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Background: The structure and physiology of skin and hair in people of African ancestry are different from other ethnic categories and studies from other continents cannot necessarily be extrapolated to Sub‐Saharan Africa (SSA) due to the differences in genetics, lifestyle, climate, cultures, and hair and skin care practices. The aim of this report is to highlight the recent advances in local skin and hair research in SSA from a grant program. Methods: African Hair and Skin Research Grants from an industrial sponsor were awarded between 2013 and 2022 on five main topics: acne, hair and scalp, keloid scars, atopic dermatitis, and air pollution. A literature search in Scopus identified publications on these topics in African or black skin in SSA and worldwide to provide insight into the impact of the program. Results: The number of publications from around the world on the skin and hair of people of African ancestry has increased significantly over the past 30 years on all five topics, especially as a result studies conducted in the United States. Fewer studies have been conducted in SSA but there has been an increasing number of publications over the past 10 years, especially from South Africa. Conclusions: Scientific and clinical partnerships between the industry, academia, and public healthcare sectors have contributed to a steady increase in hair and skin publications from SSA, which may be useful for the development of tailored products and public educational campaigns to raise awareness of the risks of using inappropriate products. [ABSTRACT FROM AUTHOR]

Objective: The objective of the scoping review will be to understand and describe risk factors associated with surgical site infection (SSI) in an orthopaedic surgery population in Sub-Saharan Africa and South Africa. This paper describes the protocol that will be used for the scoping review. Method: A comprehensive literature search will be conducted using MEDLINE (PubMed), CINAHL (EBSCO), Embase and Cochrane Libraries to identify articles meeting the inclusion criteria, including both published and grey literature, in order to provide a broad overview of the reported risk factors associated with patients who have undergone an orthopaedic surgery with an outcome of SSI within 90 days of a procedure. Additional studies will be sourced by exploring the reference list of included eligible studies. By using a combination of the Population, Exposure, Outcome framework, terms and synonyms related to each category, in different variations, along with Boolean operators (AND, OR, NOT) in the search strategy, identified comprehensive and relevant literature for the scoping review. Results: It is anticipated the results will provide a baseline of risk factors that will inform the development of a risk assessment tool for clinical use. Conclusion: This protocol will inform the development of a scoping review to describe factors associated with SSIs following orthopaedic surgery in Sub-Saharan Africa and South Africa. [ABSTRACT FROM AUTHOR]

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Background: We sought to improve the current understanding of how climate change impacts women's reproductive health in sub-Saharan Africa. Objectives: We investigated the relationship between maternal heat exposure and miscarriage (pregnancy ending before 20 weeks gestation) in a South African setting. Design: Population-based cohort study. Methods: Our study involved data for pregnancies collected via a health and demographic surveillance system in rural KwaZulu-Natal, South Africa between 2012 and 2016. Data from the South African Weather Service were used to compute maternal exposure to heat during the following time windows for each pregnancy: during the month preceding conception (T1) and during the week preceding the study outcome (either a miscarriage or no miscarriage, T2). Heat exposure was operationalized as a continuous variable and defined as the number of days that a mother was exposed to a mean daily temperature of > 26.6°C (A "hot day," equivalent to a mean daily temperature of > 80°F) during T1 or T2. Binary logistic regression was used to investigate the relationship between maternal heat exposure and miscarriage. Results: A total of 105/3477 pregnancies included in our analysis ended in miscarriage (3.0%). Each additional hot day during T1 was associated with a 26% higher odds of miscarriage (odds ratio: 1.26; 95% confidence interval: 1.15–1.38). No significant associations were observed between maternal heat exposure during T2 and the odds of miscarriage (odds ratio: 0.94, 95% confidence interval: 0.73–1.20). The relationship between maternal heat exposure during T1 and the odds of miscarriage was J-shaped. Conclusion: There is a clear relationship between maternal heat exposure during the month preceding conception and miscarriage in our sub-Saharan African setting. Given the lack of feasible strategies to reduce pregnancy loss associated with prevailing high temperatures in sub-Saharan Africa, progressive climate change will likely exacerbate existing challenges for women's reproductive health in this region. [ABSTRACT FROM AUTHOR]

The integration of social media into political discourse is becoming the norm, facilitating citizen engagement and amplifying voices across the Sub-Saharan Africa (SSA). This study centered on a literature review on the role of social media in political participation within the region. Through exploration across three databases, 50 articles were identified, with 42% of these closely related to the research focus and categorized under five distinct themes. Findings reveal various perspectives on the impact of social media on political engagement, with scholars offering different interpretations on its influence. Furthermore, majority of research underscores the role of social media in mobilizing protests and revolutionary movements driven by heightened participation observed in some SSA countries. Social media platforms are increasingly perceived as avenues to express opinions on pertinent issues contesting unfavorable government actions. Thus, this study posits the emergence of a "New Democratisation in Sub-Saharan Africa," propelled by the positive utilization of social media in political spheres. [ABSTRACT FROM AUTHOR]

Adolescents face a higher risk for HIV, STIs, and unintended pregnancy than any other age group in sub–Saharan Africa, and have unique health care needs as they navigate this period of growth and developmental milestones. We conducted the Youth Friendly Services study among adolescents in Rustenburg, South Africa to address some of these concerns. Participants aged 12–19 were followed quarterly for 12 months, asked at baseline about demographics, their sexual behavior, and tested for HIV, STIs, and pregnancy (girls). Report of sexual activity was not a requirement for enrollment. Assent and parental consent were obtained for participants under 18. Some follow up visits fell during COVID-mandated shutdowns, and we worked with participants to reschedule and extend follow up as appropriate. Here we present data on reported behaviors, participant attrition, risk of HIV, other STI, and pregnancy. From May 2018 to August 2019, we enrolled 223 HIV-negative, non-pregnant adolescents (64% girls). The median age was 17 (IQR: 14–18). Among the 119 (53%) participants who reported being sexually active at baseline, the median age at first sex was 16 years (IQR: 15–17). During follow-up, an additional 16 (7%) participants reported having their first sexual encounter. Among the sexually active participants, the incidence of HIV was 1.5 cases / 100 person-years at risk (PYAR, 95% CI: 0.4–6.0), the incidence of chlamydia was 15.7 cases (95% CI: 10.1–24.4), gonorrhea was 4.7 cases (95% CI: 2.1–10.5), and HSV was 6.3 cases (95% CI: 3.1–12.6); we observed no cases of incident syphilis. The incidence of pregnancy among sexually active girls was 15.0 pregnancies / 100 PYAR (95% CI: 8.5–26.5). Despite small numbers, the incidence of most STIs was significantly higher in females compared to males. We also observed two pregnancies and 5 incident STIs among participants who reported never having had sex, these tended to be younger participants. From March to September 2020, the clinic was shut down for COVID-19, and 53 study visits were postponed. Follow up was concluded in November 2020, a total of 19 participants were lost to follow up, however only one participant dropped off-study during COVID-19 shutdowns. Retention at the final visit was 91.5%. We successfully completed a prospective study of adolescents to learn more about the risks they face as they navigate sexual debut in the context of a program of youth-friendly counseling and services. Among self-reported sexually active participants, we observed a high rate of HIV, STI and pregnancy, however we also observed pregnancy and STIs among those who reported no sexual activity. [ABSTRACT FROM AUTHOR]

Background: In the high disease burden and resource-constrained contexts of sub-Saharan Africa (SSA), health workers experience a range of psychosocial stressors that leave them vulnerable to developing burnout, which can reduce service quality and negatively impact their own health and wellbeing. As universal testing and treatment (UTT) for HIV scales up across SSA, we sought to understand the implications of this human resource-intensive approach to HIV prevention to inform decision-making about health workforce staffing and support needs. Methods: Using the Maslach Burnout Inventory-Human Services Survey (MBI-HSS), we assessed the prevalence of three domains of burnout—emotional exhaustion, depersonalization, and personal accomplishment—among three cadres of health workers delivering health services in areas receiving a UTT intervention in Zambia and South Africa. These cadres included health facility workers (n = 478), community health workers (n = 159), and a study-specific cadre of community HIV care providers (n = 529). We used linear regression to assess risk factors associated with emotional exhaustion, the only domain with sufficient variation in our sample. Results: The MBI-HSS was completed by 1499/2153 eligible participants (69.6% response rate). Less than 1% of health workers met Maslach's definition for burnout. All groups of health workers reported lower levels of emotional exhaustion than found in previous studies of this type (mean score scores ranged from 10.7 to 15.4 out of 54 across health cadres). Higher emotional exhaustion was associated with higher educational attainment (βadj = 2.24, 95% CI 0.76 to 3.72), greater years providing HIV services (βadj = 0.20, 95% CI 0.03 to 0.36), and testing negative for HIV at last HIV test (βadj = − 3.88 − 95% CI 5.69 to − 2.07). Working as a CHW was significantly associated with lower emotional exhaustion (βadj = − 2.52, 95% CI − 4.69 to − 0.35). Among all health workers, irrespective of HIV status, witnessing stigmatizing behaviors towards people living with HIV among their co-workers was associated with significantly increased emotional exhaustion (βadj = 3.38, 95% CI 1.99 to 4.76). Conclusions: The low level of burnout detected among health workers is reassuring. However, it remains important to assess how UTT may affect levels of emotional exhaustion among health workers over time, particularly in the context of emerging global pandemics, as burnout may impact the quality of HIV services they provide and their own mental health and wellbeing. Interventions to reduce HIV stigma in health facilities may protect against emotional exhaustion among health workers, as well as interventions to increase mindfulness and resilience among health workers at risk of burnout. Trial registration ClinicalTrials.gov number: NCT01900977. [ABSTRACT FROM AUTHOR]

Introduction: Antiretroviral therapy (ART) initiation in infants living with HIV before 12 weeks of age can reduce the risk of mortality by 75%. Point‐of‐care (POC) diagnostic testing is critical for prompt ART initiation; however, despite its availability, rates of ART initiation are still relatively low before 12 weeks of age. This systematic review describes the barriers to ART initiation in infants before 12 weeks of age, despite the availability of POC. Methods: This systematic review used a narrative synthesis methodology. We searched PubMed and Scopus using search strategies that combined terms of multiple variants of the keywords "early infant initiation on antiretroviral therapy," "barriers" and "sub‐Saharan Africa" (initial search 18th January 2023; final search 1st August 2023). We included qualitative, observational and mixed methods studies that reported the influences of early infant initiation on ART. We excluded studies that reported influences on other components of the Prevention of Mother to Child Transmission cascade. Using a deductive approach guided by the updated Consolidated Framework of Implementation Research, we developed descriptive codes and themes around barriers to early infant initiation on ART. We then developed recommendations for interventions for the identified barriers using the action, actor, target and time framework from the codes. Results: Of the 266 abstracts reviewed, 52 full‐text papers were examined, of which 12 papers were included. South Africa had most papers from a single country (n = 3) and the most reported study design was retrospective (n = 6). Delays in ART initiation beyond 12 weeks in infants 0–12 months were primarily associated with health facility and maternal factors. The most prominent barriers identified were inadequate resources for POC testing (including human resources, laboratory facilities and patient follow‐up). Maternal‐related factors, such as limited male involvement and maternal perceptions of treatment and care, were also influential. Discussion: We identified structural barriers to ART initiation at the health system, social and cultural levels. Improvements in the timely allocation of resources for POC testing operations, coupled with interventions addressing social and behavioural barriers among both mothers and healthcare providers, hold a promise for enhancing timely ART initiation in infants. Conclusions: This paper identifies barriers and proposes strategies for timely ART initiation in infants. [ABSTRACT FROM AUTHOR]

Small-scale food producers can benefit significantly from the adoption and effective utilization of Information and Communication Technologies (ICTs). For example, ICTs can help improve food production and access to markets, which is particularly valuable in many Sub-Saharan African countries that both urbanize rapidly but whose food systems still rely significantly on small-scale food producers. This study examines the adoption patterns and desirable characteristics of ICTs, as well as the factors influencing them, among small-scale food producers engaged in urban agriculture in South Africa. We administered 85 in-person surveys through referrals from local producers' network in disadvantaged areas of Cape Town (n =21; Gugulethu, Philippi, Khayelitsha) and Johannesburg (n = 64; Central Business District, Soweto, Orange Farm). A substantial proportion of the respondents articulated the need for food- related mobile applications with functions that facilitate price comparisons, and the sharing of best practices and health advice. User-friendliness, low internet data use, and affordability were perceived as the most important characteristics for such food-related mobile applications. Redundancy analysis (RDA) reveals that the socioeconomic and demographic characteristics of respondents significantly influence the desired functionalities of food apps and their preferred activities among the respondents. Producers that are married and have more children, have higher income and education, and own larger land holdings, show very distinct patterns in terms of desirable functions and uses for food apps. Our research underscores the need for comprehensive approaches to the development and promotion of food-related ICTs when targeting small-scale food producers. The barriers and needs identified here can help ICT developers, development agencies and policy-makers design fit-for-purpose interventions and policies to facilitate ICT adoption among urban small-scale food producers in rapidly urbanizing areas. [ABSTRACT FROM AUTHOR]

Introduction: Sorghum is emerging as a viable crop option to increase food production under changing climate due to its resilience to drought and marginal soils. Appropriate planting date, crop cultivars, type of tillage and rotations, under contrasting climatic conditions, could make significant contribution on the effective management of sorghum under changing climatic conditions. A short-term study was carried out to investigate the effects of planting date, crop cultivar, tillage type and rotations on the growth and primary nutrient uptake of sorghum in contrasting climatic regions. Methods: The study was conducted in Free State - (FS) and KwaZulu Natal (KZN) Provinces of South Africa over two seasons (2020/21 and 2021/22). The two cultivars (Pan8816 and Macia) were sown in December (PD1) and in January (PD2) under conventional tillage (CT) and no-till (NT) and with two rotations (Sorghum-Cowpea-Sorghumand Sorghum-Sorghum-Sorghum) resulting in 2×2×2×2 factorial experiment. Results and discussion: In KZN, in both the first (2020/21) and second (2021/22) seasons, the effects of all the factors, except cultivar in the second season, were not significant on yield, and uptake of nitrogen (N), phosphorus (P) and potassium (K). In the second season, Pan8816 (4.40 t/ha) produced 3.3 times higher yield than Macia (1.32 t/ha), and took up higher N, K and P. In FS, the early planted sorghum (1.15 t/ha for season one; 3.39 t/ha for season two) had significantly higher yield than late planted sorghum (0.434 and 0.91 t/ha for seasons one and two, respectively). Furthermore, the early-planted crops took up higher N, K and P than when planted late, while Pan8816 took up 1.74 times more P than Macia. Plants grown under CT (2.61 t/ha) produced significantly higher yield than under NT (1.70 t/ha), with plants under CT taking up significantly more K than those grown on NT. These findings suggest that in the drier FS, early planting under conventional tillage, while in the wetter KZN, selecting the appropriate cultivar (PAN8816), are essential for sorghum grain yield, at least in the short-term. [ABSTRACT FROM AUTHOR]

Introduction: Double malnutrition (co-existing overnutrition and undernutrition) is increasingly prevalent in sub-Saharan Africa due to rapid epidemiological and nutritional transitions. In this region, studies of double malnutrition have largely been conducted at country and household level, with individual-level studies primarily limited to children and women of reproductive age. We investigated the prevalence and determinants of individual-level double malnutrition in middle-aged and older adults who constitute an increasing proportion of the sub-Saharan African population. Methods: 250 individuals aged 40–70 years (50% women) and resident in the Agincourt Health and socio-Demographic Surveillance System in rural Mpumalanga province, South Africa, were randomly selected. Double malnutrition was defined as overweight/obesity and anaemia only, overweight/obesity and iodine insufficiency, or overweight/obesity and any micronutrient deficiency (anaemia and/or iodine insufficiency). The Chi-squared goodness of fit test was used to compare the expected and observed numbers of individuals with the type of double malnutrition. Logistic regression was used to investigate determinants of each type of double malnutrition. Results: Double malnutrition was present in 22–36% of participants, depending on the definition used. All types of double malnutrition were more common in women than in men (overweight/obesity and anaemia: 34% vs. 10.2%, p < 0.01; overweight/obesity and iodine insufficiency: 32% vs. 12.2%, p < 0.01 and overweight/obesity and any micronutrient deficiency: 50.5% vs. 20.4%, p < 0.01). There were no differences between the overall expected and observed numbers of individuals with combinations of overweight and micronutrient deficiencies [overweight/obesity and anaemia (p = 0.28), overweight/obesity and iodine insufficiency (p = 0.27) or overweight/obesity and any micronutrient deficiency (p = 0.99)]. In models adjusted for socio-demographic factors, HIV and antiretroviral drug status, and food security or dietary diversity, men were 84–85% less likely than women to have overweight/obesity and anaemia, 65% less likely to have overweight/obesity and iodine insufficiency and 74% less likely to have overweight/obesity and any micronutrient deficiency. Conclusions: Individual-level double malnutrition is prevalent in middle-aged and older adults in a rural sub-Saharan African community. Interventions to improve nutrition in similar settings should target individuals throughout the life course and a focus on women may be warranted. [ABSTRACT FROM AUTHOR]

Background: Risky sexual behaviour (RSB), particularly multiple sexual partnerships (MSP) continues to be a major public health concern and has been linked to the increasing STIs, including HIV/AIDS in many parts of sub-Saharan Africa (SSA), suggesting that there is an association between contextual factors and multiple sexual partnering. However, in South Africa, this association is not well established in recent literature. Hence, this study examined the contextual factors contributing to multiple sexual partnerships among young people in South Africa. Materials and methods: Data was extracted from the 2016 South Africa Demographics and Health Survey (2016 SADHS). A cross-sectional study of 3889 never-married young people. Descriptive and inferential statistics as well as multilevel logistic regression were used to analyse the data on never-married young people aged 15 to 24 years. Results: The results indicated that at the individual level, young males (61.7%) were significantly more likely than their female counterparts (56.1%) to engage in multiple sexual partners, although, the difference was not as significant as expected. At the community level clustering, the likelihood of exposure to multiple sexual partnerships significantly increased among females (OR = 1.47; 95% CI: 1.25–1.73) but decreased among their male counterparts (OR = 0.73; 95% CI: 0.58–0.92), in particular, family disruption, residential instability, and ethnic diversity led young people to engage in multiple sexual partnerships. Conclusions: There is a need to intensify programmes aimed at considering appropriate policy options to reduce the prevalence of multiple sexual partnerships. Adopting the implications of these findings is essential for a developmental strategy towards achieving the sustainable development goal of ending STIs among young people in South Africa. [ABSTRACT FROM AUTHOR]

This paper examines the asymmetric link between carbon pricing and the comparative advantage in environmental goods exports in South Africa from 1995 to 2021. The non‐linear autoregressive distributed lag model is utilized to investigate the effects of both minor and major positive and negative fluctuations in carbon taxes, technological innovation, and energy transition on comparative advantage. The results reveal that carbon taxes have an asymmetric effect on comparative advantage in both the short and long runs, with positive shocks exerting a greater beneficial influence than negative shocks. Specifically, it is found that a 1% reduction in carbon taxes corresponds to a 1.24% decline in the response variable, whereas a 1% increase in carbon taxes is associated with a 2.72% increase in comparative advantage in environmental goods exports, which is twice as large. The study also uncovers evidence of an asymmetric relationship between low‐carbon technological innovation and comparative advantage in environmental goods exports. However, strong evidence of a long‐run asymmetric linkage between the energy transition and comparative advantage is not established. Nevertheless, it is noteworthy that a positive shift in energy transition is linked with a 0.32% rise in comparative advantage in environmental goods exports, whereas a negative shift in energy transition corresponds to a 0.11% decrease. The practical policy implications are also discussed. [ABSTRACT FROM AUTHOR]

The systematic integration of green infrastructure (GI) concepts in urban planning shows promise to reduce environmental hazards; while creating sociocultural benefits. However, cities in sub-Saharan Africa face rapid urbanisation and are challenged by the degradation of existing GI, increasing their vulnerability to climatic risks. This paper presents the findings of a transdisciplinary research project that investigated GI planning in the City of Tshwane, South Africa, over two years. The researchers conducted a community survey, an on-the-ground rapid assessment of multifunctional benefit provisions, first-hand observations of local stormwater systems, reviewed policy documents and conducted semi-structured interviews with metro officials. To integrate the above findings, four design studios and eight co-creation workshops were held that explored GI spatial planning in the city. The researchers examined the uptake of GI planning principles, and the challenges, opportunities and local proposals for GI applications, and here synthesised some main conclusions. Despite many well-known challenges, GI opportunities include creating socioeconomic incentives for stronger human-nature relations, providing for multifunctional benefits and anchoring GI in local communities. Interactive research can facilitate increased local awareness and engagement, but access to GI benefits is physically constrained and socially determined by knowledge, networks and safety factors. Based on the above findings, the researchers propose locally adapted planning strategies to enhance GI: creating opportunities for GI access and co-ownership, encouraging multifunctional, safe and flexible GI, supporting multiscale GI integration, and strengthening collaborative governance. A joint GI vision can reinforce city ownership along with flexible and creative design alternatives that are rooted in local communities. [ABSTRACT FROM AUTHOR]

Background/aims: The dapivirine vaginal ring is a self-administered, women-initiated, discreet, long-acting HIV-1 prevention option for women. It was found to be safe and effective in healthy HIV-negative women who adhered to product use instructions, and has been approved for use in women aged 18 and older in some African countries. A qualitative study was conducted to explore participants' and their male partners' discussions on accidental/purposeful vaginal ring removals during The Ring Study (IPM 027 clinical trial). Methods: Data were collected via in-depth interviews and focus group discussions with female trial participants and their male partners, from seven research centres in South Africa and Uganda. Data were thematically analysed using NVivo. Results: More participants reported purposeful ring removals than accidental expulsions. Various factors influenced purposeful ring removal – including individual (discomfort during use/sex and to clean it), partner (to show them, because of discomfort during sex, to test if partners could feel it, and concerns of harm), organisational (doctor's request), and socio-cultural (rumours about sickness and infertility). Some described their own ring use removal, others discussed why other participants removed their rings. Conclusions: Vaginal ring adherence is critical to improve and support product efficacy. Counselling on vaginal anatomy, vaginal ring insertion and importance of adherence is important to minimise vaginal ring removal. Couples counselling is also important to facilitate support and long-term vaginal ring adherence behaviour. Understanding factors influencing vaginal ring adherence is important for tailoring and targeting messages to support correct and consistent vaginal ring use as it is made available to the public. [ABSTRACT FROM AUTHOR]

Background: Sexual and gender-based violence (SGBV) is a prevalent issue in sub-Saharan Africa (SSA), causing injuries and trauma with severe consequences for survivors. This scoping review aimed to explore the range of research evidence on injuries and trauma resulting from SGBV among survivors in SSA and identify research gaps. Methods: The review employed the Arksey and O'Malley methodological framework, conducting extensive literature searches across multiple electronic databases using keywords, Boolean operators, medical subject heading terms and manual searches of reference lists. It included studies focusing on injuries and trauma from SGBV, regardless of gender or age, published between 2012 and 2023, and involved an SSA countries. Two authors independently screened articles, performed data extraction and quality appraisal, with discrepancies resolved through discussions or a third author. Descriptive analysis and narrative synthesis were used to report the findings. Results: After screening 569 potentially eligible articles, 20 studies were included for data extraction and analysis. Of the 20 included studies, most were cross-sectional studies (n = 15; 75%) from South Africa (n = 11; 55%), and involved women (n = 15; 75%). The included studies reported significant burden of injuries and trauma resulting from SGBV, affecting various populations, including sexually abused children, married women, visually impaired women, refugees, and female students. Factors associated with injuries and trauma included the duration of abuse, severity of injuries sustained, marital status, family dynamics, and timing of incidents. SGBV had a significant impact on mental health, leading to post-traumatic stress disorder, depression, anxiety, suicidal ideations, and psychological trauma. Survivors faced challenges in accessing healthcare and support services, particularly in rural areas, with traditional healers sometimes providing the only mental health care available. Disparities were observed between urban and rural areas in the prevalence and patterns of SGBV, with rural women experiencing more repeated sexual assaults and non-genital injuries. Conclusion: This scoping review highlights the need for targeted interventions to address SGBV and its consequences, improve access to healthcare and support services, and enhance mental health support for survivors. Further research is required to fill existing gaps and develop evidence-based strategies to mitigate the impact of SGBV on survivors in SSA. [ABSTRACT FROM AUTHOR]

Introduction: Diarrhea is a common public health problem and the third leading cause of death in the world among children under the age of five years. An estimated 2 billion cases and 1.9 million deaths are recorded among children under the age of five years every year. It causes body fluid loss and electrolyte imbalance. Even though, early initiation of recommended homemade fluid is a simple and effective approach to prevent diarrhea-related complications and mortality of children, recommended homemade fluid utilization for the treatment of diarrhea is still low in sub-Saharan African countries. Therefore, this study aimed to assess the magnitude of recommended homemade fluid utilization for the treatment of diarrhea and associated factors among children under five in sub-Saharan African countries. Method: The most recent Demographic and Health Survey dataset of 21 sub-Saharan African countries from 2015 to 2022 was used for data analysis. A total of 33,341 participants were included in this study as a weighted sample. Associated factors were determined using a multilevel mixed-effects logistic regression model. Significant factors in the multilevel mixed-effect logistic regression model were declared significant at p-values < 0.05. The adjusted odds ratio (AOR) and confidence interval (CI) were used to interpret the results. Result: The overall recommended homemade fluid utilization for the treatment of diarrhea among children under five in sub-Saharan African countries was 19.08% (95% CI = 18.66, 19.51), which ranged from 4.34% in Burundi to 72.53% in South Africa. In the multivariable analysis, being an educated mother/caregiver (primary and secondary level) (AOR = 1.15, 95% CI: 1.04, 1.27) and (AOR = 1.30, 95% CI: 1.15, 1.1.47), the primary and secondary level of fathers education (AOR = 1.53, 95% CI: 1.37, 1.71) and (AOR = 1.41, 95% CI: 1.19, 1.1.68), having antenatal care follow-up (AOR = 1.16, 95% CI: 1.01, 1.33), having multiple children (AOR = 1.17, 95% CI: 1.07, 1.28), and being an urban dweller (AOR = 1.15, 95% CI: 1.04, 1.27) were factors associated with recommended homemade fluid utilization. Conclusion: The overall recommended homemade fluid utilization for the treatment of diarrhea was low. Individual and community-level variables were associated with recommended homemade fluid utilization for the treatment of diarrhea. Therefore, special consideration should be given to rural dwellers and caregivers who have three and below children. Furthermore, better to strengthen the antenatal care service, mother/caregiver education, and father's education to enhance recommended homemade fluid utilization for the treatment of diarrhea. [ABSTRACT FROM AUTHOR]

This paper critically explores the use of satire and humour by fast-foods outlets in South Africa and Zimbabwe to advertise and market their menu through digital media platforms, Facebook and Twitter. Using Nando's South Africa and Mambo's Chicken, in Zimbabwe, as case studies, we examine how satire and humour are used as advertising strategies, and as a reflection of these countries' economic and political environments. Consumers are overwhelmed with information coming from different sources such as Television, radio, newspapers and Internet. The paper's theoretical approach is gleaned from advertising and satire. We argue that through their encounter with food, consumers tend to understand the reason behind their 'empty stomach', and mediate on prevailing socio-political and economic issues. [ABSTRACT FROM AUTHOR]

This paper tests the predictions of various conflicting theories on international trade and development by examining the impact of exporting and importing on economic level and basic needs in two developing countries of two different developing regions of the world; one in Latin America & Caribbean, and one in Sub-Saharan Africa. The two countries are Brazil and South Africa, respectively. Using fifteen-year lagged data that spanned 1984-2019, the paper finds that exporting tends to have negative and significant impact on both economic level and social basic needs in these two countries. Importing, on the other hand, was found to have positive and significant impact on economic level, and social basic needs in both countries. Implications of these findings for public policy and international trade theory development are discussed, and directions for future research are given. [ABSTRACT FROM AUTHOR]

It is no longer a myth that climate change‐related disasters are on the rise globally, with severe and devastating consequences in developing countries, particularly in Sub‐Saharan Africa, where many of the world's poor people reside. Thus, the emphasis on adaptation to climate change is no longer a choice or a deferred problem into the future, but rather an urgent matter of concern which must be considered a policy priority. As a response to retrogressive climate change challenges on social‐economic development and environmental degradation, the government of South Africa has in the last two and half decades, embarked on the progressive formulation of different policy instruments and strategic frameworks to curb and minimize the impacts of climate change on all sub‐sectors of the economy. Although much remains to be achieved, some level of success has been realized, particularly in the space of policy formulation, albeit the poor record of implementation. Using research methods inspired by the tradition of qualitative research and an appraisal of existing literature, this paper discusses the complexities of climate change adaptation governance at a local government level in South Africa, focusing on the Eastern Cape Province. It is argued in the paper that one of the major challenges for climate change governance at local municipality levels in South Africa emanates from the gap between aspirations and actions across the entire national governance system. The absence of an integrated climate change governance system has posed significant systemic challenges, and these have tended to constrain decision‐making and implementation processes. These issues have been discussed within the broader discourse of the sustainable development goals, particularly goals number 13, 16 and 17. [ABSTRACT FROM AUTHOR]

Background: Despite the many interventions that have been implemented in sub-Saharan Africa to improve the uptake of HIV testing and antiretroviral (ART) initiation services, the rates at which men are tested for HIV and initiated on ART have remained consistently lower compared to those for women. We aim to investigate barriers and facilitators for linkage to care following HIVST positive results among men aged between 18 and 49 years, and use these findings to design an intervention to improve linkage to care among men in a high-HIV prevalent district in KwaZulu-Natal province, South Africa. Methods: This multi-method study will be conducted over 24 months in eight purposively selected HIV testing and treatment facilities from December 2023 to November 2025. For the quantitative component, a sample of 197 HIV positive men aged 18–49 years old who link to care after HIV self-test (HIVST) will be recruited into the study. HIVST kits will be distributed to a minimum of 3000 men attending community services through mobile clinics that are supported by the Health Systems Trust, at different service delivery points, including schools, taxi ranks and other hotspots. The qualitative component will consist of in-depth interviews (IDIs) with 15 HIVST users and IDIs with 15 key informants. To design and develop acceptable, feasible, effective, and sustainable models for improving linkage to care, three groups of HIVST users (2*positive (N = 12) and 1*negative (N = 12)) will be purposively select to participate in a design workshop. Chi square tests will be used to identify social and demographic factors associated with linkage, while logistic regression will be used to identify independent factors. Kaplan Meier curves and cox proportional hazard models will be used to identify factors associated with time to event. Content and thematic approaches will be used to analyze the qualitative data. Discussion: There remains an urgent need for designing and implementing innovative intervention strategies that are convenient and tailored for addressing the needs of men for improving HIV testing and linkage to care at early stages in resource-limited settings, to improve individual health outcomes, reduce transmission from HIV and minimize HIV-related mortality rates. Our proposed study offers several important innovations aimed at improving linkage to care among men. Our study targets men, as they lag the HIV continuum but are also under-researched in public health studies. [ABSTRACT FROM AUTHOR]

Transition from traditional high-fiber to Western diets in urbanizing communities of Sub-Saharan Africa is associated with increased risk of non-communicable diseases (NCD), exemplified by colorectal cancer (CRC) risk. To investigate how urbanization gives rise to microbial patterns that may be amenable by dietary intervention, we analyzed diet intake, fecal 16 S bacteriome, virome, and metabolome in a cross-sectional study in healthy rural and urban Xhosa people (South Africa). Urban Xhosa individuals had higher intakes of energy (urban: 3,578 ± 455; rural: 2,185 ± 179 kcal/d), fat and animal protein. This was associated with lower fecal bacteriome diversity and a shift from genera favoring degradation of complex carbohydrates (e.g., Prevotella) to taxa previously shown to be associated with bile acid metabolism and CRC. Urban Xhosa individuals had higher fecal levels of deoxycholic acid, shown to be associated with higher CRC risk, but similar short-chain fatty acid concentrations compared with rural individuals. Fecal virome composition was associated with distinct gut bacterial communities across urbanization, characterized by different dominant host bacteria (urban: Bacteriodota; rural: unassigned taxa) and variable correlation with fecal metabolites and dietary nutrients. Food and skin microbiota samples showed compositional differences along the urbanization gradient. Rural-urban dietary transition in South Africa is linked to major changes in the gut microbiome and metabolome. Further studies are needed to prove cause and identify whether restoration of specific components of the traditional diet will arrest the accelerating rise in NCDs in Sub-Saharan Africa. Here, the authors present a comparative analysis of the diet, microbiome and metabolome of rural and urban Xhosa people in South Africa, associating urban diets with higher abundances of pro-neoplastic microbial metabolites. [ABSTRACT FROM AUTHOR]

Background: The global campaign for "Undetectable equals Untransmittable" (U = U) seeks to spread awareness of HIV treatment as prevention, aiming to enhance psychological well-being and diminish stigma. Despite its potential benefits, U = U faces challenges in Sub-Saharan Africa, with low awareness and hesitancy to endorse it. We sought to develop a U = U communications intervention to support HIV counselling in primary healthcare settings in South Africa. Methods: We used Intervention Mapping (IM), a theory-based framework to develop the "Undetectable and You" intervention for the South African context. The six steps of the IM protocol were systematically applied to develop the intervention including a needs assessment consisting of a systematic review and qualitative research including focus group discussions (FGD) and key informant (KI) interviews. Program objectives and target population were determined before designing the intervention components and implementation plan. Results: The needs assessment indicated low global U = U awareness, especially in Africa, and scepticism about its effectiveness. Lay counsellors and clinic managers stressed the need for a simple and standardized presentation of U = U addressing both patients' needs for encouragement and modelling of U = U success but also clear guidance toward ART adherence behaviour. Findings from each step of the process informed successive steps. Our final intervention consisted of personal testimonials of PLHIV role models and their partners, organized as an App to deliver U = U information to patients in primary healthcare settings. Conclusions: We outline an intervention development strategy, currently in evaluation stage, utilizing IM with formative research and input from key U = U stakeholders and people living with HIV (PLHIV). [ABSTRACT FROM AUTHOR]

Background: Sub-Saharan Africa is the region with the highest under-five mortality rate globally. Child healthcare decisions should be based on rigorously developed evidence-informed guidelines. The Global Evidence, Local Adaptation (GELA) project is enhancing capacity to use global research to develop locally relevant guidelines for newborn and child health in South Africa (SA), Malawi, and Nigeria. The first step in this process was to identify national priorities for newborn and child health guideline development, and this paper describes our approach. Methods: We followed a good practice method for priority setting, including stakeholder engagement, online priority setting surveys and consensus meetings, conducted separately in South Africa, Malawi and Nigeria. We established national Steering Groups (SG), comprising 10–13 members representing government, academia, and other stakeholders, identified through existing contacts and references, who helped prioritise initial topics identified by research teams and oversaw the process. Various stakeholders were consulted via online surveys to rate the importance of topics, with results informing consensus meetings with SGs where final priority topics were agreed. Results: Based on survey results, nine, 10 and 11 topics were identified in SA, Malawi, and Nigeria respectively, which informed consensus meetings. Through voting and discussion within meetings, and further engagement after the meetings, the top three priority topics were identified in each country. In SA, the topics concerned anemia prevention in infants and young children and post-discharge support for caregivers of preterm and LBW babies. In Malawi, they focused on enteral nutrition in critically ill children, diagnosis of childhood cancers in the community, and caring for neonates. In Nigeria, the topics focused on identifying pre-eclampsia in the community, hand hygiene compliance to prevent infections, and enteral nutrition for LBW and preterm infants. Conclusions: Through dynamic and iterative stakeholder engagement, we identified three priority topics for guideline development on newborn and child health in SA, Malawi and Nigeria. Topics were specific to contexts, with no overlap, which highlights the importance of contextualised priority setting as well as of the relationships with key decisionmakers who help define the priorities. [ABSTRACT FROM AUTHOR]

Background: The use of systems engineering tools, including the development and use of care cascades using routinely collected data, process mapping, and continuous quality improvement, is used for frontline healthcare workers to devise systems level change. South Africa experiences high rates of tuberculosis (TB) infection and disease as well as HIV co-infection. The Department of Health has made significant gains in HIV services over the last two decades, reaching their set "90–90-90" targets for HIV. However, TB services, although robust, have lagged in comparison for both disease and infection. The Systems Analysis and Improvement Approach (SAIA) is a five-step implementation science method, drawn from systems engineering, to identify, define, and implement workflow modifications using cascade analysis, process mapping, and repeated quality improvement cycles within healthcare facilities. Methods: This stepped-wedge cluster randomized trial will evaluate the effectiveness of SAIA on TB (SAIA-TB) cascade optimization for patients with TB and high-risk contacts across 16 clinics in four local municipalities in the Sarah Baartman district, Eastern Cape, South Africa. We hypothesize that SAIA-TB implementation will lead to a 20% increase in each of: TB screening, TB preventive treatment initiation, and TB disease treatment initiation during the 18-month intervention period. Focus group discussions and key informant interviews with clinic staff will also be conducted to determine drivers of implementation variability across clinics. Discussion: This study has the potential to improve TB screening, treatment initiation, and completion for both active disease and preventive measures among individuals with and without HIV in a high burden setting. SAIA-TB provides frontline health care workers with a systems-level view of their care delivery system with the aim of sustainable systems-level improvements. Trial registration: Clinicaltrials.gov, NCT06314386. Registered 18 March 2024, https://clinicaltrials.gov/study/NCT06314386. NCT06314386. [ABSTRACT FROM AUTHOR]

Background: Overweight/obesity remains a major risk factor for non-communicable diseases and their associated morbidities and mortalities. Yet, limited studies have comprehensively examined factors contributing to the rural–urban disparities in overweight/obesity among women in sub-Saharan Africa. Thus, our study sought to decompose the rural–urban disparities in overweight/obesity among women in sub-Saharan Africa (SSA) using nationally representative datasets. Methods: We performed a cross-sectional analysis of data from the Demographic and Health Surveys of 23 sub-Saharan African countries conducted from 2015 to 2022. A sample of 177,329 women was included in the analysis. Percentages with confidence intervals (CIs) were used to summarize the prevalence of overweight/obesity per rural–urban strata and pooled level. A multivariate non-linear decomposition analysis was used to identify the factors contributing to the rural–urban disparities in overweight/obesity. The results were presented using coefficients and percentages. Results: The pooled prevalence of overweight/obesity among the women was higher in urban areas (38.9%; 95% CI = 38.2–39.6) than rural areas (19.1%; 95% CI = 18.7–19.6). This pattern was observed in all the countries surveyed, except in South Africa, where women in rural areas (53.1%; 95% CI = 50.0–56.4) had a higher prevalence of overweight/obesity than those in urban areas (46.0%; 95% CI = 43.2–48.9). Approximately 54% of the rural–urban disparities in overweight/obesity was attributable to the differences in the women's characteristics or explanatory variables. More than half of the rural–urban disparities in overweight/obesity would be reduced if the disparities in women's characteristics were levelled. Among the women's characteristics, frequency of watching television (29.03%), wealth index (26.59%), and level of education (9.40%) explained approximately 65% of the rural–urban differences in overweight/obesity. Conclusion: The prevalence of overweight/obesity among women in SSA remains high and skewed towards women in urban areas. Increased frequency of watching television, high wealth index, and higher educational attainment contributed largely to the rural-urban disparities in overweight/obesity among women in SSA. Thus, interventions aimed at reducing overweight/obesity among women in SSA could be targeted at reducing the frequency of television watching as well as promoting physical activities among wealthy women and those with higher education, particularly in urban areas. [ABSTRACT FROM AUTHOR]

Firm-level innovation in sub-Saharan Africa remains under-researched. To address this gap, this paper examines the obstacles to innovation faced by small, micro, and medium-sized enterprises (SMMEs) in South Africa. Using the 2018 Business Innovation Survey, we apply the double-hurdle model to investigate factors determining a firm's decision to invest, and the intensity of innovation. Our results show that cost and institutional obstacles were significantly more important as disincentive factors for medium-sized enterprises while knowledge obstacles were significant disincentive factors for large enterprises. In addition, market obstacles hampered investment among large enterprises. Interestingly, none of these factors was found to deter innovation intensity among small and micro enterprises. The study findings suggest that there is no one-size-fits-all approach to innovation policy and intervention programmes to support innovation within firms of different sizes. [ABSTRACT FROM AUTHOR]

Background and Aim: The prevalence of type 2 diabetes (T2D) is rapidly increasing in Sub-Saharan Africa (SSA). T2D increases the risk of premature death and reduces quality of life and work productivity. This population life table modelling analysis evaluated the impact of T2D in terms of productivity-adjusted life years (PALYs) on the South African working-age population. Research Design and Methods: Life table modelling was employed to simulate the follow-up of individuals aged 20–65 with T2D in South Africa (SA). Two life table models were developed to simulate health outcomes for a SA cohort with and without diabetes. The difference in the number of deaths, years of life lost (YLL), and PALYs lost between the two cohorts represented the burden of diabetes. Scenarios were simulated in which the proportions of gross domestic productivity (GDP), productivity indices, labour force dropout, and mortality risk trends were adjusted to lower and upper uncertainty bounds. Data were sourced from the International Diabetes Federation, Statistics SA, and both publicly available and published sources. We utilised the World Health Organization (WHO) standard annual discount rate of 3% for YLL and PALYs. Results: In 2019, an estimated 9.5% (7.68% men and 11.37% women) or 3.2 million total working-age people had T2D in SA. Simulated follow-up until retirement predicted 669,427 excess mortality, a loss of 6.2 million years of life (9.3%) and 13 million PALYs (30.6%) in SA. On average, this resulted in 3.1 PALYs lost per person. Based on the GDP per full-time employee in 2019, the PALYs loss equated to US$223 billion, or US$69,875 per person. Conclusions: This study emphasises the significant impact of T2D on society and the economy. Relatively modest T2D prevention and treatment management enhancement could lead to substantial economic benefits in SA. [ABSTRACT FROM AUTHOR]

Background: The use of traditional and complementary medicine (TCM) by cancer patients remains common in several countries especially in the Sub-Saharan Africa. However, the reasons for use are complex and change with time and geographic location, they may vary from therapy to therapy, and they are different from one individual to another. The use of TCM has been associated with active coping behaviour and a way through which patients take control of their own health. However, cancer patients do not disclose their use of TCM to the attending healthcare professionals and therefore the effects of these medicines on the patients may not be ascertained. Aim: To investigate the use of traditional and complementary medicines among patients diagnosed with cancer. Methods: A cross-sectional, quantitative study was conducted at Senkatana Oncology clinic in May to June 2023. Cancer patients underwent standardized, quantitative interviews using structured questionnaires about their use of TCM. Descriptive statistics were used to analyse the data. Logistic regression analysis was also used to identify factors associated with satisfaction with the performance of TCM. Results: All interviewed patients (n = 50, 100%) reported to be using TCM. Patients consisted of 24 females (48%) and 26 males (52%) in the age range 14 to 82 years old. The majority of the study population was in the age group 35–44 years old. The most prevalent cancer among participating males was prostate cancer and among females was cervical cancer. Biological products use was the most prominent with the highest average percentage usage (14.7%). The majority of patients (66%, n = 33) indicated that they just wanted to try everything that could help. Patients (n = 47, 94%) further reported that they had been using complementary medicine during the same period as they were using conventional treatment so that both may work to help each other. Neither gender nor age predicted satisfaction with the performance of traditional and complementary medicine. Conclusions: It is concluded that all interviewed cancer patients use TCM. Patients indicated that one of the reasons for using TCM was that they wanted to try everything that could help in their cancer care. Patients further reported that they did not inform their oncologist of their concurrent use of TCM because they had been advised not to use other medicines besides what they are given at the clinic. [ABSTRACT FROM AUTHOR]

Obstetric research in sub-Saharan Africa largely focuses on the material, physical, and psychosocial aspects of pregnancy and childbirth in relation to mothers. This research aimed to address a research gap in terms of fathers' experiences of pregnancy and childbirth, particularly in the context of a medically high-risk pregnancy. Specifically, this article focuses on fathers' interactions with the healthcare system and healthcare professionals throughout the antenatal and neonatal periods. This study was exploratory and qualitative in nature. Eight fathers whose partners had experienced at least one medically high-risk pregnancy participated in semi-structured interviews that were examined using interpretive phenomenological analysis. The findings indicate that fathers' experiences vacillated between healthcare providers being supportive and informative versus them being uncompassionate and not conveying adequate information. Importantly, the distinctions were largely attributed to the type of healthcare facility (i.e. public or private) that was attended. This research offers recommendations to healthcare workers to enhance fathers' experiences during pregnancy and childbirth, especially in potentially traumatic situations. [ABSTRACT FROM AUTHOR]

Urban agriculture remains a topical issue that needs to be better understood in striving for sustainable cities, particularly in sub-Saharan Africa. Through a literature review, this article examines urban agriculture studies in South Africa to identify trends, opportunities, and gaps in the literature. The article examines the discourses that have emerged based on a narrative literature review of 62 peer-reviewed articles from 1993 to 2022. The findings indicate that several gaps in the knowledge limit our understanding of the practice of urban agriculture toward sustainable cities, for instance, an under-representation of secondary cities and the general productivist focus of most studies in the country. The author argues that future research needs to focus on underrepresented cities using rich methodologies to gain further insights into urban agriculture and its place in the city. Moreover, other under-represented themes including environmental benefits such as green infrastructure and nature-based solutions need more exploration. A more holistic understanding of urban agriculture is required in order to buttress interventions that accommodate the practice within the urban environment. [ABSTRACT FROM AUTHOR]

Low access, unreliable supply, and high‐cost electricity have hampered many African states' ability to grow their economies. Even high‐income states, like South Africa, are increasingly challenged to provide reliable electricity. To help address this shortfall, African states belong to five regional power pools: organizations that link together electricity grids of member states and create markets to buy and sell electricity across borders. Scholar have given scant attention to these power pools, and none have explored the politics behind their creation and maintenance. The path dependence framework reveals that the configuration of the power pools is directly related to the end of colonialism and the subsequent creation of regional organizations formed in the 1960's. Applying the comparative regionalism framework, I find the principal drivers for adding electricity to pre‐existing organizations fall into three categories: development interests (donor states and development banks), mining companies, and some African states, especially South Africa and the Democratic Republic of Congo. Using organizations designed for other means might be hampering the region's ability to improve energy security, standards of living, and climate change goals. Donors and power pool members should consider investing more heavily in bilateral rather than regional organizations and in decentralized or distributed electricity systems. [ABSTRACT FROM AUTHOR]

Aim: As climate change accelerates, assessing how climate shapes gene flow and neutral and adaptive genetic differentiation on landscapes is increasingly important. Aardvarks (Orycteropus afer) are ecologically important in sub‐Saharan Africa but are sensitive to human pressures and increasing aridity. We used individual, population and landscape genetic approaches to infer the influence of landscape, climate and potential adaptive differences on gene flow. Location: We surveyed 8 protected and 4 privately owned areas in South Africa, 2 protected areas in Eswatini and one location in Kenya during 2016–2018. Methods: We developed microsatellite markers and methods for DNA extraction from faeces, collected and genotyped faecal samples from focal areas and estimated genetic structure. We inferred space use from individual redetections, tested for close relatives and estimated genetic neighbourhood distance. We applied individual‐based landscape genetic analyses at multiple scales to test hypotheses about genetic differentiation by landscape resistance and potential adaptive differences. Results: We developed 19 variable microsatellite loci and collected 253 faecal samples from 13 focal areas. We genotyped 104 samples successfully at ≥8 loci as needed for individual identification. The genetic structure suggested 3 regional divisions in South Africa. We detected individuals at locations ≤7.3 km distant and closely related individuals at ≤44 km; genetic neighbourhood distance was <55 km. Lower precipitation increased landscape resistance and strongly predicted genetic differentiation at most spatial scales. Temperature differences at sampling sites also influenced structure, suggesting climate‐associated adaptive differences. Main Conclusions: The genetic structure of aardvarks is strongly shaped by climate, with arid areas limiting gene flow and reflects apparent isolation by adaptation associated with temperature. Dispersal distances likely are <55 km. The markers we developed will facilitate studies of space use, dispersal, population density or survival. Aridification will increase fragmentation and we recommend monitoring aardvark presence as an indicator of ecosystem change associated with aridification. [ABSTRACT FROM AUTHOR]

Around 70% of global Human Immunodeficiency Virus (HIV) diagnoses are in sub-Saharan Africa (SSA), where sexual transmission remains the primary mode of HIV transmission. Poor outcomes among persons living with HIV (PLHIV) in SSA are linked to delayed diagnosis, poor linkage to HIV care and suboptimal adherence to antiretroviral therapy (ART). This study is a systematic review of published articles on the application of the theory of planned behaviour (TPB) to HIV prevention and management in SSA. A systematic search was conducted in Google Scholar, Embase, Scopus and PubMed and institutional library searches. The search followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A study conducted in South Africa in 2012 revealed that TPB explained 12% of the variance in intention to adhere to ART. This was slightly higher in Tanzania where the TPB constructs explained 14.7% of intention to adhere to ART. Interestingly the variance was much higher in Malawi where attitudes, subjective norms and perceived behavioural control explained 55% of the variance of intention to adhere to ART. Studies conducted in Ghana, Tanzania, Ethiopia and South Africa revealed that attitude towards the behaviour was a predictor of intention to use condoms consistently. Among all the constructs of the TPB, subjective norms and attitudes towards the behaviour were found to have the most influence on the intention to adhere to ART and consistent condom use. Interventions to improve HIV management and prevention in SSA using the TPB should focus on the significant proximal constructs. [ABSTRACT FROM AUTHOR]

The opportunistic fungal infection cryptococcal meningoencephalitis is a major cause of death among people living with HIV in sub‐Saharan Africa. We report pharmacokinetic (PK) and safety data from a randomized, four‐period crossover phase I trial of three sustained‐release (SR) oral pellet formulations of 5‐flucytosine conducted in South Africa. These formulations were developed to require less frequent administration, to provide a convenient alternative to the current immediate release (IR) formulation, A. Formulations B, C, and D were designed to release 5‐flucytosine as a percentage of the nominal dose in vitro. We assessed their safety and PK profiles in a single dose (1 × 3000 mg at 0 h), relative to commercial IR tablets (Ancotil 500 mg tablets; 3 × 500 mg at 0 h and 3 × 500 mg at 6 h) in healthy, fasted participants. Forty‐two healthy participants were included. All treatments were well‐tolerated. The primary PK parameters, maximum observed plasma concentration (Cmax) and area under the concentration‐time profiles, were significantly lower for the SR formulations than for the IR tablets, and the geometric mean ratios fell outside the conventional bioequivalence limits. The median maximum time to Cmax was delayed for the SR pellets. Physiologically‐based PK modeling indicated a twice‐daily 6400 mg dose of SR formulation D in fasted condition would be optimal for further clinical development. This regimen is predicted to result in a rapid steady‐state plasma exposure with effective and safe trough plasma concentration and Cmax values, within the therapeutic boundaries relative to plasma exposure after four times per day administration of IR tablets (PACTR202201760181404). [ABSTRACT FROM AUTHOR]

Background: Multiple factors shape health and mental well-being (MWB). These factors are considered indicators for a holistic assessment of the well-being construct. Analyzing existing literature on indicators related to health and MWB is necessary to support a comprehensive evaluation in the sub-Saharan African context to assess and improve the population’s health and MWB. Methods: This study is a literature review conducted by adapting the POWER framework while leveraging the Web of Science (WoS) database, complemented with random Google-led searches. Leveraging the POWER framework, this paper reviewed related literature on mental health and well-being (HWB) to provide a framework for action. Results: Going through the planning, writing, and reflection phases, of the POWER framework, the WoS database search produced 22 pieces of literature published in South Africa from 2014 to 2022 and 5 pieces of literature published in Nigeria from 2019 to 2022 with 26 manuscripts across higher institutions in South Africa and eight manuscripts with various organizations. The study revealed abilities to realize potential, cope with the normal stresses of life, work productively and fruitfully, and meaningful community engagement as some of the crucial mental health indicators. The reviewed literature revealed that MWB as a multi-phased construct is fast gaining attention in sub-Saharan African contexts. Conclusion: This study concluded that mental HWB assessment has multiple indicators being largely deployed linearly using Western-developed or validated assessment instruments. Therefore, an adaptive health and MWB assessment with a more accurate assessment capacity should be developed as a transdicsiplinary illness prevention intervention. [ABSTRACT FROM AUTHOR]

Malaria is a deadly disease caused by protozoan pathogens of the Plasmodium parasite. Transmission to humans occurs through the bite of an infected female Anopheles mosquito. According to the World Health Organization (WHO), an estimated 247 million cases of malaria were recorded worldwide in 2021, with approximately 619 000 malaria deaths. The initial signs of malaria can be mild and challenging to diagnose due to the signs and symptoms being similar to those of other illnesses. The malaria burden remains largely concentrated in the WHO sub-Saharan African region and has been recognised as a significant contributor to morbidity and mortality. This review aims to contribute to the existing knowledge on malaria in South Africa, a region within sub-Saharan Africa, focusing on the epidemiology and life cycle of the malaria parasite as well as diagnostic approaches for detecting malaria. In addition, nonpharmacological and pharmacological interventions for treating and preventing malaria infections will also be discussed herein. While there has been a significant reduction in the global burden of this disease, malaria remains a public health issue in South Africa. As such, the implementation of effective preventative measures and strategies, early diagnosis, and appropriate treatment regimens are crucial to reducing the malaria burden in South Africa. [ABSTRACT FROM AUTHOR]

Background: In South Africa, Neisseria gonorrhoeae , which is the predominant cause of male urethritis, is treated syndromically using dual ceftriaxone and azithromycin therapy. We determined antimicrobial susceptibilities of N. gonorrhoeae isolates from urethral discharge specimens, and genetically characterised those with elevated minimum inhibitory concentrations (MICs) for first-line antimicrobials. Methods: Routine antimicrobial susceptibility testing (AST) of N. gonorrhoeae isolates included E-test for ceftriaxone, cefixime and gentamicin and agar dilution for azithromycin and spectinomycin. Neisseria gonorrhoeae Sequence Typing for Antimicrobial Resistance (NG-STAR) was performed for isolates with elevated MICs to identify antimicrobial resistance (AMR) determinants, and Neisseria gonorrhoeae Multi-Antigen Sequence Typing (NG-MAST) was used to determine strain relatedness. Results: N. gonorrhoeae was cultured from urethral discharge swab specimens obtained from 196 of 238 (82.4%) men presenting to a primary healthcare facility in Johannesburg in 2021. All viable isolates were susceptible to extended-spectrum cephalosporins. Four isolates had high azithromycin MICs ranging from 32 mg/L to >256 mg/L and grouped into two novel NG-MAST and NG-STAR groups. Two isolates from Group 1 (NG-MAST ST20366, NG-STAR ST4322) contained mutated mtrR (G45D) and 23S rRNA (A2059G) alleles, while the two isolates from Group 2 (NG-MAST ST20367, NG-STAR ST4323) had different mutations in mtrR (A39T) and 23S rRNA (C2611T). Conclusions: We report the first cases of high-level azithromycin resistance in N. gonorrhoeae from South Africa. Continued AMR surveillance is critical to detect increasing azithromycin resistance prevalence in N. gonorrhoeae , which may justify future modifications to the STI syndromic management guidelines. We report the first cases of high-level azithromycin resistant N. gonorrhoeae emerging from South Africa. All viable isolates obtained during 2021 were susceptible to extended-spectrum cephalosporins; however, four isolates had high azithromycin MICs ranging from 32 mg/L to >256 mg/L and grouped into two distinct novel NG-MAST and NG-STAR groups. Continued antimicrobial resistance surveillance is critical to detect increasing azithromycin resistance prevalence in N. gonorrhoeae , which may justify future modifications to the STI syndromic management guidelines. [ABSTRACT FROM AUTHOR]

HIV infection increases the risk of developing cervical cancer; however, longitudinal studies in sub‐Saharan Africa comparing cervical cancer rates between women living with HIV (WLWH) and women without HIV are scarce. To address this gap, we compared cervical precancer and cancer incidence rates between WLWH and women without HIV in South Africa using reimbursement claims data from a medical insurance scheme from January 2011 to June 2020. We used Royston‐Parmar flexible parametric survival models to estimate cervical precancer and cancer incidence rates as a continuous function of age, stratified by HIV status. Our study population consisted of 518 048 women, with exclusions based on the endpoint of interest. To analyse cervical cancer incidence, we included 517 312 women, of whom 564 developed cervical cancer. WLWH had an ~3‐fold higher risk of developing cervical precancer and cancer than women without HIV (adjusted hazard ratio for cervical cancer: 2.99; 95% confidence interval [CI]: 2.40‐3.73). For all endpoints of interest, the estimated incidence rates were higher in WLWH than women without HIV. Cervical cancer rates among WLWH increased at early ages and peaked at 49 years (122/100 000 person‐years; 95% CI: 100‐147), whereas, in women without HIV, incidence rates peaked at 56 years (40/100 000 person‐years; 95% CI: 36‐45). Cervical precancer rates peaked in women in their 30s. Analyses of age‐specific cervical cancer rates by HIV status are essential to inform the design of targeted cervical cancer prevention policies in Southern Africa and other regions with a double burden of HIV and cervical cancer. [ABSTRACT FROM AUTHOR]

Indigenous chicken production consists of an array of activities important to smallholder poultry farmers in Africa. One of the many factors influencing their production and threating the local food security is in the area of nutrition, particularly, that related to protein supplementation. The available feed resources to farmers are not enough to sustain the productivity of the chickens. Hence, the chickens’ diets often require nutritional supplementation. There is therefore an urgent need for the validation of locally grown feed ingredients to improve the sustainability of poultry production in sub-Saharan Africa. A dietary ingredient that may be used in the diets of chickens is lucerne (Medicago sativa), which is also known as alfalfa. In South Africa, lucerne is the most cultivated forage legume and approximately 1.3 million metric tonnes of lucerne are produced per year. Lucerne has high nutritional value, as it is a source of protein, amino acids, vitamins, and fatty acids. The potential of lucerne as a feed resource for indigenous chickens should, therefore, be investigated so that strategies to improve the nutrition of such chickens can be developed. The purpose of this review was to highlight lucerne as a potential dietary ingredient for indigenous chickens and discuss its effects on the productivity of broilers, egg-layers, and dual-purpose chickens. [ABSTRACT FROM AUTHOR]

Postpartum depression (PPD) is a significant public health concern in resource-constrained sub-Saharan Africa (SSA). Efforts to combat this burden are hampered by the region's wide variation in reported prevalence. This review aimed to systematically synthesize up-to-date data on PPD in SSA. The review was structured per the Preferred Reporting Item for Systematic Reviews and Meta-analyses. Included in the review were studies that reported the prevalence of PPD in SSA. A search was undertaken of PubMed, Medline, CINAHL, Academic Search Complete, and PsycINFO. A random-effect model was fitted to estimate the pooled burden of postpartum depressive symptoms in SSA. We conducted subgroup analyses to estimate the distribution of postpartum depressive symptoms based on important study characteristics: sample size, the timing of diagnosis, design, study setting/region, instrument, and income/economy. The prevalence of postpartum depressive symptoms ranged from 3.8% to 69.9%, with a pooled estimate of 22.1% (CI 18.5-26.2; I² = 98.2; Tau = 0.848; p<0.001). There was a significant variation in postpartum depressive symptoms with sample size (p<0.001). The highest prevalence (25.6% CI 21.5-30.1) was obtained within 12 weeks postpartum. The prevalence estimate was highest (23.3%; CI 20.1-26.8) with the Edinburgh Postnatal Depression Scale (EPDS). South Africa (30.6%; CI 23.6-38.7) and Zimbabwe (29.3%; CI 22.2-37.5) reported the highest prevalence rates, while Tanzania (13.5%; CI 10.1-17.9) reported the lowest prevalence estimates. Upper-middle SSA countries presented the highest prevalence rates (30.6%; CI 23.6-38.7). The prevalence was highest within the period 2010-2015. PPD constitutes a significant health burden in SSA and is fast becoming an epidemic in southern Africa. Significance: * Given that PPD is a recurring mental health challenge among women in sub-Saharan Africa, there is an urgent need for strategic policy provisions to ameliorate its burden. * An increase in prevalence of PPD from 2005-2010 to 2015-2021 is indicative of the need for national governments to intensify efforts targeted at achieving the UN Sustainable Development Goals 3 and 5 in the region. * In SSA, the prevalence of PPD is highest (approximately 30%) in Southern Africa, precisely South Africa and Zimbabwe, where it is fast becoming an epidemic; hence strategies are needed to curtail its growing trend. * There is a need to characterise and stratify the risk factors of PPD in sub-Saharan to guide policy development of predictive algorithms and implementation strategies. [ABSTRACT FROM AUTHOR]

Breast cancer incidence has increased globally in the last decade, especially in low‐ and middle‐income countries. In Sub‐Saharan Africa, breast cancer trends have been described only in a few populations owing to the scarcity of population‐specific data. Using data collected between 2011 and 2021 at Inkosi Albert Luthuli Central Hospital, this retrospective study describes demographic and genetic trends for hereditary breast cancer patients in the KwaZulu‐Natal province, South Africa. Six hundred and forty‐five patients were included, of whom 44.3% were Black, 36.8% Indian, 15.6% White and 3.2% Coloured. The number of annual new cases increased from eight in 2011 to 145 in 2021, with a notable increase among Blacks. The mean onset age was 46 years, and Black patients were diagnosed ~10 years earlier than White and Indian patients. Triple‐negative breast cancers accounted for 20.3% of hereditary cases, and 51.1% of them were Black. Bilateral and recurrent breast cancers constituted 7.4%, while pathogenic sequence variants in BRCA1/2 were reported in 10.4% of all patients, and the majority were Blacks and Indians. Overall, the KwaZulu‐Natal province has seen an increase in hereditary breast cancer incidence in the past decade. Despite testing negative for pathogenic sequence variants, Black women frequently presented with breast cancers that are BRCA1‐like, while Indians presented with extensive family history. This suggests that South African patients may require unique approaches to interventions, such as early detection and awareness programs among Blacks and increased genetic screening among Indians. [ABSTRACT FROM AUTHOR]

The need to swiftly transition to clean energy and expand electricity access is pressing; however, the goals of SDG7 are unlikely to be met by 2030, with the UN specifically mentioning land‐locked states as being off track. Through the conceptual lens of 'leapfrogging' fossil fuels, straight from traditional fuel sources to renewable energy, this paper discusses the relationship between electricity production and independence. It makes a conceptual contribution by introducing the term 'energy independence through leapfrogging', which is used to characterise the process of reducing dependency on another country – in the case of Eswatini, electricity is supplied by South Africa. Drawing from empirical research in Eswatini involving document analysis and in‐depth interviews, this paper discusses the potential for the country to move from being primarily an importer of electricity to generating its own supply from renewable sources. With Eswatini's current electricity supply from South Africa at risk/expiring in 2025, this research argues that the country faces a moment of opportunity for Eswatini to build further generation capacity, with a recommended focus on solar energy. The paper identifies potential challenges/barriers to this energy transition, examining power generation, storage, maintenance and affordability as key areas for intervention. Drawing on previous theories of electricity access, the paper argues that 'access' to electricity requires consideration of the affordability and reliability of energy systems. Eswatini is an understudied geographical area, and this paper makes a contribution to the literature on energy transitions by examining the specific circumstances attending this transition and examining these with relevance for other land‐locked nations in sub‐Saharan Africa. [ABSTRACT FROM AUTHOR]

Background: Many Adolescents in Sub-Saharan Africa do not access HIV and reproductive health services optimally. To improve uptake of these services, it is important to understand the Learners' preferences for how services are delivered so that implementation strategies can reflect this. Methods: A discrete choice experiment (DCE) was used to elicit preferences. The DCE was completed between 07/2018 and 09/2019 and conducted in 10 high schools situated in neighbourhoods of varying socio-economic status (SES) in Gauteng (South Africa). Learners aged ≥ 15 years (Grades 9–12) were consented and enrolled in the DCE. Parental consent and assent were required if < 18 years old. Conditional logistic regression was used to determine preferred attributes for HIV and contraceptive service delivery. Results were stratified by gender and neighbourhood SES quintile (1 = Lowest SES; 5 = Highest SES). Results: 805 Learners were enrolled (67% female; 66% 15–17 years; 51% in grades 9–10). 54% of Learners in quintile 1 schools had no monthly income (family support, grants, part-time jobs etc.); 38% in quintile 5 schools had access to R100 ($7.55) per month. Preferences for accessing HIV and contraceptive services were similar for male and female Learners. Learners strongly preferred services provided by friendly, non-judgmental staff (Odds ratio 1.63; 95% Confidence Interval: 1.55–1.72) where confidentiality was ensured (1.33; 1.26–1.40). They preferred services offered after school (1.14; 1.04–1.25) with value-added services like free Wi-Fi (1.19; 1.07–1.32), food (1.23; 1.11–1.37) and youth-only waiting areas (1.18; 1.07–1.32). Learners did not have a specific location preference, but preferred not to receive services within the community (0.82; 0.74–0.91) or school (0.88; 0.80–0.96). Costs to access services were a deterrent for most Learners irrespective of school neighbourhood; female Learners were deterred by costs ≥$3.85 (0.79; 0.70–0.91); males by costs ≥ R100 ($7.55) (0.86; 0.74-1.00). Conclusions: Preferences that encourage utilisation of services do not significantly differ by gender or school neighbourhood SES. Staff attitude and confidentiality are key issues affecting Learners' decisions to access HIV and contraceptive services. Addressing how healthcare providers respond to young people seeking sexual and reproductive health services is critical for improving adolescents' uptake of these services. [ABSTRACT FROM AUTHOR]

Background: The prevalence of sedentary behaviour has concurrently risen with multiple cardiometabolic risk markers independent of physical activity levels. Office-based workers accumulate the highest levels of sitting time during occupational times. This study aims to investigate the short-term effects of using height-adjustable sit-to-stand workstations on cardiometabolic risk markers of office-based workers in South Africa. Results: Sixty-two office-based workers were randomized into intervention (n = 44), and the control group (n = 18). Small improvements were observed in BMI, blood pressure, and cholesterol levels in this cohort. Conclusion: This preliminary investigation confirms that short-term height-adjustable sit-stand interventions are effective in reducing workplace sitting time and selected health outcomes. South Africa has been attributed with the highest burden of obesity in Sub-Saharan Africa, as a result, there is a need to implement long-term workplace intervention to reverse these implications. Trial registration: Pan African Clinical Trial Registry, PACTR201911656014962 on the 12th of November 2019. [ABSTRACT FROM AUTHOR]

• Agromorphological trait variability between and within landraces. • This is the first report of the trichome and stoma types in Bambara groundnut. • There are differences in trichome type and density between grouped landraces. • Leaf anatomy can be used in the selection of landraces with favourable traits. In many parts of Sub-Saharan Africa, female subsistence farmers rely on the production of underutilized crops such as Bambara groundnut (Vigna subterranea (L.) Verdc) for both sustenance and generating income. Bambara groundnut is, however, grown at a low rate especially in South Africa. Although it has the potential to yield high amounts of seed and can grow under adverse weather conditions, amongst offering other benefits, it remains underutilized and under-researched. To date there are no improved varieties. Farmers therefore rely on indigenous knowledge systems to select varieties based on their preferences, thereby unconsciously contributing to genetic erosion of the crop. Improved varieties are important for adaptability under environmental stochasticity. This study was conducted to determine whether seed coat colour can be used as a basis for selecting Bambara groundnut landraces with favourable agronomic traits for breeding programs and development of genetically enhanced varieties. A completely randomized design with ten replications was used to assess whether landraces classified based on seed coat colour are both morphologically and genetically similar. Significant differences (P <0.05) in the yield parameters, number of pods per plant, and growth habit were observed. This suggests that some genotypes yield more seed than others. Anatomical assessment of the leaf revealed that there are genotypes with high trichome density and two types of trichomes on the same plant. These characteristics make those plants more resilient to disease pressure than others. There is, however, little evidence that these findings are related to the seed coat colour. Attributing one character i.e. seed coat colour to genetic diversity is therefore reductive and should not be undertaken. [ABSTRACT FROM AUTHOR]

Genetic diversity is crucial for crop improvement in any breeding program. Cowpea is an important indigenous grain vegetable legume crop. The crop has a significant potential to improve food and nutritional security in sub-Saharan Africa (SSA), and family income for resource poor famers. Cowpea is a source of proteins, vitamins (folate, thiamine and vitamin C), minerals (Fe, Zn, Mn and Ca) and amino acids such as lysine and tryptophan, hence, has a high potential for combating nutrient deficiencies. The SSA countries, including South Africa, have been experiencing many dry seasons, which have negatively affected agricultural production and productivity. Cowpea has a long taproot with the ability to grow in arid and semi-arid regions; however, lasting exposure to severe droughts will result in significant yield and grain quality reduction. There has been limited progress in drought tolerance research in cowpea due to the complexity of this trait, as it involves numerous genes, which in turn are affected by environmental conditions. It is therefore important to review research done on the nutritional, phenotypic and genotypic diversity of cowpea and the importance of diversity when breeding for complex quantitative traits such as drought tolerance and yield. The review will also outline the important omics tools used for drought tolerance breeding, cultivar development and as reference for future cowpea breeding. Cowpea is a highly nutrient-dense, underutilised orphan legume crop with high potential to address malnutrition and food security in the world. Cowpea crop can withstand drought and high-temperature conditions, however, lasting exposure to severe droughts will result in significant yield reduction and poor grain quality. Thus, understanding the variation present in the available cowpea accessions will assist in breeding superior cowpea varieties that can withstand the ever-changing climate. [ABSTRACT FROM AUTHOR]

In sub-Saharan Africa (SSA), adolescent girls and young women (AGYW) have the highest risk of acquiring HIV. This has led to several studies aimed at identifying risk factors for HIV in AGYM. However, a combination of the purported risk variables in a multivariate risk model could be more useful in determining HIV risk in AGYW than one at a time. The purpose of this study was to develop and validate an HIV risk prediction model for AGYW. We analyzed HIV-related HERStory survey data on 4,399 AGYW from South Africa. We identified 16 purported risk variables from the data set. The HIV acquisition risk scores were computed by combining coefficients of a multivariate logistic regression model of HIV positivity. The performance of the final model at discriminating between HIV positive and HIV negative was assessed using the area under the receiver-operating characteristic curve (AUROC). The optimal cut-point of the prediction model was determined using the Youden index. We also used other measures of discriminative abilities such as predictive values, sensitivity, and specificity. The estimated HIV prevalence was 12.4% (11.7% − 14.0) %. The score of the derived risk prediction model had a mean and standard deviation of 2.36 and 0.64 respectively and ranged from 0.37 to 4.59. The prediction model's sensitivity was 16. 7% and a specificity of 98.5%. The model's positive predictive value was 68.2% and a negative predictive value of 85.8%. The prediction model's optimal cut-point was 2.43 with sensitivity of 71% and specificity of 60%. Our model performed well at predicting HIV positivity with training AUC of 0.78 and a testing AUC of 0.76. A combination of the identified risk factors provided good discrimination and calibration at predicting HIV positivity in AGYW. This model could provide a simple and low-cost strategy for screening AGYW in primary healthcare clinics and community-based settings. In this way, health service providers could easily identify and link AGYW to HIV PrEP services. [ABSTRACT FROM AUTHOR]

Antimicrobial resistance (AMR) is being increasingly seen as the next pandemic due to high morbidity and mortality rates, with Sub-Saharan Africa currently having the highest mortality rates driven by high rates of inappropriate prescribing in ambulatory care. In South Africa, nurses typically provide a range of services, including prescribing, in public ambulatory care clinics. However, little is currently known about the perception of final-year nursing students regarding antibiotic use, AMR, and antimicrobial stewardship (AMS). Consequently, we sought to address this important evidence gap. A quantitative descriptive study using a self-administered online questionnaire via Google Forms® was undertaken among six universities in South Africa offering a Baccalaureus of Nursing. Knowledge on the classes of antibiotics, organisms covered, and mechanism of action was lacking. The sample size to achieve a confidence interval of 95% with a 5% error margin was 174, increased to 200 to compensate for possible attrition. Only 15.3% of nurses knew that ceftazidime is not a fourth-generation cephalosporin, and only 16.1% knew that clavulanic acid does not decrease inflammation at the site of infection. In addition, only 58.9% and 67.7% agreed that the prescribing of broad-spectrum antibiotics and poor infection control, respectively, increase AMR. AMS was also not a well-known concept among final-year nurses. The lack of knowledge regarding antibiotics, AMR, and AMS among final-year nurses could have important repercussions in practice once these nurses are qualified. Consequently, this information gap needs to be urgently addressed going forward with updated curricula and post-qualification educational activities to reduce AMR in South Africa [ABSTRACT FROM AUTHOR]