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Background: As opportunities grow for resource-constrained countries to use eHealth (digital health) to strengthen health systems, a dilemma arises. Wise eHealth investments require adequate appraisal to address opportunity costs. Economic appraisal techniques conventionally utilised for this purpose require sufficient economic expertise and adequate data that are frequently in short supply in low- and middle-income countries. This paper aims to identify, and, if required, develop, a suitable framework for performing eHealth investment appraisals in settings of limited economic expertise and data., Methods: Four progressive steps were followed: (1) identify required framework attributes from published checklists; (2) select, review, and chart relevant frameworks using a scoping review; (3) analyse the frameworks using deductive and inductive iterations; and, if necessary, (4) develop a new framework using findings from the first three steps., Results: Twenty-four candidate investment appraisal attributes were identified and seven relevant frameworks were selected for review. Analysis of these frameworks led to the refinement of the candidate attributes to 23 final attributes, and each framework was compared against them. No individual framework adequately addressed sufficient attributes. A new framework was developed that addressed all 23 final attributes., Conclusions: A new evidence-based investment appraisal framework has been developed that provides a practical, business case focus for use in resource-constrained African settings.

This paper examines how African immigrants living with HIV negotiate and reconstruct their productive (i.e., educational and career opportunities), sexual, and reproductive identities. We used data from a mixed-methods study to explore how stigma and social networks in which participants were embedded shaped how they understood and negotiated their role expectations and responsibilities. Participants revealed how HIV not only changed their identities and limited their sex life, partner choices, and fundamental decisions about fertility and reproduction, but also presented them with the opportunity to reinvent/reshape their lives. Our analysis revealed that the cultural discourses about illness and HIV in participant's countries of origin, the acculturative and migratory stressors, and the competing influences and expectations from family and friends in their home and host countries shape their illness experience, and how they adjust to life with HIV. This paper builds on sociological understanding of illness experience as a social construct that shapes the ill person's identity, role, and function in society. Specifically, the paper contributes to discourses on how (i) participants' social location and identity (as transnational migrants adjusting to acculturative stressors associated with resettlement into a new country), (ii) cultural discourses about illness and HIV in their countries of origin, and (iii) embeddedness in transnational social networks influence health outcomes, including lived experiences with chronic illnesses and stigmatized conditions such as HIV.

Indigenous groups across Africa mobilized Indigenous Knowledge (IK) practices, albeit not without challenges, to respond to the COVID-19 pandemic. Yet Indigenous Knowledge Systems (IKS) continue to be sidelined in formal healthcare policies and programmes. This underscores the urgency to liberate Africa's epistemologies. Employing the decoloniality lens, this paper examined the colonial influences inherent in African responses to COVID-19 while also exploring the role of IKS in the uMkhanyakude District Municipality (UKDM). The argument is made that, in the case of the UKDM, the efficacy of IKS was demonstrated in the response to and fight against the COVID-19 pandemic. This is the basis for the call to embrace and recognize that IKS is a legitimate body of knowledge comparable to Western science. Such recognition paves the way for more equitable, contextually relevant, and sustainable health strategies that can better address the complexities of current and future pandemics.

Health communication has been highlighted as a cost-effective preventive intervention in Africa, where the prevalence of tobacco use is still relatively low compared to other World Health Organization (WHO) regions. This scoping review aimed to examine tobacco control health communication interventions in Africa. The review was guided by the PRISMA-ScR checklist. Data was extracted from 20 peer-reviewed papers, WHO Global Health Observatory on anti-tobacco mass-media campaigns for 54 African countries, and 6 WHO Framework Convention on Tobacco Control reports on Article 12. Data extraction informed by the Joanna Briggs Institute (JBI) data-extraction questions was used for peer-reviewed studies while a pre-determined template was used for the other sources. Narrative data synthesis informed by the JBI manual for evidence synthesis was employed. A lack of research that comprehensively addresses all areas of health communication and inconsistent use of health communication campaigns were identified. Only an average of 6 countries had ever implemented high-quality national mass-media campaigns in a decade, while an average of 33 countries consistently failed to conduct campaigns that lasted more than 3 weeks. Although the involvement of key populations was clearly vital to ensure content relevance and message clarity, a lack of health communication informed by young people was observed, as they rarely participated in key decision-making despite reportedly being the targets of interventions. Clear health communication for tobacco-use prevention informed by young people is lacking in African countries. Active participation of young people in developing targeted campaigns is needed to facilitate content relevance and comprehension to ultimately contribute to tobacco-use prevention.

This paper brings together researchers, clinicians, technology developers and digital innovators to outline current applications of remote symptom monitoring being developed for palliative cancer care delivery in Africa. We outline three remote symptom monitoring approaches from three countries, highlighting their models of delivery and intended outcomes, and draw on their experiences of implementation to guide further developments and evaluations of this approach for palliative cancer care in the region. Through highlighting these experiences and priority areas for future research, we hope to steer efforts to develop and optimise remote symptom monitoring for palliative cancer care in Africa.

(1) Background: Decisions to use eHealth are complex and involve addressing a large opportunity cost. Sound choices are essential. Weighing up investment options is challenging in resource-constrained settings where there are frequently insufficient economics data and expertise to conduct adequate appraisals. To address this, a new eHealth Investment Appraisal Framework (eHIAF) for Africa has been designed and developed. The aim of this paper was to validate the new framework to consider whether it is fit for purpose and to refine it as needed. (2) Methods: An online survey of purposively selected eHealth experts was used to conduct a desktop validation of the proposed eHIAF for Africa. The survey covered the framework development process, structure, content, completeness, and utility. Expert opinions were charted, and a reflective and iterative process used to assess the tool and extract recommendations for refinement. (3) Results: Eleven eHealth experts who completed the survey had experience in African countries and elsewhere. The majority agreed with the eHIAF for Africa development approach and output. They provided valuable suggestions for minor refinements and felt that with these amendments, the eHIAF for Africa would be 'fit for purpose'. (4) Conclusions: The eHIAF for Africa is considered appropriate for use by policy- and decision-makers working in resource-constrained settings who face the task of selecting optimal eHealth investments. It has the potential for applicability beyond Africa and the framework should now be tested in African countries.

Road traffic accidents are strongly associated with driver behaviour. Africa, as a region, has the highest road accident fatality rate, but there is very little research dealing with this critical issue on the continent. This paper, therefore, sought to establish the state of driver behaviour and road safety scholarship in Africa to determine current research trends as well as potential future research directions. To this end, two bibliometric analyses were conducted, one which considered the issue from an African perspective and the other which considered the broader body of work. The analysis revealed a critical shortage of research related to driver behaviour in Africa. The existing body of research primarily focused on the identification of issues and tended to focus on narrow research problems within limited geographical areas. A need was identified for the collection of broader macro-level data and statistical analyses thereof to indicate regional traffic crash patterns; causes and effects; country-level studies, particularly countries with high traffic fatality rates and low levels of research; cross-country comparisons; and modelling. Future research directions should also include the link between driver behaviour, traffic safety and the sustainable developments goals, as well as policy-related research to determine current and potential future country-level policies.

There is a growing number of children affected by HIV in Africa. Research on HIV-exposed uninfected children (HEU) is also growing. This systematic review focuses on the psychological well-being of HEU and its association with school intervention, outcomes, and enrollment in the African context, which is where the rate of HIV reaches its highest levels. Research on public databases was conducted according to PRISMA standards. Only studies on HEU primary school children in Africa, both quantitative and qualitative, were included. Out of 1510 papers retrieved, 50 met the inclusion criteria. These studies demonstrate that HEU children are more likely to perform worse in school compared to their counterparts who were not exposed to HIV and to show poorer concentration in the classroom. Children with parents suffering from AIDS are worried for them and have to take household responsibility, resulting in school dropouts, juvenile work, and risky behaviors. Few interventions have been conducted in the school environment with some of them being successful; therefore, future research should involve schools to create an inclusive environment where HEU children could enhance their potential and improve their psychological health.

Refugee resettlement significantly contributes to Australia's migration programs, with recent policy directives prioritising rural resettlement. As a result, the cultural diversity of populations of several Australian rural towns has substantially expanded. Newcomers may encounter challenges becoming part of closed social networks and accessing the resources they need for a healthy life in resettlement. However, there are also benefits that stem from positive integration for newcomers and for receiving populations. As part of a larger study, which aimed to explore facilitators and barriers to successful resettlement in a rural setting, the objective of this paper was to show how social ties were important for participants' health, both facilitating access to resources, including health services, and connecting people to health-promoting living conditions. In-depth individual interviews with 44 participants from refugee communities originally from Africa and South-East Asia, settled in a rural South Australian town, were conducted. Participants were invited to the study through snowball sampling via known connections between the researchers and key people within the communities. Interview transcripts were analysed using framework thematic analysis. The findings demonstrate how participants drew on connections within their cultural communities, reflecting collectivist cultural values. These social ties were key to enabling access to resources for health. These included emotional resources, such as a sense of belonging, as well as physical and practical resources, including food, housing, and/or accessing services. Several participants were also working towards a career in the health industry. Populations from refugee communities in rural towns are growing, not only with the continuation of new arrivals to these towns, but also as the settled populations expand their families and communities. Effective health service provision in these locations needs to serve these growing communities, and there is scope for services to tap into community networks to assist with this.

Background: Cost-effectiveness is a tool to maximize health benefits and to improve efficiency in healthcare. However, efficient outcomes are not always the most equitable ones. Distributional cost-effectiveness analysis (DCEA) offers a framework for incorporating equity concerns into cost-effectiveness analysis., Objective: This systematic review aims to outline the challenges and limitations in applying DCEA in healthcare settings., Methods: We searched Medline, Scopus, BASE, APA Psych, and JSTOR databases. We also included Google Scholar. We searched for English-language peer-reviewed academic publications, while books, editorials and commentary papers were excluded. Titles and abstract screening, full-text screening, reference list reviews, and data extraction were performed by the main researcher. Another researcher checked every paper for eligibility. Details, such as study population, disease area, intervention and comparators, costs and health effects, cost-effectiveness findings, equity analysis and effects, and modelling technique, were extracted. Thematic analysis was applied, focusing on challenges, obstacles, and gaps in DCEA., Results: In total, 615 references were identified, of which 18 studies met the inclusion criteria. Most of these studies were published after 2017. DCEA studies were mainly conducted in Europe and Africa and used quality health-adjusted measurements. In the included studies, absolute inequality indices were used more frequently than relative inequality indices. Every stage of the DCEA presented challenges and/or limitations., Conclusion: This review provides an overview of the literature on the DCEA in healthcare as well as the challenges and limitations related to the different steps needed to conduct the analysis. In particular, we found problems with data availability, the relative unfamiliarity of this analysis among policymakers, and challenges in estimating differences among socioeconomic groups.

Under the influence of economic globalization, the internationalization trend of energy security issues has become increasingly prominent. This paper adopts the natural discontinuity grading method to classify the energy security status of 102 countries into five categories: Best, Better, Good, Poor and Worse types; reveals the dynamic evolution characteristics and main formation mechanisms of world energy security; and puts forward the game focus of future energy geopolitics. The results show that: (1) during 1995-2019, global energy security presents local turbulence and an overall "J" shaped trend; (2) the global energy security pattern coincides with the international geopolitical order. The countries with the "Best" energy security are found in Western Europe and North America while the countries with "Poor" or "Worse" energy security are located in Asia and the less developed regions of Africa; (3) the main reason why developed economies have better energy security is due to their high energy use efficiency, while developing countries lag behind mainly because of their lower innovation capacity, lower productivity and lower disposable income; and (4) the global energy security landscape is expected to be affected by the changing US-China relationship, coercive energy transition and the uncertainty of the political environment.

Under the background of global environmental change, a huge impact has been made on the village ecosystem, which leads to disorder of structure and function of the village ecosystem. The current management measures of the village have failed in allowing the village to achieve sustainable development. Research on the vulnerability and resilience of the village ecosystem is helpful in regards to the ecological restoration of the village. The research status and progress in regards to the vulnerability and resilience of the village ecosystem are not clear, and the summary of research results and problems is insufficient. Based on 87 related literatures, this paper focuses on the current status and progress of village ecosystem vulnerability and resilience research, and reveals the current research results and shortcomings of village ecosystem vulnerability and resilience. We found that: (1) the research on vulnerability and resilience of the village ecosystem is on the rise; (2) the research mainly focuses on the index system, monitoring and assessment, mechanism research and strategy research. The monitoring and assessment research is the most prominent, which mainly discusses the research methods, the vulnerability and the resilience of the village ecosystem; (3) the study area is mainly concentrated in Asia, North America and Africa. Research institutions are mainly institutions of higher learning and research institutes (centers). Finally, this paper finds that major scientific and technical studies such as the construction of indicator systems and the study of governance strategies in the study of vulnerability and resilience of village ecosystems are lagging behind. In future research, we should deepen the research on the concept and connotation of vulnerability and resilience. We must establish a scientific and reasonable research framework for vulnerability and resilience of the village ecosystem. We should also strengthen and improve the index system of vulnerability and resilience of the village ecosystem. We should strengthen research on the impact mechanisms and governance strategies of vulnerability and resilience, and apply the research on vulnerability and resilience to the planning and governance of the village ecosystem.

Africa has a long history of novel and re-emerging infectious disease outbreaks. This reality has attracted the attention of researchers interested in the general research theme of predicting infectious diseases. However, a knowledge mapping analysis of literature to reveal the research trends, gaps, and hotspots in predicting Africa's infectious diseases using bibliometric tools has not been conducted. A bibliometric analysis of 247 published papers on predicting infectious diseases in Africa, published in the Web of Science core collection databases, is presented in this study. The results indicate that the severe outbreaks of infectious diseases in Africa have increased scientific publications during the past decade. The results also reveal that African researchers are highly underrepresented in these publications and that the United States of America (USA) is the most productive and collaborative country. The relevant hotspots in this research field include malaria, models, classification, associations, COVID-19, and cost-effectiveness. Furthermore, weather-based prediction using meteorological factors is an emerging theme, and very few studies have used the fourth industrial revolution (4IR) technologies. Therefore, there is a need to explore 4IR predicting tools such as machine learning and consider integrated approaches that are pivotal to developing robust prediction systems for infectious diseases, especially in Africa. This review paper provides a useful resource for researchers, practitioners, and research funding agencies interested in the research theme-the prediction of infectious diseases in Africa-by capturing the current research hotspots and trends.

Background: African-born migrants and refugees arriving from fragile states and countries with political and economic challenges have unique health needs requiring tailored healthcare services and support. However, there is little investigation into the distribution of this population and their spatial access to healthcare in Australia. This paper reports on research that aimed to map the spatial distribution of Africa-born migrants from low and lower-middle-income countries (LLMICs) and refugees in New South Wales (NSW) and access to universal child and family health (CFH) services and hospitals. Methods: We analysed the Australian Bureau of Statistics 2016 Census data and Department of Social Services 2018 Settlement data. Using a Geographic Information System mapping software (Caliper Corporation. Newton, MA, USA), we applied data visualisation techniques to map the distribution of Africa-born migrants and refugees relative to CFH services and their travel distance to the nearest service. Results: Results indicate a spatial distribution of 51,709 migrants from LLMICs in Africa and 13,661 refugees from Africa live in NSW, with more than 70% of the total population residing in Sydney. The Africa-born migrant and refugee population in Sydney appear to be well served by CFH services and hospitals. However, there is a marked disparity between local government areas. For example, the local government areas of Blacktown and Canterbury-Bankstown, where the largest number of Africa-born migrants and refugees reside, have more uneven and widely dispersed services than those in Sydney's inner suburbs. Conclusion: The place of residence and travel distance to services may present barriers to access to essential CFH services and hospitals for Africa-born refugees and migrants. Future analysis into spatial-access disadvantages is needed to identify how access to health services can be improved for refugees and migrants.

This paper shows the prevalence of psychosocial risks for workers in the greenhouse construction industry in south-eastern Spain. Method : The assessment of the workers' psychosocial risks was carried out through simple random sampling, which uses a questionnaire containing 13 variables characterizing the companies, 14 variables characterizing the workers, and 15 questions proposed by the Mini Psychosocial Factors (MPFs) risk assessment method. A descriptive analysis and multiple correspondence analysis were performed on the sample data. Results : Greenhouse construction businesses in south-eastern Spain can generally be classified as small companies with an average annual turnover below EUR 2.0 million (69.3%), an average of 22.8 workers with an average age of 39.84 years old, most of whom are married, with an average of 1.76 children. The prevalence of workers at high risk was 2.9%, while 45.1% were at medium-high risk. Of the 12 psychosocial factors assessed using the MPF method, 7 of them presented a high level of worker risk: Mobbing (3.2%), Relationships (1.6%), Recognition (1.6%), Autonomy (12.9%), Emotional (8.0%), Control (4.8%), and Demands (3.2%). Lastly, the variables were grouped into four clusters, showing that larger companies are correlated with a medium (workers over 40 years of age or less than 25 years of age) to high (workers under 25 years of age) risk level in several of the psychosocial factors assessed for workers who are Spanish nationals, while in smaller companies, the workers are usually middle aged (between 25 and 40 years old) and from Eastern Europe or Africa, presenting either a low or high level of risk depending on the psychosocial factors and tasks performed. Impact of the results : The study reveals a lack of prevention management regarding psychosocial risks. Therefore, it is necessary to carry out new prevention programmes that optimise the psychosocial conditions of the workers, involving the workers, employers, and other social agents.

Background: Emigration to Australia by people from Africa has grown steadily in the past two decades, with skilled migration an increasingly significant component of migration streams. Challenges to resettlement in Australia by African migrants have been identified, including difficulties securing employment, experiences of racism, discrimination and social isolation. These challenges can negatively impact resettlement outcomes, including health and wellbeing. There has been limited research that has examined protective and resilience factors that help highly skilled African migrants mitigate the aforementioned challenges in Australia. This paper discusses how individual and community resilience factors supported successful resettlement Africans in Australia. The paper is contextualised within a larger study which sought to investigate how belonging and identity inform Afrodiasporic experiences of Africans in Australia., Methods: A qualitative inquiry was conducted with twenty-seven (n = 27) skilled African migrants based in South Australia, using face-to-face semi-structured interviews. Participants were not directly questioned about 'resilience,' but were encouraged to reflect critically on how they navigated the transition to living in Australia, and to identify factors that facilitated a successful resettlement., Results: The study findings revealed a mixture of settlement experiences for participants. Resettlement challenges were observed as barriers to fully meeting expectations of emigration. However, there were significant protective factors reported that supported resilience, including participants' capacities for excellence and willingness to work hard; the social capital vested in community and family support networks; and African religious and cultural values and traditions. Many participants emphasised their pride in their contributions to Australian society as well as their desire to contribute to changing narratives of what it means to be African in Australia., Conclusions: The findings demonstrate that despite challenges, skilled African migrants' resilience, ambition and determination were significant enablers to a healthy resettlement in Australia, contributing effectively to social, economic and cultural expectations, and subsequently meeting most of their own migration intentions. These findings suggest that resilience factors identified in the study are key elements of integration.

Least developed countries (LDCs) are home to over a billion people throughout Africa, Asia-Pacific, and the Caribbean. The people who live in LDCs represent just 13% of the global population but 40% of its growth rate. Characterised by low incomes and low education levels, high proportions of the population practising subsistence living, inadequate infrastructure, and lack of economic diversity and resilience, LDCs face serious health, environmental, social, and economic challenges. Many communities in LDCs have very limited access to adequate sanitation, safe water, and clean cooking fuel. LDCs are environmentally vulnerable; facing depletion of natural resources, the effects of unsustainable urbanization, and the impacts of climate change, leaving them unable to safeguard their children's lifetime health and wellbeing. This paper reviews and describes the complexity of the causal relationships between children's health and its environmental, social, and economic influences in LDCs using a causal loop diagram (CLD). The results identify some critical feedbacks between poverty, family size, population growth, children's and adults' health, inadequate water, sanitation and hygiene (WASH), air pollution, and education levels in LDCs and suggest leverage points for potential interventions. A CLD can also be a starting point for quantitative systems science approaches in the field, which can predict and compare the effects of interventions.

This paper was part of a large study that explored suicide among African youths in South Australia. The paper reports perspectives about alcohol and other drugs (AOD) use and mental health among African migrant and refugee youths in South Australia. The study employed a qualitative inquiry, conducting 23 individual interviews and one focus group discussion with eight participants. An acculturative stress model informed data analysis, interpretation and the discussion of the findings that form the current paper. African migrant and refugee youths revealed challenging stressors, including related to cultural, socioeconomic, living conditions, and pre- and post-migration factors that contributed to mental health problems and the use of AOD in their new country. The traumatic loss of family members and social disruption experienced in their countries of origin were expressed as part of factors leading to migration to Australia. While in Australia, African migrant and refugee youths experienced substantial stressors related to inadequate socioeconomic and cultural support, discrimination, poverty, and unemployment. Participants believed that differences in cultural perspectives about AOD use that existed in Africa and Australia also shaped the experiences of social stressors. Additionally, participants believed that these cultural differences and the identified stressors determined AOD use and mental health problems. The findings highlight the need to understand these social and cultural contexts to improve mental health services and help reduce the use of AOD, which, when problematic, can influence the health and integration experiences of these populations.

This paper was part of a large study that aimed to explore determinants of increased suicides among African youths in South Australia. As part of this larger study, narratives from participants indicated that identity crisis could be a potential determinant of suicide. This paper reports on how African youths negotiate and form identity in Australia. A qualitative inquiry was undertaken with 31 African youths using a focus group and individual interviews. Data analysis was guided by a framework for qualitative research. These youths negotiated multiple identities, including those of race, gender, ethnicity and their origin. 'Freedom and opportunity', 'family relationships', 'neither belonging here nor there' and 'the ability to cope against the paradox of resourcefulness in Australia' appeared to be important themes in negotiating individual identities. An opportunity was used to acknowledge privileges available in Australia relative to Africa. However, the extent to which individuals acted on these opportunities varied, affecting a person's sense of purpose, identity formation and belonging in Australia. The loss of social networks following migration, and cultural differences between African and Australian societies, shaped the experience of belonging and identity formation. These findings are crucial as they indicate the need for policies and practices that consider experiences of youths as they form their identity in Australia. Further studies with large numbers of participants are needed to explore these issues further among African youths in Australia.

Globally, traditional food security fears have been supplemented by concerns about food system sustainability that link current agricultural production practices to damages of environmental ecosystems and the world's climate, thus threatening the natural resource base of future generations. This paper aims at creating a better understanding of the evolution of diet sustainability from 1961 to 2013. Data from the Food and Agriculture Organization of the United Nations were used to investigate the situation for the world as a whole as well as for its macro-regions Africa, Asia, the Americas, Europe and Oceania. We define diet sustainability by (a) the share of daily per capita calorie intake derived from vegetable/plant products and (b) the variety of vegetable/plant products consumed, measured by the Simpson diversity index. Moreover, total calorie consumption is considered. Then the correlations between diet sustainability and (a) macro-regional life expectancy rates and (b) food system greenhouse gas emissions are calculated. The results show that diet sustainability has not changed much during the last 50 years. Moreover, the nexus between diets and health and climate outcomes is not fully evident at the macro-regional level. Therefore, Malthus 2.0, i.e., scientific food pessimism, should be avoided. In particular, the limitations of dietary contributions to human and planetary health ought to be more widely acknowledged., Competing Interests: The authors declare no conflict of interest.

Modern global cropland products have been widely used to assess the impact of land use and cover change (LUCC) on carbon budgets, climate change, terrestrial ecosystems, etc. However, each product has its own uncertainty, and inconsistencies exist among different products. Understanding the reliability of these datasets is essential for knowing the uncertainties that exist in the study of global change impact forced by cropland reclamation. In this paper, we propose a set of coincidence assessments to identify where reliable cropland distribution is by overlaying ten widely used global land cover/cropland datasets around 2000 AD. A quantitative assessment for different spatial units is also performed. We further discuss the spatial distribution characteristics of different coincidence degrees and explain the reasons. The results show that the high-coincidence proportion is only 40.5% around the world, and the moderate-coincidence and low-coincidence proportion is 18.4% and 41.1%, respectively. The coincidence degrees among different continents and countries have large discrepancies. The coincidence is relatively higher in Europe, South Asia and North America, while it is very poor in Latin America and Africa. The spatial distribution of high and moderate coincidence roughly corresponds to the regions with suitable agricultural conditions and intensive reclamation. In addition to the random factors such as the product's quality and the year it represented, the low coincidence is mainly caused by the inconsistent land cover classification systems and the recognition capability of cropland pixels with low fractions in different products., Competing Interests: The authors declare no conflict of interest.

Chinese medical aid team members (CMATMs) play an important role in the implementation of China's health assistance strategies in Africa. This paper explored the influencing factors of expatriation willingness for Chinese medical aid team members (CMATMs). We employed a qualitative descriptive study using semi-structured interviews with twenty-five participants. Participants included hospital directors and local Health and Family Planning Commission (HFPC) officers who were in charge of CMATMs dispatching, and CMATMs that had returned from medical aid service. Six influencing factors emerged: career advancement, loneliness, living conditions, personal safety, family-work conflict, and doctor-patient relationship. Career advancement is the most important factor and concern for doctor CMATMs. Social use of Internet is on the core of entertainment. Enhancing technical title promotion policies is the most important motivator. This study obtained baseline information that is useful to relevant stakeholders in their attempts to improve CMATMs' expatriation willingness., Competing Interests: The authors declare no conflict of interest.

In this paper, human security-related causes of large-scale forced migration (LSFM) in Africa are investigated for the period 2011-2017. As distinct from the conventional understanding of (national) security, human security involves economic, public health, environmental and other aspects of people's wellbeing. Testing various hypotheses, we have found that civil and interstate conflicts, lack of democracy and poverty are the most important drivers of mass population displacements, whereas climate change has an indirect effect on the dependent variable. As a policy tool, foreign aid is also tested to see if it lowers the probability of LSFM. Our findings have implications for policy planning, since the conventional understanding of security falls short of addressing LSFM without taking various aspects of human security into account.

In this paper, we present the applications of spatial technologies-Geographic Information Systems (GIS) and remote sensing-in the international monitoring of river basins particularly analyzing the ecological, hydrological, and socio-economic issues along the Senegal River. The literature on multinational water crisis has for decades focused on mediation aspects of trans-boundary watershed management resulting in limited emphasis placed on the application of advances in geo-spatial information technologies in multinational watershed conservation in the arid areas of the West African sub-region within the Senegal River Basin for decision-making and monitoring. While the basin offers life support in a complex ecosystem that stretches across different nations in a mostly desert region characterized by water scarcity and subsistence economies, there exists recurrent environmental stress induced by both socio-economic and physical factors. Part of the problems consists of flooding, drought and limited access to sufficient quantities of water. These remain particularly sensitive issues that are crucial for the health of a rapidly growing population and the economy. The problems are further compounded due to the threats of climate change and the resultant degradation of almost the region's entire natural resources base. While the pace at which the institutional framework for managing the waters offers opportunities for hydro electricity and irrigated agriculture through the proliferation of dams, it has raised other serious concerns in the region. Even where data exists for confronting these issues, some of them are incompatible and dispersed among different agencies. This not only widens the geo-spatial data gaps, but it hinders the ability to monitor water problems along the basin. This study will fill that gap in research through mix scale methods built on descriptive statistics, GIS and remote sensing techniques by generating spatially referenced data to supplement the existing ones for the management of the Senegal River Basin. The results show the incidence of change predicated on pressures from demography, natural forces and the proliferation of river basin development which resulted in more irrigated areas to meet the needs of the inhabitants of the basin. With the substantial increase in bare surface areas, the basin faces growing exposure to the threats of desertification.