles in the provision of abortion care specific to the legal context of each country and permitted task-shifting of abortion service provision. Where guidelines did not exist, medical abortion medicines and their use were not well integrated into the public health care system. Community awareness activities on abortion rights and services have been limited in scope across the countries assessed, however, end-users' awareness of misoprostol as a medical abortion medicine was reported., Conclusion: The national landscape assessments identified several cross-cutting opportunities to improve availability of medical abortion medicines, including importing quality-assured medical abortion medicines; developing nationally approved abortion service and delivery guidelines that optimize healthcare worker roles; and expanding communication strategies to reach end-users and pharmacists., Competing Interests: Declarations. Ethics approval and consent to participate: Ethics approval was conferred by the Research and Ethics Committee in Lesotho (Ref: ID 2021-29) on 13 June 2021 and a waiver conferred by the Ministry of the Health and Social Services, Research Management Committee off ice of the Executive Director in Namibia (Ref: 17/3/3/SJ) on 12 May 2021. Ethics approval was not applicable in the other country assessments as the ministries of health led and deemed them programme assessments. The information collected during the desk review is public available data and the key informants all participated within their official capacity and were selected by the ministries of health. Verbal informed consent to participate in the assessment was obtained from all participants. Consent for publication: Consent was sought from the Research Management Committee (RMC) of the Ministry of Health and Social Services (MoHSS) in Namibia, as requested in the approval for publication of the report: Landscape assessment on availability of Co-package mifepristone-misoprostol (Combipack) letter from the MoHSS, to publish the manuscript in a peer review journal. No other consent was needed. Disclaimer: The views expressed in this article are those of the authors and do not necessarily represent the views of, and should not be attributed to, the World Health Organization. The mention of specific companies or of certain manufacturers’ products does not imply that they are endorsed or recommended by WHO in preference to others of a similar nature that are not mentioned. Errors and omissions excepted the names of proprietary products are distinguished by initial capital letters. Competing interests: The authors declare that they have no competing interests., (© 2024. World Health Organization.)

Geography is a well-known factor shaping genetic variation in human populations. However, the potential role played by cultural variables remains much understudied. This study investigates the impact of socio-cultural variables on genomic similarity and the saliva microbiome, using data from populations in Lesotho and Namibia. Geographic distance within Lesotho increases genetic differentiation, while shared clan affiliation surprisingly increases it. In Namibia, ethnicity is the predominant factor influencing genetic affinity. Saliva metagenomic data shows a negative correlation between age and alpha diversity, with notable differences in host-interacting taxa and viral load. These findings highlight the role of geography in shaping genetic affinity even at small scales and the complex influences of cultural factors. The saliva microbiome appears primarily affected by unrecorded individual behaviors rather than geographic or cultural variables. At population-level these oral microbiomes reveal insights into some dietary habits, oral health, and also the communal viral load, which appears to have greater incidence in Lesotho possibly related to the long-term effects of the HIV epidemic in the country.

This systematic review evaluated the effectiveness of community-wide screening for pulmonary tuberculosis (TB) in high-burden areas by analysing randomised controlled trials (RCTs). The review focused on interventions offering TB screening to entire communities, comparing them to standard care or alternative approaches. The main outcome assessed was microbiologically confirmed TB diagnoses, including rates and prevalence. We searched MEDLINE, Embase, Cochrane Central Register of Controlled Trials, WHO Global Index Medicus, Web of Science, and trial registries up to 27 May 2024, without language restrictions. Screening, data extraction, and risk of bias assessment were done in duplicate. Results were not pooled. Certainty of the evidence was assessed using GRADE. PROSPERO: CRD42023453356. We included six cluster-RCTs after screening 2460 titles/abstracts and 86 full-text articles. The evidence for symptom screening was very uncertain. We found that sputum smear microscopy screening may result in little to no difference in the prevalence of culture-confirmed TB (n = 962,655, RR 1.09; 95% CI: 0.86-1.38, 1 RCT, low certainty evidence). Community-wide nucleic acid amplification test (NAAT) screening probably reduces the prevalence of NAAT-positive TB (n = 105,108, RR 0.56; 95% CI: 0.40-0.78, 1 RCT, moderate certainty evidence). Community-wide screening for pulmonary TB may reduce TB prevalence if done annually with an accurate screening test and high coverage., Competing Interests: All authors declare no competing interests., (© 2024 The Authors.)

The genus Alphavirus harbors arboviruses of great concern, such as the Chikungunya virus and the equine encephalitis viruses. Transmission of pathogenic alphaviruses by mosquitoes could be influenced by insect-specific alphaviruses such as Eilat virus (EILV). However, insect-specific alphaviruses are rarely found in wild mosquitoes and only a few have been described in the literature. Here, we report the detection of EILV in a Culex univittatus mosquito from the north-eastern Namibian Zambezi region. Full genome analysis of MP458-NA-2018 showed 94.5% nucleotide identity to an EILV isolate from Israel. MP458-NA-2018 grouped with EILV in phylogenetic analysis and was placed within the clade of insect-specific alphaviruses. The virus was isolated in mosquito cells and shown to be restricted to insects as hosts by the inability to infect different vertebrate cell lines and a complete block of virus replication at 34°C. We further showed that infection of cells with EILV MP458-NA-2018 reduced production of infectious particles of Sindbis virus by 2000-fold over the entire course of infection, whereas reduction rates of Bagaza and Middleburg virus were approximately 3-10-fold and dependent on time after infection. While production of infectious particles of cells superinfected with the Chikungunya virus were approximately 30-fold reduced and more pronounced at a lower multiplicity of infection of 0.01, EILV seemed to enhance production of West Nile virus infectious particles by >5-fold when superinfected at a multiplicitiy of infection of 0.1. In summary, EILV from the Namibian Zambezi region influences in vitro replication of endemic flavi- and alphaviruses., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2024 Guggemos et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Giraffe (Giraffa spp.) are among the most unique extant mammals in terms of anatomy, phylogeny, and ecology. However, aspects of their evolution, ontogeny, and taxonomy are unresolved, retaining lingering questions that are pivotal for their conservation. We assembled the largest known dataset of Giraffa skulls (n = 515) to investigate patterns of cranial variability using 3D geometric morphometrics. The results show distinct sexual dimorphism and divergent ontogenetic trajectories of skull shape for the north clade (G. camelopardalis antiquorum, G. c. camelopardalis, G. c. peralta, and G. reticulata) and the south clade (G. giraffa angolensis, G. g. giraffa, G. tippelskirchi tippelskirchi, and G. t. thornicrofti) which was further supported statistically. Discriminant functions found statistically significant cranial shape differences between all four Giraffa species, and in some cases also between subspecies of the same species. Our 3D morphometric analysis shows that the four genetically distinct Giraffa spp. also have distinct cranial morphologies, largely addressable to features of display (ossicones). Our results highlight the importance of focusing future giraffe conservation efforts on each taxon to maintain their unique characteristics and biodiversity in the wild., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2024 Kargopoulos et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Introduction: Brucellosis and Rift Valley fever (RVF) are neglected zoonotic diseases (NZD) that threaten public health, animal health, and production in resource-limited countries including Namibia., Methods: The objective of this cross-sectional study was to determine Brucella spp. and RVFV seroprevalence in cattle at the wildlife-livestock interface in the Kabbe South constituency (Zambezi region) of Namibia. Cattle sera ( n = 371) were randomly collected from 18 cattle herds in six constituency areas and tested for antibodies against Brucella [complement fixation test (CFT) and indirect enzyme-linked immunosorbent (ELISA) assay in parallel] and Rift Valley fever virus (competitive ELISA)., Results: Apparent individual animal prevalence for Brucella spp. was 5.9% (95% CI: 3.95%-8.81%, 22/371) and 20.8% (95% CI: 16.9%-25.2%, 77/371) based on the CFT and I-ELISA, respectively. For RVFV, apparent and true animal prevalence were 41.0% (95% CI: 36.1%-46.0%, 152/371) and 47.6% (95% CI: 41.8%-53.6%), respectively. Animal and true prevalence of Brucella spp. based on the CFT and ELISA in parallel were 22.6% (95% CI: 18.7%-27.2%, 84/371) and 19.7% (95% CI: 15.6%-24.4%), respectively. About 10.8% (40/371) of cattle tested positive for both Brucella spp. and RVFV antibodies. Prevalence of Brucella -positive cattle herds was 83.3% (15/18). Within herd Brucella spp. seroprevalence was 0%-70%. All cattle herds tested positive for RVFV, with prevalence of 1.7% to 70%. Binomial logistic regression revealed that sex was a significant predictor ( p < 0.05) for RVFV seropositivity, but not for Brucella spp. seropositivity ( p > 0.05). Test agreement between CFT and I-ELISA when used for the detection of anti- Brucella antibodies was poor (k = 0.2322)., Discussion: Brucella spp. and RVFV infections were prevalent in communal pastoral cattle at the human-wildlife-livestock interface in the Zambezi region suggesting a higher likelihood of occurrence of reproduction losses in cattle and zoonotic disease in humans. We recommend the enforcement of the requirements for the vaccination of heifers against brucellosis in the affected communal areas to reduce the risk of human infection. The use of One Health principles for the surveillance, prevention and control of Brucella spp. and RVFV infections can promote the effective control of these zoonotic infections at the interface., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. The author(s) declared that they were an editorial board member of Frontiers, at the time of submission. This had no impact on the peer review process and the final decision., (Copyright © 2024 Madzingira, Munzel, Simasiku, Lucas, Mwenda, Chinyoka, Tjipura-Zaire, Shilongo, Borgemeister, Khaiseb, Chitanga and Junglen.)

Background: Clear communication during informed consent is crucial in paediatric computed tomography (CT) procedures, particularly in resource-constrained settings. CT offers valuable diagnostic information but carries potential radiation risks, especially for paediatric patients. Parents play a critical role in decision-making, necessitating thorough risk-benefit discussions. This study aimed to explore parental experiences regarding risk-benefit communication during their children's CT scans in under-resourced healthcare facilities., Methods: A qualitative approach with a descriptive design was employed. Semi-structured interviews were conducted with 13 purposefully selected and consenting parents accompanying paediatric patients for CT scans at two public hospitals. Data were analysed using Tesch's eight-step method and ATLAS.ti software., Results: Participants were parents of children aged 0-10 years (8 males, 5 females), with 11 making their first visit to the CT department. Three main themes emerged: (1) Compromised consenting process, characterised by inadequate explanation of consent and limited risk-benefit communication; (2) Procedural information deficiency, including minimal communication about the procedure and lack of information on examination results; and (3) Preference for improved communication, with parents expressing a desire for comprehensive information and varied opinions on who should disseminate this information. Parents reported feeling uninformed, anxious, and unable to make well-informed decisions due to communication gaps., Conclusions: Significant improvements are needed in risk-benefit communication during paediatric CT scans. Healthcare providers should use simplified language, visual aids, and patient-centred discussions to enhance understanding and reduce parental anxiety. Radiographers should allocate sufficient time for discussions, involve referring physicians when necessary, and document the informed consent process thoroughly. Addressing these issues can improve patient experiences and contribute to positive health outcomes in resource-constrained settings., (Copyright © 2024. Published by Elsevier Inc.)

Purpose: In Sub-Saharan Africa (SSA), breast cancer survivors' (BCS) quality of life (QoL) remains understudied. We compared QoL in BCS to cancer-free (CF) women across SSA settings with different levels of development, healthcare systems, ethnic compositions, and HIV prevalence., Methods: In 2022-2023, all 5 + year BCS from the African Breast Cancer-Disparities in Outcomes study and age-matched CF women from the community setting answered the WHOQOL-BREF questionnaire in Namibia, Nigeria, and Uganda. For each WHOQOL-BREF domain and general item, we estimated BCS-CF adjusted mean differences (AMD) in scores in absolute percentage points (p.p.)., Results: Overall, 862 women (BCS 357 vs. CF 505) (mean age ± SD, 57.5 ± 12.5 vs. 55.1 ± 11.2; tertiary education, 30% vs. 20%) were included. BCS reported higher/better overall QoL (AMD (95% CI) 10.65 p.p. (7.56, 13.74), i.e., ~ 40% of a change in QoL category), general health (5.84 (2.71, 8.98)), psychological (3.46 (1.43, 5.49)), social relationships (3.94 (1.25, 6.63)), and environment scores (4.27 (1.88, 6.67)) than CF women. There was no BCS-CF difference for physical health in all settings (1.52 (- 0.82, 3.87)), psychological health in Namibian Black women (0.58 (- 2.90, 4.06)), and social relationships in Nigeria (- 0.33 (- 5.81, 5.14)). BCS reported both lower energy and sexual life satisfaction than CF women., Conclusions: In SSA, long-term BCS have slightly better QoL than CF women except for physical health. Areas for which BCS scored lower or similar than CF women may indicate BCS' QoL issues., Implications for Cancer Survivors: BCS-only studies using cancer-specific QoL questionnaires are needed to better characterize BCS' QoL in SSA., Competing Interests: Declarations. Ethics approval: The study was approved by all local and institutional ethics committees [21]. Consent to participate: Informed consent was obtained from all individual participants included in the study. Conflict of interest: The authors declare no competing interests. Disclaimers: Where authors are identified as personnel of the International Agency for Research on Cancer/World Health Organization, the authors alone are responsible for the views expressed in this article and they do not necessarily represent the decisions, policy, or views of the International Agency for Research on Cancer/World Health Organization. Research reported in this publication was supported by the National Cancer Institute of the National Institutes of Health under Award Number R01CA244559. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health., (© 2024. The Author(s).)

Introduction: Globally, health care organizations need to provide quality, culturally congruent health care to increasingly diverse patients. Nursing education institutions must therefore produce culturally competent nursing professionals to provide safe and culturally congruent care. This review aimed to identify and outline strategies to enhance cultural competence of undergraduate nursing students., Methodology: The integrative literature review followed the five steps of Lubbe et al. searching the university Libguides, EBSCOhost, Scopus, and Google Scholar databases for literature published between 2014 and 2023 that met the inclusion criteria. The methodological quality was ensured through the John Hopkins Evidence-based Appraisal Tool., Results: Five themes emerged as strategies that can enhance cultural competence for nursing students: integrating cultural competence into undergraduate nursing curriculum, cultural immersion, innovative pedagogical approaches, role of nurse educators, and students' assessment., Conclusion: Findings provide nurse educators with evidence-based information on strategies to enhance cultural competence of undergraduate nursing students at nursing education institutions., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Hypertension is a serious health concern, especially in developing countries, and assessing people's knowledge, attitudes, and practices (KAP) is important for its awareness and management. This cross-sectional study aimed to assess the KAP on hypertension among students and staff from the Health Sciences and Veterinary Medicine Faculty of the University of Namibia. A cross-sectional study design was conducted on adult participants who completed the KAP questionnaire while resting, and thereafter their blood pressure (BP) was measured. This study was conducted in September 2023. The sample comprised 99 participants (77 females and 22 males) aged 18 to 64 years. The majority (94%) of the participants had normal BP (≥140/90 mm Hg). The systolic BP of females (113.13 ± 13.70 mm Hg) was significantly lower (P = .011) than that of males (121.64 ± 13 mm Hg); however, there was no significant difference in diastolic BP between the 2 genders (73.58 ± 9.37 for females and 75.95 ± 10.55 for males; P = .311). Approximately 85% of the participants demonstrated a good understanding of the risk factors associated with hypertension. About 91% of the participants believed that hypertension is a serious health problem and were willing to change their daily routine to better manage their hypertension. Only approximately 39% of the participants regularly monitored their BP. Just above 50% of the participants regularly engaged in physical activities and made dietary modifications to maintain a healthy heart. It is important to host regular hypertension campaigns among health science personnel, as this would help refresh and improve their KAP in prevention and management., Competing Interests: The authors have no conflicts of interest to disclose., (Copyright © 2024 the Author(s). Published by Wolters Kluwer Health, Inc.)

Lead (Pb) exposure negatively impacts fertility in both males and females, pregnancy outcomes, and child brain development. We investigated the reproductive and neurological effects of Pb exposure on male and female mice via Pb-contaminated soil for 4 weeks. Breeding was conducted after completion of exposure, in four groups; group 1 consisted of exposed dams and unexposed sires, group 2 consisted of exposed sires and unexposed dams, group 3 consisted of exposed sires and exposed dams and group 4 was the control. Generally, Pb exposure reduced observed conception rates, with a cumulative decrement observed when both males and females are exposed. Gene expression of the testes revealed oxidative stress as the cause of reduced conception rates. Neurological tests: Morris water maze and rotarod were conducted on F1 generation offspring. Maternally and paternally exposed F1 mice performed poorly in the Morris water maze when compared to the control. The severity of the neurological effects was also parent-dependent and sex-dependent. Paternal Pb exposure effects were more pronounced in female offspring. A comparison of gene expression changes of the hippocampus and prefrontal cortex showed paternal Pb-exposure resulted in more prefrontal cortex changes than in the hippocampus, a trend also recorded in the exposed sires. The pronounced effects in female offspring of paternal Pb exposure may suggest that Pb neurological effects may be X-chromosome-linked., Competing Interests: Declarations. Competing interests: The authors declare no competing interests., (© 2024. The Author(s).)

Antimicrobial resistance poses a significant threat to public health, particularly in cholera treatment. The emergence of antibiotic resistance, coupled with the sharp decline in pharmaceutical companies developing new cholera antibiotics, is a cause for concern. We formulate a multidrug-resistant (MDR) cholera epidemic model that incorporates a stage-switching strategy between two antibiotics to reduce the magnitude of resistance. The model is analyzed mathematically, and sensitivity analysis of the reproduction number is performed using sub-reproduction numbers. Stability analysis of the cholera-sensitive-only and cholera-resistant-only equilibria is investigated using Centre Manifold Theory. The model is calibrated through Markov Chain Monte Carlo simulations in Stan, showing stability at equilibrium points, which is further verified through numerical simulations. The simulations demonstrate an inverse relationship between the number of MDR cholera cases and the number of individuals receiving second-line treatment for cholera. This study suggests that the correct use of antibiotics can effectively manage the emergence of antimicrobial resistance. From a public health policy perspective, these findings emphasize the importance of antibiotic stewardship programs and the need for policies that promote the responsible use of existing antibiotics while encouraging the development of new treatment options. Such measures could help mitigate the global burden of MDR cholera and prevent further escalation of resistance., Competing Interests: Declarations. Competing interests: The authors declare no competing interests., (© 2024. The Author(s).)

Plant communities are composed of species that differ both in functional traits and evolutionary histories. As species' functional traits partly result from their individual evolutionary history, we expect the functional diversity of communities to increase with increasing phylogenetic diversity. This expectation has only been tested at local scales and generally for specific growth forms or specific habitat types, for example, grasslands. Here we compare standardized effect sizes for functional and phylogenetic diversity among 1,781,836 vegetation plots using the global sPlot database. In contrast to expectations, we find functional diversity and phylogenetic diversity to be only weakly and negatively correlated, implying a decoupling between these two facets of diversity. While phylogenetic diversity is higher in forests and reflects recent climatic conditions (1981 to 2010), functional diversity tends to reflect recent and past climatic conditions (21,000 years ago). The independent nature of functional and phylogenetic diversity makes it crucial to consider both aspects of diversity when analysing ecosystem functioning and prioritizing conservation efforts., Competing Interests: Competing interests: The authors declare no competing interests., (© 2024. The Author(s), under exclusive licence to Springer Nature Limited.)

Studying wildlife taxonomic diversity and identifying distinct populations has traditionally been largely based on morphology and geographic origin. More recently, this method has been supplemented by genetic data from the mitochondrial genome. However, this is limited as only maternally inherited and may not reflect the true nature of a population's genetics. Within the giraffe (Giraffa spp.), subspecies and unique populations were successfully characterized using both mitochondrial and genomic DNA studies, which led to new insights and, in some cases, unexpected results that required further verification. Here, we sequenced the genomes of 85 southern giraffe (G. giraffa) individuals from ten populations across southern Africa for a detailed investigation into the genetic diversity and history of its two subspecies, the Angolan (G. g. angolensis) and the South African (G. g. giraffa) giraffe. While the overall genotypes show low levels of runs of homozygosity compared to other mammals, the degree of heterozygosity is limited despite the large population size of South African giraffe. The nuclear genotype is largely congruent with the mitochondrial genotype. However, we have identified that the distribution of the Angolan giraffe is not as far east as indicated in an earlier mitochondrial DNA study. Botswana's Central Kalahari Game Reserve giraffe are unique, with a clear admixture of Angolan and South African giraffe populations. However, the enigmatic desert-dwelling giraffe of northwest Namibia is locally distinct from other Angolan giraffe yet exhibits intra-subspecies signs of admixture resulting from a recent introduction of individuals from Namibia's Etosha National Park. Whole genome sequencing is an invaluable and nearly indispensable tool for wildlife management to uncover genetic diversity that is undetectable through mitogenomic, geographical, and morphological means., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Authors. Published by Elsevier Inc. All rights reserved.)

Hypertension is a leading cardiovascular risk factor, contributing significantly to morbidity and mortality in Africa. The continent is plagued with a high incidence, coupled with low treatment and control rates. The causes are multifactorial, and among the major causes is an absence of standardized African guidelines for the management of hypertension. Systems of care vary across the continent, with low-income countries having less care than middle-income countries. International guidelines include recommendations for Black populations, but do not account for the cultural and sociodemographic situation of the African. There is therefore the need for African guidelines based on local data to improve the quality of hypertension care. These guidelines will cover the clinical approach to hypertension and its complications at facilities with physicians and nonphysician health workers (NPHW). It will also proffer suggestions for policies to improve the care for patients with hypertension on the continent., (Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.)

Background: Computer-aided detection (CAD) tools for TB detection have the potential to enable screening programmes and reduce the diagnostic gap in settings where access to radiologists is limited. However, there are concerns that other common chest X-ray (CXR) abnormalities not due to TB may be missed., Methods: We assessed the performance of three commercialised CAD tools (qXR, INSIGHT CXR and DrAID TM TB XR) to detect common non-TB abnormalities against readings with a standardised annotation guide by an expert radiologist. More than 20 well-characterised diagnoses besides TB significant in TB high-burden countries were examined., Results: The 517 CXRs included were deemed abnormal by the three CAD with a sensitivity of respectively 97% (95% CI 95-98), 94% (95% CI 91-95), and 87% (95% CI 84-90) for INSIGHT CXR, qXR, and DrAID. The CAD generally detected abnormalities in patients with critical diagnoses such as lung cancer or heart failure. Performance for detecting other abnormalities was variable., Conclusion: This study showed that the three CAD tools identified CXRs as abnormal when diseases other than TB were present. Our findings alleviate ethical concerns of missing abnormalities other than TB when using commercially available CAD for TB screening and show their potential broader applicability., Competing Interests: Conflict of interest: none declared., (© 2024 The Authors.)

Introduction: Medical imaging's critical role in diagnosis requires prompt and precise image interpretation. Numerous radiology departments, especially in low-resourced settings, encounter challenges such as a shortage of radiologists in their operational setup. This study explored the perceptions of radiographers and radiologists from low-resourced departments in a single country regarding operational challenges and potential solutions in image interpretation., Methods: A qualitative approach was utilised, involving heads of departments, senior radiographers, and radiologists with a minimum of 5 years of experience, from three major state referral hospitals. Face-to-face, semi-structured interviews were conducted in November 2022, using an interview guide that included questions on the challenges encountered during image interpretation and the proposed solutions. Data analysis was conducted using Atlas.ti version 9.0, following the four-step content analysis method. All participants willingly provided consent to participate in the study., Results: Ten participants, comprising two radiologists and eight radiographers participated in the study. The research identified three main themes: image interpretation pathways, image interpretation operational challenges and proposed solutions for image interpretation. In addition, a total of 10 subthemes were generated from the three main themes., Conclusion: The study revealed critical challenges and the need to explore the formal inclusion of radiographers in image interpretation, as a way to improve efficiency. However, a comprehensive assessment of the image interpretation system, encompassing radiographers' knowledge and competence, is recommended for context-specific, empirical-based modifications to enhance service provision., (© 2024 The Author(s). Journal of Medical Radiation Sciences published by John Wiley & Sons Australia, Ltd on behalf of Australian Society of Medical Imaging and Radiation Therapy and New Zealand Institute of Medical Radiation Technology.)

Physiology education in Africa faces challenges due to gaps in curricula across many of its universities, such as divergent content, a lack of standardized competencies, and suitable benchmarking. Here, we describe the development of the Physiology Curriculum for African Universities (PhysioCAFUN), a competency-based curriculum development guideline, as a first step to address such shortcomings. A committee of 15 physiologists from different African regions, Europe, and the United States was constituted to draft the PhysioCAFUN, which was introduced and revised during the joint East African Society of Physiological Sciences (EASPS) and African Association of Physiological Sciences (AAPS) conference held in Tanzania late 2023. The PhysioCAFUN consists of 23 modules. Modules 1-15 cover the organ systems, including principles and concepts of physiology, molecular biology, and cell physiology. Modules 16-23 contain optional content, including environmental physiology, pharmacology, and topics related to skill development. PhysioCAFUN serves as a freely available resource document for African stakeholders regarding the desired undergraduate physiology training and competencies. It will help universities in Africa, and elsewhere to draft a curriculum suitable for their local needs where there is a dearth of physiologists or to benchmark and revise their curricula where physiology programs are already in place. NEW & NOTEWORTHY We described the development of Physiology Curriculum for African Universities (PhysioCAFUN), a competency-based curriculum development guideline to promote physiology education in Africa. This freely accessible resource document should help African universities where there is a dearth of physiologists and thus aid in drafting a curriculum suitable for their local needs. Likewise, it should assist universities globally where physiology programs are already in place to benchmark and/or revise their curriculum as may be needed.

Owing to their rapid cooling rate and hence loss-limited propagation distance, cosmic-ray electrons and positrons (CRe) at very high energies probe local cosmic-ray accelerators and provide constraints on exotic production mechanisms such as annihilation of dark matter particles. We present a high-statistics measurement of the spectrum of CRe candidate events from 0.3 to 40 TeV with the High Energy Stereoscopic System, covering 2 orders of magnitude in energy and reaching a proton rejection power of better than 10^{4}. The measured spectrum is well described by a broken power law, with a break around 1 TeV, where the spectral index increases from Γ&#95;{1}=3.25±0.02(stat)±0.2(sys) to Γ&#95;{2}=4.49±0.04(stat)±0.2(sys). Apart from the break, the spectrum is featureless. The absence of distinct signatures at multi-TeV energies imposes constraints on the presence of nearby CRe accelerators and the local CRe propagation mechanisms.

Long-term quantification of temporal species trends is fundamental to the assignment of conservation status, which in turn is critical for planning and targeting management interventions. However, monitoring effort and methodologies can change over the assessment period, resulting in heterogeneous data that are difficult to interpret. Here, we develop a hierarchical, random effects Bayesian model to estimate site-level trends in density of African elephants from geographically disparate survey data. The approach treats the density trend per site as a random effect and estimates a parametric distribution of these trends for each partitioning of the data. Data were available from 475 sites, in 37 countries, between 1964 and 2016 (a total of 1,325 surveys). We implemented the model separately and in combination for the African forest ( Loxodonta cyclotis ) and savannah ( Loxodonta africana ) elephant species, as well as by region. Inference from these distributions indicates a mean site-level decline for each species over the study period, with the average forest elephant decline estimated to be more than 90% compared to 70% for the savannah elephant. In combination, there has been a mean 77% decline across all sites; but in all models, substantial heterogeneity in trends was found, with stable to increasing trends more common in southern Africa. This work provides the most comprehensive assessment undertaken on the two African elephant species, illustrating the variability in their status across populations., Competing Interests: Competing interests statement:The authors declare no competing interest.

Background: Active case finding could effectively detect tuberculosis (TB) patients, but it can be costly. Therefore, a feasible, cost-saving, and efficient algorithm for community-based TB screening is needed., Methods: The study population was based on a previous TB prevalence survey conducted in the Zambia/South Africa Tuberculosis and HIV/AIDS Reduction trial. We developed predictive scoring models for HIV-positive and HIV-negative/unknown populations for practical purposes. We compared the cost-effectiveness of our models with that of WHO tools through average cost-effectiveness ratio (ACER) and incremental cost-effectiveness ratio., Results: The prediction model for HIV-positive population presented higher area under the curve (AUC) = 0.652, 95% confidence interval (CI) = 0.602-0.701) than WHO-recommended four-symptom screen (AUC = 0.568, 95% CI = 0.524-0.612) among South African participants. The AUC of the model for HIV-negative/unknown population was 0.673 (95% CI = 0.648-0.697), which was higher than that of the WHO tools as well. The ACER of our model can range from 246 to 1670 USD per TB case detected in the South African communities., Conclusions: The scoring system for active TB case finding presented a better performance and showed cost-effectiveness, which can provide new strategies for active TB case finding with multiple options under budget considerations., Competing Interests: Disclosure of interest: The authors completed the ICMJE Disclosure of Interest Form (available upon request from the corresponding author) and disclose no relevant interests., (Copyright © 2024 by the Journal of Global Health. All rights reserved.)

This study presents the systemisation of lessons learned from the urban sector in which the measures based on the guiding principle of risk-informed development (RID) have been implemented in the Southern African Development Community (SADC) region at the national and/or sub-national levels. Despite notable risks in the region, these are not adequately considered in urban development planning and programming. Aiming at strengthening RID in the SADC region, the objectives of this peer-to-peer exchange were achieved through virtual workshops, roundtables and briefings on a cloud-based and open-source BigBlueButton Web conferencing system. Risk-based decision frameworks were used as footprints throughout the moderation phases. Peer-to-peer exchanges totalled 25 events and 80 registered individual members. About 14 SADC member states and 26 cities represented by city officials, local governments and academia participated in this process. Results along the risk-based decision frameworks lead to a clustering of recurring topics during the peer-to-peer exchange, which are presented along legal and organisational setups; budget and funding; risk assessment and mitigation options; and data and information flows considerations., Contribution: Aligned with the 'Regional Assessment on Urban Vulnerability and Resilience in SADC Member States' by conclusions provide a series of recommendations for risk-informed urban development in the SADC region., Competing Interests: The author(s) declare that they have no financial or personal relationship(s) that may have inappropriately influenced them in writing this article., (© 2024. The Authors.)

Background: The Coronavirus disease (COVID-19) pandemic caused significant morbidity and mortality in Africa, in addition to other socio-economic consequences. Across the continent, Schools of Public Health (SPHs) played several roles in supporting national, regional, and global response to the pandemic. Following a published and grey literature search, this paper reviews and analyses the contribution of SPHs in Africa during the COVID-19 pandemic., Contribution of the Schools of Public Health: SPH faculty in most countries contributed their expertise through COVID-19 task forces and advisory committees where they guided and supported decision-making. Faculty also supported the identification, review, and synthesis of rapidly evolving global and local evidence, adapting it to the local context to guide policy decisions. Through research, SPHs contributed to a better understanding of the disease epidemiology, response interventions, as well as prevention and control measures. SPHs engaged in training field epidemiologists, frontline health workers, and district response teams. SPH staff, students and field epidemiology trainees also supported field activities including surveillance, contact tracing, as well as managing quarantine facilities and points of entry. SPHs engaged in public education and awareness-raising initiatives to share information and dispel misinformation. In partnership with other stakeholders, SPHs also developed important innovations and technologies., Conclusion: SPHs are a critical pillar for pandemic prevention, preparedness, and response, that support health systems with important functions. To further enhance their capacity, efforts to improve coordination of SPHs, strengthen collaboration among schools, harmonize training and curricula, and enhance capacity for advanced research are needed. There is also a need to bridge the inequities in capacity and resources that exist among SPHs across regions and countries., Competing Interests: Declarations. Ethics approval and consent to participate: Not applicable. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests., (© 2024. The Author(s).)