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After more than a year of living with the COVID-19 pandemic, much experience has been accumulated by countries around the world. There have been many failures, and there have been some things that have gone well. Adult learning and education in some form has played a significant role in public health since, without the ongoing continuing educational interventions mainly via the mass media, the number of doctors and hospital beds would likely have been insufficient. In this paper we focus on the role of group behaviours in relation to the risk of contagion and we argue that any attempts to define a strategy to combat the pandemic must include a strong commitment to information dissemination and to the training of the populations in order to encourage behaviour change necessary to mitigate the spread of the virus. Against the backdrop of the United Nations Sustainable Development Goals, this article argues for commitment by governments to use adult learning and education as a tool for health prevention and health awareness and to prepare populations for whatever pandemics and national disasters that might emerge in the twenty-first century, the "century of pandemics". We therefore argue that populations must have at least a basic level of literacy and numeracy as foundational skills essential for enabling citizens to receive and act on vital information during a pandemic or disaster in order to engender greater resilience.

Purpose: This paper aims to critically analyze the empirical literature on health and human development in high-, middle- and low-income countries to develop a sustainable model for investing in human health. The model is critical in building a comprehensive health-care system that fosters the stakeholders' financial stability, economic growth and high-quality education for the local community. Design/methodology/approach: A comprehensive literature review was carried out on health, human development and sustainable health investment. After thoroughly examining theoretical frameworks underlying the strategies of successful human health systems, a summary of empirical articles is created. Summaries provided in this paper represent relevant health-care strategies for Kenya. Findings: Based on the empirical review of literature, a Nexus Health Care model focusing on human development, social and cultural development, economic development and environmental development in high-, middle- and low-income countries is proposed. The goal of this model is to enhance sustainable development where wealth creation is accompanied with environmental uplifting and protection of social and material well-being. Research limitations/implications: This paper is limited to a comprehensive literature review presenting empirical evidence of human development and sustainability. Originality/value: Kenya like other developing nations aspires to contribute significantly in improving health through development of health products but the approaches used have been limiting. In most cases, the use of Western theories, lack of empowering the community and dependence on donor support have hindered the country from achieving comprehensive health and human development. This papers seeks to develop a model for health-care investment and provide strategies, operations and structure of successful health systems and human development for a developing country, such as Kenya.

Research on the effects of socioeconomic well-being on health is important for policy makers in developing countries, where limited resources make it crucial to use existing health care resources to the best advantage. This paper develops and tests a set of measures of socioeconomic status indicators for predicting health status in developing countries. We construct socioeconomic indexes that capture both household and community attributes so as to allow us to separate the social from the purely economic dimensions of the socioeconomic status within a cross-national perspective, with applications to data from Demographic and Health Surveys (DHS) fielded in five African countries in the 1990s. This study demonstrates the distinctive contributions of socioeconomic indexes measured at the household vs. community level in understanding inequalities in health and survival and underlines the importance of going beyond the purely economic view of socioeconomic status to cover the multidimensional as well as multilevel concept of economic and social inequality.

This editorial provides an overview of the six papers included in this special supplement on health leadership in Africa. Together the papers provide evidence of leadership in public hospital settings and of initiatives to strengthen leadership development. On the one hand, they demonstrate both that current leadership practices often impact negatively on staff motivation and patient care, and that contextual factors underpin poor leadership. On the other hand, they provide some evidence of the positive potential of new forms of participatory leadership, together with ideas about what forms of leadership development intervention can nurture new forms of leadership. Finally, the papers prompt reflection on the research needed to support the implementation of such interventions. [ABSTRACT FROM AUTHOR]

Research ethics education is critical to developing a culture of responsible conduct of research. Many countries in sub-Saharan Africa (SSA) have a high burden of infectious diseases like HIV and malaria; some, like Uganda, have recurring outbreaks. Coupled with the increase in non-communicable diseases, researchers have access to large populations to test new medications and vaccines. The need to develop multi-level capacity in research ethics in Uganda is still huge, being compounded by the high burden of disease and challenging public health issues. Only a few institutions in the SSA offer graduate training in research ethics, implying that the proposed ideal of each high-volume research ethics committee having at least one member with in-depth training in ethics is far from reality. Finding best practices for comparable situations and training requirements is challenging because there is currently no "gold standard" for teaching research ethics and little published information on curriculum and implementation strategies. The purpose of this paper is to describe a model of research ethics (RE) education as a track in an existing 2-year Master of Public Health (MPH) to provide training for developing specific applied learning skills to address contemporary and emerging needs for biomedical and public health research in a highly disease-burdened country. We describe our five-year experience in successful implementation of the MPH-RE program by the Mbarara University Research Ethics Education Program at Mbarara University of Science and Technology in southwestern Uganda. We used curriculum materials, applications to the program, post-training and external evaluations, and annual reports for this work. This model can be adapted and used elsewhere in developing countries with similar contexts. Establishing an interface between public health and research ethics requires integration of the two early in the delivery of the MPH-RE program to prevent a disconnect in knowledge between research methods provided by the MPH component of the MPH-RE program and for research in ethics that MPH-RE students are expected to perform for their dissertation. Promoting bioethics education, which is multi-disciplinary, in institutions where it is still "foreign" is challenging and necessitates supportive leadership at all institutional levels. [ABSTRACT FROM AUTHOR]

Salmonellosis represents a significant economic and public health concern for the poultry industry in Africa, leading to substantial economic losses due to mortality, reduced productivity, and food safety problems. However, comprehensive information on the burden of poultry salmonellosis at the continental level is scarce. To address this gap, a systematic review and meta-analysis were conducted to consolidate information on the prevalence and circulating serotypes of poultry salmonellosis in African countries. This involved the selection and review of 130 articles published between 1984 and 2021. A detailed systematic review protocol was structured according to Cochrane STROBE and PRISMA statement guideline. From the 130 selected articles from 23 different African countries, the overall pooled prevalence estimate (PPE) of poultry salmonellosis in Africa was found to be 14.4% (95% CI = 0.145–0.151). Cameroon reported the highest PPE at 71.9%. The PPE was notably high in meat and meat products at 23%. The number of research papers reporting poultry salmonellosis in Africa has shown a threefold increase from 1984 to 2021. Salmonella Enteritidis and Typhimurium were the two most prevalent serotypes reported in 18 African countries. Besides, Salmonella Kentucky, Virchow, Gallinarum, and Pullorum were also widely reported. Western Africa had the highest diversity of reported Salmonella serotypes (141), in contrast to southern Africa, which reported only 27 different serotypes. In conclusion, poultry salmonellosis is highly prevalent across Africa, with a variety of known serotypes circulating throughout the continent. Consequently, it is crucial to implement strategic plans for the prevention and control of Salmonella in Africa. RESEARCH HIGHLIGHTS The pooled sample prevalence of poultry salmonellosis in Africa is high (14.4%). The highest PPE was recorded in meat and meat products. Salmonella serotypes of zoonotic importance were found in all sample types. Salmonella Enteritidis and Typhimurium are common serotypes spreading in Africa. [ABSTRACT FROM AUTHOR]

Heat is one of the most serious hazards in the world as it affects human health and is extremely dangerous to vulnerable populations such as the elderly, people with preexisting cardiovascular or respiratory conditions, and even healthy people with prolonged sunlight exposure during heat waves. As the globe has warmed over the past several decades, extreme heat has become more frequent and intense than ever before, and Africa, especially the Sahel in West Africa, is one of the regions of the world where heat is a major public health concern exacerbated by livelihood activities during the heat season. Yet, there is a major gap in monitoring and forecasting heat waves in Africa. This paper describes NOAA's role in enabling heat–health early warning in Africa, working with meteorological services and health professionals. Emphasis is on real-time heat wave forecasting at week 2, including the postprocessing of the NCEP model outputs, and providing the information to the meteorological services in Africa to serve as guidance in national heat wave forecasts. In addition, the paper describes the end-to-end process of heat hazard outlooks and translating the forecasts into early action and early planning to reduce heat risk to human health. Furthermore, the paper addresses the very important aspect of capacity development tailored at enhancing forecasters' skills to prepare and issue heat wave forecasts and training of a cadre of health professionals to work with meteorologists to coproduce heat–health bulletins and to issue heat–health early warnings. [ABSTRACT FROM AUTHOR]

Several attempts have been made by the global public health efforts and national governments to contain the spread and vulnerabilities to COVID-19. Evidence, however, shows a disproportionate upsurge in COVID-19 cases in correctional facilities such as prisons, particularly, in low- and middle-income countries (LMICs). The poor adherence to COVID-19 preventive protocols in these settings has raised a serious "moral panic" among the public. There are public health concerns about the most effective and state-of-the-art approach to tackling the continuous spread of the virus in prisons. This paper discusses the feasibility of depopulation and vaccination rollouts in combating COVID-19 in correctional facilities with a particular focus on African prisons. The paper proposes selective and strategic depopulation of prisoners, effective prioritization of vaccination among prisoners, and general sensitization of prisoners toward vaccine disbursement in this total institution. [ABSTRACT FROM AUTHOR]

Background: Risk perception has been found to be a crucial factor explaining inconsistent or non-use of HIV prevention interventions. Considerations of risk need to expand beyond risk of infection to also include the personal, social, emotional, and economic risks associated with prevention intervention use. Objectives: This systematic review of qualitative peer-reviewed literature from sub-Saharan Africa examines perceptions of risk associated with HIV infection and HIV prevention intervention use. Data sources: We searched Medline, Embase, PsychInfo, Africa Wide Info, CINAHL, and Global Health for publications and screened them for relevance. Study eligibility criteria: Peer-reviewed qualitative studies published since 2003 were eligible for inclusion if they examined risk perception or uncertainty in the context of a medically regulated intervention. Only studies focusing on adults were included. Study appraisal and synthesis methods: Included publications were quality assessed using the Hawker method and coded thematically. Results: 10318 unique papers were identified, of which 29 are included. Among the themes identified, a particularly salient one was the potential of HIV prevention interventions to threaten the stability of a relationship and impact on how and when people may—or may not—choose to use prevention interventions. Limitations: This literature review excludes grey-literature, which may have distinct valuable insights. We also excluded quantitative studies that may have challenged or triangulated our findings. Conclusions and implications: When considering the risk of HIV acquisition, it is insufficient to examine biological risk in isolation from the personal, relational and economic costs associated with intervention use. This loss of emotional, physical, or material support may be perceived as more consequential than the prevention of a potential infection. [ABSTRACT FROM AUTHOR]

Background: Despite mortality from breast cancer in Africa being higher than in high income countries, breast cancer has not been extensively studied in the region. The aim of this paper was to highlight the rising burden of breast cancer with an emphasis on sub-Saharan Africa as well as trends, characteristics, controversies and their implications for regional development. Methodology: A review of published studies and documents was conducted in Medline, Scopus, Pubmed and Google using combinations of key words-breast neoplasm, breast cancer, cancer, incidence, mortality, Africa, Nigeria. Graphical and frequency analyses were carried out on some of the incidence and mortality figures retrieved from published papers and the GLOBOCAN website. Findings: Globally, about 25% and 15% of all new cancer cases and cancer deaths respectively among females were due to breast cancer. Africa currently had the highest age-standardized breast cancer mortality rate globally, with the highest incidence rates being recorded within the sub-Saharan African sub-region. Incidence trends such as inherently aggressive tumour and younger age profile had been subject to controversies. Certain factors such as westernized diet, urbanization and possibly increasing awareness had been implicated, though their specific contributions were yet to be fully established. Conclusion: Unless urgent action is taken, breast cancer will compound sub-Saharan Africa's disease burden, increase poverty and gender inequality as well as reverse the current global gains against maternal and neonatal mortality. [ABSTRACT FROM AUTHOR]

Capacity building programmes for African regulators should link education, training and research with career development in an approach that combines an academic base and experiential learning aligned within a competency framework. A regulatory ecosystem that engages with a broad range of stakeholders will mean that expertise in the ever‐expanding field of regulatory science filters into teaching and research in a symbiotic way. In this way capacity development interventions will be a collaborative approach between the learning context (academic and training institutions) and the performance context (regulatory agencies and industry), which will ultimately best serve the patients. Monitoring and evaluation of capacity development interventions will be essential to show value of investments and ultimately guide continued funding and sustainability. This paper reviews the skills and human capacity gaps, reports on regulatory assessment pathways used in Ghana, South Africa and Zimbabwe and outlines a staged tactical approach for Africa that builds on previous efforts to strengthen African regulatory ecosystems. [ABSTRACT FROM AUTHOR]

Introduction: The proportion of older persons in developing countries is increasing with no clear evidence of improvement in physical health. The aim of this paper was to examine the factors associated with older persons’ physical health in rural Uganda. Methods: This paper is based on a cross-sectional study of 912 older persons age 60 years and older across four major regions of Uganda. The study was conceptualized basing on World Health Organization quality of life BREF (WHOQOL-BREF). Analysis was done at three levels, that is, frequency distributions were generated to describe background characteristics of respondents and cross-tabulations were done to determine associations between dependent and each of the independent variables. Ordinal logistic regression was used to determine the predictors of physical health. Results: The likelihood of good physical health is high among older persons (Ops) who controlled their household assets (OR = 3.64; CI = 1.81–7.30) or the household assets controlled by their spouses (OR = 4.44; CI = 1.91–10.32) relative to those whose household assets were controlled by their children. There is high likelihood of good physical health among those who engage in physical activities (OR = 2.28; CI = 1.52–3.43) compared to those who do not. Conclusion: The findings have various policy implications, including creating an enabling environment and building capacities of older persons to remain in control of their household assets. Interventions focusing on deepening sensitization of older persons about importance of physical exercises could be a viable strategy for improving physical health of older persons. [ABSTRACT FROM AUTHOR]

Policy decisions and the practice of public health nutrition need to be based on solid evidence, developed through rigorous research studies where objective measures are used and results that run counter to dogma are not dismissed but investigated. In recent years, enhancements in study designs, and methodologies for systematic reviews and meta-analysis, have improved the evidence-base for nutrition policy and practice. However, these still rely on a full appreciation of the strengths and limitations of the measures on which conclusions are drawn and on the thorough investigation of outcomes that do not fit expectations or prevailing convictions. The importance of 'hard facts' and 'misfits' in research designed to advance knowledge and improve public health nutrition is illustrated in this paper through a selection of studies from different stages in my research career, focused on the nutritional requirements of resource-poor populations in Africa and Asia. [ABSTRACT FROM AUTHOR]

Background Despite increasing investment in health research capacity strengthening efforts in low and middle income countries, published evidence to guide the systematic design and monitoring of such interventions is very limited. Systematic processes are important to underpin capacity strengthening interventions because they provide stepwise guidance and allow for continual improvement. Our objective here was to use evidence to inform the design of a replicable but flexible process to guide health research capacity strengthening that could be customized for different contexts, and to provide a framework for planning, collecting information, making decisions, and improving performance. Methods We used peer-reviewed and grey literature to develop a five-step pathway for designing and evaluating health research capacity strengthening programmes, tested in a variety of contexts in Africa. The five steps are: i) defining the goal of the capacity strengthening effort, ii) describing the optimal capacity needed to achieve the goal, iii) determining the existing capacity gaps compared to the optimum, iv) devising an action plan to fill the gaps and associated indicators of change, and v) adapting the plan and indicators as the programme matures. Our paper describes three contrasting case studies of organisational research capacity strengthening to illustrate how our five-step approach works in practice. Results Our five-step pathway starts with a clear goal and objectives, making explicit the capacity required to achieve the goal. Strategies for promoting sustainability are agreed with partners and incorporated from the outset. Our pathway for designing capacity strengthening programmes focuses not only on technical, managerial, and financial processes within organisations, but also on the individuals within organisations and the wider system within which organisations are coordinated, financed, and managed. Conclusions Our five-step approach is flexible enough to generate and utilise ongoing learning. We have tested and critiqued our approach in a variety of organisational settings in the health sector in sub-Saharan Africa, but it needs to be applied and evaluated in other sectors and continents to determine the extent of transferability. [ABSTRACT FROM AUTHOR]

The aim of the present paper is to review capacity building in public health nutrition (PHN), the need for which has been stressed for many years by a range of academics, national and international organisations. Although great strides have been made worldwide in the science of nutrition, there remain many problems of undernutrition and increasingly of obesity and related chronic diseases. The main emphasis in capacity building has been on the nutrition and health workforce, but the causes of these health problems are multifactorial and require collaboration across sectors in their solution. This means that PHN capacity building has to go beyond basic nutrition and beyond the immediate health workforce to policy makers in other sectors. The present paper provides examples of capacity building activities by various organisations, including universities, industry and international agencies. Examples of web-based courses are given including an introduction to the e-Nutrition Academy. The scope is international but with a special focus on Africa. In conclusion, there remains a great need for capacity building in PHN but the advent of the internet has revolutionised the possibilities. [ABSTRACT FROM AUTHOR]

Fungal infections (FIs) are spreading globally, raising a significant public health concern. However, its documentation remains sparse in Africa, particularly in Rwanda. This report provides a comprehensive review of FIs in Rwanda based on a systematic review of reports published between 1972 and 2022. The findings reveal a rich diversity of fungal pathogens, including Blastomyces, Candida, Cryptococcus, Histoplasma, Microsporum, Pneumocystis, Rhinosporidium, and Trichophyton caused human infections. Candida infections predominantly affect the vagina mucosa, while Histoplasma duboisi was linked to disseminated infections. Other pathogens, such as Blastomyces dermatitidis and Rhinosporidium seeberi, were associated with cerebellar and nasal mucosa infections, respectively. The widespread observation of soilborne fungi affecting bean crops highlights the pathogens' threat to agricultural productivity, food security, and socioeconomic stability, as well as potential health impacts on humans, animals, and the environment. Of particular importance is that there is no information about FIs among animals in the country. Moreover, the analysis underscores significant limitations in the detection, reporting, and healthcare services related to FIs in the country, indicating gaps in diagnostic capacity and surveillance systems. This is underscored by the predominant use of traditional diagnostic techniques, including culture, cytology, and histopathology in the absence of integrating more sensitive and specific molecular tools in investigating FIs. Developing the diagnostic capacities and national surveillance systems are urgently needed to improve the health of crops, animals, and humans, as well as food security and socioeconomic stability in Rwanda. Also, it is important to indicate severe gaps in the evidence to inform policymaking, guide strategic planning, and improve healthcare and public health services, underscoring the urgent need to build national capacity in fungal diagnosis, surveillance, and research. Raising awareness among the public, scientific community, healthcare providers, and policymakers remains crucial. Furthermore, this report reveals the threats of FIs on public health and food insecurity in Rwanda. A multisectoral one health strategy is essential in research and intervention to determine and reduce the health and safety impacts of fungal pathogens on humans, animals, and the environment. [ABSTRACT FROM AUTHOR]

Keywords: COVID-19; Africa; Response; Innovation; Public health EN COVID-19 Africa Response Innovation Public health 1 3 3 05/23/20 20200522 NES 200522 Background As the coronavirus disease (COVID-19) continues to spread, countries in sub-Saharan Africa are still experiencing outbreaks of other infectious diseases; the top causes of outbreaks from 2016 to 2018 were cholera, measles, and viral hemorrhagic diseases, such as Ebola virus disease, yellow fever, dengue fever, Lassa fever, and Rift Valley fever. In our recent paper [[3]], we observed that Africa is better prepared than ever before because of our stronger national public health institutes, the rapid scale-up of testing capacity, better coordination at the continental level, and the capacity of built-in surveillance and contact tracing which has occurred since the 2013-2016 West African Ebola outbreak. COVID-19 Coronavirus disease HIV Human immunodeficiency virus IDSR Integrated Disease Surveillance and Response IHR International Health Regulations JEE Joint External Evaluation NAPHS National Action Plan for Health Security Publisher's Note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. [Extracted from the article]

Background: Making inferences about measles distribution patterns at small area level is vital for more focal targeted intervention. However, in statistical literature, the analysis of originally collected data on one resolution with the purpose to make inferences on a different level of spatial resolution is referred to as the misalignment problem. In Namibia the measles data were available in aggregated format at regional level for the period 2005 to 2014. This leads to a spatial misalignment problem if the purpose is to make decisions at constituency level. Moreover, although data on risk covariates of measles could be obtained at constituency level, they were not available each year between 2005 and 2014. Thus, assuming that covariates were constant through the study period would induce measurement errors which might have effects on the analysis results. This paper presents a spatio-temporal model through a multi-step approach in order to deal with misalignment and measurement error. Methods: For the period 2005–2014, measles data from the Ministry of Health and Social Services (MoHSS) were analysed in two steps. First, a multi-step approach was applied to correct spatial misalignment in the data. Second, a classical measurement error model was fitted to account for measurement errors. The time effects were specified using a nonparametric formulation for the linear trend through first order random walk. An interaction between area and time was modelled through type I and type II interaction structures. Results: The study showed that there was high variation in measles risk across constituencies and as well as over the study period (2005–2014). Furthermore, the risk of measles was found to be associated with (i) the number of people aged between 0 and 24 years, (ii) the percentages of women aged 15–49 with an educational level more than secondary, (iii) the percentages of children age 12–23 months who received measles vaccine, (iv) the percentages of malnourished children under 5 years, and (vi) the measles cases for each previous year. Conclusion: The study showed some of the determinants of measles risk and revealed areas at high risk through disease mapping. Additionally, the study showed a non-linear temporal distribution of measles risk over the study period. Finally, it was shown that ignoring the measurement errors may yield misleading results. It was recommended that group and geographically targeted intervention, prevention and control strategies can be tailored on the basis these findings. [ABSTRACT FROM AUTHOR]

Background: The goal of the global lymphatic filariasis (LF) program is to eliminate the disease as a public health problem by the year 2020. The WHO mapping protocol that is used to identify endemic areas in need of mass drug administration (MDA) uses convenience-based sampling. This rapid mapping has allowed the global program to dramatically scale up treatment, but as the program approaches its elimination goal, it is important to ensure that all endemic areas have been identified and have received MDA. In low transmission settings, the WHO mapping protocol for LF mapping has several limitations. To correctly identify the LF endemicity of woredas, a new confirmatory mapping tool was developed to test older school children for circulating filarial antigen (CFA) in settings where it is uncertain. Ethiopia is the first country to implement this new tool. In this paper, we present the Ethiopian experience of implementing the new confirmatory mapping tool and discuss the implications of the results for the LF program in Ethiopia and globally. Methods: Confirmatory LF mapping was conducted in 1,191 schools in 45 woredas, the implementation unit in Ethiopia, in the regions of Tigray, Amhara, Oromia, SNNP, Afar and Harari, where the results of previous mapping for LF using the current WHO protocol indicated that LF endemicity was uncertain. Within each woreda schools were selected using either cluster or systematic sampling. From selected schools, a total of 18,254 children were tested for circulating filarial antigen (CFA) using the immuno-chromatographic test (ICT). Results: Of the 18,254 children in 45 woredas who participated in the survey, 28 (0.16%) in 9 woredas tested CFA positive. According to the confirmatory mapping threshold, which is ≥2% CFA in children 9–14 years of age, only 3 woredas out of the total 45 had more CFA positive results than the threshold and thus were confirmed to be endemic; the remaining 42 woredas were declared non-endemic. These results drastically decreased the estimated total population living in LF-endemic woredas in Ethiopia and in need of MDA by 49.1%, from 11,580,010 to 5,893,309. Conclusion: This study demonstrated that the new confirmatory mapping tool for LF can benefit national LF programs by generating information that not only can confirm where LF is endemic, but also can save time and resources by preventing MDA where there is no evidence of ongoing LF transmission. [ABSTRACT FROM AUTHOR]

Despite the double burden of infectious and chronic non-communicable diseases in Africa, health care expenditure disproportionately favours infectious diseases. In this paper, we examine quantitatively the extent of this disproportionate access to diagnoses and treatment of diabetes, hypertension and malaria in Ghana. A total of 220 health facilities was surveyed across the country in 2011. Findings indicate that diagnoses and treatment of infectious diseases were more accessible than NCDs. In terms of treatment, 78% and 87% of health facilities had two of the recommended malaria drugs while less than 35% had essential diabetes and hypertension drugs. There is a significant unmet need for diagnoses and treatment of NCDs in Ghana. These inequities have implications for high morbidity and mortality from NCDs. We recommend the use of task shifting as a model to increase the delivery of NCD services. [ABSTRACT FROM AUTHOR]

Background: There is an increasing recognition that non communicable diseases impose large economic costs on households, societies and nations. However, not much is known about the magnitude of diabetes expenditure in African countries and to the best of our knowledge no systematic assessment of the literature on diabetes costs in Africa has been conducted. The aim of this paper is to capture the evidence on the cost of diabetes in Africa, review the methods used to calculate costs and identify areas for future research.Methods: A desk search was conducted in Pubmed, Medline, Embase, and Science direct as well as through other databases, namely Google Scholar. The following eligibility criteria were used: peer reviewed English articles published between 2006 and 2016, articles that reported original research findings on the cost of illness in diabetes, and studies that covered at least one African country. Information was extracted using two data extraction sheets and results organized in tables. Costs presented in the studies under review are converted to 2015 international dollars prices (I$).Results: Twenty six articles are included in this review. Annual national direct costs of diabetes differed between countries and ranged from I$3.5 billion to I$4.5 billion per annum. Indirect costs per patient were generally higher than the direct costs per patient of diabetes. Outpatient costs varied by study design, data source, perspective and healthcare cost categories included in the total costs calculation. The most commonly included healthcare items were drug costs, followed by diagnostic costs, medical supply or disposable costs and consultation costs. In studies that reported both drug costs and total costs, drug costs took a significant portion of the total costs per patient. The highest burden due to the costs associated with diabetes was reported in individuals within the low income group.Conclusion: Estimation of the costs associated with diabetes is crucial to make progress towards meeting the targets laid out in Sustainable Development Goal 3 set for 2030. The studies included in this review show that the presence of diabetes leads to elevated costs of treatment which further increase in the presence of complications. The cost of drugs generally contributed the most to total direct costs of treatment. Various methods are used in the estimation of diabetes healthcare costs and the costs estimated between countries differ significantly. There is room to improve transparency and make the methodologies used standard in order to allow for cost comparisons across studies. [ABSTRACT FROM AUTHOR]

Background: A community-based intervention comprising both men and women, known as Safe Motherhood Action Groups (SMAGs), was implemented in four of Zambia’s poorest and most remote districts to improve coverage of selected maternal and neonatal health interventions. This paper reports on outcomes in the coverage of maternal and neonatal care interventions, including antenatal care (ANC), skilled birth attendance (SBA) and postnatal care (PNC) in the study areas. Methodology: Three serial cross-sectional surveys were conducted between 2012 and 2015 among 1,652 mothers of children 0–5 months of age using a ‘before-and-after’ evaluation design with multi-stage sampling, combining probability proportional to size and simple random sampling. Logistic regression and chi-square test for trend were used to assess effect size and changes in measures of coverage for ANC, SBA and PNC during the intervention. Results: Mothers’ mean age and educational status were non-differentially comparable at all the three-time points. The odds of attending ANC at least four times (aOR 1.63; 95% CI 1.38–1.99) and SBA (aOR 1.72; 95% CI 1.38–1.99) were at least 60% higher at endline than baseline surveillance. A two-fold and four-fold increase in the odds of mothers receiving PNC from an appropriate skilled provider (aOR 2.13; 95% CI 1.62–2.79) and a SMAG (aOR 4.87; 95% CI 3.14–7.54), respectively, were observed at endline. Receiving birth preparedness messages from a SMAG during pregnancy (aOR 1.76; 95% CI, 1.20–2.19) and receiving ANC from a skilled provider (aOR 4.01; 95% CI, 2.88–5.75) were significant predictors for SBA at delivery and PNC. Conclusions: Strengthening community-based action groups in poor and remote districts through the support of mothers by SMAGs was associated with increased coverage of maternal and newborn health interventions, measured through ANC, SBA and PNC. In remote and marginalised settings, where the need is greatest, context-specific and innovative task-sharing strategies using community health volunteers can be effective in improving coverage of maternal and neonatal services and hold promise for better maternal and child survival in poorly-resourced parts of sub-Saharan Africa. [ABSTRACT FROM AUTHOR]

Background: Rapid Diagnostic Tests (RDTs) for Ebola Virus Disease (EVD) at the point of care have the potential to increase access and acceptability of EVD testing and the speed of patient isolation and secure burials for suspect cases. A pilot program for EVD RDTs in high risk areas of Guinea was introduced in October 2015. This paper presents concordance data between EVD RDTs and PCR testing in the field as well as an assessment of the acceptability, feasibility, and quality assurance of the RDT program. Methods and findings: Concordance data were compiled from laboratory surveillance databases. The operational measures of the laboratory-based EVD RDT program were evaluated at all 34 sentinel sites in Guinea through: (1) a technical questionnaire filled by the lab technicians who performed the RDTs, (2) a checklist filled by the evaluator during the site visits, and (3) direct observation of the lab technicians performing the quality control test. Acceptability of the EVD RDT was good for technicians, patients, and families although many technicians (69.8%) expressed concern for their safety while performing the test. The feasibility of the program was good based on average technician knowledge scores (6.6 out of 8) but basic infrastructure, equipment, and supplies were lacking. There was much room for improvement in quality assurance of the program. Conclusions: The implementation of new diagnostics in weak laboratory systems requires general training in quality assurance, biosafety and communication with patients in addition to specific training for the new test. Corresponding capacity building in terms of basic equipment and a long-term commitment to transfer supervision and quality improvement to national public health staff are necessary for successful implementation. [ABSTRACT FROM AUTHOR]

Introduction: Despite several interventions on the control of cholera, it still remains a significant public health problem in Africa. According to the World Health Organization, 251,549 cases and 4,180 deaths (CFR: 2.9%) were reported from 19 African countries in 2023. Tools exist to enhance the surveillance of cholera but there is limited evidence on their deployment and application. There is limited evidence on the harmonization of the deployment of tools for the evaluation of cholera surveillance. We systematically reviewed available literature on the deployment of these tools in the evaluation of surveillance systems in Africa. Method: Three electronic databases (PubMed, Medline and Embase) were used to search articles published in English between January 2012 to May 2023. Grey literature was also searched using Google and Google Scholar. Only articles that addressed a framework used in cholera surveillance in Africa were included. The quality of articles was assessed using the appropriate tools. Data on the use of surveillance tools and frameworks were extracted from articles for a coherent synthesis on their deployment. Result: A total of 13 records (5 frameworks and 8 studies) were fit for use for this study. As per the time of the study, there were no surveillance frameworks specific for the evaluation of surveillance systems of cholera in Africa, however, five frameworks for communicable diseases and public health events could be adapted for cholera surveillance evaluation. None (0%) of the studies evaluated capacities on cross border surveillance, multisectoral one health approach and linkage of laboratory networks to surveillance systems. All (100%) studies assessed surveillance attributes even though there was no synergy in the attributes considered even among studies with similar objectives. There is therefore the need for stakeholders to harmoniously identify a spectrum of critical parameters and attributes to guide the assessment of cholera surveillance system performance. [ABSTRACT FROM AUTHOR]

Background: Aflatoxins are common contaminants of staple foods in sub-Saharan Africa. These toxins are human liver carcinogens, especially in combination with chronic infection with hepatitis B virus. However, in an agricultural setting, the effects on growth, immune status, and susceptibility to infectious disease in farm animals are also well recognized. These latter effects have been far less explored in human populations.Objectives: To review some of the more recent work on aflatoxins where the health outcomes seen in the agricultural setting, including growth impairment and immune suppression, have been investigated in human populations. The paper draws largely on examples from West Africa. The paper also sets out how knowledge gained about aflatoxins in the agricultural setting can be used to design intervention studies in human populations.Methods: A review of the relevant literature.Results: Human exposure to aflatoxins begins early in life, and recent studies in West Africa have demonstrated an association between exposure and growth faltering, particularly stunting, in young children. At present the underlying mechanisms for the latter effects are unknown but may include impairment of immunity and increased susceptibility to infections. Simple postharvest intervention strategies were successful in reducing aflatoxin exposure in a subsistence farm setting, providing a rationale for prevention of aflatoxin-related disease.Conclusions: There are potential benefits to public health from intervention strategies combining expertise in the agricultural and health settings to address the aflatoxin problem. [ABSTRACT FROM AUTHOR]

Background: The recent introduction of Direct Acting Antivirals (DAAs) for treating Hepatitis C Virus (HCV) can significantly assist in the world reaching the international target of elimination by 2030. Yet, the challenge facing many individuals and countries today lies with their ability to access these treatments due to their relatively high prices. Gilead Sciences applies differential pricing and licensing strategies arguing that this provides fairer and more equitable access to these life-saving medicines. This paper analyses the implications of Gilead's tiered pricing and voluntary licencing strategy for access to the DAAs.Methods: We examined seven countries in Africa (Egypt, Ethiopia, Nigeria, Democratic Republic of Congo, Cameroon, Rwanda and South Africa) to assess their financial capacity to provide DAAs for the treatment of HCV under present voluntary licensing and tiered-pricing arrangements. These countries have been selected to explore the experience of countries with a range of different burdens of HCV and shared eligibility for supply by licensed generic producers or from discounted Gilead prices.Results: The cost of 12-weeks of generic DAA varies from $684 per patient treated in Egypt to $750 per patient treated in other countries. These countries can also procure the same DAA for 12-weeks of treatment from the originator, Gilead, at a cost of $1200 per patient. The current prices of DAAs (both from generic and originator manufacturers) are much more than the median annual income per capita and the annual health budget of most of these countries. If governments alone were to bear the costs of universal treatment coverage, then the required additional health expenditure from present rates would range from a 4% increase in South Africa to a staggering 403% in Cameroon.Conclusion: The current arrangements for increasing access to DAAs, towards elimination of HCV, are facing challenges that would require increases in expenditure that are either too burdensome to governments or potentially so to individuals and families. Countries need to implement the flexibilities in the Doha Declaration on Trade Related Intellectual Property Rights agreement, including compulsory licensing and patent opposition. This also requires political commitment, financial will, global solidarity and civil society activism. [ABSTRACT FROM AUTHOR]

Background: Cutaneous leishmaniasis (CL) is a major public health problem in Libya. In this paper, we describe the eco-epidemiological parameters of CL during the armed conflict period from January 2011 till December 2012. Current spatiotemporal distributions of CL cases were explored and projected to the future using a correlative modelling approach. In addition the present results were compared with our previous data obtained for the time period 1995–2008. Methodology/Principal findings: We investigated 312 CL patients who presented to the Dermatology Department at the Tripoli Central Hospital and came from 81 endemic areas distributed in 10 districts. The patients presented with typical localized lesions which appeared commonly on the face, arms and legs. Molecular identification of parasites by a PCR-RFLP approach targeting the ITS1 region of the rDNA was successful for 81 patients with two causative species identified: L. major and L. tropica comprised 59 (72.8%) and 22 (27.2%) cases, respectively. Around 77.3% of L. tropica CL and 57.7% of L. major CL caused single lesions. Five CL patients among our data set were seropositive for HIV. L. tropica was found mainly in three districts, Murqub (27.3%), Jabal al Gharbi (27.3%) and Misrata (13.7%) while L. major was found in two districts, in Jabal al Gharbi (61%) and Jafara (20.3%). Seasonal occurrence of CL cases showed that most cases (74.2%) admitted to the hospital between November and March, L. major cases from November till January (69.4%), and L. tropica cases mainly in January and February (41%). Two risk factors were identified for the two species; the presence of previously infected household members, and the presence of rodents and sandflies in patient’s neighborhoods. Spatiotemporal projections using correlative distribution models based on current case data and climatic conditions showed that coastal regions have a higher level of risk due to more favourable conditions for the transmitting vectors. Conclusion: Future projection of CL until 2060 showed a trend of increasing incidence of CL in the north-western part of Libya, a spread along the coastal region and a possible emergence of new endemics in the north-eastern districts of Libya. These results should be considered for control programs to prevent the emergence of new endemic areas taking also into consideration changes in socio-economical factors such as migration, conflicts, urbanization, land use and access to health care. [ABSTRACT FROM AUTHOR]

The West African Ebola epidemic of 2013–2016 was by far the largest outbreak of the disease on record. Sierra Leone suffered nearly half of the 28,646 reported cases. This paper presents a set of culturally contextualized Ebola messages that are based on the findings of qualitative interviews and focus group discussions conducted in 'hotspot' areas of rural Bombali District and urban Freetown in Sierra Leone, between January and March 2015. An iterative approach was taken in the message development process, whereby (i) data from formative research was subjected to thematic analysis to identify areas of community concern about Ebola and the national response; (ii) draft messages to address these concerns were produced; (iii) the messages were field tested; (iv) the messages were refined; and (v) a final set of messages on 14 topics was disseminated to relevant national and international stakeholders. Each message included details of its rationale, audience, dissemination channels, messengers, and associated operational issues that need to be taken into account. While developing the 14 messages, a set of recommendations emerged that could be adopted in future public health emergencies. These included the importance of embedding systematic, iterative qualitative research fully into the message development process; communication of the subsequent messages through a two-way dialogue with communities, using trusted messengers, and not only through a one-way, top-down communication process; provision of good, parallel operational services; and engagement with senior policy makers and managers as well as people in key operational positions to ensure national ownership of the messages, and to maximize the chance of their being utilised. The methodological approach that we used to develop our messages along with our suggested recommendations constitute a set of tools that could be incorporated into international and national public health emergency preparedness and response plans. [ABSTRACT FROM AUTHOR]

This paper argues for an integrative modelling approach for understanding zoonoses disease dynamics, combining process, pattern and participatory models. Each type of modelling provides important insights, but all are limited. Combining these in a ‘3P’ approach offers the opportunity for a productive conversation between modelling efforts, contributing to a ‘One Health’ agenda. The aim is not to come up with a composite model, but seek synergies between perspectives, encouraging cross-disciplinary interactions. We illustrate our argument with cases from Africa, and in particular from our work on Ebola virus and Lassa fever virus. Combining process-based compartmental models with macroecological data offers a spatial perspective on potential disease impacts. However, without insights from the ground, the ‘black box’ of transmission dynamics, so crucial to model assumptions, may not be fully understood. We show how participatory modelling and ethnographic research of Ebola and Lassa fever can reveal social roles, unsafe practices, mobility and movement and temporal changes in livelihoods. Together with longer-term dynamics of change in societies and ecologies, all can be important in explaining disease transmission, and provide important complementary insights to other modelling efforts. An integrative modelling approach therefore can offer help to improve disease control efforts and public health responses. [ABSTRACT FROM AUTHOR]