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This paper studies the association between caregiver--child interactions and early childhood development in literacy and numeracy in West and Central Africa. Data comes from Multiple Cluster Indicator Surveys (MICS) conducted in Central African Republic, Chad, Democratic Republic of the Congo, Gambia, Ghana, Guinea-Bissau, Sierra Leone, and Togo between 2017 and 2020. A multilevel logistic regression is used to estimate the likelihood of being developmentally on track for 35,752 children aged 3-4 years. The results indicate that cognitively stimulating interactions with caregivers such as reading and telling stories are correlated with a higher likelihood of being developmentally on track. Interactions with mothers are associated with significantly higher odds of being developmentally on track but not interactions with fathers.

Background/Context: Amid rising immigration from the African continent to the United States, researchers have begun to explore the transnational identities and networks of African immigrants. There is a small body of literature about whether educational supports for immigrant youth are differentiated to address the particularities of African immigrant youth. Purpose/Objective/Research Question/Focus of Study: Transnational theories presume that subjects use social networks to connect home and diaspora. They are encountering both perceived and lived social spaces to navigate belonging in and across space. This study asks, "How do youth from the African continent mediate transnational belonging in NYC?" Studying the experiences of youth has implications for the curricular and extracurricular spaces of schools wherein newcomer youth navigate how to belong in the diaspora. Population/Participants/Subjects: Research participants are 19 newcomer African youth from Centrafrique, Cote d'Ivoire, Ethiopia, Guinea, Mauritania, Niger, and Senegal. Most of the youth are multilingual and speak French and English as third or fourth languages. Research Design: This qualitative study draws from participatory action research and visual methods. The study was conducted with Sankofa Club, a weekly afterschool student-led club. In the club, students responded to stereotypes by producing websites about the continent and carrying out research within the club to compare their homes and share their migration stories. Findings/Results: The article presents "Africa" as a Mediated Transnational Space, produced by hegemonic structures, that youth mediate as they connect homes. The study finds that youth wrestled with their identification as African. It reexamines transnationalism and positions Africa as a social field through which youth are produced (come to be) as African subjects, redress their belonging to that field by contributing their own symbols and experiences, and use it as they navigate an Africain-NYC that does not adhere to continental boundaries. Conclusions/Recommendations: Educators can support the belonging to home, Africa, and the United States by representing Africa as a generative space in curriculum and social practices.

The growing population of young people in the world today makes them an indispensable factor in international, regional, national and local development today. The UN World Programme of Action for Youth (WPAY) and the African Union's African Youth Charter all attest to the concern development stakeholders pay to youth development. This paper analysis youth policy within 9 member states of the Central African Sub region, showcasing the vital, yet significant role that polities are creating in fostering an enabling environment for youth participation. It explores the tenets of youth policy within this sub region by depicting how the participation of youths in societal activities and decision making instances should be an asset and a prerequisite for sustainable economic growth and social development. It also expresses abysmal concern about the magnitude of youth unemployment and underemployment throughout in Africa and its profound implications for the future of our societies, particularly those residing in the Central African sub region. The study is descriptive and applies a qualitative approach based on expert interviews and desk research. It employs the explanatory case study approach, and the combined anthropological research techniques through the use of key informant interview, written records and non-participant observations. The authors also conducted research in major databases like google scholar, PUB Med with the search phrase being youth policies, participation and youth governance. The 2016 Youth Development Index Report indicates that all 9 Central African countries have a low index, and 4 of the 9 countries are ranked in the bottom 10 of the classification. The findings also reveal that conflicts, underdevelopment and lack of political willingness are customarily accountable for the lagging of this Sub region in youth policy matters. The paper also proposes indicators to monitor and evaluate Youth Policies in the Central African Sub region, using the model proposed by Tanya BASARAB, develop initiatives to promote youth participation, and encourage networking among youth organizations and institutions with the Central African Sub region.

In this paper we present a cross-cultural study of toddler interactions with other juveniles (1-15 years of age) in two small-scale societies, the Bofi farmers and foragers of Central Africa. This paper provides a unique perspective because child development studies have predominantly been conducted in Western industrialized settings. Most studies of juvenile interactions among non-Western small-scale cultures have focused either on sibling caretaking or the functional value of juvenile play-groups, while little attention has been given to various types of juvenile interactions. In this study we utilized naturalistic observations of 21 Bofi farmer and 22 Bofi forager toddlers to examine the role of cultural group and age in how toddlers interact with other juveniles, specifically with respect to caretaking, social, and conflict interactions. Toddler-juvenile caretaking interactions were quite similar among the Bofi foragers and farmers despite differing parental ethno-theories about juvenile caretaking, and age effects were apparent only among the farmers. Toddler-juvenile social interactions were predicted by both age and cultural group: Toddlers engaged socially with juveniles more as they grew older in both groups, but farmer toddlers interacted with juveniles more than did forager toddlers overall. Bofi farmer and forager toddler conflicts appeared quite infrequent by Western standards, although cultural group differences were apparent: Farmer toddler engaged in more conflict with juveniles than forager toddlers did. Lastly, the topics of conflicts varied according to cultural group, but not age: Farmer toddler conflicts were more often related to disagreements over objects and responses to physical aggression than were forager toddler conflicts.

Negative stereotypes about Africa abound in American schools and in the media, making it virtually impossible for newly arrived African students, whether immigrants or refugees, to accomplish their goals of getting a quality education. African students arrive on American shores with vibrant hope and expectancy that their American education will surpass even their wildest dreams. However, once they have encountered the typical American school setting their hopes of getting this exalted education are quickly dashed. In this article, the author presents the findings of a study that examined the schooling experiences of recently arrived students from Africa. Findings reveal that schooling in America was not what these students expected, and the way they were received and perceived was demoralizing and denigrating. The relationship between the African and African American students at Jackson, the site of this study, was described as openly "hostile." Jackson High has about 2,000 students, 88% African American and about 200 newly arrived students from eight different countries on the continent of Africa.

Suggests nonformal education can be defined only with respect to its function in a specific context, its objectives established on an individual basis. Argues that it cannot be centralized or institutionalized. Includes nonformal education as a method of broadening access to education, providing second chance programs, and serving a Gandhian approach to basic education. (DK)

The mission of the WHO's Health Emergencies Programme is to build the capacity of Member States to manage health emergency risks and when national capacities are overwhelmed, to lead and [...]

Mpox is a zoonotic viral infectious disease first identified in humans in the Democratic Republic of the Congo (DRC) in 1970 (1). Monkeypox virus (MPXV) is endemic to forested regions [...]

In 2023, the African Region experienced yellow fever (YF) outbreaks in 3 countries (of which 2 experienced varied levels of transmission intensity), cases with epidemic potential in 3 countries, and [...]

The Central African Republic (CAR) is characterized by widespread HIV epidemic with notable prevalence and genetic diversity. We herein analysed the genetic diversity of atypical non‐M HIV‐1 strains. In‐house serotyping assays for variants of HIV‐1 (M, N, O, P) and HIV‐2 were used to test a biological collection of 6092 HIV‐seropositive blood samples collected between 2003 and 2014 at the Institut Pasteur de Bangui. Samples indicative of recombinant M/O groups, HIV‐2, or those that yield doubtful/negative results underwent further PCR tests and sequencing. We found six atypical HIV strains: specifically, three (0.05%) HIV‐1 group O strains (subtype H) detected in samples from 2005, 2008 and 2009, alongside three (0.05%) HIV‐2 strains (two group A and one group B) identified in samples from 2007 and 2009. HIV‐1/O strains showed a genetic link to Cameroon and Gabon strains. This study highlights the dominance of HIV‐1/M in the CAR's HIV epidemic over time and underscores the infrequent occurrence of HIV‐1 group O and HIV‐2 strains. These findings validate the efficacy of WHO‐recommended HIV testing protocols and emphasize the need for adaptive surveillance and management strategies to confront the complexities introduced by the genetic diversity of HIV strains. [ABSTRACT FROM AUTHOR]

Background: Mortality from physical inactivity-related non-communicable diseases (NCDs) is projected to surpass deaths from communicable diseases by 2030 in Africa. Monitoring physical activity (PA) is important for planning public health interventions addressing NCDS and planetary health, but there is a dearth of evidence on PA trends in Africa. This study explored the secular trends in overall and domains of PA (leisure, occupation, and transport), and examined the gender, age, and education disparities in PA trends across African countries. Methods: We utilized data from the STEPwise approach to NCDs risk factor surveillance in eleven African countries (Algeria, Benin, Botswana, Cabo Verde, Eritrea, Eswatini, Malawi, Mali, Central Africa Republic, Sao Tome and Principe, and Zambia) with at least two surveys conducted between 2003/2010 (first-wave) and 2010/2020 (second-waves). A total of 29,282 and 40,147 adults (18–69 years) in the first and second waves, respectively, completed PA interviews using the Global Physical Activity Questionnaire. Gender, age, and education status were self-reported. Weighted individual-country PA prevalence and 95% confidence interval (95%CI) were obtained. Random-effect meta-analysis was conducted to assess pooled estimates of PA trends across countries. Gender, age, and education disparities in PA trends were also investigated. Results: Country-specific results showed significant upward trends in total PA in eight countries. Seven countries showed significant increasing trends in some leisure-time PA (2.0% − 13.9% increase) and ≥ 150 min/week transport PA (4.0% − 24.5% increase), while five countries recorded significant increasing trends in occupational PA (6.6% − 56.9% increase). Gender, age and education disparities in meeting the WHO PA guidelines remained relatively stable over time, but disparities in leisure, transport and occupational PA increased in most countries. Conclusions: The prevalence of overall PA among African adults has marginally increased over 17 years. There are still many adults, especially women and people with lower education, not doing well in domain specific PA. Policy and environmental interventions are needed to improve PA and to reduce gender, age, and education disparities in leisure, transport, and occupational PA in African countries. [ABSTRACT FROM AUTHOR]

Background Concerns about falling (CaF) are common in older people and can lead to avoidance of activities, social isolation and reduced physical function. However, there is limited knowledge about CaF in people with osteoarthritis (OA); yet, symptoms may increase CaF. We aimed to evaluate the prevalence of CaF and associated factors in people with knee or hip OA. Methods This cross-sectional study used data from the Good Life with osteoArthritis in Denmark registry including patients with OA treated in primary care. CaF was assessed with the Short Falls Efficacy Scale International (Short FES-I, range 7–28, low to high). Associations between CaF and pain, function and psychological factors were evaluated using multivariable linear Tobit regression. Results In total, 7442 patients were included [mean age 67 years (SD: 9.6), 67% females]. Mean Short FES-I was 9.8 [95% confidence interval (CI): 9.7; 9.8]. Moderate CaF was observed in 48.1% (95% CI: 46.7; 48.9) of participants, whilst 11.3% (95% CI: 10.7; 12.1) had a high level of CaF. CaF was more prevalent in the oldest participants and in females. Pain intensity [β-value (95% CI): 0.52 (0.48; 0.55)], chair stand test [−0.21 (−0.22; −0.19)] and fear of movement [1.38 (1.19; 1.56)] were significantly associated with increased CaF across age groups and sex. Conclusions CaF is common in people with OA, especially in the oldest participants and in females. Higher pain, lower function and psychological distress are associated with CaF; yet, the causality of the associations remain to be determined. Integrating CaF assessments and interventions into OA management in primary care seems highly relevant. [ABSTRACT FROM AUTHOR]

Background: Ongoing conflict between multiple armed groups, including pastoralist herders in the Central African Republic (CAR) causes frequent population displacements, food insecurity and scarcity of healthcare services. The inaccessibility and insecurity of many areas of CAR limit data collection and assessments from national nutritional surveys. Community health workers (CHWs) trained by an international non-governmental organisation, The MENTOR Initiative, deliver basic healthcare to children under 5 years old living in hard-to-reach and conflict-affected areas in eight subprefectures of north-west CAR. Their nutritional status and its associations with geography, malaria, season and conflict are unknown. Methods: CHW monthly records (October 2015–August 2021), Armed Conflict Location and Event Data project conflict data and The World Bank Group meteorological data for eight subprefectures of north-west CAR were analysed. Associations between counts of global acute malnutrition (GAM) assessed by mid-upper arm circumference and malaria, season and conflict were investigated using negative binomial regression. Results: Of the 457,325 consultations with children aged 6–59 months, 6.2% and 0.4% were classified as moderately or severely malnourished, respectively. The negative binomial model demonstrated differences in counts of GAM by subprefecture. Counts of GAM were positively associated with the case rate of severe malaria (IRR = 1.045; 95% CI: 1.04–1.06) and the rainy season (July–September) (IRR = 1.10; 95% CI: 1.03–1.17). Conflict events coded as Battles in ACLED were associated with lower counts of GAM (IRR = 0.78; 95% CI: 0.62–0.97). Conclusions: This analysis shows geographical differences in levels of malnutrition in north-west CAR and demonstrates clear associations between malnutrition, season and malaria. It provides evidence that levels of GAM may be underestimated in north-west CAR in areas experiencing conflict. These findings highlight the need for targeted nutritional support to reach children most at risk of malnutrition. CHWs are a proven effective means of delivering essential primary healthcare services in hard-to-reach, conflict-affected areas. [ABSTRACT FROM AUTHOR]

Abstract Background Ongoing conflict between multiple armed groups, including pastoralist herders in the Central African Republic (CAR) causes frequent population displacements, food insecurity and scarcity of healthcare services. The inaccessibility and insecurity of many areas of CAR limit data collection and assessments from national nutritional surveys. Community health workers (CHWs) trained by an international non-governmental organisation, The MENTOR Initiative, deliver basic healthcare to children under 5 years old living in hard-to-reach and conflict-affected areas in eight subprefectures of north-west CAR. Their nutritional status and its associations with geography, malaria, season and conflict are unknown. Methods CHW monthly records (October 2015–August 2021), Armed Conflict Location and Event Data project conflict data and The World Bank Group meteorological data for eight subprefectures of north-west CAR were analysed. Associations between counts of global acute malnutrition (GAM) assessed by mid-upper arm circumference and malaria, season and conflict were investigated using negative binomial regression. Results Of the 457,325 consultations with children aged 6–59 months, 6.2% and 0.4% were classified as moderately or severely malnourished, respectively. The negative binomial model demonstrated differences in counts of GAM by subprefecture. Counts of GAM were positively associated with the case rate of severe malaria (IRR = 1.045; 95% CI: 1.04–1.06) and the rainy season (July–September) (IRR = 1.10; 95% CI: 1.03–1.17). Conflict events coded as Battles in ACLED were associated with lower counts of GAM (IRR = 0.78; 95% CI: 0.62–0.97). Conclusions This analysis shows geographical differences in levels of malnutrition in north-west CAR and demonstrates clear associations between malnutrition, season and malaria. It provides evidence that levels of GAM may be underestimated in north-west CAR in areas experiencing conflict. These findings highlight the need for targeted nutritional support to reach children most at risk of malnutrition. CHWs are a proven effective means of delivering essential primary healthcare services in hard-to-reach, conflict-affected areas.

In accordance with the recommendations of the International Commission for the Certification of Dracunculiasis Eradication (ICCDE), WHO has certified 200 countries, areas and territories (including 188 WHO Member States) as [...]

In recent years, interest has been growing among policymakers in how to leverage special economic zone (SEZ) policies to support local entrepreneurship. With a few recent exceptions, the academic literature to date has been silent on the matter. This article aims to contribute to addressing this gap. First, it develops a conceptual framework linking SEZ policies and entrepreneurship development. Second, it explores the state of play of entrepreneurship promotion in SEZs in Africa using a survey of African SEZs and two case studies. We And significant appetite among African SEZs to promote local entrepreneurship; however, it is less clear how best to accomplish the task. Many of the policies, facilities and services offered are open to local entrepreneurs rather than being tailored specifically to their needs. The support required in some policy areas also seems to be more straightforward than in others. Adapting the SEZ offering to the needs of local entrepreneurs is one of the key challenges to increasing the effectiveness of the support. Keywords : special economic zones, entrepreneurship, developing countries, local economic development, knowledge spillovers, sourcing linkages JEL classification codes : L26, O31, O55, O25, R58, 1. Introduction Special economic zones (SEZs) are an ever-popular policy tool for promoting investment, generating employment and stimulating innovation. Policymakers put their hopes in them to overcome key developmental challenges [...]

Despite innumerable government policies to reduce youth unemployment in Sub-Saharan Africa, the problem persists. This study examines the extent to which the hysteresis effect exists in the youth unemployment rate in Sub-Saharan African countries during the period 1991 to 2021, disaggregated according to territorial delineation, income, and gender. First, we employ the univariate and panel unit root tests including the Augmented-Dickey-Fuller, Phillips-Perron, the Dickey-Fuller-Generalized Least Square by Elliott, Rothenberg, and Stock (1996), the ADFmax by Leybourne (1995), and the Kwiatkowski, et al. (1992) test, to enable comparison with previous studies. The Pesaran's (2007), test is then applied to account for cross-sectional dependence. Finally, the Zivot--Andrews single structural break by Zivot and Andrews (1992), Clemente--Montane--Reyes two structural breaks unit root tests by Clemente, Montanes, and Reyes (1998), as well as the Karavias-Tzavalis panel unit root test with structural breaks by Karavias and Tzavalis (2014) are employed. The univariate unit root tests generally support the hysteresis hypothesis (within a band of 60% to 97%) for almost all countries, and sub-regions in SSA. However, accounting for structural breaks, the hysteresis effect in total youth unemployment is only visible in 19 countries (40%), with evidence of gender disparities pointing to the hysteresis effect in females only in 16 countries (34%), and, in males only in 10 countries (21.3%). The lower-middle-income countries reject the natural rate hypothesis in total and both male and female youth unemployment rates. While only male youths suffer from the hysteresis in low-income countries, the total youth in upper-middle-income countries shares this effect. Accounting for cross-section dependence alters the finding of the hysteresis effect only in males in Southern Africa and upper-middle-income countries. A one-size-fits-all policy may not work. Instead, we recommend an integral approach aimed at the creation of employment opportunities for youth and females, including but not limited to diversification of economic activities in rural areas to reduce urbanization, skills training, political and economic stability, cultural transformation to remove unnecessary gender-related employment discrimination, as well as improved economic integration policies. For countries found to exhibit the natural rate hypothesis, it may not be necessary to engage in costly policies to return the youth unemployment rate to equilibrium since the shock is only temporary. JEL Classifications: E20, E24, J60, N17, R10, R23 Keywords: Structural break, Hysteresis, Unit root, Cross-section dependence, Youth unemployment rate, SSA., INTRODUCTION Persistent youth unemployment has unquestionably proved to be one of the biggest threats to many developing economies. Sub-Saharan Africa (SSA) in particular has suffered enormously from several labor market [...]

Abstract Introduction Attacks on healthcare have further weakened the already fragile health system in the Central African Republic. We investigated attacks on healthcare in three conflict-affected prefectures—Ouaka, Haute-Kotto, and Vakaga—from 2016 to 2020. The study aim was to gain an in-depth understanding of the immediate and long-term effects of attacks on healthcare workers, facilities, supply chain, quality of care, and other components of the health system. We provide a qualitative description of the incidents, assess their impacts, identify mitigation efforts, and discuss challenges to recovery. Methods We used purposive and snowball sampling to identify participants in the study. Semi-structured key informant interviews were conducted with administrative and health authorities, front-line personnel, and staff of non-governmental organizations. Interviews were done in Sango, French, or English. Recorded interviews were transcribed and notes taken for non-recorded interviews. Transcripts and notes were analyzed using inductive coding, allowing participant responses to guide findings. Results Of 126 attacks identified over the study period, 36 key informants discussed 39 attacks. Attacks included killings, physical and sexual assault, abductions, arson, shelling with grenades, pillage, occupations, and verbal threats. The violence led to extended closures and debilitating shortages in healthcare services, disproportionately affecting vulnerable populations, such as children under five, or people who are elderly, chronically ill, or displaced. Healthcare workers faced psychological trauma and moral injury from repeated attacks and the inability to provide adequate care. Personnel and communities made enormous efforts to mitigate impacts, and advocate for assistance. They were limited by failed reporting mechanisms, ongoing insecurity, persistent lack of resources and external support. Conclusion Effective strategies to safeguard healthcare from violence exist but better support for communities and health workers is essential, including measures to assess needs, enhance security, and facilitate recovery by quickly rebuilding, resupplying, and re-staffing facilities. CAR’s government, international organizations, and donors should make concerted efforts to improve reporting mechanisms and end impunity for perpetrators. Their investment in community organizations and long-term health system support, especially for health worker training, salaries, and psychosocial care, are vital steps towards building resilience against and mitigating the impacts of attacks on healthcare.

Introduction. The article highlights the problem of accessibility of education (primary, secondary, higher) and income inequality in Central African countries. The purpose of the study is to present and analyze international static data that show the difficult situation with access to education in the following countries: Cameroon, Chad, Central African Republic, Congo, Gabon. The data obtained are necessary for the development of practical solutions for effective assistance to the population of countries in obtaining affordable education by different social strata of the population. Materials and Methods. Official documents and scientific sources were analyzed and synthesized. The search for relevant data was conducted using various databases, including UNdata, Academic Search Complete, Web of Science Core Collection, Education Source, E-Journals, ERIC, Google, Google Scholar, Springer, etc. mainly for the last 5 years. Special attention in the analysis was paid to the search of official information with the data of international organizations UNESCO and the World Bank. Results. In Central African countries (Cameroon, Central African Republic, Chad, Congo, Congo and Gabon), the income gap between the richest and poorest is very wide. In Cameroon and Gabon, the income gap between rich and poor is not as wide as in Chad, Congo and Central African Republic, so primary education levels in these two countries remain higher than in other countries. It was found that in Central Africa there was a sharp decrease in the number of students in higher education institutions between 2010 and 2014. One of the reasons (a distinctive feature) of the low coverage of higher education in Central Africa has been identified – the lack of material support for a larger number of the population and, as a result, minimal accessibility of higher education for the younger generation. The study proves that at this economic stage of development, Cameroon and Gabon are leaders in the field of education in Central African countries. Discussion and Conclusion. Affordable education is necessary to reduce poverty and improve economic growth, but the high cost of education combined with limited access to it leaves many children uneducated. The findings from the study of education access in Central African countries raise the issue of education for the majority of the population, with a view to developing possible ways to economically and politically revise the leadership's approach to better assist the countriesʼ populations. The article will be useful for specialists in the field of education in different countries, as well as for sociologists, culturologists, economists, and politicians.

Introduction: Attacks on healthcare have further weakened the already fragile health system in the Central African Republic. We investigated attacks on healthcare in three conflict-affected prefectures—Ouaka, Haute-Kotto, and Vakaga—from 2016 to 2020. The study aim was to gain an in-depth understanding of the immediate and long-term effects of attacks on healthcare workers, facilities, supply chain, quality of care, and other components of the health system. We provide a qualitative description of the incidents, assess their impacts, identify mitigation efforts, and discuss challenges to recovery. Methods: We used purposive and snowball sampling to identify participants in the study. Semi-structured key informant interviews were conducted with administrative and health authorities, front-line personnel, and staff of non-governmental organizations. Interviews were done in Sango, French, or English. Recorded interviews were transcribed and notes taken for non-recorded interviews. Transcripts and notes were analyzed using inductive coding, allowing participant responses to guide findings. Results: Of 126 attacks identified over the study period, 36 key informants discussed 39 attacks. Attacks included killings, physical and sexual assault, abductions, arson, shelling with grenades, pillage, occupations, and verbal threats. The violence led to extended closures and debilitating shortages in healthcare services, disproportionately affecting vulnerable populations, such as children under five, or people who are elderly, chronically ill, or displaced. Healthcare workers faced psychological trauma and moral injury from repeated attacks and the inability to provide adequate care. Personnel and communities made enormous efforts to mitigate impacts, and advocate for assistance. They were limited by failed reporting mechanisms, ongoing insecurity, persistent lack of resources and external support. Conclusion: Effective strategies to safeguard healthcare from violence exist but better support for communities and health workers is essential, including measures to assess needs, enhance security, and facilitate recovery by quickly rebuilding, resupplying, and re-staffing facilities. CAR's government, international organizations, and donors should make concerted efforts to improve reporting mechanisms and end impunity for perpetrators. Their investment in community organizations and long-term health system support, especially for health worker training, salaries, and psychosocial care, are vital steps towards building resilience against and mitigating the impacts of attacks on healthcare. [ABSTRACT FROM AUTHOR]

Background: Abortion-related complications remain a main cause of maternal mortality. There is little evidence on the availability and quality of post-abortion care (PAC) in humanitarian settings. We assessed the quality of PAC in two hospitals supported by an international organization in Jigawa State (Nigeria) and Bangui (Central African Republic, CAR). Methods: We mapped indicators corresponding to the eleven domains of the WHO Maternal and Newborn Health quality-of-care framework to assess inputs, processes (provision and experience of care), and outcomes of PAC. We measured these indicators in four components of a cross-sectional multi-methods study: 1) an assessment of the hospitals' PAC signal functions, 2) a survey of the knowledge, attitudes, practices, and behavior of 140 Nigerian and 84 CAR clinicians providing PAC, 3) a prospective review of the medical records of 520 and 548 women presenting for abortion complications and, 4) a survey of 360 and 362 of these women who were hospitalized in the Nigerian and CAR hospitals, respectively. Results: Among the total 27 PAC signal functions assessed, 25 were available in the Nigerian hospital and 26 in the CAR hospital. In both hospitals, less than 2.5% were treated with dilatation and sharp curettage. Over 80% of women received blood transfusion or curative antibiotics when indicated. However, antibiotics were given to about 30% of patients with no documented indication. Among discharged women in CAR, 99% received contraceptive counseling but only 39% did in Nigeria. Over 80% of women in Nigeria reported positive experiences of respect and preservation of dignity. Conversely, in CAR, 37% reported that their privacy was always respected during examination and 62% reported short or very short waiting time before seeing a health provider. In terms of communication, only 15% felt able to ask questions during treatment in both hospitals. The risk of abortion-near-miss happening ≥ 24h after presentation was 0.2% in Nigeria and 1.1% in CAR. Only 65% of women in the Nigerian hospital and 34% in the CAR hospital reported that the staff provided them best care all the time. Conclusion: Our comprehensive assessment identified that these two hospitals in humanitarian settings provided lifesaving PAC. However, hospitals need to strengthen the patient-centered approach engaging patients in their own care and ensuring privacy, short waiting times and quality provider-patient communication. Health professionals would benefit from instituting antibiotic stewardships to prevent antibiotic-resistance. Plain English summary: In humanitarian contexts, abortion complications are a leading cause of maternal mortality. Providing quality post-abortion care (PAC) is therefore an important part of needed services. We assessed the quality of PAC in two hospitals supported by an international organization in Jigawa State (Nigeria) and Bangui (Central African Republic). We measured quality indicators in four components: 1) an assessment of the equipment and human resources available in hospitals, 2) a survey of the knowledge, attitudes, practices, and behavior of clinicians providing PAC, 3) an assessment of the medical care provided by clinicians to women presenting with abortion complications and, 4) a survey of a subgroup of these women who were hospitalized. Both hospitals had almost all the equipment and human resources necessary to provide post-abortion care. Less than 2.5% of women received a non-recommended method to evacuate their uterus in both hospitals. More than 80% of women received a blood transfusion or antibiotics when they needed them. However, 30% of women received antibiotics without written justification and only 15% of women reported being able to ask questions about their treatment. Overall, only 65% of Nigerian women and 34% of Central African women said that the staff provided them with the best care all the time. The fact that less than 2% of women experienced a very severe complication 24 hours or more after their arrival at the two hospitals suggests that the care provided was lifesaving. But they urgently need to adopt a better patient-centered approach as well as to improve the rational management of antibiotics. [ABSTRACT FROM AUTHOR]

Malaria is a significant health problem in Africa, primarily due to the Plasmodium falciparum species, but this is not the only etiological factor responsible for malaria on the continent. The goal of the present research was to describe asymptomatic malaria cases and to identify Plasmodium species responsible for malaria in the BaAka Pygmies, inhabitants of the Central African Republic (CAR). Screening was realised in the period of August–September 2021 among 308 people, including 74 children and 234 adults reporting to a healthcare facility in Monasao (southwest CAR), an area inhabited by a semi-nomadic tribe of BaAka Pygmies. The study consisted of two phases. Phase I, which was conducted in Africa, consisted of performing malaria rapid diagnostic tests (mRDTs), taking haemoglobin measurements and collecting blood samples onto Whatman FTA cards for molecular diagnostics. Phase II, which was conducted in Poland, involved molecular tests (RT-PCR) to confirm or rule out malaria infections and to identify Plasmodium species responsible for the infections. mRDTs detected Plasmodium infections in 50.3% of children and 17.1% of adults participating in the study, whereas RT-PCR assays yielded positive results for 59.5% children and 28.6% adults. Molecular tests detected multiple Plasmodium falciparum infections but also three infections with P. malariae, three with P. ovale and one with P. vivax. The obtained results have confirmed numerous asymptomatic Plasmodium infections among the BaAka Pygmies. The rates of asymptomatic malaria cases in adults were twice as high as those in children, which may be indicative of the gradual acquisition of protective immunity with age. The study findings have also demonstrated that although most cases of malaria in Africa are caused by P. falciparum, three other species are also present in the region. [ABSTRACT FROM AUTHOR]

A simplified, combined protocol admitting children with a mid‐upper‐arm circumference (MUAC) of <125 mm or oedema to malnutrition treatment with ready‐to‐use therapeutic food (RUTF) uses two sachets of RUTF per day of those with MUAC < 115 mm and/or oedema and one sachet of RUTF per day for those with MUAC 115–<125 mm. This treatment previously demonstrated noninferior programmatic outcomes compared with standard treatment and high recovery in a routine setting. We aimed to observe the protocol's effectiveness in a routine setting at scale, in two health districts of the Central African Republic through an observational cohort study. The pilot enrolled children for 1 year in consortium by the Ministry of Health and nongovernmental partners. A total of 7909 children were admitted to the simplified, combined treatment. Treatment resulted in an 81.2% overall recovery, with a mean length of stay (LOS) of 38.7 days and a mean RUTF consumption of 43.4 sachets per child treated. Among children admitted with MUAC < 115 mm or oedema, 67.9% recovered with a mean LOS of 48.1 days and consumed an average of 70.9 RUTF sachets. Programme performance differed between the two districts, with an overall defaulting rate of 31.1% in the Kouango‐Grimari health district, compared to 8.2% in Kemo. Response to treatment by children admitted with severe acute malnutrition (SAM) by MUAC and SAM by oedema was similar. The simplified, combined protocol resulted in a satisfactory overall recovery and low RUTF consumption per child treated, with further need to understand defaulting in the context. [ABSTRACT FROM AUTHOR]

The main objective of this project was to compare in the field conditions two strategies of re‐nutrition of children with moderate acute malnutrition (MAM) aged from 6 to 24 months, targeting the microbiota in comparison with a standard regimen. A three‐arm, open‐label, pragmatic randomised trial was conducted in four countries (Niger, CAR, Senegal and Madagascar). Children received for 12 weeks either fortified blended flour (FBF control) = arm 1, or FBF + azithromycin (oral suspension of 20 mg/kg/day daily given with a syringe) for the first 3 days at inclusion = arm 2 or mix FBF with inulin/fructo‐oligosaccharides (6 g/day if age ≥12 months and 4 g if age <12 months) = arm 3. For each arm, children aged from 6 to 11 months received 100 g x 2 per day of flours and those aged from 12 to 24 months received 100 g × 3 per day of FBF. The primary endpoint was nutritional recovery, defined by reaching a weight‐for‐height z‐score (WHZ) ≥ −1.5 within 12 weeks. Overall, 881 children were randomised (297, 290 and 294 in arm 1, arm 2 and arm 3, respectively). Three hundred and forty‐four children were males (39%) and median/mean age were 14.6/14.4 months (SD = 4.9, IQR = 10.5–18.4). At inclusion, the three arms were comparable for all criteria, but differences were observed between countries. Overall, 44% (390/881) of the children recovered at week 12 from MAM, with no significant difference between the three arms (41.4%, 45.5% and 45.9%, in arm 1, arm 2 and arm 3, respectively, p = 0.47). This study did not support the true advantages of adding a prebiotic or antibiotic to flour. When using a threshold of WHZ ≥ −2 as an exploratory endpoint, significant differences were observed between the three arms, with higher success rates in arms with antibiotics or prebiotics compared to the control arm (66.9%, 66.0% and 55.2%, respectively, p = 0.005). Key messages: Re‐nutrition of children with MAM is still a concern as the duration of recovery is always long and recurrences are frequent.Literature suggests that prebiotics and antibiotics show potentially useful properties to speed this process of recovery.However, in this open‐label study, prebiotics and antibiotics did not lead to advantages on the recovery rates defined by reaching the WHZ (−1.5) cut‐off. [ABSTRACT FROM AUTHOR]

Introduction. Unlike traumatic rupture of the spleen, which is the most common consequence of blunt abdominal trauma and is well documented in the literature, and unlike the atraumatic rupture of the spleen, which is less common but also well described, spontaneous rupture of the spleen in a patient with malaria is a rare complication, with a potentially fatal outcome. Case report. A soldier aged 46 years, was hospitalized, with the clinical picture of abdominal colic and diarrhea, previously treated for a primary attack of acute malaria. During hospitalization, deterioration of health condition occurred, with the development of a clinical picture of an acute abdomen due to spontaneous rupture of the spleen which was successfully resolved by splenectomy. Conclusion. Splenectomy is the method of choice for patients with unstable clinical presentation due to atraumatic rupture of the spleen. [ABSTRACT FROM AUTHOR]

In this study, hindcasts from eight Copernicus Climate Change Service (C3S) and three North American Multi‐Model Ensemble (NMME) operational seasonal forecast systems, based on dynamical climate models, are employed to investigate the influence of the South Atlantic Ocean Dipole (SAOD) on the predictive skill of Central Africa (CA) rainfall. The focus is primarily on the June–July–August season for 1993–2016. The findings reveal that, when regionally averaged, all models exhibit positive skill in predicting CA rainfall, except for the Geophysical Fluid Dynamics Laboratory (GFDL‐SPEAR) model. Notably, there are significant spatial variations in skill across different regions. Model performance is particularly low (high) in the Central African Republic and Congo Basin (Gabon and Chad) and tends to deteriorate with increasing lead‐time. Models that demonstrate a strong connection between SAOD and CA rainfall tend to exhibit better predictive skills in forecasting rainfall, in contrast to models with weaker connections. This leads to a significant in‐phase relationship between the predictive skills of rainfall and the strength of the SAOD–rainfall connection among the models. Furthermore, the atmospheric circulation responding to SST forcing associated with the El Niño–Southern Oscillation exerts a significant influence on the robust atmospheric circulation associated with the climatological mean of SST over the SAO. This suggests that mean state bias in the SAO/equatorial Pacific region plays a role in modulating the strength of the simulated SAOD–CA rainfall connection and, consequently, the prediction skill of CA rainfall. In general, both NMME and C3S models appear to be valuable tools capable of providing essential seasonal information several months in advance. These insights can aid decision‐makers in the region in making informed decisions regarding adaptation and mitigation measures. [ABSTRACT FROM AUTHOR]

We repurpose multidecadal ethnoarchaeological investigations of human hunting, prey availability, and socioeconomics in a rural Central African Republic village in the service of human ecology. Focusing on forest foragers in the village of Grima, initial 1999–2005 (Old Grima) data collection included documentation of hunting technology and offtakes, identification of wild meat bone assemblages, inventories of household material goods, and measurements of horticultural fields. Similar datasets were collected in 2021–2022 (New Grima) and longitudinal comparisons of prey remains and material wealth detected many significant differences. Old Grima house middens contained larger numbers of bones representing an array of wild meat taxa and inventories recorded diverse and abundant collections of material goods. The New Grima comparative data showed a reduction in the consumption of wild meat, increases in guns and especially metal cable snares, and marked declines in local wild meat (notably duiker) populations and forager material wealth paired with increases in debt. In 2022 the New Grima inhabitants were actively pursuing escargot for food and income and house middens were dominated by tortoise remains. All the data point to resource depression from overhunting and a community in jeopardy. The comparisons are also important because they include the transition from traditional nets and spears to more efficient metal cable snares and guns and provide information on the effects of hunting technology. The complexities of evaluating ecological perturbations and sustainability require multidisciplinary datasets and we propose ethnoarchaeology as a valuable tool to help identify subtleties in human food webs and biodiversity loss. [ABSTRACT FROM AUTHOR]

Youth as a category that informs international interventions in conflict-affected settings has gained currency in the past decade. This article traces the rising rhetoric of youth in UN Disarmament, Demobilization and Reintegration (DDR) discourse and demonstrates how changes in its dominant representations have implications beyond the matter of semantics. Drawing on post-structuralist traditions, the article highlights how the DDR discourse delineates problems through particular framings that call forth certain solutions, which in turn reinforce the very (mis)understandings that underlie the interventions. A case study from the Central African Republic illustrates how the hegemonic representation of youth-as-troublemakers in UN documents, together with a compelling narrative that naturalized the link between youth, unemployment and violence, made possible and conferred legitimacy to the proliferation of projects with an overwhelming economic focus. The article discusses how the resource landscape, such as opportunities to unlock earmarked funding, incentivizes the reproduction of certain constructions of youth that align with today's policy panic around violent extremism. In so doing, it puts into question the instrumental approach towards discourse by pointing to surprising ways in which discourses become appropriated by both international peacebuilders and the 'subjects' of these interventions. [ABSTRACT FROM AUTHOR]