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In view of the United Nations' Sustainable Development Goals on clean and responsible energy consumption, climate change mitigation, and sustainable economic growth (UN-SDGs-7, 11–13), this study examines institutional quality (IQ)–carbon emissions nexus in the framework of the Environmental Kuznets Curve (EKC) hypothesis. Six dimensions of IQ from the World Governance Indicators (WGIs) were used while focusing on Sub-Saharan African (SSA) countries between 1996 and 2019. After controlling for growth, energy use, and industrialization levels, the empirical results validated the EKC hypothesis for the SSA as a unit increase in economic growth initially worsens the environment while further economic expansion eventually improves the environment. However, mixed results were obtained on the effects of IQ indicators. CO2 emissions are only substantially reduced by corruption control, regulatory quality, and the rule of law among other IQ measures. Furthermore, the causality analysis showed a unidirectional causality between growth and environmentally detrimental energy consumption levels coupled with a two-way emission-population growth causality flow as well as a two-way emissions—IQ causality channel. While economic growth, energy use, and industrialization levels undermine environmental sustainability in the SSA region via increased carbon emissions, the overall findings signal the moderating roles of IQ. Hence, the strengthening of institutions is recommended for environmental sustainability enhancement in the SSA region. [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]

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Governments engage in infrastructural developments across the globe, and the level of success often colligates with institutional quality levels. However, despite the presence of governance, the lack of well‐developed infrastructure has bedevilled sub‐Saharan African (SSA) countries for decades. Therefore, this study investigates the governance‐led infrastructural development hypothesis for the SSA region from an institutional quality perspective towards addressing the infrastructural deficit challenges of the region. A combination of advanced panel econometric techniques was applied to data collected from the African Development Bank, World Bank World Development Indicator, and International Monetary Fund (IMF) to investigate the governance‐led infrastructural development hypothesis in SSA while controlling for financial development, economic growth, and industrialization in the region. The findings show that the interaction of institutional quality measures and governance indicators significantly and positively induces infrastructure in sub‐Saharan Africa (SSA). Additionally, while economic growth and financial development yield no expected significant influence on infrastructural developments, industrialization plays a crucial role, as its spillover effects are not confined to boosting economic growth alone but also to infrastructural transformations. Thus, the provision of policy frameworks by authorities to strengthen institutions and promote good governance is vital for articulating and facilitating infrastructural development plans for SSA. [ABSTRACT FROM AUTHOR]

This article uses a qualitative approach to examine the pre-colonial legal systems of the people of Dagbon and how they have evolved in contemporary practices. The laws in the early societies were to regulate the behavior and conduct of people. The pre-colonial legal systems in Africa, the Gold Coast, and specifically the Dagbon went through several transformations due to the arrival of the Europeans. During the pre-colonial period, the settlement of disputes among the indigenous people of Africa was done through the use of the traditional court of arbitration. The local chiefs were the custodians of the customary laws and administered justice using traditional institutions. The core customary laws of pre-colonial Dagbon were based on marriage, criminal justice, inheritance, and land laws among others. The embedding of the British and German legal systems and institutions in the Northern territories marked a change in the customary legal systems of the people of Dagbon. The postcolonial era saw another modification in the legal systems: legal pluralism (concurrent use of customary and British laws). The central finding of the article is that the pre-colonial legal systems in Dagbon were built on the customs and norms of the land. Besides the already mentioned, it was also found that customary laws remain crucial in the adjudication of cases while playing an important role in the hybrid partnerships with contemporary liberal court systems. This has brought many interesting dynamics regarding the place of customary law in hybrid governance which has further implications for the legal space in Sub-Saharan Africa and the global south context even in contemporary times. [ABSTRACT FROM AUTHOR]

A lot of attention has been paid to environmental pollution worldwide, due to the increase in anthropogenic activities. Massive investment in non-renewable energy options raises questions regarding environmental sustainability and how to maximize food and non-food output while still preserving a healthy ecosystem. To this end, the present study explores the three-way nexus between economic growth, CO2 emission, and agriculture-value added will accounting for other control variables across a balanced panel of selected African economies from 1997 to 2020. Panel econometrics method of the generalized method of moments (two-step difference GMM) is used to obtain a robust result. From the present study, the environmental pollution model shows that economic growth significantly contributes to environmental pollution in Africa. Additionally, the food price index, capital, and FDI promote pollution, while agricultural production and labor decrease pollution. In the case of the economic growth model, the findings reveal that environmental pollution supports the growth-led pollution hypothesis. Also, the food price index and capital ameliorate economic growth, while foreign direct investments decrease economic growth. Finally, the agricultural production model indicates that economic growth increases agricultural production when the interaction term between GDPC and FDI is included in the model. In summary, the combination of explanatory variables, environmental pollution, capital, and foreign direct investment decreases agricultural production. On the contrary, the food price index and labor promote agricultural production in Africa. Furthermore, the study provides a lot of policies for authorities and stakeholders in Sub-Saharan African countries and other developing economies. [ABSTRACT FROM AUTHOR]

Background: The World Health Organisation recommends that all mothers seek postnatal care (PNC) within the first two months after childbirth. This study examined PNC utilisation for babies within the first two months after childbirth. Methods: We used data from the most recent Demographic and Health Surveys (DHS) (2018–2020) of eleven countries in SSA. Descriptive and a multivariate analysis were carried out, and presented in adjusted odds ratios. The explanatory variables included: age, place of residence, level of formal education, wealth quintile, antenatal care visits, marital status, frequency of watching TV, listening to radio and reading newspaper, getting permission to go medical help for self, getting money needed for treatment, and distance to facility. Results: PNC utilisation was 37.5% and 33% in urban and rural residences, respectively. Higher level of education (Urban: AOR = 1.39, CI = 1.25, 1.56; Rural: AOR = 1.31, CI = 1.10, 1.58), 4 or more ANC visits (Urban: AOR = 1.32, CI = 1.23, 1.40; Rural: AOR = 1.49, CI = 1.43, 1.56 0.86), requiring permission to go to the health facility (Urban: AOR = 0.67, CI = 0.61, 0.74; Rural: AOR = 0.86, CI = 0.81, 0.91), listening to the radio at least once a week (Urban: AOR = 1.32, CI = 1.23, 1.41; Rural: AOR = 0.86, CI = 0.77, 0.95), and watching television at least once a week (Urban: AOR = 1.11, CI = 1.03, 1.21; Rural: AOR = 1.15, CI = 1.07, 1.24) were significantly associated with PNC service utilisation in both rural and urban areas. However, belonging to a richer wealth status (AOR = 1.11, CI = 1.02, 1.20) and having a problem with distance (AOR = 1.13, CI = 1.07, 1.18) were significant in only rural areas, while having a problem with money for treatment was significant only in urban areas (AOR = 1.15, CI = 1.08, 1.23). Conclusion: In this study, we conclude that the PNC service utilisation within the first 2 months after delivery was low across rural and urban residences. There is, therefore, a need for SSA countries to develop population tailored interventions such as advocacy and health education targeted at women with no formal education in both rural and urban areas. Our study also suggests that SSA countries must intensify radio programs and advertisements on the health benefits of PNC to improve maternal and child health. [ABSTRACT FROM AUTHOR]

Background High-risk fertility behaviours such as too early or advanced age at delivery, shorter birth interval, birth order and a higher number of live births to a woman often lead to adverse maternal and child health outcomes. We assessed high-risk fertility behaviours and their associated factors among women in sub-Saharan Africa (SSA). Methods Data on 200 716 women pooled from the demographic and health surveys of 27 countries conducted between 2010 and 2020 in SSA were analysed. High-risk fertility behaviour from four indicators, mother aged <18 years at the time of delivery; mother aged >34 years at the time of delivery; mother of a child born after a short birth interval (<24 months) and mother of high parity (>3 children), was derived. Multi-level multi-variable logistic regression analyses were carried out and the results were presented as adjusted odds ratios at 95% confidence interval. Results Women who were in polygamous marriages had higher odds of single and multiple high-risk fertility behaviour compared with their counterparts who were in monogamous marriages. Women with middle or high maternal decision-making power had higher odds of single and multiple high-risk fertility behaviours compared with those with low decision-making power. Single and multiple high-risk fertility behaviours were lower among women with access to family planning, those with at least primary education and those whose partners had at least primary education compared with their counterparts who had no access to family planning, those with no formal education and those whose partners had no formal education. Conclusion Family structure, women's decision-making power, access to family planning, women's level of education and partners' level of education were identified as predictors of high-risk fertility behaviours in SSA. These findings are crucial in addressing maternal health and fertility challenges. Policy makers, maternal health and fertility stakeholders in countries with high prevalence of high parity and short birth intervals should organize programs that will help to reduce the prevalence of these high-risk factors, taking into consideration the factors that predispose women to high-risk fertility behaviours. [ABSTRACT FROM AUTHOR]

Environmental degradation has accelerated rapidly in recent decades. Researchers and policymakers around the world have concentrated their efforts on this phenomenon because of its effect on human beings. Because of the expanding desire for fossil fuels in developed and developing nations, there has been minimal worldwide agreement on how energy consumption and carbon emissions can be reduced in recent years. On the other hand, several nations are implementing steps to adhere to the Paris Climate Agreement, which was signed in 2015. Therefore, this research intends to examine the effect of trade, economic growth, natural resources, clean energy, and urbanization on consumption-based carbon emissions (CCO2) for economies in Sub-Saharan Africa (SSA) from 1990 to 2018. The study employed second-generation techniques including CS-ARDL, which revealed that trade flow, income, natural resources, and urbanization exert a positive impact on CCO2 emissions. Furthermore, the interaction between trade and income contribute to the increase in CCO2 emissions. In addition, clean energy impacts CCO2 emissions negatively. From the causality analysis, it is observed that there is a feedback causality between CCO2 emissions and income, clean energy, and urbanization, while a one-way causality was detected running from natural resources rent to CCO2 emission. These outcomes might help policymakers to adopt measures that are eco-friendly such as the utilization of clean energy in order for countries in Sub-Saharan Africa to attain a green environment. [ABSTRACT FROM AUTHOR]

The tourism industry is undoubtedly among the largest contributors to economic growth and employment generation in most economies of the world, and Africa is not an exception as outlined by World Tourism Organization (UNWTO). Thus, many countries in sub-Saharan Africa (SSA) are paying more attention to tourism development as alternative growth path to boost their economies. However, the tourism-induced growth is not void of its environmental issues. To this end, this study using recent econometrics analysis explored the nexus between tourism arrival GDP growth, urbanization, carbon dioxide emission, and foreign direct investment for oil and non-oil sub-Saharan Africa (SSA) countries, that is, to ascertain the real impacts of tourism and FDI on the environmental performance of the regions. Empirical results show that tourism, GDP growth, and FDI dampen the quality of the environment. For instance, a 1% increase in tourism activities worsens the quality of the environment by 1.09%. Interestingly, renewable energy shows statistical strength to improve environmental quality. The causality analysis resonates with the outcomes of the regression by giving credence to one-way causality between tourism and carbon dioxide emission. A similar trend of causality is seen between FDI and carbon dioxide emission and urbanization and carbon dioxide emission. Thus, as a policy prescription, strict environmental guidelines and regulations are necessary for controlling the unhealthy and undue economic activities that are suspected to impact environment negatively. [ABSTRACT FROM AUTHOR]

The issue of increased renewable energy consumption has been widely debated, and this has become a central energy policy concern for developing and developed countries. The existing literature provides evidence that there is a positive relationship between energy consumption and economic growth in developed economies. However, findings in respect of developing/emerging economies remain inconclusive. Thus, this paper aims to investigate the impact on renewable energy consumption on economic growth by controlling other macroeconomic variables for regions of Sub-Saharan Africa (East, Central and West) covering the 1990–2018 sample period. For this purpose, common correlated effects mean group estimator (CCEMG) and Dumitrescu-Hurlin Granger causality test approach are used to consider both cross-sectional dependency and cross-country heterogeneity across countries. The CCEMG result indicates that an increase in renewable energy consumption led to reduction in economic growth even when the sample is analyzed based on geographical locations as East, West, and Central Africa. Granger causality results validate the feedback hypothesis for only Central Africa; the growth hypothesis is supported for East and West Africa. The empirical results suggest that energy planners, governments, and policy makers must act together to increase the renewable energy consumption share in her energy mix to promote economic growth for regions of Sub-Saharan Africa. [ABSTRACT FROM AUTHOR]

The intensification of international trade movements and economic interconnectivity has far-reaching implications for many macroeconomic indicators, not to mention ecological consequences. To this end, this analysis examines the dynamic interaction between foreign direct investment (FDI), natural resources, economic advancement, and urbanization on consumption-based carbon emission which is adjusted to global trade for oil-producing Sub-Saharan Africa countries. The time frame for this analysis is from 1990 to 2018. To examine the nature of relationship between the outlined variables, a balanced panel econometric analysis alongside augmented mean group (AMG), common correlated effect mean group (CCEMG), and the Driscoll-Kraay(DK) OLS techniques while the system-GMM was utilized for robustness purposes. The outcomes reveal that income increases consumption-based carbon emission within the range of 0.668 to 1.1333%; natural resources also increase consumption-based carbon emission within the range of 0.0159 to 0.2304%; FDI on the other hand increases consumption-based carbon emission around 0.0156 to 0.186%, while urbanization increases consumption-based carbon emission within the range of 0.0231 to 0.6176% in the long run. Thus, there is a positive relationship between consumption-based carbon emission and all the understudied variables within the oil-producing Sub-Sahara Africa countries thereby affirming the pollutant haven hypothesis for the countries on the premises that foreign direct investment inflow has a detrimental influence on the receiving economies alongside natural resource. Hence, the outcomes suggest the need to pursue low-carbon strategies for a cleaner and friendly environment. [ABSTRACT FROM AUTHOR]

Background: Sickle cell disease, the inherited blood disorder characterized by anemia, severe pain and other vaso-occlusive complications, acute chest syndrome, disproportionate hospitalization, and early mortality, has significant financial, social, and psychosocial impacts and drains individuals, families, and health systems globally. Hydroxyurea could improve the health of the 300,000 individuals born each year with sickle cell disease in sub-Saharan Africa; however, challenges to adoption and adherence persist. This study assessed the barriers to therapeutic use of hydroxyurea for sickle cell disease within the Nigerian healthcare system, specifically from the level of the patient, provider, and health system. Methods: We used purposive sampling to recruit participants from 13 regions in Nigeria. A cross-sectional survey was administered to physicians (n = 70), nurses or counselors (n = 17), and patients or their caregivers (n = 33) at 13 health centers. Findings were mapped onto the appropriate Consolidated Framework for Implementation Research (CFIR) domains. Results: This study was able to identify factors that mapped onto the inner setting, outer setting, and characteristics of individuals domains of CFIR. The majority of physicians (74.3%) prescribe hydroxyurea, and half stated hydroxyurea is the standard of care. Among clinicians, barriers included limited knowledge of the drug, as well as low self-efficacy to prescribe among physicians and to counsel among nurses; perceived side effects; perceived patient preference for traditional medicine; cost for patient and expense of accompanying laboratory monitoring; and limited availability of the drug and equipment for laboratory monitoring. Among patients and caregivers, barriers included lack of knowledge; perceived side effects; cost; religious beliefs of disease causation; and lack of pediatric formulation. Conclusions: Findings suggest that patient, provider, and health systems-level interventions are needed to improve hydroxyurea uptake among providers and adherence among patients with sickle cell disease in Nigeria. Interventions such as patient education, provider training, and policy change could address the disproportionate burden of sickle cell disease in sub-Saharan Africa and thus improve health equity. [ABSTRACT FROM AUTHOR]

In the energy-environment literature, a handful of the advanced economies, mostly the European Union countries, have met some of the national environmental sustainability targets. Consequently, most of these countries are renewing their policies for 2040, while the African bloc largely seems to have a longer path to emerge from the woods. Giving this insight, we are compelled to draw inferences from the role of major energy sources (conventional and renewable) in the sub-Saharan Africa's drive for environmental sustainability target. To achieve this objective, we examine the validity of an N-shaped hypothesis for sub-Saharan region which has received less documentation in the extant literature. Thus, this study employed the pooled mean group autoregressive distributed lag (PMG-ARDL) and Dumitrescu and Hurlin panel causality approaches as estimation techniques. Our empirical results show that conventional and renewable energy aspects respectively worsen and improve environmental quality in both short and long run. Importantly, the study establishes the validity of the N-shaped hypothesis in the two periods (short and long run) as reported by the study regression with 17.830% for GDP growth, −2.241 % for quadratic form of GDP, and 0.094% for cubic form of GDP growth, respectively, in the long run. Moreso, renewable energy shows a magnitude of −1.306% and −0.157% for short- and long-run period, respectively, on carbon dioxide emission. The implication is that environmental quality in the sub-Saharan region is potentially characterized in cycles of worse (decreased quality), improvement (better quality), and again worse (deceased quality) resulting from the significant change in the region's economic prosperity. In addition to the ARDL approach, the causality analysis further reiterates that there is significant causality from the energy forms and economic expansion to carbon emission at least in one direction. While examining the validity of N-shaped hypothesis for the first time for Africa, the study offers policy perspective to the governments and environmental stakeholders in the panel countries, especially to re-engineer the region's economic dynamics if the region must meet the anticipated Sustainable Development Goals 2030. [ABSTRACT FROM AUTHOR]

Most states in sub-Saharan Africa face a legitimacy crisis. This has affected the kind of democracy practised on the continent. Political instability has taken place in many states within the region and this is attributed to a lack of state legitimacy. Scholars and observers praise and adjudge Ghana's Fourth Republic as the yardstick for other democracies in the region, yet its electoral processes are characterised by violence and conflicts mainly between the two =major' political parties. This study sought to find out how the Fourth Republic has been able to survive through this acrimonious environment. It qualitatively analysed data from secondary sources to assess how conflict and cooperation occur within the Fourth Republic. This paper argued that the success of the Fourth Republic is due to a successful mediation of conflicts among political players and the advances in the democratic culture of tolerance for opposing political beliefs. It recommended strong institutional independence to enable the country to effectively address political conflicts. [ABSTRACT FROM AUTHOR]

Background. Preeclampsia is a major cause of maternal and neonatal morbidity and mortality in sub-Saharan Africa. Evidence indicates that endothelial dysfunction is central to the pathogenesis of preeclampsia. This study assessed the level of the components of the arginine-nitric oxide pathway to evaluate endothelial dysfunction in normotensive pregnancies and pregnancies complicated with preeclampsia. Methods. This case-control study was conducted among pregnant women who visited Comboni Hospital from January 2017 to May 2018. A total of 180 pregnant women comprising 88 preeclamptic women (PE) and 92 healthy normotensive pregnant women (NP) were recruited. Sociodemographic, clinical, and obstetric data were obtained using validated questionnaires. Blood pressure and anthropometrics were measured, and blood samples were collected for the estimation of nitric oxide (NO∙), L-arginine, asymmetric dimethylarginine (ADMA), and 3-nitrotyrosine using an enzyme-linked immunosorbent assay technique. Results. The mean NO∙ (p = 0.010) and L-arginine/ADMA ratio (p < 0.0001) was significantly lower in PE compared to NP while mean L-arginine (p = 0.034), ADMA (p < 0.0001), and 3-nitrotyrosine (p < 0.0001) were significantly higher in PE than NP. ADMA showed a significant positive association with systolic blood pressure (β = 0.454 , p = 0.036) in severe PE. Women with PE had significant intrauterine growth restriction (p < 0.0001) and low birth weight infants (p < 0.0001) when compared to NP. Conclusion. Preeclampsia is associated with reduced NO∙ bioavailability, L-arginine/ADMA ratio, and elevated levels of ADMA and 3-nitrotyrosine. Measurements of the levels of these parameters can help in the early prediction of endothelial dysfunction in preeclampsia. Exogenous therapeutic supplementation with L-arginine during pregnancy to increase the L-arginine/ADMA ratio should be considered to improve endothelial function in preeclampsia and pregnant women at risk of developing preeclampsia. [ABSTRACT FROM AUTHOR]

Background: Physician shortage is a major barrier to hypertension (HTN) control in Ghana, with only one physician to 10,000 patients in 2015, thus limiting its capacity for HTN control at the primary care level such as the Community Health Planning and Services (CHPS) compounds, where most Ghanaians receive care. A Task-Shifting Strategy for HTN control (TASSH) based on the WHO Cardiovascular (CV) Risk Package is an evidence-based strategy for mitigating provider- and systems-level barriers to optimal HTN control. Despite its effectiveness, TASSH remains untested in CHPS zones. Additionally, primary care practices in low- and middle-income countries (LMICs) lack resources and expertise needed to coordinate multilevel system changes without assistance. The proposed study will evaluate the effectiveness of practice facilitation (PF) as a quality improvement strategy for implementing TASSH within CHPS zones in Ghana.Methods: Guided by the Consolidated Framework for Implementation Research and the Reach, Effectiveness, Adoption, Implementation, and Maintenance framework, we will evaluate, in a hybrid clinical effectiveness-implementation design, the effect of PF on the uptake of an evidence-based TASSH, among 700 adults who present to 70 CHPS zones with uncontrolled HTN. Components of the PF strategy include (a) an advisory board that provides leadership support for implementing the intervention within the CHPS zones and (b) trained task-strengthening facilitators (TSFs) who serve as practice coaches to provide training, and performance feedback to community health officers (CHOs) who will deliver TASSH at the CHPS zones. For this purpose, the TSFs are trained to identify, counsel, and refer adults with uncontrolled HTN to community health centers in Bono East Region of Ghana.Discussion: Uptake of community-based evidence-supported interventions for hypertension control in Ghana is urgently needed to address the CVD epidemic and its associated morbidity, mortality, and societal costs. Findings from this study will provide policymakers and other stakeholders the "how to do it" empirical literature on the uptake of evidence-based task-strengthening interventions for HTN control in Ghana and will serve as a model for similar action in other low, middle-income countries.Trial Registration: ClinicalTrials.gov, NCT03490695 . Registered on 6 April 2018.Protocol Version and Date: Version 1, date: 21 August, 2019. [ABSTRACT FROM AUTHOR]

Of the 37 million people estimated to be living with HIV globally in 2017, about 24.7 million were in the sub-Saharan Africa region, which has been and remains worst affected by the epidemic. Enrolment of newly diagnosed individuals into care in the region, however, remains poor with up to 54% not being linked to care. Linkage to care is a very important step in the HIV cascade as it is the precursor to initiating antiretroviral therapy (ART), retention in care, and viral suppression. A systematic review was conducted to gather information regarding the strategies that have been documented to increase linkage to care of Persons living with HIV(PLHIV) in urban areas of sub-Saharan Africa. An electronic search was conducted on Scopus, Cochrane central, CINAHL Plus, PubMed and OpenGrey for linkage strategies implemented from 2006. A total of 189 potentially relevant citations were identified, of which 7 were eligible for inclusion. The identified strategies were categorized using themes from literature. The most common strategies included: health system interventions (i.e. comprehensive care, task shifting); patient convenience and accessibility (i.e. immediate CD4 count testing, immediate ART initiation, community HIV testing); behavior interventions and peer support (i.e. assisted partner services, care facilitation, mobile phone appointment reminders, health education) and incentives (i.e. non-cash financial incentives and transport reimbursement). Several strategies showed favorable outcomes: comprehensive care, immediate CD4 count testing, immediate ART initiation, and assisted partner services. Assisted partner services, same day home-based ART initiation, combination intervention strategies and point-of-care CD4 testing significantly improved linkage to care in urban settings of sub-Saharan African region. They can be delivered either in a health facility or in the community but should be facilitated by health workers. There is, however, the need to conduct more linkage-specific studies in the sub-region. [ABSTRACT FROM AUTHOR]

Background: Integrated cardiovascular disease (CVD) and HIV (CVD-HIV) care interventions are being adopted to tackle the growing burden of noncommunicable diseases (NCDs) in low-and middle-income countries (LMICs) but there is a paucity of studies on the feasibility of these interventions in LMICs. This scoping review aims to present evidence of the feasibility of integrated CVD-HIV care in LMICs, and the alignment of feasibility reporting in LMICs with the existing implementation science methodology. Methods: A systematic search of published articles including systematic and narrative reviews that reported on integrated CVD-HIV care was conducted, using multiple search engines including PubMed/Medline, Global Health, and Web of Science. We examined the articles for evidence of feasibility reporting. Adopting the definition of Proctor and colleagues (2011), feasibility was defined as the extent to which an intervention was plausible in a given agency or setting. Evidence from the articles was synthesized by level of integration, the chronic care continuum, and stages of intervention development. Results: Twenty studies, reported in 18 articles and 3 conferences abstracts, reported on feasibility of integrated CVD-HIV care interventions. These studies were conducted in Sub-Saharan Africa, Southeast Asia and South America. Four of these studies were conducted as feasibility studies. Eighty percent of the studies reported feasibility, using descriptive sentences that included words synonymous with feasibility terminologies in existing definition recommended by Proctor and colleagues. There was also an overlap in the use of descriptive phrases for feasibility amongst the selected studies. Conclusions: Integrating CVD and HIV care is feasible in LMICs, although methodology for reporting feasibility is inconsistent. Assessing feasibility based on settings and integration goals will provide a unique perspective of the implementation landscape in LMICs. There is a need for consistency in measures in order to accurately assess the feasibility of integrated CVD-HIV care in LMICs. [ABSTRACT FROM AUTHOR]

The real estate valuation literature on sub-Saharan Africa (SSA) shows a growing concern over valuation errors, especially wide variation in valuations. Although there have been increased business and investment activities in the last decade or more in the region, these valuation errors pose a challenge to the maturity of SSA real estate markets as valuations promote transparency and support efficient operation of property markets. Based on archival and survey data, as well as insights from the task complexity discourse, this study examines the extent of variations in valuations and the effect of complex valuation tasks on the levels of the variations in Ghana. The study finds high levels of variations in valuation opinions of 33.6-63% for the archival and survey data, respectively. These levels of variations are substantially higher than have been reported in the literature for advanced markets suggesting that the concerns of valuation errors in SSA may be well grounded. Consistent with theory, it is further established that variations in valuation opinions may be more pronounced in comparatively more complex assignments. These findings have several implications including possible loss of confidence of market players in valuations, heightening of market uncertainty and increase in transaction costs. [ABSTRACT FROM AUTHOR]

Background: The burden of malaria in terms of morbidity and mortality is huge is Sub-Saharan Africa, particularly among pregnant women. Among the measures to curb down this burden include intermittent preventive treatment (IPT) and effective case management. These strategies were adopted by Ghana and implemented since 2003; however, there is still high dropout rate in IPT coverage. This study sought to investigate factors contributing to high dropout rate between IPT1 and IPT3 in the Tamale Metropolis, one of the health facilities with the highest IPT dropout rates in Ghana. Methods: Survey, in-depth interviews and short ethnographic techniques were conducted among pregnant women, antenatal care (ANC) health workers and heads of health facilities to investigate factors which account for dropout rate of intermittent treatment of malaria. Results: Shortage of sulphadoxine pyrimethamine (SP), inadequate supply of portable water for administration of SP, unavailability of IPT during outreach services, lack of knowledge by ANC staff about the dropout rate in their area of jurisdiction and poor attitude of some health workers were identified as barriers to achieving high IPT3 coverage. Conclusions: Late ANC visit, provider and logistical barriers account for the women's missed opportunities to prevent malaria in pregnancy through IPT. Addressing the above barriers will contribute to saving lives and ensuring progress towards the goal of combating malaria as well as reducing maternal, neonatal and child mortalities. [ABSTRACT FROM AUTHOR]

Hypertension, once a rare problem in Sub-Saharan Africa (SSA), is predicted to be a major cause of death by 2020 with mortality rates as high as 75%. However, comprehensive knowledge of provider-level factors that influence optimal management is limited. The objective of the current study was to discover physicians’ perceptions of factors influencing optimal management and control of hypertension in SSA. Twelve physicians attending the Cardiovascular Research Training (CaRT) Institute at the University of Ghana, College of Health Sciences, were invited to complete a concept mapping process that included brainstorming the factors influencing optimal management and control of hypertension in patients, sorting and organizing the factors into similar domains, and rating the importance and feasibility of efforts to address these factors. The highest ranked important and feasible factors include helping patients accept their condition and availability of adequate equipment to enable the provision of needed care. The findings suggest that patient self-efficacy and support, physician-related factors, policy factors, and economic factors are important aspects that must be addressed to achieve optimal hypertension management. Given the work demands identified by physicians, future research should investigate cost-effective strategies of shifting physician responsibilities to well-trained no-physician clinicians in order to improve hypertension management. [ABSTRACT FROM AUTHOR]

Aims to suggest approaches that can be applied to close the digital divide between Sub-Saharan Africa (SSA) and the rest of the world, including the provision of information and communication technology (ICT) infrastructure, access to ICTs and the development of appropriate content and information literacy skills. Identifies some international initiatives to develop ICT infrastructure and proposes the development of telecenters, techmobiles and technology resource centers, and the use of the `old boy network' or `past students' associations', to provide access to digital technology. Identifies the need to create Internet content in African languages, developing African language keyboards and conduct needs assessments of local users. Makes proposals for training teachers to teach information literacy skills, involving libraries in information literacy skills development and instituting mass information literacy programs. Concludes that implementing these approaches to closing the digital divide calls for strategic interventions by governments. [ABSTRACT FROM AUTHOR]

Alternative energy has been hailed as a feasible resolution to the environmental degradation and energy problems that have plagued Sub-Saharan Africa (SSA) recently. The expansion of the clean energy sector, on the other hand, relies on economic growth, effective governance, and financial considerations. As a result, it is important to investigate the links between these variables in SSA. This study investigated the influence of economic growth, institutional quality, foreign direct investment (FDI), and financial development on renewable energy at the national threshold in SSA using a two-step difference GMM model based on panel data collected from 2002 to 2019. The outcome shows that economic growth and all three financial development indicators (FD1, FD2 and FD3) have a positive significant relationship with renewable energy. Furthermore, for SSA countries, FDI, as well as all six proxy factors for institutional quality, had a negative significant influence on renewable energy. Our empirical findings propose a variety of policies that might help the renewable energy sector grow. [ABSTRACT FROM AUTHOR]

• The evolving epidemic of Human Immunodeficiency Virus type 1 in Sub-Saharan Africa and South Africa. • The impact of the epidemic on diagnostic algorithms. • 2019 World Health Organisation's HIV testing guidelines. • Considerations for implementing the new HIV algorithm in South Africa. HIV-1/2 testing is the first step in ensuring HIV-infected individuals are diagnosed and appropriately managed. The impact of suboptimal HIV-1/2 testing algorithms significantly contributes to the increased rates of misdiagnosis of HIV infection. Recently, the World Health Organization (WHO) recommended that high burden countries revise their testing algorithm from a 2 to 3-test testing strategy in the context of an evolving HIV epidemic. Implementation of a new HIV-testing algorithm must be tailor-made within a national framework and must be balanced out with operational feasibility, patient outcomes, and cost-effectiveness. In this review, we provide an overview of the current state of the HIV epidemic and its impact on HIV testing, further we highlight areas of concern in changing from a 2-step to a 3-step test algorithm in the context of South Africa's HIV epidemic and public health program. [ABSTRACT FROM AUTHOR]