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IntroductionPeople living with HIV have high rates of hypertension. Integrated HIV and hypertension care with aligned multi-month dispensing of medications (MMD) could decrease the burden of care for individuals and health systems. We sought to describe hypertension control and evaluate its association with different durations of MMD among Malawian adults receiving integrated care with aligned dispensing of antiretroviral therapy (ART) and antihypertensive medication.MethodsWe conducted a cross-sectional survey and retrospective chart review of adults (≥18 years) receiving integrated HIV and hypertension care on medications for both conditions for at least 1 year, with aligned MMD at seven clinics in Malawi. Data were collected from July 2021 to April 2022 and included socio-demographics, clinical characteristics, antihypertensive medications and up to the three most recent blood pressure measurements. Bivariate analyses were used to characterize associations with hypertension control. Uncontrolled hypertension was defined as ≥2 measurements ≥140 and/or ≥90 mmHg. Chart reviews were conducted for a random subset of participants with uncontrolled hypertension to describe antihypertensive medication adjustments in the prior year.ResultsWe surveyed 459 adults receiving integrated care with aligned dispensing (58% female; median age 54 years). Individuals most commonly received a 3-month aligned dispensing of ART and antihypertensive medications (63%), followed by every 6 months (16%) and every 4 months (15%). Hypertension control was assessed in 359 respondents, of whom only 23% had controlled hypertension; 90% of individuals in this group reported high adherence to blood pressure medications (0-1 missed days/week). Control was more common among those with longer aligned medication dispensing intervals (20% among those with 1- to 3-month dispensing vs. 28% with 4-month dispensing vs. 40% with 6-month dispensing, p = 0.011). Chart reviews were conducted for 147 individuals with uncontrolled hypertension. Most had high self-reported adherence to blood pressure medications (89% missing 0-1 days/week); however, only 10% had their antihypertensive medication regimen changed in the prior year.ConclusionsUncontrolled hypertension was common among Malawian adults receiving integrated care with aligned MMD and was associated with shorter refill intervals and few antihypertensive medication escalations. Integrated care with aligned MMD is promising, but further work is needed to understand how to optimize hypertension outcomes.

BackgroundGlobal surgery research efforts have been criticized for failure to transition from problem identification to intervention implementation. We developed a context-appropriate trauma quality improvement (TQI) bundle to ameliorate care gaps at a regional referral hospital in Cameroon. We determined associations between bundle implementation and improvement in trauma resuscitation practices.MethodsWe implemented a TQI bundle consisting of a hospital-specific trauma protocol, staff training, a trauma checklist, provision of essential emergency trauma supplies in the resuscitation area, and monthly quality improvement meetings. We compared trends in target process measures (e.g., frequency and timing of vital sign collection and primary survey interventions) in the six-month period pre- and post-bundle implementation using Wilcoxon rank-sum and Fisher's exact tests.ResultsWe compared 246 pre-bundle patients with 203 post-bundle patients. Post-bundle patients experienced a greater proportion of all vital signs collected compared to the pre-intervention cohort (0 % pre-bundle vs. 69 % post-bundle, p < 0.001); specifically, the proportion of respiratory rate (0.8 % pre-bundle vs. 76 % post-bundle, p < 0.001) and temperature (7 % pre-bundle vs. 91 % post-bundle, p < 0.001) vital sign collection significantly increased. The post-bundle cohort had vital signs measured sooner (74 % vital signs measured within 15 min of arrival pre-bundle vs. 90 % post-bundle, p < 0.001) and more frequently per patient (7 % repeated vitals pre-bundle vs 52 % post-bundle, p < 0.001). Key primary survey interventions such as respiratory interventions (1 % pre-bundle vs. 8 % post-bundle, p < 0.001) and cervical collar placement (0 % pre-bundle vs. 7 % post-bundle, p < 0.001) also increased in the post-bundle cohort.ConclusionsThe implementation of a context-appropriate TQI bundle was associated with significant improvements in previously identified trauma care deficits at a single regional hospital. Data-derived interventions targeting frontline capacity at the local level can bridge the gap between identifying care limitations and improvement in resource-limited settings.

Across sub-Saharan Africa, men are less likely to know their HIV status than women, leading to later treatment initiation. Little is known about how experiences with general health services affect men's use of HIV testing. We used data from a 2019 community-representative survey of men in Malawi to understand frequency and cause of men's negative health service experiences (defined as men reporting they "would not recommend" a facility) and their association with future HIV testing. We conducted univariable and multivariable logistic regressions to determine which aspects of health facility visits were associated with would-not-recommend experiences and to determine if would-not-recommend experiences 12-24 months prior to the survey were associated with HIV testing in the 12 months prior to the survey. Among 1,098 men eligible for HIV testing in the 12 months prior to the survey, median age was 34 years; 9% of men reported at least one would-not-recommend experience, which did not differ by sociodemographics, gender norm beliefs, or HIV stigma beliefs. The factors most strongly associated with would-not-recommend experiences were cost (aOR 5.8, 95%CI 2.9-11.4), cleanliness (aOR 4.2, 95%CI 1.8-9.9), medicine availability (aOR 3.3, 95%CI 1.7-6.4), and wait times (aOR 2.7, 95%CI 1.5-5.0). Reporting a would-not-recommend experience 12-24 months ago was associated with a 59% decrease in likelihood of testing for HIV in the last 12 months (aOR 0.41; 95% CI:0.17-0.96). Dissatisfaction with general health services was strongly associated with reduced HIV testing. Coverage of high-priority screening services like HIV testing may benefit from improving overall health system quality.

BACKGROUND: Safer conception services are needed to minimize HIV transmission among HIV sero-discordant couples desiring pregnancy. Few studies have evaluated the choices couples make when they are offered multiple safer conception methods or real-world method acceptability. This paper addresses an important knowledge gap regarding factors that influence the choice of safer conception methods, couples actual experiences using safer conception methods, and why some couples switch safer conception methods. METHODS: Between February and June 2019, we conducted semi-structured in-depth interviews among 14 men and 17 women, representing 17 couples who exited the SAFER study-a pilot safer conception study for HIV sero-discordant couples in Zimbabwe that offered couples a choice of ART with monthly viral load monitoring (ART/VL), oral PrEP, vaginal insemination, and semen washing. All couples in SAFER had used at least two safer conception methods. RESULTS: We found that safer conception method choice often centered around a desire for intimacy, condomless sex, and certainty in the conception process, particularly for men. Method-related attributes such as familiarity, perceived ease of use, side effects, and perceived level of effectiveness in preventing HIV and achieving pregnancy influenced method choice, switching, and satisfaction. Concerns were expressed about each safer conception method and couples were willing to try different methods until they found method(s) that worked for them. The majority of participants reported having positive experiences using safer conception, especially those using ART/VL + PrEP, citing that they were able to attempt pregnancy for the first time with peace of mind and experienced joy and satisfaction from being able to achieve pregnancy safely. CONCLUSIONS: The differences in method preferences and experiences voiced by participants in this study and in other studies from the region point to the importance of having a variety of safer conception options in the service delivery package and addressing concerns about paternity, intimacy, and method-related attributes to enable HIV sero-discordant couples to safely achieve their reproductive goals.

IntroductionIdentifying the optimal approaches to offering HIV prevention to meet the needs of those at risk is a high priority, particularly given the expanding toolkit of biomedical HIV prevention options. An ongoing study in rural East African communities evaluated the uptake of choices in product, testing mode and location of care delivery through a structured patient-centred HIV prevention delivery model. In this qualitative study, we sought to understand clients' experiences of this "dynamic choice prevention model" (DCP) and highlight pathways of action to inform HIV prevention delivery models.MethodsIn-depth semi-structured interviews were conducted from November 2021 through March 2022 with a purposively selected sample of n = 56 participants in DCP trials (across outpatient departments, antenatal clinics and community settings), and n = 21 healthcare providers (total n = 77). A seven-person multi-regional team translated and inductively coded transcript data. We used a framework analysis approach to identify emergent themes.ResultsIndividuals taking up HIV pre-exposure prophylaxis (PrEP) reported feelings of relief, liberation from fears of acquiring HIV and satisfaction with being able to take action despite partners' behaviours. Couples used a range of approaches afforded by the study to persuade partners to get tested and opt for PrEP. Post-exposure prophylaxis (PEP) use was less common, although women welcomed it in the event of sexual coercion or assault. Participants discussed switching from PEP to PrEP after familiarizing themselves with usage and ascertaining ongoing risk. Participants felt respected by providers, trusted them and appreciated being able to contact them directly for telephone support. Prevention uptake was hindered by stigma, limited experience with and knowledge of prevention methods, gendered and generational power dynamics within intimate partnerships and families, and negative perceptions of methods due to the products themselves. Participants anticipated long-acting injectable PrEP could solve their challenges regarding pill size, daily pill burden and the likelihood of unwanted disclosure.ConclusionsDiverse preferences and barriers to uptake of prevention require a choice of HIV prevention options, locations and delivery modalities-but in addition, flexible, competent and friendly care provision is crucial to promote uptake. Helping clients feel valued, and addressing their unique needs and challenges, enables their agency to prioritize their health.

BACKGROUND: Across sub-Saharan Africa, mid-level healthcare managers oversee implementation of national guidelines. It remains unclear whether leadership and management training can improve population health outcomes. METHODS: We sought to evaluate leadership/management skills among district-level health managers in Uganda participating in the SEARCH-IPT randomised trial to promote isoniazid preventive therapy (IPT) for persons with HIV (PWH). The intervention, which led to higher IPT rates, included annual leadership/management training of managers. We conducted a cross-sectional survey assessing leadership/management skills among managers at trial completion. The survey evaluated self-reported use of leadership/management tools and general leadership/management. We conducted a survey among a sample of providers to understand the interventions impact. Targeted minimum loss-based estimation (TMLE) was used to compare responses between trial arms. RESULTS: Of 163 managers participating in the SEARCH-IPT trial, 119 (73%) completed the survey. Intervention managers reported more frequent use of leadership/management tools taught in the intervention curriculum than control managers (+3.64, 95% CI 1.98-5.30, P < 0.001). There were no significant differences in self-reported leadership skills in the intervention as compared to the control group. Among providers, the average reported quality of guidance and supervision was significantly higher in intervention vs control districts (+1.08, 95% CI 0.63-1.53, P = 0.001). CONCLUSIONS: A leadership and management training intervention increased the use of leadership/management tools among mid-level managers and resulted in higher perceived quality of supervision among providers in intervention vs control districts in Uganda. These findings suggest improved leadership/management among managers contributed to increased IPT use among PWH in the intervention districts of the SEARCH-IPT trial.

Introduction Onchocerciasis, more commonly known as river blindness, is a neglected tropical disease caused by the parasitic worm Onchocerca volvulus. The disease is transmitted to humans through the bite of [...]

Introduction In an age of unprecedented global wealth and technological advancement, the persistence of hunger and food insecurity remains one of the most glaring contradictions of our time. The right [...]

Approximately 39 million people living with HIV (PLWH) are at risk of infection with severe acute respiratory syndrome Coronavirus 2 (SARS-CoV-2) that causes Coronavirus Disease 2019 (COVID 19). COVID 19 can lead to serious negative health outcomes for PLWH with a low CD4+ count and increased viral load (VL). The objective of this study was to determine the effect of herbal soup (formulated by mixing; dried ginger powder, dried garlic powder, roasted butternut squash powder, ground chia seeds, ground sunflower seeds, dried turmeric powder and chili pepper powder) on the immunological parameters of PLWH. This was a parallel single blind randomized control trial (RCT) conducted in Kakamega County Teaching and Referral Hospital (KCTRH) Comprehensive Care Centre (CCC). Block randomization and sequentially numbered opaque envelopes were used to assign respondents to either control group (received standard care including Nutrition counselling and anti-HIV drugs) or treatment group (received herbal soup in addition to the standard care). Participants in the treatment group prepared and consumed 1 serving (16.35g) of the soup daily for 3 months. A total of 60 respondents were selected for the control group (n=30) and treatment group (n=30), of whom, a small sample size of 41 completed the study limiting the study findings from drawing policy conclusions. Statistical Packages for Social Sciences was used for data organization and management. Paired t-test was used to determine the effect of herbal soup on CD4+ cell count and Viral Load (VL). The study findings indicated no significant effect on the mean CD4+ cell count (p=0.838), ([+ or -]277) and mean VL (p=0.051), ([+ or -]42) in the control group. There was a significant effect on mean CD4+ cell count (p=0.012), ([+ or -]199), however, no significant effect on the mean VL (p=0.102), ([+ or -]74) in the treatment group. The study concluded that the herbal soup had an effect on the CD4+ cell count and can be adopted for use at household and facility level to improve the immune defence of PLWH during emerging virus-related epidemics such as COVID 19. Key words: HIV/AIDS, SARS-CoV-2, COVID 19, CD4+ cell count, viral load, herbal soup, INTRODUCTION The estimated global burden of HIV/AIDS is approximately 39 million [1]. The HIV epidemic is disproportionately concentrated in sub-Saharan Africa (SSA) with an estimated 25.6 million PLWH [2]. Out [...]

BACKGROUND: Antenatal care (ANC) is critical to reducing maternal and infant mortality. However, sub-Saharan Africa (SSA) continues to have among the lowest levels of ANC receipt globally, with half of mothers not meeting the WHO minimum recommendation of at least four visits. Increasing ANC coverage will require not only directly reducing geographic and financial barriers to care but also addressing the social determinants of health that shape access. Among those with the greatest potential for impact is maternal education: past research has documented a relationship between higher educational attainment and antenatal healthcare access, as well as related outcomes like health literacy and autonomy in health decision-making. Yet little causal evidence exists about whether changing educational policies can improve ANC coverage. This study fills this research gap by investigating the impact of national-level policies that eliminate tuition fees for lower secondary education in SSA on the number of ANC visits. METHODS: To estimate the effect of womens exposure to tuition-free education policies at the primary and lower secondary levels on their ANC visits, a difference-in-difference methodology was employed. This analysis leverages the variation in the timing of education policies across nine SSA countries. RESULTS: Exposure to tuition-free primary and lower secondary education is associated with improvements in the number of ANC visits, increasing the share of women meeting the WHO recommendation of at least four ANC visits by 6-14%. Moreover, the impact of both education policies combined is greater than that of tuition-free primary education alone. However, the effects vary across individual treatment countries, suggesting the need for further investigation into country-specific dynamics. CONCLUSIONS: The findings of this study have significant implications for policymakers and stakeholders seeking to improve ANC coverage. Removing the tuition barrier at the secondary level has shown to be a powerful strategy for advancing health outcomes and educational attainment. As governments across Africa consider eliminating tuition fees at the secondary level, this study provides valuable evidence about the impacts on reproductive health outcomes. While investing in free education requires initial investment, the long-term benefits for both human development and economic growth far outweigh the costs.

Several actors have turned their attention to Africa, and the continent is becoming a focal point for international relations. These actors have adopted various approaches to improve their relations with African countries. Tis study examines the alternative dimension of rising international competition on the continent. The main focus of the study is Turkiye's and China's alternative approaches to Africa. Accordingly, the study seeks to answer three interrelated questions: What are the differences between the traditional and alternative approaches? What are the main factors shaping China's and Turkiye's alternative approaches toward Africa? What are the similarities in Beijing's and Ankara's approaches regarding African countries in practice? As a result, this study argues that China and Turkiye present an alternative stance to the Western-centered approach for competition in Africa, despite some differences in their relations with continental countries. Keywords: Africa, China, Turkiye, International Competition, Alternative Approaches, Introduction Africa's strategic importance in international relations is constantly growing. Notably, the continent's economic and political potential continues to increase the influence of African countries in global politics. In contrast, [...]

Introduction Turkiye's contemporary engagement with Africa comes from a long tradition of solidarity and mutual respect with Africa, quite different from the colonial legacies of the other global powers. The [...]

Turkiye's comprehensive, pragmatic, multi-dimensional, and multi-stakeholder strategy towards Africa is commendable for adopting a collaborative approach that aligns well with the region's needs. This study aims to explore Turkiye's security relations in Sub-Saharan Africa through a constructivist perspective, focusing on the sub-regions of East Africa, West Africa, and the Sahel Belt. The research employs a qualitative methodology, drawing on official documents, academic literature, reports from international organizations, and discourse analysis to examine Turkiye's security policy in the region. Turkiye's security cooperation in Sub-Saharan Africa extends beyond mere military ties, encompassing a holistic strategy that supports regional peace and stability. By enhancing and strengthening these efforts, Turkiye significantly bolsters its standing in Sub-Saharan Africa and contributes to regional security architecture. Keywords: Sub-Saharan Africa, Constructivism, Turkish Model, Security, Counter-terrorism, Introduction Turkiye has pursued an increasingly vibrant partnership policy with the African countries. Turkiye successfully adopts a conceptual framework of cooperation with African countries that includes all actors and makes [...]

Strong foreign relations among nations are crucial for fostering global stability, economic growth, and cross-cultural understanding. A stable global system that resolves conflicts through dialogue rather than confrontation benefits from positive foreign relations. This paper examines Turkiye's changing foreign policy approach towards Sub-Saharan African regional blocs, with an emphasis on their political, cultural, and economic facets. Turkiye's strategic involvement with influential regional bodies such as the African Union (AU) and the Economic Community of West African States (ECOWAS), among others, reflects its broader objective to expand its influence and cultivate multifaceted partnerships across the African continent. The scope of this paper is limited to the AU and ECOWAS. Through a comprehensive analysis, the paper evaluates Turkiye's economic initiatives, including trade agreements and investment flows, as well as its contributions to infrastructure development. The findings established Turkiye's peacekeeping roles, cultural diplomacy, diplomatic efforts, and educational exchanges. Through the investigation of these diverse aspects, the conclusion outlines a comprehensive understanding of Turkiye's place in geopolitical dynamics and regional integration in Sub-Saharan Africa. Keywords: Foreign Policy, Foreign Relations, Turkiye, Sub-Saharan Africa, Regional Blocs, Introduction Following the end of the Cold War, a new concept emerged to deal with international and foreign affairs. This concept was dubbed the 'New World Order.' (1) However, the [...]

BackgroundFacility HIV self-testing (HIVST) in outpatient departments can dramatically increase testing among adult outpatients. However, it is still unclear why populations opt out of facility HIVST and reasons for opt outing. Using data from a parent facility HIVST trial, we sought to understand individual characteristics associated with opting out of facility HIVST and reported reasons for not testing.MethodsExit surveys were conducted with outpatients aged ≥15 years at 5 facilities in Central and Southern Malawi randomized to the facility HIVST arm of the parent trial. Outpatients were eligible for our substudy if they were offered HIVST and eligible for HIV testing (ie, never previously tested HIV positive and tested ≥12 months ago or never tested). Summary statistics and multivariate regression models were used.ResultsSeven hundred seventy-one outpatients were included in the substudy. Two hundred sixty-three (34%) opted out of HIVST. Urban residency (adjusted risk ratios [aRR] 3.48; 95% CI: 1.56 to 7.76) and self-reported poor health (aRR 1.86; 95% CI: 1.27 to 2.72) were associated with an increased risk of opting out. Male participants had a 69% higher risk of opting out (aRR 1.69; 95% CI: 1.14 to 2.51), with risk being 38% lower among working male participants. Primary reasons for not testing were feeling unprepared to test (49·4%) and perceived low risk of HIV infection (30·4%)-only 2.6% believed that HIVST instructions were unclear, and 1.7% were concerned about privacy.ConclusionWorking, risky sexual behavior, rural residence, and good self-rated health were positively associated with opting out of HIVST among outpatients. Strategies to address internalized barriers, such as preparedness to test and perceived need to test, should be incorporated into facility HIVST interventions.

RationaleHIV and cardiometabolic disorders including hypertension and diabetes pose a serious double threat in Malawi. Supportive couple relationships may be an important resource for managing these conditions. According to the theory of communal coping, couples will more effectively manage illness if they view the illness as "our problem" (shared illness appraisal) and are united in shared behavioral efforts.MethodsThis study qualitatively investigated communal coping of 25 couples living with HIV and hypertension or diabetes in Zomba, Malawi. Partners were interviewed separately regarding relationship quality, shared illness appraisal, communal coping, and dyadic management of illness.ResultsMost participants (80%) were living with HIV, and more than half were also living with hypertension. Most participants expressed high levels of unity and the view that illness was "our problem." In some couples, partners expected but did not extend help and support and reported little collaboration. Communal coping and dyadic management were strongly gendered. Some women reported a one-sided support relationship in which they gave but did not receive support. Women were also more likely to initiate support interactions and offered more varied support than men. In couples with poor relationship quality and weak communal coping, dyadic management of illness was also weak. Partner support was particularly crucial for dietary changes, as women typically prepared meals for the entire family. Other lifestyle changes that could be supported or hindered by a partner included exercise, stress reduction, and medication adherence.ConclusionWe conclude that gendered power imbalances may influence the extent to which couple-level ideals translate into actual communal coping and health behaviors. Given that spouses and families of patients are also at risk due to shared environments, we call for a shift from an illness management paradigm to a paradigm of optimizing health for spouses and families regardless of diabetes or hypertension diagnosis.

In Kenya, the number of adults aged ≥60 is expected to nearly quadruple by 2050, making it one of the most rapidly aging countries in Sub-Saharan Africa (SSA). Accordingly, we designed the Longitudinal Study of Health and Ageing in Kenya (LOSHAK) to generate novel data to address the health and economic consequences of this demographic transition. Specifically, LOSHAK will investigate the social, economic, environmental, biological, and policy processes that shape late-life health and economic well-being in Kenya. Modeled on the U.S. Health and Retirement Study (HRS), LOSHAK joins a network of harmonized studies on aging in >45 countries worldwide; however, LOSHAK will be only the 2nd such study in SSA. The current feasibility and pilot phase of LOSHAK will validate measures and data collection procedures in a purposive sample of Kenyan adults aged ≥45 years. We have linguistically and culturally translated instruments while aiming to maintain harmonization with both existing HRS network studies and the ongoing Kenya Life Panel Survey. The current phase of LOSHAK is nested within the Kaloleni/Rabai Community Health and Demographic Surveillance System on the coast of Kenya. LOSHAK will advance population aging research in low- and middle-income countries through the study of (a) biomarkers and physiological measures; (b) the impacts of air pollution and climate vulnerability; (c) Alzheimers disease and related dementias, mental health, disability, caregiving, and psychosocial wellbeing; and (d) economic security, including the impact of social welfare. LOSHAK will inform future public health and economic policy to address challenges related to rapid aging in Kenya and throughout SSA. Accordingly, this paper aims to introduce and provide a description of LOSHAK and its aims and objectives, as well as to inform the scientific community of current study activities being used to build toward the full population-representative study.

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

PURPOSE: The aim of this study is to expand the current knowledge on the relationship between poverty, family functioning, and the mental health of adolescent girls in families affected by poverty and HIV/AIDS in southern Uganda. The study investigates the association between family functioning and mental health and examines whether family functioning moderates the intervention effect on adolescent mental health. METHODS: Longitudinal data were collected over the course of 24 months in a cluster randomized controlled trial conducted among N=1,260 girls aged 14-17 years in Uganda. Participants were randomized into control group (n=408 girls from n=16 schools), matched youth development accounts treatment, YDA (n=471 girls from n=16 schools), and integrated intervention combining YDA with multiple family group component (n=381 girls from n=15 schools). RESULTS: We found a significant positive association between family functioning and mental health of adolescent girls in our sample. Moderator analyses suggests that effect of the intervention on Beck Hopelessness Scale was significantly moderated by family cohesion (χ2 (4) =21.43; p = .000), frequency of family communication (χ2 (4) =9.65; p = .047), and quality of child-caregiver relationship (χ2 (4) =11.12; p = .025). Additionally, the intervention effect on depression was moderated by the comfort of family communication (χ2 (4) =10.2; p = .037). DISCUSSION: The study findings highlight the importance of family functioning when examining the link from poverty to adolescent mental health. The study contributes to the scarce evidence suggesting that asset-accumulation opportunities combined with a family strengthening component may improve parenting practices and adolescent mental health in poor households.

Objectives Methods Results Conclusions Our objective was to evaluate bone mineral density (BMD) among older people living with HIV at the time of enrolment into a clinical trial in Kenya.The bictegravir/emtricitabine/tenofovir alafenamide (BFTAF) Elderly Study is a clinical trial among virally suppressed people living with HIV aged ≥60 years randomized to switch to BFTAF or continue their pre‐enrolment regimen. At enrolment, dual‐energy x‐ray absorptiometry (DXA) of the lumbar spine, total hip, and femoral neck was performed and T‐scores calculated for BMD. Osteoporosis was defined as T‐score −2.5 or lower and osteopenia as T‐score between −1 and −2.5. Fracture risk was calculated based on clinical risk factors (not including BMD), considering HIV as a secondary cause of osteoporosis, and the correlation between FRAX®‐HIV and BMD assessed.Between February and May 2022, a total of 296 participants were enrolled. All were Black African, 147 (49.7%) were female, the median age was 64 years (range 60–77), and 280 (94.6%) were on tenofovir disoproxil fumarate. The median BMD of lumbar spine, total hip, and femoral neck was 0.87 g/cm2 (interquartile range [IQR] 0.78–0.99), 0.89 g/cm2 (IQR 0.79–1.01), and 0.75 g/cm2 (IQR 0.67–0.84), respectively, with median T‐scores of −1.9 (IQR −2.8 to −0.7), −1.0 (IQR −1.9 to −0.3), and −1.5 (IQR −2.2 to −0.9), respectively. Osteoporosis and osteopenia were found in 37.5% and 47.3% of participants, respectively. Major osteoporotic fracture and hip fracture 10‐year median probabilities using FRAX®‐HIV were 3.4% (IQR 2.8–4.6) and 1.0% (IQR 0.7–1.3). Correlation coefficients between these FRAX®‐HIV probabilities and femoral neck BMD were −0.204 for major osteoporotic fracture and −0.338 for hip fracture.The prevalence of osteoporosis is high among older people living with HIV in Kenya, where DXA is not readily available and risk calculation without BMD had low correlation with measured BMD values. Additional data are required on the impact of investment in fracture risk assessment and treatment, including population‐specific risk calculators. [ABSTRACT FROM AUTHOR]

Background: Men who have sex with men (MSM) are disproportionately affected by sexually transmitted infections (STI) including Neisseria gonorrhoeae (Ng) and Chlamydia trachomatis (Ct). The lack of robust data on STIs among African MSM has limited the development of evidence-based screening strategies. This study aimed at documenting the pooled prevalence of Ng/Ct among MSM in sub-Saharan Africa (SSA). Methods: This systematic review was performed according to the Preferred Reporting Items for Systematic Review and Meta-analyses (PRISMA) 2020 guidelines. Relevant articles from the following databases were searched: PubMed, Scopus, ISI Web of Science, and the Directory of Open Access Journals (DOAJ). Eligible studies reported on the prevalence of Ng/Ct among the MSM population in SSA. Publication bias was assessed using the Hoy tool, Doi plot, and LFK ratio. Due to heterogeneity among studies, subgroup analyses were performed using the MetaXL add-on tool for Microsoft Excel. Results: Of 525 articles screened, 20 were selected for inclusion. Six were cross-sectional, four had a prospective cohort study design, and one was an epidemiological study. The pooled prevalence of Ng/Ct in MSM was 27% (95% CI, 19–39%), with an I2 of 98% signifying heterogeneity among the studies. Subgroup analysis by country revealed South Africa had the highest prevalence (38%). Discussion: Interpretation The high prevalence of Ng/Ct infection among MSM in SSA is of concern. Limitations Due to limited data available on Ng/Ct prevalence, the true prevalence of SSA and its associated risk factors is uncertain. Conclusion: As the first study to systematically review the available literature on STI prevalence among the MSM population in SSA, it showed the burden of Ng/Ct is higher than in other regions, warranting the strengthening of health systems to improve education, testing, and treatment in MSM population. Systematic review registration: PROSPERO CRD42022327095. [ABSTRACT FROM AUTHOR]

This systematic review and meta-synthesis assesses the effectiveness of Conditional Cash Transfers (CCTs) and Unconditional Cash Transfers (UCTs) in Sub-Saharan Africa. Analyzing 27 studies (2014–2024) using PRISMA guidelines, the research examines impacts on financial stability, education, and health. CCTs generally outperform UCTs in achieving specific education and health targets by incentivizing behaviors, while UCTs offer greater flexibility, improving mental health and economic resilience in fragile settings. The findings stress the context-dependent nature of cash transfer programs and the need for tailored, integrated approaches. Policy recommendations emphasize designing programs based on local conditions and desired outcomes. [ABSTRACT FROM AUTHOR]

Objective Methods Results Conclusions We first estimated the prevalence of primary and secondary infertility in Tanzania and then examined its association with recent experiences of intimate partner violence (IPV).We used cross‐sectional data from the Tanzania Demographic and Health Survey 2022 and included 6894 women aged 20–49 years to estimate the prevalence of primary and secondary infertility. In a subset of 2802 partnered women who were surveyed about physical, emotional, and sexual IPV, we also examined the association of any form of IPV in the 12 months prior to the survey with both primary and secondary infertility using multivariable logistic regression.The prevalence of primary infertility was 1.8% (95% confidence interval [CI]: 1.0, 3.1) and secondary infertility was 15.4% (95% CI: 2.1, 61.0). Primary infertility was higher in urban areas (1.9%) compared to rural areas (1.7%) (P < 0.001). Over one‐third (37.9%) of the women who were surveyed concerning IPV reported experiencing at least one form of IPV in the 12 months prior to the survey. Almost one‐fifth (18.3%) of women with secondary infertility had experienced at least one form of violence in the past 12 months prior to the survey, compared to 1.5% with primary infertility (P = 0.656). Women with secondary infertility were 1.58 times more likely to have experienced any form of IPV (aOR = 1.58, 95% CI: 1.08, 2.33).In Tanzania, the high prevalences of both infertility and IPV and the link between the two warrants the need for strengthening infertility care and treatment and support for women experiencing IPV. [ABSTRACT FROM AUTHOR]

Background Objective Search Strategy Selection Criteria Data Collection and Analysis Main Results Conclusion High maternal mortality rates in sub‐Saharan Africa necessitate the need for aligned research focusing on prevalent causes and neglected conditions in the region.This mapping review aimed to describe the characteristics of longitudinal maternal health studies between 2012 and 2022 in sub‐Saharan Africa and identify gaps in priority conditions or geographical locations.We identified references through a Medline (PubMed) search covering September 2012 to June 2022.We included prospective cohort or clinical trials that enrolled at least 1000 pregnant women, with a study site in sub‐Saharan Africa, and published in English or French.Screening and data extraction were done in duplicate using EPPI‐reviewer software. Descriptive analysis was used to summarize the results, identifying patterns in studies across time, country, study design, topics, and funders.We identified 213 eligible studies, which were covered in 534 publications. We identified studies in 33 of the 48 sub‐Saharan African countries, with the majority in east and southern Africa. The predominant study topics were HIV (36.4%), nutrition (20%), and malaria (16.3%), with very few publications on hypertensive disorders of pregnancy (6.4%), ante/postpartum hemorrhage (3.7%), and sexually transmitted infections (3.2%). More studies were cohorts (115/213; 54%) than clinical trials. The National Institutes of Health (31.5%), Bill and Melinda Gates Foundation (22.1%), and USAID (10.8%) were the largest research funders.Identifying research trends and mismatches between research topics and disease burden provides useful information for guiding future research prioritization. In particular, gaps exist for studies on hypertensive disorders of pregnancy and ante/postpartum hemorrhage, among the top causes of maternal mortality in sub‐Saharan Africa. [ABSTRACT FROM AUTHOR]

Background: Maternal recognition of neonatal danger signs following birth is a strong predictor of care-seeking for newborn illness, which increases the odds of newborn survival. However, research suggests that maternal knowledge of newborn danger signs is low. Similarly, maternal knowledge of optimal newborn care practices has also been shown to be low. Since both issues are typically addressed during antenatal care, this study sought to determine whether group antenatal care (G-ANC) could lead to improvements in maternal recognition of danger signs and knowledge of healthy newborn practices, as well as boosting postnatal care utilization. Methods: This cluster randomized controlled trial of G-ANC compared to routine individual antenatal care (I-ANC) was conducted at 14 health facilities in Ghana, West Africa, from July 2019 to July 2023. Facilities were randomized to intervention or control, and pregnant participants at each facility were recruited into groups and followed for the duration of their pregnancies. 1761 participants were recruited: 877 into G-ANC; 884 into I-ANC. Data collection occurred at enrollment (T0), 34 weeks' gestation to 3 weeks postdelivery (T1) and 6–12 weeks postpartum (T2). Comparisons were made across groups and over time using logistic regression adjusted for clustering. Results: Overall, knowledge of newborn danger signs was significantly higher for women in G-ANC, both in aggregate (13-point scale) and for many of the individual items over time. Likewise, knowledge of what is needed to keep a newborn healthy was higher among women in G-ANC compared to I-ANC over time for the aggregate (7-point scale) and for many of the individual items. Women in G-ANC were less likely to report postnatal visits for themselves and their babies within 2 days of delivery than women in I-ANC, and there was no difference between groups regarding postnatal visits at one week or 6 weeks after birth. Conclusion: This study illustrates that group ANC significantly improves knowledge of newborn danger signs and healthy newborn practices when compared to routine care, suggesting that the impact of G-ANC extends beyond impacts on maternal health. Further research elucidating care pathways for ill newborns and maternal behaviors around healthy newborn practices is warranted. Trial registration: : ClinicalTrials.gov Identifier: NCT04033003, Registered: July 25, 2019 Protocol Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9508671/. [ABSTRACT FROM AUTHOR]

ABSTRACT Objective Design Sample Measurements Results Conclusion To identify the determinants of cervical cancer (CC) screening among underserved rural women in Zimbabwe.Community‐based cross‐sectional survey.840 rural women (25–65 years).A structured, pretested questionnaire was used to collect data on sociodemographic characteristics and factors influencing screening. The outcome was defined as self‐reported ever screening for CC. Multivariable logistic regression was used to examine the association between CC screening and independent variables.Of the 840 women included, 33% had a history of screening. Women 25–45 years (adjusted odds ratio (aOR): 0.43; 95% CI: 0.30–0.61) and without medical insurance (aOR: 0.66; 95% CI: 0.45–0.97) had reduced odds of CC screening. Conversely, women who had seen or heard messages on CC screening (aOR: 1.48; 95% CI: 1.03–2.13), were living with HIV (aOR: 1.87; 95% CI: 1.22–2.87) reported recent antibiotic use (aOR: 4.50; 95% CI: 1.47–13.79) and had malaria in the last 6 months (aOR: 2.45; 95% CI: 1.02–5.86) had increased odds of CC screening.There is a need for intensified efforts to improve CC screening uptake, particularly in underserved rural areas with suboptimal screening rates and high CC burden. Strategies should include widespread tailored awareness messaging targeting younger women, women living with HIV, and women without medical insurance. [ABSTRACT FROM AUTHOR]

We examine the short-term dynamics of on-farm rural youth employment in Tanzania and Malawi and its implications for development policy. Employment dynamics are assessed as the mobility between on-farm and off-farm occupations using nationally representative longitudinal data from four periods between 2010 and 2021. Most of the rural youth engaged in farming with high stability over time. In both countries, about 85 per cent of rural youth engaged in farming in 2010/11 and a significant majority remained in farming in subsequent periods. On-farm employment of female youth was more stable than that of males; it was higher and more stable for those owning land. We also discovered a considerable mobility of youth between on-farm and off-farm occupations, but the movement into on-farm employment outpaced the movement out of it. While the high stability of on-farm employment may be explained by underemployment or poor prospects in the non-agricultural sector, the considerable inter-sector mobility reflects the significantly diverse livelihood strategies of rural youth. Policies to employ and keep youth in agriculture while supporting their economic diversification strategies are needed to strengthen the sector and the broader rural economy by improving youth access to critical resources, and an enabling environment. [ABSTRACT FROM AUTHOR]

Objective: This scoping review aims to identify risk factors for COPD and asthma, examine the burden and intervention measures, and clarify the findings in the context of climate change, with a particular focus on LMICs. Methods: Following the PRISMA-ScR guidelines, we conducted a scoping review using PubMed, Embase, and Scopus, focusing on studies published from 2011 to 2024. Results: Our review included 52 studies that encompassed 244,004 participants. Predominantly conducted in SSA (n = 43, 83%) and Asia (n = 16, 31%), they address indoor and ambient air pollution, occupational hazards, and environmental conditions. Climate change exacerbates risks, varying regionally. SSA faces severe household and occupational exposures, while other LMICs deal with industrial and urban pollution. Stigma, social exclusion and economic burden underscore the necessity for intervention strategies (e.g., educational programs, pulmonary rehabilitation, low-emission cookstoves). Conclusion: Our research shows a strong link between air pollution, occupational and environmental exposures, and the prevalence of COPD and asthma in LMICs. It suggests that targeted interventions are effective ways to mitigate these diseases and also highlights the significant impact of climate change on respiratory health. [ABSTRACT FROM AUTHOR]

Background: Female Sex Workers (FSW) in Sub Saharan Africa face multiple challenges increasing their vulnerability to poor health, particularly poor sexual and reproductive (SRH) health outcomes and violence. The aim of this study was to assess the use of gynecology health care services and factors associated with its use as well as experiences of violence among FSW in Togo. Method: A cross-sectional study was carried out in 2021 among FSW in two cities of Togo. A snowball sampling method was used and initial seeds were identified in each site in collaboration with FSW non-governmental organizations. A logistic regression was performed to identify factors associated with the use of a SRH service and violence. Results: A total of 447 FSW with a median age of 30 [IQR: (24–38)] participated in this study and 43.4% of them had reached at least secondary school. Among them, 29.1% reported having been to a gynecological consultation over the previous year. Factors associated with a gynecological consultation included: living in the Lomé capital city (aOR = 0.35, 95%CI 0.22–0.54), and an experience of condom breakage or slippage (aOR = 2.00; 95%CI 1.19–2.64). The majority reported at least one lifetime pregnancy (87.9%), 39.8% reported ever having an unintended pregnancy and 67.6% of them ever had an abortion. Finally, 61.1% indicated being victims of physical, sexual, or emotional violence in the previous six months. Sex workers living in Lomé (aOR = 1.78; 95%CI 1.16–2.73); a history of abortion (aOR = 1.53; 95%CI 1.03–2.31) and having more than 15 clients per week (aOR = 4.87; 95% CI 1.99–11.94), were more likely to experience violence. Conclusion: There is an under-utilization of health care services among FSW in Togo in addition to overall poor sexual and reproductive health outcomes with a high prevalence of gender-based violence. Those results highlight the importance of continued advocacy for the integration of SRH care with HIV prevention services geared toward FSW as well as a holistic approach to SRH care with innovative ways to prevent violence. Plain Language Summary: Female Sex Workers (FSW) in sub-Saharan Africa face multiple challenges including challenges linked to access to health care services, particularly sexual and reproductive health services and issues related to violence. However, few studies in Togo have explored sexual and reproductive health and violence among FSW. We used a cross-sectional study design to describe the use of sexual and reproductive health services by FSW in Togo and to document their experience of violence. A total of 130 FSW reported a gynecological consultation in the previous year, 42.7% had STI symptoms and 60.7% of them consulted a health care professional for those symptoms. We also found that 179 FSW ever had an unintended pregnancy and among them 67% ever had an abortion. Almost all FSW reported the use of condoms as their main contraception method, however 87.7% of FSW used condoms consistently with their clients. The majority of FSW reported ever being victim of physical, sexual or emotional violence. FSW with a history of abortion, with a high number of clients per week (> 15), and living in the capital city were more likely to have experience of violence. Those results would be helpful as a basis to advocate for a greater access of FSW to SRH services as part of their package of HIV prevention, care and treatment. [ABSTRACT FROM AUTHOR]

Background: There is critical need to strengthen the global nursing and midwifery workforce. This is especially true in Malawi where they are the primary providers of obstetric and neonatal care. In Neno district, Malawi, in 2017, we implemented an intensive training and longitudinal bedside mentorship intervention for nurses and midwives. From inception, there was a pre-planned project target completion after 5 years, including a staged handover to local ownership after 3 years. The objective of this study was to assess differences in reported maternal and neonatal complications following project completion and handover to local leadership. Methods: The project was a partnership between an academic institution and local nongovernmental organization. In October 2020, the intervention was handed over and maintained by the local organization with limited support from the academic institution. Data from January 2019 to May 2023 were extracted from the Malawi District Health Information Software 2. Bivariate analyses explored differences in the pre- and post-handover periods for all government-collected, birth-related variables. The "pre-handover" period encompassed January 2019 to September 2020 and "post-handover" from October 2020 to May 2023. Multivariate linear regression explored outcomes while controlling for health facility. Results: Data were collected from 10 health facilities in the district and included a total of 23,259 births. Overall, there were few significant changes between periods. Exceptions were in reporting of antepartum hemorrhage (p < 0.01), maternal sepsis (p = 0.01), and manual removal of the placenta (p < 0.01), where we observed decreases in reporting. There was a significant decrease in the reporting of neonatal sepsis (p = 0.01) in the bivariate analysis, which remained only borderline significant in the multivariate model (p = 0.05). Where differences occurred, they were associated with improvements in reported identification of complications and provision of associated emergency care. Conclusions: Few differences in reported maternal and neonatal complications between the periods suggest positive impact of the intervention was sustained following project handover and transition of activities to local leadership. These findings strengthen support for longitudinal mentorship as a pivotal component for skill retention after training. Transparent partnerships which include pre-determined end points and time for handover of activities to local ownership are crucial components for sustainability. [ABSTRACT FROM AUTHOR]

ABSTRACT This study investigated family mechanisms through which pandemic stressors affect parental stress using the Double ABC‐X model of family stress and adaptation. Specifically, this study examines the moderated mediation effects to test the conditional indirect influence of a moderating variable (i.e., family resilience beliefs) on the relationship between a predictor (i.e., stressor pile‐up) and an outcome variable (i.e., stress) through potential mediators (i.e., family satisfaction and relationship satisfaction). The analytic sample included 9269 participants from 10 sub‐Saharan countries. The findings do not support the hypothesis predicting a second‐stage moderating mediation model where family resiliency beliefs would moderate the second‐stage indirect paths of family satisfaction and relationship satisfaction, creating conditional indirect effects. The findings suggest that interventions should involve community‐based programmes that emphasize family support and access to resources while recognizing the complex interplay between family resilience beliefs, cultural values and beliefs of African families. [ABSTRACT FROM AUTHOR]

Food insecurity disproportionately affects smallholder farming households and within them women, who bear primary caregiving responsibilities and contend with time and resource constraints that heighten their vulnerability to adverse nutrition‐related health outcomes. This study cross‐sectionally investigates the association between food production practices, household consumer behaviour, and the experience of food insecurity with women's waist‐hip ratio (WHR), a key indicator of abdominal obesity, in a coastal community in Kenya. In total, 394 households were randomly selected from a list of farming households in Kaloleni and Rabai sub‐counties of Kilifi. Trained enumerators administered questionnaires to adult female family members who play a pivotal role in household management. Household dietary diversity scores (HDDS) were computed from 16 food groups consumed in the 7 days preceding the survey. Waist‐hip measurements focused on these females, representing vulnerable populations. Pathway‐based regression models were constructed using STATA version 13 (p < 0.05). Most households practised mixed farming (59.9%) and monocropping (73.2%) and most female respondents were widowed (75.1%) with limited education (73.1% had no formal education) and over 20 years of farming experience. Food insecurity was prevalent, affecting 80.7% of households. Limited dietary diversity was noted with an average HDDS of 9. The most commonly consumed foods were cereals, spices, condiments and beverages, while meat, eggs and fruits were infrequently eaten. An inverse association was observed between HDDS and WHR (standardised regression coefficient = −0.1328; p = 0.026) but while food insecurity was inversely associated with both HDD and WHR, these associations did not reach statistical significance (HDDS‐standardised regression coefficient −0.0294; p = 0.592: WHR‐standardised regression coefficient −0.0155; p = 0.791). Existing research has primarily addressed the undernutrition and hunger‐related impacts of food insecurity. The findings underscore the need to better understand the complex interplay between food insecurity and nutritional health, including markers of adiposity, to effectively promote health. [ABSTRACT FROM AUTHOR]

Despite the increasing morbidity and mortality associated with fungal diseases in low-income and sub-Saharan Africa countries, it is apparent that most of the fungal pathogens involved have been omitted from the dilated list of neglected and emerging tropical diseases (NETDs). Because most of these pathogens are inextricably linked with other underlying diseases such as tuberculosis and AIDS, the main fungal pathogens causing diseases viz. Pneumocyctosis and meningitis are categorized as deadly AIDS-associated opportunistic infections, and they most often coexist with tuberculosis. In addition, other infections like candidiasis, keratitis, histoplasmosis, and mycetoma often cause deforming and debilitating illnesses that affect the working class in rural communities, largely due to underlying comorbidities. Inadequate diagnostic tests prevent easy identification of the burden associated with these diseases making treatment very difficult. Likewise, the rise of resistance to most antifungal medications currently accessible in Africa is still extremely concerning, as observed in other locations. To expatiate on the destructive impact of fungal infections on the socioeconomic and health status of sub-Saharan Africa's skint populace and to improve the menace posed by these pathogens, there is a need to stop trivializing and underestimating fungal pathogens of health importance. This viewpoint is intended to revisit threats associated with neglected, emerging, and re-emerging fungal pathogens (NEFPs) in sub-Saharan Africa. As a result, information needed to prioritize strategies for the diagnosis, prevention, and control of neglected fungal pathogens and emerging superbugs will be presented. Revisiting threats and possible diagnoses associated with NEFPs could serve as a better leverage toward curbing the effects of opportunistic pathogens on individuals living with either an underlying health condition or impaired immunological status in sub-Saharan Africa/ low-income countries. Article Highlights: Structural presentation of deforming and debilitating illnesses associated with NEFPs. Reassessment of important therapeutic antibodies against NEFPs. Improved diagnostic methods for the diagnosis, prevention, and control of neglected fungal pathogens and emerging superbugs. [ABSTRACT FROM AUTHOR]

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

Introduction Methods Results Conclusion Malaria is a health threat in sub‐Saharan Africa, where Plasmodium is not tested in blood bags. Our objective was to determine the prevalence of plasmodial carriage in blood bags and the associated factors, and the involvement of these bags in the occurrence of malaria in recipients.From 1st April to 30th November, 2020, we conducted a prospective cross‐sectional study of 348 blood bags stored at 4°C in Bamako. Using SPSS 21.0 software, statistical analyses were performed using a binary logistic regression model with a significance threshold of p < 0.05 and the odds ratio (OR) framed by its 95% confidence interval (CI).During this period, 348 blood bags were transfused into 108/152 hospitalised patients, generating a transfusion frequency of 71.1%, with a prevalence of plasmodial carriage of 22%. Among the 54 initially malaria‐negative recipients, all 20 (37%) who received malaria‐positive blood bags and slept under long‐acting insecticide‐treated nets (LLINs) developed malaria. We recorded 33.3% deaths. Donor age ≤ 34 years (p = 0.011; OR = 2.55[CI.95% = 1.25–5.23]), replacement donation (p = 0.000; OR = 0.04[CI.95% = 0.0–0.19]) and not regular use of LLINs by donors (p = 0.048; OR = 0.53[CI.95% = 0.29–1]) were factors associated with plasmodial carriage of blood bags. CD4 count<200 cells/mm3 (p = 0.002; OR = 0.2[CI.95% = 0.10–0.52]), severe anaemia (p = 0.034; OR = 0.26[CI.95% = 0.10–0.90]) and decompensated anaemia (p = 0.034; OR = 3.88[CI.95% = 1.11–13.56]) were factors independently associated with recipient death.The prevalence of plasmodial carriage among blood donors is increasing in Mali. Transfusion malaria is a reality to be feared, with the risk increasing with the level of malaria endemicity of the blood donor. [ABSTRACT FROM AUTHOR]

Low-income urban and rural communities in Sub-Saharan Africa are habitats for more than 556 million profoundly poor people, and the United Nations and the African Union are pessimistic that sustainable development goals will be met. The number of people falling into poverty is increasing, and policy initiatives to reduce poverty have been confounded by various economic, political, social, structural, and environmental issues. Despite a wealth of natural and human assets, there is no systematic approach to sustainable development for poverty alleviation in Sub-Saharan Africa. This case study of an urban community in Ghana, West Africa, investigates the potential role of digital twins in a systematic approach to sustainable development for poverty alleviation. Aerial and community surveys of the built environment and social and economic surveys of businesses and households were compiled to inform a virtual representation of the study area. A small e-commerce business intervention was introduced, and data was recorded for studies on the impact of the intervention. A 3D interactive view, extensive video, and fixed images provided a comprehensive view of the built environment. A limited view of the social and economic environment was obtained from a small population sample. It was observed that online transactions increased in the businesses receiving the e-commerce intervention, demonstrating a willingness of businesses and their customers to engage in e-commerce when incentives are provided. A single successful community-centric initiative has little value unless it can be generalized across the broader society. This limited case study focused on developing and testing virtual and physical constructs to enhance a deeper understanding of the community, community engagement, and pathways to sustainability. The scale of the intervention was too small to conclude generalizability. Future research will focus on improving the data collection processes, fidelity of virtual representations, visualization methods, and methodologies for constructing viable virtual interventions. [ABSTRACT FROM AUTHOR]

Women who have migrated from sub-Saharan Africa (SSA) are underrepresented among HIV pre-exposure prophylaxis (PrEP) users in France (∼2%), yet they account for around 20% of new HIV infections annually. We conducted focus groups to explore the knowledge, attitudes, and perspectives of these women toward PrEP in a French family planning center (FPC). Focus groups occurred from November 2023 to February 2024 within the Lariboisière Hospital FPC in Paris. The social ecological model informed the discussion guide, which explored women's PrEP experiences and determinants for uptake on various levels. Five focus groups were conducted (N = 19). The median age of participants was 29 [interquartile range (IQR) 28–37]. Eight African countries were represented. The average time in France since migration was 3 (IQR 1–6) years. The majority of women had never heard of PrEP but expressed strong interest in learning more about it. Women underscored the difficulty of negotiating HIV prevention tools with their partners, risks from transactional sex, and barriers to PrEP use such as adherence challenges to daily pills and misconceptions about HIV transmission. There was strong interest in long-acting injectable PrEP. Women reported high trust in FPC providers and viewed the FPC as an ideal location to access PrEP. Conspiracy theories, cultural beliefs, and anticipated stigma were also identified as barriers to PrEP uptake. Most women advocated for disseminating PrEP information to their peers using diverse community outreach strategies. Despite a strong interest, increasing PrEP uptake in women from SSA will remain challenging without multi-faceted and adapted implementation strategies. [ABSTRACT FROM AUTHOR]