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

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

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

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

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

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

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

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

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

Background: Alcohol use disorder (AUD) and major depressive disorder (MDD) drive HIV transmission in many sub-Saharan African settings. The impact of screening and treating AUD and MDD on HIV outcomes is unknown. We aimed to identify the cost-effectiveness of AUD and MDD interventions in Zimbabwe, and their potential contribution to reaching Zimbabwe's Ending the HIV Epidemic 2030 goal. Methods: Using a validated HIV compartmental transmission model in Zimbabwe, we compared four policy scenarios: prevention as usual (baseline); implement AUD screening (using AUDIT) and treatment (motivational interviewing and cognitive-behavioral therapy); implement MDD screening (using PHQ-9) and treatment (cognitive-behavioral therapy); and implement screening and treatment for both. Outcomes were HIV incidence projections, infections averted through 2030, quality-adjusted life-years gained, cost per infection averted, and cost per QALY gained. Analyses considered "spillover," when treatment for AUD also results in an improvement in MDD and the converse. Sensitivity analyses identified cost reductions necessary for AUD and MDD interventions to be as cost-effective as other HIV interventions, particularly the scale-up of long-acting PrEP. Results: AUD and MDD combined will be responsible for 21.1% of new HIV infections in Zimbabwe by 2030. Without considering spillover, compared to the baseline, MDD intervention can reduce new infections by 5.4% at $2039/infection averted and $3186/QALY. AUD intervention can reduce new infections by 5.8%, but at $2,968/infection averted and $4753/QALY, compared to baseline. Both MDD and AUD interventions can reduce new infections by 11.1% at $2810/infection averted and $4229/QALY, compared to baseline. Considering spillover, compared to the baseline, MDD intervention can reduce new infections by 6.4% at $1714/infection averted and $2630/QALY. AUD intervention can reduce new infections by 7.4%, but at $2299/infection averted and $3560/QALY compared to baseline. Both MDD and AUD interventions can reduce new infections by 11.9% at $2247/infection averted and $3382/QALY compared to baseline. For MDD intervention to match the cost-effectiveness of scaling long-acting PrEP, the cost of MDD intervention would need to be reduced from $16.64 to $12.88 per person. Conclusions: Implementing AUD and MDD interventions can play an important role in HIV reduction in Zimbabwe, particularly if intervention cost can be decreased while preserving effectiveness. [ABSTRACT FROM AUTHOR]

Introduction: Work-related musculoskeletal disorders represent a major public health problem, contributing significantly to the global burden of disability-adjusted life years and affecting the quality of life of all population groups. The main problem in most musculoskeletal disorders is low back pain. Therefore, our study aims to identify the overall prevalence of work-related low back pain among the working population in sub-Saharan Africa. Methods: Research published between 2010 and 2023 in English, conducted in Sub-Saharan Africa was included in this systematic review and meta-analysis. Using Boolean logic operators and targeted keywords, we searched for publications on a number of electronic databases (Web of Science, PubMed, Google Scholar, African Journals Online (AJOL), and Science Direct). The Joanna Briggs Institute Critical Appraisal techniques were utilized to conduct a quality assessment of the papers and ascertain their relevance to the study. The degree of heterogeneity among the included studies, the 95% confidence interval, and the pooled prevalence were estimated using a random effects model. Sensitivity studies were carried out to determine the causes of heterogeneity and the impact of outliers. Results: In this study, a total of 970 articles were retrieved, and 35 studies were included in the systematic review and meta-analysis. The overall estimated pooled prevalence of low back pain among the working population in sub-Saharan Africa was (55.05% [95% CI: 49.34, 60.76]). Based on a sub-group analysis by countries, the higher pooled prevalence of low back pain was found in Uganda at (61.48% [95% CI: 40.39, 82.57]), while the lower pooled prevalence of low back pain was in Ghana at (34.48% [95% CI: 17.96, 51.01]). Conclusions: This systematic review and meta-analysis found that 55.05% of the included study participants experienced low back pain in the previous years. Therefore, it is recommended that policymakers incorporate and enhance strategies for the prevention and management of low back pain within the health system management guidelines of each country. [ABSTRACT FROM AUTHOR]

Background: Hypertensive disorders of pregnancy (HDP) are associated with placental insufficiency and adverse perinatal outcomes—over half (58.9%) of women with HDP at Mbarara Regional Referral Hospital (MRRH) have adverse perinatal outcomes. The cerebroplacental ratio (CPR) is an important predictor and prevents approximately 30% of these adverse perinatal outcomes. We determined the prevalence and factors associated with abnormal CPR among women with HDP at MRRH. Methods: We conducted a cross‐sectional study from December 2022 to May 2023 at the high‐risk obstetrics unit of MRRH. We consecutively enrolled all women with hypertensive disorders and gestational ages ≥ 26 weeks and performed obstetric Doppler studies to document the pulsatility index (PI) of the umbilical artery (UA) and middle cerebral artery (MCA) and then calculated the CPR as a ratio of the MCA‐PI and UA‐PI. The prevalence of women with an abnormal CPR ≤ 1.0 was expressed as a percentage. We used robust modified Poisson regression analysis to determine the factors associated with abnormal CPR. Results: We enrolled 128 women with hypertensive disorders in pregnancy, with a mean age of 28.8 ± 6.3 years. Of these, 67 (52.3%) had abnormal CPR. The factors associated with abnormal CPR were severe pre‐eclampsia (adjusted prevalence ratio (aPR): 5.0, 95% CI: 1.28, 29.14) and eclampsia (aPR: 5.27, 95% CI: 1.11, 34.27). Conclusion: On average, half of the women with hypertensive disorders have abnormal CPR. Women with severe pre‐eclampsia or eclampsia are more likely to have abnormal CPR. Obstetric Doppler studies with CPR may be warranted for all pregnant women with severe pre‐eclampsia and eclampsia. We recommend further research to assess perinatal outcomes among those with and without abnormal CPR to profile women with HDP at increased risk of adverse perinatal outcomes. [ABSTRACT FROM AUTHOR]

Northern corn leaf blight (NCLB), caused by Setosphaeria turcica, is a major fungal disease affecting maize production in sub-Saharan Africa. Utilizing host plant resistance to mitigate yield losses associated with NCLB can serve as a costeffective strategy. In this study, we conducted a high-resolution genome-wide association study (GWAS) in an association mapping panel and linkage mapping with three doubled haploid (DH) and three F3 populations of tropical maize. These populations were phenotyped for NCLB resistance across six hotspot environments in Kenya. Across environments and genotypes, NCLB scores ranged from 2.12 to 5.17 (on a scale of 1-9). NCLB disease severity scores exhibited significant genotypic variance and moderate-to-high heritability. From the six biparental populations, 23 quantitative trait loci (QTLs) were identified, each explaining between 2.7% and 15.8% of the observed phenotypic variance. Collectively, the detected QTLs explained 34.28%, 51.37%, 41.12%, 12.46%, 12.11%, and 14.66% of the total phenotypic variance in DH populations 1, 2, and 3 and F3 populations 4, 5, and 6, respectively. GWAS, using 337,110 highquality single nucleotide polymorphisms (SNPs), identified 15 marker-trait associations and several putative candidate genes linked to NCLB resistance in maize. Joint linkage association mapping (JLAM) identified 37 QTLs for NCLB resistance. Using linkage mapping, JLAM, and GWAS, several QTLs were identified within the genomic region spanning 4 to 15 Mbp on chromosome 2. This genomic region represents a promising target for enhancing NCLB resistance via marker-assisted breeding. Genome-wide predictions revealed moderate correlations with mean values of 0.45, 0.44, 0.55, and 0.42 for within GWAS panel, DH pop1, DH pop2, and DH pop3, respectively. Prediction by incorporating marker-by-environment interactions did not show much improvement. Overall, our findings indicate that NCLB resistance is quantitative in nature and is controlled by few major-effect and many minor-effect QTLs. We conclude that genomic regions consistently detected across mapping approaches and populations should be prioritized for improving NCLB resistance, while genome-wide prediction results can help incorporate both major- and minor-effect genes. This study contributes to a deeper understanding of the genetic and molecular mechanisms driving maize resistance to NCLB. [ABSTRACT FROM AUTHOR]

Key Points: Question: How has the widescale distribution of rapid diagnostic tests for malaria across sub-Saharan African countries affected febrile illness management and mortality for children younger than 5 years of age? Findings: Increasing distribution of rapid diagnostic tests for malaria was associated with increased blood testing, use of antimalarial drugs, and antibiotic use and modestly improved child survival. The greatest benefits occurred in areas with a high prevalence of malaria. Meaning: The distribution of rapid diagnostic tests for malaria was associated with changes in pediatric febrile illness management and improved survival. Importance: A prompt malaria diagnosis is crucial for the management of children with febrile illness in sub-Saharan African countries, where malaria remains a leading cause of mortality among children younger than 5 years of age. The development and distribution of point-of-care rapid diagnostic tests (RDTs) for malaria has transformed practice, but limited systematic evidence exists on how malaria RDTs have affected the management of febrile illness and mortality for children younger than 5 years of age across sub-Saharan Africa countries. Objective: To evaluate the association between the distribution of malaria RDTs and the management of febrile illness and mortality among children younger than 5 years of age in sub-Saharan African countries. Design, Setting, and Participants: This quasi-experimental study used a novel dataset linking malaria RDT distribution to 165 nationally representative household surveys across 35 sub-Saharan African countries with mortality data. The sample comprised approximately 3.9 million child-year observations and approximately 260 000 febrile illness episodes in children younger than 5 years of age between 2000 and 2019. Main Outcomes and Measures: Fixed-effects linear probability models were used to analyze the association between variation in malaria RDTs distributed per child younger than 5 years of age (by country per year) and blood testing, antimalarial drug use, antibiotic use, use of symptomatic treatments, and mortality rates. Variation in the effects of testing and treatment was also assessed across the sub-Saharan African countries that had varying prevalence of malaria. Results: The mortality sample included 1 317 866 children and the fever sample included 256 292 children. The mean age of the children with febrile illness was 2.4 years (SD, 1.3 years) and 49% were female. Each additional malaria RDT distributed per child younger than 5 years of age was associated with an increase of 3.5 percentage points (95% CI, 3.2-3.8 percentage points) in blood testing, an increase of 1.5 percentage points (95% CI, 1.2-1.8 percentage points) in the use of antimalarial drugs, an increase of 0.4 percentage points (95% CI, 0.1-0.6 percentage points) in antibiotic use, and a decrease of 0.4 percentage points (95% CI, 0.1-0.8 percentage points) in the use of treatments for symptoms. Each additional malaria RDT distributed per child younger than 5 years of age was associated with a reduction in child mortality of 0.34 deaths per 1000 child-years (95% CI, 0.15-0.52 deaths per 1000 child-years). The effects of malaria RDT distribution on medication use and child mortality varied across prevalence settings (low vs high) for malaria; there were survival improvements only in areas that had a high prevalence of malaria. Conclusions and Relevance: Increasing distribution of malaria RDTs was associated with increased blood testing, increased use of antimalarial drugs, and modestly improved survival in children younger than 5 years of age in sub-Saharan African countries. However, malaria RDTs were associated with increases in the rates of antibiotic use that were already high, suggesting that more comprehensive approaches to case management of febrile illness are needed. This quasi-experimental study evaluates the association between the distribution of rapid diagnostic tests for malaria and the management of febrile illness and mortality among children younger than 5 years of age in sub-Saharan African countries. [ABSTRACT FROM AUTHOR]

Background Shorter prophylactic vaccine schedules may offer more rapid protection against Ebola in resource-limited settings. Methods This randomized, observer-blind, placebo-controlled, phase 2 trial conducted in 5 sub-Saharan African countries included people without human immunodeficiency virus (HIV) (PWOH, n = 249) and people with HIV (PWH, n = 250). Adult participants received 1 of 2 accelerated Ebola vaccine regimens (MVA-BN-Filo, Ad26.ZEBOV administered 14 days apart [n = 79] or Ad26.ZEBOV, MVA-BN-Filo administered 28 days apart [n = 322]) or saline/placebo (n = 98). The primary endpoints were safety (adverse events [AEs]) and immunogenicity (Ebola virus [EBOV] glycoprotein–specific binding antibody responses). Binding antibody responders were defined as participants with a >2.5-fold increase from baseline or the lower limit of quantification if negative at baseline. Results The mean age was 33.4 years, 52% of participants were female, and among PWH, the median CD4+ cell count was 560.0 (interquartile range, 418.0–752.0) cells/μL. AEs were generally mild/moderate with no vaccine-related serious AEs or remarkable safety profile differences by HIV status. At 21 days post–dose 2, EBOV glycoprotein–specific binding antibody response rates in vaccine recipients were 99% for the 14-day regimen (geometric mean concentrations [GMCs]: 5168 enzyme-linked immunosorbent assay units [EU]/mL in PWOH; 2509 EU/mL in PWH) and 98% for the 28-day regimen (GMCs: 6037 EU/mL in PWOH; 2939 EU/mL in PWH). At 12 months post–dose 2, GMCs in PWOH and PWH were 635 and 514 EU/mL, respectively, for the 14-day regimen and 331 and 360 EU/mL, respectively, for the 28-day regimen. Conclusions Accelerated 14- and 28-day Ebola vaccine regimens were safe and immunogenic in PWOH and PWH in Africa. Clinical Trials Registration.  NCT02598388. [ABSTRACT FROM AUTHOR]

Background: Young people (YP) are disproportionately affected by the HIV pandemic in sub-Saharan Africa (SSA), but testing rates remain low despite global targets of testing 95% of people with HIV infection by 2030. HIV self-testing (HIVST) has been recently introduced to reach high-risk population groups such as these. Thus, synthesis of emerging evidence on the acceptability and use of HIVST among YP in SSA is needed so that comprehensive information can be generated to inform policy and practice. Methods: We employed a mixed methods systematic review of quantitative and qualitative literature reporting on HIVST among YP involving any design and published in English by 31st of October 2023. The review synthesized quantitative evidence on acceptability and use of HIVST, and qualitative evidence on perspectives of YP about HIVST. We searched databases of published articles (e.g. MEDLINE, CINAHL) and Gray literature sources (e.g. Google, Google Scholar). The concepts for the search included self-testing, HIV/AIDS, and countries in SSA. Two authors independently screened, retrieved full-text, and assessed quality of the studies. Results: A total of 4150 studies were retrieved and 32 studies were finally included in the review. Acceptability of HIVST computed from a single item asking YP on their preference or willingness or demand for HIVST was moderate (34–67%) to high (≥ 67%) among YP in SSA. Nine of the fourteen studies that reported on acceptability found high acceptability of HIVST. Use of HIVST ranged from 0.8 to 100% while in most studies the use rate was below 50%. Key barriers to HIVST use were coping with a positive test in the absence of counselling and support, physical discomfort, and cost of kits. Perceived enablers included perceptions of HIVST as promoting personal empowerment and autonomy; privacy and confidentiality; and convenience in location, time, and skill. Conclusions: HIVST was highly accepted but not well utilized among YP in SSA. YP showed diversified needs with mixed preferences for location, and modalities of service provision. Overall, the review identified heterogeneous evidence in terms of methods, population, outcome measures, and results. The review was registered in the International Prospective Registry of Systematic Reviews (PROSPERO: ID = CRD42021278919). [ABSTRACT FROM AUTHOR]

Background: Sub-Saharan Africa (sSA) continues to rank among the regions in the world with the highest rates of maternal mortality and the lowest rates of utilization of maternal health care. The risk of death for women in sSA is 268 times higher than that of women in high-income nations. Adequate antenatal care (ANC) services utilization is essential to the mother's and the baby's survival and well-being. This study aimed to identify both individual and community-level factors associated with adequate antenatal care services utilization in sSA. Method: We used data from the most recent Health and Demographic Surveys (DHS), which were carried out between 2012 and 2022 in 33 sSA countries. A total of 240,792 women were included in this study. The two-level mixed-effects logistic regression model was used to identify the individual and community-level factors associated with the use of adequate ANC service. Results: The pooled prevalence of adequate ANC service utilization in sSA was 55.48% (95% CI: 55.28–55.68). The study showed that secondary and above-educated women (AOR = 2.13, 95% CI 2.07–2.19, secondary and above-educated husbands (AOR = 1.55, 95% CI 1.51–1.60), rich women AOR = 1.26, 95% CI 1.24–1.29), women 35–49 years of age (AOR = 1.36, 95% CI 1.32–1.41) and distance to a health facility is not a big problem (AOR = 1.13; 95% CI 1.11–1.16) was significantly and positively correlated with the use of adequate ANC services. However, rural women (AOR = 0.80; 95% CI 0.78–0.82), not having mass media access (AOR = 0.74, 95% CI 0.72–0.75), 5 and above birth order (AOR = 0.73, 95% CI 0.68–0.78) were significantly and negatively correlated with the use of adequate ANC services. Additionally, the random effects model showed that variables at the community and individual levels were responsible for approximately 62.60% of the variation in the use of adequate ANC services. Conclusion: The sSA countries had a low prevalence of adequate utilization of ANC with a significant variation among countries. Moreover, public health initiatives should focus on rural women, poor women, and uneducated women to enhance maternal health services utilization. Furthermore, policies and programs that address cluster variations in the utilization of adequate ANC services must be developed, and their implementation must be vigorously pursued. [ABSTRACT FROM AUTHOR]

This paper analyses the role of governance quality in the relationship between the Internet and financial inclusion in Sub-Saharan African countries. The study uses data from the International Monetary Fund (IMF) database for indicators of financial inclusion, World Development Indicators (WDI) for Internet users and World Governance Indicators (WGI) for governance indicators from 2004 to 2020. Analyzing the data using the System Generalized Method of Moments (SGMM), the results show that the Internet can be effectively complemented with the quality of governance to improve financial inclusion. Thresholds of governance that are needed for the Internet to promote financial inclusion are provided. Policies aimed at reinforcing the quality of governance in SSA countries could help consolidate Internet infrastructure to promote Internet usage and, in turn, improve financial inclusion. Other policy implications are discussed. [ABSTRACT FROM AUTHOR]

This commentary explores the intersection between climate, conflict, and child nutrition, highlighting the severe child nutrition crisis in Sub-Saharan Africa exacerbated by climate change and ongoing conflicts. Shifting climate patterns disrupt agricultural productivity and food security, while persistent conflicts displace populations and destroy infrastructure, significantly increasing food insecurity and malnutrition among children. Recent UNICEF data indicates that 1 in 4 children globally live in severe food poverty, with those affected up to 50% more likely to suffer from life-threatening malnutrition. Over half a billion children reside in areas prone to climate-related extreme weather events, challenging food production, distribution, and access. Extreme weather events have led to crop failures, food shortages, and price spikes, disproportionately affecting vulnerable populations. Changes in temperature and precipitation patterns also alter the nutritional content of crops, worsening nutritional challenges. Conflicts in SSA have led to a food crisis of unprecedented scale, with over 80% of the 137 million Africans facing acute food insecurity located in conflict-affected countries. The conflict between Russia and Ukraine has further disrupted global food and fertilizer supply chains, exacerbating food shortages and inflation in many African countries. Addressing this crisis requires a multifaceted approach integrating evidence-based, cost-effective strategies. This commentary advocates for the adoption of the 3 C approach—climate-smart school feeding programs, cultivation of edible insects, and community-based food hubs—as solutions to enhance child nutrition and build climate resilience. [ABSTRACT FROM AUTHOR]

Introduction: Cataract is a leading cause of visual impairment and blindness, mainly affecting older adults in sub-Saharan Africa (SSA). This scoping review aims to map evidence on the prevalence, contextual factors, and management strategies for cataracts among older adults in SSA. Method: Four central databases (PubMed, Scopus, Medline, and Google Scholar) were searched, yielding 383 records. Additional searches produced eight records. After screening and applying inclusion criteria, 26 full-text articles were eligible for further review. Finally, seven full-text records were included in the thematic analysis and synthesis. Results: Cataract prevalence among older adults in SSA ranged from 13.5–62.5% across different countries. Surgery remains the primary management strategy, but cataract surgical coverage varies widely (12.1–96%). Significant barriers to effective management include lack of awareness, limited access to healthcare, economic constraints, gender disparities, and cultural misconceptions about cataract surgery. Conclusion: There is a significant burden of cataracts among older adults in SSA, with considerable variations in prevalence and surgical coverage across the region. Comprehensive strategies addressing awareness, accessibility, affordability, and cultural factors are needed to improve cataract management and reduce visual impairment in SSA. [ABSTRACT FROM AUTHOR]

The study tests the effect of poverty-reduction intervention on family functioning reported by AIDS-orphaned children in extended families in Southern Uganda by asking two questions: (1) based on children's reports, how does poverty reduction intervention affect family functioning? and (2) to what extent do these effects vary by a child's gender and orphanhood status? Informed by the social causation theory, family stress model, and asset theory, the study aims to address the existing knowledge gap on effects of poverty reduction interventions on family functioning in low-income families caring for AIDS orphaned children in Uganda. We ran multilevel regression models using longitudinal data collected in a cluster-randomized controlled trial from N = 1410 children (n = 621 boys and n = 789 girls) recruited from 48 rural primary schools in Uganda. Survey data was collected every 12 months over the course of 5 years. The average age of children at enrollment was 13 years. We found significant positive effects of the intervention on family cohesion, family communication, and child-caregiver relationship. Effects vary by child's gender and orphanhood category. Intervention improves family communication for boys, while improving family cohesion and quality of child-caregiver relationship for girls. Single maternal orphans reported improved family communication, while single paternal orphans reported improved child-caregiver relationship. Poverty reduction interventions are important to improve family functioning for low-income families. Variations by child's gender and orphanhood status have not been reported in previous studies, and our findings underscore the importance of continued research in this area. Highlights: Poverty reduction interventions are important to improve family functioning for low-income families in Sub-Saharan Africa. Asset-based poverty-reduction intervention improves family functioning among families caring for AIDS orphans in Uganda. Effects vary by child's gender and orphanhood category, which has not been reported in previous studies. Findings suggest a need for comprehensive consideration of complexities related to gender variations and family structures. [ABSTRACT FROM AUTHOR]

The negative impacts of COVID-19, the ongoing war between Russia and Ukraine, political unrest, and natural disasters in sub-Saharan Africa have caused widespread suffering. In light of these crises, many have questioned the relevance of theology in addressing such complex challenges. This article tackles critical questions such as: How can public theology effectively engage with the socio-political and economic issues facing sub-Saharan Africa? What role does public pastoral care play in fostering resilience within these communities? Can theology provide tangible support in the face of widespread suffering, and if so, how? The article argues that public theology offers a resilient framework to guide communities through these difficult times, particularly when integrated with public pastoral care. Public theology can provide hope, support, and a sense of purpose to those affected by engaging both spiritual and social dimensions. The article further explores how public pastoral care, as a practical expression of public theology, can address individuals' and communities' emotional, psychological, and spiritual needs. Ultimately, it demonstrates that public theology is relevant and essential in fostering resilience and promoting human flourishing in the face of adversity. [ABSTRACT FROM AUTHOR]

The gender gap in education is not limited to the subject of mathematics or only to be found in high-income countries, and its repercussions can have generational consequences. Previous literature has sought to explain why the gender gap persists in most high- and middle-income countries vis-à-vis social gender inequality without drawing from similarly comprehensive data from the African context with its unique gender gap landscape. This paper examines the correlation between more gender-equal countries and the gender gap in student test scores for reading, mathematics, and HIV-AIDS awareness in southern and eastern Africa. We use ordinary least squares and quantile regression to analyse student information from the SACMEQ III dataset in comparison with measurements of social gender inequality such as the Gender Inequality Index and the Global Gender Gap Index. As such, this analysis draws on data from roughly 60,000 African students and includes test scores from reading comprehension and HIV-AIDS awareness, a unique subject that is critical for health, wealth and wellbeing on the continent. Our study finds that in each subject at every quantile, the gender gap displays a robust inverse relationship with more gender-equal countries specifically demonstrating higher educational performance among girls. With youthful populations and burgeoning economies, these countries in Africa have much to gain from addressing the gender gap in education. These findings encourage policymakers to consider how the social condition of gender-equality might influence the academic performance of students, especially for girls. [ABSTRACT FROM AUTHOR]

This research analyses the 2013 Nigeria Demographic and Health Survey Data. The multilevel logistic regression is used as the model estimation technique. The study investigates how the intersection of being a paternal orphan or vulnerable child and having close versus distant biological relations with the household head impacts wasting. Findings indicate that paternal orphans or vulnerable children who are grandchildren face the greatest significant probability of wasting compared to paternal orphans or vulnerable children who are biological children and non-orphans/non-vulnerable children who are grandchildren. Grandparent-headed households are not meeting the nutritional needs of paternal orphans and vulnerable children who are grandchildren. Policy needs to focus on directing monetary, food, and health resources to grandmothers caring for orphaned and vulnerable grandchildren. [ABSTRACT FROM AUTHOR]

Biometric digital identity systems have been promoted as a solution for Africa's development challenges. By providing accurate and reliable identification of citizens, these systems are expected to enable better planning and resource allocation by states. However, this optimistic view overlooks the border logic embedded in the design and deployment of these systems. In this article, the author critically examines the assumptions and implications of biometric digital identity systems in Africa. By broadening the debate on the intersection of African 'mobilities', responsible innovation, and the deployment of biometric technology, the author attempt to pry open the 'black box' of national digital identity systems and contends that the diffusion of these systems in Africa is driven more by the Global North's border interests than by the local populations' development needs. [ABSTRACT FROM AUTHOR]

Background: Antiretroviral treatment failure is a global issue, particularly in developing countries such as Sub-Saharan Africa. Prior research findings were highly variable and inconsistent across areas. As a result, the goal of this systematic review and meta-analysis was to determine the pooled prevalence of treatment failure among children receiving antiretroviral medication in Sub-Saharan Africa. Methods: To find qualifying papers, we searched databases (such as PubMed, Google Scholar, African Journals Online, Scopus, and the Cochrane Library). The data were retrieved using Microsoft Excel and exported to STATA Version 14 for analysis. To check for publication bias, we employed Egger and Begg's regression tests. A random-effects model was used to assess the pooled prevalence of treatment failure due to high levels of variability. Results: Following the removal of duplicated articles and quality screening, a total of 33 primary articles were determined to be appropriate for inclusion in the final analysis for this study. Overall, the pooled prevalence of treatment failure among HIV-infected children was 25.86% (95% CI: 21.46, 30.26). There is great variety across the included studies, with the majority of them being conducted in Ethiopia. Cameroon had the greatest pooled prevalence of treatment failure among HIV-infected children, at 39.41% (95% CI: 21.54, 57.28), while Ethiopia had the lowest, at 13.77% (95% CI: 10.08, 17.47). Conclusions: The pooled estimate prevalence of treatment failure among HIV-infected children in Sub-Saharan Africa was high. The implementation of national and international policies and strategies on ART clinic care services should be given special focus in order to reduce treatment failure in children living with HIV/AIDS. Trial registration: The protocol has been registered in the PROSPERO database under the registration number CRD-429011. [ABSTRACT FROM AUTHOR]

Access to finance is perceived as one of the major problems facing businesses in Sub-Saharan Africa, as well as the structures that support them in their development. This paper aims to measure the probability that a support structure with given characteristics, specific services to entrepreneurs and some technical capacities will face large-scale financial problems. We estimate a multinomial logistic model using a pool of disaggregated data collected by the Nkafu Policy Institute in a survey of 80 business support structures in Burkina Faso, Cameroon and Ghana in 2021. Our results show that the financial health of a business support structure is not fundamentally dependent on the duration of support, but rather on other factors related to the quality of services offered to entrepreneurs. [ABSTRACT FROM AUTHOR]

Commercial sexual exploitation of children (CSEC) has emerged as a critical child protection and public health concern in recent years. While the phenomenon is prevalent globally, its impact is compounded in sub-Saharan Africa owing to the cultural and socioeconomic challenges that leave many households in the region vulnerable. The present study synthesized existing evidence using the socioecological model as a guiding framework to assess the risk and protective factors associated with CSEC in sub-Saharan Africa. A protocol for the study was published in PROSPERO (CRD42022331832) with pre-specified inclusion and exclusion criteria. Studies were screened and extracted from eight databases: PsycINFO, Scopus, Web of Science, PROQUEST (Social Science Premium), PubMed, CINAHL, EMBASE, and MEDLINE via Ovid. After an initial screening of 4,377 papers, seven studies were found eligible for the final review. The review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guide for reporting systematic reviews. Included studies were appraised and rated using the Cambridge Quality Checklist and GRADE. Findings revealed risk factors, including adverse childhood experience and victimization, females aged 16 years and older, school dropouts, technology influence, child and parental alcohol use, and separation from caregivers. On the other hand, protective factors such as the number of female adolescents in a household, frequent health screening in schools, children being in school, and high parental monitoring were found to be associated with a lower risk of CSEC. Based on these findings, we recommend that interventions in sub-Saharan Africa adopt a holistic approach that addresses identified risk factors while harnessing protective factors to combat CSEC effectively. [ABSTRACT FROM AUTHOR]

This paper examines the effect of climate change on cereal yields via malaria prevalence in sub-Saharan African (SSA) countries. To achieve this objective, this paper uses a model composed of a system of two equations estimated with the 3SLS method, the semi-parametric approach and the two-stage system GMM method. Panel data from 31 SSA countries over the period 2000–2019 are used. Results reveal, on the one hand, that a change in temperature and rainfall leads to a significant increase in malaria prevalence. On the other hand, malaria prevalence reduces cereal yields by 2.6% on average in most SSA countries, via its effects on household's agricultural productivity. To reduce malaria prevalence to increase agricultural yields, policy-makers may need to disseminate malaria-reduction-related practices such as the use of insecticide-treated bed-nets and improving access to malaria treatments in rural dwellings. [ABSTRACT FROM AUTHOR]

Ex-rebels govern almost a quarter of sub-Saharan Africa today. How does war affect these countries' long-run political development, and what explains their rebel regimes' longevity? The article explores the role of coercion in rebel governance: postwar governance draws from wartime strategies, which helps to explain (1) the continued use of organized coercion in postwar politics when faced with challenges to ruling party dominance and (2) where such coercion is most effectively employed. I examine Zimbabwe where the anticolonial rebel party has remained in power since 1980. I rely on archival data to qualitatively trace mechanisms, map prewar to current-day administrative divisions, and code a measure of wartime governance. I combine these data with Afrobarometer surveys to demonstrate long-run subnational variation in coercive political control. Findings deepen our understanding of war's effects on peacetime politics and provide one explanation for infrequent political turnovers despite regular elections in many postconflict states. [ABSTRACT FROM AUTHOR]

Purpose: Delays in initiating cancer treatment time to treatment initiation (TTI) can negatively impact patient outcomes. This study aimed to quantify the association between TTI and survival in breast, cervical and prostate cancer patients at Inkosi Albert Luthuli Central Hospital (IALCH) in KwaZulu-Natal, South Africa, as a microcosm of Sub-Saharan Africa (SSA). Methods: We analyzed electronic medical records of patients diagnosed with breast, cervical or prostate cancer at IALCH between 2010 and 2020. Median TTI was calculated for different treatment modalities. To assess the link between treatment delay and mortality, we employed a Cox proportional hazards model to estimate hazard ratios (HRs) and 95% confidence intervals (CIs), treating breast cancer and patients over 40 as competing events. Additionally, Kruskal-Wallis one-way analysis and linear regression were used to compare TTI across racial groups. Results: The study included patients with breast (44%), cervical (44%) and prostate cancer (12%). Mean age at diagnosis was 62.6, 56.6 and 73.0 years, respectively. Breast cancer patients experienced the longest delays for mastectomy (median 18.4 weeks), followed by prostate cancer patients waiting for radiotherapy (median 16.6 weeks). Significantly longer TTI for radiotherapy was observed in patients younger than 40 with cervical (HR = 2.30, 95% CI: 2.16-2.44, p < 0.001) or prostate cancer (HR = 1.42, 95% CI: 1.03-1.95, p = 0.033) compared to older breast cancer patients. Similar trends were seen for younger patients with cervical cancer receiving chemotherapy. Notably, all racial groups exhibited substantial delays in initiating treatment for all three cancers (breast p < 0.001, prostate p = 0.004 and cervical cancer p < 0.001). Conclusion: This study identified significant delays in treatment initiation (TTI) for breast, prostate and cervical cancer patients at Inkosi Albert Luthuli Central Hospital (IALCH) in South Africa. These delays were concerning, particularly for younger patients and individuals across all racial backgrounds. Delays in treatment initiation have been linked to increased mortality risk in other studies, highlighting the urgency of addressing this issue. Furthermore, this study serves as a valuable model for future research throughout SSA to collectively address the challenges of treatment delays and improve cancer care for the region. [ABSTRACT FROM AUTHOR]

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

Introduction Current international standards in consent to surgery practices are usually derived from health systems in Western countries, while little attention has been given to other contexts such as sub-Saharan Africa (SSA), despite this region facing the highest burdens of disease amenable to surgery globally. The aim of this study was to examine how the concept of informed consent for surgery is interpreted and applied in the context of SSA, and factors affecting current practices. Methods A systematic search of Medline, Embase and African Journal OnLine databases as well as grey sources was executed in May 2023 to retrieve relevant literature published since 2010 in English language against a set of given criteria. The socioecological framework for health was used for organising and summarising the identified evidence. Results A total of 27 papers were included in the review. Findings revealed that consent to surgery practices is generally substandard across SSA and the process is not adequate. Patients' understanding of informed consent is limited, likewise awareness of their rights to decision-making. A range of factors at the individual, interpersonal, institutional and system/societal levels affect the informed consent process. Conclusion There is a need to find more culturally acceptable and ethical ways to include the participation of patients in the decision-making process for surgical treatment in the SSA and define standards more closely aligned with the local context. [ABSTRACT FROM AUTHOR]

Despite recent economic growth and reductions in child mortality in many African countries, the region has experienced a slow fertility transition. In this study, we explore whether the slow structural economic change on the continent can explain this discrepancy. We construct a unique panel dataset combining Demographic and Health Surveys and nighttime light intensity data (an indicator of industrialization) from 57 countries at the subnational region level over three decades to analyze the drivers of fertility transitions across low- and middle-income countries. Our results confirm that household wealth, reduced child mortality, and female primary education are crucial for fertility declines. However, our analysis also highlights the importance of indicators of structural economic change, including the share of labor in nonagricultural occupations, industrialization, the share of women with higher education, and the formalization of the economy. Our simulations suggest that if high-fertility countries in sub-Saharan Africa underwent structural economic transformations comparable to those of other low- and middle-income countries with low fertility rates, their fertility levels could fall by 1 to 1.6 children. [ABSTRACT FROM AUTHOR]

The objective of this paper is to assess the contribution of insurance to infrastructure development in Sub-Saharan Africa. The researchers used a sample of 31 Sub-Saharan African countries from a panel of data observed over the period 2003–2020. The methodologies used in this paper are the Driscoll-Kraay and Panels Corrected Standard Error. The results show that insurance (life and non-life) positively explains the level of infrastructure in Sub-Saharan Africa. Furthermore, using disaggregated infrastructure indices, the effect remains the same for transport, electricity, and water and sanitation infrastructure. However, insurance has no significant effect on telecommunications infrastructure. Our results remain robust using an instrumental variable technique, two stage least square. The economic policy suggestions concern the improvement of the regulatory framework for the insurance business so that it can participate effectively in financing the economy. In addition, a strengthening of the public–private partnership is commendable in order to provide governments with an alternative source of infrastructure financing, different from the generally used public financing, whose capacity is likely to be insufficient. [ABSTRACT FROM AUTHOR]

Background. Sexual transmission accounts for a substantial proportion of HIV infections. Although some countries are experiencing an upward trend in HIV infections, there has been a lack of studies assessing the global burden of HIV/AIDS acquired through sexual transmission. We assessed the global, regional, and national burdens of HIV/AIDS acquired through sexual transmission from 1990 to 2019. Methods. Data on deaths, years of life lost (YLLs), years lived with disability (YLDs), and disability-adjusted life years (DALY) of HIV/AIDS acquired through sexual transmission in 204 countries and territories from 1990 to 2019 were retrieved from the Global Burden of Disease Study (GBD) 2019. The burdens and trends were evaluated using the age-standardised rates (ASR) and estimated annual percentage change (EAPC). Results. Globally, HIV/AIDS acquired through sexual transmission accounted for ~695.8 thousand (95% uncertainty interval 628.0-811.3) deaths, 33.0 million (28.7-39.9) YLLs, 3.4 million (2.4-4.6) YLDs, and 36.4 million (32.2-43.1) DALYs in 2019. In 2019, Southern sub-Saharan Africa (11350.94), Eastern sub-Saharan Africa (3530.91), and Western sub-Saharan Africa (2037.74) had the highest ASR of DALYs of HIV/AIDS acquired through sexual transmission per 100,000. In most regions of the world, the burden of HIV/AIDS acquired through sexual transmission has been increasing from 1990 to 2019, mainly in Oceania (EAPC 17.20, 95% confidence interval 12.82-21.75), South Asia (9.00, 3.94-14.30), and Eastern Europe (7.09, 6.35-7.84). Conclusions. HIV/AIDS acquired through sexual transmission results in a major burden globally, regionally, and nationally. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this study is to empirically investigate how external debt vulnerability has affected the economy of emerging countries over time, with particular reference to Sub-Saharan African countries. It also deals with the policy issues associated with the economic effects. Design/methodology/approach: The techniques of dynamic ordinary least squares and fully modified ordinary least squares are used in this investigation, covering the period 1990–2022. A panel of 43 Sub-Saharan African countries is used in the study. Findings: The estimation results reveal that external debt vulnerability impacted negatively on economic growth, thus validating the concerns raised about the debt problem in Sub-Saharan Africa. Furthermore, the results revealed that domestic credit and openness of economy played a passive role and were therefore unable to cushion the adverse effect of debt vulnerability. Capital stock, however, stands out as the only variable that played a significant positive role in facilitating economic growth. The results are considered to be highly reliable for short-term forecast of economic growth and formulation of relevant policies. Originality/value: Over the years, economic analysts and stakeholders have expressed concern about the inadequate ratio of foreign reserves to external debt in developing countries. The effect of this external debt vulnerability on the economy of these countries has yet to be given sufficient attention by researchers. In view of this perceived void, this current study is carried out to determine the economic and policy consequences of the problem. [ABSTRACT FROM AUTHOR]

Climate change adversely impacts the livelihoods of smallholder farmers across East and Southern Africa. Climate-related information is assumed to support smallholder farmer decision-making and use of adaptive practices as a means to improve livelihoods, resiliency and levels of food security. However, the value of climate information provision and its role in promoting adaptive practices remains poorly understood. We examined smallholder household access to, and use of, climate information. Survey data was collected from 5322 households across Eswatini, Kenya, Lesotho, Tanzania and Zimbabwe using the Multidimensional Poverty Assessment Tool. Overall, the majority of households regularly accessed at least one source of climate information, primarily via radio (64.9%, n = 3453). Our statistical models showed that households with relatively better access to credit and land tenure were more likely to receive climate information (p < 0.01 and p < 0.001, respectively, n = 1421), and of those, households who reported observing past climate-related changes were more likely to actually use climate information (p < 0.05, n = 1097). Secure land tenure was positively associated with information use, though not statistically significant. Findings from our study offer guidance for improving the targeting and delivery of climate information programmes and policies, and indicate that the assumed benefits of climate information provision should be more rigorously evaluated. [ABSTRACT FROM AUTHOR]

Infrastructure development's contribution to community wellbeing in sub-Saharan Africa (SSA) is largely unknown. Existing scholarship over-represents externally funded projects, sidelining micro-level initiatives. Empirical studies hardly apply Structural Equation Modeling (SEM) approaches that estimate wellbeing as a composite function of infrastructure development. We review the topical literature on infrastructure development and community wellbeing in SSA. We find positive effects of infrastructure development on community wellbeing in SSA. SEM was not applied in any reviewed case study. We then use the Partial Least Square Structural Equation Model (PLS – SEM) to assess the impacts of multiple micro-level infrastructure projects on community wellbeing in Cameroon. All four examined micro-projects had positive effects on community wellbeing. However, only the effects of two projects (hospitals and schools) were statistically significant. The study recommends more SEM-based studies as prerequisite to disentangling composite wellbeing benefits of infrastructure development in SSA, with cost efficiency and outcome-optimizing implications. [ABSTRACT FROM AUTHOR]

Background: Traditional and new media use links to young people's sexual risk behaviour. The social contexts of young people's daily lives that influence media use and sexual risk behaviour are often investigated as independent causal mechanisms. We examined the link between media use and young people's sexual risk behaviour, considering the intersecting socio-contextual factors in Sub-Saharan Africa. Methods: Age-adjusted bivariate logistic regression models tested the association between traditional media (TV, radio, and newspapers), and new media (mobile phone and online) use and sexual risk behaviour using the Demographic and Health Surveys from six Sub-Saharan African countries among unmarried sexually active youths, aged 15–24 years. Multivariate logistic regression models ascertained the media sources that had an additional influence on young people's sexual risk behaviour, after accounting for socio-contextual factors, and knowledge about HIV and other sexually transmitted infections. Results: Socio-contextual factors attenuated the association between media use and young people's sexual risk behaviour in many countries. However, those who did not have access to new and traditional media were more likely to use unreliable contraceptive methods or not use contraception. Adolescents in Nigeria who did not own phones were 89% more likely to use unreliable contraceptive methods or not use any methods [(AOR = 1.89 (1.40–2.56), p <.001)], those in Angola who did not read newspapers had higher odds of not using contraception or used unreliable methods [(aOR = 1.65 (1.26–2.15), p <.001)]. Young people in Angola (aOR = 0.68 (0.56–0.83), p <.001), Cameroon [(aOR = 0.66 (0.51–0.84), p <.001)], Nigeria [(aOR = 0.72 (0.56–0.93), p =.01)], and South Africa [(aOR = 0.69 (0.49–0.98), p =.03)] who did not own phones were less likely to have 2 or more sexual partners compared to those who owned phones. Lack of internet access in Mali was associated with lower odds of having 2 or more sexual partners (aOR = 0.45 (0.29–0.70), p <.001). Traditional media use was significantly associated with transactional sex in many countries. Conclusions: Media use is linked to sexual risk behaviour among young people in Sub-Saharan Africa. Socioeconomic inequalities, levels of globalization, as well as rural–urban disparities in access to media, underscore the need to deliver tailored and targeted sexual risk reduction interventions to young people using both traditional and new media. Plain language summary: In addition to television, radio, magazines, and newspapers, young people in Sub-Saharan Africa are increasingly using their phones and the Internet to connect with their peers. However, these media sources can lead to sexual risk behaviour because of access to inappropriate and inaccurate information. Social environmental factors in Sub-Saharan Africa, such as gender, place of residence, and socio-economic status influence young people's access to and use of these media sources. However, many studies that consider the influence of these social factors on the use of media among young people evaluate each of them and fail to consider that these social forces jointly influence young people's access to the internet, and ability to own phones, watch television, or read newspapers. Our study considered these combined social factors and their influence on the link between the use of media and sexual risk behaviour among young people. We found that considering these social environmental factors reduced the association between media use and young people's sexual risk behaviour but those who did not have access to these media sources were more likely to use unreliable methods to prevent pregnancy or sexually transmitted diseases. Those who listened to the radio, or read newspapers and magazines were more likely to give or receive cash or other gifts in exchange for sex. In contrast, young people who never owned phones or lacked access to the internet were less likely to have had multiple sexual partners. Our findings stress the need to consider social contexts and media use in promoting young people's sexual health. [ABSTRACT FROM AUTHOR]

Background: The United Nations' 95-95-95 (95% of people with HIV being aware of their diagnosis, 95% of those aware of their diagnosis being on treatment and 95% achieving viral suppression) target aims to reduce morbidity and mortality of HIV. However, with 60% of new HIV infections occurring in sub-Saharan Africa (SSA), achieving this target in the region is challenging. Viral load (VL) monitoring is the gold-standard approach of assessing treatment efficacy, and its implementation into national health systems is a global health priority if elimination of HIV as a public health threat is to be achieved by 2030. This systematic review aims to investigate VL monitoring outcomes in SSA, and to identify gaps and possible interventions to help nations meet their 2030 targets. Methods: A literature search of three electronic platforms (MEDLINE, EMBASE and Global Health) was undertaken from 1 January to 9 August 2024 to identify studies published in English and conducted in SSA. The primary outcome was the proportion of people living with HIV (PLHIV) on antiretroviral therapy (ART) with routine VL monitoring at the recommended time points (initially, 6 months, 12 months and annually). Secondary outcomes reported proportions of PLHIV who received routine VL monitoring who went on to complete the cascade of care after identified virological failure [enhanced adherence counselling (EAC), switch to second-line ART, and finally viral suppression]. Results: The initial search identified 342 papers, of which 35 studies were included for narrative synthesis. Included studies reported on findings from 14 African countries and demonstrated extensive variation in rates of VL monitoring (range: 24.3-99.7%, mean: 63.8%). Results were more unfavourable in the latter steps of the viral load monitoring cascade, with a range of 0-88%, and a switch to second-line ART mean of 42% (range: 4.4-93%). Studies with additional support, and those with community-based models of care, had higher rates of VL testing and viral suppression. Conclusions: VL monitoring and management of virological failure are suboptimal in many SSA countries due to individual and health system-related challenges. Health system strengthening is vital to ensure the sustainability of HIV treatment programmes and the achievement of 95-95-95 targets by 2030. [ABSTRACT FROM AUTHOR]

Background: Neonatal jaundice is a leading cause of death and disability among newborns in sub-Saharan Africa, due in large part to late identification of an otherwise treatable illness. The burden of NNJ recognition and care-seeking falls on infant caretakers and community health workers (CHWs), who are in charge of both maternal education and neonatal home visits. Objective: This study sought to understand community health workers' (CHW) knowledge and perceptions of community beliefs surrounding neonatal jaundice (NNJ), a treatable but potentially fatal condition prevalent in sub-Saharan Africa. Methods: In this cross-sectional qualitative study, CHWs in Kumasi, Ghana, completed in-depth interviews with trained research assistants using a semi-structured interview guide. Interviews were audiotaped, transcribed verbatim, and analyzed using grounded theory methodology. Results: Knowledge of NNJ varied widely among the 23 respondents: 74% knew NNJ could cause death, 57% knew how to screen for NNJ. 35% of CHWs favored home treatment (sunlight therapy or watchful waiting). Three main themes emerged: CHWs perceived that caregivers prefer home treatment, equating hospital care with death; sunlight and herbs are the most common home treatments; and caregivers attribute NNJ to supernatural causes, delaying jaundice diagnosis. Conclusion: Incomplete understanding of NNJ among trained CHWs and local communities will require improved education among both groups to improve outcomes. [ABSTRACT FROM AUTHOR]

Background: mHealth has increasingly been touted as having the potential to help Sub-Saharan Africa achieve their health-related sustainable development goals by reducing maternal mortality rates. Such interventions are implemented as one-way or two-way systems where maternal clients receive pregnancy related information via SMS. While such technologies often view the users (the maternal health client) as having agency to adopt, we know from pregnancy literature that the pregnancy experience in Africa and other developing countries is often more collective. In addition to the maternal health client, other members of the community have high stakes in the pregnancy, and this often affects maternal healthcare-seeking behavior. Objective: The aim of this paper, therefore, is to understand the pathways through which these other members of the community affect mHealth use. Methods: The study used a qualitative approach and a case study research design. We analyzed two mHealth cases from Kenya and Malawi. In the Kenyan case, maternal health clients had mobile phones to receive pregnancy-related messages, while in the Malawi case, maternal health clients did not have mobile phones. Data were collected through interviews and focus group discussions. The study used an inductive thematic analysis to analyze the data. Results: The findings show that maternal stakeholders form a community of purpose (CoP) that plays a crucial role in the implementation, uptake, and use of mHealth. The CoP influences maternal health clients through a diverse range of mechanisms ranging from sensitization, bridging the digital literacy gap and legitimization of the intervention. The nature of influence is largely dependent on the contextual socio-cultural nuances. Conclusion: Our results provide useful insights to mHealth implementers to know how best to leverage the CoP for better mHealth uptake and usage. For example, engaging healthcare providers could champion adoption and use, while engaging other family-related stakeholders will ensure better usage and compliance, encourage behavior change, and reduce mHealth attrition. [ABSTRACT FROM AUTHOR]

This study investigates the spatial effects of armed conflict on Sub-Saharan Africa's (SSA) economic growth, focusing on Central Africa, East Africa, and West Africa. Utilizing Spatial Durblin Model (SDM), the analysis reveals significant spatial effects of armed conflict intensity, indicating that conflict in neighboring countries influences conflict levels within a focal country. The study finds a weak or inconclusive relationship between GDP per capita (GDPpc) and conflict intensity, with East Africa showing a significant negative association, suggesting that higher economic prosperity in neighboring countries may mitigate conflict. Conversely, higher corruption levels in Central and West Africa are positively associated with increased conflict intensity, highlighting corruption's destabilizing influence. Spatial lag SDM results suggest potential benefits of regional economic cooperation in reducing conflict intensity. Moreover, significant positive spatial autocorrelation underscores the interconnected nature of conflict within SSA, with West Africa exhibiting more pronounced spatial spillover effect. Findings from Spatial Autoregressive (SAR) models confirm the weak association between GDPpc and conflict intensity but emphasize the consistent positive association between corruption and conflict intensity. Additionally, the Spatial Error Model (SEM) reaffirms corruption's detrimental impact on governance and stability. Additionally, the hypothesis of a significant difference in the effect of armed conflict across different SSA subregions is supported, with Central Africa experiencing the strongest negative impact on economic growth, followed by East and West Africa. The study highlights substantial regional heterogeneity in the economic consequences of armed conflict, emphasizing the need for regionally tailored policy interventions to address conflict-related economic disruptions in SSA. [ABSTRACT FROM AUTHOR]