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Heavy alcohol use (HAU) can destabilize engagement along the HIV care continuum. Population-based studies assessing associations of HAU with HIV treatment outcomes are lacking, especially in sub-Saharan Africa. We leveraged data from the Kenya Population-based HIV Impact Assessment to identify associations of self-reported HAU, assessed using two items measuring the frequency and quantity of past-year alcohol consumption, with serum biomarkers for HIV serostatus unawareness, antiretroviral therapy (ART) non-use, and HIV viremia (≥1000 RNA copies/mL). Overall and sex-stratified survey-weighted logistic regression with jackknife variance estimation modeled adjusted odds ratios (adjOR) of HIV treatment indicators by HAU. Overall, 1491 persons living with HIV aged 15–64 years (68.4% female) were included. The prevalence of HAU was 8.9% (95% confidence interval [95%CI]: 6.8–11.0%) and was significantly more pronounced in males than females (19.6% vs. 4.0%, p < 0.001). In multivariable analysis, HAU was significantly (p < 0.001) associated with HIV serostatus unawareness (adjOR = 3.65, 95%CI: 2.14–6.23), ART non-use (adjOR = 3.81, 95%CI: 2.25–6.43), and HIV viremia (adjOR = 3.13, 95%CI: 1.85–5.32). Incorporating sex-specific alcohol use screening into HIV testing and treatment services in populations where HAU is prevalent could optimize clinical outcomes along the HIV care continuum. [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]

• What is the primary question addressed by this study? To what extent do activity limitation and emotional distress serially mediate the association between pain characteristics and sleep quality among older adults? • What is the main finding of this study? Pain characteristics (i.e., pain intensity and pain interference) were significantly associated with increased sleep problems among older adults in the sub-Saharan African context, where research on this topic is largely neglected. Most importantly, the association was significantly and serially mediated by activity limitation and emotional distress. • What is the meaning of the finding? Older adults with pains may be at greater risk of sleep problems, underscoring the need for conscious policy and public health interventions to manage pain-induced sleep problems in later life effectively. Indeed, before intervening in pain-induced sleep problems in old age, clinicians should screen for functional status and emotional distress. Pain is increasingly becoming common among middle-aged and older adults. While research on the association between pain characteristics and sleep problems (SP) is limited in low- and middle-income countries, the underlying mechanisms of the association are poorly understood. This study examines the association of bodily pain intensity and pain interference with SP and investigates the mediating role of activity limitation and emotional distress in this association. We analyzed population-based data, including 1,201 individuals aged ≥50 (mean [SD] age 66.14 [11.85] years) from the 2016–2018 AgeHeaPsyWel-HeaSeeB study in Ghana. Multiple OLS regressions and serial multiple mediation modeling using bootstrapping analyses examined direct and indirect effects from pain to SP through activity limitation and emotional distress. Regressions demonstrated that pain intensity and interference were significantly associated with higher levels of activity limitation, emotional distress, and SP (range: β = 0.049–0.658). Bootstrapping analysis showed that activity limitation and emotional distress serially mediated the relationship between pain intensity and SP (total effect: β = 0.264, Bootstrap 95% confidence interval [CI] = 0.165–0.362; direct effect: (β = 0.107, Bootstrap 95% CI = 0.005–0.210; total indirect effect: β = 0.156, Bootstrap 95% CI = 0.005–0.210) accounting for ∼59%. Activity limitation and emotional distress mediated pain interference and SP association (total effect: β = 0.404, Bootstrap 95% CI = 0.318–0.490; direct effect: β = 0.292, Bootstrap 95% CI = 0.201–0.384; and total indirect effect: β = 0.112, Bootstrap 95% CI = 0.069–0.156) yielding ∼28%. Our data suggest that activity limitation and emotional distress may convey stress-related risks of pain on SP. Future research should evaluate if activity limitation and emotional distress could be effective targets to reduce the effect of pain on sleep in later-life. [ABSTRACT FROM AUTHOR]

Antiretroviral therapy roll-out has dramatically reduced HIV-related mortality; more women are living to reach menopause. Menopausal estrogen loss causes bone loss, as does HIV and some of its treatments. However, data describing HIV's impact on osteoporosis prevalence and fracture risk are scarce in southern Africa. A cross-sectional study of women aged 40-60 years (49% women with HIV [WLH]) was conducted in Harare, Zimbabwe. Menopause, fracture, and HIV history were collected, and anthropometry and BMD (by DXA) measured, and FRAX 10-year fracture probabilities quantified. The FRAX probability of a major osteoporotic fracture (MOF) included HIV as a risk factor for secondary osteoporosis. Linear and Poisson regression determined the relationships between clinical risk factors and both femoral neck (FN) BMD and the 10-year FRAX probability of MOF respectively. The 393 participants had a mean (SD) age of 49.6 (5.8) years and mean (SD) BMI of 29.1 (6.0) kg/m2. 95% of WLH were antiretroviral therapy (ART) established (85% tenofovir disoproxil fumarate) and 81% had a viral load <50 copies/mL. A BMD T-score ≤ –2.5 was more common in WLH than those without, at both FN and lumbar spine (LS) (FN, 22 [11.4%] vs 5 [2.5%]; LS, 40 [20.8%] vs 9 [4.5%], respectively). Prior fracture was more prevalent in WLH: any fracture type (27 [14%] vs 14 [7%]); MOF (14 [7.3%] vs 5 [2.5%]). WLH had a higher 10-year MOF probability (median, 1.2%; IQR, 0.9-1.8) compared with those without HIV (1.0%; IQR, 0.9-1.5) (p <.001), although probabilities were low. Older age, low weight, and HIV infection were strongly associated with lower FN BMD. Higher probability of MOF was associated with older age, HIV infection, parental hip fracture and prior fracture, although adjustment attenuated the association with HIV. No woman reported anti-osteoporosis medication use. While osteoporosis and previous fractures were common and untreated in this relatively young population, particularly in WLH, the FRAX-predicted 10-year MOF risk was low. Clinical risk factors considered in fracture risk prediction tools in Zimbabwe may need contextual modification. Lay Summary: Improved access to treatment for HIV now means women with HIV are able to live well into older adulthood; however, this puts them at risk of age-related diseases, such as osteoporosis. HIV and some of its treatments are known to cause bone loss, as does menopause, but studies on osteoporosis and fracture risk are scarce in southern Africa, where most people with HIV live. In this study in Zimbabwe, we found women with HIV were more likely to have osteoporosis and to have had a fracture, and a higher risk of having a major osteoporotic fracture over the next 10 years, compared with women without HIV (calculated using FRAX, a fracture risk prediction tool), although the risk was surprisingly low. Older age, being underweight, and having HIV were strongly related to lower bone density at hip (an important site for fractures). Higher risk of future fracture was associated with older age, previous fracture, having HIV, and having a parent who had a hip fracture. Despite these findings, no woman had ever been offered any anti-osteoporosis medication. Our findings suggest that osteoporosis is underrecognized and undertreated in Zimbabwe, where clinical fracture risk prediction tools need to be modified for the specific context. [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]

Whether bank competition promotes access to finance is highly debated in economic literature and policy circles. Amidst this debate, this paper investigates the implications of bank competition, financial stability, and gender gap on access to finance for 40 Sub‐Saharan African countries using 12,504 firm‐level observations from the World Bank Enterprise Survey. In addition to structural measures, competition has been measured by three non‐structural measures (Lerner index, Boone indicator, and Panzar‐Rosse H‐statistic). Results obtained through the probit model and probit model with sample selection (PSS) suggest that a higher degree of bank competition positively affects firm's credit availability in the Sub‐Saharan African region. Results also indicate that firms owned by female entrepreneurs are more likely to report greater difficulties in obtaining formal finance. The findings suggest that policymakers and other stakeholders should direct policy actions that promote competition in the credit market by reducing the cost of credit. [ABSTRACT FROM AUTHOR]

Over the last two decades, scientific studies have increasingly highlighted the vulnerability of cities to global changes, especially in sub-Saharan Africa, where climate phenomena and urbanization are intensifying. These realities necessitate a reassessment of current urban management models in order to reaffirm the central role of cities in promoting sustainability. In this context, establishing a robust scientific foundation for evaluating the transition processes of cities towards sustainability is essential. This article presents a methodology developed to select and validate indicators, taking into account local issues and the needs expressed by stakeholders. The research was conducted using a mixed-methods approach, which included a literature review, consultations with populations from five study districts, analysis of the indicator needs of development stakeholders, adoption of two methods, and validation of the indicators by a group of experts. The outcome of this research is a set of 20 indicators organized into five dimensions: environmental, social, economic, built environment, and cultural. The analysis of the proportional distribution of these indicators across dimensions reveals a notable predominance of the social dimension, which accounts for 35% of the indicators, including key indicators such as access to potable water, electricity, education, and healthcare services, inter alia. The environmental and built environment dimensions each comprise 20% of the indicators, encompassing indicators such as the preservation of natural resources, waste management, land use management, and flood management, among others. The economic and cultural dimensions represent 15% and 10% of the selected indicators, respectively. These data indicate that achieving sustainable urban development within the context of this study requires a focused effort on enhancing the performance of these indicators, with substantial efforts needed in the social domain. It is of paramount importance to incorporate these indicators into the decision-making processes related to urban development planning in Moundou and other cities in the region, as they provide valuable scientific insights crucial to the pursuit of sustainability. [ABSTRACT FROM AUTHOR]

The expansion of cities in Sub-Saharan Africa has led to an increase in impervious surfaces, intensifying stormwater management challenges, especially in informal settlements situated in ecologically sensitive areas like wetlands. This urban growth has heightened flood risks and negatively impacted biodiversity, water quality, and socio-economic conditions, particularly during extreme weather events intensified by climate change. Nature-Based Solutions (NbSs), including Sustainable Urban Drainage Systems (SUDSs), offer sustainable strategies for managing stormwater and mitigating these adverse effects. However, the success of such solutions relies not only on their technical implementation but also on the social and institutional contexts within urban communities. Community-level governance is crucial in integrating NbSs into urban stormwater management frameworks. This research evaluates how community governance of NbSs, specifically SUDSs, can enhance stormwater management and flood resilience in Kampala, Uganda. Using an assessment framework grounded in the Policy Arrangement Approach (PAA)—which considers discourses, actors, resources, and rules of engagement—this study incorporates structural, social, and political factors that influence SUDS community governance performance. Concentrating on the Sembule zones within the Nalukolongo catchment area, this research investigates the impact of community governance dynamics on SUDS implementation. This study examines key aspects such as community engagement, resource management, and regulatory frameworks to assess the effectiveness of these initiatives, providing valuable insights for advancing nature-based urban stormwater management. [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]

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]

The paper investigates whether public debt explains income inequality in several Sub-Saharan African (SSA) countries. The core method employed is the Bayesian Model Averaging (BMA) estimator, which uses a dataset covering the period 1997–2019. The key findings reveal that public debt tends to reduce inequality among the poor but may harm the rich in the WAEMU region. Public debt generally has a neutral impact on inequality in EMCCA but can improve income distribution among the rich under stringent corruption control. In terms of contributions, the paper is one of the first works that examine how public debt impacts inequality in the Sub-Saharan African (SSA) countries across different levels of income. Moreover, it explores the intricate relationship among public debt, socio-economic characteristics, corruption, and inequality within the region. [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: A central challenge to closing the mental health treatment gap in low- and middle-income countries (LMICs) is determining the most effective pathway for delivering evidence-based mental health services. We are conducting a cluster-randomized, Type 2 hybrid implementation-effectiveness trial across 20 districts of Mozambique called the Partnerships in Research to Implement and Disseminate Sustainable and Scalable EBPs (PRIDE) program. Following training of nonspecialized providers in facilitation of evidence-based treatments for mental health and informed by the Consolidated Framework for Implementation Research (CFIR), we identified how PRIDE compares to care as usual and the perceived barriers and facilitators of implementation and modifications needed for widescale service delivery and scale-up. Methods: We conducted rapid ethnographic assessment using freelisting among 34 providers, followed by four focus group discussions (n = 29 participants) with a subsample of psychiatric technicians and primary care providers from 14 districts in Nampula Province. We used Thematic Analysis to inductively apply open codes to transcripts and then deductively applied the CFIR domains and constructs to organize open codes. Results: The main Outer Setting constructs relevant to implementation were recognition that patient mental health needs were significant. Additionally, numerous community-level characteristics were identified as barriers, including distance between clinics; shortage of providers; and low awareness of mental health problems, stigma, and discrimination among community members towards those with mental health struggles. The PRIDE program was perceived to offer a relative advantage over usual care because of its use of task-sharing and treating mental illness in the community. PRIDE addressed Inner Setting barriers of having available resources and training and provider low self-efficacy and limited knowledge of mental illness. Providers recommended leadership engagement to give support for supervision of other task-shared professionals delivering mental healthcare. Conclusions: Primary care providers and psychiatric technicians in Mozambique perceived the relative advantage of the PRIDE program to address mental health treatment access barriers and offered recommendations for successful sustainment and scale up of integrated mental health care. [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]

Background: People living with HIV (PLWH) are at risk of kidney function impairment due to HIV-related inflammation, antiretroviral therapy (ART), diabetes mellitus, and hypertension. Older persons may experience a higher burden of chronic kidney disease (CKD) as kidney function declines with increasing age. There is a paucity of data comparing the prevalence of kidney function impairment in older PLWH to that in people without HIV in sub-Saharan Africa. Methods: We conducted a cross-sectional study among people aged ≥ 60 years living with and without HIV in Kampala, Uganda who were matched 1:1 by community location. We collected data on sociodemographics, comorbidities, and HIV-related clinical characteristics. We defined kidney function impairment as an estimated glomerular filtration rate(eGFR) < 60mls/min/1.73m2 with or without proteinuria. We constructed multivariable logistic regression models to study associations between participant characteristics and kidney function impairment. Results: We enrolled 278 people (median age 66 years); 50% were PLWH, and 51.8% were female. Among PLWH, 33.1% (95% CI: 25.7-41.4%) had kidney function impairment versus 12.9% (95% CI: 8.3-19.7%) among people without HIV, (p-value < 0.01). The prevalence of proteinuria among PLWH versus people without HIV was 43.9% (95% CI:35.8-52.3%) versus 19.4% (95% CI:13.6-26.9%) p-value < 0.01. Living with HIV (OR = 3.89(95% CI: 2.04–7.41), p-value < 0.01), older age (OR = 1.13, (95% CI:1.07–1.20), p-value < 0.01), female sex (OR = 1.95, (95% CI:1.06–3.62), p-value = 0.03) and a prior diagnosis of hypertension (OR = 2.19(95% CI:1.02–4.67), p-value = 0.04) were significantly associated with kidney function impairment. Conclusions: HIV infection is strongly associated with kidney function impairment among older PLWH. Prioritizing routine measurements of kidney function and proteinuria in older PLWH will enable early detection and institution of measures to reduce the progression of kidney disease. [ABSTRACT FROM AUTHOR]

Income disparity between females and males in the Global South continues to grow, especially in Africa South of the Sahara (SSA). In this current study, we have analyzed the effect of engagement in agriculture by women on income disparity in SSA. Data between 1991 and 2018 from two main sources were used for the analyses of the study. The sources of the data were the Global Development Index and Standard World Income Inequality Database databases. To analyze the results, we employed the two‐stage least squares and pooled ordinary least squares estimation methods. From the analyses of the results, we found that women's engagement in agriculture (WOMENAP) reduced inequalities in income distribution in Africa. WOMENAP lowered the disparity in Southern and Western Africa but worsened it in Central and Eastern Africa. The study concluded that women's involvement in agriculture reduced income inequality (InE). Specifically, women who work in agriculture are able to contribute to reducing InE in southern and western parts of Africa. However, WOMANAP exacerbated InE in the eastern and central parts of Africa. The study, therefore, recommended maintaining gender balance in agriculture to close the existing economic gap. [ABSTRACT FROM AUTHOR]

Background: The use of substances such as alcohol, tobacco, khat, or drugs among young people is becoming a public health concern globally, with particularly high prevalence rates in low and middle-income settings, where socio-cultural and economic factors contribute to distinct challenges in addressing this problem. This review aimed to summarize the current literature on the prevalence of substance use among young people in sub-Saharan Africa (SSA) and identify gaps in the current body of literature. Methods: Seven databases and Google were searched for studies reporting on substance use prevalence among young people (aged 10-24 years) in SSA, published between January 2010 and May 2024. Observational studies were included, assessed for methodological quality, and checked for the presence of heterogeneity and publication bias using standard methods. A random effect model was used to estimate the pooled proportions for substance use among young people. Results: The literature search identified 1,889 hits from the databases and Google. Among these 60 eligible studies involving 83,859 respondents were included in the review. The overall lifetime, 12-month, and current prevalence of any substance use among young people in SSA was found to be 21.0% (95% CI= 18.0, 24.0), 18% (95% CI=10,27), and 15% (95% CI=12,18), respectively. Among young people from SSA, alcohol use problem was the most prevalent (40%), followed by khat use (25%), stimulant use (20%), and cigarette smoking (16%). Other substances used by a smaller proportion of young people included cannabis, cocaine, inhalants, sedatives, shisha, hallucinogens, steroids, and mastics. The prevalence of substance use problems was higher among males compared to females, highest in the southern African region followed byWestern and Eastern regions, and in community-based studies compared to institutional- based studies. Conclusions: In SSA, over a fourth of young people use at least one substance in their lifetime, with higher rates among males than females and in community-based compared to institution-based studies. These results emphasize the need for interventions targeting the wider young population and those in specific subgroups identified as being at higher risk of substance use. This approach allows for the provision of tailored support and resources to those who need it most while also promoting positive health outcomes for the entire population of young people in the region. [ABSTRACT FROM AUTHOR]

Sharing large digital-first datasets, including for purposes for which they were not originally intended, is a hallmark of the “big data revolution”. Through their routine operations, private commercial companies collect massive amounts of diverse data from their customers, some of which may interest those working in the public sector, such as health researchers. Researchers and government agencies worldwide have been increasingly using data from commercial entities (such as Google, Microsoft, Apple, Facebook/Meta, Twitter/X and Amazon, among others) to generate health-related insights. This article explores ethical issues raised by the practice of commercial companies sharing consumer data with third parties for the purposes of promoting health in the sub-Saharan African (SSA) context. First, as an illustrative example, it examines some of the ways telecommunication (telecom) companies in SSA shared mobility data from cellphone users with public health researchers during the COVID-19 pandemic. Second, it examines a recent debate about the ethical responsibilities of companies that collect, process and share user-generated data, drawing implications for the SSA context. Finally, since this is a relatively understudied subject, we point out some areas where future conceptual and empirical work could contribute to the development of relevant ethics guidance and regulatory governance in SSA. [ABSTRACT FROM AUTHOR]

Introduction: Ensuring young people receive adequate information and guidance about puberty is essential for healthy adolescent transitions. Although many countries are moving toward including comprehensive sexuality education in national curricula, content on puberty during early adolescence, including peer pressure and stigma related to physical and emotional changes, are rarely included. Limited evidence exists about the inclusion of puberty education in schools, and the role of teachers in delivering such content in low-and middleincome countries, including Sierra Leone. Methods: We conducted a qualitative assessment using multiple methodologies (in-depth interviews with teachers; focus group discussions with girls and boys; key informant interviews with teacher training lecturers and government) to explore the feasibility and acceptability of a puberty education package (a teacher training guide and boys' and girls' puberty books) for primary school teachers to introduce puberty content in Sierra Leone. Results: Three key themes were identified, including the importance of teacher comfort in discussing puberty, the value of the teacher's guide for delivering puberty content, and system and resource constraints that impact the implementation of puberty education. Additional insights included how integrating puberty education into existing curriculum courses may be more effective than stand-alone puberty classes; education systems can enable in-service and pre-service teacher training, along with culturally appropriate puberty resources, to increase effective puberty education delivery in schools; and governments serve a key role in providing puberty education teacher training, ensuring sustainable funding to retain trained teachers, and offering guidance on national curriculum requirements on puberty education. Discussion: There is a strong need to integrate puberty education into formal educational systems, with well trained teachers serving a valuable role in its delivery. Research is needed on how best to scale sustainable teacher training interventions to support the delivery of puberty education to adolescents in low- and middle-income contexts. [ABSTRACT FROM AUTHOR]

Introduction: Household water treatment practices, also known as point-of-use water management, offer means to enhance the overall drinking water quality and reduce the prevalence of diarrheal diseases. Nevertheless, there is a scarcity of information on household water treatment practices and related factors in sub-Saharan Africa. Objective: This study aimed to determine the pooled prevalence of water treatment practices and associated factors in sub-Saharan Africa. Methods: We conducted a search of eligible primary studies in PubMed, Google Scholar, and Hinari, as well as gray literature available in online repositories. The Stata v.17 software was utilized to extract and analyze the data obtained from these studies. To determine the overall pooled prevalence of water treatment practices and their predictors, a weighted inverse-variance random-effects model was employed. We assessed variations across the included studies using forest plots, funnel plots, I 2 statistics, and Egger's tests. Results: In this study, we reviewed a total of 927 articles, 28 of which were eligible for inclusion. The overall pooled prevalence of water treatment practices in sub-Saharan Africa was 36.31(95% CI: 27.64, 44.98). The factors associated with water treatment practices included having formal education (AOR: 2.38, 95% CI: 1.70, 3.34), being male (AOR: 1.78, 95% CI: 1.39, 2.29), having a higher income (AOR: 2.12, 95% CI: 1.39, 3.25), and having received training in water treatment (AOR: 2.25, 95% CI: 1.59, 3.18). Conclusions: In this review, the pooled prevalence of water treatment practices in sub-Saharan Africa was found to be considerably low. Therefore, we recommend that household heads receive enhanced information on water treatment practices through strengthened health education and intensive training in small-scale water treatment practices. [ABSTRACT FROM AUTHOR]

Background Tenofovir/lamivudine/dolutegravir (TLD) is the preferred first-line antiretroviral therapy (ART) regimen for people with HIV (PWH), including those who were previously virologically suppressed on nonnucleoside reverse transcriptase inhibitors (NNRTIs). We sought to estimate the real-world effectiveness of the TLD transition in Ugandan public-sector clinics. Methods We conducted a prospective cohort study of PWH aged ≥18 years who were transitioned from NNRTI-based ART to TLD. Study visits were conducted on the day of TLD transition and 24 and 48 weeks later. The primary end point was viral suppression (<200 copies/mL) at 48 weeks. We collected blood for retrospective viral load (VL) assessment and conducted genotypic resistance tests for specimens with VL >500 copies/mL. Results We enrolled 500 participants (median age 47 years; 41% women). At 48 weeks after TLD transition, 94% of participants were in care with a VL <200 copies/mL (n = 469/500); 2% (n = 11/500) were lost from care or died; and only 2% (n = 9/500) had a VL >500 copies/mL. No incident resistance to DTG was identified. Few participants (2%, n = 9/500) discontinued TLD due to adverse events. Conclusions High rates of viral suppression, high tolerability, and lack of emergent drug resistance support use of TLD as the preferred first-line regimen in the region. Clinical Trials Registration NCT04066036. [ABSTRACT FROM AUTHOR]

Background: Understanding the aetiological organisms causing maternal infections is crucial to inform antibiotic treatment guidelines, but such data are scarce from Sub-Saharan Africa (SSA). We performed this systematic review and meta-analysis to address this gap. Methods: Microbiologically confirmed maternal infection data were collected from PubMed, Embase, and African Journals online databases. The search strategy combined terms related to bacterial infection, pregnancy, postnatal period, observational studies, SSA. Exclusion criteria included colonization, asymptomatic infection, and screening studies. Pooled proportions for bacterial isolates and antimicrobial resistance (AMR) were calculated. Quality and completeness of reporting were assessed using the Newcastle–Ottawa and STROBE checklists. Findings: We included 14 papers comprising data from 2,575 women from four sources (blood, urine, surgical wound and endocervical). Mixed-growth was commonly reported at 17% (95% CI: 12%-23%), E. coli from 11%(CI:10%-12%), S. aureus from 5%(CI: 5%-6%), Klebsiella spp. at 5%(CI: 4%- 5%) and Streptococcus spp. at 2%(CI: 1%-2%). We observed intra-sample and inter-sample heterogeneity between 88–92% in all meta-analyses. AMR rates were between 19% -77%, the highest with first-line beta-lactam antibiotics. Convenience sampling, and limited reporting of laboratory techniques were areas of concern. Interpretation: We provide a comprehensive summary of microbial aetiology of maternal infections in SSA and demonstrate the paucity of data available for this region. We flag the need to review the current local and international empirical treatment guidelines for maternal bacterial infections in SSA because there is high prevalence of AMR among common causative bacteria. Funding: This research was supported by the NIHR-Professorship/NIHR300808 and the Wellcome-Strategic-award /206545/Z/17/Z. Trial registration: Prospero ID CRD42021238515. [ABSTRACT FROM AUTHOR]

If properly used, condoms can serve as an effective family planning method and preventive tool towards sexually transmitted diseases (STDs). Despite its anticipated effectiveness, there are different myths and misconceptions which have been observed as hindrances to both its use and effectiveness. This review examines the myths and misconceptions of condom use among youths and explores challenges in condom usage in sub‐Saharan Africa (SSA). A narrative review was employed of which different journal articles were reviewed. The search words/phrases were "condom use in SSA, condom use among youths in SSA, myths and misconceptions on condom use among youths in SSA." A total of 1074 studies were identified, 93 were relevant to the topic, and only 71 suited the review. The identified myths and misconceptions of condom use include that males were the ones to decide on the use of condoms during sexual intercourse, economic power determines the use of condoms, condom use reduces sexual pleasure, condom use relates to the spread of HIV/AIDS, and condom use is against God's will. Other identified myths and misconceptions of condom use include that the use of condoms is a sign of lack of trust associated with fornication and adultery, also the use of condoms is only for family planning purposes. The challenges identified were breakage of condom during sexual intercourse, condom slippage, condom leakage, incorrect storage, and reuse of condoms. The identified myths and misconceptions lead to low knowledge of condom use within communities. There is a need for collaboration between governments, researchers, and NGOs to provide education on condom use to communities, particularly youths. [ABSTRACT FROM AUTHOR]

This paper deconstructs everyday mobility practices from a perspective of accessibility and social and transport (dis)advantage in two capital port cities in sub-Saharan Africa (SSA) – Freetown, Sierra Leone and Maputo, Mozambique. The paper proposes a novel framework that interprets social and transport (dis)advantage conditions as critical drivers of mobility behaviours and the resulting (in)accessibility that circumscribes individuals’ experience. Building on its framework, the paper raises unique empirical qualitative evidence from eight neighbourhoods about mobility practices across populations facing different degrees of social and transport (dis)advantage. The study’s design is grounded in the in-depth understanding of accessibility using qualitative methods as a counterpoint to predominant quantitative and spatial approaches, filling critical data gaps in cities in SSA. The findings reveal a deep-seated aspiration for car ownership, tempered by the urgency of other immediate material needs, as well as the dynamic nature of travel behaviour due to changing conditions during the day and throughout the year. The findings also indicate informality plays a significant role in enabling access to critical opportunities and the need to strengthen trust in popular transport systems. [ABSTRACT FROM AUTHOR]

Background: Uterine fibroids, or Leiomyoma is a type of Smooth Muscle Tumors of the uterus (SMTs) and are common in the black race. Giant uterine fibroids, on the other hand, are uncommon and may occur during patient dissimulation. Dissimulation may occur because of a dread of surgery and hospitals visits, fear of surgical death, chronic intake of herbal concussion, and a religio-traditional strong belief system on instant healing following prayers, among others. Myths like belief of defecating the uterine fibroids, some herbs that can melt them away, and the belief that such illness may follow ancestral curses can fuel dissimulation. The surgical approach can be a source of challenge, careful case selection considering the size and number of tumors can be helpful. Case report: We present a 35-year-old nulligravida who presented to the clinic with a 14-year history of progressive abdominal swelling. Examination revealed a firm mass with a symphysio-fundal height of 55 cm. She subsequently had an open abdominal myomectomy with all the myoma nodules weighing 12.9 kg in total! Histology confirmed uterine fibroid. Conclusion: It is possible to offer open myomectomy in patients with giant uterine fibroid following careful patient selection with a consent for possible hysterectomy. Dissimulation can be minimized with repetitive counseling of patients. The choice of surgery depends on the size and number of uterine fibroids, but surgical approach does not necessarily influence fecundity. [ABSTRACT FROM AUTHOR]

Introduction: Cancers are amajor cause of childhood mortality worldwide especially in LMICs where underdiagnoses and lack of quality cancer data hampers effective cancer control efforts. This study aimed to document and describe the patterns and characteristics of childhood cancers in the North East geopolitical zone of Nigeria. Methods: This was a retrospective cross-sectional study that collected cancer data from 4 out of the 6 states in the North East of Nigeria. The data included all malignancies diagnosed in children aged 0-19 years between 2019 and 2022. The age-specific incidence rates were also calculated for the individual 5-year age groups (0-4 years, 5-9 years, 10-14 years, and 15-19 years). The crude incidence rates (CIR) were calculated as the weighted averages of the respective ASRs in each age range within 0-14 years and 0-19 years respectively. The cancers were grouped according to the International Incidence of Childhood Cancers, volume 3 (IICC3). Results: Cancers in people <20 years accounted for 7.3% of all cancers diagnosed over the same period. The crude incidence rates (CIR) for cancers in children and adolescents were 20.9 per million children aged 0-19 years and 18.8 per million children aged 0-14 years respectively, while the agestandardized rates (ASR) were 1.80 and 1.63 per million person-years respectively. There was a variation in the most commonly diagnosed cancers across all age groups. However, lymphomas were the most commonly diagnosed cancers overall, while CNS tumors were overwhelmingly rare. Conclusion: Despite data limitations, this study provides useful insights into patterns of cancers in the region and will hopefully provide a basis for the strengthening of pediatric oncology care, childhood cancer control programs and population-based cancer registries. [ABSTRACT FROM AUTHOR]

A thriving literature exists about the role of financial inclusion in socio-economic development. Nevertheless, the environmental effects of financial inclusion are largely unknown in the literature, especially in sub-Saharan African countries. Therefore, this study explores the association between financial inclusion and CO2 emissions utilizing data from 23 sub-Saharan Africa for the period 2004–2019. Based on different estimation methods such as dynamic ordinary least squares (DOLS), fully modified ordinary least squares (FMOLS), canonical correlation regression (CCR), and an instrumental variable generalized-method of moment (IV-GMM), the results show that financial inclusion is responsible for a substantial increase in CO2 emissions. In addition, financial inclusion moderates economic growth, resulting in higher CO2 emissions. Alternatively, financial inclusion moderates renewable energy use to lower CO2 emissions. The outcomes also verify the presence of the Environmental Kuznets Curve hypothesis (EKC). This study proposes uniting financial inclusion and environmental policies as a strategy for reducing CO2 emissions in sub-Saharan Africa. [ABSTRACT FROM AUTHOR]

AbstractPurposeMaterials and methodsResultsConclusion\nIMPLICATIONS FOR REHABILITATIONTo investigate the psychometric properties of the MOSE-Benin, a French-language version of the Measure of Stroke Environment (MOSE) for Sub-Saharan Africa.The original English version of the MOSE has been translated into French following the guidelines for cross-cultural adaptation. The resulting questionnaire (MOSE-Benin) was administered to a convenience sample of participants recruited in Benin, a French-speaking country.Eighty-two stroke survivors (41 females; mean ± SD: 54.94 ± 11.6 years old) participated in the study. Internal consistency of each domain of the MOSE-Benin and the overall questionnaire was high (Cronbach’s α: 0.78 to 0.92). Test-retest reliability was excellent (n = 31; ICC: 0.977 to 0.998). Overall, the standard error of measurement (SEM) and the minimum detectable change (MDC) showed very low values (SEM = 0.85; MDC = 2.35). Convergent validity demonstrated moderate correlations for the three domains in separate comparison respectively with the ACTIVLIM-Stroke questionnaire, the Participation Measurement Scale, and the communication domain of the Stroke Impact Scale (r or ρ: 0.42 to 0.54; p < 0.0001).MOSE-Benin has good evidence regarding psychometric properties (i.e., content validity, convergent validity, internal consistency, and test-retest reliability) that can support its use for the assessment of perceived environmental barriers after stroke in a French-speaking Sub-Saharan African country, such as Benin.Stroke survivors in French-speaking Sub-Saharan Africa may face environmental challenges related to acceptability, physical environment, and communication.Stroke survivors should be assessed in their communities to identify environmental barriers, using valid and robust tools.A French version of the MOSE (MOSE-Benin) is now available and can be used to assess the environmental concerns faced by stroke survivors in Sub-Saharan Africa.Stroke survivors in French-speaking Sub-Saharan Africa may face environmental challenges related to acceptability, physical environment, and communication.Stroke survivors should be assessed in their communities to identify environmental barriers, using valid and robust tools.A French version of the MOSE (MOSE-Benin) is now available and can be used to assess the environmental concerns faced by stroke survivors in Sub-Saharan Africa. [ABSTRACT FROM AUTHOR]

Background: Post-discharge malaria chemoprevention (PDMC) is an intervention aimed at reducing morbidity and mortality in patients hospitalized with severe anaemia, with its effectiveness established in several clinical trials. The aim of this study was to better understand factors that would influence the scale up of this intervention, and to identify preferences for two delivery mechanisms, facility-based or community-based. Methods: Forty-six qualitative individual interviews were conducted in five sub-Saharan countries amongst malaria key opinion leaders and national decision makers. Findings were analysed following a thematic inductive approach. Results: Half of participants were familiar with PDMC, with a satisfactory understanding of the intervention. Although PDMC was perceived as beneficial by most respondents, there was some unclarity on the target population. Both delivery approaches were perceived as valuable and potentially complementary. From an adoption perspective, relevant evidence generation, favorable policy environment, and committed funding were identified as key elements for the scale up of PDMC. Conclusions: The findings suggest that although PDMC was perceived as a relevant tool to prevent malaria, further clarification was needed in terms of the relevant patient population, delivery mechanisms, and more evidence should be generated from implementation research to ensure policy adoption and funding. [ABSTRACT FROM AUTHOR]

Background: Pregnancy-related anxiety significantly impacts maternal and fetal health in low- and middle-income countries (LMICs), including those within Sub-Saharan Africa (SSA). Most studies conducted to evaluate pregnancy-related anxiety in LMICs have utilized scales developed in high-income countries, despite significant variations in pregnancy-related anxiety due to socioeconomic and cultural contexts. This review surveyed existing literature in order to identify which scales have been used to measure pregnancy-related anxiety in SSA. Methods: A systematic search was conducted in PubMed, Health and Psychosocial Instruments, and APA PsycNet for relevant studies published in the English language up to March 22, 2023. Eligible studies focused on anxiety in pregnant populations within SSA, using validated scales or tools. Screening followed PRIMSA guidelines, with blinded review at the abstract/title level and subsequent full-text review. Data was extracted and analyzed to identify trends and characteristics of the screening tools used. Results: From 271 articles, 37 met inclusion criteria, identifying 24 different tools used to measure anxiety in pregnant women in SSA. The most common tools were the Generalized Anxiety Disorder 7-item scale (seven uses), State-Trait Anxiety Inventory (five uses), and the Self-Reporting Questionnaire 20 (five uses). Seven tools were pregnancy-specific, with only two designed specifically for SSA: the Risk Factor Assessment (RFA), and the 4-Item Screening Tool. Studies were most frequently conducted in South Africa, followed by Tanzania, Ethiopia, Nigeria, and Ghana. Conclusions: This scoping review illustrates that only two tools (the RFA and 4-item Screening Tool) were created to assess pregnancy-related anxiety specifically in SSA. This highlights the need for more culturally sensitive tools tailored to the specific contexts of pregnant populations in SSA. [ABSTRACT FROM AUTHOR]

The issue of greenhouse gas emissions from foreign direct investment (FDI) continues to fuel debate in the climate change mitigation literature. Some support the pollution halo hypothesis while others emphasize on the pollution haven hypothesis. Thus, the overall objective of this research is to analyze the effect of agricultural foreign direct investment on methane emissions in Sub‐Saharan Africa. The data for the study are from several sources, mainly FAOSTAT, WDI, and Chin‐Ito Index. For econometric estimations, Dynamic Ordinary Least Squares (DOLS) model is applied to unbalanced panel data and the Fully Modified Ordinary Least Squares (FMOLS) is used for robustness check. The results indicate that increasing agricultural foreign direct investment by 1% increases methane emissions by 3.30% in Sub‐Saharan Africa, thus confirming the pollution haven hypothesis. Consequently, the move toward the Paris Agreement is proving to be delicate in an increasing agricultural FDI context. Thus, the integration of climate change mitigation strategies into the business plans of foreign agricultural investors is strongly recommended in Sub‐Saharan Africa. [ABSTRACT FROM AUTHOR]

In sub-Saharan Africa, adolescents and young adults make up 30–35% of the population. However, 14% are reported to struggle with some psychological distress. Because mental health is often stigmatized in Africa, many adolescents conceal their psychological distress, further compounding their mental health challenges. This study used the Youth Outcome Questionnaire to assess psychological distress in a group of adolescents (n = 333) in three regions in Ghana – Savannah, Central, and Greater Accra. A one-way ANOVA revealed statistically significant differences in distress based on location. The differences existed only in adolescents from Savannah and Central but not Greater Accra. Additionally, a Hotelling T2 test revealed that social isolation and depression-anxiety were statistically significantly different based on gender; there were no differences in conduct problems. Implications are proffered for clinicians and policymakers on how best to support adolescents as they transition from childhood to adulthood. [ABSTRACT FROM AUTHOR]

Background: Despite Africa's significant infectious disease burden, it is underrepresented in global vaccine clinical trials. While this trend is slowly reversing, it is important to recognize and mitigate the challenges that arise when conducting vaccine clinical trials in this environment. These challenges stem from a variety of factors peculiar to the population and may negatively impact adverse event collection and reporting if not properly addressed. Methods: As a team of clinical researchers working within the MRCG (Medical Research Council Unit The Gambia), we have conducted 12 phase 1 to 3 vaccine trials over the past 10 years. In this article, we discuss the challenges we face and the strategies we have developed to improve the collection and reporting of adverse events in low-income settings. Outcome. Healthcare-seeking behaviors in the Gambia are influenced by spiritual and cultural beliefs as well as barriers to accessing orthodox healthcare; participants in trials may resort to non-orthodox care, reducing the accuracy of reported adverse events. To address this, trial eligibility criteria prohibit self-treatment and herbal product use during trials. Instead, round-the-clock care is provided to trial participants, facilitating safety follow-up. Constraints in the healthcare system in the Gambia such as limitations in diagnostic tools limit the specificity of diagnosis when reporting adverse events. To overcome these challenges, the Medical Research Council Unit maintains a Clinical Services Department, offering medical care and diagnostic services to study participants. Sociocultural factors, including low literacy rates and social influences, impact adverse event collection. Solicited adverse events are collected during home visits on paper-based or electronic report forms. Community engagement meetings are held before each study starts to inform community stakeholders about the study and answer any questions they may have. These meetings ensure that influential members of the community understand the purpose of the study and the risks and benefits of participating in the trial. This understanding makes them more likely to support participation within their communities. Conclusion: Conducting ethical vaccine clinical trials in resource-limited settings requires strategies to accurately collect and report adverse events. Our experiences from the Gambia offer insights into adverse event collection in these settings. [ABSTRACT FROM AUTHOR]

Urban green infrastructure is critical for creating garden cities, promoting public health, environmental quality, and building resilience to climate change. While these spaces are increasingly recognised as valuable ecological and environmental assets, the state of urban green infrastructure in Sub-Saharan Africa (SSA) cities is concerning. Rapid urbanisation, weak enforcement of development controls, and informal settlements have reduced the availability of green infrastructure, which has implications on the sustainability of African cities. This paper provides a review of the state and challenges associated with urban green infrastructure in SSA, focusing on the loss of green spaces, urban planning challenges, and the need for policy and citizen action. Drawing on extensive literature (secondary data), the paper highlights the importance of integrating greeneries into the urban fabric of SSA cities to promote resilience to climate change and enhance environmental sustainability. It argues that concrete steps are needed at all levels of society - from policymakers to citizens - to ensure that SSA cities can regain their status as garden cities and promote a healthier, and more resilient ecological landscape. [ABSTRACT FROM AUTHOR]

Introduction: Cervical cancer is a prevalent cancer among women in low and middle-income countries, but it can be largely prevented through screening programs and HPV vaccination. This study aimed to determine the level of knowledge, attitudes, and practices regarding cervical cancer screening among healthcare providers in Sub-Saharan African countries. Methods: Systematic review and meta-analysis were conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines. Relevant databases including PubMed, Cochrane Library, AJOL, Google Scholar, and ScienceDirect databases were used to retrieve and search articles. The study included published and unpublished research written in English between January 2013 and May 16, 2024 for studies reporting knowledge, attitude, and practice towards cervical cancer screening among healthcare providers in Sub-Saharan Africa. This review has been registered on PROSPERO. The heterogeneity of the data was evaluated using the I² statistic. A meta-analysis was conducted using STATA 17 software, with a 95% confidence interval. The researchers also conducted publication bias and sensitivity analysis. Results: The review included 30 studies involving 7542 healthcare providers. The pooled magnitude of good knowledge status towards cervical cancer was 67.93% (95% CI: 53.36-82.50) whereas the pooled magnitude of positive attitude towards cervical cancer was 55.26% (95% CI: 34.28-76.23). The results also showed that about 49.68% (95% CI: 33.18-66.17) of healthcare providers had good knowledge status about cervical cancer screening, 66.63%(95% CI: 50.36-82.89) had a positive attitude towards it, and only 17.23% (95% CI; 6.08-28.37) had ever screened for cervical cancer. Conclusion: The overall magnitude of knowledge and attitude of healthcare providers in Sub-Saharan Africa towards cervical cancer and its screening was suboptimal. Furthermore, a low percentage of female healthcare providers in the region had undergone screening for cervical cancer. As a result, policymakers and program administrators should focus on improving the knowledge, attitude, and practices of healthcare providers to meet the global health goal of cervical cancer screening and effectively eliminating cervical cancer. Healthcare providers must serve as role models for other women who should also undergo screening. [ABSTRACT FROM AUTHOR]

High blood stress is one of the most historic threat representatives for is chaemic heart complaint, stroke, different cardiovascular conditions, habitual order complaint and madness. Mean blood stress and the frequency of aired blood stress possess deselected mainly in High- profit areas since at least the 1970s. By discrepancy, blood stress has risen in East, South and Southeast Asia, Oceania and sub-Saharan Africa. presented these currents, the frequency of hypertension is right now advanced in low- profit and medium- profit nations than in High- profit nations. In 2015, an assessed8.5 million exits were attributable to systolic blood stress> 115mmHg, 88 of which were by low- profit and medium profit nations. The application and authority of hypertension treatment differ mainly across nations. spanning up treatment content and perfecting its neighbourhood authority can mainly degrade the fitness burden of hypertension. [ABSTRACT FROM AUTHOR]

Ghana was the first sub-Saharan country to implement a National Health Insurance Scheme (NHIS). In furtherance of the nation's Universal Health Coverage (UHC) goals, in 2008, Ghana actualized plans for a Free Maternal Healthcare Policy (FMHCP) under the NHIS. The FMHCP was aimed at removing financial barriers to accessing maternal and neonatal health services. This scoping review was conducted to map out the literature on the effects of the FMHCP under the NHIS on the utilization of maternal and infant health care in Ghana. Six databases including CINAHL, PubMed, Sage Journals, Academic Search Premier, Science Direct, and Medline were searched in conducting this review with key terms. A total of 175 studies were retrieved after the search and finally, 23 articles were included in the study after various stages of elimination. The review followed the reporting guidelines stated in the Preferred Reporting Items for Systematic and Meta-analyses Extensions for Scoping Reviews (PRISMA-ScR). The results showed an overall increase in the utilization of antenatal care, facility-based delivery, and postnatal care services. However, certain systemic issues persist regarding access to maternal and infant healthcare. Socio-demographic inequalities such as maternal level of education, place of residence, and economic status likewise barriers such as the existence of out-of-pocket payments, long distance to health facilities, and poor distribution of resources in rural areas hindered the utilization of maternal and infant healthcare. The country faces significant work to eliminate existing barriers and inequalities to ensure that it achieves its UHC goals. [ABSTRACT FROM AUTHOR]

The genus Merodon Meigen (Diptera: Syrphidae) is one of the most species-rich hoverfly genera distributed across the Palaearctic and Afrotropical regions. In the Palaearctic, the genus Merodon boasts 195 described species, while its Afrotropical region pales in comparison, with a mere 17 species documented thus far. As a result of 8 years of fieldwork conducted in the Republic of South Africa, in this paper, we present the description of 11 new species for science with a description of immature stages for 2 species, which increases the diversity of this genus in the Afrotropical region by remarkable 39%. These revelations are based on integrating morphology, molecular analysis (COI gene and 28S rRNA) and geometric morphometry. All described species belong to the Merodon planifacies subgroup, the Merodon desuturinus lineage and, within that, to the Afrotropical Merodon melanocerus group. Additionally, we provide an illustrated key to 15 species belonging to the subgroup, a detailed discussion on relevant taxonomic characters, a morphological diagnosis, a distribution map and clarification of the association between M. capi complex and host plants from the genus Merwilla. [ABSTRACT FROM AUTHOR]

Introduction: Estimating the real extent of the health impact caused by malaria globally is essentially an educated estimation in the scientific realm. However, there is no denying that the most significant toll is observed in sub-Saharan Africa. Methods: This research will involve an intervention study utilizing a two-arm double-blind parallel randomized controlled trial, conducted in three stages. The initial stage will focus on creating a Health Belief Model (HBM) program. In the second stage, pregnant women will be enlisted, evaluated for baseline data, randomly assigned to two study arms, and monitored over a six-month period. The final phase will assess the influence of the intervention on the Health Belief Model (HBM) and share the results. Information will be gathered through a structured questionnaire incorporating validated instruments. The primary outcome will be the treatment effect assessed with the HBM Knowledge of malaria and ITNs use, attitude towards malaria and ITNs use, practices towards malaria and ITNs use, health seeking behaviour and health belief model factors, and data will be analyzed using SPSS, version 22 of the following analysis: Independent T-Test, Repeated Anova and (Gee) General Estimating Equation. Discussion: The research will add to the current understanding of care programs for pregnant women in hospitals in developing nations with limited existing literature. It will provide a broader perspective on the significance of measuring Health Belief Model (HBM) in intervention studies related to malaria and other infectious diseases in this specific context. [ABSTRACT FROM AUTHOR]

This study investigates the effect of the shadow economy on tax revenue and the moderating effect of mobile phone penetration in Sub-Saharan Africa. Using data on 26 SSA countries over 11 years and employing the system General Method of Moments (GMM) approach, the study reveals that the shadow economy has a significant negative effect on tax revenue in SSA, whereas mobile phone penetration has a significant positive effect on tax revenue. Again, mobile phone penetration plays a moderating role in the shadow economy-tax revenue nexus in SSA. Governments in the SSA region need to update their tax administration systems, construct and enhance infrastructure linked to emerging mobile technology, and implement best practices in tax regulations. Lastly, governments and telecommunications companies should implement some kind of consumer education in the informal sector to raise awareness of the advantages of using mobile phones for business transactions and the simplicity of paying taxes using a mobile device. [ABSTRACT FROM AUTHOR]

Recent years have witnessed an unprecedented rise in attacks on women's rights and freedom in sub‐Saharan Africa. No historical quantitative research exists that analyzes how sexual, physical, and emotional violence against women is influenced by the rise of radical Islam in Nigeria. Consecutive survey data for the years 2008, 2013, and 2018 were analyzed to determine associations between religion and other risk factors for violence against women. Multiple logistic regression was used to control for covariates. Sexual violence against Muslim women increased by 216.7% compared to a 25.4% increase among Catholics. Muslim women with no education had a lower estimate of the sexual violence they experienced (β = −0.15, CI: −0.137 to −0.016) than Christian women with no education (β = −0.05, CI: −0.138 to −0.004). The risk of violence against women has increased in recent years due to the activities of Boko Haram in the Muslim‐dominant north. We show that the effects of religion and education on violence against women are interconnected. [ABSTRACT FROM AUTHOR]

This research investigates how enhancing remittances affects total factor productivity (TFP) dynamics in Sub‐Saharan Africa. The Generalized Method of Moments empirical strategy is adopted for this study and the engaged TFP dynamics are: TFP, real TFP, welfare TFP, and real welfare TFP. Significant net effects are not apparent from enhancing remittances for TFP, real TFP growth, and welfare TFP while positive net effects are apparent on real welfare TFP. The unexpected findings are elucidated and policy implications are discussed. This study has complemented the attendant literature by assessing how growing remittances influence the dynamics of TFP in sub‐Saharan Africa. [ABSTRACT FROM AUTHOR]

BACKGROUND: Access to safe drinking water remains a critical challenge in Sub-Saharan Africa, driven by a complex mix of environmental, political, social, economic, and infrastructural factors. This scoping review aims to map the literature on water access in Sub-Saharan Africa over the past decade. METHODS: We conducted a comprehensive search of academic databases and grey literature from January 2013 to the present. We included peer-reviewed quantitative, qualitative, and mixedmethods research, as well as reviews and reports focusing on factors influencing water access and related interventions in SubSaharan Africa. Data were extracted on study characteristics, key determinants, proposed solutions, and outcomes. RESULTS: A total of 137 studies were included. Commonly reported determinants included droughts, climate change, conflict, governance, gender, wealth, education, poverty, and inadequate infrastructure. Identified potential interventions included infrastructure development, water quality monitoring, climate adaptation, governance reforms, decentralized management, targeted subsidies, and integrated water resources management. However, most studies described barriers rather than evaluating solutions. CONCLUSIONS: Persistent inequities in water access are driven by interconnected factors such as poverty, governance, gender, and infrastructure. Implementing integrated solutions is crucial, with a shift from problem identification to evaluating contextualized interventions across sectors. Dedicated implementation research is needed to translate knowledge into action, advancing water security and achieving Sustainable Development Goal 6 in the region. [ABSTRACT FROM AUTHOR]

BACKGROUND: Urology is one of the most rapidly evolving and technologically advanced surgical specialties. However, training programs in Sub-Saharan Africa (SSA) face unique challenges. This study aimed to assess the current status of urology training in SSA and identify areas for improvement, providing crucial insights into the strengths and limitations of these programs. METHODS: A 24-discrete items online survey was developed with “Google Forms” in English and French. The questionnaire was composed of two parts. The first part assessed general information about the urology training, and the second part evaluated the consultant's or department head's ability to perform and teach endourology procedures. RESULT: A total of 25 responses were received from 18 countries. The oldest training center is the University of Cape Town, South Africa; the program started in 1950. The number of consultants in the department ranges from 1 to 12, with an average of 4.79. Twenty of the training sites have a compulsory general surgery clinical attachment in their program. Fourteen of the training sites stated that research is mandatory in their curriculum. Fourteen of the centers reported providing laparoscopic urology surgery. Cystoscopy is the most mastered procedure and percutaneous nephrolithotomy (PCNL) is the most difficult procedure to gain any experience with by residents. CONCLUSION: Urology training in sub-Saharan Africa started late but is increasing in number through time. Urology training in Africa faces multiple challenges, including inadequate number of experts, limited availability of advanced equipment and simulation-based training sites. Training institutions should be encouraged to facilitate research and basic urological skills training. [ABSTRACT FROM AUTHOR]