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This study explores the complex nature of female genital mutilation/cutting (FGM/C) by juxtaposing the mental and sexual health of women who had undergone FGM/C as part of initiation/membership into a traditional women's society (TWS) with those who were also cut but not initiated into a TWS. While considerable differences emerged between TWS members and nonmembers, there was no evidence that TWS membership was protective against the physical and psychological trauma typically ascribed to FGM/C. In fact, the pattern of results would tend to suggest the opposite. Possible explanations for and implications of these findings are discussed. [ABSTRACT FROM AUTHOR]

This article explores the racial politics around African colonial subjects in Spain during the second half of the nineteenth century. Between the 1840s and the 1880s, colonial authorities brought to the metropole small groups of Africans from the Gulf of Guinea with the goal of turning them into hispanicized agents of colonization upon return to their communities. Drawing on official documents, newspapers and travel narratives I examine how the representations of the first groups reveal how Spain was moving from a model of social categorization based on monogenetic theories to a new paradigm influenced by the rise of scientific racism, albeit ideas from both would frequently converge. I will also argue that the mutable and unstable representations of African bodies correlate with the politicization of race, sometimes eluding depictions of physical features, while at other times showcasing them to construct an idea of racial difference. [ABSTRACT FROM AUTHOR]

Background: Pursuant to studies, receiving the three key maternal health services (Antenatal Care, Skilled Delivery Service, and Postnatal Care) in a continuum could prevent 71% of global maternal deaths. Despite the Western African region being known for its high maternal death and poor access to maternal health services, there is a dearth of studies that delve into the spectrum of maternal health services uptake. Hence, this study aimed to assess the level and predictors of partial and adequate utilization of health services in a single analytical model using the most recent Demographic and Health Survey (DHS) data (2013–2021). Methods: This study was based on the appended women's (IR) file of twelve West African countries. STATA software version 16 was used to analyze a weighted sample of 89,504 women aged 15–49 years. A composite index of maternal health service utilization has been created by combining three key health services and categorizing them into 'no', 'partial', or 'adequate' use. A multilevel multivariable multinomial logistic regression analysis was carried out to examine the effects of each predictor on the level of service utilization. The degree of association was reported using the adjusted relative risk ratio (aRRR) with a corresponding 95% confidence interval, and statistical significance was declared at p < 0.05. Results: 66.4% (95% CI: 64.9, 67.7) and 23.8% (95% CI: 23.3, 24.2) of women used maternal health services partially and adequately, respectively. Togo has the highest proportion of women getting adequate health care in the region, at 56.7%, while Nigeria has the lowest proportion, at 11%. Maternal education, residence, wealth index, parity, media exposure (to radio and television), enrolment in health insurance schemes, attitude towards wife beating, and autonomy in decision-making were identified as significant predictors of partial and adequate maternal health service uptake. Conclusion: The uptake of adequate maternal health services in the region was found to be low. Stakeholders should plan for and implement interventions that increase women's autonomy. Program planners and healthcare providers should give due emphasis to those women with no formal education and from low-income families. The government and the private sectors need to collaborate to improve media access and increase public enrolment in health insurance schemes. [ABSTRACT FROM AUTHOR]

In the intake records of the Foundling Hospital in Florence between 1445 and 1453, only two infants, out of almost three hundred, were marked as "ghezzo" and "nero," meaning dark-skinned and Black. At the same time, about fifty percent of the children left there were the children of enslaved women, who accounted for ninety-two percent of the enslaved population of Florence. While archival documents have not yet shown evidence of enslaved West Africans arriving in Florence before 1462, the Foundling Hospital records demonstrate the pervasiveness of Black and White boundaries as a site of difference. The use of epidermal descriptors, hereditary racialization, and gender division in a single archival record reveals the necessity of an intersectional approach to the study of enslavement. My article applies premodern critical race studies (PCRS) to archival documents by examining the language Florentines used for enslaved domestic servants in their sale, in their daily lives, and in describing their offspring. Through an examination of racialized terminology in the Florentine archives, I argue that considerations of race and race-thinking should now form a part of any scholarly analysis of this late medieval Tuscan city. The formulations of racial languages are found in the daily interactions and relationships of Florentines, especially women, with enslaved domestic laborers. I conclude that women, both enslaved and free, were instrumental to race-thinking in Florence. Since race in the late medieval Mediterranean was written on the canvas of female bodies and their productive capabilities, its study necessitates a close analysis of the words used about and by women. [ABSTRACT FROM AUTHOR]

We report midline impacts of a community-randomized cash transfer intervention to 1857 vulnerable mothers in 140 rural cocoa-farming communities of Côte d'Ivoire. Compared to mothers in the comparison group who participated in village savings and loan associations (VSLAs), treatment mothers participated in VSLAs and received 8 € each week for up to one year with no conditions attached (the midway point of a two-year program). We find small- to moderate-sized treatment effects on four of six indicators of economic well-being (d = 0.23–0.75), as well as small reductions in maternal stress (d = −0.27). We find no statistically detectable impacts on educational engagement, educational aspirations, or educational expectations for children. Results suggest that cash transfer programs in rural West African communities can improve economic well-being and reduce maternal stress. Implications for children and families and for future cash transfer evaluations are discussed. [ABSTRACT FROM AUTHOR]

Background: Female genital mutilation affects an estimated 200 million women and girls worldwide. This article examines a midwife-led service that integrates health advocates and counsellors into a model of holistic woman-centred care and was the blueprint for new national clinics opened in 2019. Methods: This retrospective case note review examined referral patterns, clinical findings and interventions over 11 years at a UK specialist clinic for non-pregnant women with female genital mutilation. Results: More than 2000 consultations were conducted. Two thirds of women had type 3 mutilation. Most were Somali (73.4%) with 18 other ethnic backgrounds represented. Women presented with dysuria, dyspareunia/apareunia, dysmenorrhea, recurrent infections, post-traumatic stress disorder, nightmares, flashbacks and psychosexual issues. Interventions included deinfibulation under local anaesthetic (many as same day walk-in cases), clinical reports for asylum applications and trauma counselling. One in 10 attendees were healthcare professionals/carers. Nearly 5% were refugees/asylum seekers. There were 12 safeguarding referrals, three cases of mandatory reporting duty and two protection orders. Intersectional violence was frequently reported among women of West African origin. Conclusions: Significant numbers of non-pregnant women require specialist help. Innovative means to publicise clinics and routine enquiry during gynaecological consultations and GP registration, could ensure earlier signposting to services. Deinfibulation can be safely performed by an expert midwife in a community or outpatient setting. [ABSTRACT FROM AUTHOR]

Existing literary studies on migration and diaspora have mostly concentrated on issues affecting the homeland, questions of identity, memory, belonging and longing, and the politics of location across borders. Cross-sub continental comparison between south Asians and West African migrants' lived experiences seem to be less under the radar. However, since diaspora space represents an intersection of cultures, peoples, religions and psychic processes, this paper attempts to comparatively explore the processes that plunge migrants into an unsettling liminal space of unwelcome using Nadeem Aslam's Maps for Lost Lovers from South Asia and Chimamanda Ngozi Adichie's Americanah from West Africa. The engagement of these works from both divides is to explore the contours inherent when people are dislocated from their homeland attempting to navigate their ways in the new world. The impetus is to examine the geographical peculiarities that heighten the tension of migrants on one hand and the contest of cultural beliefs especially, religious practices that portend a distortion of identity, alienation and create tension between characters in the novels. The study divulges that the perception of the migrants about the flora and fauna from both subcontinents are similar and it heightens the feeling of alienation in diaspora on one hand and on the other, the differences in cultural systems create a tension especially among the characters of Islamic background. It is concluded that for Muslims living in the west, religio-cultural conflict is major signifier in the contests that are inherent in diaspora space. [ABSTRACT FROM AUTHOR]

Agricultural development projects increasingly aim to improve health and nutrition outcomes, often by engaging women. Although evidence shows such projects can improve women's and children's health and nutrition and empower women, little is known about their impacts on women's health- and nutrition-related agency and the extent to which impacts emerge through women's empowerment, largely due to a lack of instruments that measure the dimensions of women's agency that are directly relevant to health and nutrition outcomes. We developed an optional, complementary module for the project-level women's empowerment in agriculture index (pro- WEAI) to measure health- and nutrition-related agency (pro-WEAI + HN). Our method for developing related indicators used data collected from six agricultural development programmes implemented across Bangladesh, Burkina Faso and Mali (pooled sample = 12,114) and applied psychometric analysis (exploratory and confirmatory factor analysis) and the Alkire-Foster methodology. Results revealed seven indicators covering women's agency in the areas of her own health and diet; her health and diet during pregnancy; her child's diet; breastfeeding and weaning; purchasing food and health products; and acquiring food and health products. Multigroup confirmatory factor analysis revealed measurement invariance across contexts and samples. Tests of association (Cramer's V) and redundancy suggest that the pro-WEAI + HN indicators measured aspects of agency that are distinct from the core pro-WEAI. The uptake of these indicators in studies of nutrition-sensitive agricultural development projects may strengthen the evidence on how such programming can enhance women's empowerment to improve health and nutrition outcomes for themselves and their children. [ABSTRACT FROM AUTHOR]

Background: Studies assessing the concordance of albuminuria and retinal microvascular dysfunction (RMD) in type 2 diabetes (T2D) have yielded inconsistent results. Similar to ethnicity, hypertension may be a potential explanatory variable. We compared the association between albuminuria and RMD in West Africans with T2D with and without hypertension. Materials and methods: This was a cross-sectional study among 177 systematically sampled Ghanaians with T2D aged ≥ 35 years. Albuminuria was based on urinary albumin-creatinine ratio≥30 mg/g. Retinal images were analyzed and graded according to the Early Treatment Diabetic Retinopathy Study criteria. Logistic regression was used to examine the associations of albuminuria and RMD with adjustments for age, sex, socioeconomic status, diabetes duration, HbA1c, smoking, systolic blood pressure (BP), BMI, and total cholesterol. Results: RMD was more prevalent in individuals with albuminuria than in those without albuminuria (41.7% vs. 24.0%, p = 0.026). In the fully adjusted model, albuminuria remained significantly associated with RMD (odds ratio 2.41[95% CI:1.00–5.80], p = 0.049); the association between albuminuria and RMD was more pronounced in individuals with hypertension (3.10 [1.01–9.50], 0.048) than without hypertension (1.70[0.33–8.77],0.523). In analyses stratified by BP control, albuminuria was significantly associated with RMD in individuals with suboptimal BP (2.76[1.07–7.14], 0.037) but not in individuals with optimal BP (0.24[0.00–17.04],0.512) Conclusion: Our study shows positive associations between albuminuria and RMD among West Africans with T2D, with the strength of association, accentuated in individuals with hypertension/suboptimal BP. Future studies could further characterize the role of hypertension in the associations between albuminuria and RMD.

Evidence from implementation research suggests that group-based behaviour change interventions (GBCIs) can encourage the development of peer support, promote psychosocial skills, and facilitate collaborative therapeutic relationships. However, although the mechanisms of action that mediate the behaviour change process have been extensively described in other settings, less is known about the implementation strategies and contextual factors that actuate the reported behaviour changes among programme participants in Ghana and sub-Saharan Africa, more generally. We draw on insights from the literature and field experiences from designing, implementing, and evaluating GBCIs across several rural and peri-urban communities in Ghana to discuss a range of theoretical, methodological, and contextual factors that facilitate the behaviour change process in programme participants. We offer suggestions to guide researchers to envision and manage potential challenges with the programme development and implementation processes. We propose that intervention programmes designed to facilitate health behaviour change in the defined context should (i) have a context-relevant focus, (ii) be coherent and well-structured, (iii) have explicit techniques to facilitate inter-personal and intra-personal change processes, (iv) include appropriate mechanisms to monitor and assess the progress of the interventional sessions; and (v) be implemented by trained facilitators with a deep knowledge of the sociocultural values and norms of the target group and of the principles and theories underlying the intervention programme. We envisage that these insights could serve to guide the design, implementation, and evaluation of contextually-tailored and potentially effective GBCIs that align with the needs, capacities, and circumstances of the local population. [ABSTRACT FROM AUTHOR]

Background: The relationship of diet with stroke risk among Africans is not well understood. Aim: The aim of this study was to investigate the association between dietary patterns and stroke risk among West Africans. Methods: In this multi-center case–control study, 3684 stroke patients matched (for age and sex) with 3684 healthy controls were recruited from Nigeria and Ghana. Food consumption was assessed using a food frequency questionnaire, and dietary patterns were summarized using principal component analysis. Stroke was defined using predefined criteria primarily on clinical evaluation following standard guidelines. Conditional logistic regression was applied to compute odds ratio (OR) and 95% confidence interval (CI) for stroke risk by tertiles of dietary patterns adjusting for relevant confounders. Results: Overall, mean age was 59.0 ± 13.9 years, and 3992 (54.2%) were males. Seven dietary patterns were identified. Multivariable-adjusted OR (95% CI) for risk of stroke by second and third tertiles (using the lowest and first tertile as reference) of dietary patterns was 1.65 (1.43, 1.90) and 1.74 (1.51, 2.02), for "poultry product and organ meat"; 1.69 (1.47, 1.96) and 1.51 (1.31, 1.75) for "red meat"; 1.07 (0.92, 1.23) and 1.21 (1.04, 1.40) for "fried foods and sweetened drinks"; 0.69 (0.60, 0.80) and 0.45 (0.39, 0.53) for "vegetables"; 0.84 (0.72, 0.97) and 0.81 (0.70, 0.93) for "whole-grain and fruit drinks"; and 0.97 (0.84, 1.12) and 0.85 (0.73, 0.98) for "fruits" respectively (p < 0.05). Conclusion: These data suggest that plant-based diets are associated with a lower risk of stroke and might be a beneficial dietary recommendation for the primary prevention of stroke among Africans. Graphical abstract [ABSTRACT FROM AUTHOR]

This is a Lewinian-field-theory approach to understanding the Graduate Record Examination (GRE) in the context of racism to contribute to the debate about whether graduate schools should remove GRE scores from admissions processes. Woo and colleagues (this issue) review the empirical literature on bias from a psychometric perspective. In this commentary, I challenge the definition of the underlying construct measured by the GRE and offer alternative definitions of what is measured. Next, drawing on an analogy from genome-wide association studies, I discuss how genomic models predicting height that are trained on data from European ancestral populations systematically underpredict the height of West Africans. Our access to data from tape measures, and their correlation with height, provide objective opportunities to audit our prediction. I discuss the implications of this when the criterion variable for validating the GRE is first-year grades. I then probe an analogy used by Woo and colleagues in which they assert that blaming the GRE for disparities in scores across groups is akin to blaming the thermometer for global warming. I describe racism as context for a field-theory approach to thinking about the limitations of this misguided analogy. Finally, I suggest pathways forward. [ABSTRACT FROM AUTHOR]

The article presents a case study of a young 26-year-old Nigerian man who presented with a 3-year history of itchy skin lesions with centrifugal growth. The clinical diagnosis of tinea corporis was confirmed by direct microscopy and fungal culture of skin scrapings, with the identification of "Trichophyton rubrum." Treatment included terbinafine with the almost total disappearance of the lesions in three months leading to the replacement of terbinafine with fluconazole for an additional month.

Immigration scholars and religious studies scholars have explored generational changes in religiosity. Less clear is the significance of religion in the lives of Black immigrant second-generation youth. Moreover, while there is research on intraracial boundary-negotiations between Black Americans and Black immigrants in the United States, it is rarely discussed in the context of religion. Drawing on interviews with seventy one second-generation West African teenagers in New York City, this paper explores the role of religion in the integration of Black immigrant second-generation youth. I find that religion is a primary tool through which ethnoracial boundaries are maintained between the children of West African immigrants and their Black American counterparts. I spotlight three means through which religion matters for ethnoracial boundaries: congregational demographics, religious codes of conduct and Islamophobia. Collectively, these findings demonstrate that religion is a key component of second-generation ethnoracial identity-formation. [ABSTRACT FROM AUTHOR]

Objectives: We report the association between pre‐antiretroviral therapy (pre‐ART) soluble vascular cell adhesion molecule‐1 (sVCAM‐1) levels and long‐term mortality in HIV‐infected West African adults participating in a trial of early ART in West Africa (Temprano ANRS 12136 trial). Methods: The ART‐naïve HIV‐infected adults were randomly assigned to start ART immediately or defer ART until the WHO criteria were met. Participants who completed the trial follow‐up were invited to participate in a post‐trial phase (PTP). The PTP end‐point was all‐cause death. We used multivariable Cox proportional models to analyse the association between baseline sVCAM‐1 and all‐cause death, adjusting for ART strategy, sex, CD4 count, plasma HIV‐1 RNA and peripheral blood mononuclear cell HIV‐1 DNA levels. Results: In all, 954 adults (77% women, median CD4 count of 387 cells/μL) were randomly assigned to start ART immediately (n = 477) or to defer initiation of ART (n = 477). They were followed for a median of 5.8 years [interquartile range (IQR): 5.2–6.3]. In multivariable analysis, the risk of death was significantly associated with baseline sVCAM‐1 [≥1458 vs. < 1458 ng/mL; adjusted hazard ratio = 2.86, 95% confidence interval (CI): 1.60–5.11]. The 6‐year probability of death rates were 14.4% (95%CI: 9.1–22.6) and 9.4% (5.4–16.1) in patients with baseline sVCAM‐1 ≥ 1458 ng/mL randomized to deferred and immediate ART, respectively, and 3.8% (2.2–6.5) and 3.5% (1.9–6.3) in patients with baseline sVCAM‐1 < 1458 ng/mL randomized to deferred and immediate ART. The median difference between pre‐ART and 12‐month sVCAM‐1 levels in patients randomized to immediate ART was −252 (IQR: −587 to −61). Conclusions: Pre‐ART sVCAM‐1 levels were significantly associated with mortality, independently of whether ART was started immediately or deferred, but they significantly decreased after 12 months of ART. [ABSTRACT FROM AUTHOR]

Background: Type 2 diabetes mellitus (T2DM) is becoming one of the leading causes of morbidity and mortality worldwide, including among Africans. Knowledge of the association between traditional risk factors and both diabetes and pre-diabetes, and whether these differ by age and sex, is important for designing targeted interventions. However, little is known about these associations for African populations.Methods: The study used data from WHO STEPS surveys, comprising 15,520 participants (6,774 men and 8,746 women) aged 25-64 years, from 5 different West African countries, namely Burkina Faso (4,711), Benin (3,816), Mali (1,772), Liberia (2,594), and Ghana (2,662). T-test and chi-square tests were used to compare differences in the prevalence of traditional risk factors for both sexes. Multinomial logistic regression was conducted to ascertain the relative risks (RR) and 95% confidence intervals (CI) for both T2DM and impaired fasting glucose (IFG) relating to each risk factor, including obesity [defined by BMI, waist circumference (WC), waist-to-hip ratio (WHR), and waist-to-height ratio (WHtR)], high blood pressure (HBP), fruit and vegetable consumption, physical inactivity, alcohol consumption, and smoking. Models for each of these traditional risk factors and interactions with age and sex were fitted.Results: Factors associated with T2DM and IFG were age, obesity [defined by BMI, WC, WHtR, and WHR], HBP, smoking, physical inactivity, and fruit and vegetable consumption (p < 0.05). Analysis of interaction effects showed few significant differences in associations between risk factors and T2DM according to age or sex. Significant interaction with age was observed for HBP*age and T2DM [RR; 1.20, 95% CI: (1.01, 1.42)) (p = 0.04)], WHtR*age and T2DM [RR; 1.23, 95% CI: (1.06, 1.44) (p = 0.007)] and WHR*age and IFG [RR: 0.79, 95% CI: (0.67, 0.94) (p = 0.006)]. Some interactions with age and sex were observed for the association of alcohol consumption and both IFG and T2DM, but no clear patterns were observed.Conclusion: The study found that with very few exceptions, associations between traditional risk factors examined and both IFG and T2DM did not vary by age or sex among the West African population. Policies and public health intervention strategies for the prevention of T2DM and IFG should target adults of any age or sex in West Africa. [ABSTRACT FROM AUTHOR]

Background: The coronavirus disease (COVID-19) outbreak has caused a universal health crisis resulting in significant morbidities and mortalities particularly among high-risk groups. This study sought to determine regional factors associated with knowledge and attitude towards COVID-19 mitigation practices and risk perception of contracting the disease in Sub-Saharan African (SSA) countries. Methods: A cross-sectional anonymous online study was conducted among 1970 participants between April and May 2020, during the lockdown in many SSA countries. Recruitment of participants was via WhatsApp, Facebook and emails using authors' networks. The outcome variables were KAP (knowledge, attitudes and practice) of COVID-19 and analysis of variance (ANOVA) with post hoc test was run to assess the level of KAP by four regions in SSA. Simple and multiple linear regression (MLR) analyses were performed to examine factors associated with the outcome measures in the four SSA regions. Results: Mean knowledge (P = 0.707) and risk perception (P = 0.904) scores by four regions in SSA did not differ significantly. However, the mean attitude score was higher among West Africans compared with Southern (P = 0.019) and Central Africans (P = 0.003). MLR analysis revealed that among those living in West (adjusted coefficient β = -0.83 95% CI: -1.19, -0.48) and Southern Africa (β = -0.91 95% CI: -1.42, -0.40), having a primary or secondary education was associated with a decrease in knowledge scores while not being worried about COVID-19 decreased risk perception scores across the four SSA regions(West [β = -6.57, 95% CI: -7.53, -5.62], East [β = -6.24: 95% CI: -8.34,-4.15], Central [β = -6.51, 95% CI: -8.70, -4.31], and Southern Africa [β = -6.06: 95% CI: -7.51, -4.60]). Except among Southern Africans, participants who practiced self-isolation had positive attitude towards COVID-19. Conclusion: Future research on health education regarding COVID-19 or a future related pandemic in SSA should target people with lower education, those who do not self-isolate, those living in Southern and Western Africa and not worried about contracting COVID-19. [ABSTRACT FROM AUTHOR]

Background: Asymptomatic HIV-infected people who start ART early may feel less motivated and neglect compliance. This might promote the emergence of resistance.Methods: In the Temprano trial, ART-naive HIV-infected adults with high CD4 counts were randomly assigned to start ART immediately (immediate group) or defer ART until the WHO criteria were met (deferred group). All participants were monitored for 30 months. Those in the deferred group who started ART were monitored for longer, until they had completed 30 months on ART. We compared the rate of virological failure and drug resistance between the immediate and deferred groups 30 months after ART initiation.Results: Of the 2056 participants in Temprano, 1033 were assigned to start ART immediately and 1023 to defer ART. Of the latter, 488 started ART during trial follow-up. Patients in the deferred group who started ART had a lower median CD4 count (280 versus 465 cells/mm3) and a higher median plasma HIV-1 RNA (5.1 versus 4.7 log10 copies/mL) at baseline. During follow-up, participants in both groups had similar antiretroviral drug exposure. Thirty months after ART initiation, patients in the deferred group had a higher rate of virological failure (35.3% versus 29.9%, P = 0.04) and a lower genotypic susceptibility score (P = 0.04).Conclusions: Starting ART early decreases the risk of virological failure and drug resistance in the medium term. This benefit is of particular importance in countries where access to viral load monitoring and the number of antiretroviral drug lines is limited. [ABSTRACT FROM AUTHOR]

An in-depth understanding of the impact of aging, cognitive reserve, and HIV status on cognitive function is needed in older West African adults. Ninety-nine HIV-negative and 334 HIV-positive adults aged ≥ 50 years were enrolled in three clinics (Senegal and Côte d'Ivoire) participating in the IeDEA West Africa collaboration. All subjects underwent the Free and Cued Selective Reminding Test (FCSRT) and the Isaacs Set Test (IST). Age (both linear and quadratic), education level, and HIV status effects on Z-scores were assessed using multivariate linear regression models. Interactions between HIV status and age or educational level were tested. In the present cohort of older West African adults, the role of age and educational level on episodic memory and verbal fluency was observed without revealing an interaction between HIV status and age effect. As age had quadratic effects, older HIV-positive adults should not be considered as a unique group irrespective of their age. Low-educated HIV-positive patients had the lowest verbal fluency performance compared to others. Further studies are needed to duplicate these results. In clinical settings, screening and adapted programs focusing on improving cognition in those patients are needed. [ABSTRACT FROM AUTHOR]

This essay examines the histories of two enslaved Africans living in Cuba and sent to prison in the mid-nineteenth century, to consider the ways in which prison represented a path to freedom within and beyond slave societies. Formerly enslaved people in Cuba and Puerto Rico, released from bondage upon entering the carceral system, were often resold into slavery upon completion of their prison sentences – but not always. The essay focuses first on the case of Gregorio Lucumí, imprisoned in Cuba, whose civil status post-sentence was debated by authorities seeking to discourage crime as a means to secure prison sentences that might yield freedom from slavery. It then turns to the lengthier case of Isidoro Gangá, sent to prison in Melilla, North Africa, and who, post-sentence, appealed for freedom via free soil principles. [ABSTRACT FROM AUTHOR]

Olusola Olawoye,1,2 Tarela Sarimiye,1,2 Adeyinka Ashaye,1,2 Young Hoon Hwang,3 Jong Chul Han,4 Byung Heon Ahn3 1Department of Ophthalmology, College of Medicine, University of Ibadan, 2Department of Ophthalmology, University College Hospital, Ibadan, Nigeria; 3Department of Ophthalmology, Konyang University, Kim’s Eye Hospital, Myung-Gok Eye Research Institute, 4Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University, School of Medicine, Seoul, South Korea Purpose: The aim of this study was to report the safety and efficacy of the membrane-tube (MT)-type glaucoma shunt device (Finetube MT) in the management of refractory glaucoma in indigenous West Africans.Methods: The Finetube MT was implanted into 25 eyes of 25 West African patients with refractory glaucoma. These patients had inadequate intraocular pressure (IOP) control despite maximum tolerable IOP-lowering medications with or without previous ocular surgeries. IOP, postoperative complications, interventions, visual acuities, and the number of IOP-lowering medications were analyzed preoperatively and postoperatively.Results: The mean (standard deviation [SD]) age of the patients was 49.7 (20.9) years. The mean (SD) follow-up duration was 21.0 (10.6) months. Postoperatively, the mean (SD) IOP reduced from a preoperative value of 38.1 (10.3) mmHg to 14.5 (4.6), 16.1 (7.8), and 14.7 (3.0) mmHg at 1, 2, and 3 years postoperatively, respectively, representing 61.9%, 57.7%, and 61.4% reduction from baseline (P

Public health professionals may be confronted with unique ethical challenges in outbreak response situations. We conducted interviews with twenty-two public health professionals involved in responses to the 2014–2015 Ebola epidemic in Sierra Leone and Liberia to explore how they understood and experienced the ethical challenges involved in this work. The concerns covered in these interviews ranged dramatically, but three themes emerged as unique contributions from a subset of individuals integrally involved with the frontline response, who framed concerns about representation as key ethical issues. These included concerns regarding misrepresentations of West Africans as 'resistant' to the epidemic response, failures in material and information resources provided in the response, and representations of 'rationality' between responders and publics. Such concerns suggest that perspectives advanced in the critical public health literature in recent decades are circulating amongst public health professionals involved in outbreak response, although discord amongst respondents suggests the need for more deliberate efforts to reframe thinking about resistance, resources, and rationality in future public health outbreak responses. [ABSTRACT FROM AUTHOR]

The outbreak of the novel coronavirus pandemic, otherwise known as COVID-19 brought about the use of new terminologies—new lexical items such as social distancing, self-isolation, and lockdown. In developed countries, basic social amenities to support these are taken for granted; this is not the case in West African countries. Instead, those suggested safeguards against contracting COVID-19 have exposed the infrastructural deficit in West African countries. In addition, and more profoundly, these safeguards against the disease have distorted the traditional community-individuality balance. The enforcement of social distancing, self-isolation, and lockdown has made it impossible for West Africans to drift to their ancestral homes and villages, as is usually the case in times of crisis, with attendant consequences for communal life and traditional burial rites. This could be one of the reasons why some COVID-19 patients are escaping from isolation centres, since to die in such centres violates their bodily integrity at an ontological level. [ABSTRACT FROM AUTHOR]

Background/Context: This conceptual essay contributes to recent education research on immigrant youth from West African countries that examines the interplay of popularized narratives of immigrant youth and young adults, and their Diasporic literacy practices. Specifically, we examine embodied Diaspora literacies as affirming and extending presences and absences of Black immigrant bodies across two contexts: an after-school African Club, and a qualitative inquiry of civic learning and action-taking of immigrant youth and young adults from West African countries. Purpose: We theorize in this conceptual essay the interplay of the humanity of Black immigrant youth and young adults and their embodied Diaspora literacy practices. We highlight possibilities for research, literacy teaching, and teacher education when intentionally naming, affirming, and building with the humanity of Black immigrant youth and young adults from West African countries--what we conceptualize as humanizing the Black immigrant body. We conceptualize humanizing the Black immigrant body as an enacting of embodied Diaspora literacies. In theorizing embodied Diaspora literacies, we build with African Indigenous lensings, and African, Black, and Chicana/Latina feminisms. We further contextualize humanizing the Black immigrant body as an enacting of embodied Diaspora literacies expressed in the creative and artistic practices and artifacts of artists, literary authors, playwrights, and youth and young adults who have long authored and told narratives that affirm, extend, and historicize the strengths of Black immigrant communities. Interpretive Analysis: We highlight in this conceptual essay the urgency of humanizing the Black immigrant body across four moments, or tellings of embodied Diaspora literacies. Our use of Diasporic tellings, an intentional naming and humanizing research approach, draws on the words of Chinua Achebe, the Nigerian author who reflected on the urgency of a global "balance of stories." We examine four Diasporic tellings: (1) youth in an African Club in a high school in New York City attending an off-Broadway play authored by a daughter of Ghanaian immigrants, (2) participating in a group discussion following the play, and (3) engaging in Youth Participatory Action Research inquiries; and (4) youth and young adults from West African countries discussing their creative and artistic embodied Diaspora literacies, and civic learning and action-taking across contexts of peers, schooling, and families. Conclusion / Recommendations: We theorize humanizing the Black immigrant body as a vibrant, necessary research and teaching stance to recognize the humanity of Black immigrant youth who daily negotiate and render visible their language and literacy practices. These practices comprise the coalescing of Black immigrant bodies, discursive perspectives, and material artifacts of teaching and learning, and their racialized, social, and educational experiences across contexts of schools and communities. These Diasporic tellings provide important insights for productive approaches in research, teaching, and teacher education with youth and young adults making sense of the lives of Black immigrants, across contexts of literacy learning and lived experiences that meaningfully recognize the humanity of Black immigrant youth from West African countries. [ABSTRACT FROM AUTHOR]

This article reports findings of a research study that examined how black Muslim women seek help for domestic violence. A sample comprised of six black Muslim women, four African American and two West African, completed a series of in-depth interviews about their experiences. Data was analyzed using grounded theory methodology. Four overarching help-seeking strategies emerged: family and/or friends, religion and/or spirituality, services, legal system. Participants revealed what initiated or prevented their use of these strategies, as well as the outcome of strategy utilization. Implications for research and practice are discussed. [ABSTRACT FROM AUTHOR]

Systolic (SBP) and diastolic blood pressure (DBP) are commonly used for cardiovascular disease (CVD) risk prediction, and pulse pressure (PP) and mean arterial blood pressure (MAP) can provide additional information. It is therefore important to understand the factors associated with these cardiovascular risk markers. This cross-sectional study involved 1839 men and women aged 40–60 years. Data on SBP, DBP, MAP, PP, sociodemography, lifestyle, anthropometry, and lipids were collected. Gender-stratified linear regression analyses were performed to determine the association between log-transformed blood pressure indices and the study variables. Age was associated with all measured blood pressure indices (p < 0.001) among men and women. Men had higher SBP (p = 0.007) and PP (p < 0.001) than women. Nankana ethnicity was associated with higher PP levels (p < 0.005) in the total population. Vendor meal consumption among women was associated with higher PP levels (p < 0.05). Fruit intake among men was associated with lower PP levels (p < 0.05). Currently unmarried women had higher SBP (p < 0.005), DBP (p < 0.05), MAP (p < 0.005), and PP (p < 0.005) than currently married women. Pesticide exposure was negatively associated with SBP (p < 0.005), DBP (p < 0.005), MAP (p < 0.005), and PP (p < 0.05) among women. Increased subcutaneous fat was associated with DBP (p < 0.005) and MAP (p < 0.05) among women. Among men, hip circumference was associated with higher DBP and MAP (p < 0.05 for both associations), subcutaneous fat associated with higher SBP (p < 0.005), DBP (p < 0.001), and MAP (p < 0.001) and visceral fat was associated with higher PP (p < 0.05). In the total population, visceral fat was associated with higher DBP (p < 0.05) and MAP (p < 0.001). High-density lipoprotein cholesterol was positively associated with SBP (p < 0.005), DBP (p < 0.005), and MAP (p < 0.001) for women and positively associated with SBP, DBP, and MAP (p < 0.001 for all three) and PP (p < 0.05) for men. The association of blood pressure indices with modifiable risk factors suggests that targeted health interventions may reduce CVD risk in this population. [ABSTRACT FROM AUTHOR]

African Americans have a wide range of continental genetic ancestry. It is unclear whether racial differences in blood pressure (BP) control are related to ancestral background. The authors analyzed data from the Jackson Heart Study, a cohort exclusively comprised of self-identified African Americans, to assess the association between estimated West African ancestry (WAA) and BP control (systolic and diastolic BP < 140/90 mm Hg). Three nested modified Poisson regression models were used to calculate prevalence ratios for BP control associated with the three upper quartiles, separately, vs the lowest quartile of West African ancestry. The authors analyzed data from 1658 participants with hypertension who reported taking all of their antihypertensive medications in the previous 24 hours. WAA was estimated using 389 ancestry informative markers and categorized into quartiles (Q1: <73.7%, Q2: >73.7%-81.0%, Q3: >81.0%-86.3%, and Q4: >86.3%). The proportion of participants with controlled BP in the lowest-to-highest WAA quartile was 75.2%, 76.1%, 76.6%, and 74.4%. The prevalence ratios (95% CI) for controlled BP comparing Q2, Q3, and Q4 to Q1 of WAA were 1.00 (0.93-1.08), 1.02 (0.94-1.10), and 0.99 (0.91-1.07), respectively. Among African Americans in the Jackson Heart Study taking antihypertensive medication, BP control rates did not differ across quartiles of WAA. [ABSTRACT FROM AUTHOR]

Spontaneous intracerebral hemorrhage (ICH) is associated with a high case fatality rate in resource-limited settings. The independent predictors of poor outcome after ICH in sub-Saharan Africa remains to be characterized in large epidemiological studies. We aimed to determine factors associated with 30-day fatality among West African patients with ICH. The Stroke Investigative Research and Educational Network (SIREN) study is a multicentre, case-control study conducted at 15 sites in Nigeria and Ghana. Adults aged ≥18 years with spontaneous ICH confirmed with neuroimaging. Demographic, cardiovascular risk factors, clinical features and neuroimaging markers of severity were assessed. The independent risk factors for 30-day mortality were determined using a multivariate logistic regression analysis with an adjusted odds ratio (OR) and 95% confidence interval (CI). Among 964 patients with ICH, 590 (61.2%) were males with a mean age (SD) of 54.3(13.6) years and a case fatality of 34.3%. Factors associated with 30-day mortality among ICH patients include: Elevated mean National Institute of Health Stroke Scale(mNIHSS);(OR 1.06; 95% CI 1.02–1.11), aspiration pneumonitis; (OR 7.17; 95% CI 2.82–18.24), ICH volume > 30mls; OR 2.68; 95% CI 1.02–7.00)) low consumption of leafy vegetables (OR 0.36; 95% CI 0.15–0.85). This study identified risk and protective factors associated with 30-day mortality among West Africans with spontaneous ICH. These factors should be further investigated in other populations in Africa to enable the development of ICH mortality predictions models among indigenous Africans. • A prospective multicentre, case-control study in patients with spontaneous intracerebral hemorrhage in Nigeria and Ghana. • Intracerebral hemorrhage is associated with high case fatality. • Low GCS, large hematoma volume, and aspiration pneumonitis are associated with 30-day mortality. • Cardiac disease, intraventricular hemorrhage, pyrexia and origin of the hemorrhage were not associated with mortality. [ABSTRACT FROM AUTHOR]

Purpose: African Americans, especially men, have a higher incidence of lung cancer compared with all other racial and ethnic groups in the US. Self-reported race is frequently used in genomic research studies to capture an individual's race or ethnicity. However, it is clear from studies of genetic admixture that human genetic variation does not segregate into the same biologically discrete categories as socially defined categories of race. Previous studies have suggested that the degree of West African ancestry among African Americans can contribute to cancer risk in this population, though few studies have addressed this question in lung cancer.Methods: Using a genetic ancestry panel of 100 SNPs, we estimated West African, European, and Native American ancestry in 1,407 self-described African Americans and 2,413 European Americans.Results: We found that increasing West African ancestry was associated with increased risk of lung cancer among African American men (ORQ5 vs Q1 = 2.55 (1.45-4.48), p = 0.001), while no association was observed in African American women (ORQ5 vs Q1 = 0.90 (0.51-1.59), p = 0.56). This relationship diminished following adjustment for income and education.Conclusions: Genetic ancestry is not a major contributor to lung cancer risk or survival disparities. [ABSTRACT FROM AUTHOR]

Prior research on Black immigrants in the US has almost exclusively focused on those from the Caribbean. Yet African immigrants are poised to become the largest Black immigrant group in the US. This article addresses this issue by exploring the ethnoracial identity-work central to the processes by which the children of African immigrants integrate into American. I draw upon interviews of 36 West African and Black American high school students in the Bronx, New York. The findings reveal an identificational convergence where African and Black American youth identify similarly (i.e. as 'Black' and 'African-American') yet make different meanings of behind these terms. I examined three prominent domains (e.g. physical appearances, parenting and cultural stereotypes) that shape these varied articulations and intraracial boundaries. [ABSTRACT FROM AUTHOR]

This article examines the interactions between Ivorian television genre and global genres, such as telenovelas and sitcoms. During the 2000s, Ma famille, an Ivorian TV show, was an unprecedented success throughout French-speaking Africa. The show presents family relations in a modern urban Africa, until then a topic hardly seen on television screens. Many attribute this innovation in Ivorian televisual genre to telenovelas' omnipresence on West African screens since the 1990s. However, based on directors' interviews and on a method informed by genre innovation dialectic, this article argues instead for the important role played by edutainment television shows in this process, which adapted the telenovela modalities to local formats. This strategy used by edutainment demonstrates the importance of tropes and themes recurring across a genre, highlighting a surprising course for telenovelas in Côte d'Ivoire and the centrality of Ivorian endogenous popular tradition in the process. [ABSTRACT FROM AUTHOR]

The African Movement of Working Children and Youth aims to empower and support young people, who otherwise would be excluded from educational and socioeconomic chances, to 'prepare their future'. In so doing, they re-interpret and re-combine transnational and local frames of reference in order to legitimize and materialize their ideas. I conceptualize this commitment as promoting a democratization of the future because they broaden the meaning of the (good) future as well as the means of access to it. [ABSTRACT FROM AUTHOR]

During an Ebola outbreak, the WHO recommends that health professionals consider people as suspect cases (SCs) when they show key signs such as the sudden onset of high fever or specific symptoms after having had contact with a suspect or confirmed Ebola case. SCs should then get care, be isolated and be reported to health authorities until the Ebola virus disease is confirmed through a lab test. This exploratory study aims to understand this identification process in the field based on a qualitative analysis of the diagnosis and therapeutic itineraries of 19 SCs in Cote d'Ivoire and Senegal (2014-2015). Results indicate that the main criteria for SC identification at the field level were fever (understood broadly) and provenance from a highly affected country (applied indiscriminately). WHO criteria were not followed in at least 9 of the 19 cases. Several medical, social and cultural factors favour over-identification of people as SCs, including relativism in defining 'high fever', placism, humanitarian or securitarian bias, issues in categorising SC's contact cases, and the context of fear. To avoid undue categorisation and its possible harmful social effects, the WHO definition should be implemented more carefully in various contexts and with greater consideration for ethical issues, while prioritising diagnosis strategies with higher specificity. [ABSTRACT FROM AUTHOR]

Reducing potential dangers by changing routine behavior to avoid certain people, places, or technologies can be prudent, but reporting avoidance also can be symbolic. This study probed Americans' reactions to Ebola from December 2014 to May 2015 with a longitudinal study (final n = 625), plus a representative sample in May: How much did they claim to avoid West Africans, commercial flights, Ebola-associated cities, and four other targets? What factors affected self-reported avoidance? Did people with opportunities to implement avoidance report more (e.g. frequent flyers can change their routine behavior more to avoid commercial flights than can infrequent flyers)? The December 2014 survey found most people never considered avoidance, but substantial minorities claimed acting or intending to avoid each target; substantial majorities of May 2015 respondents reported avoidance intentions if a new Ebola outbreak occurred in Africa or the United States. Perceptions of personal risk, concern about infection, and following Ebola news were primary factors in reported avoidance, with temporal reversals (e.g. news following increased avoidance in December but decreased it in May). Opportunity enhanced reported avoidance in December 2014 by indirect effects through personal risk, concern, and news following, but decreased avoidance intentions in May 2015 through direct effects of opportunity on avoidance. Temporal shifts in avoidance reports and associations seem consistent with objective declines in Ebola cases, perhaps mediated by changes in news coverage. Further consideration of avoidance behavior and the role of opportunity could enhance hazard management. [ABSTRACT FROM AUTHOR]

Highlights • Novel method to measure vulnerability to stunting without using a panel. • Use of DHS surveys merged with satellite data on climatic shocks. • Categorization of kids into consistently stunted, vulnerable and non-vulnerable. • Estimates of vulnerability to stunting in the Sahel. Abstract This paper presents a simple simulation framework for understanding and analyzing vulnerability to stunting. We utilize Demographic and Health Surveys merged with satellite data on climatic shocks. Children aged 0–5 years are grouped into three categories: consistently stunted, vulnerable, and non-vulnerable. The first group constitutes those who are stunted and will also be stunted in any hypothetical period. Non-vulnerable are those whose likelihood to be stunted is zero. The vulnerable face a probability between 0 and 1 of being stunted. The probability is calculated as the share of years in which the child would be stunted, given the village level distribution of weather shocks over the period 2000–2013. We provide estimates of vulnerability to stunting in Burkina Faso, Northern Ghana, Mali, Northern Nigeria, and Senegal by aggregating over villages, districts and countries. [ABSTRACT FROM AUTHOR]

We conducted an observational cohort study of end-stage kidney disease (ESKD) in >7000 African and Caribbean people with HIV in the UK. Using Poisson regression and East Africans as the reference group, the adjusted incidence rate ratio (95% confidence interval) of ESKD was 3.14 (1.26-7.84) in Southern Africans, 6.35 (2.53-15.96) in West Africans, and 5.26 (1.91-14.43) in Caribbeans. Higher CD4 cell count and suppressed HIV replication were associated with reduced risk of ESKD. The risk of ESKD varied among HIV-positive people of African heritage, with the highest rates observed in those of West African descent. [ABSTRACT FROM AUTHOR]

Chapter Seven of a book by Heather Salazar and Roderick Nicholls is presented which explores the philosophy of spirituality. Topics discussed include the spirituality of post-1965 West African immigrants in the West, the relationships that exist between everyday aesthetics and everyday religion, West African diaspora in the U.S., and symbolism and spirituality.

Abstract: Immigrants make up large proportions of many low‐income neighborhoods, but have been largely ignored in the neighborhood safety literature. We examined perceived safety's association with migration using a six‐item, child‐specific measure of parents’ perceptions of school‐aged (5–12 years of age) children's safety in a sample of 93 West African immigrant parents in New York City. Aims of the study were (a) to identify pre‐migration correlates (e.g., trauma in home countries), (b) to identify migration‐related correlates (e.g., immigration status, time spent separated from children during migration), and (c) to identify pre‐migration and migration correlates that accounted for variance after controlling for non‐migration‐related correlates (e.g., neighborhood crime, parents’ psychological distress). In a linear regression model, children's safety was associated with borough of residence, greater English ability, less emotional distress, less parenting difficulty, and a history of child separation. Parents’ and children's gender, parents’ immigration status, and the number of contacts in the U.S. pre‐migration and pre‐migration trauma were not associated with children's safety. That child separation was positively associated with safety perceptions suggests that the processes that facilitate parent–child separation might be reconceptualized as strengths for transnational families. Integrating migration‐related factors into the discussion of neighborhood safety for immigrant populations allows for more nuanced views of immigrant families’ well‐being in host countries. [ABSTRACT FROM AUTHOR]

Aims and objectives: This paper reports on women's experiences of weight gain and obesity as they became acculturated to the Australian diet and lifestyle. Background: Migrants from sub-Saharan Africa have a much higher risk of obesity than the native population when settling in industrialised countries. Method: Qualitative. Results: Women in this study reported weight gain post-migration. This was attributed to increased access to a wide variety of food including takeaway food and more sedentary lifestyles. Conclusions: Obesity has long-term consequences for health and well-being. Further research is needed to support a healthy transition to life in Australia. Relevance to clinical practice: Gaining insight into the underlying reasons that West African immigrants to Australia become obese could contribute to assisting health professionals design culturally appropriate interventions and health education programmes to support new arrivals. [ABSTRACT FROM AUTHOR]

Objective Worldwide, the highest frequencies of APOL1-associated kidney variants are found in indigenous West Africans among whom small vessel disease ( SVD) ischemic stroke is the most common stroke phenotype. The objective of this study was to investigate the association and effect sizes of 23 selected SNPs in 14 genes of relevance, including the APOL1 G1 variants, with the occurrence of SVD ischemic stroke among indigenous West African participants in the Stroke Investigative Research and Education Network ( SIREN) Study. Materials and Methods Cases were consecutively recruited consenting adults (aged 18 years or older) with neuroimaging-confirmed first clinical stroke. Stroke-free controls were ascertained using a locally validated version of the Questionnaire for Verifying Stroke-Free Status ( QVSFS). Logistic regression models adjusting for known vascular risk factors were fitted to assess the associations of the 23 SNPs in rigorously phenotyped cases (N = 154) of SVD ischemic stroke and stroke-free (N = 483) controls. Results Apolipoprotein L1 ( APOL1) rs73885319 ( OR = 1.52; CI: 1.09-2.13, P-value = .013), rs2383207 in CDKN2A/ CDKN2B ( OR = 3.08; CI: 1.15-8.26, P -value = .026) and rs2107595 ( OR = 1.70; CI: 1.12-2.60, P-value = .014) and rs28688791 ( OR = 1.52; CI: 1.03-2.26, P-value = .036) in HDAC9 gene were associated with SVD stroke at 0.05 significance level. Polymorphisms in other genes did not show significant associations. Conclusion This is the first report of a specific association of APOL1 with a stroke subtype. Further research is needed to confirm these initial findings and deepen understanding of the genetics of stroke in people of African ancestry with possible implications for other ancestries as all humans originated from Africa. [ABSTRACT FROM AUTHOR]

Background: While the semen analysis appears to be the cornerstone in the evaluation of testicular function, the testicular volume has long been associated with testicular function. However, racial variations in testicular volume do exist. Neither the critical minimum testicular volume that guarantees adequate function, nor the optimal testicular volume that indicates peak testicular function are also known. Objective: To evaluate the relationship between testicular volume and function using scrotal ultrasound scan in black West African men. Patients and methods: The study examined 236 subjects over a period of one year. The subjects comprised of 136 patients with diagnosis of male infertility, as well as 100 healthy individuals as control. The relevant clinical history of each patient was extracted from their case notes. All the subjects had their testes examined using a high frequency (7.5 mHz) linear transducer of an ultrasound scanner. The results were expressed as percentages and tests of significance were done using the chi-square and Student's t-test. A P-value

This article contributes to the study of migrant ‘illegality’ and deportability by focusing on informal regimes of citizenship and regulation between state and society. It sheds light, in particular, on the interactions between West African migrant traders and immigration officers in Angola. Although Angola deports thousands of ‘illegal’ West African and other migrants every year, during everyday checks police officers often extort money from, rather than expel, undocumented migrants. Far from jeopardizing immigration enforcement, this kind of predatory policing is sustained by the deportation apparatus. The article demonstrates that illegalization and the threat of deportation spread discretionary power and authoritarianism down the state hierarchy, resulting in more intense and frequent street-level predation. What deportability downgrades is therefore not only migrants’ formal rights, but also the more informal rules of corruption through which migrants negotiate their inclusion in the state. [ABSTRACT FROM PUBLISHER]

Background The greatest burden from stroke-related disability is borne by Low-and-Middle Income countries (LMICs) where access to rehabilitation after stroke is severely challenged. Tele-rehabilitation could be a viable avenue to address unmet rehabilitation needs in LMICs. Objectives To assess the burden of post-stroke physical deficits, rates of utilization of physiotherapy services, and perceptions of tele-rehabilitation among recent Ghanaian stroke survivors. Methods Using a consecutive sampling strategy, 100 stroke survivors attending an outpatient Neurology clinic in a Ghanaian tertiary medical center were enrolled into this cross-sectional study. After collecting basic demographic data, clinical history on stroke type, severity and level of disability, we administered the validated 20-item Functional Independence Measure questionnaire to evaluate functional status of study participants and an 8-item questionnaire to assess participants' attitudes towards telemedicine administered rehabilitation intervention. Results Mean ± SD age of study participants was 57.2 ± 13.3 years of which 51.0% were males with a mean duration of stroke of 1.3 ± 2.2 years. 53% had Modified Rankin scores of ≥ 3, 57% were fully independent and only 27% reported utilizing any physiotherapy services. Barriers to access to physiotherapy included financial constraints due to cost of physiotherapy services and transportation as well as premature discharge from physiotherapy to avoid overburdening of available physiotherapy services. These factors led to the limited provision of rehabilitative therapy. Participants held positive views of the potential for tele-rehabilitation interventions (80–93%). However, while 85% owned mobile phones, only 35% had smart phones. Conclusion Despite, a high burden of residual disability, only about 1 out of 4 stroke patients in this Ghanaian cohort was exposed to post-stroke physiotherapy services, largely due to relatively high costs and limited health system resources. These Ghanaian stroke patients viewed the potential role of Tele-rehabilitation as positive, but this promising intervention needs to be formally tested for feasibility, efficacy and cost-effectiveness. [ABSTRACT FROM AUTHOR]

Background Inherited genetic variations offer a possible explanation for the observed peculiarities of stroke in sub - Saharan African populations. Interleukin–6 polymorphisms have been previously associated with ischemic stroke in some non-African populations. Aim Herein we investigated, for the first time, the association of genetic polymorphisms of IL-6, CDKN2A- CDKN2B and other genes with ischemic stroke among indigenous West African participants in the Stroke Investigative Research and Education Network (SIREN) Study. Methods Twenty-three previously identified single nucleotide polymorphisms (SNPs) in 14 genes of relevance to the neurobiology of ischemic stroke were investigated. Logistic regression models adjusting for known cardiovascular disease risk factors were constructed to assess the associations of the 23 SNPs in rigorously phenotyped cases (N = 429) of ischemic stroke (Men = 198; Women = 231) and stroke– free (N = 483) controls (Men = 236; Women = 247). Results Interleukin-6 ( IL6 ) rs1800796 (C minor allele; frequency: West Africans = 8.6%) was significantly associated with ischemic stroke in men (OR = 2.006, 95% CI = [1.065, 3.777], p = 0.031) with hypertension in the model but not in women. In addition, rs2383207 in CDKN2A/CDKN2B (minor allele A with frequency: West Africans = 1.7%) was also associated with ischemic stroke in men (OR = 2.550, 95% CI = [1.027, 6.331], p = 0.044) with primary covariates in the model, but not in women. Polymorphisms in other genes did not show significant association with ischemic stroke. Conclusion Polymorphisms rs1800796 in IL6 gene and rs2383207 in CDKN2A/CDKN2B gene have significant associations with ischemic stroke in indigenous West African men. CDKN2A/CDKN2B SNP rs2383207 is independently associated with ischemic stroke in indigenous West African men. Further research should focus on the contributions of inflammatory genes and other genetic polymorphisms, as well as the influence of sex on the neurobiology of stroke in people of African ancestry. [ABSTRACT FROM AUTHOR]

Background Disability-adjusted life-years lost after stroke in Low & Middle-Income Countries (LMICs) is almost seven times those lost in High-income countries. Although individuals living with chronic neurological and mental disorders are prone to stigma, there is a striking paucity of literature on stroke-related stigma particularly from LMICs. Objective To assess the prevalence, severity, determinants and psycho-social consequences of stigma among LMIC stroke survivors. Methods Between November 2015 and February 2016, we conducted a cross-sectional survey of 200 consecutive stroke survivors attending a neurology clinic in a tertiary medical center in Ghana. The validated 8-Item Stigma Scale for Chronic Illness (SSCI-8) questionnaire was administered to study participants to assess internalized and enacted domains of stigma at the personal dimension with further adaptation to capture family and community stigma experienced by stroke participants. Responses on the SSCI-8 were scored from 1 to 5 for each item, where 1 = never, 2 = rarely, 3 = sometimes, 4 = often and 5 = always with a score range of 8–40. Demographic and clinical data on stroke type and severity as well as depression and Health-Related Quality of Life indicators were also collected. Predictors of stroke-related stigma were assessed using Linear Models (GLM) via Proc GENMOD in SAS 9.4. Results 105 (52.5%) subjects recruited were males and the mean ± SD age of stroke survivors in this survey was 62.0 ± 14.4 years. Mean SSCI-8 score was highest for personal stigma (13.7 ± 5.7), which was significantly higher than family stigma (11.9 ± 4.6; p = 0.0005) and social/community stigma (11.4 ± 4.4; p < 0.0001). Approximately 80% of the cohort reported experiencing mild-to-moderate degrees of stigma. A graded increase in scores on the Geriatric Depression Scale and Centre for Epidemiological Studies-Depression scale was observed across the three categories. Living in an urban setting was associated with higher SSCI-8 scores. Moreover, stroke subjects with more severe post-stroke residual symptom deficits reported a significantly higher frequency of stigma. Conclusion Four out of five stroke survivors in this Ghanaian cohort reported experiencing some form of stigma. Stigmatized individuals were also more likely to be depressed and have lower levels of quality of life. Further studies are required to assess the consequences of stigma from stroke in LMIC. [ABSTRACT FROM AUTHOR]