Iron Deficiency Diagnosis in Sub-Saharan Africa: Challenges, Barriers, and Opportunities.

1. Ann Chen Wu, MD* 2. Leann Lesperance, MD, PhD* 3. Henry Bernstein, DO*† 1. *Pediatric Health Associates, Hunnewell Ground Children’s Hospital 2. †Associate Professor of Pediatrics, Harvard Medical School, Boston, MA After completing this article, readers should be able to: 1. Determine the most common cause of iron deficiency in the United States. 2. Describe the pathogenesis of iron deficiency. 3. List populations at high risk for iron deficiency. 4. Outline the common signs and symptoms of iron deficiency. 5. Specify the American Academy of Pediatrics recommendations for screening for iron deficiency. In the March and April issues of Pediatrics in Review, we published a two-part article on managing anemia in a pediatric office practice. This article expands on the various tests for iron deficiency, including some relatively new ones. These articles should be read as complementary.—RJH Iron deficiency is the most common nutritional deficiency in the world, responsible for a staggering amount of ill health, lost productivity, and premature death. Although its prevalence in the United States has declined since the late 1960s, iron deficiency with or without anemia still is seen frequently in infants, toddlers, adolescent females, and women of childbearing age. In fact, iron deficiency anemia remains the most common hematologic disease of infants and children. Anemia is defined as a low hemoglobin (Hgb) concentration or red blood cell (RBC) mass compared with age-specific norms. Anemia may be caused by decreased RBC production, increased RBC destruction, or blood loss. Based on the size of the RBC, hematologists categorize anemia as macrocytic, normocytic, or microcytic. Iron is found in different compartments within the body. Total body iron (measured by ferritin), transport iron (measured by transferrin saturation), serum iron, and other hematologic and biochemical markers are used to describe the degrees of iron deficiency. Iron depletion refers to the earliest stage of diminishing iron stores in the setting of insufficient iron supply. Iron deficiency (without anemia) develops as these iron stores are depleted further and begin to impair Hgb synthesis. Finally, iron deficiency anemia results …

Worldwide, transmission of emerging and reemerging malaria infections poses a significant threat to human health in the Sub-Saharan Africa, one that can quickly overwhelm public health resources. While the disease burden of malaria in the Sub-Saharan Africa appears to be on a gradual decline, it is characterized by spatial and temporal variability occasioning a sorry state for the Global South Countries. New evidence on long-term complications of malaria heightens our awareness of its public health impact. Given the likelihood of misdiagnosis, and the unknown levels of malaria transmission across different landscapes, many missed opportunities for prevention occur. Africa's population growth, unplanned urbanization, habitat destruction, and trans-border travel are contributing to a rise in the calamitous epidemiology of malaria. Despite empirical statistics demonstrating a downward trend in the malaria disease burden attributable to the scale-up of multiple control strategies, including new diagnostic technologies, malaria remains a global threat to human health in Sub-Sahara Africa. Malaria is a severe public health threat globally, despite several advancements and innovations in its control. Six species of the genus Plasmodium including Plasmodium malariae, Plasmodium falciparum, Plasmodium cynomolgi, Plasmodium knowlesi, Plasmodium ovale, and Plasmodium vivax are known to infect humans. However, greatest disease burden and fatalities are caused by Plasmodium falciparum. Globally, about 3 billion individuals are at risk of contracting malaria disease every year, with over 400,000 fatalities reported in the Sub-Saharan Africa. World Health Organization (WHO) 2018 malaria report indicated that approximately 405,000 mortalities and 228 million cases were reported worldwide, with Africa carrying the highest disease burden. Over the last decade, there has been a significant decline in malaria deaths and infections, which may be related to the availability of effective diagnostic techniques. However, in certain areas, the rate of decline has slowed or even reversed the gains made so far. Accurate diagnosis, adequate treatment, and management of the disease are critical WHO-set goals of eliminating malaria by 2030. Microscopy, rapid diagnostic tests (RDTs), nucleic acid amplification tests (NAATs), and biosensors are all currently accessible diagnostic methods. These technologies have substantial flaws and triumphs that could stymie or accelerate malaria eradication efforts. The cost, ease, accessibility, and availability of skilled persons all influence the use of these technologies. These variables have a direct and indirect ramification on the entire management portfolio of patients. Despite the overall decline in the malaria disease burden driven partly by new diagnostic technologies, a sobering pattern marked by limited number of studies and spatial as well as temporal heterogeneity remains a concern. This review summarizes the principle, performance, gaps, accomplishments, and applicability of numerous malaria diagnostic techniques and their potential role in reducing the malaria disease burden in Sub-Saharan Africa.

In the last half-century the world has witnessed dramatic gains in health status. These are occurring in developing countries now but started in Europe and other wealthier countries around the global in the late 19th century and early 20thcentury. These improvements were partly attributed to increasing in education and income of the population which resulted in more hygienic living conditions and nutrition later in the 20th, expansion of health and public health services by governments and biomedical innovations. Sub-Saharan Africa still carries most of the global burden of disease with low life expectancy at birth with majority of deaths occurring to children under the age of 5 years. Infectious diseases are the major contributors to the disease burden in sub-Saharan Africa that affect the poorest in addition to noncommunicable diseases. The health system is a major determinant in reversing
\nthis burden in sub-Saharan Africa. Health systems in sub-Saharan Africa are weak and need to cope with simultaneous communicable and noncommunicable epidemics. Health information systems play a significant role in steering health system strengthening and documenting progress as it provides reliable information on health determinants, health system performance and population health status. Despite its importance, health information systems in many developing countries are weak, fragmented and often focused exclusively on disease-specific programme
\nareas. Integration of health information systems will provide the basis for public health professionals to look at the health system from different viewpoints.
\nEnterprise architecture (EA) is a management tool that provides means for aligning information systems with organisation’s mission, goals and objectives. EA is used to develop a comprehensive description of all of the key elements and relationships of an organization and its alignment with an organization’s mission, goals, and strategic objectives with information systems. EA can be used as a method for designing health information systems in terms of a well defined set of building blocks, and showing how the building blocks fit together and how they communicate with each other. This research aims to study the potential of EA as a strategic methodology that can be used to systematically gather and document health information system
\nrequirements to design a unified comprehensive health information system that integrates data from diverse sources at all levels of the health system for localised evidence-based decision making and health systems strengthening.
\nThis research used qualitative method to collect primary and secondary data. Primary research data was collected through in-depth interviews with key stakeholders and observation and discussions in workshops and meetings. Secondary research include desk research by searching for published and unpublished research outputs, white papers, reports, user manuals and training materials.
\nGathering and documenting requirements and processes that facilitate systematic design and development of health information systems that are usable, integrated, interoperable and sustainable are practices neglected by Ministries of Health and donor partners in health systems strengthening. In response, this thesis presents original studies on the potential use of an EA approach to strengthen health information systems in low income countries.
\nEA is a systems science approach that is widely used in software design in developed countries.
\nIt is common to see, in developing countries, the application of EA to be focusing on developing eHealth or HIS architecture in silos with little attention paid its application in the context of the health system. This thesis shows developing countries would benefit more from EA by applying it to simplify the complexity of the health system through guiding a systems thinking approach to describe processes, personnel, information systems, data and sub-systems their alignment and
\nhow they are all intended to complement health systems goals and strategic direction. In the process of developing EA developing countries should use the opportunity to reassess the current processes, indicators and data usage and take a decision to either eliminate processes that are no longer required or rationalise them.
\nDeveloping countries has realised the potential of ICT in improving healthcare delivery and availability of information for evidence decision making. Despite this realisation many HISs in developing countries are chaotic characterised by silo systems unable to communicate with each other. EA approach facilitates the design of integrated HISs by describing HIS in a more systemic holistic way.
\n
\nZusammenfassung
\nIn den letzten fünfzig Jahren hat sich der Gesundheitszustand der Weltbevölkerung dramatisch verbessert. Während sich dieser Fortschritt heute vor allem auf Entwicklungsländer beschränkt, begann er in Europa und anderen wohlhabenden Ländern auf der ganzen Welt schon im späten 19. und frühen 20. Jahrhundert. Solche Verbesserungen sind teilweise der höheren Bildung und dem höheren Einkommen der Bevölkerung zuzuschreiben, welche hygienischere
\nLebensverhältnisse und Ernährungsgewohnheiten im 20. Jahrhundert zur Folge hatten, aber auch erweiterten Gesundheitsdiensten durch Regierungen und biomedizinischen Erfindungen. 
\nAfrika südlich der Sahara trägt nach wie vor den grössten Teil der globalen Krankheitslast mit einer tiefen Lebenserwartung bei der Geburt und der höchsten Todesfallrate bei Kindern unter 5 Jahren. Infektionskrankheiten sind neben nichtansteckenden Krankheiten Hauptbestandteil der Krankheitslast, die die ärmsten in Afrika südlich der Sahara trifft. Das Gesundheitssystem ist ein bedeutender Einflussfaktor, wenn es um die Reduktion dieser Krankheiten in Afrika südlich der
\nSahara geht. Gesundheitssysteme in Afrika südlich der Sahara sind schwach und kämpfen gleichzeitig mit Epidemien ansteckender und nichtansteckender Krankheiten. 
\nGesundheitsinformationssysteme spielen eine wichtige Rolle bei der Verbesserung der Gesundheitssysteme und helfen, den Fortschritt zu dokumentieren, da sie verlässliche Informationen zu Gesundheitsfaktoren, Effizienz des Gesundheitssystems und den Gesundheitszustand der Bevölkerung liefern. Obwohl sie so bedeutend sind, sind Gesundheitsinformationssysteme in vielen Entwicklungsländern schwach, bruchstückhaft und oft nur auf bestimmte betroffene Gebiete beschränkt. Die Vernetzung der Gesundheitsinformationssysteme würde es für Angestellte des Gesundheitswesens ermöglichen, das Gesundheitssystem von verschiedenen Blickwinkeln her zu betrachten.
\n „Enterprise architecture“ (EA) ist ein Führungsinstrument, das es ermöglicht,
\nInformationssysteme mit dem Auftrag und den Zielvereinbarungen einer Organisation zu vergleichen. EA entwickelt eine umfassende Beschreibung aller Schlüsselelemente und Beziehungen einer Organisation, um das Informationssystem auf den Auftrag und die strategischen Ziele der Organisation auszurichten. EA kann zur Entwicklung von Gesundheitsinformationssystemen mittels genau definierter Bausteine verwendet werden und zeigen wie die Bausteine zusammenpassen und miteinander in Verbindung stehen. Die vorliegende Forschungsarbeit untersucht die Möglichkeiten von EA als strategische Methode zum systematischen Sammeln und Dokumentieren von Anforderungen eines Gesundheitsinformationssystems. Dadurch soll ein umfassendes, einheitliches Gesundheitsinformationssystem entwickelt werden, das Daten von verschiedenen Quellen auf allen Stufen des Gesundheitssystems zusammenführt, um eingegrenzte, evidenzbasierte
\nEntscheidungen und die Stärkung des Gesundheitssystems zu fördern.
\nIn dieser Forschungsarbeit wurden qualitative Methoden verwendet, um primäre und sekundäre Daten zu sammeln. Primäre Daten wurden durch Tiefeninterviews mit den wichtigsten Interessenvertretern erhoben, sowie anhand von Beobachtungen und Diskussionen in Workshops und Sitzungen. Die sekundäre Datenerhebung beinhaltet Schreibtischarbeit wie die Suche nach publizierten und nicht-publizierten Forschungsergebnissen, Weissbüchern, Berichten, Bedienungsanleitungen und Schulungsunterlagen.Das Sammeln und Dokumentieren von Vorgaben und Prozessen, die das systematische Designen und Entwickeln von Gesundheits-informationssystemen, die anwendbar, umfassend, kompatibel und nachhaltig sind, vereinfachen, wird von den Gesundheitsministerien und Geberpartnern bei
\nder Stärkung der Gesundheitssysteme vernachlässigt. Die vorliegende Arbeit präsentiert Originalstudien zur möglichen Anwendung von EA, um Gesundheits-informationssysteme in einkommensschwachen Ländern zu stärken.
\nEA ist eine systematische, wissenschaftliche Herangehensweise, deren Anwendung im Softwaredesign in entwickelten Ländern weit verbreitet ist. Üblicherweise wird in
\nEntwicklungsländern EA bei der Entwicklung von eHealth oder der Architektur von
\nGesundheitsinformationssystemen in Silos angewendet, wobei der Verwendung im
\nZusammenhang mit dem Gesundheitssystem wenig Beachtung geschenkt wird. Die vorliegende Arbeit zeigt, dass Entwicklungsländer mehr von EA profitieren würden, wenn sie es zur Vereinfachung von Komplexitäten im Gesundheitssystem anwenden würden. Durch einen „Systems Thinking“-Ansatz könnten Prozesse, Personal, Informationssysteme, Daten und Subsysteme beschrieben und angepasst werden, um Ziele und strategische Richtung des Gesundheitssystems zu ergänzen. Während der Erarbeitung des EA sollten Entwicklungsländer die Gelegenheit nutzen, ihre Prozessabläufe, Indikatoren und Datenanwendungen zu überdenken,
\nund überholte Prozesse zu eliminieren oder zu rationalisieren.
\nEntwickelte Länder haben das Potential der Informations- und Kommunikations-technologie erkannt, um die Gesundheitsvorsorge und die Verfügbarkeit von Informationen fü

A new chapter in HIV

Non-communicable diseases (NCDs) are the leading cause of mortality globally and account for a growing proportion of the disease burden in sub-Saharan Africa (SSA), where health systems face significant resource constraints. The COVID-19 pandemic disrupted healthcare delivery globally, raising concerns that interruptions to routine NCD care could lead to higher morbidity and mortality among populations requiring ongoing care. Although evidence of the pandemic’s impact on NCD care has been documented in high-income settings, the experience of SSA health systems, which entered the pandemic with preexisting infrastructure and workforce limitations, remains incompletely understood. This scoping review aimed to systematically map the evidence on COVID-19’s impact on NCD care in SSA and to identify service adaptations implemented to maintain care continuity during the pandemic. Studies examining the COVID-19 pandemic and disruptions in NCD screening, diagnosis, or monitoring among adults in SSA were identified from four electronic databases: PubMed/Medline, Scopus, EBSCOhost, and Web of Science. The search strategy combined Medical Subject Headings (MeSH) terms and keywords related to geographic location (SSA), exposure (COVID-19 pandemic and related public health measures), and outcomes (screening, diagnosis, and monitoring of NCDs). Inclusion was limited to original research published between March 2020 and December 2023, written in English, French, or German, and reporting observational data on pandemic-related disruptions to NCD care. Two reviewers independently screened titles, abstracts, and full texts, with data extraction conducted using a standardized form capturing study characteristics, NCD types examined, nature of documented disruptions, and reported innovations. Twenty-eight studies were eligible for inclusion across seven countries in SSA, with the majority of evidence originating from South Africa and Ethiopia. Included studies were mainly retrospective and cross-sectional, with some using mixed-methods and time-series designs, and examined various NCDs, including diabetes mellitus, hypertension, and cancers. Sample sizes ranged from fewer than 100 participants to datasets exceeding 9 million records. Due to the heterogeneity of study designs, populations, and outcomes, findings were synthesized narratively. Six major themes emerged: disrupted access to routine care, interruptions to diagnostics and monitoring, medicine supply chain challenges, adoption of remote care models, health equity impacts, and clinical outcome implications. The pandemic was associated with widespread barriers to healthcare access, diagnostic delays, and medication shortages, with the implementation of innovations such as telemedicine and community-based delivery often hindered by technological and resource limitations. COVID-19 significantly disrupted NCD care across SSA, though health systems demonstrated notable capacity for adaptation, emphasizing the need for resilient service delivery models and equity-focused monitoring to safeguard care during future health emergencies.

HIV/AIDS is a leading cause of disease burden in sub-Saharan Africa. Existing evidence has demonstrated that there is substantial local variation in the prevalence of HIV; however, subnational variation has not been investigated at a high spatial resolution across the continent. Here we explore within-country variation at a 5 × 5-km resolution in sub-Saharan Africa by estimating the prevalence of HIV among adults (aged 15–49 years) and the corresponding number of people living with HIV from 2000 to 2017. Our analysis reveals substantial within-country variation in the prevalence of HIV throughout sub-Saharan Africa and local differences in both the direction and rate of change in HIV prevalence between 2000 and 2017, highlighting the degree to which important local differences are masked when examining trends at the country level. These fine-scale estimates of HIV prevalence across space and time provide an important tool for precisely targeting the interventions that are necessary to bringing HIV infections under control in sub-Saharan Africa.

Climate change increasingly disrupts food systems in Sub-Saharan Africa, yet the implications for food-borne neglected tropical disease (NTD) transmission remain poorly synthesised. To map and synthesise evidence on how climate-driven disruptions in local food systems influence transmission pathways of food-borne NTDs in Sub-Saharan Africa. A scoping review was conducted in accordance with PRISMA-ScR guidelines and five electronic databases (PubMed/MEDLINE, Scopus, Web of Science, Embase, and African Journals Online) were searched from inception up till January 31st 2026. Peer-reviewed primary studies examining climate-related disruptions to food systems and food-borne NTD transmission in Sub-Saharan Africa were included. Data were charted and synthesised thematically. Twenty studies were included and five key themes emerged: climate variability as a driver of food system vulnerability; food system stages as critical transmission nodes; behavioural and socioeconomic mediators; zoonotic and environmental interfaces; and structural gaps in surveillance, policy, and interventions. Climate-related stressors consistently disrupted food production, storage, distribution, and preparation, increasing exposure to food-borne NTDs. Climate-driven food system disruptions represent a critical but under-recognised pathway for food-borne NTD transmission. Integrating food system resilience into climate adaptation and NTD control strategies is essential for reducing disease burden in Sub-Saharan Africa.

Background: Sickle cell anaemia (SCA) imposes a significant disease burden in sub-Saharan Africa, with Nigeria bearing the highest national prevalence worldwide. Although international guidelines recommend early initiation of hydroxyurea (HU) in paediatric SCA, uptake remains low in many low- and middle-income settings due to limited provider knowledge, cost constraints, and supply challenges.Methods: We conducted a retrospective, descriptive crosssectional study of 517 children aged 1–17 years with confirmed SCA who commenced HU therapy at Jos University Teaching Hospital (JUTH), Nigeria, between 2016 and 2023. Using a dedicated Sickle Cell Disease registry, we extracted data on demographics, HU initiation age, treatment duration and dose, clinical indications, and initiation motivations. Uptake trends were assessed by the proportion of HU recipients relative to the total paediatric SCD population.Results: HU was initiated between the ages of 1 and 5 years in 40.2% of the patients, with the youngest starting at 12 months. The cohort comprised 53.8% males. Frequent vaso-occlusive crises were the most common indication for HU initiation (59.8%), while patient or caregiver testimonials motivated 62.0% of participants to begin therapy. HU uptake increased markedly from 1.2% in 2016 to 44.3% in 2023—a more than forty-fold rise. The mean HU duration was 57.2 months, and the mean dose was 21.8 mg/kg/day.Conclusion: Despite systemic barriers, JUTH successfully implemented and scaled HU therapy for paediatric SCA. Key enablers included focused physician training, community engagement via patient and caregiver success stories, and targeted policy support—including NIH-funded medication provision during the pilot phase.

Disease burden in sub-Saharan Africa

Group B streptococcus (GBS) is a leading neonatal sepsis pathogen globally. Investment in GBS disease prevention, such as maternal vaccination, requires evidence of disease burden, particularly in high infant mortality regions like sub-Saharan Africa. We aimed to provide such evidence by conducting a systematic literature review and meta-analysis to estimate maternal colonization proportion, GBS disease incidence and GBS serotype distribution. MEDLINE, MEDLINE in process and Cochrane Library were searched for studies published during 1990-2014, pertaining to sub-Saharan Africa. Eligible studies were used to estimate the proportion of pregnant women colonized with GBS, early-onset GBS disease incidence, late-onset GBS disease incidence and respective serotype distributions. Random effects meta-analysis was conducted to estimate weighted means and confidence intervals (CIs). We identified 17 studies of colonization, 9 of disease incidence, and 6 of serotype distribution meeting inclusion criteria. 21.8% (95% CI: 18.3, 25.5) of expectant women were colonized with GBS. The incidence of early-onset GBS disease was 1.3 per 1000 births (95% CI: 0.81, 1.9), that of late-onset GBS disease 0.73 per 1000 births (95% CI: 0.48, 1.0). The most common disease-causing serotype was 3, followed by 1a. Serotypes 1b, 2 and 5 were next most common in frequency. Despite methodological factors leading to underestimation, GBS disease incidence appears high in sub-Saharan Africa. A small number of GBS serotypes cause almost all disease. GBS disease burden in sub-Saharan Africa suggests that safe, effective and affordable GBS disease prevention is needed.

Bone Marrow Iron in CKD: Correlation With Functional Iron Deficiency

BackgroundAcute lower respiratory tract infections (ALRTIs) among children under five are still the leading cause of mortality among this group of children in low and middle-income countries (LMICs), especially countries in sub-Saharan Africa (SSA). This scoping review aims to map evidence on prevalence and risk factors associated with ALRTIs among children under 5 years to inform interventions, policies and future studies.MethodsA thorough search was conducted via four main databases (PubMed, JSTOR, Web of Science and Central). In all, 3,329 records were identified, and 107 full-text studies were considered for evaluation after vigorous screening and removing duplicates, of which 43 were included in this scoping review.FindingsFindings indicate a high prevalence (between 1.9% to 60.2%) of ALRTIs among children under five in SSA. Poor education, poverty, malnutrition, exposure to second-hand smoke, poor ventilation, HIV, traditional cooking stoves, unclean fuel usage, poor sanitation facilities and unclean drinking water make children under five more vulnerable to ALRTIs in SSA. Also, health promotion strategies like health education have doubled the health-seeking behaviours of mothers of children under 5 years against ALRTIs.ConclusionALRTIs among children under five still present a significant disease burden in SSA. Therefore, there is a need for intersectoral collaboration to reduce the burden of ALRTIs among children under five by strengthening poverty alleviation strategies, improving living conditions, optimising child nutrition, and ensuring that all children have access to clean water. There is also the need for high-quality studies where confounding variables in ALRTIs are controlled.

BackgroundHepatitis C (HCV) is a deleterious virus that can be cured with new, highly effective anti-viral treatments, yet more than 185 million individuals worldwide remain HCV positive (with the vast majority un-diagnosed or untreated). Of importance, HCV is a leading cause of chronic liver disease and liver cancer, especially in Sub-Saharan Africa (SSA) where the prevalence remains high but uncertain due to little population-based evidence of the epidemic. We aimed to synthesize available data to calculate and highlight the HCV disease burden in SSA.MethodsWeighted random-effects generalized linear mixed models were used to estimate prevalence by risk cohort, African region (Southern, Eastern, Western, and Central Africa), type of assay used, publication year, and whether the estimate included children. A pooled prevalence estimate was also calculated. Multi-variable analyses were limited to cohort and region specific prevalence estimates in the adult population due to limited studies including children. Prevalence estimates were additionally weighted using the known adult population size within each region.ResultsWe included more than 10 years of data. Almost half of the studies on HCV prevalence in SSA were from the Western region (49 %), and over half of all studies were from either blood donor (25 %) or general population cohorts (31 %). In uni-variable analyses, prevalence was lowest in Southern Africa (0.72 %), followed by Eastern Africa at 3.00 %, Western Africa at 4.14 %, and Central Africa at 7.82 %. Blood donors consistently had the lowest prevalence (1.78 %), followed by pregnant women (2.51 %), individuals with comorbid HIV (3.57 %), individuals from the general population (5.41 %), those with a chronic illness (7.99 %), and those at high risk for infection (10.18 %). After adjusting for the population size in each region, the overall adult prevalence of HCV in SSA rose from 3.82 to 3.94 %.ConclusionThis meta-analysis offers a timely update to the HCV disease burden in SSA and offers additional evidence of the burgeoning epidemic. The study highlights the need to account for type of cohort and region variation when describing the HCV epidemic in SSA, the need for more studies that include children, as well as the need to factor in such variations when planning public health interventions.Electronic supplementary materialThe online version of this article (doi:10.1186/s12879-016-1584-1) contains supplementary material, which is available to authorized users.

Cervical cancer remains a major public health challenge in sub-Saharan Africa (SSA), mainly due to low screening uptake. Mass media exposure (including radio, newspapers, and television) can play a key role in promoting health services utilisation; however, little is known about its relationship with cervical cancer screening uptake in SSA. This study examined the association between mass media exposure and cervical cancer screening uptake among women aged 30-49 years in four SSA countries. This cross-sectional study utilized data from the Demographic and Health Surveys conducted between 2022 and 2023 in four SSA countries: Ghana, Kenya, Mozambique, and Tanzania. A pooled weighted sample of 26,936 women aged 30-49 years was analysed. Univariable and multivariable logistic regression models were fitted to assess the association between mass media exposure and cervical cancer screening uptake. Adjusted odds ratios with their corresponding 95% confidence intervals were estimated. The pooled prevalence of cervical cancer screening was 15.2% (95% CI: 14.5-15.9), with the lowest rate in Ghana at 7.3% and highest in Kenya at 27.0%. The multivariable analysis revealed that women exposed to mass media were 74% more likely to have been screened for cervical cancer (AOR: 1.74; 95% CI: 1.40-2.16.) compared to those without media exposure. This study demonstrated a positive association between mass media exposure and uptake of cervical cancer screening among women in SSA. This highlights the important role that mass media can play in promoting the uptake of screening in the region. Thus, increasing access to media platforms, such as radio, television, and newspapers could enhance awareness and participation in cervical cancer screening services, ultimately helping reduce the disease burden in SSA.

Introduction Although cardiovascular diseases (CVDs) are among the leading causes of death in Sub-Saharan Africa (SSA), prevention is not a priority and effective treatments are not widely available. This perspective discusses the burden, challenges, and potential opportunities for improvement of CVD prevention and control efforts in SSA. Areas covered This paper focuses on ischemic heart disease and stroke, and their key contributors of obesity, hypertension, diabetes and dyslipidaemia which are well-established, rapidly rising, and significant contributors to disease burden in SSA. However, their prevention, detection, treatment and control of are currently disorganized, inconsistent, unreliable, and insufficient with most SSA countries not geared to respond to this growing problem. National policies are frequently lacking or, if available, remain poorly implemented, for the control of these conditions. Primary healthcare systems have not adapted to cope with these rising CVD burdens and remain weak, underfunded and under resourced. Numerous barriers at the healthcare service, healthcare provider, and patient levels prevent optimal CVD risk factor care. Expert opinion Innovative approaches such as task-shifting with the reallocation of care to lower-level healthcare workers and the potential use of inexpensive technological options should be encouraged to provide equitable CVD preventive and curative solutions to SSA’s poor.