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This study aims to fill a significant knowledge gap by examining the dynamics of sectoral per capita greenhouse gas (GHG) emissions convergence across 54 African countries from 1980 to 2019. Using the log (t) club convergence approach, this study uncovers the presence of multiple local steady-state convergence patterns within each sector. A significant correlation emerges between the classification of countries regarding their total and energy sector emissions. In particular, less industrialized African countries with higher proportions of renewable energy consumption tend to demonstrate elevated convergence rates in both total and per capita energy emissions. Further, the analysis indicates that wealthier countries with greater trade intensity and increased industrialization are associated with a higher rate of convergence in the agriculture sector. By highlighting the heterogeneity in sectoral patterns and the evolving landscape of GHG emissions in Africa, this study provides valuable insight for the formulation of policies that concurrently address the challenges of sustainable development and climate change mitigation.

Abstract Background Participatory praxis is increasingly valued for the reliability, validity, and relevance of research results that it fosters. Participatory methods become an imperative in health-related stigma research, where the constitutive elements of stigma, healthcare settings, and research each operate on hierarchies that push those with less social power to the margins. Discussion Particularly for people who are stigmatized, participatory methods balance the scales of equity by restructuring power relationships. As such, participatory praxis facilitates a research process that is responsive to community-identified priorities and creates community ownership of the research, catalyzing policy change at multiple levels and foregrounds, and addresses risks to communities from participating in research. Additionally, through upholding the agency and leadership of communities facing stigma, it can help to mitigate stigma’s harmful effects. Health-related stigma research can reduce the health inequities faced by stigmatized groups if funders and institutions require and reward community participation and if researchers commit to reflexive, participatory practices. A research agenda focused on participatory praxis in health-related stigma research could stimulate increased use of such methods. Conclusion For community-engaged practice to become more than an ethical aspiration, structural changes in the funding, training, publishing, and tenure processes will be necessary.

Abstract Health-related stigma remains a major barrier to improving health and well-being for vulnerable populations around the world. This collection on stigma research and global health emerged largely as a result of a 2017 meeting on the “The Science of Stigma Reduction” sponsored by the US National Institutes of Health (NIH). An overwhelming consensus at the meeting was reached. It was determined that for stigma research to advance further, particularly to achieve effective and scalable stigma reduction interventions, the discipline of stigma research must evolve beyond disease-specific investigations and frameworks and move toward more unified theories of stigma that transcend individual conditions. This introduction reflects on the value of taking this cross-cutting approach from both a historical and current perspective, then briefly summarizes the span of articles. Collectively, the authors apply theory, frameworks, tools, interventions and evaluations to the breadth of stigma across conditions and vulnerabilities. They present a tactical argument for a more ethical, participatory, applied and transdisciplinary line of attack on health-related stigma, alongside promoting the dignity and voice of people living with stigmatized conditions. The collection homepage can be found at http://www.biomedcentral.com/collections/stigma.

Background: Peripheral arterial disease (PAD) is common in HIV patients and can be diagnosed noninvasively using the ankle-brachial index (ABI). The burden of PAD has not been investigated in Ghanaian HIV patients. We investigated the prevalence and risk factors associated with PAD in HIV patients at a periurban hospital in Ghana., Methods: In a case-control design, ABI was measured in 158 cART-treated HIV patients, 150 cART-naïve HIV patients and 156 non-HIV controls with no clinical symptoms of CVDs. PAD was defined as ABI ≤ 0.9. A structured questionnaire was used to collect socio-demographic and clinical data. Fasting venous blood samples were collected to measure plasma levels of glucose, lipid profile, and CD4+ lymphocytes., Results: The prevalence of PAD was 13.9% among cART-treated HIV patients, 21.3% among cART-naïve HIV patients, and 15.4% among non-HIV controls. Patients with PAD had increased odds of having low CD4+ cell counts [OR (95% CI) = 3.68 (1.41-12.85)]. In cART-treated HIV patients, those on TDF-based [5.76 (1.1-30.01), p = 0.038] and EFV-based [9.28 (1.51-57.12), p = 0.016] regimens had increased odds of having PAD., Conclusion: In our study population, there was no difference in the prevalence of PAD between cART-treated HIV patients compared to cART-naïve HIV patients or non-HIV controls. Having a low CD4 cell count and being on TDF- or EFV-based regimens were associated with an increased likelihood of having PAD., Competing Interests: Declaration of Competing Interest The authors have no conflict of interest to disclose., (Copyright © 2023. Published by Elsevier Inc.)

Objective: Evidence shows that the conventional cardiometabolic risk factors do not fully explain the burden of microvascular complications in type 2 diabetes (T2D). One potential factor is the impact of pulmonary dysfunction on systemic microvascular injury. We assessed the associations between spirometric impairments and systemic microvascular complications in T2D., Design: Cross-sectional study., Setting: National Diabetes Management and Research Centre in Ghana., Participants: The study included 464 Ghanaians aged ≥35 years with established diagnosis of T2D without primary myocardial disease or previous/current heart failure. Participants were excluded if they had primary lung disease including asthma or chronic obstructive pulmonary disease., Primary and Secondary Outcome Measures: The associations of spirometric measures (forced expiratory volume in 1 s (FEV 1 ), forced vital capacity (FVC) and FEV 1 /FVC ratio) with microvascular complications (nephropathy (albumin-creatinine ratio ≥3 mg/g), neuropathy (vibration perception threshold ≥25 V and/or Diabetic Neuropathy Symptom score >1) and retinopathy (based on retinal photography)) were assessed using multivariable logistic regression models with adjustments for age, sex, diabetes duration, glycated haemoglobin concentration, suboptimal blood pressure control, smoking pack years and body mass index., Results: In age and sex-adjusted models, lower Z-score FEV 1 was associated with higher odds of nephropathy (OR 1.55, 95% CI 1.19-2.02, p=0.001) and neuropathy (1.27 (1.01-1.65), 0.038) but not retinopathy (1.22 (0.87-1.70), 0.246). Similar observations were made for the associations of lower Z-score FVC with nephropathy (1.54 (1.19-2.01), 0.001), neuropathy (1.25 (1.01-1.54), 0.037) and retinopathy (1.19 (0.85-1.68), 0.318). In the fully adjusted model, the associations remained significant for only lower Z-score FEV 1 with nephropathy (1.43 (1.09-1.87), 0.011) and neuropathy (1.34 (1.04-1.73), 0.024) and for lower Z-score FVC with nephropathy (1.45 (1.11-1.91), 0.007) and neuropathy (1.32 (1.03-1.69), 0.029). Lower Z-score FEV 1 /FVC ratio was not significantly associated with microvascular complications in age and sex and fully adjusted models., Conclusion: Our study shows positive but varying strengths of associations between pulmonary dysfunction and microvascular complications in different circulations. Future studies could explore the mechanisms linking pulmonary dysfunction to microvascular complications in T2D., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2023. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Background: Physical exercise aids glycemic control and the prevention of diabetes-related complications. However, exercise beyond an individual's pulmonary functional capacity may be detrimental. To date, little is known about the relationship between pulmonary function and exercise capacity in people with type 2 diabetes (T2D). We investigated the relationship between pulmonary function and exercise capacity in T2D., Methods: Spirometry and 6-min walk test (6MWT) were conducted for 263 systematically sampled adults with T2D without primary heart/lung disease. The primary measure of exercise capacity was the 6-min walk distance (6MWD); impaired exercise capacity was defined as 6MWD<400 m. Logistic regression analyses were used to assess the associations between spirometric measures and exercise capacity with adjustments for age, sex, height, body mass index, diabetes duration, glycated hemoglobin concentration, smoking, suboptimum blood pressure control, and total cholesterol concentration., Results: Compared with individuals with normal spirometry, those with pulmonary restriction/obstruction had significantly lower 6MWD (404.67 m vs. 451.70),p < 0.001). The proportion of individuals with impaired exercise capacity was higher in individuals with impaired pulmonary function compared with those with normal pulmonary function (39.8% vs. 20.7%,p = 0.001). In the unadjusted models, decreasing Z-score FEV 1 [odds ratio 1.40, 95% confidence interval (1.07-1.83),p = 0.013] and Z-score FVC [1.37 (1.06-1.76),0.016], but not Z-score FEV 1 /FVC ratio [1.00 (0.78-1.27),0.972] were significantly associated with impaired exercise capacity. In the fully adjusted model, the strength of association remained statistically significant for Z-score FEV 1 [1.60 (1.06-2.41),0.025] but not Z-score FVC [1.48 (0.98-2.23),0.065]., Conclusions: Our study shows inverse associations between FEV 1 and impaired exercise capacity in T2D, Future research could characterize optimal exercise levels based on a patient's FEV 1 ., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Background: There is an increasing prevalence of cardiovascular diseases (CVDs) and risk factors in HIV patients as the levels of AIDS-related mortality and morbidity decrease. Metabolic syndrome (MetS) is the accumulation of various CVD risk factors that predict the occurrence of CVDs. We investigated the prevalence of MetS and associated risk factors in HIV patients treated with combination antiretroviral therapy (cART), cART-naïve HIV patients, and non-HIV controls., Methods: In a case-control design, 158 cART-treated HIV patients, 150 cART-naïve HIV patients, and 156 non-HIV controls were recruited from a periurban hospital in Ghana. A structured questionnaire was used to collect data on demography, lifestyle, and medication. Anthropometric indices and blood pressure were measured. Fasting blood samples were collected to measure the plasma levels of glucose, lipid profile, and CD4+ cells. The presence of MetS was defined using the joint scientific statement criteria., Results: The prevalence of MetS was higher in cART-treated HIV patients compared with cART-naïve HIV patients and non-HIV controls (57.3% vs. 23.6% vs. 19.2% and p < 0.001, respectively). MetS was associated with cART-treated HIV patients (odds ratio (95% CI) = 7.24 (3.41-15.39) and p < 0.001), cART-naïve HIV patients (2.04 (1.01-4.15), p =0.048), and female gender (2.42 (1.39-4.23) and p =0.002). In cART-treated HIV patients, those on zidovudine (AZT)-based regimens were associated with increased likelihood (3.95 (1.49-10.43) and p < 0.006), while those on tenofovir (TDF)-based had decreased likelihood (0.32 (0.13-0.8) and p =0.015) of having MetS., Conclusion: In our study population, there was a high prevalence of MetS in cART-treated HIV patients compared to cART-naïve HIV patients and non-HIV controls. HIV patients on AZT-based regimens had an increased likelihood of having MetS, while those on TDF-based regimens had a reduced likelihood of having MetS., Competing Interests: The authors declare that they have no conflicts of interest., (Copyright © 2023 Bartholomew Dzudzor et al.)

In Africa, the maternal mortality rate in sickle cell disease (SCD) is ~10%. Our team previously demonstrated an 89% decrease in mortality rate in a before-and-after feasibility study among women with SCD living in low-resource setting in Ghana. In the same cohort including additional participants with and without SCD, we used a prospective cohort design to test the hypothesis that implementing a multidisciplinary care team for pregnant women with SCD in low-resource setting will result in similar maternal and perinatal mortality rates compared to women without SCD. We prospectively enrolled pregnant women with and without SCD or trait and followed them up for 6-week postpartum. We tested the newborns of mothers with SCD for SCD. We recruited age and parity matched pregnant women without SCD or trait as the comparison group. Maternal and perinatal mortality rates were the primary outcomes. A total of 149 pregnant women with SCD (HbSS, 54; HbSC, 95) and 117 pregnant women without SCD or trait were included in the analysis. Post-intervention, maternal mortality rates were 1.3% and 0.9% in women with and without SCD, respectively (P = 1.00); the perinatal mortality rates were 7.4% and 3.4% for women with and without SCD, respectively (P = 0.164). Among the mothers with SCD, ~15% of newborns had SCD. Multidisciplinary care of pregnant women with SCD may reduce maternal and perinatal mortality rates to similar levels in pregnant women without SCD in low-resource settings. Newborns of mothers with SCD have a high rate of SCD., (© 2018 Wiley Periodicals, Inc.)

Sickle cell disease (SCD) is associated with adverse pregnancy outcome. In women with SCD living in low-resource settings, pregnancy is associated with significantly increased maternal and perinatal mortality rates. We tested the hypothesis that implementing a multidisciplinary obstetric and hematology care team in a low-resource setting would significantly reduce maternal and perinatal mortality rates. We conducted a before-and-after study, at the Korle-Bu Teaching Hospital in Accra, Ghana, to evaluate the effect of a multidisciplinary obstetric-hematology care team for women with SCD in a combined SCD-Obstetric Clinic. The pre-intervention period was assessed through a retrospective chart review to identify every death and the post-intervention period was assessed prospectively. Interventions consisted of joint obstetrician and hematologist outpatient and acute inpatient reviews, close maternal and fetal surveillance, and simple protocols for management of acute chest syndrome and acute pain episodes. Primary outcomes included maternal and perinatal mortality rates before and after the study period. A total of 158 and 90 pregnant women with SCD were evaluated in the pre- and post- intervention periods, respectively. The maternal mortality rate decreased from 10 791 per 100 000 live births at pre-intervention to 1176 per 100 000 at post-intervention, representing a risk reduction of 89.1% (P = 0.007). Perinatal mortality decreased from 60.8 per 1000 total births at pre-intervention to 23.0 per 1000 at post-intervention, representing a risk reduction of 62.2% (P = 0.20). A multidisciplinary obstetric and hematology team approach can dramatically reduce maternal and perinatal mortality in a low-resource setting., (© 2017 Wiley Periodicals, Inc.)