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The present study focused on evaluation of neuroprotective effect of hydromethanolic extracts of Vanda tessellate (VT), also considered as Rasna. Aluminum Chloride (AlCl3) induces neuroinflammation in rats and finally the development of AD. PASS online and molecular docking insilico studies were conducted with PPAR-γ for β-sitosterol and AChE for gigantiol. Total 36 trained Wistar rats were divided into VI groups 6 in each. Group I - normal control, Group II - Disease control, Group III - Rivastigmine (0.3mg/kg, p.o), Group IV and V - Hydromethanolic extract of VT (HMEVT, 150mg/kg, 300mg/kg, p.o) respectively, Group VI - Ayurvedic Formulation of Rasna (AFR) (1ml/kg, p.o). All the animals received Aluminum Chloride (AlCl3) (300mg/kg, p.o) except group I. The rats were treated for 20 days but mean time behavioural study, body weight changes were monitored on 0th, 7th, 14th & 20th day. On 21th day, rats were sacrificed, brains were isolated, then antioxidant enzymes levels, protein content and neurotransmitters levels were determined. Histopathology of cortex and hippocampus parts of the brain were studied. Group II animals showed reduction in locomotor activity, increased in the number of entries as well as time spent in closed arm and time taken to climb the pole was increased but it was reversed in groups treated with 150mg/kg, 300mg/kg doses of HMEVT and AFR. Increased level of protein content, malondialdehyde, reduction in body weight and antioxidants enzymes like superoxide dismutase, catalase, glutathione were observed in disease control group and it was due to free radicals generation and were corrected and restored in groups treated with HMEVT and AFR. Moreover, the histopathological report also showed cellular level protection efficacy found with HMEVT and AFR. The neuroprotective action of HMEVT was due to the active constituents and was proved in insilico study. The order of neuroprotective efficacy was HMEVT > AFR. [ABSTRACT FROM AUTHOR]

Compares present agriculture practices to permaculture farming techniques, presents a historical perspective of permaculture and where these techniques are being successfully practiced around the world. Inserts (vignettes) enumerate the principles of permaculture and the background of Bill Mollison who conceptualized this farming practice. (MCO)

Se presentan los resultados de un estudio sobre la atención primaria de salud. Se informa que en América Latina se encuentra una mayor integralidad de la atención primaria de salud en países con sistemas de salud universales, que en los países de bajo y mediano ingreso la atención primaria de salud se orienta a mejorar el acceso a servicios de salud materno-infantil y que existe poca confianza en la atención primaria de salud en África debido a la falta de suministros médicos y otros factores.

Objective To provide the international community with an estimate of the amount of financial resources needed to scale up malaria control to reach international goals, including allocations by country, year and intervention as well as an indication of the current funding gap. Methods A costing model was used to estimate the total costs of scaling up a set of widely recommended interventions, supporting services and programme strengthening activities in each of the 81 most heavily affected malaria-endemic countries. Two scenarios were evaluated, using different assumptions about the effect of interventions on the needs for diagnosis and treatment. Current health expenditures and funding for malaria control were compared to estimated needs. Findings A total of US$ 38 to 45 billion will be required from 2006 to 2015. The average cost during this period is US$ 3.8 to 4.5 billion per year. The average costs for Africa are US$ 1.7 billion and US$ 2.2 billion per year in the optimistic and pessimistic scenarios, respectively; outside Africa, the corresponding costs are US$ 2.1 billion and US$ 2.4 billion. Conclusion While these estimates should not be used as a template for country-level planning, they provide an indication of the scale and scope of resources required and can help donors to collaborate towards meeting a global benchmark and targeting funding to countries in greatest need. The analysis highlights the need for much greater resources to achieve the goals and targets for malaria control set by the international community. [ABSTRACT FROM AUTHOR]

The article presents the authors' views on the impact of Maasai gummivory on human diet and public health in Africa during the Paleolithic period. The consumption of myrrhs and other gums and resins influences the health of Maasai pastoralists. It also has implications for general human ecological significance. The consumption of plant chemical constituents or phytochemicals has an impact on public health.

An essay is presented on the pharmaceutical counterfeiting in Africa. The counterfeit drugs specialized medicines for the most chronic and serious diseases including cancer, AIDS, diabetes and Alzheimer's disease. The author emphasizes that the World Health Organization (WHO) has made a Rapid Alert System to control the distribution of the fake medicines in the international trade networks.

The geochemical and isotopic composition of terrigenous clays from marine sediments can provide important information on the sources and pathways of sediments. International Ocean Discovery Program Expedition 361 drilled sites along the eastern margin of southern Africa that potentially provide archives of rainfall on the continent as well as dispersal in the Agulhas Current. We used standard methods to remove carbonate and ferromanganese oxides and Stokes settling to isolate the clay fractions. In comparison to most previous studies that aimed to extract the detrital signal from marine sediments, we additionally applied a cation exchange wash using CsCl as a final step in the sample preparation. The motivation behind the extra step, not frequently applied, is to remove ions that are gained on the clay surface due to adsorption of authigenic trace metals in the ocean or during the leaching procedure. Either would alter the composition of the detrital fraction if no cation exchange was applied. Moreover, using CsCl will provide an additional measure of the cation exchange capacity (CEC) of the samples. However, no study so far has evaluated the potential and the limitations of such a targeted protocol for marine sediments. Here, we explore the effects of removing and replacing adsorbed cations on the clay surfaces with Cs+, conducting measurements of the chemical compositions, and radiogenic isotopes on a set of eight clay sample pairs. Both sets of samples underwent the same full leaching procedure except that one batch was treated with a final CsCl wash step. In this study, organic matter was not leached because sediments at IODP Site U1478 have relatively low organic content. However, in general, we recommend including that step in the leaching procedure. As expected, significant portions of elements with high concentrations in seawater were replaced by Cs+ (2SD 2.8%.) from the wash, including 75% of the sodium and approximately 25% of the calcium, 10% of the magnesium, and 8% of the potassium. Trace metals such as Sr and Nd, whose isotopes are used for provenance studies, are also found to be in lower concentrations in the samples after the exchange wash. The exchange wash affected the radiogenic isotope compositions of the samples. Neodymium isotope ratios are slightly less radiogenic in all the washed samples. Strontium and Pb isotopes showed significant deviations to either more or less radiogenic values in different samples. The radiogenic isotopes from the CsCl-treated fractions gave more consistent correlations with each other, and we suggest this treatment offers a superior measure of provenance. Although we observed changes in the isotope ratios, the general trend in the data and hence the overall provenance interpretations remained the same. However, the chemical compositions are significantly different. We conclude that a leaching protocol including a cation exchange wash (e.g. CsCl) is useful for revealing the terrestrial fingerprint. CEC could, with further calibration efforts, be useful as a terrestrial chemical weathering proxy. • Application of CsCl-wash leads to significant change in geochemical signature of the sediment. • Elements in high concentrations in seawater are replaced by Cs+ from the wash. • Cation exchange wash reveals a truer terrigenous signal. • The cation exchange capacity of the sediment may provide additional environmental information. [ABSTRACT FROM AUTHOR]

Childhood pneumonia causes a significant burden of preventable child morbidity and mortality in Chad, Guinea, Somalia/Somaliland, and South Sudan. Leaders from these countries have committed to reducing this burden and are preparing to introduce the pneumococcal conjugate vaccine (PCV) into their immunization programs. To support long-term sustainability for expected PCV introductions in settings afflicted by prolonged humanitarian crises this research explores national stakeholders' perspectives on contextual factors that may influence optimal vaccine implementation. This qualitative study used purposive sampling to identify and interview stakeholders involved in vaccine decision-making. Interview transcripts were analyzed through the framework method, an approach involving charting data into pre-populated matrices. Findings from interviews with 16 key informants from government, partner organizations, and international health agencies fit within the following four overarching themes: (1) population-level vulnerabilities to pneumonia, exacerbated by climatic risks and low levels of maternal education; (2) disease burden and the interest in enhancing surveillance to monitor vaccine impact and integrate disease control efforts; (3) policy processes, including formalizing vaccine decision-making; and (4) vaccine implementation preparation, including the conduct of robust communication campaigns, training, and cold chain upgrades. This research explores perspectives from leaders in these countries which are at pivotal moments in their journeys toward introducing PCV. Widespread commitment among leaders, in addition to financial support, will facilitate vaccine introduction. Further, fostering a shared understanding among partners about context-specific determinants of program success will help build tailored implementation strategies for each country.

Nanoparticle-based therapies represent a transformative approach to managing gynecological cancers, offering targeted treatment strategies that minimize harm to healthy tissues while maximizing therapeutic efficacy. Despite their potential, implementing these advanced treatments in Africa is needed by a complex interplay of technological, economic, regulatory, and ethical challenges. This paper examines the current landscape of nanoparticle-based therapies, identifying critical barriers to their adoption, including inadequate infrastructure, high costs, and insufficient regulatory frameworks. Technological deficiencies manifest as a need for advanced nanoparticle synthesis, delivery, and diagnostics equipment, impeding research and clinical applications. Economically, the high production costs of nanoparticles, compounded by limited access to advanced diagnostic and treatment facilities, create significant financial barriers for healthcare systems and patients alike. Additionally, the regulatory environment needs to be more cohesive, characterized by a lack of established protocols and expertise to evaluate the unique properties of nanomedicines. However, opportunities for advancement exist through focused research and development initiatives. Targeted drug delivery systems, early detection methods, and immunotherapy integration are promising avenues to enhance treatment outcomes. Collaborative partnerships between African institutions and international research entities, alongside public-private collaborations, could bolster local capabilities in nanomedicine. To facilitate the integration of nanoparticle-based therapies, African governments must prioritize funding for nanomedicine research, create robust regulatory frameworks, and ensure equitable access to these innovative treatments. A concerted effort involving policy reforms, investment, and collaboration is essential for overcoming existing barriers and realizing the full potential of nanoparticle-based therapies in improving health outcomes for gynecological cancer patients across Africa., Competing Interests: Declarations. Competing interests: The authors declare no competing interests. Ethical approval and consent to participate: The study was approved by the ethics committee of the selected universities. Informed consent was obtained from all participating students, ensuring that their participation was voluntary and that their confidentiality was maintained throughout the study. Consent for publication: Not applicable., (© 2024. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Introduction: Application of data science in maternal, newborn, and child health (MNCH) across Africa is variable with limited documentation. Despite efforts to reduce preventable MNCH morbidity and mortality, progress remains slow. Accurate data are crucial for holding countries accountable for tracking progress towards achieving the Sustainable Development Goal 3 targets on MNCH. Data science can improve data availability, quality, healthcare provision and decision-making for MNCH programmes. We aim to map and synthesise data science use cases in MNCH across Africa., Methods and Analysis: We will develop a conceptual framework encompassing seven domains: (1) infrastructure and systemic challenges, (2) data quality, (3) data governance, regulatory dynamics and policy, (4) technological innovations and digital health, (5) capacity development, human capital and opportunity, (6) collaborative and strategic frameworks and (7) recommendations for implementation and scaling.We will use a scoping review methodology involving literature searches in seven databases, grey literature sources and data extraction from the Digital Health Atlas. Three reviewers will screen articles and extract data. We will synthesise and present data narratively and use tables, figures and maps. Our structured search strategy across academic databases and grey literature sources will find relevant studies on data science in MNCH in Africa., Ethics and Dissemination: This scoping review does not require formal ethical review and approval because it will not involve collecting primary data. The findings will showcase gaps, opportunities, advances, innovations, implementation and areas needing additional research. They will also propose next steps for integrating data science in MNCH programmes in Africa. The implications of our findings will be examined in relation to possible methods for enhancing data science in MNCH, such as community and clinical settings, monitoring and evaluation. This study will illuminate data science applications in addressing MNCH issues and provide a holistic view of areas where gaps exist and where there are opportunities to leverage and tap into what already exists. The work will be relevant for stakeholders, policymakers and researchers in the MNCH field to inform planning. Findings will be disseminated through peer-reviewed journals, conferences, policy briefs, blogs and social media platforms., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

The devastating impact of climate change has intensified discussions on balancing sustainable economic growth with environmental sustainability achievement. To contribute to the discourse, this study explores how environmental tax, foreign investment, natural resource (NRR), and technological innovation impact Sub-Saharan Africa's efforts towards a low-carbon future. Using data from 1995 to 2019 and advanced methodologies (Cross Sectional Augmented Autoregressive Distributed Lag, and Method of Moments Quantile Regression), the results showed that environmental taxes effectively minimize carbon emissions. FDI in the short run causes carbon emissions to rise slowly but causes a significant reduction in the long run. An increase in natural resources rent was found to cause damage to the environment significantly while technological innovation in the long run demonstrates a significant reduction in carbon emissions. The MMQR results confirm environmental tax significantly reduced CO 2 emissions in all the quantiles. FDI and Technology in the long run cause a reduction in CO 2 emissions while natural resource rent causes environmental destruction in all the quantiles. We recommend that policymakers introduce more carbon tax policies, establish sub-regional carbon offset markets, and prioritize the development of clean energy infrastructure., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work submitted for publication. Therefore, no conflict of interest in this manuscript., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

According to the World Health Organization (WHO), tobacco use causes over 8 million deaths annually including 1.3 million due to second-hand exposure. Furthermore, data from the Tobacco Atlas show that the tobacco industry continues to target new markets in the WHO African region, one of two regions where absolute numbers of smokers continue to increase. Understanding context contributes to policy formulation and implementation ensuring relevance to a country's political economy. Focusing on the WHO African region, this scoping review (i) maps the extent of academic research examining contextual factors on the WHO Framework Convention on Tobacco Control (WHO FCTC) national-level implementation, and (ii) reports on contextual factors impacting the WHO FCTC implementation. Using a stepwise structured approach, we conducted a search across four academic databases, yielding 10 342 articles and 42 were selected for full data extraction. Leichter's four categories of context (situational, structural, cultural and exogenous) and the stages of heuristic policy model guided data extraction. Study findings indicated that situational contextual factors such as the burden of disease or its impact on health can push governments toward policy formulation. Structural contextual factors included political considerations, economic interests, funding, institutional congruence, strength of policy and institutional capacity as important. Cultural contextual factors included the influence of policy entrepreneurs, current social trends and public opinion. Exogenous contextual factors included the WHO FCTC, tobacco industry influence at the national-level and bi-lateral partnerships. Further understanding contextual factors affecting the WHO FCTC national implementation can strengthen policy formulation and align required support with the WHO FCTC Secretariat and other relevant bodies., (© The Author(s) 2024. Published by Oxford University Press.)

Purpose: This paper aims to explore the effect of COVID-19 and the roles of COVID-19-induced economic and community factors on adolescent food insufficiency across five urban poor settings in Africa and Asia., Methods: The analysis included respondents who completed a COVID-19 quantitative module as part of the longitudinal Global Early Adolescent Study. Data were divided into pre- and mid-COVID-19 periods to examine whether food insufficiency increased and modified by the pandemic and sociodemographical characteristics through longitudinal logistic regression. The roles of COVID-19-induced economic and community factors in food insufficiency were explored using multivariate logistic regression., Results: During COVID-19, food insufficiency among adolescents increased by 6.7% (95% confidence interval [CI]: 4.4%-8.9%) in Shanghai, 26.6% (95% CI: 13.3%-40.0%) in Kinshasa, 20.3% (95% CI: 8.0%-32.7%) in Denpasar, 6.9% (95% CI: -4.7% to 17.9%) in Semarang, and 24.2% (95% CI: 21.5%-27.0%) in Blantyre. We detected the impact of COVID-19 on food insufficiency was modified by gender, family wealth, caregiver type, and neighborhood safety in Blantyre. Food insufficiency during the pandemic was consistently associated with affordability challenges and positively linked to perceptions of anger toward distancing rules in three Asian sites., Discussion: This study reveals the increased trends of food insufficiency among adolescents living in urban poor settings following the onset of COVID-19. It expands our understanding of community factors associated with adolescent food insufficiency in Asia and Africa. Comprehensive strategies are needed to tackle economic and community disparities for adolescents at risk of food insufficiency., (Copyright © 2024 Society for Adolescent Health and Medicine. Published by Elsevier Inc. All rights reserved.)

Background: Sickle cell disease (SCD) is a prevalent inherited blood disorder. Globally, approximately 515 000 babies are born with SCD annually, with 75% of these births occurring in Africa. Integrating newborn screening (NBS) for SCD into primary healthcare structures, such as immunisation programmes, holds significant promise, with dried blood spots (DBS)-point-of-care technologies (POCT) like HaemoTypeSC offering cost-effective screening solutions. However, scaling up DBS-POCT for NBS of SCD in Africa remains challenging., Objective: This study aims to explore individual, organisational and external factors that may influence the reliability, feasibility, acceptability, adoption and sustainability of using DBS-POCT with HaemoTypeSC for NBS of SCD at primary healthcare centres in African countries., Method: This qualitative study will be conducted in seven African countries that are part of the SickleInAfrica consortium sites. The study design is informed by the Consolidated Framework for Implementation Research (CFIR) and the Implementation Outcome Model. Participants will be mothers whose babies have been diagnosed with SCD, healthcare professionals and policy-makers. In-depth interviews and focus group discussions will be used for data collection. Data analysis will be through thematic analysis., Ethics and Dissemination: Research ethics approvals have been obtained from the seven countries. Written informed consent will be obtained from all participants. The study results will be disseminated in peer-reviewed scientific journals, scientific conferences, reports to national ministries of public health and webinars., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Objectives: Chest x-ray (CXR) plays an important role in childhood tuberculosis (TB) diagnosis, but access to quality CXR remains a major challenge in resource-limited settings. Digital CXR (d-CXR) can solve some image quality issues and facilitate their transfer for quality control. We assess the implementation of introducing d-CXR in 12 district hospitals (DHs) in 2021-2022 across Cambodia, Cameroon, Ivory Coast, Mozambique, Sierra Leone and Uganda as part of the TB-speed decentralisation study on childhood TB diagnosis., Methods: For digitisation of CXR, digital radiography (DR) plates were setup on existing analogue radiography devices. d-CXR were transferred to an international server at Bordeaux University and downloaded by sites' clinicians for interpretation. We assessed the uptake and performance of CXR services and health care workers' (HCW) perceptions of d-CXR implementation. We used a convergent mixed method approach utilising process data, individual interviews with 113 HCWs involved in performing or interpreting d-CXRs and site support supervision reports., Results: Of 3104 children with presumptive TB, 1642 (52.9%) had at least one d-CXR, including 1505, 136 and 1 children with one, two and three d-CXRs, respectively, resulting in a total of 1780 d-CXR. Of them, 1773 (99.6%) were of good quality and 1772/1773 (99.9%) were interpreted by sites' clinicians. One hundred and sixty-four children had no d-CXR performed despite attending the radiography department: 126, 37 and 1 with one, two and three attempts, respectively. d-CXRs were not performed in 21.6% (44/203) due to connectivity problem between the DR plate captor and the computer. HCW reported good perceptions of d-CXR and of the DR plates provided. The main challenge was the upload to and download from the server of d-CXRs due to limited internet access., Conclusion: d-CXR using DR plates was feasible at DH level and provided good quality images but required overcoming operational challenges., (© 2024 The Authors Tropical Medicine & International Health published by John Wiley & Sons Ltd.)

Purpose of Review: To review the latest data on prevention of HIV vertical transmission in Asia and Africa and discuss strategic directions to achieve an AIDS free generation by 2030., Recent Findings: Progress in vertical transmission elimination efforts in Africa and Asia have stalled in the last decade, with 130 000 new infections in 2022. Main causes of vertical transmissions vary; in Asia-Pacific due to its low-burden, thus low testing coverage, but high overall vertical transmission rates, in South and East Africa due to new HIV infections during pregnancy and breast/chestfeeding, whereas in Western and Central Africa due to low antiretroviral therapy (ART) coverage. Long-acting injectable ART and neutralizing antibodies for treatment and prevention show promise in supporting efforts to further reduce vertical transmissions. Integrated and more accessible pre- and postnatal care is needed to achieve an AIDS-free generation., Summary: Much can be implemented to address existing HIV service gaps; including strengthening of HIV prevention services for youth and women of childbearing age and pregnant people, early detection and treatment, and the delivery of integrated services that can reach and retain pregnant and postpartum people living with HIV in care., (Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.)

On August 14, 2024, following a regional declaration by the Africa Centres for Disease Control and Prevention, the World Health Organization declared mpox a Public Health Emergency of International Concern, marking the second such declaration in two years. A series of outbreaks involving the more virulent clade I virus (compared to clade II, which caused a global outbreak in 2022), has now spread in 13 African countries, exposing the inadequacies of the public health infrastructure in these settings. There was significant investment during the 2022 global outbreak, but these efforts failed to address vaccine access and treatment in the Global South. Regulatory delays, unequal access to vaccines, and a lack of compassionate use treatments for severe cases have resulted in preventable cases and deaths, especially among vulnerable populations such as pregnant women, children, and the immunocompromised. The current outbreak also underscores critical knowledge gaps in our understanding of mpox, including its transmission, pathogenesis, and viral evolution. We join intensified calls for global solidarity and action to control mpox, emphasizing immediate containment measures and long-term local and international investment in African public health systems, to prevent future epidemics.

Aim: To explore perceptions and attitudes of African immigrants (Ghanaians, Nigerians, Liberians, and Sierra Leoneans) in the Baltimore-Washington, DC, metropolitan area toward cardiovascular health., Methods: This was a qualitative study among African immigrants recruited from religious and community-based organizations in the Baltimore-Washington metro area. A purposive sample of 66 African immigrants originally from Ghana, Nigeria, Liberia, and Sierra Leone completed a sociodemographic survey and participated in focus group discussions. Focus group data were analysed using qualitative description to develop emergent themes., Results: A total of 66 African immigrants with a mean (±standard deviation) age of 51 (±11.8) years participated in the focus group discussions. Fifty percent were women, 91% had at least a bachelor's degree, 84% were employed, 80% had health insurance, and 75% were married/cohabitating. The majority of the participants (74%) had lived in the US for 10 years or more, 44% of them had hypertension, and 12% had diabetes. Findings from the focus group discussions revealed: gender differences in descriptions of cardiovascular health and healthiness, an emotional response associated with cardiovascular disease (evoking fear and anxiety and associated with family secrecy), positive and negative lifestyle changes after migration, cardiovascular screening behaviours, and facilitators and barriers to cardiovascular disease prevention practices and heart-healthy lifestyle., Conclusions: Participants understood health to be a holistic state of well-being. Secrecy in disclosing their cardiovascular disease diagnoses informed by historical socio-cultural belief systems, perceived racial discrimination by healthcare providers, communication and health literacy barriers, economic barriers of holding multiple jobs and the exorbitant cost of heart-healthy foods were identified as some barriers to achieving optimal cardiovascular health in this immigrant population., Impact: Our study expanded on the body of knowledge on African immigrants' perceptions and attitudes toward cardiovascular health. Addressing this knowledge gap will provide important intervention opportunities targeted at improving cardiovascular health outcomes in this population., Patient or Public Contribution: No patient or public contribution., (© 2024 John Wiley & Sons Ltd.)

Background: Stakeholder engagement in policy decision-making is critical to inform required trade-offs, especially in low-and-middle income settings, such as many African countries. Discrete-choice experiments are now commonly used to engage stakeholders in policy decisions, but other methods such as best-worst scaling (BWS), a theory-driven prioritization technique, could be equally important. We sought to document and explore applications of BWS to assess stakeholder priorities in the African context to bring attention to BWS as a method and to assess how and why it is being used to inform policy., Methods: We conducted a literature review of published applications of BWS for prioritization in Africa., Results: Our study identified 35 studies, with the majority published in the past four years. BWS has most commonly been used in agriculture (43%) and health (34%), although its broad applicability is demonstrated through use in fields influencing social and economic determinants of health, including business, environment, and transportation. Published studies from eastern, western, southern, and northern Africa include a broad range of sample sizes, design choices, and analytical approaches. Most studies are of high quality and high policy relevance. Several studies cited benefits of using BWS, with many of those citing potential limitations rather than observed limitations in their study., Conclusions: Growing use of the method across the African continent demonstrates its feasibility and utility, recommending it for consideration among researchers, program implementers, policy makers, and funders when conducting preference research to influence policy and improve health systems., Registration: The review was registered on PROSPERO (CRD42020209745)., (© 2024. The Author(s).)

Objective: The prevalence, management, and outcomes of hydrocephalus remain underexplored in Africa. This study aimed to analyze demographic and clinical features, evaluate treatment strategies, and assess neurological outcomes of pediatric hydrocephalus in Africa., Methods: A systematic review of the literature using the PubMed, Google Scholar, and Web of Science electronic databases was completed according to the PRISMA guidelines to identify articles describing pediatric patients in Africa with hydrocephalus., Results: Seventy-four retrospective and prospective studies and 33 case reports involving 12,355 patients were included. In 54 retrospective articles reporting patient demographics, 53.8% (3926/7297) were male with a mean age of 12.3 months. Nineteen studies reported macrocephaly (80.2%, 1639/2043) as the most common presentation. The etiology of hydrocephalus was reported as postinfectious (41.0%, 2303/5614) across 27 articles and congenital (48.6%, 1246/2563) in 10 articles. Eleven articles reported 46.7% (609/1305) of patients had communicating hydrocephalus while 53.3% (696/1305) had obstructive hydrocephalus. Diagnostic imaging included CT (76.1%, 2435/3202; n = 29 articles), ultrasonography (72.9%, 2043/2801; n = 15 articles), and MRI (44.8%, 549/1225; n = 11 articles). In 51 articles, 83.1% (7365/8865) of patients had ventriculoperitoneal shunting (VPS) while 33 articles described 54.1% (2795/5169) receiving endoscopic third ventriculostomy (ETV) for hydrocephalus surgical management. Postoperative complications included sepsis (6.9%, 29/421; n = 4 articles), surgical site infections (5.1%, 11/218; n = 4 articles), and CSF leaks (2.0%, 15/748; n = 8 articles). Shunt-related complications included infections (4.3%, 117/2717; n = 21 articles) and blockages (4.1%, 34/829; n = 6 studies). In 15 articles, 9.0% (301/3358) of patients with shunts had revisions. The mean follow-up duration was 18.9 ± 16.7 months with an overall mortality rate of 7.4% (397/5383; n = 29 articles). In the analysis of comparative studies, the 160 patients undergoing ETV demonstrated significantly higher odds of a successful operation (OR 1.54, 95% CI 0.51-4.69; p = 0.03) and neurological improvement at last follow-up (OR 3.36, 95% CI 0.46-24.79; p < 0.01) compared with the 158 who received VPS, but no significant differences were observed for complications and mortality between the two groups (p > 0.05)., Conclusions: This review offers a comprehensive summary of pediatric hydrocephalus in Africa, highlighting shunting as the primary treatment. However, the observed variations across studies highlight the need to establish standardized guidelines for reporting patient characteristics, management strategies, and outcomes to ensure consistency and comparability in articles.

The article argues the thesis that institutions have a prima facie obligation to fund the feedback of individual findings in genomic research conducted on the African continent by drawing arguments from an underexplored Afro-communitarian view of distributive justice and rights of researchers to be aided. Whilst some studies have explored how institutions have a duty to support return as a form of ancillary care or additional foreseeable service in research by mostly appealing to dominant principles and theories in the Global North, this mostly normative study explores this question by appealing to underexplored African philosophy. This is a new way of thinking about institutional responsibility to fund feedback and responds to the call to decolonise health research in Africa. Further studies are required to study how this prima facie obligation will interact with social contexts and an institution's extant relationships to find an actual duty. The research community should also work out procedures, policies and governance structures to facilitate feedback. In our opinion, though the impacts of feeding back can inform how institutions think about their actual duty, these do not obliterate the binding duty to fund feedback., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. No commercial re-use. See rights and permissions. Published by BMJ.)

Introduction: Determining aetiology of severe illness can be difficult, especially in settings with limited diagnostic resources, yet critical for providing life-saving care. Our objective was to describe the accuracy of antemortem clinical diagnoses in young children in high-mortality settings, compared with results of specific postmortem diagnoses obtained from Child Health and Mortality Prevention Surveillance (CHAMPS)., Methods: We analysed data collected during 2016-2022 from seven sites in Africa and South Asia. We compared antemortem clinical diagnoses from clinical records to a reference standard of postmortem diagnoses determined by expert panels at each site who reviewed the results of histopathological and microbiological testing of tissue, blood, and cerebrospinal fluid. We calculated test characteristics and 95% CIs of antemortem clinical diagnostic accuracy for the 10 most common causes of death. We classified diagnostic discrepancies as major and minor, per Goldman criteria later modified by Battle., Results: CHAMPS enrolled 1454 deceased young children aged 1-59 months during the study period; 881 had available clinical records and were analysed. The median age at death was 11 months (IQR 4-21 months) and 47.3% (n=417) were female. We identified a clinicopathological discrepancy in 39.5% (n=348) of deaths; 82.3% of diagnostic errors were major. The sensitivity of clinician antemortem diagnosis ranged from 26% (95% CI 14.6% to 40.3%) for non-infectious respiratory diseases (eg, aspiration pneumonia, interstitial lung disease, etc) to 82.2% (95% CI 72.7% to 89.5%) for diarrhoeal diseases. Antemortem clinical diagnostic specificity ranged from 75.2% (95% CI 72.1% to 78.2%) for diarrhoeal diseases to 99.0% (95% CI 98.1% to 99.6%) for HIV., Conclusions: Antemortem clinical diagnostic errors were common for young children who died in areas with high childhood mortality rates. To further reduce childhood mortality in resource-limited settings, there is an urgent need to improve antemortem diagnostic capability through advances in the availability of diagnostic testing and clinical skills., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY. Published by BMJ.)

Objective: We evaluated the effectiveness of team-based care interventions in improving blood pressure (BP) outcomes among adults with hypertension in Africa., Design: Systematic review and meta-analysis., Data Source: PubMed, CINAHL, EMBASE, Cochrane Library, HINARI and African Index Medicus databases were searched from inception to March 2023., Eligibility Criteria for Selecting Studies: We included randomised controlled trials (RCTs) and pre-post study designs published in English language focusing on (1) Adults diagnosed with hypertension, (2) Team-based care hypertension interventions led by non-physician healthcare providers (HCPs) and (3) Studies conducted in Africa., Data Extraction and Synthesis: We extracted study characteristics, the nature of team-based care interventions, team members involved and other reported secondary outcomes. Risk of bias was assessed using the Cochrane Risk of Bias tool for RCTs and the National Heart, Lung, and Blood Institute assessment tool for pre-post studies. Findings were summarised and presented narratively including data from pre-post studies. Meta-analysis was conducted using a random effects model for only RCT studies. Overall certainty of evidence was determined using the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) tool for only the primary outcome (systolic BP)., Results: Of the 3375 records screened, 33 studies (16 RCTs and 17 pre-post studies) were included and 11 RCTs were in the meta-analysis. The overall mean effect of team-based care interventions on systolic BP reduction was -3.91 mm Hg (95% CI -5.68 to -2.15, I² = 0.0%). Systolic BP reduction in team-based care interventions involving community health workers was -4.43 mm Hg (95% CI -5.69 to -3.17, I² = 0.00%) and nurses -3.75 mm Hg (95% CI -10.62 to 3.12, I² = 42.0%). Based on the GRADE assessment, we judged the overall certainty of evidence low for systolic BP reduction suggesting that team-based care intervention may result in a small reduction in systolic BP., Conclusion: Evidence from this review supports the implementation of team-based care interventions across the continuum of care to improve awareness, prevention, diagnosis, treatment and control of hypertension in Africa. PROSPERO registration number CRD42023398900., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Background: IMPAACT 1077BF/FF (PROMISE) compared the safety/efficacy of two HIV antiretroviral therapy (ART) regimens to zidovudine (ZDV) alone during pregnancy for HIV prevention. PROMISE found an increased risk of preterm delivery (<37 weeks) with antepartum triple ART (TDF/FTC/LPV+r or ZDV/3TC/LPV+r) compared with ZDV alone. We assessed the impact of preterm birth, breastfeeding, and antepartum ART regimen on 24-month infant survival., Methods: We compared HIV-free and overall survival at 24 months for liveborn infants by gestational age, time-varying breastfeeding status, and antepartum ART arm at 14 sites in Africa and India. Kaplan-Meier survival probabilities and Cox proportional hazards ratios were estimated., Results: Three thousand four hundred and eighty-two live-born infants [568 (16.3%) preterm and 2914 (83.7%) term] were included. Preterm birth was significantly associated with lower HIV-free survival [0.85; 95% confidence interval (CI) 0.82-0.88] and lower overall survival (0.89; 95% CI 0.86-0.91) versus term birth (0.96; 95% CI 0.95-0.96). Very preterm birth (<34 weeks) was associated with low HIV-free survival (0.65; 95% CI 0.54-0.73) and low overall survival (0.66; 95% CI 0.56-0.74). Risk of HIV infection or death at 24 months was higher with TDF-ART than ZDV-ART (adjusted hazard ratio 2.37; 95% CI 1.21-4.64). Breastfeeding initiated near birth decreased risk of infection or death at 24 months (adjusted hazard ratio 0.05; 95% CI 0.03-0.08) compared with not breastfeeding., Conclusion: Preterm birth and antepartum TDF-ART were associated with lower 24-month HIV-free survival compared with term birth and ZDV-ART. Any breastfeeding strongly promoted HIV-free survival, especially if initiated close to birth. Reducing preterm birth and promoting infant feeding with breastmilk among HIV/antiretroviral drug-exposed infants remain global health priorities., (Copyright © 2024 The Author(s). Published by Wolters Kluwer Health, Inc.)

Primary prevention of human papillomavirus (HPV) infection is particularly important in Africa, where there is a high and accelerating burden of cervical cancer. Stakeholders have increasingly called for integration of other services with HPV vaccination in low- and middle-income countries, yet successful and sustainable integration requires intensive resource inputs, and few countries in Africa have tested integrated approaches. We describe co-author experience and previously published assessments to present the experiences of four African countries, Senegal, Togo, Tanzania, and Lesotho, with integrating HPV vaccine services with other programmes and services. The resulting case series explores how countries are operationalizing the concept of integration and describes contextual factors for success and sustainability. A simple three-level framework for describing HPV vaccine integrated service delivery has emerged to guide future endeavors., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023. Published by Elsevier Ltd.)

The COVID-19 pandemic resulted in widespread disruptions to primary health care and other sectors, halting the majority of routine immunisation services and particularly impacting newer, less routinized HPV vaccine programmes. We present a series of five country case studies, drawing directly from frontline experiences in Côte d'Ivoire, Kenya, Liberia, Zambia, and Senegal to explore potential barriers and enablers of national HPV vaccine programme resiliency in the aftermath of a pandemic. A series of common themes emerged, articulating common challenges to maintaining HPV vaccine programmes, common factors that supported programme resilience, and common themes of resource needs to rebuild stronger routine immunisation programmes to face future threats., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023 The Authors. Published by Elsevier Ltd.. All rights reserved.)

This article presents an overview of the main challenges and lessons learned that were presented during the symposia organized by the Coalition to Strengthen the HPV Immunization Community (CHIC) in Africa and South Asia in 2022. Discussions at these meetings revolved around introduction, planning, implementation, and sustainability of HPV prevention and control programmes, with a particular focus in HPV immunisation, as well as cervical cancer screening in South Asian countries. This article also discusses the recently endorsed off-label single-dose HPV vaccination schedule and its potential impact on programme delivery and access. Furthermore, it highlights the importance of intersectional collaboration, effective communication and advocacy strategies, and the need for robust health information systems. Some of the critical factors identified for reducing the burden of cervical cancer in low- and middle-income countries (LMICs) included strategies for increasing access and coverage, addressing vaccine hesitancy, and building capacity among health care providers. The symposia emphasized the importance of face-to-face interactions for collaboration and decision making, with live translation services enabling full participation by stakeholders from diverse backgrounds. The paper concludes with a call for continued collaboration to make progress in reducing the burden of cervical cancer in LMICs., Competing Interests: Declaration of Competing Interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: Emilie Karafillakis reports financial support was provided by Bill & Melinda Gates Foundation. Ana Bolio reports financial support was provided by Bill & Melinda Gates Foundation. Alex Vorsters reports financial support was provided by Bill & Melinda Gates Foundation. Emmanuel Njambe Tondo Opute reports a relationship with World Health Organization that includes: employment. Emilie Karafillakis reports a relationship with Janssen Pharmaceutica NV that includes: funding grants. Emilie Karafillakis reports a relationship with Astra Zeneca that includes: funding grants. Emilie Karafillakis reports a relationship with Merck Sharp & Dohme Limited that includes: funding grants. Emilie Karafillakis reports a relationship with GlaxoSmithKlein that includes: funding grants. Nelly Mugo reports a relationship with Merck & Co Inc that includes: funding grants. Alex Vorsters reports a relationship with GlaxoSmithKline Biologicals SA that includes: funding grants. Alex Vorsters reports a relationship with Merck that includes: funding grants. Alex Vorsters reports a relationship with Roche Diagnostics Corp that includes: funding grants. Alex Vorsters reports a relationship with Becton Dickinson and Company that includes: funding grants. Alex Vorsters reports a relationship with Hologic Inc that includes: funding grants., (Copyright © 2023 University of Antwerpen. Published by Elsevier Ltd.. All rights reserved.)