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IntroductionPeople living with HIV have high rates of hypertension. Integrated HIV and hypertension care with aligned multi-month dispensing of medications (MMD) could decrease the burden of care for individuals and health systems. We sought to describe hypertension control and evaluate its association with different durations of MMD among Malawian adults receiving integrated care with aligned dispensing of antiretroviral therapy (ART) and antihypertensive medication.MethodsWe conducted a cross-sectional survey and retrospective chart review of adults (≥18 years) receiving integrated HIV and hypertension care on medications for both conditions for at least 1 year, with aligned MMD at seven clinics in Malawi. Data were collected from July 2021 to April 2022 and included socio-demographics, clinical characteristics, antihypertensive medications and up to the three most recent blood pressure measurements. Bivariate analyses were used to characterize associations with hypertension control. Uncontrolled hypertension was defined as ≥2 measurements ≥140 and/or ≥90 mmHg. Chart reviews were conducted for a random subset of participants with uncontrolled hypertension to describe antihypertensive medication adjustments in the prior year.ResultsWe surveyed 459 adults receiving integrated care with aligned dispensing (58% female; median age 54 years). Individuals most commonly received a 3-month aligned dispensing of ART and antihypertensive medications (63%), followed by every 6 months (16%) and every 4 months (15%). Hypertension control was assessed in 359 respondents, of whom only 23% had controlled hypertension; 90% of individuals in this group reported high adherence to blood pressure medications (0-1 missed days/week). Control was more common among those with longer aligned medication dispensing intervals (20% among those with 1- to 3-month dispensing vs. 28% with 4-month dispensing vs. 40% with 6-month dispensing, p = 0.011). Chart reviews were conducted for 147 individuals with uncontrolled hypertension. Most had high self-reported adherence to blood pressure medications (89% missing 0-1 days/week); however, only 10% had their antihypertensive medication regimen changed in the prior year.ConclusionsUncontrolled hypertension was common among Malawian adults receiving integrated care with aligned MMD and was associated with shorter refill intervals and few antihypertensive medication escalations. Integrated care with aligned MMD is promising, but further work is needed to understand how to optimize hypertension outcomes.

BackgroundGlobal surgery research efforts have been criticized for failure to transition from problem identification to intervention implementation. We developed a context-appropriate trauma quality improvement (TQI) bundle to ameliorate care gaps at a regional referral hospital in Cameroon. We determined associations between bundle implementation and improvement in trauma resuscitation practices.MethodsWe implemented a TQI bundle consisting of a hospital-specific trauma protocol, staff training, a trauma checklist, provision of essential emergency trauma supplies in the resuscitation area, and monthly quality improvement meetings. We compared trends in target process measures (e.g., frequency and timing of vital sign collection and primary survey interventions) in the six-month period pre- and post-bundle implementation using Wilcoxon rank-sum and Fisher's exact tests.ResultsWe compared 246 pre-bundle patients with 203 post-bundle patients. Post-bundle patients experienced a greater proportion of all vital signs collected compared to the pre-intervention cohort (0 % pre-bundle vs. 69 % post-bundle, p < 0.001); specifically, the proportion of respiratory rate (0.8 % pre-bundle vs. 76 % post-bundle, p < 0.001) and temperature (7 % pre-bundle vs. 91 % post-bundle, p < 0.001) vital sign collection significantly increased. The post-bundle cohort had vital signs measured sooner (74 % vital signs measured within 15 min of arrival pre-bundle vs. 90 % post-bundle, p < 0.001) and more frequently per patient (7 % repeated vitals pre-bundle vs 52 % post-bundle, p < 0.001). Key primary survey interventions such as respiratory interventions (1 % pre-bundle vs. 8 % post-bundle, p < 0.001) and cervical collar placement (0 % pre-bundle vs. 7 % post-bundle, p < 0.001) also increased in the post-bundle cohort.ConclusionsThe implementation of a context-appropriate TQI bundle was associated with significant improvements in previously identified trauma care deficits at a single regional hospital. Data-derived interventions targeting frontline capacity at the local level can bridge the gap between identifying care limitations and improvement in resource-limited settings.

Across sub-Saharan Africa, men are less likely to know their HIV status than women, leading to later treatment initiation. Little is known about how experiences with general health services affect men's use of HIV testing. We used data from a 2019 community-representative survey of men in Malawi to understand frequency and cause of men's negative health service experiences (defined as men reporting they "would not recommend" a facility) and their association with future HIV testing. We conducted univariable and multivariable logistic regressions to determine which aspects of health facility visits were associated with would-not-recommend experiences and to determine if would-not-recommend experiences 12-24 months prior to the survey were associated with HIV testing in the 12 months prior to the survey. Among 1,098 men eligible for HIV testing in the 12 months prior to the survey, median age was 34 years; 9% of men reported at least one would-not-recommend experience, which did not differ by sociodemographics, gender norm beliefs, or HIV stigma beliefs. The factors most strongly associated with would-not-recommend experiences were cost (aOR 5.8, 95%CI 2.9-11.4), cleanliness (aOR 4.2, 95%CI 1.8-9.9), medicine availability (aOR 3.3, 95%CI 1.7-6.4), and wait times (aOR 2.7, 95%CI 1.5-5.0). Reporting a would-not-recommend experience 12-24 months ago was associated with a 59% decrease in likelihood of testing for HIV in the last 12 months (aOR 0.41; 95% CI:0.17-0.96). Dissatisfaction with general health services was strongly associated with reduced HIV testing. Coverage of high-priority screening services like HIV testing may benefit from improving overall health system quality.

BACKGROUND: Safer conception services are needed to minimize HIV transmission among HIV sero-discordant couples desiring pregnancy. Few studies have evaluated the choices couples make when they are offered multiple safer conception methods or real-world method acceptability. This paper addresses an important knowledge gap regarding factors that influence the choice of safer conception methods, couples actual experiences using safer conception methods, and why some couples switch safer conception methods. METHODS: Between February and June 2019, we conducted semi-structured in-depth interviews among 14 men and 17 women, representing 17 couples who exited the SAFER study-a pilot safer conception study for HIV sero-discordant couples in Zimbabwe that offered couples a choice of ART with monthly viral load monitoring (ART/VL), oral PrEP, vaginal insemination, and semen washing. All couples in SAFER had used at least two safer conception methods. RESULTS: We found that safer conception method choice often centered around a desire for intimacy, condomless sex, and certainty in the conception process, particularly for men. Method-related attributes such as familiarity, perceived ease of use, side effects, and perceived level of effectiveness in preventing HIV and achieving pregnancy influenced method choice, switching, and satisfaction. Concerns were expressed about each safer conception method and couples were willing to try different methods until they found method(s) that worked for them. The majority of participants reported having positive experiences using safer conception, especially those using ART/VL + PrEP, citing that they were able to attempt pregnancy for the first time with peace of mind and experienced joy and satisfaction from being able to achieve pregnancy safely. CONCLUSIONS: The differences in method preferences and experiences voiced by participants in this study and in other studies from the region point to the importance of having a variety of safer conception options in the service delivery package and addressing concerns about paternity, intimacy, and method-related attributes to enable HIV sero-discordant couples to safely achieve their reproductive goals.

IntroductionIdentifying the optimal approaches to offering HIV prevention to meet the needs of those at risk is a high priority, particularly given the expanding toolkit of biomedical HIV prevention options. An ongoing study in rural East African communities evaluated the uptake of choices in product, testing mode and location of care delivery through a structured patient-centred HIV prevention delivery model. In this qualitative study, we sought to understand clients' experiences of this "dynamic choice prevention model" (DCP) and highlight pathways of action to inform HIV prevention delivery models.MethodsIn-depth semi-structured interviews were conducted from November 2021 through March 2022 with a purposively selected sample of n = 56 participants in DCP trials (across outpatient departments, antenatal clinics and community settings), and n = 21 healthcare providers (total n = 77). A seven-person multi-regional team translated and inductively coded transcript data. We used a framework analysis approach to identify emergent themes.ResultsIndividuals taking up HIV pre-exposure prophylaxis (PrEP) reported feelings of relief, liberation from fears of acquiring HIV and satisfaction with being able to take action despite partners' behaviours. Couples used a range of approaches afforded by the study to persuade partners to get tested and opt for PrEP. Post-exposure prophylaxis (PEP) use was less common, although women welcomed it in the event of sexual coercion or assault. Participants discussed switching from PEP to PrEP after familiarizing themselves with usage and ascertaining ongoing risk. Participants felt respected by providers, trusted them and appreciated being able to contact them directly for telephone support. Prevention uptake was hindered by stigma, limited experience with and knowledge of prevention methods, gendered and generational power dynamics within intimate partnerships and families, and negative perceptions of methods due to the products themselves. Participants anticipated long-acting injectable PrEP could solve their challenges regarding pill size, daily pill burden and the likelihood of unwanted disclosure.ConclusionsDiverse preferences and barriers to uptake of prevention require a choice of HIV prevention options, locations and delivery modalities-but in addition, flexible, competent and friendly care provision is crucial to promote uptake. Helping clients feel valued, and addressing their unique needs and challenges, enables their agency to prioritize their health.

BACKGROUND: Across sub-Saharan Africa, mid-level healthcare managers oversee implementation of national guidelines. It remains unclear whether leadership and management training can improve population health outcomes. METHODS: We sought to evaluate leadership/management skills among district-level health managers in Uganda participating in the SEARCH-IPT randomised trial to promote isoniazid preventive therapy (IPT) for persons with HIV (PWH). The intervention, which led to higher IPT rates, included annual leadership/management training of managers. We conducted a cross-sectional survey assessing leadership/management skills among managers at trial completion. The survey evaluated self-reported use of leadership/management tools and general leadership/management. We conducted a survey among a sample of providers to understand the interventions impact. Targeted minimum loss-based estimation (TMLE) was used to compare responses between trial arms. RESULTS: Of 163 managers participating in the SEARCH-IPT trial, 119 (73%) completed the survey. Intervention managers reported more frequent use of leadership/management tools taught in the intervention curriculum than control managers (+3.64, 95% CI 1.98-5.30, P < 0.001). There were no significant differences in self-reported leadership skills in the intervention as compared to the control group. Among providers, the average reported quality of guidance and supervision was significantly higher in intervention vs control districts (+1.08, 95% CI 0.63-1.53, P = 0.001). CONCLUSIONS: A leadership and management training intervention increased the use of leadership/management tools among mid-level managers and resulted in higher perceived quality of supervision among providers in intervention vs control districts in Uganda. These findings suggest improved leadership/management among managers contributed to increased IPT use among PWH in the intervention districts of the SEARCH-IPT trial.

Introduction Onchocerciasis, more commonly known as river blindness, is a neglected tropical disease caused by the parasitic worm Onchocerca volvulus. The disease is transmitted to humans through the bite of [...]

Approximately 39 million people living with HIV (PLWH) are at risk of infection with severe acute respiratory syndrome Coronavirus 2 (SARS-CoV-2) that causes Coronavirus Disease 2019 (COVID 19). COVID 19 can lead to serious negative health outcomes for PLWH with a low CD4+ count and increased viral load (VL). The objective of this study was to determine the effect of herbal soup (formulated by mixing; dried ginger powder, dried garlic powder, roasted butternut squash powder, ground chia seeds, ground sunflower seeds, dried turmeric powder and chili pepper powder) on the immunological parameters of PLWH. This was a parallel single blind randomized control trial (RCT) conducted in Kakamega County Teaching and Referral Hospital (KCTRH) Comprehensive Care Centre (CCC). Block randomization and sequentially numbered opaque envelopes were used to assign respondents to either control group (received standard care including Nutrition counselling and anti-HIV drugs) or treatment group (received herbal soup in addition to the standard care). Participants in the treatment group prepared and consumed 1 serving (16.35g) of the soup daily for 3 months. A total of 60 respondents were selected for the control group (n=30) and treatment group (n=30), of whom, a small sample size of 41 completed the study limiting the study findings from drawing policy conclusions. Statistical Packages for Social Sciences was used for data organization and management. Paired t-test was used to determine the effect of herbal soup on CD4+ cell count and Viral Load (VL). The study findings indicated no significant effect on the mean CD4+ cell count (p=0.838), ([+ or -]277) and mean VL (p=0.051), ([+ or -]42) in the control group. There was a significant effect on mean CD4+ cell count (p=0.012), ([+ or -]199), however, no significant effect on the mean VL (p=0.102), ([+ or -]74) in the treatment group. The study concluded that the herbal soup had an effect on the CD4+ cell count and can be adopted for use at household and facility level to improve the immune defence of PLWH during emerging virus-related epidemics such as COVID 19. Key words: HIV/AIDS, SARS-CoV-2, COVID 19, CD4+ cell count, viral load, herbal soup, INTRODUCTION The estimated global burden of HIV/AIDS is approximately 39 million [1]. The HIV epidemic is disproportionately concentrated in sub-Saharan Africa (SSA) with an estimated 25.6 million PLWH [2]. Out [...]

BACKGROUND: Antenatal care (ANC) is critical to reducing maternal and infant mortality. However, sub-Saharan Africa (SSA) continues to have among the lowest levels of ANC receipt globally, with half of mothers not meeting the WHO minimum recommendation of at least four visits. Increasing ANC coverage will require not only directly reducing geographic and financial barriers to care but also addressing the social determinants of health that shape access. Among those with the greatest potential for impact is maternal education: past research has documented a relationship between higher educational attainment and antenatal healthcare access, as well as related outcomes like health literacy and autonomy in health decision-making. Yet little causal evidence exists about whether changing educational policies can improve ANC coverage. This study fills this research gap by investigating the impact of national-level policies that eliminate tuition fees for lower secondary education in SSA on the number of ANC visits. METHODS: To estimate the effect of womens exposure to tuition-free education policies at the primary and lower secondary levels on their ANC visits, a difference-in-difference methodology was employed. This analysis leverages the variation in the timing of education policies across nine SSA countries. RESULTS: Exposure to tuition-free primary and lower secondary education is associated with improvements in the number of ANC visits, increasing the share of women meeting the WHO recommendation of at least four ANC visits by 6-14%. Moreover, the impact of both education policies combined is greater than that of tuition-free primary education alone. However, the effects vary across individual treatment countries, suggesting the need for further investigation into country-specific dynamics. CONCLUSIONS: The findings of this study have significant implications for policymakers and stakeholders seeking to improve ANC coverage. Removing the tuition barrier at the secondary level has shown to be a powerful strategy for advancing health outcomes and educational attainment. As governments across Africa consider eliminating tuition fees at the secondary level, this study provides valuable evidence about the impacts on reproductive health outcomes. While investing in free education requires initial investment, the long-term benefits for both human development and economic growth far outweigh the costs.

Several actors have turned their attention to Africa, and the continent is becoming a focal point for international relations. These actors have adopted various approaches to improve their relations with African countries. Tis study examines the alternative dimension of rising international competition on the continent. The main focus of the study is Turkiye's and China's alternative approaches to Africa. Accordingly, the study seeks to answer three interrelated questions: What are the differences between the traditional and alternative approaches? What are the main factors shaping China's and Turkiye's alternative approaches toward Africa? What are the similarities in Beijing's and Ankara's approaches regarding African countries in practice? As a result, this study argues that China and Turkiye present an alternative stance to the Western-centered approach for competition in Africa, despite some differences in their relations with continental countries. Keywords: Africa, China, Turkiye, International Competition, Alternative Approaches, Introduction Africa's strategic importance in international relations is constantly growing. Notably, the continent's economic and political potential continues to increase the influence of African countries in global politics. In contrast, [...]

Introduction Turkiye's contemporary engagement with Africa comes from a long tradition of solidarity and mutual respect with Africa, quite different from the colonial legacies of the other global powers. The [...]

Turkiye's comprehensive, pragmatic, multi-dimensional, and multi-stakeholder strategy towards Africa is commendable for adopting a collaborative approach that aligns well with the region's needs. This study aims to explore Turkiye's security relations in Sub-Saharan Africa through a constructivist perspective, focusing on the sub-regions of East Africa, West Africa, and the Sahel Belt. The research employs a qualitative methodology, drawing on official documents, academic literature, reports from international organizations, and discourse analysis to examine Turkiye's security policy in the region. Turkiye's security cooperation in Sub-Saharan Africa extends beyond mere military ties, encompassing a holistic strategy that supports regional peace and stability. By enhancing and strengthening these efforts, Turkiye significantly bolsters its standing in Sub-Saharan Africa and contributes to regional security architecture. Keywords: Sub-Saharan Africa, Constructivism, Turkish Model, Security, Counter-terrorism, Introduction Turkiye has pursued an increasingly vibrant partnership policy with the African countries. Turkiye successfully adopts a conceptual framework of cooperation with African countries that includes all actors and makes [...]

Strong foreign relations among nations are crucial for fostering global stability, economic growth, and cross-cultural understanding. A stable global system that resolves conflicts through dialogue rather than confrontation benefits from positive foreign relations. This paper examines Turkiye's changing foreign policy approach towards Sub-Saharan African regional blocs, with an emphasis on their political, cultural, and economic facets. Turkiye's strategic involvement with influential regional bodies such as the African Union (AU) and the Economic Community of West African States (ECOWAS), among others, reflects its broader objective to expand its influence and cultivate multifaceted partnerships across the African continent. The scope of this paper is limited to the AU and ECOWAS. Through a comprehensive analysis, the paper evaluates Turkiye's economic initiatives, including trade agreements and investment flows, as well as its contributions to infrastructure development. The findings established Turkiye's peacekeeping roles, cultural diplomacy, diplomatic efforts, and educational exchanges. Through the investigation of these diverse aspects, the conclusion outlines a comprehensive understanding of Turkiye's place in geopolitical dynamics and regional integration in Sub-Saharan Africa. Keywords: Foreign Policy, Foreign Relations, Turkiye, Sub-Saharan Africa, Regional Blocs, Introduction Following the end of the Cold War, a new concept emerged to deal with international and foreign affairs. This concept was dubbed the 'New World Order.' (1) However, the [...]

BackgroundFacility HIV self-testing (HIVST) in outpatient departments can dramatically increase testing among adult outpatients. However, it is still unclear why populations opt out of facility HIVST and reasons for opt outing. Using data from a parent facility HIVST trial, we sought to understand individual characteristics associated with opting out of facility HIVST and reported reasons for not testing.MethodsExit surveys were conducted with outpatients aged ≥15 years at 5 facilities in Central and Southern Malawi randomized to the facility HIVST arm of the parent trial. Outpatients were eligible for our substudy if they were offered HIVST and eligible for HIV testing (ie, never previously tested HIV positive and tested ≥12 months ago or never tested). Summary statistics and multivariate regression models were used.ResultsSeven hundred seventy-one outpatients were included in the substudy. Two hundred sixty-three (34%) opted out of HIVST. Urban residency (adjusted risk ratios [aRR] 3.48; 95% CI: 1.56 to 7.76) and self-reported poor health (aRR 1.86; 95% CI: 1.27 to 2.72) were associated with an increased risk of opting out. Male participants had a 69% higher risk of opting out (aRR 1.69; 95% CI: 1.14 to 2.51), with risk being 38% lower among working male participants. Primary reasons for not testing were feeling unprepared to test (49·4%) and perceived low risk of HIV infection (30·4%)-only 2.6% believed that HIVST instructions were unclear, and 1.7% were concerned about privacy.ConclusionWorking, risky sexual behavior, rural residence, and good self-rated health were positively associated with opting out of HIVST among outpatients. Strategies to address internalized barriers, such as preparedness to test and perceived need to test, should be incorporated into facility HIVST interventions.

RationaleHIV and cardiometabolic disorders including hypertension and diabetes pose a serious double threat in Malawi. Supportive couple relationships may be an important resource for managing these conditions. According to the theory of communal coping, couples will more effectively manage illness if they view the illness as "our problem" (shared illness appraisal) and are united in shared behavioral efforts.MethodsThis study qualitatively investigated communal coping of 25 couples living with HIV and hypertension or diabetes in Zomba, Malawi. Partners were interviewed separately regarding relationship quality, shared illness appraisal, communal coping, and dyadic management of illness.ResultsMost participants (80%) were living with HIV, and more than half were also living with hypertension. Most participants expressed high levels of unity and the view that illness was "our problem." In some couples, partners expected but did not extend help and support and reported little collaboration. Communal coping and dyadic management were strongly gendered. Some women reported a one-sided support relationship in which they gave but did not receive support. Women were also more likely to initiate support interactions and offered more varied support than men. In couples with poor relationship quality and weak communal coping, dyadic management of illness was also weak. Partner support was particularly crucial for dietary changes, as women typically prepared meals for the entire family. Other lifestyle changes that could be supported or hindered by a partner included exercise, stress reduction, and medication adherence.ConclusionWe conclude that gendered power imbalances may influence the extent to which couple-level ideals translate into actual communal coping and health behaviors. Given that spouses and families of patients are also at risk due to shared environments, we call for a shift from an illness management paradigm to a paradigm of optimizing health for spouses and families regardless of diabetes or hypertension diagnosis.

In Kenya, the number of adults aged ≥60 is expected to nearly quadruple by 2050, making it one of the most rapidly aging countries in Sub-Saharan Africa (SSA). Accordingly, we designed the Longitudinal Study of Health and Ageing in Kenya (LOSHAK) to generate novel data to address the health and economic consequences of this demographic transition. Specifically, LOSHAK will investigate the social, economic, environmental, biological, and policy processes that shape late-life health and economic well-being in Kenya. Modeled on the U.S. Health and Retirement Study (HRS), LOSHAK joins a network of harmonized studies on aging in >45 countries worldwide; however, LOSHAK will be only the 2nd such study in SSA. The current feasibility and pilot phase of LOSHAK will validate measures and data collection procedures in a purposive sample of Kenyan adults aged ≥45 years. We have linguistically and culturally translated instruments while aiming to maintain harmonization with both existing HRS network studies and the ongoing Kenya Life Panel Survey. The current phase of LOSHAK is nested within the Kaloleni/Rabai Community Health and Demographic Surveillance System on the coast of Kenya. LOSHAK will advance population aging research in low- and middle-income countries through the study of (a) biomarkers and physiological measures; (b) the impacts of air pollution and climate vulnerability; (c) Alzheimers disease and related dementias, mental health, disability, caregiving, and psychosocial wellbeing; and (d) economic security, including the impact of social welfare. LOSHAK will inform future public health and economic policy to address challenges related to rapid aging in Kenya and throughout SSA. Accordingly, this paper aims to introduce and provide a description of LOSHAK and its aims and objectives, as well as to inform the scientific community of current study activities being used to build toward the full population-representative study.

INTRODUCTION: Gastric cancer (GC) is the third leading cause of global cancer-related mortality. Despite the shifting burden of GC to low-and middle-income countries, the data regarding incidence, treatment, and outcomes in these settings are sparse. The primary aim of this systematic review was to aggregate all available data on GC in sub-Saharan Africa (SSA) to describe the variability in incidence across the region. METHODS: Studies reporting population-based primary data on GC in SSA were considered. The inclusion was limited to primary studies published between January 1995 and March 2022 which comprised of adult patients in SSA with GC. Studies without accessible full text in either French or English language were excluded. Unadjusted GC incidence rates with their standard errors for each study were recalculated from the crude numerators and denominators provided in individual studies. RESULTS: A total of 5,626 articles were identified in the initial search, of which, 69 studies were retained. Reported incidence rates ranged from a high of 5.56 GC cases per 100,000 in Greater Meru Kenya to a low of 0.04 GC cases per 100,000 people in Benin City Nigeria. The overall crude pooled incidence was 1.20 GC cases per 100, 000 (95%CI 1.15-1.26) with a variability of 99.83% (I2 p < 0.001). From the 29 high-quality population-based registry studies the crude pooled incidence was 1.71 GC cases per 100,000 people (95%CI 1.56-21.88) with a variability of 99.60%. CONCLUSION: This systemic review demonstrates that GC incidence is highly variable across SSA. The limited data on GC treatment, mortality, and survival presents a significant challenge to providing a complete epidemiologic description of the burden of GC in SSA. There is a need for further robust data collection, exploration, and research studies on cancer care in SSA, with continued assessment of primary data availability.

PURPOSE: The aim of this study is to expand the current knowledge on the relationship between poverty, family functioning, and the mental health of adolescent girls in families affected by poverty and HIV/AIDS in southern Uganda. The study investigates the association between family functioning and mental health and examines whether family functioning moderates the intervention effect on adolescent mental health. METHODS: Longitudinal data were collected over the course of 24 months in a cluster randomized controlled trial conducted among N=1,260 girls aged 14-17 years in Uganda. Participants were randomized into control group (n=408 girls from n=16 schools), matched youth development accounts treatment, YDA (n=471 girls from n=16 schools), and integrated intervention combining YDA with multiple family group component (n=381 girls from n=15 schools). RESULTS: We found a significant positive association between family functioning and mental health of adolescent girls in our sample. Moderator analyses suggests that effect of the intervention on Beck Hopelessness Scale was significantly moderated by family cohesion (χ2 (4) =21.43; p = .000), frequency of family communication (χ2 (4) =9.65; p = .047), and quality of child-caregiver relationship (χ2 (4) =11.12; p = .025). Additionally, the intervention effect on depression was moderated by the comfort of family communication (χ2 (4) =10.2; p = .037). DISCUSSION: The study findings highlight the importance of family functioning when examining the link from poverty to adolescent mental health. The study contributes to the scarce evidence suggesting that asset-accumulation opportunities combined with a family strengthening component may improve parenting practices and adolescent mental health in poor households.

Introduction Methods Results Conclusion Malaria is a health threat in sub‐Saharan Africa, where Plasmodium is not tested in blood bags. Our objective was to determine the prevalence of plasmodial carriage in blood bags and the associated factors, and the involvement of these bags in the occurrence of malaria in recipients.From 1st April to 30th November, 2020, we conducted a prospective cross‐sectional study of 348 blood bags stored at 4°C in Bamako. Using SPSS 21.0 software, statistical analyses were performed using a binary logistic regression model with a significance threshold of p < 0.05 and the odds ratio (OR) framed by its 95% confidence interval (CI).During this period, 348 blood bags were transfused into 108/152 hospitalised patients, generating a transfusion frequency of 71.1%, with a prevalence of plasmodial carriage of 22%. Among the 54 initially malaria‐negative recipients, all 20 (37%) who received malaria‐positive blood bags and slept under long‐acting insecticide‐treated nets (LLINs) developed malaria. We recorded 33.3% deaths. Donor age ≤ 34 years (p = 0.011; OR = 2.55[CI.95% = 1.25–5.23]), replacement donation (p = 0.000; OR = 0.04[CI.95% = 0.0–0.19]) and not regular use of LLINs by donors (p = 0.048; OR = 0.53[CI.95% = 0.29–1]) were factors associated with plasmodial carriage of blood bags. CD4 count<200 cells/mm3 (p = 0.002; OR = 0.2[CI.95% = 0.10–0.52]), severe anaemia (p = 0.034; OR = 0.26[CI.95% = 0.10–0.90]) and decompensated anaemia (p = 0.034; OR = 3.88[CI.95% = 1.11–13.56]) were factors independently associated with recipient death.The prevalence of plasmodial carriage among blood donors is increasing in Mali. Transfusion malaria is a reality to be feared, with the risk increasing with the level of malaria endemicity of the blood donor. [ABSTRACT FROM AUTHOR]

Tax buoyancy exhibits unique behaviour in nations facing specific challenges. This phenomenon is particularly pronounced in sub-Saharan countries which often implement tax exemptions to boost investment and facilitate trade. This study investigates tax buoyancy in Rwanda. It uses government administrative data and rigorous statistical techniques. The Engle-Granger test for co-integration and Ordinary Least Squares regression techniques were used to assess long-term relationships and models. The study findings revealed that the Gross Domestic Product (GDP) was co-integrated with Direct Taxes while the Total Consumption correlates with Taxes on Goods and Services. The study revealed that there was no sustained correlation between s and international trade taxes in Rwanda. This was attributed to the increasing use of customs tax exemptions for trade facilitation and investment promotion. The GDP emerged as a reliable predictor for international trade taxes. The findings revealed the dynamic tax system in Rwanda was characterized by substantial buoyancy rates. Crucially, the study recommends not relying on import volumes for forecasting international trade taxes, not only in Rwanda but also in other countries adopting similar tax policies. The lessons drawn from Rwanda's experience offer valuable insight for policymakers confronting similar challenges. [ABSTRACT FROM AUTHOR]

Purpose: The MAKASI intervention aimed to empower Sub-Saharan African immigrants living in precarious situations in the Paris metropolitan area. Because there are factors specifically related to immigration that may increase the risk for common mental disorders, the present study aimed to examine participants' levels of depression and loneliness and analyze the effect of the intervention on depression and loneliness. Methods: The MAKASI study was designed as a stepped wedge cluster randomized trial. Study participants were recruited through an outreach program led by a nongovernmental organization and randomly assigned to two clusters, with an intervention delay of 3 months between them. Participants were assessed for 6 months after inclusion and the effect of the intervention on depression and loneliness was assessed using generalized linear mixed models. The study was conducted from 2018 to 2021 and took in consideration whether being interviewed during one of the Covid-19 confinement had an effect on the results. Results: Between 2018 and 2021 a total of 821 subjects participated in the Makasi study. High levels of depression and loneliness were found in the study population. We found no effect of the intervention on depression [95% CI 0.77 to 2.40]. Similarly, no effect of the intervention was found on loneliness [95% CI 0.87 to 2.54]. Conclusions: The intervention tested did not appear to improve the level of depression and loneliness among participants. However, the high prevalence of mental and emotional problems in the study population suggests a public health crisis among immigrants in the greater Paris area. Clinical Trial Registration Number: Trial registration Clinicaltrials.gov, NCT04468724 (July 13, 2020). [ABSTRACT FROM AUTHOR]

Background: Early experiences of sexual violence may influence HIV care and treatment outcomes among women living with HIV (WLHIV). We examined whether self-report by WLHIV of being forced into their first sexual experience was associated with awareness of HIV-positive status, being on antiretroviral therapy (ART) and being virologically suppressed. Setting: We conducted a secondary analysis using nationally representative, cross-sectional Population-based HIV Impact Assessment surveys from Lesotho, Malawi, Zambia, and Zimbabwe conducted from 2015 through 2017. Methods: Adjusted logistic regression models with survey weights and Taylor series linearization were used to measure the association between forced first sex and 3 HIV outcomes: (1) knowledge of HIV status among all WLHIV, (2) being on ART among WLHIV with known status, and (3) virological suppression among WLHIV on ART. Results: Among WLHIV, 13.9% reported forced first sex. Odds of knowledge of HIV status were not different for WLHIV with forced first sex compared with those without (adjusted odds ratio [aOR], 1.17; 95% CI: 0.95 to 1.45). Women living with HIV with forced first sex had significantly lower odds of being on ART (aOR 0.74, 95% CI: 0.57 to 0.96) but did not have lower odds of virological suppression (aOR 1.06, 95% CI: 0.80 to 1.42) compared with WLHIV without forced first sex. Conclusions: While high proportions of WLHIV were on ART, report of nonconsensual first sex was associated with a lower likelihood of being on ART which may suggest that early life trauma could influence long-term health outcomes. [ABSTRACT FROM AUTHOR]

Our study reviews critical social science and policy literature on human settlement research. It examines how the gender of household heads determines housing location preferences in Sub-Saharan African cities. Five themes are obtained from the review: circumstances under which household headships emerge, household fundamental gender roles, interaction with the local property market, power relations and gender in social networks, as well as differing gendered residential location choices. Uncovering how varied gender-influenced household location choices are made underscores the differing significance of the unique gendered preferences in selecting urban housing in rapidly urbanising cities of Sub-Saharan Africa. Engendering the differing preferences and their effect on housing location choices is critical in tracking the housing location journeys of respective household heads and guiding policy action. [ABSTRACT FROM AUTHOR]

This research explores the effect of implementing educational open microcredentials on student motivation, engagement, and completion in open access online courses. Our case study reviews the impact on the Community of Learning for African PhD Fellows, a capacity-building project supporting PhD fellows in Sub-Saharan Africa. It builds on an analysis of data from learning analytics, surveys, and semi-structured interviews. Our case study findings indicate that course completion was low, in course offering rounds with and without online certification. Main hurdles to completion are lack of time and lack of direct career benefits or academic value attached to the course completion. We found that, while open access online courses are appreciated by PhD fellows, the implementation of open microcredentials did not provide an incentive towards completion of online courses for this population. Hard and soft copy certificates at this point are more appreciated. [ABSTRACT FROM AUTHOR]

Belief in evil and hidden supernatural forces, generally referred to as witchcraft, is widespread in many parts of the African continent. In addition to affecting individual health, perceived security, and social relations, witchcraft allegations may be used as covert political instruments, resulting in governance challenges such as lack of trust, transparency, administrative delegation, and political accountability. Since witchcraft is commonly associated with physiological and psychological violence, some citizens may be less willing to participate in political activities, including seeking elected office or criticizing political elites for fear of falling victim to witchcraft. The focus of our study is Malawi where large groups in the population believe in the power of witchcraft. We aim to unpack how local witchcraft beliefs have a bearing on governance – whether, and the extent to which, witchcraft influences how citizens understand and practice transparency and accountability in everyday life. Particularly, the belief in witchcraft among Malawian elites' warrants closer scrutiny, especially since existing literature and local discourse on the impact of witchcraft tend to largely focus on rural and less educated groups in the population. As the highly secret and complex dimensions of witchcraft resist clear-cut definitions, representations, and analysis, it is not our intention to describe witchcraft in everyday life. Rather, we explore the potential political implications of not addressing elite discourses of and belief in witchcraft. We find that belief in witchcraft can influence citizens' perceptions of power and authority and can potentially undermine the legitimacy of democratic institutions and processes. [ABSTRACT FROM AUTHOR]

Renewable energy projects are increasingly being implemented at scale to meet global climate goals, often targeting lands on the margins of the state and affecting the livelihoods of Indigenous or marginalized populations. This article argues a need for project-developers, investors and rights advocates to consider the potentially significant 'gap' between their expectations that the rights of local populations will be settled at the start of a particular investment and the conflicts over rights, recognition and benefits that emerge during implementation that risk derailing investments. This is particularly relevant for renewable investments, as their claims to global and national benefits divert attention from their local impacts. Empirically, this is explored through the case of the Lake Turkana Wind Power project in Kenya. Based on interviews and literature review, the article examines the relations between the key stakeholders in this project by acknowledging their various 'ways of seeing' rights. Ruling elites often see rights as settled once they have been written into law and investors assume that rights have been dealt with at the project's start, but local populations typically begin exploring their rights following project-induced changes. The interaction of stakeholders with such diverse views has important implications for the practice of human rights in the context of renewable energy investments. [ABSTRACT FROM AUTHOR]

The component structure of executive functioning (EF) has been shown to change across development. Empirical research examining this in Sub‐Saharan Africa is limited. We report the development of EF component structure with a large sample of Ghanaian children (n = 2,979) followed longitudinally from ages 3 through 12 across six waves. Existing literature suggests unitary models of EF (components loading onto a single factor) early in childhood, with development across childhood and into adolescence resulting in a more diversified EF model (components loading onto two‐ or three‐factors). To test these developmental differences, participants completed EF batteries that measured EF components: working memory, short‐term memory, inhibition, and cognitive flexibility/shifting. We employed confirmatory factor analysis to test factor models in 3‐ to 4‐year‐olds, 5‐ to 6‐year‐olds, 7‐ to 9‐year‐olds, and 10‐ to 12‐year‐olds. Contrary to existing literature, a two‐factor EF model best explained EF performance as early as 3–4 years of age. Findings suggest that diversification of EF components may emerge earlier in childhood than expected in some contexts, questioning the universality in the timing of unification and diversification of EF structure. [ABSTRACT FROM AUTHOR]

This paper argues for the importance of foregrounding learners' experiences in language-in-education research, particularly in sub-Saharan Africa and other postcolonial contexts where there is an unfamiliar language of learning and teaching. Standing firmly on the shoulders of decades of research that compellingly demonstrates a range of ways in which the use of an unfamiliar language is detrimental to classroom practice and learning outcomes, we suggest that there are yet further negative consequences that are currently under-researched. We argue that combining observation of learners with methods that create space for learners to explain their experiences in their own words enables important new insights into how epistemic injustices intersect with broader structural injustices in learners' lives. Our proposition is informed by our work and research in a variety of contexts but draws most heavily from qualitative research conducted with young people in primary and secondary schools in Tanzania, Rwanda and South Africa. Our conclusions demonstrate how learner-focused research could importantly and beneficially extend the evidence base that is available to support calls for changes to language-in-education policy and practice. [ABSTRACT FROM AUTHOR]

This article discusses the place of the concept of global citizenship within the context of African values. It holds that if the modern concept of global citizenship education as espoused by UNESCO and other global organisations is relatively recent, the same concept is ancient within the context of sub-Saharan Africa and it is subsumed within African values. The article argues that the search for a universal theory of global citizenship education is yet to yield any positive result and it critiques the three methodologies so far adopted in promoting global citizenship education across the world. The article concludes that whilst modern global citizenship education is tied to the material world and the benefits derivable therefrom, the concept of global citizenship education advanced by at least five African values is rooted in the depth of humanity from where it rises to smoothen human relations and sooth the pains caused by human avarice. [ABSTRACT FROM AUTHOR]

This paper examines the impact of informal economy and ecological footprint on environmental regulation for a sample of 25 Sub-Saharan Africa economies (SSA) countries from 1991 to 2017. The results obtained from the techniques of static panel (Pooled ordinary least squares (POLS), random effects (RE), fixed effects (FE), and panel corrected standard error (PCSE)) as well as from dynamic panel (generalized method of moments in differences (D-GMM), and generalized method of moments in system (S-GMM)) were all consistent. They showed that the environmental regulation has a significant positive impact for both informal economy and ecological footprint in the selected economies. Regarding the relation between ecological footprint and per capita gross domestic product (GDP), an inverted U-shaped environmental Kuznets curve is verified. The study concludes that weak environmental regulation in the region reinforces informal economy and environmental pollution. Hence, findings from this study can help policymakers in the region to have a better understanding of the role of environmental regulation in reducing informal economy and environmental degradation. [ABSTRACT FROM AUTHOR]

Transect surveys are widely used to quantify mismanaged plastic waste discarded to the environment. However, very few studies have quantified inter-observer reliability in environmental waste surveys. The aim of this study was to assess inter-observer reliability for a set of environmental waste indicators derived from transect surveys in slum areas of two sub-Saharan African cities. Pairs of observers independently recorded counts of scattered waste items, large waste piles, and burnt waste along 64 environmental transects in Kisumu, Kenya, and Greater Accra, Ghana. Concordance correlation coefficients were used to measure inter-observer reliability for derived indicators measuring mismanaged waste density, waste composition, waste origins of policy concern, and waste disposal practices. Evidence across all observers consistently showed that single-use disposable diapers, discarded Personal Protective Equipment, and bagged or bottled water are locally important constituents of mismanaged waste in both cities that should be addressed through urban waste management strategies. In both cities, there was generally excellent inter-observer reliability for density of burnt waste and density of large waste piles (concordance correlation coefficient > 0.9 for all but one observer pair), but weak to moderate inter-observer reliability for scattered waste density and densities of specific waste items such as disposable nappies and discarded Personal Protective Equipment. Our study shows that beach litter survey protocols can be adapted for use in slums. However, to generate robust estimates of scattered waste, its composition, and waste origins of policy concern in slums, assessment of inter-observer reliability should be incorporated into field team training. [ABSTRACT FROM AUTHOR]

Historically, pregnant and lactating populations (PLP) have been excluded or disenrolled from biomedical HIV prevention trials, despite being more likely to acquire HIV during pregnancy and the post-partum period. We conducted a meta-analysis of pregnancy events in biomedical HIV prevention trials in sub-Saharan Africa to support trialists moving toward more inclusive clinical and implementation studies. We searched peer-reviewed literature reporting pregnancy events and contraceptive requirements in HIV prevention trials between 2001 and 2022. We hypothesized four variables to explain variation: contraceptive requirements, study start year, study product, and sub-region. We fit a meta-analytic model to estimate individual effect sizes and sampling variances, then conducted sub-group analyses to assess moderating effects. We identified 38 references for inclusion, across which the proportion of pregnancy events was 8% (95% confidence interval [CI]: 6–10%) with high heterogeneity (I2 = 99%). Studies not requiring contraceptives (21%, 95%CI: 7–48%) reported a significantly higher proportion of pregnancy events than studies requiring two methods (5%, 95%CI: 2–10%). Studies launched between 2001 and 2007 (11%, 95%CI: 8–16%), microbicide gel trials (12%, 95%CI: 8–18%), and studies conducted in Western Africa (28%, 95%CI: 13–51%) reported higher proportions of pregnancy events than reference groups. Together, these variables have a moderating effect on pregnancy events (p < 0.0001), explaining 63% of heterogeneity in trials. Results describe how, over time, more stringent contraceptive requirements reduced pregnancy events, which ensured necessary statistical power but limited reproductive choice by participants. With the move toward continuing PLP on experimental products, trialists can utilize estimated pregnancy events reported here to inform strategies that accommodate participants' changing fertility preferences. [ABSTRACT FROM AUTHOR]

Obesity (overweight) is a widespread concern not only in high‐income nations but also in low‐income countries across sub‐Saharan Africa (SSA). Although many studies attribute this trend to economic development triggering a shift in nutrition patterns within SSA, they tend overlook a critical factor: the level at which these determinants are measured. Assessing them nationally while drawing comparisons with individual‐level obesity data introduces a statistical challenge known as the ecological fallacy. To address this, we utilize local‐level night light data as a proxy for local economic development. Analyzing demographic and health surveys from 44 SSA countries spanning the period 1992–2019, we find that local development is associated with a 0.002% increase in the body mass index of women. In addition, we find that night light intensity is associated with 0.2%–0.3% increases in probabilities of a woman being overweight and obese. Our results remain robust when we employ an instrumental variable approach by using a control function based on peer effect. In terms of policy implication, our research highlights that local development may entail potential health costs, emphasizing the need for African governments to invest in healthcare and also build physical infrastructure that can promote active lifestyles. [ABSTRACT FROM AUTHOR]

Despite the advent of trade liberalisation, trade taxes still remain a key source of tax revenues in sub‐Saharan Africa. Further trade reforms in the form of the African Continental Free Trade Area could, however, hinder output growth in the region if these reforms lead to a decline in total tax revenues. Motivated by this conundrum, this paper investigates the impact of trade liberalisation on tax revenues across a panel of sub‐Saharan African countries. The results indicate that trade liberalisation is associated with an increase in total tax revenues. Also, the reduction of import and export duties significantly increases and decreases domestic and trade tax revenues, respectively. In addition, greater urbanisation is associated with an increase in total tax revenues, while inflation decreases tax revenues. [ABSTRACT FROM AUTHOR]

This study evaluates the role of growth in poverty reduction within the sub‐Saharan Africa (SSA) region in direct comparison to other global regions along time‐delineated thresholds. The study's results show (i) A significant gulf in the performance of SSA economies in comparison to their global cohorts; (ii) An improved role played by growth after the mid‐2000s for poverty reduction in SSA; (iii) A less deleterious impact of rising income inequality on poverty reduction within the SSA sub‐region relative to other global regions, and (iv) An improved performance of resource‐dependent SSA economies in translating growth to poverty reduction since the mid‐2000s. The convergence in growth‐induced poverty reduction between SSA and its global cohorts energizes prospects for attaining the Sustainable Development Goal of eradicating global extreme poverty by 2030; it however also calls for renewed strategies toward improving the efficacy of growth in future poverty reduction within the sub‐region. [ABSTRACT FROM AUTHOR]

The reported incidences of co-participation of Mycoplasma capricolum capripneumoniae (Mccp) and Pasteurella multocida in increased severity and pathogenesis of goats with Contagious caprine pleuropneumonia (CCPP) in sub-Saharan Africa elicited the study’s purpose. Using the preferred reporting items for systematic review and meta-analysis (PRISMA) guideline, two search engines, namely Google Scholar and PubMed, were queried to systematically review all the available literature on the current epidemiological status of CCPP and Pneumonic Pasteurellosis co-concurrently detected in goats and assess the available treatment and control measures and their challenges in the Sub-Saharan region. The search was limited to papers published between 1998 and 2024, whereby only peer-reviewed English articles were included in the study. Review papers, papers displaying abstracts only, duplicated information, papers beyond the sub-Saharan Africa region and papers published in other languages were excluded from the study. Only articles with full text and focused on goats were included for further screening process and review. A total of 3311 articles were retrieved from both databases, whereas only 58 articles met the inclusion criteria and hence were included in the data analysis. Only eight countries namely, Ethiopia, Kenya, Uganda, Nigeria, Sudan, Eritrea, Zambia and Tanzania reported the occurrence of CCPP and or Pasteurellosis: Ethiopia 23/58(39%), Tanzania 18/58 (31%), 1/58(2%) Nigeria, 1/58(2%) Zambia, 1/58(2%) Eritrea, Uganda 2/58 (3%), 2/58(3%) Sudan and Kenya 10/58(16%). Only 5/58 (9%) reported the occurrence of pneumonic pasteurellosis in Nigeria and Ethiopia. Only Tanzania (75%) and Ethiopia (33%) reported Mccp and Pasteurella multocida co-isolation and/ or detection in CCPP cases. Information on the antimicrobial susceptibility profile of Mccp and Pasteurella multocida from Sub-Saharan Africa was unavailable. One vaccine against CCPP, namely F-38 inactivated, and one vaccine against pneumonic pasteurellosis were identified to be developed and used in Sub-Saharan Africa. Developing bivalent candidate vaccines for both etiological agents is highly recommended. [ABSTRACT FROM AUTHOR]

Purpose: In recent times, stakeholders have called on corporate organizations especially those charged with governance to embrace full disclosure on non-financial issues, especially sustainability reporting. Based on this premise, this study aims to examine the influence of corporate board and assurance on sustainability reporting practices (SRP) of selected 80 firms from 8 countries in sub-Saharan Africa. Design/methodology/approach: To measure the corporate board, the authors use both board variables and audit committee variables. Also, the authors adapted the sustainability score model as used by previous authors in the field of sustainability disclosure to measure SRPs. The analysis was done using both ordered logistic regression and probit regression models. Findings: The results show that the combination of board corporate and assurance has a positive and significant impact on the sustainability reporting practice of selected firms in sub-Saharan Africa. Practical implications: The study places emphasis on the need for strong collaboration between the corporate board and external assurance in evaluating and enhancing the quality of sustainability disclosure. Originality/value: The study bridged the gap in the literature in the area of corporate board, assurance and SRP of corporate firms which has received little attention within sub-Saharan Africa. [ABSTRACT FROM AUTHOR]

Background: Musculoskeletal injuries are noticeably high among the nursing fraternity, with lower back pain (LBP) being the most prevalent. Therefore, this study aimed to map evidence on the burden of occupational musculoskeletal disorders (MSD) among nurses in sub-Saharan Africa (SSA). Methods: This scoping review was guided by Arksey and O'Malley's framework. We conducted a comprehensive literature search with no date limit from the following databases: Science Direct, PubMed, Sabinet (SA ePublications), EBSCOhost platform, World Health Organization (WHO) Library, Google Scholar, SCOPUS, Taylor and Francis, and WorldCat Academic Search with full text for published studies. The search took place from May 2022 to December 2022. Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) was used for reporting the search results, and a thematic content analysis was used to present the emerging themes from the included studies. Results: A total of 16,714 studies were identified after the database search. Only 29 studies met the inclusion criteria after full-article screening and were included for data extraction. The studies reported a total of 6343 participants from different regions in SSA. The 29 included studies showed evidence on the prevalence of MSD, associated risk factors of MSD and LBP among nurses in SSA with some recommendations on how to reduce the prevalence of MSD among nurses. Conclusion: The study findings reveal that there is a high prevalence of MSD among nurses, especially LBP. The etiology of MSD among nurses is multifactorial, and multifaceted strategies to address MSD are recommended. Further research is recommended to explore strategies that can be used to curb the high prevalence of MSD among nurses. [ABSTRACT FROM AUTHOR]

Background: POT is a relatively newly described benign odontogenic tumor with very few cases registered to date. We present the 1st case of Primordial odontogenic tumor (POT) from Sub-Saharan Africa with unique clinicopathological features; also, this is the first case to report POT's existence as a Hybrid Odontogenic lesion (HOL), with a pertinent review of the literature. Case presentation: This was a 17-year-old patient who presented with slow-growing, painless posterior mandibular swelling. The imaging revealed a well-defined, unilocular, expansile, lytic lesion with internal calcific foci surrounding an impacted #36, indicating a calcifying odontogenic cyst. The incisional biopsy revealed the presence of POT. The tumor was excised along with the involved tooth. Conclusion: POT is predominantly a non-aggressive and mostly affects the pediatric population. Hence, clinicians must be updated on all the aspects of this tumor to diagnose it appropriately and avoid any undue over—or under-treatment. [ABSTRACT FROM AUTHOR]

Background Objective Search Strategy Selection Criteria Data Collection and Analysis Main Results Conclusions Training health workers might facilitate respectful maternity care (RMC); however, the content and design of RMC training remain unclear.To explore the content and design of RMC training packages for health workers in sub‐Saharan Africa.MEDLINE, EMBASE, CINAHL Complete, Web of Science Core Collections, SCOPUS, and grey literature sources (including websites of RMC‐focused key organizations and Ministries of Health) were searched for journal papers, reports, and training guides from January 2006 up to August 2022.There were no restrictions on study designs, language, or health‐worker cadre. Two reviewers independently screened results.Key data, including training content and methods used, were extracted and summarized.Thirty‐two citations from 26 studies/programs were identified (24 journal papers, 5 manuals/guides, 2 reports and 1 PhD thesis), with 27 citations from 22 studies informing the review findings. About half of all conducted studies were from East Africa. The most common topics in RMC trainings were communication, privacy and confidentiality, and human resources. Most trainings were multicomponent and appear to be largely in‐service training. Health workers providing direct care to women, compared with non‐clinical staff such as receptionists and cleaners, were the only recipients of training in most studies (81.8%). Two broad categories of training methods/tools were identified: workshop‐based and action‐based. Over 90% of the studies assessed impact of the training, with a majority focused on impacts on maternal health and care; however, half of the latter studies did not appear to have feedback mechanisms in place for implementing change.The content and design of RMC training in sub‐Saharan Africa are multifaceted, suggesting the complexity of implementing/promoting RMC. Some progress has been made; however, missed opportunities in training remain with respect to study populations, training topics, cadres, and feedback mechanisms. [ABSTRACT FROM AUTHOR]

Related Articles This article suggests that since people who believe in magic and those who believe in conspiracy theories produce meaning and make sense of the world by engaging in the same process of signification, they should be more likely to have one such belief if they hold the other. To test this proposition, we perform both macro‐ and micro‐level analyses using, respectively, cross‐national datasets and an original set of Tanzanian data. Our findings from both sets of analyses reveal a strong association between witchcraft beliefs and the belief in conspiracy theories.Gainous, Jason, and Bill Radunovich. 2008. “Religion and Core Values: A Reformulation of the Funnel of Causality.” Politics & Policy 33(1): 154–80. https://doi.org/10.1111/j.1747‐1346.2005.tb00213.x.Richey, Sean. 2017. “A Birther and a Truther: The Influence of the Authoritarian Personality on Conspiracy Beliefs.” Politics & Policy 45(3): 465–85. https://doi.org/10.1111/polp.12206.Tubadji, Annie. 2023. “You'll Never Walk Alone: Loneliness, Religion, and Politico‐economic Transformation.” Politics & Policy 51(4): 661–95. https://doi.org/10.1111/polp.12538. [ABSTRACT FROM AUTHOR]

Background: Maternal mortality in sub-Saharan Africa and Malawi remains high. Effective antenatal care (ANC) services can reduce maternal morbidity and mortality. However, attendance to ANC clinics and the quality of services provided remain a challenge. Malawi adopted the 2016 WHO antenatal care model and there is a need to assess factors that influence antenatal care attendance. The main objective of this study was to assess factors influencing attendance in the era of the eight ANC contact policy in Blantyre. Methods: This was an exploratory qualitative design in which 28 respondents participated using in-depth interviews and focus group discussions for the data collection process. The study sites included two healthcare facilities, namely Queen Elizabeth Central Hospital and Bangwe Health Centre, and a rural community (William Village Bangwe Rural) in Blantyre district. The 28 study participants included 11 ANC attendees, which comprised seven women in their final trimester and four postpartum women who attended ANC during their pregnancy, five midwives running the ANC clinics, and 12 non-users of ANC. The recordings were transcribed verbatim. The data were organized using Microsoft Excel and Microsoft word and analyzed using inductive content analysis. Results: The factors promoting ANC attendance in the context of the eight ANC contact policy include; motivation from health workers, family, and spouses and the women's perceptions of ANC particularly the role it plays in preventing, detecting, and treating illness, but also preventing adverse pregnancy outcomes. On the other hand, the hindering factors to ANC attendance included lack of knowledge of the new ANC visit guidelines, financial constraints, quality of health services provided, attitude of healthcare workers, inadequate availability and training of healthcare workers, perceived poor quality of ANC services and personal beliefs. Conclusion: It is essential to provide comprehensive training to healthcare workers in the antenatal department regarding the new WHO ANC recommendations. This will help improve the quality of services at the antenatal clinics, including ensuring the availability of all necessary resources to encourage attendance. Additionally, promoting comprehensive spousal support, encouraging participation in activities, and adequately planning scheduled visits can help overcome financial barriers and further support antenatal attendance. [ABSTRACT FROM AUTHOR]