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Rickettsia africae is a tick‐borne bacteria known to cause African tick bite fever (ATBF). While the disease was first described more than 100 years ago, knowledge of transmission risk factors and disease burden remain poorly described. To better understand the burden of R. africae, this article reviewed and summarized the published literature related to ATBF epidemiology and clinical management. Using a systematic approach, consistent with the PRISMA guidelines, we identified more than 100 eligible articles, including 65 epidemiological studies and 41 case reports. Most reports described R. africae in ticks and livestock, while human studies were less common. Human disease case reports were exclusively among returning travellers from non‐endemic areas, which limits our disease knowledge among at‐risk populations: people living in endemic regions. Substantial efforts to elucidate the ATBF risk factors and clinical manifestations among local populations are needed to develop effective preventative strategies and facilitate appropriate and timely diagnosis. [ABSTRACT FROM AUTHOR]

Objective: Globally, there are estimated to be 2.9 million cholera cases annually. Early detection of cholera outbreaks is crucial for resource allocation for case management and for targeted interventions to be delivered to stop the spread of cholera. In resource limited settings such as Eastern Democratic Republic of the Congo (DRC), there is often limited laboratory capacity for analysing stool samples for cholera by bacterial culture. Therefore, rapid diagnostic tests (RDTs) for cholera present a promising tool to rapidly test stool samples in a health facility setting for cholera. Our objective is to evaluate the Crystal VC O1 RDT for cholera detection compared with bacterial culture and polymerase chain reaction (PCR) for Vibrio cholerae. Methods: From March 2020 to December 2022, stool samples were collected from 644 diarrhoea patients admitted to 94 health facilities in Bukavu in Eastern DRC. Patient stool samples were analysed by Crystal VC O1 RDT for cholera and by bacterial culture and PCR for V. cholerae O1. Results: Twenty six percent of diarrhoea patients (166/644) had stool samples positive for cholera by RDT, and 24% (152/644) had stool samples positive for V. cholerae O1 by bacterial culture or PCR. The overall specificity and sensitivity of the Crystal VC O1 RDT by direct testing was 94% (95% confidence interval [CI]: 92%–96%) and 90% (95% CI, 84%–94%), respectively, when compared with either a positive result by bacterial culture or PCR. Conclusion: Our findings suggest that the Crystal VC O1 RDT presents a promising tool for cholera surveillance in this cholera endemic setting in sub‐Saharan Africa. [ABSTRACT FROM AUTHOR]

Tungiasis (sand flea disease) is a neglected tropical disease that is endemic in Sub‐Saharan Africa and Latin America. Tungiasis causes pain, mobility restrictions, stigmatisation and reduced quality of life. Very severe cases with hundreds of sand fleas have been described, but treatment of such cases has never been studied systematically. During a larger community‐based tungiasis control programme in a hyperendemic region in Karamoja, northeastern Uganda, 96 very severe tungiasis cases were identified and treated with the dimeticone formula NYDA®. They were repeatedly followed‐up and treated again when necessary. The present study traces tungiasis frequency, intensity and morbidity among these 96 individuals over 2 years. At baseline, very severe tungiasis occurred in all age groups, including young children. Throughout the intervention, tungiasis frequency decreased from 100% to 25.8% among the 96 individuals. The overall number of embedded sand fleas in this group dropped from 15,648 to 158, and the median number of embedded sand fleas among the tungiasis cases decreased from 141 to four. Walking difficulties were reported in 96.9% at the beginning and in 4.5% at the end of the intervention. Repeated treatment with the dimeticone formula over 2 years was a successful strategy to manage very severe cases in a hyperendemic community. Treatment of very severe cases is essential to control the spread and burden of tungiasis in endemic communities. [ABSTRACT FROM AUTHOR]

Objective: The burden of extra‐pulmonary tuberculosis (EPTB) is not well quantified in TB endemic countries such as those in sub‐Saharan Africa. This study aimed to quantify that burden via a systematic review of the prevalence of EPTB in African countries. Methods: Studies were retrieved by searching five databases; 105 studies published between 1990 and 2023 were included. The studies described the prevalence of EPTB among the general population (4 studies), TB patients (68) and patients with other conditions, including HIV (15), meningitis (3), renal failure (3) and other comorbidities, some of which are cancer (12). Due to the low number of studies reporting EPTB in patients with conditions other than TB, the meta‐analysis was performed on studies reporting on EPTB among TB patients (68 studies). Meta‐analysis was performed on the 68 studies (271,073 participants) using a random‐effects model to estimate the pooled prevalence of EPTB. Meta‐regression was used to explore possible explanations for heterogeneity according to regions and time periods. Results: The pooled prevalence of EPTB among TB patients was 26% (95% CI 23–29%). There was substantial heterogeneity of prevalence for the five African regions. The Eastern region had the highest prevalence of 32% (95% CI 28–37%) and the lowest in Western Africa, 16% (95% CI 10–24%). There was no significant difference in the prevalence of EPTB between the 3 eleven‐year time periods. Conclusions: Our systematic review and meta‐analysis give insight into the burden of EPTB in Africa. This review could inform clinical and programmatic practices–a higher suspicion index for clinicians and more effort for better services. This could contribute to efforts aiming to end TB, which have historically been focused on PTB.Coordinated efforts that target both EPTB and PTB are needed. [ABSTRACT FROM AUTHOR]

Objectives: Up to 85% of people living with epilepsy (PwE) reside in low‐and middle‐income countries. In sub‐Saharan Africa, the lifetime prevalence of epilepsy is 16 per 1000 persons. In Northern rural Rwanda, a 47.7 per 1000 prevalence has been reported. As variations in prevalence across geographical areas have been observed, we studied the prevalence in Southern rural Rwanda using the same robust methodology as applied in the North. Methods: We conducted a three‐stage, cross‐sectional, door‐to‐door survey in two rural villages in Southern Rwanda from June 2022 to April 2023. First, trained enumerators administered the validated Limoges questionnaire for epilepsy screening. Second, neurologists examined the persons who had screened positively to confirm the epilepsy diagnosis. Third, cases with an inconclusive assessment were separately reexamined by two neurologists to reevaluate the diagnosis. Results: Enumerators screened 1745 persons (54.4% female, mean age: 24 ± 19.3 years), of whom 304 (17.4%) screened positive. Epilepsy diagnosis was confirmed in 133 (52.6% female, mean age: 30 ± 18.2 years) and active epilepsy in 130 persons. Lifetime epilepsy prevalence was 76.2 per 1000 (95% CI: 64.2–89.7‰). The highest age‐specific rate occurred in the 29–49 age group. No gender‐specific differences were noted. In 22.6% of the PwE, only non‐convulsive seizures occurred. The treatment gap was 92.2%, including a diagnosis gap of 79.4%. Conclusion: We demonstrated a very high epilepsy prevalence in Southern rural Rwanda, with over 20% of cases having only non‐convulsive seizures, which are often underdiagnosed in rural Africa. In line with previous Rwandan reports, we reiterate the high burden of the disease in the country. Geographic variation in prevalence throughout Africa may result from differences in risk and aetiological factors. Case–control studies are underway to understand such differences and propose adapted health policies for epilepsy prevention. [ABSTRACT FROM AUTHOR]

Background: Healthcare resources are often limited in areas of sub‐Saharan Africa. This makes accurate and timely diagnoses challenging and delays treatment of childhood febrile illness. We explored longitudinal characteristics related to symptoms, diagnosis and treatment of hospitalised febrile children in a rural area of Ghana highly endemic for malaria. Methods: Febrile children under 15 years, admitted to the study hospital paediatric ward, were recruited to the study and clinical data were collected throughout hospitalisation. Descriptive statistics were reported for all cases; for longitudinal analyses, a subset of visits with limited missing data was used. Results: There were 801 hospitalised children included in longitudinal analyses. Malaria (n = 581, 73%) and sepsis (n = 373, 47%) were the most prevalent suspected diagnoses on admission. One‐third of malaria suspected diagnoses (n = 192, 33%) were changed on the discharge diagnosis, compared to 84% (n = 315) of sepsis suspected diagnoses. Among malaria‐only discharge diagnoses, 98% (n/N = 202/207) received an antimalarial and 33% (n/N = 69/207) an antibiotic; among discharge diagnoses without malaria, 28% (n/N = 108/389) received an antimalarial and 83% (n/N = 324/389) an antibiotic. Conclusions: Suspected diagnoses were largely based on clinical presentation and were frequently changed; changed diagnoses were associated with lingering symptoms, underscoring the need for faster and more accurate diagnostics. Medications were over‐prescribed regardless of diagnosis stability, possibly because of a lack of confidence in suspected diagnoses. Thus, better diagnostic tools are needed for childhood febrile illnesses to enhance the accuracy of and confidence in diagnoses, and to cut down unjustified medication use, reducing the risk of antimicrobial and malaria resistance. [ABSTRACT FROM AUTHOR]

This article explores the limited understanding and research on myeloid neoplasms, a type of blood cancer, in sub-Saharan Africa, with a focus on Nigeria. It emphasizes the need for more comprehensive studies to gather epidemiological data and improve diagnostic capabilities for these disorders. The authors call for collaboration between healthcare professionals and researchers, as well as increased funding and prioritization of research on myeloid neoplasms in the region. [Extracted from the article]

Background and Objective: Of ~5 million people living with epilepsy (PLWE) in Sub‐Saharan Africa, roughly one‐third experience depression and over one third experience anxiety. In Guinea, these issues may be compounded by fewer available resources, such as appropriate anti‐seizure medications (ASMs). We aim to quantify seizure frequency, anxiety and depression in PLWE in Guinea, before and after a free ASM intervention and neurologist's consultation. Methods: Guinean participants >12 years old with ≥2 unprovoked seizure were prospectively recruited. As part of a broader interview, participants reported prior 30‐day seizure frequency and screened for depression (PHQ‐9) (range 0–27 points) and anxiety (GAD‐7) (range 0–21 points) with re‐evaluation at 90 days. Results: Of 148 participants enrolled (mean age = 27.3 years, range 12–72; 45% female), 62% were currently taking ASMs. For the 30 days pre‐enrolment, average seizure frequency was 3.2 (95%CI 2.3, 4.2); 28% of participants were seizure‐free. ASM regimens were modified for 95% of participants, mostly initiating levetiracetam (n = 115, 80% of modifications). 90‐day study retention was 76% (n = 113) among whom 87% reported full adherence to the ASM. After 90 days, the average seizure frequency over the prior 30 days was 1.5 (95%CI 0.5, 2.6), significantly lower than at baseline (p = 0.002). 66% were seizure‐free. At baseline, average PHQ‐9 score was 21.2 (95%CI [20.2, 22.2]), indicating severe depressive symptoms. Average GAD‐7 score was 16.5 [15.6, 17.4], indicating severe anxious symptoms. At 90‐days, average PHQ‐9 score was 17.5[16.4, 18.5] and significantly lower than baseline (p < 0.001). Average GAD‐7 score was 14.4 [13.6, 15.3] and significantly lower than baseline (p = 0.002). Seizure frequency was not correlated with PHQ‐9 nor GAD‐7 scores at baseline but was at 90 days for both PHQ‐9 (r = 0.24, p = 0.01) and GAD‐7 (r = 0.22, p = 0.02) scores. The prevalence of suicidal ideation dropped from 67% to 47% of participants (p = 0.004). Discussion: ASM management has dual importance for PLWE in resource‐limited settings, improving both seizure control and mental health. [ABSTRACT FROM AUTHOR]

Objectives: To summarise data on human immunodeficiency virus (HIV) services available to farmworkers in sub‐Saharan Africa (SSA). Methods: We conducted a systematic review to understand which HIV prevention and care services were accessed by farm workers in SSA. MEDLINE (PubMed), Embase, CINAHL (EBSCO Host), Cochrane library, African Index Medicus, Scopus, Google Scholar, Open Grey, and Web of Science Proceedings Citation Index were searched. Studies were eligible for inclusion if they measured or reported on the presence of HIV workplace policy frameworks, guidelines, or programmes for HIV prevention, treatment and care services, and other treatment modalities specifically targeting farmworkers. Results: Nine studies published between 2005 and 2019 were included in the review. Six themes emerged from included studies, which include HIV policy, HIV prevention (awareness, education, and condom supply), voluntary counselling and testing, antiretroviral therapy (ART), linkage to care, and mobile clinic. Though availability of an HIV policy was inadequate, a significant positive impact of the HIV policy in influencing behaviour change was reported. Most of the farm workers could access HIV education and condom supply in their places of work. Access to ART, treatment support, and linkage to care was inadequate, but community outreach programmes and mobile clinics showed success in reaching a high number of workers with HIV testing and treatment. A majority of farm workers faced barriers in accessing government health facilities. Conclusions: The findings suggest that there is poor access to HIV services for farmworkers in SSA. There is a dire need to scale up HIV services and programmes, including mobile health facilities, in agricultural settings. Due to high labour migration patterns among farmworkers, we recommend cross‐country HIV programmes that allow continuity of care across borders. [ABSTRACT FROM AUTHOR]

Objective: HIV risk prediction tools are a critical component of efforts to end the HIV pandemic. We aimed to create and validate tools for identifying individuals at highest risk of prevalent and incident HIV in an African setting. Methods: We used Logistic regression and Poisson regression to determine risk factors for HIV prevalence and incidence in a multi‐country HIV vaccine trial preparedness cohort study among individuals at high risk of HIV, and used the identified factors to create and validate tools that predict HIV risk. We also assessed the performance of the VOICE risk score in predicting HIV incidence among women in the cohort. Results: The prevalent HIV prediction tool created had good predictive ability [area under the curve (AUC) = 0.70, 95% CI 0.66–0.74]. It included the following participant variables: age, sex, recreational drug use, unprotected male‐to‐male anal sex, a sexual partner who had other partners, transactional sex and having a partner who was a long‐distance truck driver/miner. It was not possible to create a valid HIV incidence prediction tool. Participants with high VOICE risk scores (≥7) had slightly higher HIV incidence but this tool performed poorly within our study (AUC = 0.58, 95% CI 0.51–0.64: Harrell's concordance index = 0.59). Conclusion: We created a prevalent HIV prediction tool that could be used to increase efficiency in diagnosis of HIV and linkage to care in sub‐Saharan Africa. Existing incident HIV prediction tools may need modification to include context‐specific predictors such as calendar period, participant occupation, study site, before adoption in settings different from those in which they were developed. [ABSTRACT FROM AUTHOR]

Objectives: Men in sub‐Saharan Africa (SSA) have lower rates of antiretroviral therapy (ART) initiation and higher rates of early default than women. Little is known about effective interventions to improve men's outcomes. We conducted a scoping review of interventions aimed to increase ART initiation and/or early retention among men in SSA since universal treatment policies were implemented. Methods: Three databases, HIV conference databases and grey literature were searched for studies published between January 2016 to May 2021 that reported on initiation and/or early retention among men. Eligibility criteria included: participants in SSA, data collected after universal treatment policies were implemented (2016–2021), quantitative data on ART initiation and/or early retention for males, general male population (not exclusively focused on key populations), intervention study (report outcomes for at least one non‐standard service delivery strategy), and written in English. Results: Of the 4351 sources retrieved, 15 (reporting on 16 interventions) met inclusion criteria. Of the 16 interventions, only two (2/16, 13%) exclusively focused on men. Five (5/16, 31%) were randomised control trials (RCT), one (1/16, 6%) was a retrospective cohort study, and 10 (10/16, 63%) did not have comparison groups. Thirteen (13/16, 81%) interventions measured ART initiation and six (6/16, 37%) measured early retention. Outcome definitions and time frames varied greatly, with seven (7/16, 44%) not specifying time frames at all. Five types of interventions were represented: optimising ART services at health facilities, community‐based ART services, outreach support (such as reminders and facility escort), counselling and/or peer support, and conditional incentives. Across all intervention types, ART initiation rates ranged from 27% to 97% and early retention from 47% to 95%. Conclusions: Despite years of data of men's suboptimal ART outcomes, there is little high‐quality evidence on interventions to increase men's ART initiation or early retention in SSA. Additional randomised or quasi‐experimental studies are urgently needed. [ABSTRACT FROM AUTHOR]

Objective: HIV stigma and discrimination is widespread in sub‐Saharan Africa and is associated with poor clinical outcomes. Schools play a critical role in the life of youth and have been identified as a potentially stigmatising environment. We sought to explore school HIV stigma drivers, facilitators, manifestations and outcomes among youth living with HIV (YLH) as well as potential stigma reduction interventions in Kenya. Methods: Semi‐structured in‐depth qualitative interviews with 28 school‐attending YLH aged 14–19 years and 24 caregivers of YLH were analysed using directed content analysis. Results were summarised using the Health and Stigma Framework. Results: Drivers and facilitators of HIV stigma in the school environment included misconceptions about HIV transmission, HIV treatment outcomes and long‐term overall health of people living with HIV. HIV stigma manifested largely as gossip, isolation and loss of friendships. Fear of HIV stigma or experienced stigma resulted in poor adherence to antiretroviral treatment—particularly among YLH in boarding schools—and poor mental health. Stigma also impacted school choice (boarding vs. day school) and prevented HIV disclosure to schools which was necessary for optimal support for care. Proposed interventions to address HIV stigma in schools included HIV education, psychosocial support for YLH, support for HIV disclosure to schools while ensuring confidentiality and building YLH resilience. Conclusion: There is an urgent need to develop interventions to address HIV stigma in schools to ensure optimised health and social outcomes for YLH. Future studies to understand the most effective and efficient interventions are needed. [ABSTRACT FROM AUTHOR]

Objectives: To document the prevalence of impaired glucose tolerance (IGT) and undiagnosed diabetes mellitus (DM) and to identify factors associated with undiagnosed DM in people living with HIV (PLWH). Methods: Cross‐sectional study performed at Ndlovu Medical Center, Limpopo, South Africa including PLWH aged ≥18 years. Between August and November 2017, 356 HIV‐positive participants were included. Information was collected on socio‐demographics, DM symptoms and risk factors for DM. IGT and DM were diagnosed using random plasma glucose and/or HbA1c. Factors associated with undiagnosed DM were assessed by comparing participants with newly diagnosed DM to participants without DM. Results: IGT was diagnosed in 172 (48.3%) participants. Twenty‐nine (8.1%) participants met the definition of DM, of whom 17 (58.6%) were newly diagnosed. Compared to participants without DM, participants with DM were on average 5 years older, were more likely to have a positive family history for DM, were less physically active and had higher systolic blood pressure, body mass index and waist circumference. Factors associated with undiagnosed DM included age ≥45 years (odds ratio [OR] = 3.59) and physical inactivity (OR = 3.17). Conclusions: The prevalence of IGT and DM among PLWH is high and more than half of DM cases were undiagnosed. Regular screening for DM in PLWH is recommended, especially in an ageing population with additional cardiovascular disease risk factors. [ABSTRACT FROM AUTHOR]

Objective: Optimising antibiotic use is important to limit increasing antibiotic resistance. In rural Burkina Faso, over‐the‐counter dispensing of antibiotics in community pharmacies and non‐licensed medicine retail outlets facilitates self‐medication. We investigated its extent, reasons and dispensing patterns. Methods: In an exploratory mixed‐method design conducted between October 2020 and December 2021, this study first explored illness perceptions, the range of healthcare providers in communities, antibiotics knowledge and reasons for seeking healthcare outside healthcare facilities. Second, frequencies of illness and healthcare utilisation in the last 3 months were quantitatively measured. Results: Participants distinguished between natural and magico‐religious illnesses, according to origins. For illnesses considered to be 'natural', healthcare was mainly sought at healthcare facilities, private pharmacies and informal drug outlets. For illnesses considered as magico‐religious, traditional healers were mainly visited. Antibiotics were perceived in the community as medicines similar to painkillers. Healthcare‐seeking outside healthcare facilities was reported by 660/1973 (33.5%) participants reporting symptoms, including 315 (47.7%) to informal vendors. Healthcare seeking outside facilities was less common for 0–4‐year‐olds (58/534, 10.9% vs. 379/850, 44.1% for ≥5‐year‐olds) and decreased with improving socio‐economic status (108/237, 45.6% in the lowest quintile; 96/418, 23.0% in the highest). Reported reasons included financial limitation, and also proximity to informal drug vendors, long waiting times at healthcare facilities, and health professionals' non‐empathetic attitudes towards their patients. Conclusion: This study highlights the need to facilitate and promote access to healthcare facilities through universal health insurance and patient‐centred care including reducing patients' waiting time. Furthermore, community‐level antibiotic stewardship programmes should include community pharmacies and informal vendors. [ABSTRACT FROM AUTHOR]

The advent and use of antimicrobials have played a key role in treating potentially life‐threatening infectious diseases, improving health, and saving the lives of millions of people worldwide. However, the emergence of multidrug resistant (MDR) pathogens has been a significant health challenge that has compromised the ability to prevent and treat a wide range of infectious diseases that were once treatable. Vaccines offer potential as a promising alternative to fight against antimicrobial resistance (AMR) infectious diseases. Vaccine technologies include reverse vaccinology, structural biology methods, nucleic acid (DNA and mRNA) vaccines, generalised modules for membrane antigens, bioconjugates/glycoconjugates, nanomaterials and several other emerging technological advances that are offering a potential breakthrough in the development of efficient vaccines against pathogens. This review covers the opportunities and advancements in vaccine discovery and development targeting bacterial pathogens. We reflect on the impact of the already‐developed vaccines targeting bacterial pathogens and the potential of those currently under different stages of preclinical and clinical trials. More importantly, we critically and comprehensively analyse the challenges while highlighting the key indices for future vaccine prospects. Finally, the issues and concerns of AMR for low‐income countries (sub‐Saharan Africa) and the challenges with vaccine integration, discovery and development in this region are critically evaluated. [ABSTRACT FROM AUTHOR]

Objective: Sexually transmitted infections (STIs), including syphilis, chlamydia, gonorrhoea and trichomoniasis, are of global public health concern. While STI incidence rates in sub‐Saharan Africa are high, longitudinal data on incidence and recurrence of STIs are scarce, particularly in rural areas. We determined the incidence rates of curable STIs in HIV‐negative women during 96 weeks in a rural South African setting. Methods: We prospectively followed participants enrolled in a randomised controlled trial to evaluate the safety and efficacy of a dapivirine‐containing vaginal ring for HIV prevention in Limpopo province, South Africa. Participants were included if they were female, aged 18–45, sexually active, not pregnant and HIV‐negative. Twelve‐weekly laboratory STI testing was performed during 96 weeks of follow‐up. Treatment was provided based on vaginal discharge by physical examination or after a laboratory‐confirmed STI. Results: A total of 119 women were included in the study. Prevalence of one or more STIs at baseline was 35.3%. Over 182 person‐years at risk (PYAR), a total of 149 incident STIs were diagnosed in 75 (65.2%) women with incidence rates of 45.6 events/PYAR for chlamydia, 27.4 events/100 PYAR for gonorrhoea and 8.2 events/100 PYAR for trichomoniasis. Forty‐four women developed ≥2 incident STIs. Risk factors for incident STI were in a relationship ≤3 years (adjusted hazard ratio [aHR]: 1.86; 95% confidece interval [CI]: 1.04–2.65) and having an STI at baseline (aHR: 1.66; 95% CI: 1.17–2.96). Sensitivity and specificity of vaginal discharge for laboratory‐confirmed STI were 23.6% and 87.7%, respectively. Conclusion: This study demonstrates high STI incidence in HIV‐negative women in rural South Africa. Sensitivity of vaginal discharge was poor and STI recurrence rates were high, highlighting the shortcomings of syndromic management in the face of asymptomatic STIs in this setting. [ABSTRACT FROM AUTHOR]

Objective: Diabetes prevalence has risen rapidly in Sub‐Saharan Africa, but rates of retention in diabetes care are poorly understood. We conducted a systematic review and meta‐analysis to determine rates of retention in care of persons with type 2 diabetes. Methods: We searched MEDLINE, Global Health and CINAHL online databases for cohort studies and randomised control trials (RCTs) published up to 12 October 2021, that reported retention in or attrition from care for patients with type 2 diabetes in Sub‐Saharan Africa. Retention was defined as persons diagnosed with diabetes who were alive and in care or with a known outcome, while attrition was defined as loss from care. Results: From 6559 articles identified, after title and abstract screening, 209 articles underwent full text review. Forty six papers met the inclusion criteria, comprising 22,610 participants. Twenty one articles were of RCTs of which 8 trials had 1 year or more of follow‐up and 25 articles were of non‐randomised studies of which 19 had 12 months or more of follow‐up. A total of 11 studies (5 RCTs and 6 non‐randomised) were assessed to be of good quality. Sixteen RCTs were done in secondary or tertiary care settings. Their pooled retention rate (95% CI) was 80% (77%, 84%) in the control arm. Four RCTs had been done in primary care settings and their pooled retention rate (95% CI) was 53% (45%, 62%) in the control arm. The setting of one trial was unclear. For non‐randomised studies, retention rates (95% CI) were 68% (62%, 75%) among 19 studies done in secondary and tertiary care settings, and 40% (33%, 49%) among the 6 studies done in primary care settings. Conclusion: Rates of retention in care of people living with diabetes are poor in primary care research settings. [ABSTRACT FROM AUTHOR]

Objectives: This cross‐sectional survey aimed to explore associations between age of menarche, early sexual debut and high‐risk sexual behaviour among urban Tanzanian schoolgirls. Methods: Secondary schoolgirls aged 17–18 years from Mwanza, Tanzania, participated in structured face‐to‐face questionnaire‐based interviews, conducted by nurses and clinicians. Age of menarche was evaluated in categories of 11–12, 13–14, 15–16 or ≥17 years. Primary outcome measures were self‐reported early sexual debut (first vaginal sex at <16 years) and high‐risk sexual behaviour, including non‐use of condoms, having sex for gifts/money, having older sexual partners and/or other risky behaviours. Results: Of 401 girls enrolled, 174 (43.4%) reported prior vaginal sex. Prevalence of early sexual debut was 14.2% but pressured/forced sex and risky sexual behaviours were common. Adjusted for potential confounding, younger age at menarche was associated with early sexual debut (adjusted odds ratio for linear trend: 1.88 per category, 95% confidence interval: 1.21–2.92, p = 0.005). This association remained after excluding girls with first sex at <8 years or experiencing pressure or force at first sex. Further, adjusted for potential confounding (including ever experiencing forced sex), early sexual debut was associated with high‐risk sexual behaviour (adjusted odds ratio: 2.85, 95% confidence interval: 1.38–5.88, p = 0.004). Conclusions: Among urban Tanzanian school girls, younger age of menarche was associated with early sexual debut, and early sexual debut was associated with high‐risk sexual behaviour. Researchers and public health professionals developing and delivering interventions aimed at preventing adverse sexual health outcomes should consider the impact of these early biological and sexual exposures. [ABSTRACT FROM AUTHOR]

Background: Achievement of ISO15189 accreditation demonstrates competency of a laboratory to conduct testing. Three programmes were developed to facilitate achievement of accreditation in low‐ and middle‐income countries: Strengthening Laboratory Management Towards Accreditation (SLMTA), Stepwise Laboratory Improvement Process Towards Accreditation (SLIPTA) and Laboratory Quality Stepwise Implementation (LQSI). Objective: To determine the level of accreditation and associated barriers and facilitators among medical laboratories in the WHO‐AFRO region by 2020. Methods: A desk review of SLIPTA and SLMTA databases was conducted to identify ISO15189‐accredited medical laboratories between January 2013 and December 2020. Data on access to the LQSI tool were extracted from the WHO database. Facility and country characteristics were collected for analysis as possible enablers of accreditation. The chi‐square test was used to analyse differences with level of significance set at <0.05. Results: A total of 668 laboratories achieved accreditation by 2020 representing a 75% increase from the number in 2013. Accredited laboratories were mainly in South Africa (n = 396; 55%) and Kenya (n = 106; 16%), two countries with national accreditation bodies. About 16.9% (n = 113) of the accredited laboratories were registered for the SLIPTA programme and 26.6% (n = 178) for SLMTA. Approximately 58,217 LQSI users were registered by December 2020. Countries with a higher UHC index for access to HIV care and treatment, higher WHO JEE scores for laboratory networks, a larger number of registered LQSI users, with national laboratory policy/strategic plans and PEPFAR‐priority countries were more likely to have an accredited laboratory. Of the 475 laboratories engaged in the SLIPTA programme, 154 attained ≥4 SLIPTA stars (ready to apply for accreditation) and 113 achieved ISO 15189 accreditation, with 96 enrolled into the SLMTA programme. Lower‐tier laboratories were less likely to achieve accreditation than higher‐tier laboratories (7.7% vs. 30%) (p < 0.001). The probability of achieving ISO 15189 accreditation (19%) was highest during the first 24 months after enrolment into the SLIPTA programme. Conclusion: To sustainably anchor quality improvement initiatives at facility level, national approaches including access to a national accreditation authority, adoption of national quality standards and regulatory frameworks are required. [ABSTRACT FROM AUTHOR]

Objectives: Next to monitoring the clinical health of people living with HIV through the triple 90 targets, a 4th 90 target was proposed in 2016 to improve HIV health-related quality of life (HrQoL) by addressing comorbidities and other psychosocial challenges. This scoping review aimed at understanding related psychosocial determinants, including strategies to improve HrQoL for people living with HIV in sub-Saharan Africa (SSA), as an initiative to ameliorate the continuum of care.Methods: This scoping review followed PRISMA guidelines. We searched PubMed and Wiley databases from 01 January 2011 to 19 April 2021 for articles on HrQoL, including determinants and related interventions in SSA. We also conducted a manual search to retrieve grey literature on the '4th 90' target. The six domains of HrQoL defined in the most widely used instrument (i.e., WHOQOL-HIV-BREF tool) served as a guiding framework.Results: Thirty-three articles were included for analysis. Seven articles illustrated the ongoing debate on the 4th 90 target, highlighting challenges with measuring indicators. Nine articles discussed HrQoL domains, reporting the highest scores in the spirituality and physical domains and lowest scores in the social and environmental domains. The presence of stigma and depressive symptoms was associated with low HrQoL. Seventeen articles discussed HrQoL interventions, highlighting that improved HrQoL enhanced health-seeking behaviour. Only two interventions addressed the environmental domain highlighting the fact that selection of intervention aims were not evidence led.Conclusion: Introducing the 4th 90 target in SSA as a strategy to enhance HrQoL amongst people living with HIV could improve the HIV continuum of care; however, efforts are required to effectively address environmental and structural determinants. [ABSTRACT FROM AUTHOR]

Background: Ethics review preparedness is a major foundation for national effective response to public health emergencies, because it promotes pertinent research and enhances the protection of research participants and communities. In low-income countries, it can also promote equitable research partnership. However, most relevant literature is in English and not easily accessible for the members of research ethics committees in French-speaking African countries.Methods: A training module in French, addressing the issue of research ethics review during outbreaks and other public health emergencies, was designed based on a non-systematic literature review, and in order to be complementary to the Democratic Republic of Congo (DRC) national guidelines for ethics review. The module was administered to 42 members of the five ethics committees in DRC that expressed their interest for the training.Result: This training, co-designed with local stakeholders, in the local working language and taking into account local circumstances and regulation, provided participants with up-to-date insights of research ethics (and research ethics preparedness) in public health emergencies. It resulted in rich reflection and knowledge-sharing on good practices across the ethics committees.Conclusion: As most participating ethics committees do not have yet explicit standard operating procedures for expedited review of protocols submitted in emergency situations, this would be a next important step to facilitate emergency reviews in the most efficient way. [ABSTRACT FROM AUTHOR]

Objectives: To assess antiretroviral therapy (ART) coverage among pregnant women living with HIV and compare the characteristics of women who received and did not receive ART during pregnancy in Zambia.Methods: A cross-sectional study was conducted at urban and rural health facilities in Southern Province, Zambia, from 2016 to 2019. Pregnant women living with HIV delivering at study sites were enrolled and administered a questionnaire, and the results of infant diagnostic testing for HIV at birth was documented.Results: About 1184 mother/infant pairs were enrolled. ART coverage was 93.7%. Most women who did not receive ART during pregnancy reported HIV diagnosis at delivery (18.0%) or during pregnancy (57.7%). The primary reported reason for not receiving ART was not wanting to take the drugs. Women who did not receive ART during pregnancy were significantly younger, less likely to have disclosed their HIV-infection status to others, and less likely to have received antenatal care than women who received ART. ART use correlated with higher levels of education in urban but not rural sites. Overall, 1.0% of infants were infected with HIV at birth, including 0.8% of infants born to women who received ART and 4.1% of infants born to women who did not.Conclusions: Most women received ART according to guidelines, resulting in low perinatal transmission rates of HIV to infants. Efforts to increase ART coverage and prevent vertical transmission should focus on identifying incident HIV infections during pregnancy and strengthening counselling for newly diagnosed pregnant women. [ABSTRACT FROM AUTHOR]

Objectives: First, to describe the implementation process, benefits and challenges of a multidisciplinary service for pregnant women with cardiac disease in Namibia. Second, to assess pregnancy outcomes in this population.Methods: In a tertiary hospital in Namibia, a multidisciplinary service was implemented by staff of obstetric and cardiology departments and included preconception counselling, provision of antenatal care and reliable contraception. Management guidelines developed for high-income settings were used, since no locally adapted guidelines were available. A cohort study was performed to assess cardiac, obstetric and fetal outcomes. Included were pregnant women with cardiac disease, referred to this service between 1 August 2016 and 31 July 2018.Results: Important benefits of this service were the integrated approach, improved access to reliable contraception and insight into drivers of poor outcome. Several challenges with use of available guidelines were encountered, as contextual factors specific to lower-income settings were not taken into consideration, such as higher rates of infection or barriers to access care. The cohort consisted of 65 women. Cardiac disease was diagnosed for the first time in 16 (24.6%) women, of whom 11 had pre-existing cardiac disease. These women presented more often with heart failure than women with known heart disease (75.0% vs. 6.1%, RR 12.5, 95% CI 3.9-38.0). Five women died. Cardiac events occurred in twenty-two women of whom eight developed thromboembolic events and two endocarditis. The majority had no indication for prophylaxis, based on available guidelines. Fetal events occurred in 36 pregnancies. After pregnancy more than half of women (35/65, 53.8%) were using long-acting reversible contraception.Conclusions: Despite several barriers, it was possible to implement a multidisciplinary service in a high-burden setting. Cardiac and fetal event rates in this cohort were high. To improve outcomes the focus should be on availability of context-specific guidelines and better detection of cardiac disease. [ABSTRACT FROM AUTHOR]

Sub-Saharan Africa (SSA) has the fastest growing adolescent population in the world. In addition to developmental changes, adolescents in SSA face health and socioeconomic challenges that increase their vulnerability to mental ill-health. This paper is a narrative review of adolescent mental health (AMH) in SSA with a focus on past achievements, current developments, and future directions in the areas of research, practice and policy in the region. We describe the status of AMH in the region, critical factors that negatively impact AMH, and the ways in which research, practice and policy have responded to this need. Depression, anxiety and post-traumatic stress disorders are the most common mental health problems among adolescents in SSA. Intervention development has largely been focused on HIV/AIDS service delivery in school or community programs by non-specialist health workers. There is a severe shortage of specialised AMH services, poor integration of services into primary health care, lack of a coordinated inter-sectoral collaboration, and the absence of clear referral pathways. Policies for the promotion of AMH have been given less attention by policymakers, due to stigma attached to mental health problems, and an insufficient understanding of the link between mental health and social determinants, such as poverty. Given these gaps, traditional healers are the most accessible care available to help-seeking adolescents. Sustained AMH research with a focus on the socioeconomic benefits of implementing evidence-based, contextually adapted psychosocial interventions might prove useful in advocating for much needed policies to improve AMH in SSA. [ABSTRACT FROM AUTHOR]

Objectives: Sex work sites have been hypothesised to be at the root of the observed heterogeneity in HIV prevalence in sub‐Saharan Africa. We determined if proximity to sex work sites is associated with HIV prevalence among the general population in Zimbabwe, a country with one of the highest HIV prevalence in the world. Methods: In this cross‐sectional study we use a unique combination of nationally representative geolocated individual‐level data from 16,121 adults (age 15–49 years) from 400 sample locations and the locations of 55 sex work sites throughout Zimbabwe; covering an estimated 95% of all female sex workers (FSWs). We calculated the shortest distance by road from each survey sample location to the nearest sex work site, for all sites and by type of sex work site, and conducted univariate and multivariate multilevel logistic regressions to determine the association between distance to sex work sites and HIV seropositivity, controlling for age, sex, male circumcision status, number of lifetime sex partners, being a FSW client or being a stable partner of an FSW client. Results: We found no significant association between HIV seroprevalence and proximity to the nearest sex work site among the general population in Zimbabwe, regardless of which type of site is closest (city site adjusted odds ratio [aOR] 1.010 [95% confidence interval {CI} 0.992–1.028]; economic growth point site aOR 0.982 [95% CI 0.962–1.002]; international site aOR 0.995 [95% CI 0.979–1.012]; seasonal site aOR 0.987 [95% CI 0.968–1.006] and transport site aOR 1.007 [95% CI 0.987–1.028]). Individual‐level indicators of sex work were significantly associated with HIV seropositivity: being an FSW client (aOR 1.445 [95% CI 1.188–1.745]); nine or more partners versus having one to three lifetime partners (aOR 2.072 [95% CI 1.654–2.596]). Conclusions: Sex work sites do not seem to directly affect HIV prevalence among the general population in surrounding areas. Prevention and control interventions for HIV at these locations should primarily focus on sex workers and their clients, with special emphasis on including and retaining mobile sex workers and clients into services. [ABSTRACT FROM AUTHOR]

OBJECTIVES: The objective was to compare COVID‐19 outcomes in the Omicron‐driven fourth wave with prior waves in the Western Cape, assess the contribution of undiagnosed prior infection to differences in outcomes in a context of high seroprevalence due to prior infection and determine whether protection against severe disease conferred by prior infection and/or vaccination was maintained. METHODS: In this cohort study, we included public sector patients aged ≥20 years with a laboratory‐confirmed COVID‐19 diagnosis between 14 November and 11 December 2021 (wave four) and equivalent prior wave periods. We compared the risk between waves of the following outcomes using Cox regression: death, severe hospitalisation or death and any hospitalisation or death (all ≤14 days after diagnosis) adjusted for age, sex, comorbidities, geography, vaccination and prior infection. RESULTS: We included 5144 patients from wave four and 11,609 from prior waves. The risk of all outcomes was lower in wave four compared to the Delta‐driven wave three (adjusted hazard ratio (aHR) [95% confidence interval (CI)] for death 0.27 [0.19; 0.38]. Risk reduction was lower when adjusting for vaccination and prior diagnosed infection (aHR: 0.41, 95% CI: 0.29; 0.59) and reduced further when accounting for unascertained prior infections (aHR: 0.72). Vaccine protection was maintained in wave four (aHR for outcome of death: 0.24; 95% CI: 0.10; 0.58). CONCLUSIONS: In the Omicron‐driven wave, severe COVID‐19 outcomes were reduced mostly due to protection conferred by prior infection and/or vaccination, but intrinsically reduced virulence may account for a modest reduction in risk of severe hospitalisation or death compared to the Delta‐driven wave. [ABSTRACT FROM AUTHOR]

Objectives: Person‐centred care (PCC) meets the needs of individuals by increasing convenience, providing supportive and culturally appropriate services to diverse populations, and engaging families, communities, and stakeholders in planning and provision of care. While the evidence demonstrates that PCC approaches can lead to clinical improvements across the HIV care continuum, it is not yet well defined in the context of HIV service delivery. Methods: A systematic review was conducted to define PCC practices for HIV treatment services in health facilities in sub‐Saharan Africa. Data synthesis led to the development of a PCC framework including domain and sub‐domain development. The study team used the Effective Public Health Project Practice tool for quantitative studies to assess the quality of the included studies. Results: Thirty‐one studies from 12 countries met the inclusion criteria, including 56,586 study participants (females 42%–100% and males 0%—58%), resulting in three major domains and 11 sub‐domains. These include staffing (sub‐domains of composition, availability, and competency); service delivery standards (sub‐domains of client feedback mechanisms; service efficiency and integration; convenience and access; and digital health worker support tools); and direct client support services (sub‐domains of psychosocial services, logistics support, client‐agency, and digital client support tools). Twenty‐five of the person‐centred interventions within these domains resulted in improvements in linkage to care, treatment retention, and/or viral suppression. Conclusions: The PCC framework can help to provide a more consistent classification of HIV treatment interventions and will support improved assessment of these interventions to ensure that people receive personalised care. [ABSTRACT FROM AUTHOR]

Objective: The objective of the study was to review the evidence on interventions to improve obstetric emergency referral decision making, communication and feedback between health facilities in sub‐Saharan Africa (SSA). Methods: A systematic search of PubMed, Embase, Cochrane Register and CINAHL Plus was conducted to identify studies on obstetric emergency referral in SSA. Studies were included based on pre‐defined eligibility criteria. Details of reported referral interventions were extracted and categorised. The Joanna Biggs Institute Critical Appraisal checklists were used for quality assessment of included studies. A formal narrative synthesis approach was used to summarise findings guided by the WHO's referral system flow. Results: A total of 14 studies were included, with seven deemed high quality. Overall, 7 studies reported referral decision‐making interventions including training programmes for health facility and community health workers, use of a triage checklist and focused obstetric ultrasound, which resulted in improved knowledge and practice of recognising danger signs for referral. 9 studies reported on referral communication using mobile phones and referral letters/notes, resulting in increased communication between facilities despite telecommunication network failures. Referral decision making and communication interventions achieved a perceived reduction in maternal mortality. 2 studies focused on referral feedback, which improved collaboration between health facilities. Conclusion: There is limited evidence on how well referral interventions work in sub‐Saharan Africa, and limited consensus regarding the framework underpinning the expected change. This review has led to the proposition of a logic model that can serve as the base for future evaluations which robustly expose the (in)efficiency of referral interventions. [ABSTRACT FROM AUTHOR]

Objectives: People with diabetes mellitus (DM) have a higher tuberculosis (TB) risk, but the evidence from sub‐Saharan Africa (SSA) was scarce until recently and not included in earlier global summaries. Therefore, this systematic review aims to determine the risk of active TB disease among people with DM in SSA and whether HIV alters this association. Methods: Medline, Embase, CINAHL, Web of Science, Global Health and African Index Medicus were searched between January 1980 and February 2021. Cohort, case‐control and cross‐sectional studies from SSA, which assessed the association between DM and active TB, were included if adjusted for age. Two researchers independently assessed titles, abstracts, full texts, extracted data and assessed the risk of bias. Estimates for the association between DM and TB were summarised using a random effects meta‐analysis. PROSPERO: CRD42021241743. Results: Nine eligible studies were identified, which reported on 110,905 people from 5 countries. Individual study odds ratios (OR) of the TB–DM association ranged from 0.88 (95% CI 0.17–4.58) to 10.7 (95% CI 4.5–26). The pooled OR was 2.77 (95% CI 1.90–4.05). High heterogeneity was reduced in sensitivity analysis (from I2 = 57% to I2 = 6.9%), by excluding one study which ascertained DM by HbA1c. Risk of bias varied widely between studies, especially concerning the way in which DM status was determined. Conclusions: There is a strong positive association between DM and active TB in SSA. More research is needed to determine whether HIV, a key risk factor for TB in SSA, modifies this relationship. [ABSTRACT FROM AUTHOR]

Objective: User experience is an important aspect of quality of care that is highly valued by patients. However, there are currently no validated tools for measuring user experience among caregivers of sick children in low‐ and middle‐income countries. We aimed to develop and validate a measure of user experience in this population in primary healthcare facilities in rural Tanzania, where major quality improvement efforts to date have not included a large focus on user experience. We then aimed to describe variation in user experience between and within facilities. Methods: Informed by theory and formative qualitative research, we developed questions to measure user experience across three domains: prompt care, respect, and communication. We then conducted interviewer‐administered surveys with caregivers of sick children. Using survey data, we conducted psychometric analyses to inform the development of a composite measure of user experience. Finally, we used multilevel models to describe variation in user experience and examine associations with facility, patient, and caregiver characteristics. Results: Surveys were completed by 1085 caregivers across 75 facilities. In exploratory factor analysis, user experience items did not group according to theoretical domains. We therefore assessed items individually and designed a single 8‐item additive measure of user experience. Using this composite measure, and adjusting for differences in case mix across facilities, we found that 69% of variation in user experience was within facilities and 31% was between facilities. Smaller facility size and more caregiver education were positively associated with user experience. Conclusions: We found that user experience varied significantly across health facilities in rural Tanzania, highlighting opportunities for improvement. Measurement tools are needed to inform efforts to improve user experience and monitor changes over time. The scale developed in this study could serve as a starting point for the measurement of user experience among caregivers in similar settings. [ABSTRACT FROM AUTHOR]

Objective: To investigate whether maternal common mental disorders (CMD) in the postnatal period are prospectively associated with child development at 2.5 and 3.5 years in a rural low‐income African setting. Methods: This study was nested within the C‐MaMiE (Child outcomes in relation to Maternal Mental health in Ethiopia) population‐based cohort in Butajira, Ethiopia, and conducted from 2005 to 2006. The sample comprised of 496 women who had recently given birth to living, singleton babies with recorded birth weight measurements, who were 15 to 44 years of age, and residing in six rural sub‐districts. Postnatal CMD measurements were ascertained 2 months after delivery. Language, cognitive, and motor development were obtained from the child 2.5 and 3.5 years after birth using a locally adapted version of the Bayley Scales of Infant Development (3rd Ed). Maternal CMD symptoms were measured using a locally validated WHO Self‐Reporting Questionnaire. A linear mixed‐effects regression model was used to analyze the relationship between postnatal CMD and child development. Results: After adjusting for confounders, there was no evidence for an association between postnatal CMD and overall child development or the cognitive sub‐domain in the preschool period. There was no evidence of effect modification by levels of social support, socioeconomic status, stunting, or sex of the child. Conclusions: Previous studies from predominantly urban and peri‐urban settings in middle‐income countries have established a relationship between maternal CMD and child development, which contrasts with the findings from this study. The risk and protective factors for child development may differ in areas characterized by high social adversity and food insecurity. More studies are needed to investigate maternal CMD's impact on child development in low‐resource and rural areas. [ABSTRACT FROM AUTHOR]

Objectives: The contribution of African authors to the biomedical literature is small. We evaluated the African and non‐African scientific production published in the international literature on the COVID‐19 in Africa during the first year of the epidemic (2020). Methods: Papers on COVID‐19 in Africa were extracted from the Medline (PubMed) database for bibliometric analysis including the proportions of three leading and last authors by study type, study country, authors' and laboratories/institutions' countries of affiliation and journal ranking. Results: A total of 160 articles fulfilling the inclusion criteria were analysed. The majority (91.3%) was produced by half (53.7%) of African countries, with important regional disparities, and generally without sources of funding mentioned. The majority (>85.0) of authors in lead positions (first, second, third and last authors) were Africans. Only a small number (8.7%) of studies on COVID‐19 in Africa were carried out by laboratories not on the African continent (mainly Europe, USA and China) and generally received funding. The last and first authors were more frequently of non‐African origin in journals with an Impact Factor ranking ≥1, and more frequently of African origin in journals with a lower ranking (< 1). The first and last non‐African authors tended to report their studies in high ranking ≥1 journals. Conclusions: Our study demonstrates that the emergence of promising African research capable of publishing in indexed but low‐impact factor medical journals and reveals the persistence of a North‐South asymmetry in international cooperation in biomedical research with Africa. [ABSTRACT FROM AUTHOR]

Objective: Incident HIV infections in pregnant and breastfeeding mothers pose significant challenges to prevention of mother‐to‐child HIV transmission efforts in sub‐Saharan Africa. We identified the predictors of willingness to self‐test for HIV when retesting in pregnancy and postpartum among antenatal clients in a tertiary hospital in Northern Nigeria. Methods: Structured and validated questionnaires were administered to a cross section of antenatal attendees (n = 370) in March 2021. Willingness to self‐test and adjusted odds ratios of potential predictors were generated from logistic regression models. Results: Of the 317 respondents who agreed to repeat HIV test during pregnancy, 29.3% (n = 93) were willing to self‐test. Similarly, of those (n = 350) willing to retest after delivery, 27.4% (n = 96) were willing to self‐test. Willingness to self‐test during pregnancy was higher among respondents who were multiparous (2–4 births) (adjusted odds ratio, aOR = 2.40, 95% confidence interval CI, 1.14–6.43), employed (aOR = 1.49, 95% CI, 1.13–4.53) and those with at least secondary education (aOR = 2.96, 95% CI, 1.43–11.47). In contrast, willingness to self‐test was lower among those who were unaware of the husband's HIV status (aOR = 0.05, 95% CI, 0.02–0.13). Willingness to self‐test after delivery was higher among respondents who were married (aOR = 15.41, 95% CI, 3.04–78.2), multiparous (aOR = 2.01, 95% CI, 1.27–5.63), employed (aOR = 1.59, 95% CI, 1.08–2.35) and had at least to secondary education (aOR = 6.12, 95% CI, 1.36–27.47). In contrast, willingness to self‐test postpartum was lower among those who booked late (≥29 weeks) (aOR = 0.11, 95% CI, 0.022–0.52), those who were unaware of the risk of HIV transmission during breastfeeding (aOR = 0.29, 95% CI, 0.12–0.68) and participants who were unaware of the husband's HIV status (aOR = 0.076, 95% CI, 0.03–0.19). Conclusion: Willingness to self‐test for HIV in pregnancy and postpartum was low in this population and was influenced by risk perception, socio‐demographic and obstetric attributes. Communication interventions and training of potential mentor mothers among early adopters could improve self‐testing in this group and similar settings. [ABSTRACT FROM AUTHOR]

Objectives: Existing health services for young people (YP)(10–24 years), which are predominantly designed for but not with young people, often do not meet YP's needs. The 2018 Global Consensus Statement on meaningful adolescent and youth engagement affirms that YP have a fundamental right to actively and meaningfully engage in all matters that affect their lives. We present four case studies from three countries in sub‐Saharan Africa as practical examples of the engagement of young people as partners in health research. We critically reflect on best practices to inform and guide the increasing adoption of collaborative approaches. Methods: We developed a narrative summary of each case study through review of study documentation and discussions with research staff and young people. A youth engagement framework was used to describe partnership activities according to the following dimensions: purpose, process, positioning, perspective, power relations, place and protection. We reflected on innovative practices used, overall level of participation achieved and strategies to address ethical, logistical and/or financial barriers. Results: In all case studies, we found evidence of engagement activities that aligned with the Global Consensus Statement on Meaningful Youth Engagement. However, access to participation was often uneven and despite efforts, marginalised young people continue to have insufficient opportunities to engage. Furthermore, although young people had some opportunity to influence the research methods, many of the key design decisions had been determined prior to their involvement. In our case studies, researchers had built in insufficient opportunities to evaluate the level and impact of youth engagement. Conclusions: We therefore recommend early involvement of young people in the research process so that they can contribute to setting the research agenda, the design of planned studies and thus increase the scope of their engagement from the beginning. Youth engagement activities need to be evaluated from the perspective of all stakeholders including young people themselves with a focus on opportunities to engage, the level of engagement achieved and impact of engagement. From the beginning, researchers should provide space for learning, and involve young people in encouraging critical reflection of what does not yet work, as well as what does, to enable improvements. [ABSTRACT FROM AUTHOR]

Objective: We aimed to determine the associations of non‐alcoholic fatty liver disease (NAFLD) with cardio‐metabolic risk factors for diabetes in adult Kenyans. Methods: A cross‐sectional study was undertaken among rural and urban Kenyans of different ethnic origin. Ultrasonography scanning (USS) methods were used for the assessment of hepatic fat accumulation for NAFLD assessment and abdominal fat distribution, and simple anthropometry measurements were performed. All participants underwent a 2‐h oral glucose tolerance test, and biochemical, haemodynamic and lifestyle data were obtained. Multivariate logistic regression analyses were used to assess sex, age, residency and ethnic differences in the association between NAFLD and various metabolic parameters. Results: In total, 743 individuals (59.1% women) with a mean age of 38.0 (range 18–68) years participated in the study. Overall, 118 individuals (15.9%) had NAFLD, of whom 94.1% had mild steatosis. Age >40 years was significantly associated with having NAFLD compared with <30 years of age with no difference found in NAFLD between ethnic groups (Luo, Kamba, Maasai). All body composition and clinical measurements were associated with NAFLD (p < 0.045 for OR). Conclusion: Finding lower odds for NAFLD in men was unexpected, as was the lack of differences in NAFLD among the ethnic groups, while higher odds for NAFLD with increasing age and in urban vs. rural populations was expected. Especially the sex‐specific results warrant further studies in black African populations on biology of body composition for having NAFLD, and whether this translates into insulin resistance and higher risk of diabetes and consequently cardiovascular disease in black African women. [ABSTRACT FROM AUTHOR]

Alcohol, tobacco, and other drug (ATOD) use by adolescents are major contributors to death and disability in sub‐Saharan Africa (SSA). This paper reviews the extent of adolescents' ATOD use, risk and protective factors, and studies evaluating prevention interventions for adolescents in SSA. It also describes the harms associated with adolescents' ATOD use in SSA, which mainly include interpersonal violence, sexual risk behaviours, and negative academic outcomes. We use the socio‐ecological model as our framework for understanding ATOD use risk and protective factors at individual, interpersonal, peer/school, and societal/structural levels. We used two strategies to find literature evaluating ATOD interventions for adolescents in SSA: (a) we sought systematic reviews of adolescent ATOD interventions in SSA covering the period 2000–2020; and (b) we used a comprehensive evidence review strategy and searched for studies that had evaluated ATOD interventions in all SSA countries between 2000 and 2020. Only two community interventions (a brief intervention and an HIV prevention intervention), out of four that were identified, were partially effective in reducing adolescent ATOD. Furthermore, only one school‐based intervention (HealthWise), out of six that we uncovered, had any effect on ATOD use among adolescents. Possible reasons why many interventions were not effective include methodological limitations, involvement of non‐evidence‐based education‐only approaches in some studies, and shortcomings in adaptations of evidence‐based interventions. The scale of ATOD and related problems is disproportionate to the number of evaluated interventions to address them in SSA. More ATOD interventions need to be developed and evaluated in well‐powered and well‐designed studies. [ABSTRACT FROM AUTHOR]

Objectives: In 2010, WHO published guidelines emphasising parasitological confirmation of malaria before treatment. We present data on changes in fever case management in a low malaria transmission setting of northern Tanzania after 2010. Methods: We compared diagnoses, treatments and outcomes from two hospital‐based prospective cohort studies, Cohort 1 (2011–2014) and Cohort 2 (2016–2019), that enrolled febrile children and adults. All participants underwent quality‐assured malaria blood smear‐microscopy. Participants who were malaria smear‐microscopy negative but received a diagnosis of malaria or received an antimalarial were categorised as malaria over‐diagnosis and over‐treatment, respectively. Results: We analysed data from 2098 participants. The median (IQR) age was 27 (3–43) years and 1047 (50.0%) were female. Malaria was detected in 23 (2.3%) participants in Cohort 1 and 42 (3.8%) in Cohort 2 (p = 0.059). Malaria over‐diagnosis occurred in 334 (35.0%) participants in Cohort 1 and 190 (17.7%) in Cohort 2 (p < 0.001). Malaria over‐treatment occurred in 528 (55.1%) participants in Cohort 1 and 196 (18.3%) in Cohort 2 (p < 0.001). There were 30 (3.1%) deaths in Cohort 1 and 60 (5.4%) in Cohort 2 (p = 0.007). All deaths occurred among smear‐negative participants. Conclusion: We observed a substantial decline in malaria over‐diagnosis and over‐treatment among febrile inpatients in northern Tanzania between two time periods after 2010. Despite changes, some smear‐negative participants were still diagnosed and treated for malaria. Our results highlight the need for continued monitoring of fever case management across different malaria epidemiological settings in sub‐Saharan Africa. [ABSTRACT FROM AUTHOR]

Objective: To assess the care for hypertension in Sierra Leone, by the use of a cascade‐of‐care approach, to identify where the need for healthcare system interventions is greatest. Methods: Using data from a nationwide household survey on surgical conditions undertaken in 1956 participants ≥18 years from October 2019 to March 2020, a cascade of care for hypertension consisting of four categories – hypertensive population, those diagnosed, those treated and those controlled – was constructed. Hypertension was defined as having a blood pressure ≥140/90 mmHg, or self‐reported use of antihypertensive medication. Logistic regression analysis was used to investigate factors associated with undiagnosed hypertension. Results: The prevalence of hypertension was 22%. Among those with hypertension, 23% were diagnosed, 11% were treated and 5% had controlled blood pressure. The largest loss to care (77%) was between being hypertensive and receiving a diagnosis. Male sex, age and living in a rural location, were significantly associated with the odds of undiagnosed hypertension. There was no significant difference between men and women in the number of patients with controlled blood pressure. Adults aged 40 or older were observed to be better retained in care compared with those younger than 40 years of age. Conclusion: There is a significant loss to care in the care cascade for hypertension in Sierra Leone. Our results suggest that increasing awareness of cardiovascular risk and risk factor screening for early diagnosis might have a large impact on hypertension care. [ABSTRACT FROM AUTHOR]

Background: The prevalence of diseases other than tuberculosis (TB) detected during chest X‐ray screening is poorly described in sub‐Saharan Africa. Computer‐assisted digital chest X‐ray technology is available for TB screening and has the potential to be a screening tool for non‐communicable diseases as well. Low‐ and middle‐income countries are in a transition period where the burden of non‐communicable diseases is increasing, but health systems are mainly focused on addressing infectious diseases. Methods: Participants were adults undergoing computer‐assisted chest X‐ray screening for tuberculosis in a community‐wide tuberculosis prevalence survey in Blantyre, Malawi. Adults with abnormal radiographs by field radiographer interpretation were evaluated by a physician in a community‐based clinic. X‐ray classifications were compared to classifications of a random sample of normal chest X‐rays by radiographer interpretation. Radiographic features were classified using WHO Integrated Management for Adult Illnesses (IMAI) guidelines. All radiographs taken at the screening tent were analysed by the Qure.ai qXR v2.0 software. Results: 5% (648/13,490) of adults who underwent chest radiography were identified to have an abnormal chest X‐ray by the radiographer. 387 (59.7%) of the participants attended the X‐ray clinic, and another 387 randomly sampled normal X‐rays were available for comparison. Participants who were referred to the community clinic had a significantly higher HIV prevalence than those who had been identified to have a normal CXR by the field radiographer (90 [23.3%] vs. 43 [11.1%] p‐value < 0.001). The commonest radiographic finding was cardiomegaly (20.7%, 95% CI 18.0–23.7). One in five (81/387) chest X‐rays were misclassified by the radiographer. The overall mean Qure.ai qXR v2.0 score for all reviewed X‐rays was 0.23 (SD 0.20). There was a high concordance of cardiomegaly classification between the physician and the computer‐assisted software (109/118, 92.4%). Conclusion: There is a high burden of cardiomegaly on a chest X‐ray at a community level, much of which is in patients with diabetes, heart disease and high blood pressure. Cardiomegaly on chest X‐ray may be a potential tool for screening for cardiovascular NCDs at the primary care level as well as in the community. [ABSTRACT FROM AUTHOR]

Summary: Cervical cancer is the leading cause of cancer‐related morbidity and mortality in many sub‐Saharan African (SSA) countries, including Tanzania. Most cervical cancer cases worldwide are attributable to infection of the cervix with Human Papillomavirus (HPV), a vaccine‐preventable sexually transmitted infection (STI). Over the past 10 years, we have conducted a programme of HPV research in pre‐adolescents and adolescents in Mwanza, the second‐largest city in Tanzania, which is situated in a malaria‐endemic region. In this narrative review article, we summarise the contribution of our work, alongside work of others, to improve the understanding of HPV epidemiology in SSA and development of setting‐appropriate, evidence‐based intervention strategies. We present evidence for very high prevalence and incidence of HPV infection among female SSA adolescents around the time of sexual debut, describe risk factors for HPV acquisition, and discuss associations between HPV, HIV and other STIs, which are also highly prevalent within this population. We summarise findings from early clinical trials of HPV vaccines in SSA, the first of which was an immunogenicity and safety trial conducted in Mwanza, Tanzania, and Dakar, Senegal. Within the trial, we evaluated for the first time the potential impact of malaria and helminth infection on vaccine‐induced antibody responses in Tanzanian girls. We describe research evaluating optimal HPV vaccine delivery strategies within this setting, perceived requirements for and barriers to vaccine implementation among key informants from LMIC, vaccine acceptability among girls and parents, and opportunities for co‐delivery of interventions alongside HPV vaccination to an adolescent population. Finally, we discuss country‐level barriers to vaccine uptake in LMIC, and ongoing studies in Tanzania and other SSA countries of reduced‐dose HPV vaccination schedules that may alleviate cost and logistical barriers to vaccine implementation. [ABSTRACT FROM AUTHOR]

The transitional period of adolescence has long been associated with physical, social and behavioural change. During this time, adolescents start to develop their own self‐identity, make important life decisions and acquire the necessary skills to successfully transition to adulthood. More recently, advances in brain imaging technology have enabled increased understanding of structural and functional changes in the human brain during this developmental period, and how they relate to social, emotional, motivational and cognitive development. The ability to integrate these developing cognitive processes in increasingly complex social contexts is a key aspect of mature decision‐making, which has implications for adolescent health, educational, economic and social outcomes. Insights from the field of developmental cognitive neuroscience could increase our understanding of this influential stage of life and thus inform potential interventions to promote adolescent health, a critical goal for global health research. Many social changes occur during adolescence and the social environment shapes both brain and cognitive development and the decisions adolescents make. Thus, it is important to study adolescent neurocognitive development in socio‐cultural context. Yet, despite evidence from Western studies that socio‐cultural and economic factors impact on adolescent neurocognitive development, existing studies of adolescent neurocognitive development in sub‐Saharan Africa are relatively scarce. We summarise research findings from Western and sub‐Saharan African contexts and highlight areas where research is lacking. Longitudinal studies from more diverse global samples will be needed to build a comprehensive model of adolescent development, that characterises both commonalities in developmental trajectories, as well as the way these can meaningfully differ between both individuals and contexts. [ABSTRACT FROM AUTHOR]

Summary: Objective: This article provides a concise overview of the current challenges that adolescents face in sub‐Saharan Africa, summarises possible solutions and ongoing efforts to implement these, and briefly introduces the subsequent papers of this series. Methods: We draw on data from the WHO Maternal, Newborn, Child and Adolescent Health and Ageing Data Portal. Results: The opportunity provided by the growing number of adolescents in sub‐Saharan Africa will only be realised if they survive, are healthy, receive a quality education and remain in Africa rather than joining the increasing out‐migration exodus. Fortunately, there is an increasing focus on adolescent health and well‐being both globally and in sub‐Saharan Africa, and growing knowledge of what to do to promote adolescent health and well‐being and how to do it, and a powerful resource in the form of adolescents themselves. Conclusion: There is no time to lose. African adolescents demand it, but are also ready to be part of the solution. [ABSTRACT FROM AUTHOR]

Objectives: To describe the experience and resource requirements of implementing point-of-care testing for early infant diagnosis of HIV in rural Zambia.Methods: A demonstration project was conducted using a hub-and-spoke model in 2018-2019 at five clinics in rural Zambia. Two testing hubs were established, and all HIV-exposed infants were tested with the GeneXpert system. Data on costs, turnaround times and test results were collected.Results: Seven hundred and eighty six tests were conducted. At the hubs, results were available a median of 2.4 (IQR: 2.1, 2.8) hours after sample collection and most mothers (84%) received same-day results. At the spoke facilities, results were available a median of 9 days (IQR: 7, 12) after sample collection and provided to the mother a median of 16 days (IQR: 10, 28) after sample collection. Eleven children tested positive, and 9 (82%) started treatment a median of 13 days (IQR: 7, 21) after sample collection and on the day mothers received results. In contrast, results from matching samples sent for routine testing were available a median of 38 days (IQR: 27, 61) after sample collection and provided to the mother a median of 91 days (IQR: 47, 135) after sample collection.Conclusions: Implementing point-of-care testing in a network of rural health centres in Zambia required significant initial and ongoing investment in infrastructure, training and supervision. However, point-of-care testing can rapidly diagnose HIV-infected infants, so they can benefit from early treatment. [ABSTRACT FROM AUTHOR]

Objective: To assess the knowledge, attitudes and perceptions (KAP) of long‐acting reversible contraceptive (LARC) methods among healthcare workers (HCWs) in sub‐Saharan Africa (SSA). Methods: A systematic review and meta‐analysis were conducted following the PRISMA method. Two authors independently searched three electronic databases for studies published between 2000 and January 2020 reporting on the KAP of LARC methods among HCWs in SSA. Titles and abstracts were screened against eligibility criteria, data were extracted and the included studies were assessed for risk of bias. A meta‐analysis of proportions for 11 pre‐determined questions relating to LARC KAP was performed. Heterogeneity was explored using the I2‐statistic and publication bias investigated using funnel plots and Egger's tests. Results: Twenty‐two studies comprising 11,272 HCWs from 11 SSA countries were included. 50% (95% CI: 34%, 67%) of HCWs had received intrauterine contraceptive device (IUCD) insertion training while 63% (95% CI: 44%, 81%) expressed a desire for training. Only 27% (95% CI: 18%, 36%) deemed IUCD appropriate for HIV‐infected women. Restrictions for IUCD and injectables based on a minimum age were imposed by 56% (95% CI: 33%, 78%) and 60% (95% CI: 36%, 84%), respectively. Minimum parity restrictions were observed among 29% (95% CI: 9%, 50%) of HCWs for IUCDs and 36% (95% CI: 16%, 56%) for injectable contraceptives. Heterogeneity was high and publication bias was present in two of the 11 questions. Conclusion: The systematic review and meta‐analysis indicate that unnecessary provider‐imposed restrictions may hinder the uptake of LARC methods by women in SSA. [ABSTRACT FROM AUTHOR]

Objectives: Effective coverage of non-communicable disease (NCD) care in sub-Saharan Africa remains low, with the majority of services still largely restricted to central referral centres. Between 2015 and 2017, the Rwandan Ministry of Health implemented a strategy to decentralise outpatient care for severe chronic NCDs, including type 1 diabetes, heart failure and severe hypertension, to rural first-level hospitals. This study describes the facility-level implementation outcomes of this strategy.Methods: In 2014, the Ministry of Health trained two nurses in each of the country's 42 first-level hospitals to implement and deliver nurse-led, integrated, outpatient NCD clinics, which focused on severe NCDs. Post-intervention evaluation occurred via repeated cross-sectional surveys, informal interviews and routinely collected clinical data over two rounds of visits in 2015 and 2017. Implementation outcomes included fidelity, feasibility and penetration.Results: By 2017, all NCD clinics were staffed by at least one NCD-trained nurse. Among the approximately 27 000 nationally enrolled patients, hypertension was the most common diagnosis (70%), followed by type 2 diabetes (19%), chronic respiratory disease (5%), type 1 diabetes (4%) and heart failure (2%). With the exception of warfarin and beta-blockers, national essential medicines were available at more than 70% of facilities. Clinicians adhered to clinical protocols at approximately 70% agreement with evaluators.Conclusion: The government of Rwanda was able to scale a nurse-led outpatient NCD programme to all first-level hospitals with good fidelity, feasibility and penetration as to expand access to care for severe NCDs. [ABSTRACT FROM AUTHOR]

Background: In 2017, 785 million people globally lacked access to basic services of drinking water and 2 billion people lived without basic sanitation services. Most of these people live in low‐ and lower‐middle‐income countries in South Asia, Southeast Asia and sub‐Saharan Africa. To monitor the progress towards universal access to water and sanitation, this study aimed to predict the coverage of access to basic drinking water supply and sanitation (WSS) services as well as the reduction in the practice of open defecation by 2030, under two assumptions: following the current trends and accelerated poverty reduction. Methods and findings: Households reporting access to basic WSS services and those practising open defecation were extracted from 210 nationally representative Demographic Health Surveys and Multiple Cluster Indicator Surveys (1994–2016) from 51 countries. A Bayesian hierarchical mixed effect linear regression model was developed to predict the indicators in 2030 at national, urban–rural and wealth‐specific levels. A Bayesian regression model with accelerated reduction in poverty by 2030 was applied to assess the impact of poverty reduction on these indicators. Out of 51 countries, only nine (Bangladesh, Bhutan, Ghana, India, Nepal, Pakistan, The Philippines, Togo and Vietnam) were predicted to reach over 90% coverage in access to basic services of drinking water by 2030. However, none of the countries were projected to achieve equivalent coverage for access to basic sanitation services. By 2030, 21 countries were projected to achieve the target of less than 10% households practising open defecation. Urban–rural and wealth‐derived disparities in access to basic WSS services, especially sanitation, were more pronounced in sub‐Saharan Africa than South Asia and Southeast Asia. Access to basic sanitation services was projected to benefit more from poverty reduction than access to basic drinking water services. Households residing in rural settings were predicted to receive greater benefit from poverty reduction than urban populations in access to both basic WSS services. Conclusion: Achieving poverty eradication targets may have a substantial positive impact on access to basic water supply and sanitation services. However, many low‐ and lower‐middle‐income countries will struggle to achieve the goal of universal access to basic services, especially in the sanitation sector. [ABSTRACT FROM AUTHOR]

Objectives: This study investigated the molecular epidemiology of respiratory syncytial virus (RSV) among febrile children with acute respiratory tract infection in Ghana, Gabon, Tanzania and Burkina Faso between 2014 and 2017 as well as the evolution and diversification of RSV strains from other sub-Saharan countries.Methods: Pharyngeal swabs were collected at four study sites (Agogo, Ghana: n = 490; Lambaréné, Gabon: n = 182; Mbeya, Tanzania: n = 293; Nouna, Burkina Faso: n = 115) and analysed for RSV and other respiratory viruses using rtPCR. For RSV-positive samples, sequence analysis of the second hypervariable region of the G gene was performed. A dataset of RSV strains from sub-Saharan Africa (2011-2017) currently available in GenBank was compiled. Phylogenetic analysis was conducted to identify the diversity of circulating RSV genotypes.Results: In total, 46 samples were tested RSV positive (Ghana n = 31 (6.3%), Gabon n = 4 (2.2%), Tanzania n = 9 (3.1%) and Burkina Faso n = 2 (1.7%)). The most common RSV co-infection was with rhinovirus. All RSV A strains clustered with genotype ON1 strains with a 72-nucleotide duplication and all RSV B strains belonged to genotype BAIX. Phylogenetic analysis of amino acid sequences from sub-Saharan Africa revealed the diversification into 11 different ON1 and 22 different BAIX lineages and differentiation of ON1 and BAIX strains into potential new sub-genotypes, provisionally named ON1-NGR, BAIX-KEN1, BAIX-KEN2 and BAIX-KEN3.Conclusion: The study contributes to an improved understanding of the molecular epidemiology of RSV infection in sub-Saharan Africa. It provides the first phylogenetic data for RSV from Tanzania, Gabon and Burkina Faso and combines it with RSV strains from all other sub-Saharan countries currently available in GenBank. [ABSTRACT FROM AUTHOR]

Objectives: Increasing life expectancy and decreasing mortality in patients with HIV infection are well documented. However, details of how many of the years of healthy life are damaged by HIV infection vs. good health have not been understood. We conducted this study to provide a comprehensive assessment of the levels and trends of the global burden, as measured by disability-adjusted life years (DALYs), of HIV infection.Methods: Data on HIV-related DALY were obtained from the Global Burden of Disease Study 2019. The absolute numbers and age-standardised rates of DALYs due to HIV were reported between 1990 and 2019. Estimated annual percentage changes in age-standardised rates by sex, region and nation were calculated to quantify the temporal trends in HIV burden.Results: Global HIV infection caused 47.63 million DALYs in 2019, presenting a 1.28-fold increase from 1990 to 2019. In 2019, years of life lost contributed to most of the total DALYs, but the increases in HIV-related years lived with disability have outpaced increases in years of life lost. The age-standardised rates of HIV-related DALYs in 2019 decreased as the sociodemographic indexes increased. The highest age-standardised rates were observed in sub-Saharan Africa, and the greatest increments over time were detected in Oceania.Conclusions: Globally, HIV continues to cause enormous healthy life loss. The first and foremost strategy for controlling the HIV burden is still the reduction of premature deaths, and much effort needs to be exerted to mitigate the harm of comorbidities. [ABSTRACT FROM AUTHOR]

Objective: To give an overview of the recently reported literature on the aetiologies of meningitis and encephalitis in western sub-Saharan Africa.Methods: We conducted a scoping review following PRISMA guidance on published meningitis and encephalitis cases in the 16 countries of the United Nations-defined western sub-Saharan African region as identified in cohort studies, case series, and case reports, published 01/01/2000-08/01/2020, and available in four databases in August 2020 with an abstract in English, French or Italian.Results: There were 38 distinct pathogens identified from 91 cohort studies' data and 48 case reports or case series' data. In cohort-level data, the majority of cases were caused by Neisseria meningitidis (71.5%), Streptococcus pneumoniae (17.6%) and Haemophilus influenzae (7.3%). In case report- and case series-level data, 40.5% of patients were <18 years old, 28.6% were female, and 28.6% were known to be immunocompromised. The case fatality rate was 39.3%. The most commonly reported pathogens among immunocompetent patients were Salmonella species (13 cases) and Ebola virus (9 cases), and the most commonly reported pathogen among immunocompromised patients was Cryptococcus neoformans (18 cases). Most cohort cases (52.3%) derived from Niger followed by Burkina Faso (28.6%). Most cases from single reports or series were reported from Nigeria (21.4%), Mali (20.2%) and Burkina Faso (19.0%).Conclusions: Given the small number of pathogens reported, our findings underscore the need to better screen, diagnose and monitor populations in western sub-Saharan Africa for additional CNS pathogens, including those posing significant outbreak risks. [ABSTRACT FROM AUTHOR]

Objectives: To perform scoping review of the existing literature available specific to child and adolescent mental health in Tanzania. Methods: An extensive literature search of PubMed, Scopus, MEDLINE and EMBASE was undertaken to identify studies that focussed specifically on mental illness in children and young people in Tanzania. This included neurological and functional disorders, affective disorders, psychosis, epidemiological, intervention and treatment‐based studies. Qualitative analysis of the studies was then undertaken to assess what is currently known about the subject and how reliable this information is and to identify areas for further research. Results: Of 23 studies were included in the final synthesis, which could be broadly split into studies focussing on the prevalence and incidence of child and adolescent mental illness, hypothesised causes and correlations, identified treatments and interventions and qualitative studies of human experience. Conclusion: There is a dearth of published research regarding child and adolescent mental health in Tanzania. Although some high‐quality studies allow us good insight into the epidemiology of mental illness, interventional studies are often small and low‐power, and significant correlational relationships are yet to be drawn. There is significant scope for further child and adolescent mental health research in Tanzania. [ABSTRACT FROM AUTHOR]