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Scholars have long debated whether international organizations (IO) matter in international politics. Skeptics argue that power politics determine outcomes while champions see IOs as important, independently shaping outcomes and reshaping the structure of politics. Between these extremes, scholars have made numerous theoretical and empirical contributions to understanding under what conditions IOs make a difference. Yet, the fundamental question remains: when IOs identify a significant problem, can they solve it? We identify an underutilized analytical approach to understanding this broad debate. Specifically, we suggest scholars analyze this question by focusing on an IOs response to given crises to provide internal validity to claims throughout this debate. Furthermore, we encourage scholars to move beyond the oft-cited global or European cases to better incorporate insights from IOs in various parts of the world. Here, we explore the Southern African Development Community's attempt to coordinate member states' maritime strategy to solve the emergent piracy problem caused by the Somali civil war. In identifying these new directions for research, we demonstrate that IOs, even under difficult circumstances, are effective actors in international politics. [ABSTRACT FROM AUTHOR]

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

Riverbank filtration (RBF) has emerged as a crucial and functional water treatment method, particularly effective in improving surface water quality. This review is aimed at assessing the suitability of RBF in regions with limited access to clean water, such as Africa, where it has the potential to alleviate water scarcity and enhance water security. This review used various studies, highlighting the principles, applications, and advancements of RBF worldwide. The findings of this review revealed that RBF effectively addresses a broad range of contaminants, including microbial pathogens, organic compounds, heavy metals, and micro-pollutants, through natural processes like adsorption, biodegradation, and filtration. These natural mechanisms significantly reduce waterborne contaminants, making RBF an eco-friendly, sustainable, and cost-effective alternative to conventional water treatment methods. Hydro geological factors, such as aquifer thickness and hydraulic conductivity, play an important role in the efficiency and overall performance of RBF systems. The integration of RBF with advanced treatment technologies not only removes contaminants more effectively but also ensures a sustainable supply of clean water for various applications. The cost-saving aspect of RBF, compared to traditional methods, is particularly significant in low-income regions. The study suggests a wider use of RBF, particularly in Africa, where it can strengthen resilient water supply systems in response to growing water scarcity and climate change concerns., Competing Interests: Declarations. Ethical approval: Not applicable. Consent to participate: Not applicable. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests., (© 2025. The Author(s).)

Spina bifida is a congenital neural tube defect that results in abnormal development of the spine and central nervous system. Infants born with this condition face a range of physical disabilities and associated complications. Although the global burden has declined in recent decades due to folic acid fortification and prenatal screening, spina bifida remains a significant public health challenge in many low- and middle-income countries (LMICs), particularly in sub-Saharan Africa. This research aimed to comprehensively assess the current epidemiological trends, clinical management practices, and socioeconomic impacts of spina bifida across African LMICs. Through a systematic analytical search of published literature from major medical databases covering the years 2000-2023, relevant data were extracted on the prevalence, risk factors, clinical presentations, treatment modalities, outcomes, and contextual barriers faced in preventing and caring for spina bifida in these settings. The findings were analyzed and synthesized to provide an overview of the contemporary landscape. The findings highlight the need for collaborative efforts between governments, healthcare providers, nongovernmental organizations, and international stakeholders to address the multifaceted challenges posed by spina bifida in LMICs, particularly within the African continent, and to promote equitable access to comprehensive care and support for affected individuals and their families., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial or personal relationships that could be viewed as influencing the work reported in this paper., (Published by Elsevier Masson SAS.)

The ongoing mpox outbreak in Africa, now classified as a Public Health Emergency of International Concern by the World Health Organization, presents a severe challenge, particularly for vulnerable populations like sex workers. Despite the endemic presence of mpox in Africa since the 1970s, recent developments, including the emergence of a new clade Ib strain with increased transmissibility, have exacerbated the situation. Sex workers are at heightened risk due to their occupational exposure, compounded by stigma, criminalization, and limited access to healthcare. These factors significantly impede efforts to control the spread of the virus, leading to underreporting and inadequate intervention. This article highlights the urgent need for an inclusive public health response that prioritizes the health and safety of sex workers. Such a response should involve tailored health services, legal protections, and community engagement to ensure that this marginalized group is not overlooked. The decriminalization of sex work is also proposed as a critical public health measure to improve access to care and reduce stigma, ultimately curbing the spread of mpox in Africa., Competing Interests: Potential conflicts of interest. All authors: No reported conflicts. All authors have submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest. Conflicts that the editors consider relevant to the content of the manuscript have been disclosed., (© The Author(s) 2024. Published by Oxford University Press on behalf of Infectious Diseases Society of America. All rights reserved. For commercial re-use, please contact reprints@oup.com for reprints and translation rights for reprints. All other permissions can be obtained through our RightsLink service via the Permissions link on the article page on our site—for further information please contact journals.permissions@oup.com.)

Journal editors instruct authors to describe human participant protections in original research reports. However, little is known about African biomedical journal authors' adherence to such journal editors' instructions. This study investigated changes in editors' instructions to authors and authors' reporting of research ethics information in selected African biomedical journals between 2008 and 2017. Twelve selected journal websites and online articles were reviewed in Eastern, Southern, and Western African [ESWA] countries. A pre-tested schema and a checklist were used to collect data from journal websites and articles published in 2008 and 2017, and the data were analysed using descriptive and inferential statistics. Half of the journals requested prospective authors to disclose ethics approval and related issues in their manuscripts between 2008 and 2017. There was a significant increase in instructions to authors regarding information on the protection of research participants within this period; more authors complied with these requirements in 2017 than in 2007., Competing Interests: Declaration of Conflicting InterestsThe second author is a member of the REC that reviewed this project for ethics exemption and declares that due to a declared conflict of interest, he had no part in the ethics review decision (exemption) granted to this study. As Editor-in-Chief of this journal, the second author declares that the review and final decision regarding this article was completely independently and confidentially conducted by an Associate Editor of the Journal.

Background and aim: Billfish are epipelagic marine predators facing increasing pressures such as overfishing and rising global temperatures. Overfishing is a major concern, as they are caught by industrial longline fishers targeting tuna. Billfish are targeted by multiple fishing sectors, which provides food, socio‐economic and cultural benefits. To support effective billfish management and conservation, it is essential to understand their spatial distribution and the environmental factors that may influence it. Location: The focus of this study is the Indian Ocean (IO), where there are gaps in understanding the interactions between fisheries and billfish distribution. Three of six billfish species are at risk from overfishing. Therefore, determining their distribution is crucial to their management and conservation. Methods: Using Ocean Biogeographic Information System (OBIS) occurrence data, Indian Ocean Tuna Commission (IOTC) catch data, and environmental covariates, we applied species distribution models to investigate the spatial extent of the realized niches of six billfish species in the IO. We also determined the role and relative importance of environmental drivers. Moreover, we evaluated the association between species' spatial distribution and the fishing effort distribution. Results: We found niche partitioning and overlap among the six species identified spatial distribution, with higher species richness in the northern region of the IO and off the East coast of Africa. Temperature, mixed layer depth and salinity were identified as the most important predictors of species distribution, with moderately warm and stable environments preferred by most billfish species. Areas with high species richness and high fishing effort overlap were primarily found in the Areas Beyond National Jurisdiction (ABNJ). In contrast, areas with high species diversity richness and low fishing effort were found mainly in the Exclusive Economic Zone (EEZ). Main conclusion: Spatial overlap between fishing effort and billfish projected distribution suggests inadvertent fishing pressure on billfish populations as they are caught together with targeted tuna. Spatial distribution transcends maritime zones, reinforcing a need to formulate effective management policies for marine areas beyond national jurisdictions. [ABSTRACT FROM AUTHOR]

Terrestrial‐marine dust fluxes, pedogenic carbonate δ13C values, and various paleovegetation proxies suggest that Africa experienced gradual cooling and drying across the Pliocene‐Pleistocene (Plio‐Pleistocene) boundary (2.58 million years ago [Ma]). However, the timing, magnitude, resolution, and relative influences of orbitally‐driven changes in high latitude glaciations and low latitude insolation differ by region and proxy. To disentangle these forcings and investigate equatorial eastern African climate across the Plio‐Pleistocene boundary, we generated a high‐resolution (∼3,000‐year) data set of compound‐specific n‐alkane leaf wax δ2H values—a robust proxy for atmospheric circulation and precipitation amount—from the HSPDP‐BTB13‐1A core, which spans a ∼3.3–2.6 Ma sequence in the Baringo‐Tugen Hills‐Barsemoi Basin of central Kenya. In combination with the physical sedimentology, our data indicate that precipitation varied strongly with orbital obliquity, not precession, during the late Pliocene, perhaps imparted by variations in the cross‐equatorial insolation gradient. We also observe a marked shift toward wetter conditions beginning ∼3 Ma that corresponds with global cooling, drying in western Australia, and a steepening of the west‐east zonal Indian Ocean (IO) sea surface temperature (SST) gradient. We propose that northward migration of the Subtropical Front reduced Agulhas current leakage, warming the western IO and causing changes in the IO zonal SST gradient at 3 Ma, a process that has been observed in the latest Pleistocene‐Holocene but not over longer timescales. Thus, the late Cenozoic moisture history of eastern Africa is driven by a complex mixture of low‐latitude insolation, the IO SST gradient, and teleconnections to distal high‐latitude cooling. Key Points: We present new high resolution (3,000‐year) leaf wax δ2H data from central Kenya spanning 3.3–2.6 million years before present (Ma)Pronounced 41,000‐year variability throughout is potentially attributable to the cross‐equatorial insolation gradientLong‐term (>200,000‐year) variability in eastern African hydroclimate tracks the zonal Indian Ocean surface temperature gradient [ABSTRACT FROM AUTHOR]

In-situ measurements from IAGOS are used to characterise extreme values of carbon monoxide (CO) in the troposphere between 2002 and 2019. The SOFT-IO model, combining the FLEXPART lagrangian dispersion model with emission inventories over the footprint region is used to identify the origins of the CO in the sampled plumes. The impact of biomass burning and anthropogenic emissions on such CO plumes are characterised through CO mixing ratios and simultaneously recorded ozone (O3) ones. In the Northern Hemisphere, maximum of CO are reached in DJF in the lower troposphere because of the elevated anthropogenic emissions and reduced convective activity of the season. Due to the low photochemistry and the fresh age of the air mass the O3 values of these plumes are low. CO plumes in the upper troposphere result from intense emissions and efficient vertical transport, peaking during JJA. Among the anomalies detected in the UT in JJA, the ones with the higher associated O3 values are the ones associated with biomass burning emissions. The middle troposphere combines the two previous vertical levels with contributions from both local emissions and long-range transport. The emission regimes and meteorological conditions are fundamentally different within the troposphere over Africa. Convection is no longer the limiting factor and the transport of the CO plumes is driven by the ITCZ shift, trade winds and the upper branch of the Hadley cell redistributing the pollution to higher latitudes. [ABSTRACT FROM AUTHOR]

Africa faces a significant burden of infectious diseases, including Malaria and HIV/AIDS, along with an increasing prevalence of non-infectious diseases such as diabetes and cancer. This dual health challenge is amplified by socioeconomic difficulties, restricted access to healthcare, and lifestyle changes, thus present unique scientific needs. Effectively addressing these issues requires a skilled scientific workforce adept in comprehensive healthcare strategies. This analysis explores the critical landscape of health research in Africa, emphasizing the unique opportunity presented by the continent's youthful population, projected to reach almost 1 billion by 2050. The youth's innovative potential and fresh perspectives offer a chance to overcome development barriers in health research. Nevertheless, challenges such as under-resourced education, limited research training, inadequate mentorship, and funding difficulties persist. This paper urgently calls upon African leaders, international partners, and stakeholders to prioritize health research, mobilize funding, forge strategic partnerships, and empower the youth as essential steps to capitalize on the continent's dynamic youth for breakthrough health outcomes. Such investments are vital not just for health but for the overall economic, social, and strategic growth of the continent. Through shared responsibility and a united effort, the potential of African youth can be harnessed, leading to transformative research, improved health outcomes, and a prosperous future. This perspective represents the collective voice of passionate young researchers and advocates across Africa, calling for a new era of health research on the continent., (© 2024. The Author(s).)

The WHO Unity Studies initiative engaged low- and middle-income countries in the implementation of standardised SARS-CoV-2 sero-epidemiological investigation protocols and timely sharing of comparable results for evidence-based action. To gain a deeper understanding of the methodological challenges faced when conducting seroprevalence studies in the African region, we conducted unstructured interviews with key study teams in five countries. We discuss the challenges identified: participant recruitment and retention, sampling, sample and data management, data analysis and presentation. Potential solutions to aid future implementation include preparedness actions such as the development of new tools, robust planning and practice., Competing Interests: The authors declare no conflict of interest., (© 2023 The Authors. Influenza and Other Respiratory Viruses published by John Wiley & Sons Ltd.)

Glomerulonephritis (GN) is a predominant cause of kidney failure in Africa. The prevalence of primary GNs varies widely across Africa depending on the relative proportion of secondary GNs and genetic predispositions. We assessed the overall and sub-regional prevalence of primary GN and its histologic subtypes in Africa. We searched PubMed, EMBASE and African Journals Online for studies of biopsy-proven primary GNs across all age groups in Africa published between 2010 and 2022. Data for primary GNs [minimal change disease (MCD), focal segmental glomerulosclerosis (FSGS), membranous nephropathy (MN), mesangioproliferative GN (MesPGN), membranoproliferative GN (MPGN), post-infectious GN (PIGN), IgA Nephropathy (IgAN), and crescentic GN (CresGN)] were extracted. Pooled prevalence was determined using the random effects model. Seventeen eligible articles (n = 6,494 individuals) from 8 African countries met the inclusion criteria. The overall pooled prevalence of FSGS, MCD, MN, MPGN, MesPGN, PIGN, IgAN and CresGN was 26.10%, 22.40%, 8.40%, 6.40%, 6.40%, 2.60%, 2.60%, 1.40%, respectively. Only 4 studies (23.5%) used light microscopy (LM), immunofluorescence (IF), and electron microscopy (EM) for diagnosis. There were significant differences in the distribution of histologic subtypes in the paediatric compared to the adult population and across geographic sub-regions, with West Africa having a higher prevalence of FSGS. Overall, the dominance of FSGS across most regions and age groups has implications for disease diagnosis and ongoing care. Research efforts to understand the impact of this trend on kidney disease outcomes and efforts to improve kidney biopsy practice as a means of early disease detection are needed in Africa., Competing Interests: The authors declare no competing interests., (Copyright: Udeme Ekpenyong Ekrikpo et al.)

Regional industrialisation and integration form part of the economic policy priorities of a number of countries in Southern Africa and of the Southern African Development Community (SADC). Manufacturing can be seen as a key driver of domestic and regional industrialisation and growth, given its ability to exhibit high backward and forward input-output linkages. While most input-output research for African countries explores domestic input-output linkages, this paper investigates inter-country intersectoral linkages among five Southern African countries for the years 2000 and 2015. We find that linkages tend to be highest in the manufacturing sector, particularly in 'food and beverages', across the countries in the study. We also find that the highest inter-country linkages are found between neighbouring countries. These findings suggest that regional growth may benefit from promoting manufacturing, especially agro-processing sectors. Regional integration may benefit from a specific focus on bilateral relationships between neighbouring countries. [ABSTRACT FROM AUTHOR]

Introduction: left ventricular hypertrophy (LVH) measured by echocardiography seen in human immunodeficiency virus/acquired immunodeficiency disease (HIV/AIDS) affects the morbidity and mortality. The hemodynamic and metabolic changes in (HIV/AIDS) affect the heart adversely causing hypertrophic remodeling with left ventricular hypertrophy. The aim of this study was to determine the prevalence and risk factors associated with LVH in African children with HIV/AIDS., Methods: an analytical case-control study was conducted using echocardiography to assess cardiac function. Descriptive statistics was used to determine percentages and univariate analysis to find association between dependent variable and independent variables. Independent variables that had an association in a univariate were included in the multivariate model to determine strength of association., Results: the mean age of the study population was 7.8 ± 2.07 years for controls and 8.3 ± 3.04 years for cases respectively. They were made up of 51.2% (n= 86) males and 48.8% (n = 82) females (M: F=1.05: 1). We studied eighty-four (n= 84) cases, and LVH was seen in 67.7% (n= 56) of the patients. Mean left ventricular mass index (g/m 2 ) was significantly higher in the cases (90.37± 35.50) than controls (89.37 ± 14.25, p= 0.04.) Relative wall thickness (mm) was within normal in the control, 0.35 ± 0.06 and high in the cases, 0.67 ± 0.17, p= 0.01. Eccentric hypertrophy was the most common type seen in 36.9% (n= 31) of the patients. Multiple linear regression analysis, revealed that the presence of LVH was associated with 0.212 (95% CI: 0.001 - 0.014; p= 0.001) lower Body mass index (BMI) for age and 0.396 (95% CI; 0.002 - 0.066; p= 0.03) lower CD4+ cell count as predictors of LVH., Conclusion: the prevalence of LVH was high. Lower body mass index (BMI) and CD4+cells count predicted LVH. This supports the recommendation by the National Heart, Lung and Blood Institute (NHLBI) working group on research priorities for cardiovascular complications in HIV/AIDS, for baseline and periodic echocardiography in the management of children with HIV/AIDS., Competing Interests: The authors declare no competing interests., (Copyright: Ijeoma Ogugua Arodiwe et al.)

Food safety investments in Africa, through international donors or national programs, were primarily focused on the formal market sector. However, increasing consumer food safety concerns about foods sold in the growing informal food markets, the rising foodborne disease burden in Africa, and the emergence of COVID-19 have all made food safety a major concern and ultimately brought it to an inflection point in Africa. In addition, Data on foodborne disease outbreaks revealed a scarcity of reported cases before and during the pandemic. The lack of information on foodborne disease reporting in Africa translates into one of the reasons why food safety in Africa is becoming a rising subject matter. This perspective discusses the situation of food safety in Africa before and after the COVID-19 pandemic. Finally, challenges confronting ongoing efforts to improve food safety in the post-COVID era in Africa are summarized and highlighted., (Copyright © 2023 The Author(s). Published by Elsevier Ltd.. All rights reserved.)

Background: African countries have not had the high case and death rates from COVID-19 as was predicted early in the pandemic. It is not well understood what factors modulated the rate of COVID-19 cases and death on the continent., Methods: We collated data from the World Bank data site, Our World in Data and Freedom House for African for 54 African countries who are members of the African Union. We used them as explanatory variables in two general linear model regression analyses. COVID cases and deaths per 100,000 obtained from WHO COVID-19 dashboard on August 12, 2021, as outcome variables in two prediction models., Results: GDP, percentage of population under 14 years of age, Maternal Mortality Ratio, number of international tourists visiting per year and public transportation closures were not significant in predicting COVID-19 cases. Higher percentage of unemployed adults in the population, lower percentage of the population over 25 years of age with secondary education, internal travel restrictions increased spread of COVID-19 while international travel restrictions were associated with lower COVID-19 cases per 100,000 population. Higher levels of democratization results in higher cases of COVID-19. Unemployment, education and democratization were still significant for COVID-19 death in the same direction as they were for COVID-19 cases. Number of tourism visitors per year was also associated with higher COVID-19 death rates but not with case rates., Conclusion: In African countries, internal movement restrictions enacted to inhibit COVID-19, had the opposite effect and enabled COVID-19 spread. Low Education levels and high unemployment were associated with having higher death rates from COVID-19. More studies are needed to understand the impact of tourism on COVID-19 and other infectious diseases arising from other regions on African countries, in order to put in place adequate control protocols., (© 2023. The Author(s).)

In this study, we explore the possible mechanism of opposite ENSO effects on summer rainfall in the JJAS region (northern GHA) and autumn rainfall in the OND region (equatorial GHA). The two regions are identified based on the spatial distribution of high seasonal fractions of annual rainfall for the period 1979–2016. The summer rainfall over the JJAS region is negatively correlated with ENSO. It is because the warm Niño3.4 SST triggers zonal wave one pattern in tropics and forces upper-level westerly anomaly and the low-level easterly anomaly over tropical Africa. Thus, the weakened upper-level Tropical Easterly Jet (TEJ) and the low-level westerly over the JJAS region result in deficient rainfall during JJAS over the northern GHA. For the autumn rainfall variability over the equatorial GHA, IOD is a pivotal factor. But, autumn rainfall anomalies are far greater in ENSO and IOD coexisting years than those in IOD alone years. In other words, ENSO has a significant impact on the autumn rainfall over the equatorial GHA by means of IOD. It is because the warming SST, which is fully developed over western Indian Ocean (IO) in autumn of ENSO developing year, causes low-level convergence over the equatorial GHA and enhances upper-level easterly over tropical Africa. Those conditions are favorable for abundant rainfall over the equatorial GHA in autumn. [ABSTRACT FROM AUTHOR]

Introduction: Thyrotoxicosis is one of the most common endocrine disorders seen in clinical practice. This study aims to determine the etiologies and treatment modalities of thyrotoxicosis in Africa., Areas Covered: The study design is a systematic review with a meta-analysis. Medical databases and the gray literature were systematically searched following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Studies done in Africa on the etiology and treatment of thyrotoxicosis were selected., Expert Opinion: In Africa, it is still believed that autoimmune diseases, generally, are not as common as what is seen in the western world. The frequency of Graves' disease is reportedly lower in Africa. The treatment of thyrotoxicosis depends on the cause. Therefore, it is of substantial importance to establish the etiology following the diagnosis of the clinical syndrome.

Competing Interests: Competing interests: None declared.

Indian Ocean sea surface temperatures impact precipitation across the basin through coupled ocean‐atmosphere responses to changes in climate. To understand the hydroclimate response over the western Indian Ocean and equatorial east Africa to different forcing mechanisms, we present four new proxy reconstructions from core VM19‐193 (2.98°N, 51.47°E) that span the last 250 ky. Sub‐surface water temperatures (Sub‐T; TEX86) show strong precessional (23 ky) variability that is primarily influenced by maximum incoming solar radiation (insolation) during the Northern Hemisphere spring season, likely indicating that local insolation dominates the upper water column at this tropical location over time. Leaf waxes, on the other hand, reflect two different precipitation signals: δ13Cwax (in phase with boreal fall insolation) is likely reflecting vegetation changes in response to local rainfall over east Africa, whereas δDprecip (primarily driven by boreal summer insolation) represents changes in regional circulation associated with the summer monsoon. Glacial‐interglacial changes in ocean temperatures support glacial shelf exposure over the Maritime Continent in the eastern Indian Ocean and the subsequent weakening of the Indian Walker Circulation as a mechanism driving 100 ky climate variability across the tropical Indo‐Pacific. Additionally, the 100 ky spectral power in δDprecip supports a basin‐wide weakening of summer monsoon circulation in response to glacial climates. Overall, the proxy records from VM19‐193 indicate that both precession and glacial‐interglacial cycles exert control over hydroclimate at this tropical location. Key Points: New multi‐proxy reconstructions from the tropical western Indian Ocean show both precession and glacial‐interglacial variabilityA new precipitation isotope record likely reflects large‐scale Indian summer monsoon circulation changes over timeGlacial‐scale changes in upper water column structure across the Indian Ocean support shelf exposure as a primary hydroclimate influence [ABSTRACT FROM AUTHOR]

Background: Otitis media with effusion (OME) is a middle ear condition characterized by the accumulation of serous fluid. It is common, though not exclusive; among children with its attendant developmental consequence if missed or untreated in early life. OME could be managed surgically, pharmacologically, or physiologically. EarPopper is a medical device developed for physiologic management of OME, Eustachian tube dysfunction, and related problems. We aim to ascertain the suitability/efficiency of EarPopper® device for the treatment of OME in our setting., Methodology: This is a prospective interventional study of volunteers diagnosed with OME from four (4) medical centers in Abuja. Pneumatic otoscopy, video-otoscopy, tympanometry, and pure-tone audiometry were done to confirm the diagnosis. Serial EarPopper sessions were performed twice weekly for 2-12 weeks, and outcome was assessed using patients' reports. The reports include the EarPopper scoring system (ESS) and audiometric parameters (before and after therapy)., Results: Forty-five patients (17 males and 28 females) aged between 3-56 years were enrolled. Thirty-five were diagnosed with bilateral OME and 10 unilateral. All patients had Type-B tympanometry tracing with mild-to-moderate conductive hearing losses and ESS of between 2.45% and 84%. Out of the 45 participants, 32 (71.1%) completed the treatment, whereas 13 (28.9%) were lost to follow-up. Duration of EarPopper treatment ranged from 2 to 12 weeks. The outcome revealed improvement in 26/32 (81.3%) with significant reduction in ESS (1% to 9.8%). Six patients 6/32 (18.9%) had persistence symptoms. These 18.9% had the propensity to progress to chronic OME., Conclusion: This study highly suggests good prospect in using EarPopper for the management of OME among Africans., Competing Interests: None

Decades after its discovery in East Africa, Zika virus (ZIKV) emerged in Brazil in 2013 and infected millions of people during intense urban transmission. Whether vertebrates other than humans are involved in ZIKV transmission cycles remained unclear. Here, we investigate the role of different animals as ZIKV reservoirs by testing 1723 sera of pets, peri-domestic animals and African non-human primates (NHP) sampled during 2013-2018 in Brazil and 2006-2016 in Côte d'Ivoire. Exhaustive neutralization testing substantiated co-circulation of multiple flaviviruses and failed to confirm ZIKV infection in pets or peri-domestic animals in Côte d'Ivoire ( n =259) and Brazil ( n =1416). In contrast, ZIKV seroprevalence was 22.2% (2/9, 95% CI, 2.8-60.1) in West African chimpanzees ( Pan troglodytes verus ) and 11.1% (1/9, 95% CI, 0.3-48.3) in king colobus ( Colobus polycomos ). Our results indicate that while NHP may represent ZIKV reservoirs in Africa, pets or peri-domestic animals likely do not play a role in ZIKV transmission cycles.

This paper presents a model for how the impact of the COVID-19 pandemic on economic output in developing countries can be assessed with a new approach. Existing models lack sectoral granularity in developing countries, which can, however, be obtained through inputoutput modelling by changing the social accounting matrix to simulate a COVID-19 economy. Results have been estimated for 65 sectors and 141 regions which correspond to the Global Trade Analysis Project's data. The analyses showed that the average impact in Africa and Asia on industry output is -2.6 per cent and -2.9 per cent, respectively. It is estimated that tourism and services are the most heavily impacted sectors, between -15 per cent and -19 per cent for hospitality, recreation, and other service activities, and between -4 per cent and -7 per cent for transport services. The model is a first attempt at estimating impact at this level of granularity per country and sector, which by triangulation with empirical data can be used to make substantiated management or policy decisions. [ABSTRACT FROM AUTHOR]

The World Health Organization described herd immunity, also known as population immunity, as the indirect fortification from an infectious disease that happens when a population is immune either through vaccination or immunity developed through previous exposure to infection. The emergence of COVID-19 vaccine is a step towards the achievement of herd immunity. Over one billion people across the globe have been vaccinated and Africa recorded only 2%. The objective of this article was to develop a forecast of the number of people to be vaccinated to achieve herd immunity in the 13 WHO-identified priority African countries for COVID-19. Herd immunity is achieved when one infected person in a population causes less than one secondary case on average, corresponding to the effective basic reproduction number (R 0 ). Vaccine delivery and distribution infrastructure including the cold chain remains weak. Vaccine hesitancy is also one of the limiting factors that may hinder herd immunity in Africa. In order to achieve herd immunity globally, African countries should not be excluded in fair and equal distribution of vaccines. Relevant stakeholders should foster commitment as well as community sensitization on COVID-19 vaccines and integration of COVID-19 vaccines in existing healthcare services., (© 2021. The Author(s).)

Background: The travel distance from home to a treatment centre, which may impact the stage at diagnosis, has not been investigated for retinoblastoma, the most common childhood eye cancer. We aimed to investigate the travel burden and its impact on clinical presentation in a large sample of patients with retinoblastoma from Africa and Europe., Methods: A cross-sectional analysis including 518 treatment-naïve patients with retinoblastoma residing in 40 European countries and 1024 treatment-naïve patients with retinoblastoma residing in 43 African countries., Results: Capture rate was 42.2% of expected patients from Africa and 108.8% from Europe. African patients were older (95% CI -12.4 to -5.4, p<0.001), had fewer cases of familial retinoblastoma (95% CI 2.0 to 5.3, p<0.001) and presented with more advanced disease (95% CI 6.0 to 9.8, p<0.001); 43.4% and 15.4% of Africans had extraocular retinoblastoma and distant metastasis at the time of diagnosis, respectively, compared to 2.9% and 1.0% of the Europeans. To reach a retinoblastoma centre, European patients travelled 421.8 km compared to Africans who travelled 185.7 km (p<0.001). On regression analysis, lower-national income level, African residence and older age (p<0.001), but not travel distance (p=0.19), were risk factors for advanced disease., Conclusions: Fewer than half the expected number of patients with retinoblastoma presented to African referral centres in 2017, suggesting poor awareness or other barriers to access. Despite the relatively shorter distance travelled by African patients, they presented with later-stage disease. Health education about retinoblastoma is needed for carers and health workers in Africa in order to increase capture rate and promote early referral., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2021. No commercial re-use. See rights and permissions. Published by BMJ.)

Despite a total prohibition on the practice of female genital mutilation (FGM), young girls continue to be victims in some African countries. There is a paucity of data on the effect of FGM practice in two generations in Africa. This study assessed the current practice of daughters' FGM among women living in 14 FGM-prone countries in Africa as a proxy to assess the future burden of FGM in the continent. We used Demographic and Health Surveys data collected between 2010 and 2018 from 14 African countries. We analyzed information on 93,063 women-daughter pair (Level 1) from 8,396 communities (Level 2) from the 14 countries (Level 3). We fitted hierarchical multivariable binomial logistic regression models using the MLWin 3.03 module in Stata version 16 at p<0.05. The overall prevalence of FGM among mothers and their daughters was 60.0% and 21.7%, respectively, corresponding to 63.8% reduction in the mother-daughter ratio of FGM. The prevalence of FGM among daughters in Togo and Tanzania were less than one per cent, 48.6% in Guinea, with the highest prevalence of 78.3% found in Mali. The percentage reduction in mother-daughter FGM ratio was highest in Tanzania (96.7%) and Togo (94.2%), compared with 10.0% in Niger, 15.0% in Nigeria and 15.9% in Mali. Prevalence of daughters' FGM among women with and without FGM was 34.0% and 3.1% respectively. The risk of mothers having FGM for their daughters was significantly associated with maternal age, educational status, religion, household wealth quintiles, place of residence, community unemployment and community poverty. The country and community where the women lived explained about 57% and 42% of the total variation in FGM procurement for daughters. Procurement of FGM for the daughters of the present generation of mothers in Africa is common, mainly, among those from low social, poorer, rural and less educated women. We advocate for more context-specific studies to fully assess the role of each of the identified risk factors and design sustainable intervention towards the elimination of FGM in Africa., Competing Interests: The authors have declared that no competing interests exist.

Since the launch of the Sustainable Development Goals (SDGs) in 2015, Africa has made some progress towards its achievements, particularly in the area of gender equality- SDG 5, climate change -SDG 13 and preserving life on land- SDG 15. Although, some African countries have made tangible impact on the other goals such as health, food production and economic growth; these efforts experienced some setbacks with attention shifting to curbing the spread of the novel coronavirus. As much as mitigating the spread of the spread of COVID-19 is important, so is ensuring efforts made on other goals are not lost, as the SDGs are much interconnected, and failure in one impacts others. For the African continent to achieve sustainable development beyond COVID-19, strategic actions which will involve innovations, evaluations and strong political will towards implementations must be taken by relevant stakeholders, so the continent is not left behind in the global goals achievement by 2030., Competing Interests: The authors declare no competing interests., (Copyright: Goodness Ogeyi Odey et al.)

Competing Interests: Competing interests: The authors completed the ICMJE Unified Competing Interest form (available upon request from the corresponding author), and declare no conflicts of interest.

Africa's health systems are strained by the COVID-19 pandemic. There are global efforts toward the development and trial of COVID-19 vaccines. However, considering the challenges and economic conditions of African nations, there could be limited access and availability of the vaccines on the continent. This will be the result of high cost and technical requirements to acquire the vaccines. There are indications that possible donor funding for COVID-19 vaccines from rich countries maybe put off considering the various challenges they face currently and the moves they are making in response to the disease. The issue of justice in health for protecting the vulnerable populations and regions also supports the need for COVID-19 vaccine availability on the African continent. Means to achieve uniform control of the disease burden across the globe should be adopted. Governments of African nations should also scale up their efforts toward COVID-19 vaccine acquisition and utilization through viable efforts. It is therefore important to assist the African continent in acquiring the COVID-19 vaccines by leveling all power dynamics that will affect access and distribution.

The debate around the COVID-19 response in Africa has mostly focused on effects and implications of public health measures, in light of the socio-economic peculiarities of the continent. However, there has been limited exploration of the impact of differences in epidemiology of key comorbidities, and related healthcare factors, on the course and parameters of the pandemic. We summarise what is known about (a) the pathophysiological processes underlying the interaction of coinfections and comorbidities in shaping prognosis of COVID-19 patients, (b) the epidemiology of key coinfections and comorbidities, and the state of related healthcare infrastructure that might shape the course of the pandemic, and (c) implications of (a) and (b) for pandemic management and post-pandemic priorities. There is a critical need to generate empirical data on clinical profiles and the predictors of morbidity and mortality from COVID-19. Improved protocols for acute febrile illness and access to diagnostic facilities, not just for SARS-CoV-2 but also other viral infections, are of urgent importance. The role of malaria, HIV/TB and chronic malnutrition on pandemic dynamics should be further investigated. Although chronic non-communicable diseases account for a relatively lighter burden, they have a significant effect on COVID-19 prognosis, and the fragility of care delivery systems implies that adjustments to clinical procedures and re-organisation of care delivery that have been useful in other regions are unlikely to be feasible. Africa is a large region with local variations in factors that can shape pandemic dynamics. A one-size-fits-all response is not optimal, but there are broad lessons relating to differences in epidemiology and healthcare delivery factors, that should be considered as part of a regional COVID-19 response framework., (© 2020 John Wiley & Sons Ltd.)

The world has witnessed rapid advancement and changes since the COVID-19 pandemic emerged in Wuhan, China. The significant changes experienced during these times remain unprecedented. The African continent has initiated significant responses to curb the spread of the pandemic. However, there is an increasing concern that rural Africa is facing serious challenges in their responses to the COVID-19 pandemic. This is due to the uncertainty if the populations are detached from or in synch with information on COVID-19. The findings reported here suggest that rural Africa is burdened with misinformation and infodemic regarding COVID-19 due to widespread misconceptions and anecdotal reports. It is, therefore, necessary to engage with community leaders to provide awareness campaigns in rural communities to ensure access to reliable information issued by local and international health authorities. It is pertinent to set up avenues that improve health literacy in communities in rural Africa as it is a major determinant of information assimilation.

Rural areas in Africa make up a large proportion of the continent. Since the emergence of COVID-19 on the continent, major attention and responses have been placed on urban areas. Rural areas are typified by certain challenges which may serve as limitations to the provision of resources and tools for COVID-19 responses in these areas. These major challenges include limited access to these areas due to poor road networks which may hamper the possibility of conveying resources and manpower. Shortage of healthcare workforce in these areas, poor health facilities/structures and limited access to COVID-19 diagnostics services may also make containment challenging. It is therefore important that investment should be made in these areas towards providing the necessary tools, resources, and manpower to ensure effective containment of COVID-19 and to alleviate the plight caused by the pandemic in rural Africa. Rural communities in Africa should not be left behind in COVID-19 responses., (© 2020 John Wiley & Sons Ltd.)

Background: Critical illness represents a major global health-care burden and critical care is an essential component of hospital care. There are few data describing the prevalence, treatment, and outcomes of critically ill patients in African hospitals., Methods: This was an international, prospective, point prevalence study in acute hospitals across Africa. Investigators examined all inpatients aged 18 years or older, regardless of location, to assess the coprimary outcomes of critical illness and 7-day mortality. Patients were classified as critically ill if at least one vital sign was severely deranged. Data were collected for the available resources at each hospital and care provided to patients., Findings: We included 19 872 patients from 180 hospitals in 22 African countries or territories between September, 2023 and December, 2023. The median age was 40 (IQR 29-59) years, and 11 078/19 862 (55·8%) patients were women. There were 967/19 780 (4·9%) deaths. On census day, 2461/19 743 (12·5%) patients were critically ill, with 1688/2459 (68·6%) cared for in general wards. Among the critically ill, 507/2450 (20·7%) patients died in hospital. Mortality for non-critically ill patients was 458/17 205 (2·7%). Critical illness on census day was independently associated with subsequent in-hospital mortality (adjusted odds ratio 7·72 [6·65-8·95]). Of the critically ill patients with respiratory failure, 557/1151 (48·4%) were receiving oxygen; of the patients with circulatory failure, 521/965 (54·0%) were receiving intravenous fluids or vasopressors; and of patients with low conscious level, 387/784 (49·4%) were receiving an airway intervention or placed in the recovery position., Interpretation: One in eight patients in hospitals in Africa are critically ill, of whom one in five dies within 7 days. Most critically ill patients are cared for in general wards, and most do not receive the essential emergency and critical care treatments they require. Our findings suggest a high burden of critical illness in Africa and that improving the care of critically ill patients would have the potential to save many lives., Funding: National Institute for Health and Care Research (NIHR) Global Health Group in Perioperative and Critical Care (NIHR133850)., Competing Interests: Declaration of interests TB declares technical consultancies with UNICEF, the World Bank, USAID, and PATH, all outside the submitted work. GB has received scholarships from PainSA, the National Research Foundation (South Africa), and the Oppenheimer Memorial Trust, speakers’ fees for talks on pain and rehabilitation, and travel grants for conferences from the University of Cape Town and National Research Foundation (South Africa). COS has received travel support from WHO for attending critical care workshops. RMP has received research grants and honoraria from Edwards Lifesciences. All other authors declare no competing interests., (Copyright © 2025 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license. Published by Elsevier Ltd.. All rights reserved.)

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The active participation in international organisations (IOs) is an important condition for the ability of states to exert influence over the content of international norms and rules. Thus, this paper adopts a comparative perspective and examines how active African states are in more than 500 international negotiations and under what conditions they are likely to remain silent. This reveals that diplomatic staff capacities are an essential precondition for active participation, while incentive structures, such as the scope of interests, impact how often states take the floor. An alternative to voicing national interest is to negotiate on behalf of regional organisations or regional groups. This paper shows that especially weaker and smaller African states benefit from regional group membership and use references to them in order to increase their leverage in international negotiations and improve, thereby, their chances to exert influence over the international architecture of rules and norms. [ABSTRACT FROM AUTHOR]

In this paper, the fate of biomass burning emissions of carbon monoxide is studied with the global chemistry–transport model MOCAGE (MOdélisation de Chimie Atmosphérique à Grande Échelle) and IAGOS (In-Service Aircraft for a Global Observing System) airborne measurements for the year 2013. The objectives are firstly to improve their representation within the model and secondly to analyse their contribution to carbon monoxide concentrations in the upper troposphere. At first, a new implementation of biomass burning injection is developed for MOCAGE, using the latest products available in Global Fire Assimilation System (GFAS) biomass burning inventory on plume altitude and injection height. This method is validated against IAGOS observations of CO made in fire plumes, identified thanks to the SOFT-IO source attribution data. The use of these GFAS products leads to improved MOCAGE skill to simulate fire plumes originating from boreal forest wildfires. It is also shown that this new biomass burning injection method modifies the distribution of carbon monoxide in the free and upper troposphere, mostly at northern boreal latitudes. Then, MOCAGE performance is evaluated in general in the upper troposphere and lower stratosphere in comparison to the IAGOS observations and is shown to be very good, with very low bias and good correlations between the model and the observations. Finally, we analyse the contribution of biomass burning to upper tropospheric carbon monoxide concentrations. This is done by comparing simulations where biomass are toggled on and off in different source regions of the world to assess their individual influence. The two regions contributing the most to upper tropospheric CO are found to be the boreal forests and equatorial Africa, in accordance with the quantities of CO they emit each year and the fact that they undergo fast vertical transport: deep convection in the tropics and pyroconvection at high latitudes. It is also found that biomass burning contributes more than 11 % on average to the CO concentrations in the upper troposphere and up to 50 % at high latitudes during the wildfire season. [ABSTRACT FROM AUTHOR]

Most of current general circulation models (GCMs) show a remarkable positive precipitation bias over the southwestern equatorial Indian Ocean (SWEIO), which can be thought of as a westward expansion of the simulated IO convergence zone toward the coast of Africa. The bias is common to both coupled and uncoupled models, suggesting that its origin does not stem from the way boundary conditions are specified. The spatio-temporal evolution of the precipitation and associated three-dimensional atmospheric circulation biases is comprehensively characterized by comparing the GFDL AM3 atmospheric model to observations. It is shown that the oceanic bias, which develops in spring and reduces during the monsoon season, is associated to a consistent precipitation and circulation anomalous pattern over the whole Indian region. In the vertical, the areas are linked by an anomalous Hadley-type meridional circulation, whose northern branch subsides over northeastern India significantly affecting the monsoon evolution (e.g., delaying its onset). This study makes the case that the precipitation bias over the SWEIO is forced by the model excess response to the local meridional sea surface temperature (SST) gradient through enhanced near-surface meridional wind convergence. This is suggested by observational evidence and supported by AM3 sensitivity experiments. The latter show that relaxing the magnitude of the meridional SST gradient in the SWEIO can lead to a significant reduction of both local and large-scale precipitation and circulation biases. The ability of local anomalies over the SWEIO to force a large-scale remote response to the north is further supported by numerical experiments with the GFDL spectral dry dynamical core model. By imposing a realistic anomalous heating source over the SWEIO the model is able to reproduce the main dynamical features of the AM3 bias. These results indicate that improved GCM simulations of the South Asian summer monsoon could be achieved by reducing the springtime model bias over the SWEIO. Deficiencies in the atmospheric model, and in particular in the convective parameterization, are suggested to play a key role. Finally, the important mechanism controlling the simulated precipitation distribution over South Asia found here should be considered in the interpretation and attribution of regional precipitation variation under climate change. [ABSTRACT FROM AUTHOR]

Introduction: Continuous ambulatory peritoneal dialysis (CAPD) is the ideal modality for renal replacement therapy in most African settings given that it is relatively cheaper than haemodialysis (HD) and does not require in-centre care. CAPD is, however, not readily utilised as it is often complicated by peritonitis leading to high rates of technique failure. The objective of this study is to assess the prevalence of CAPD-related peritonitis and all-cause mortality in patients treated with CAPD in Africa., Methods and Analysis: We will search PubMed, EMBASE, SCOPUS, Africa Journal Online and Google Scholar for studies conducted in Africa from 1 January 1980 to 30 June 2017 with no language restrictions. Eligible studies will include cross-sectional, prospective observational and cohort studies of patients treated with CAPD. Two authors will independently screen, select studies, extract data and conduct risk of bias assessment. Data consistently reported across studies will be pooled using random-effects meta-analysis. Heterogeneity will be evaluated using Cochrane's Q statistic and quantified using I 2 statistics. Graphical and formal statistical tests will be used to assess for publication bias., Ethics and Dissemination: Ethical approval will not be needed for this study as data used will be extracted from already published studies. Results of this review will be published in a peer-reviewed journal and presented at conferences. The Preferred Reporting Items for Systematic reviews and Meta-Analyses for Protocols 2015 (PRISMA-P 2015) framework guided the development of this protocol., Prospero Registration Number: CRD42017072966., Competing Interests: Competing interests: None declared., (© Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.)

Background: Physical activity improves physiological, cognitive and psychosocial functioning in chronic non-communicable diseases (NCDs). This study reviewed papers on the effects and patients' experiences of physical activity interventions for chronic NCDs in Africa., Methods: We conducted a systematic review of clinical and qualitative studies by searching eight bibliographic databases and grey literature until 19 April 2017. The mixed-methods appraisal and Cochrane Collaboration's tools were used for quality and risk of bias assessments. Three-stage sequential explanatory syntheses were done., Results: One randomized controlled trial (RCT), two non-controlled before and after studies and two qualitative studies of diabetic South African and Reunion patients were included. Exercise and sports unrelated to home and occupational activities were increased in the long term (1 year, moderate quality evidence) and short term immediately after a 4-week intervention (low quality evidence). There was conflicting evidence of intervention effects on home and occupational physical activities. Behaviour-change techniques improving chronic disease knowledge, addressing environmental barriers and stimulating/supporting physical activity were important to patients. Procedure-related components-health professional training and adequate health facilities-were important to patients, but were not addressed., Conclusion: High quality RCTs are needed to confirm the intervention components for improving physical activity for chronic NCD management in Africa.

MEPI was a $130 million competitively awarded grant by President's Emergency Plan for AIDS Relief (PEPFAR) and National Institutes of Health (NIH) to 13 Medical Schools in 12 Sub-Saharan African countries and a Coordinating Centre (CC). Implementation was led by Principal investigators (PIs) from the grantee institutions supported by Health Resources and Services Administration (HRSA), NIH and the CC from September, 2010 to August, 2015. The goals were to increase the capacity of the awardees to produce more and better doctors, strengthen locally relevant research, promote retention of the graduates within their countries and ensure sustainability. MEPI ignited excitement and stimulated a broad range of improvements in the grantee schools and countries. Through in-country consortium arrangements African PIs expanded the programme from the 13 grantees to over 60 medical schools in Africa, creating vibrant South-South and South-North partnerships in medical education, and research. Grantees revised curricular to competency based models, created medical education units to upgrade the quality of education and established research support centres to promote institutional and collaborative research. MEPI stimulated the establishment of ten new schools, doubling of the students' intake, in some schools, a three-fold increase in post graduate student numbers, and faculty expansion and retention.Sustainability of the MEPI innovations was assured by enlisting the support of universities and ministries of education and health in the countries thus enabling integration of the new programs into the regular national budgets. The vibrant MEPI annual symposia are now the largest medical education events in Africa attracting global participation. These symposia and innovations will be carried forward by the successor of MEPI, the African Forum for Research and Education in Health (AFREhealth). AFREhealth promises to be more inclusive and transformative bringing together other health professionals including nurses, pharmacists, and dentists., Competing Interests: The authors have no competing interests to declare., (© 2018 The Author(s). This is an open-access article distributed under the terms of the Creative Commons Attribution 4.0 International License (CC-BY 4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. See http://creativecommons.org/licenses/by/4.0/.)

Investigating the Indian Ocean Dipole (IOD) during the Last Interglacial (LIG) can advance knowledge of IOD behaviors in orbitally‐induced warmer‐than‐present scenarios. Based on multiple model outputs from the Paleoclimate Modeling Intercomparison Project Phase 4, the analysis suggests reduced frequencies of the IOD compared to the preindustrial period. Spatially, the whole growing and mature stages of the IOD feature suppressed variability over the west and westward expansions of eastern anomalies, while the eastern perturbation enhances only at the initial phase. The overall amplitude assessed by the dipole mode index shows only minor reductions. These changes are attributed to orbitally‐induced enhancement in mean‐state westward currents along the equator, which transport more anomalous cold water westward. In addition, the subdued El Niño–Southern Oscillation (ENSO) during the LIG is unlikely to cause a weakening of the IOD, in association with a less important role of ENSO in the formation of the IOD. Plain Language Summary: The IOD is one of the leading modes of interannual climate variability in the tropical Indian Ocean, characterized by west–east contrasted sea surface temperature (SST) anomalies. The connection between changes in the IOD and mean states is an important issue to be addressed. This study examines IOD behaviors during an orbitally‐induced warm scenario, the LIG (∼127 ka BP), using the preindustrial period as the baseline. The results suggest significant reductions in IOD frequencies and structural changes, with westward extended eastern cooling and spatially uniform suppression in western warming throughout the growing and mature stages, accompanied by intensified eastern cooling at the initial phase. The overall amplitude of the IOD, as measured by the dipole mode index, exhibits only minor reductions. The main mechanism behind the change lies in enhanced equatorial easterlies over the Indian Ocean, which are triggered by orbitally‐induced amplifications in Pacific subtropical anticyclones and increases in northern Africa–South Asia summer monsoon precipitation. Subsequently, equatorial westward currents enhance, modulating the mean advection of SST anomalies during IOD events. Further composite analyses show that the concurrently subdued ENSO is unlikely to induce an IOD attenuation since the ENSO–IOD connections are diminished as indicated by decreased correlation coefficients. Key Points: Spatial structural change and less frequency of Indian Ocean Dipole in Last Interglacial compared to preindustrial periodMain causes are that orbitally‐induced enhancement of equatorial westward currents intensifies mean advection of anomalous cold waterThe concurrent suppression in El Niño–Southern Oscillation is unlikely to cause a weakening in the Indian Ocean Dipole [ABSTRACT FROM AUTHOR]

This study describes a new species, Nanopsocus ajabu n. sp., discovered on Unguja Island, Zanzibar. The species exhibits unique morphological characteristics and complex colour patterns. Material was collected and examined following standard protocols, with specimen deposited at the National Museum of Natural History, Sofia, Bulgaria. An identification key for all known Nanopsocus species is provided. [ABSTRACT FROM AUTHOR]

Objective: In this study we aimed to present our experience on the use of Gallium-68-dotatate with positron emission tomography, computed tomography ( 68 Ga-dotatate PET/CT) in the management of neuroendocrine tumors (NET) and other somatostatin expressing tumors., Subjects and Methods: We retrospectively reviewed patients with histologically confirmed or biochemically suspected NET and other somatostatin expressing (SSTR) tumors imaged at our department with 68 Ga-dotatate PET/CT. We determined the performance of this imaging technique as well as its impact on patients management. A total of 203 patients were studied: 103 females, 100 males median age 52years., Results: The commonest tumor type was gastroenteropancreatic NET (41% of patients) and the commonest sites of distant metastases were lymph nodes and the liver 34.0% and 30.5% respectively. Positron emission tomography detected foci of disease in 19 patients where CT was falsely negative. The sensitivity, specificity, positive predictive value, negative predictive value and accuracy of 68 Ga-dotatate PET/CT imaging of NET and other SST expressing tumors were 94.16%, 91.89%, 95.55%, 89.47% and 96.55% respectively., Conclusion: Gallium-68-dotatate PET/CT was better than CT in detecting primary sites of the disease and highly sensitive and specific for diagnosis and treatment of NET and other SSTR expressing tumors.

Background: One root cause of the neglect of rabies is the lack of adequate diagnostic tests in the context of low income countries. A rapid, performance friendly and low cost method to detect rabies virus (RABV) in brain samples will contribute positively to surveillance and consequently to accurate data reporting, which is presently missing in the majority of rabies endemic countries., Methodology/principal Findings: We evaluated a rapid immunodiagnostic test (RIDT) in comparison with the standard fluorescent antibody test (FAT) and confirmed the detection of the viral RNA by real time reverse transcription polymerase chain reaction (RT-qPCR). Our analysis is a multicentre approach to validate the performance of the RIDT in both a field laboratory (N'Djamena, Chad) and an international reference laboratory (Institut Pasteur, Paris, France). In the field laboratory, 48 samples from dogs were tested and in the reference laboratory setting, a total of 73 samples was tested, representing a wide diversity of RABV in terms of animal species tested (13 different species), geographical origin of isolates with special emphasis on Africa, and different phylogenetic clades. Under reference laboratory conditions, specificity was 93.3% and sensitivity was 95.3% compared to the gold standard FAT test. Under field laboratory conditions, the RIDT yielded a higher reliability than the FAT test particularly on fresh and decomposed samples. Viral RNA was later extracted directly from the test filter paper and further used successfully for sequencing and genotyping., Conclusion/significance: The RIDT shows excellent performance qualities both in regard to user friendliness and reliability of the result. In addition, the test cassettes can be used as a vehicle to ship viral RNA to reference laboratories for further laboratory confirmation of the diagnosis and for epidemiological investigations using nucleotide sequencing. The potential for satisfactory use in remote locations is therefore very high to improve the global knowledge of rabies epidemiology. However, we suggest some changes to the protocol, as well as careful further validation, before promotion and wider use., Competing Interests: The authors have declared that no competing interests exist.

Background: Endemic goiter is highly prevalent in Uganda, placing a considerable surgical burden on the healthcare system. Across Africa, prevalence varies widely, reaching 60.2%, with visible goiter affecting 30% of Uganda's rural population despite salt iodization programs. Despite evidence supporting thyroidectomy under local anesthesia (LA) for selected cases, its importance is underestimated moreover with limited access to general anesthesia (GA) and critical care providers in resource-constrained settings. The trial compared outcomes of thyroidectomy under LA versus GA in grade 1–2 uncomplicated euthyroid goiter patients in Uganda, with an aim to assess feasibility of LA as an alternative technique. Methods: In this prospective equivalence randomized, single-blind controlled trial, participants with grade 1–2 uncomplicated euthyroid goiters were enrolled and randomly assigned to two arms (LA and GA) during surgical camps in Uganda. The study compared early postoperative outcomes, including nausea, vomiting, hematoma formation, transient voice changes, and pain at 6, 12, and 24 h. It also assessed overall incurred material and medication costs, patient satisfaction using a 5-point Likert scale, and willingness to undergo a similar procedure with the same anesthetic technique at 30 days. Results: Fifty-eight participants undergoing thyroidectomy received random assignment, twenty-nine for each arm. No significant differences were found between the 2 groups in demographics, symptom duration, and early post-operative complications or patients' level of satisfaction (P > 0.05). However, the overall material and medication costs were significantly lower in the LA Group (P < 0.001). Conclusions: Thyroidectomy under LA can be performed in a well-selected patient population with low complication rates and comparable patient satisfaction to GA. These findings may support LA for thyroidectomy as a valuable cost-efficient alternative, especially in low-resource settings with fewer GA providers. Trial registration: First registered on 31/07/2022, PACTR202208635457430 by Pan African Clinical Trial Registry. [ABSTRACT FROM AUTHOR]

Background: Infectious diseases including Newcastle disease (ND) impair poultry productivity and represent a significant burden to sustainable agriculture in Nigeria. This study aimed to investigate the active circulation and seroprevalence of Newcastle disease virus (NDV) caused by virulent forms of avian paramyxovirus type-1 (APMV-1) in poultry at live bird markets (LBMs) across Nigeria. Methods: A cross-sectional study of 18 LBMs was conducted within three states in Nigeria (Kano, Oyo, and Abuja). Paired swab and tissue samples (n = 413) were collected from birds on FTA cards and tested for APMV-1 using real-time reverse transcription polymerase chain reaction (rRT-PCR). A subset of rRT-PCR-positive samples were selected for whole genome sequencing based on the originating species (chicken, duck, geese), date, and market location to provide a broad range of isolates for characterisation. Blood samples (n = 405) were also collected from birds and the seroprevalence of APMV-1 antibodies was measured using an enzyme-linked immunosorbent assay (ELISA). Results: APMV-1 RNA was detected in 21.5% (89/413) of samples from LBMs by rRT-PCR. At least one APMV-1 positive sample was detected in 55.6% (10/18) of LBMs. The largest proportion of APMV-1-positive markets was in Kano (83.3%, 5/6), whereas the lowest was in Oyo (16.7%, 1/6). Assessment of genetic data demonstrated that genotype XIV.2 APMV-1 was circulating within Nigeria with the viruses detected clustering closely with other Nigerian isolates described previously. The seroprevalence of APMV-1 in birds was 45.9% (186/405) and 94.4% (17/18) of LBMs had at least one APMV-1 seropositive sample (i.e., with at least one APMV-1-antibody-positive bird). The LBMs in Kano had the lowest seroprevalence (88.3%, 5/6). Conclusions: This study demonstrated that APMV-1 continues to circulate in LBMs in Nigeria. LBM traders, poultry producers, and related industry and policy stakeholders should be aware of the occurrence of APMV-1 and how ND may negatively impact upon poultry production and the livelihoods of poultry farmers and LBM traders. Training initiatives aimed at improving the knowledge of APMV-1 infection and improvements in biosecurity practises and the role of disease mitigation through vaccination are required to reduce the impact of this threat to food security. [ABSTRACT FROM AUTHOR]

Background: There are limited studies of juvenile dermatomyositis (JDM) in low and middle-income countries (LMIC). Many demonstrate delays to care, high prevalence of severe manifestations, and high mortality. Given the disease-associated damage with JDM, understanding JDM in Africa further is critical. Our objectives are to understand the burden of JDM in Africa and provider access to diagnostic tools and therapy through survey methodology. Methods: A survey (available in English and French) was distributed via WhatsApp to 363 total members of the African League of Associations for Rheumatology (AFLAR; n = 233) and Paediatric Society of the African League Against Rheumatism (PAFLAR; n = 130) from November 2022-January 2023. Topics included respondent specialty, number of JDM patients followed, severe manifestations, and available diagnostic tools and medications (with and without considering cost). Results: Forty-three (12%) of the 363 providers who received the survey started it. Among the 43 who started the survey, 37 (86%) provided consent and manage JDM patients; of these 37 providers, 4 (11%) partially and 16 (43%) fully completed the survey. Most were adult and/or pediatric rheumatologists (n = 19; 95%). Respondents represented all 5 African regions and described 216 children with JDM within the last 10 years. There was high prevalence of calcinosis (as high as 100%) and interstitial lung disease (ILD) (as high as 32%); mortality rates in Kenya (6/42; 14%) and Zambia (2/7; 29%) exceeded the 1–3% mortality reported in studies of high-income countries. Thirteen of 27 diagnostic tools and medications were accessible to ≤ 50% of respondents after considering cost, mostly in Northern or Southern Africa (9/13; 69%). Despite being cost-free, disease assessment tools and physical exam to assess calcinosis were not reported as universally available or accessible. Conclusions: This is the first study to explore experiences of providers caring for children with JDM in Africa. Respondents identified 216 children with JDM seen within the last 10 years, exceeding the 196 children with JDM reported within the last 25 years but likely still underestimating prevalence. Our findings align with reports of severe manifestations and poor outcomes in African children with JDM. Access to many diagnostics and medications is limited, and differences in accessibility parallel regional healthcare disparities. The potential differences in JDM severity warrant systematic study and highlight the need to include patients and providers from LMIC in collaborative research efforts. [ABSTRACT FROM AUTHOR]

Practical control of poultry diseases in Africa remains a considerable challenge, impacting food security, livelihoods, and public health. National Poultry Improvement Plan (NPIP) is a combined industry, state, and federal initiative to address specific poultry diseases. Implementing an NPIP offers Africa a promising disease management and prevention avenue. This article aims to evaluate the implementation status of the NPIP in diverse African countries, analyze the challenges faced in adopting and executing NPIP strategies within the continent's poultry industry, and the prospects for enhancing poultry disease control efforts. This review provides more detailed information about the importance of NPIP in fortifying Africa's poultry industry against diseases, ensuring food security, and driving economic growth. Collaboration among stakeholders, policymakers, and researchers is paramount to realize the full potential of the NPIP and pave the way for a healthier and more resilient poultry sector in Africa. [ABSTRACT FROM AUTHOR]