Africa Region Research Articles

“Living their best life”: PhotoVoice insights on well-being, inclusion, and access to public spaces among adolescent refugee girls in urban resettlement

ABSTRACT Purpose Newcomer adolescent girls from the Middle East and North Africa region face intersectional challenges and opportunities upon resettlement. This study employs PhotoVoice participatory research methodology to explore perspectives on well-being and belonging shared by six students who resettled to Chicago from Iraq and Syria. Methods Two programme sessions consisted of participants reflecting on their photographic responses to four prompts in focus group discussions. The subsequent four sessions included qualitative analysis skill building, participant-led generation of thematic codes and diagrams using their data, and the creation of action plan posters to share back with the community. The research team then analysed all data using a grounded theory approach with constant comparative analysis. Results Four major themes emerged: 1) public spaces served as a vehicle for exploring well-being and belonging; 2) intersectional inclusion in public spaces was deemed a vital priority; 3) schools held an important role in facilitating belonging and access to public spaces; and 4) language was a critical barrier and facilitator to access and inclusion. Conclusions Findings highlight the need for holistic approaches to support refugee youth in urban contexts and emphasize the role of schools in facilitating inclusive access to public spaces to strengthen newcomer students’ well-being and belonging.

Matriarchal leadership as the catalyst for positive change in Africa

This paper aims to investigate how moral and matriarchal leadership might enhance the continent's environment for democracy, improving living and working conditions. African nations historically esteemed the influence of matriarchs; nevertheless, their representation in politics and business has diminished significantly. Africa possesses abundant resources and numerous enduring challenges. Implementing matriarchal leadership paradigms may facilitate the discovery of previously untested solutions. This study employs many research methodologies, including qualitative and quantitative approaches, to comprehensively examine the influence of matriarchal leadership on African governance. In-depth interviews and case studies are employed in the qualitative segment to examine the challenges, experiences, and achievements of women leaders throughout various regions of Africa.

Geospatial Analysis of COVID-19 Death Rate and Influencing Factors in the Middle East and North Africa Region

Introduction: This study uses advanced geospatial modeling to analyze key determinants of COVID-19 death cases across the Middle East and North Africa (MENA) region, aiming to reveal spatial patterns and inform targeted interventions for enhanced public health response. Methods: This study employs GIS and geostatistical models, including OLS, SLM, SEM, GWR, and MGWR, to analyze spatial and demographic determinants of COVID-19 mortality across MENA. By examining socioeconomic, medical, and demographic factors, it identifies key drivers and explores spatially non-stationary relationships impacting death rates. Results: The study found that hospital bed allocation, unemployment rate, and vaccination doses positively correlate with COVID-19 death cases in MENA, likely due to better reporting and healthcare access. The OLS model (R² = 0.7346) highlighted spatial autocorrelation, prompting the use of SLM and SEM, which confirmed predictor significance. GWR (R² = 0.8140) and MGWR (R² = 0.8187) revealed spatially non-stationary relationships, with hospital beds impacting the northwest (GWR) and southwest (MGWR). Unemployment was significant in the northeast (Iran, Turkey) and northwest (Morocco), while vaccination doses were notably influential in Iran and Somalia. Conclusion: This study emphasizes the significant roles of healthcare capacity, socioeconomic factors, and vaccination coverage in influencing COVID-19 mortality across MENA. It highlights the vulnerability of healthcare systems in developing countries and underscores the need for targeted resource allocation. Using spatial models like GWR and MGWR, the research reveals regional variations, especially in the northwest, advocating for tailored, region-specific interventions. By integrating GIS and geostatistical models, this analysis lays a foundation for future research on COVID-19 dynamics, providing crucial insights to inform policy measures for better public health crisis management

A Review of Epidemiology, Clinical Manifestations, and Therapeutic Approaches for Monkeypox

Monkeypox, a zoonotic disease caused by the monkeypox virus belonging to the Orthopoxvirus genus, has emerged as a significant public health concern worldwide. Initially confined to endemic regions in Central and West Africa, the disease has spread globally, affecting multiple countries across continents. The virus primarily transmits through close contact with infected animals, humans, or contaminated materials. Clinical presentations range from mild symptoms to severe complications, with characteristic features including fever, lymphadenopathy, and distinctive skin lesions progressing through various stages. Recent outbreaks have demonstrated altered transmission patterns and clinical manifestations, particularly affecting specific population groups. Diagnostic approaches encompass molecular techniques, serological testing, and clinical assessment. While supportive care remains the primary management strategy, antiviral medications like tecovirimat show promise in severe cases. Vaccination strategies, including both pre-and post-exposure prophylaxis, play crucial roles in prevention and outbreak control. Public health measures, surveillance systems, and international collaboration are essential components in managing the spread of monkeypox. The emergence of monkeypox as a global health challenge necessitates continued vigilance, enhanced preparedness, and coordinated response efforts to effectively contain and manage future outbreaks.

Examining Water Efficiency Measures for Three- to Five-Star Graded Game Lodges and for Residential Beneficiation in Hammanskraal, South Africa

Globally, water scarcity has been a concern for the tourism and hospitality sectors, which are significant water consumers. Conflict between lodges and residents can also arise from differing priorities, competition, limited access, and inadequate infrastructure. There are limited studies addressing water governance challenges and equitable water access while balancing conservation, tourism, and local needs. In the arid regions of water-scarce South Africa, particularly in areas hosting game lodges essential to tourism, effective water management is vital in societal terms. In this context, the present study aimed to address these issues by investigating water efficiency measures adopted in game lodges and exploring sustainable solutions for equitable water access for neighboring residents. Effective water governance is essential for balancing conservation efforts, fulfilling guest expectations, and meeting the needs of local communities. Through semistructured techniques, this study explored the adoption of water efficiency measures by residents in Hammanskraal and the neighboring three-to five-star graded game lodges around Dinokeng Game Reserve, South Africa. The challenges that game lodges face is outlined, such as deficient government policy enforcement and insufficient stakeholder collaboration, which hinder the mandatory adoption of water efficiency measures. This suggests the need for stronger regulatory frameworks and better coordination among stakeholders in ensuring the success of game lodges in water management. The specific strategies and technologies employed by residents and lodges to conserve water and manage their resources sustainably were identified. Findings further illuminate the intricate relationship between game lodges, residents, and water resource management, emphasizing the need for harmonious coexistence to prevent social tensions. Additionally, the study exposed gaps in policy, corruption, and inadequate infrastructure, which have led to suboptimal water governance in the Hammanskraal region. Municipal lapses and inadequate monitoring contribute to water management issues, negatively affecting residents. The key knowledge contributions highlighted by the study include the importance of engaging local communities in water governance for more effective and resilient water management practices.

Psychological antecedents of vaccine inequity: keys to improve the rates of vaccination

BackgroundThe World Health Organization (WHO) stresses the importance of worldwide vaccine coverage of coronavirus-19 (COVID-19) vaccination. This study fills a critical gap in the literature by providing empirical evidence on the factors influencing COVID-19 vaccine hesitancy and inequity in the Middle East and North Africa (MENA) region. This study investigated the determinants of psychological antecedents and other factors behind COVID-19 vaccination and their role in vaccine coverage in MENA.MethodsAn anonymous online cross-sectional survey was conducted in 11 MENA countries (Egypt, Sudan, Kuwait, Saudi Arabia, Morocco, Iraq, Yemen, Lebanon, Libya, Afghanistan, and Pakistan). The minimum required sample size from each country was 307, which was increased to 330 to accommodate a non-response rate of 7%. A multilevel logistic regression model was used to capture the clustering of observations in each country and estimate the explanatory variables’ effects on each item of the 5C components of the psychological antecedents scale namely (confidence, constraints, complacency, calculation, and collective responsibility).ResultsThe total number of respondents was 3630, 40.5% of them were between the ages of 18 and 25 years, 61.1% were females, 54.0% completed university education, 55.8% were unmarried, 19.5% had chronic diseases, 43.7% reported a previous COVID-19 and 42.4% had relatives who died from COVID-19. Much of the variation in the log of the odds in each item of the 5Cs was due to heterogeneity between different countries (intraclass correlation > 0.05). Therefore, this variability confirms the various effects of psychological antecedents on vaccination coverage, stimulating vaccination inequity among them. Increasing confidence in vaccines and collective responsibility towards relatives and the community is related to increasing acceptance of the COVID-19 vaccine. The reduction in complacency, calculations, and constraints was found to be associated with acceptance of the COVID-19 vaccine.ConclusionsThis study is novel in shedding light on the importance of psychological determinants as hidden causes of vaccine inequities by using a multilevel logistic regression model for COVID-19 vaccination intention. The findings suggest that targeted interventions addressing socio-demographic factors, psychological antecedents, and accessibility barriers are essential to mitigate vaccine inequity and improve vaccination rates.

Quest for SDG‐13: The Aptness of Green Investments and Information and Communications Technology (ICT) to Emission Mitigation Among Central‐African States

ABSTRACTThe Sustainable Development Goal 13 (SDG‐13) enunciates the need to combat climate change by encouraging necessary actions to reduce greenhouse gas (GHG) emissions, and this laudable goal was re‐echoed at COP‐28 in the UAE. Although negatively impacted by climate change, the vast literature is silent on the Central Africa (CA) region. Thus, we empirically dissect the emission‐mitigating roles of green investment while integrating the moderating influences of ICT, foreign capitals (FDI), and non‐renewable energy intake, within the region's economic expansion and population growth. We observe that economic expansion has a non‐linear impact on emissions (an inverted U‐Shaped pattern); with initial emission‐inducing effects from non‐renewable energy, financial development, population, and foreign capitals while green investment and ICT mitigate regional emissions. Subsequent expansion in indicators (green investments, FDI, and ICT) significantly mitigates emissions except for non‐renewable energy intake. Green investments' interactive impacts with overall financial development trends also enhance regional environmental goals. Overall, the study posits that CA states can potentially mitigate environmental degradation by leveraging ICT and green investments towards the realization of SDG‐13.

“Breaking barriers: empowering African youth through implementation of a therapeutic patient education program for juvenile idiopathic arthritis”

IntroductionPatient education is crucial in managing chronic diseases like Juvenile Idiopathic Arthritis (JIA). Traditional methods such as videos and brochures often fail to maintain long-term knowledge retention. Therapeutic Patient Education (TPE) offers a more effective, patient-centered approach.ObjectivePAFLAR aimed to implement a TPE program with a “train the trainers” masterclass to ensure effective delivery and improve outcomes for children with JIA.MethodsPAFLAR's TPE program was designed through a focus group, involving a literature review and strategic planning for the implementation step. The program includes specialized training for healthcare professionals enhancing their abilities to deliver TPE workshops. Participants were selected based on volunteerism and commitment to the project. Evaluations were conducted through feedback assessment of both patients and participants.ResultsPAFLAR launched a TPE program in 2023, aimed at training healthcare providers to implement TPE effectively. This initiative included both in-person and virtual masterclasses, resulting in five workshops conducted in Kenya, Tunisia, and Nigeria. These workshops covered various aspects of JIA management, such as patient and family education, self-esteem, physical activity, treatment adherence, and pain management. Early results showed significant improvements in patients’ and parents’ understanding and management of JIA, with positive feedback indicating a need for further sessions.ConclusionPAFLAR has taken the initial step in implementing a TPE program for JIA across three countries, representing different regions of Africa. The TPE program offers a promising alternative to traditional patient education methods, significantly improving patient care, empowering healthcare providers, and advancing healthcare systems.

RT-RPA as a dual tool for detection and phylogenetic analysis of epidemic arthritogenic alphaviruses

Chikungunya (CHIKV), o’nyong-nyong (ONNV), and Mayaro (MAYV) viruses are transmitted by mosquitoes and known to cause a debilitating arthritogenic syndrome. These alphaviruses have emerged and re-emerged, leading to outbreaks in tropical and subtropical regions of Asia, South America, and Africa. Despite their prevalence, there persists a critical gap in the availability of sensitive and virus-specific point-of-care (POC) diagnostics. Traditional immunoglobulin-based tests such as enzyme-linked immunosorbent assay (ELISA) often yield cross-reactive results due to the close genetic relationship between these viruses. Molecular diagnostics such as quantitative polymerase chain reaction (qPCR) offer high sensitivity but are limited by the need for specialized laboratory equipment. Recombinase polymerase amplification (RPA), an isothermal amplification method, is a promising alternative to qPCR, providing rapid results with minimal equipment requirements. Here, we report the development and validation of three virus-specific RT-RPA-based rapid tests for CHIKV, ONNV, and MAYV. These tests demonstrated both speed and sensitivity, capable of detecting 10–100 viral copies within 20 min of amplification, without exhibiting cross-reactivity. Furthermore, we evaluated the clinical potential of these tests using serum and tissue samples from CHIKV, ONNV, and MAYV-infected mice, as well as CHIKV-infected human patients. We demonstrate that the RPA amplicons derived from the patient samples can be sequenced, enabling cost-effective molecular epidemiological studies. Our findings highlight the significance of these rapid and specific diagnostics in improving the early detection and management of these arboviral infections, particularly in resource-limited settings.

Changing patterns of family formation among internally displaced populations in Yemen: evidence from cross-sectional surveys

Introduction: Yemen has one of the highest rates of child marriage in the Middle East and North Africa region and is home to one of the world’s worst humanitarian crises. How the conflict and resulting displacement have impacted family formation patterns is not entirely clear. In this study, we investigate the impact of displacement on child marriage and early childbearing by comparing time-to-first-marriage and time-to-first-birth among displaced and non-displaced girls.MethodsWe used data collected through cross-sectional multistage stratified cluster household surveys in three governorates in Yemen with high concentrations of internally displaced persons (IDPs). Employing an analytic sample 1,861 girls aged 15–24, we compared entry into first marriage and time to first birth between IDPs and non-displaced persons using Kaplan Meier curves and Cox regressions.ResultsWe found high rates of child marriage in this population, with 37.8% and 34.5% of ever-displaced and never-displaced girls aged 20–24 married before age 18. Overall, those who were displaced had 30% higher hazard of overall marriage compared to their host counterparts (95% CI 1.16–1.47), and 23% increased hazard of child marriage (95%CI 1.01–1.51). Stratification by governorate revealed heterogeneity across governorates, with displaced populations at higher hazard of marriage in Aden and Maarib but not in Hadramout. We found that child brides and displaced participants were more likely to initiate earlier childbearing compared to non-child brides (HR = 3.44; 95% CI 2.94 4.0) and host counterparts (HR 1.35; 95% CI 1.15–1.58). Despite generally having lower age at first birth, child brides experienced a 19% lower hazard of first birth after marriage compared to those married over 18, indicating that child brides tended to wait longer before first birth (95% CI 0.72–0.92). We did not find a significant association between displacement status and marriage to birth interval after adjusting for child marriage status.ConclusionOur results highlight the impact of forced displacement on time-to-first-marriage and suggest that those who are displaced are more vulnerable to child marriage. We did not find compelling evidence for child marriage driving an increase in early childbearing. Nonetheless, our findings highlight the need for interventions that focus on prevention and mitigation of child marriage in this setting, particularly among IDPs who are at increased vulnerability.

Revealing the role of intangible factors on migration in MENA: Religious identity and freedom perceptions

AbstractThis study investigates the role of intangible factors in the migration decision‐making processes of citizens from the Middle East and North Africa (MENA) region. While the existing literature often highlights economic factors as the primary drivers of migration, this research explores how religious identity and perception of democracy and freedoms—specifically, freedom of expression and electoral freedom—influence these decisions. Utilising data from the Arab Opinion Index from 2012 to 2020, the study covers nine MENA countries and considers variables, such as gender, education level, household economic status, age, residential area, religious affiliation, and views on social and political freedoms. The findings suggest that intangible factors, particularly religious identity and perceived lack of freedoms, significantly influence individuals' migration decisions, similar to economic factors. Individuals who identify as less religious, associate with a less religious social circle, and perceive that their freedoms are not protected are more likely to consider migrating. This research contributes to a deeper understanding of migration dynamics in the MENA region, providing policymakers with crucial insights to develop evidence‐based strategies addressing the complex drivers of migration.

Short-term, lagged association of airway inflammation, lung function, and asthma symptom score with PM2.5 exposure among schoolchildren within a high air pollution region in South Africa.

Asthma affects millions of people globally, and high levels of air pollution aggravate asthma occurrence. This study aimed to determine the association between short-term lagged PM2.5 exposure and airway inflammation, lung function, and asthma symptom scores among schoolchildren in communities in the Highveld high-pollution region in South Africa. A cross-sectional study was conducted among schoolchildren aged 9-14 years in six communities in the Highveld region in South Africa, between October 2018 and February 2019. A NIOX 200 instrument was used to measure fractional exhaled nitric oxide (FeNO). Lung function indices (forced expiratory volume in one second [FEV1]; forced vital capacity [FVC] and FEV1/FVC) were collected using spirometry and the percent of predicted of these was based on the reference equations from the Global Lung Initiative, without ethnic correction. These values were further analyzed as binary outcomes following relevant thresholds (lower limits of normal for lung function and a cutoff of 35 ppb for FeNO). Asthma symptoms were used to create the asthma symptom score. Daily averages of PM2.5 data for the nearest monitoring station located in each community, were collected from the South African Air Quality Information System and created short-term 5-day lag PM2.5 concentrations. Additional reported environmental exposures were collected using standardized instruments. Of the 706 participating schoolchildren, only 1.13% of the participants had doctor-diagnosed asthma, compared to a prevalence of 6.94% with an asthma symptom score suggestive of asthma. Lag 1 (odds ratio [OR]: 1.01; 95% confidence interval [CI]: 1.00, 1.02, P = 0.039) and 5-day average lagged PM2.5 (OR: 1.02; 95% CI: 0.99, 1.04, P = 0.050) showed increased odds of the FeNO > 35 ppb. Lung function parameters (FEV1 < lower limit of normal [LLN] [OR: 1.02, 95% CI: 1.00, 1.03, P = 0.018], and FEV1/FVC < LLN [OR: 1.01; 95% CI: 1.00, 1.02, P < 0.001]) and asthma symptom score ≥ 2 (OR: 1.02; 95% CI: 1.00, 1.04, P = 0.039) also showed significant associations with lag 2, lag 4 and lag 1 of PM2.5, respectively. Lagged PM2.5 exposure was associated with an increased odds of airway inflammation and an increased odds of lung function parameters below the LLN particularly for the later lags, but a significant dose-response relationship across the entire sample was not consistent.

Enhancing flood forecasting accuracy in Data-Scarce regions through advanced modeling approaches

Flood forecasting in data-scarce regions poses significant challenges due to irregular rainfall patterns and limited hydrological monitoring networks, particularly in semi-arid regions in Africa, South America, and Asia. However, despite significant efforts and advancements, there remains a substantial gap in the accurate prediction of flood events necessary for effective risk management and mitigation, evidenced by the recurrence of devastating floods in middle to low-income countries in recent years. Here, we address this problem by testing advanced modeling techniques in a local African case, using a combination of statistical methods for extreme event prediction, hydrodynamic modeling, and remote sensing data, to recommend the most adapted and accurate approach under a variety of settings. Our case study is an emerging urban area in Northern Morocco, situated in a triangular plain interposed between adverse geomorphological and precipitation settings, and unregulated expansion flow, creating an exceptionally overwhelming context for disastrous floods. In the absence of previous studies, we integrate frequency distribution analysis to predict extreme rainfall events and flood flow modeling to simulate floodplain inundation. Data sources included high-resolution remote sensing, local hydrological measurements, fine topographical data, and interviews with stakeholders. We found the Pearson Type 3 distribution to be the most suitable for modeling extreme precipitation in coastal areas, whereas the Generalized Extreme Value (GEV) distribution better fits inland areas. For flood flow assessment, the Gradex method proved to be the most accurate, while other empirical methods outlined critical limitations. Findings reveal that advanced hydrodynamic models significantly enhance flood hazard assessments, even in regions with limited data, showing outstanding correlations with previous flood records and stakeholder feedback. The outcomes carry critical implications for highlighting the importance of selecting appropriate models based on geographical and climatic conditions to inform more resilient urban planning and disaster management practices. We anticipate that these insights will support local decision-makers and urban planners in developing strategies that enhance community resilience and reduce the adverse impacts of flooding. Our work contributes to the broader field of flood risk management, providing a foundation for future developments and practical applications in similar regions worldwide.

High prevalence and non-suppression of HIV/AIDS in the East and Central African region heightens risk of severe outcomes for Clade I monkeypox virus infection, and may be a driver for subsequent adaptation

In September 2023, a re-emergence of mpox was noted in the province of South Kivu, in DR Congo. So far, active transmission has been reported in 23 of the 26 provinces. Despite localisation within DRC, there are emerging concerns about possibility of cross-border transmission. In this perspective, we highlight the threat posed to HIV positive patients, particularly those with unsuppressed viral loads. We make several prepositions as part of the preparedness and response plans in the countries in the East and Central Africa region. The six prepositions include: 1) operationalize the Joint Africa Task Force for mpox consistent with Kinshasa declaration on mpox, 2) increased surveillance, 3) deployment of point of care diagnostics, 4) targeted reactive vaccination and enhanced antiretroviral therapy of HIV positive patients in areas of active transmission, 5) community engagement, 6) foster capacity building of national rapid response teams in East and Central Africa in mpox care and management through collaboration with DRC counterparts.

Footprint evidence for locomotor diversity and shared habitats among early Pleistocene hominins.

For much of the Pliocene and Pleistocene, multiple hominin species coexisted in the same regions of eastern and southern Africa. Due to the limitations of the skeletal fossil record, questions regarding their interspecific interactions remain unanswered. We report the discovery of footprints (~1.5 million years old) from Koobi Fora, Kenya, that provide the first evidence of two different patterns of Pleistocene hominin bipedalism appearing on the same footprint surface. New analyses show that this is observed repeatedly across multiple contemporaneous sites in the eastern Turkana Basin. These data indicate a sympatric relationship between Homo erectus and Paranthropus boisei, suggesting that lake margin habitats were important to both species and highlighting the possible influence of varying levels of coexistence, competition, and niche partitioning in human evolution.

Exploring the role of technology in the trade-off between biodiversity and poverty alleviation across countries

ABSTRACT The poor have been identified as the group that relies heavily on biodiversity as their source of livelihood. The growing rate of both natural and man-made disasters has necessitated the need to effectively manage living species so that, in the long run, man does not suffer from the ripple effect of biodiversity loss. Biodiversity and poverty alleviation are seen as two sides of a coin, which prompts the question; what is the casual nature of this relationship? This paper aims to investigate the nature of the relationship between biodiversity management and poverty reduction and the moderating effect of technological innovation on this relationship. Data from the World Bank database for over 153 countries, drawn from eight regions around the world between 2016 and 2020, and a fixed effect model were used for the analysis. Using a composite index as a proxy for poverty reduction, our study found that efforts to conserve biodiversity hurt efforts to alleviate poverty, especially in Africa, Asia, and Australia & Oceania regions. In particular, the results suggest that technological innovation effectively modulates the tradeoff between biodiversity management and poverty reduction. This suggests that technology adoption helps resolve social, economic, and environmental inefficiencies. However, this opinion did not hold for the North American region as we found no statistical significance between these policy objectives.

Sharia-supervisory board’s characteristics and green banking disclosure: exploring from Islamic banking in MENA countries

Purpose This study aims to investigate the extent to which the characteristics of Sharia supervisory boards (SSB) in banking institutions impact the disclosure of information pertaining to green banking practices. Design/methodology/approach A comprehensive dynamic panel data analysis approach was applied to a data set comprising Islamic banks from 15 countries in the Middle East and North Africa (MENA) region, covering the period from 2012 to 2022. In addition, a series of robustness and endogeneity analyses were conducted to ensure the consistency of the main findings. Findings This study shows that the characteristics of the SSB significantly impact the green banking disclosure practices of Islamic banks. Specifically, the proportion of board members who hold multiple SSB positions and the presence of foreign board members exhibit a negative and significant effect on green banking disclosure. Conversely, the size of the SSB is positively and significantly associated with green banking disclosure. Thus, the extent of green banking disclosure in Islamic banks is likely to increase with the size of the SSB. However, an increase in board members’ external commitments and a higher proportion of foreign board members are associated with a decline in green banking disclosure. Further analysis supports these findings, confirming their consistency across different contexts. Research limitations/implications The findings of this study highlight the critical role that the composition and characteristics of the SSB play in shaping the green banking practices of Islamic banks in MENA countries. These insights provide valuable guidance for policymakers and Islamic financial institutions aiming to strengthen sustainability practices while adhering to Shariah principles. As green banking becomes increasingly crucial in the global financial landscape, optimizing the SSB’s composition could be a key driver in advancing the environmental goals of Islamic banking in the MENA region. Practical implications Islamic banks in the MENA region should focus on optimizing their SSB composition to enhance green banking disclosure. Increasing the size of the SSB can positively influence disclosure practices. However, banks should manage board members’ external engagements to ensure they have sufficient focus on green initiatives. Strategic recruitment of foreign members with a commitment to sustainability, coupled with targeted training programs, can further improve disclosure. Originality/value Specific SSB characteristics such as size and foreign board members influence disclosure of green banking, which previous studies did not conduct research on.

What does it cost to expand two-way texting for post-operative follow-up? A cost analysis in routine voluntary medical male circumcision settings in South Africa.

Up to 98% of adult voluntary medical male circumcision (VMMC) clients heal without adverse events (AEs) in South Africa and in the sub-Saharan Africa (SSA) region, yet all clients in South Africa (SA) are still required to attend in-person reviews, creating added work for providers and barriers for clients. A randomized controlled trial (RCT) using our fee-free, open-source, two-way texting (2wT) approach showed that males could independently monitor their healing with support from VMMC nurse-led telehealth and that 2wT was more cost-effective than routine visits for quality post-operative monitoring. The objectives of this costing activity were to assess the additive cost of 2wT vs. SoC during a stepped wedge design (SWD) expansion trial; costing an augmentation of 2wT with dedicated personnel during peak VMMC periods; and estimate the cost savings of 2wT from the payer perspective if scaled in routine VMMC settings. Data was collected from routine financial reports and complemented by previous RCT time-motion estimates. We conducted activity-based costing of SWD and peak season periods; sensitivity analysis estimated 2wT costs at scale. We included data from 6,842 males, with 2,586 (38%) opting for 2wT. 2wT participants attended an average of zero visits; SoC males had an average of 2 visits. Under 2wT, quality care markers improved and AE ascertainment increased while loss to follow-up (LTFU) decreased. Given a VMMC population of 10,000 adults, scenario analysis suggests that: 1) 2wT becomes cost neutral with 45% 2wT enrollment; 2) 2wT saves $0.29/client with 60% 2wT enrollment; and 3) 2wT saves $0.46/client with 80% 2wT enrollment. When implemented at scale, 2wT appears to significantly reduce costs to the healthcare system while improving the quality of post-operative care and requiring no additional client costs. 2wT should be expanded for eligible males across VMMC and other post-operative contexts in South Africa.

Mpox outbreak among men who have sex with men in Kraków, Poland; June-November 2022.

Mpox is a zoonotic disease caused by mpox virus. Sporadic cases reported before 2022 were almost universally linked to a direct contact with animals or travel to endemic regions of Africa. However, in 2022, a significant shift occurred in human‑to‑human transmission, leading to a global outbreak in 117 countries. In Poland, 217 cases of mpox were reported. The aim of this study was to evaluate the epidemiology, clinical presentation, laboratory findings, and coinfections with sexually transmitted pathogens among patients with mpox. We retrospectively analyzed all mpox cases diagnosed at the University Hospital in Kraków between June 2022 and November 2022. Forty‑five patients at a median (interquartile range) age of 34 (19-48) years were diagnosed with mpox. Most of them (n = 44; 98%) were men, 42 (93%) identified themselves as men who have sex with men (MSM). Twenty‑two of the patients (49%) had previously been diagnosed with HIV. Together with mpox diagnosis, new cases of sexually transmitted infections (STIs) were identified. Specifically, 4 patients (9%) were newly diagnosed with HIV, 5 with syphilis, 4 with Chlamydia trachomatis infection, 3 with Neisseria gonorrhoeae infection, and 2 with Ureaplasma urealyticum infection; in this group, 4 patients (33%) had more than 1 sexually transmitted coinfection. The 2022 mpox outbreak in Kraków primarily affected MSM and was transmitted through sexual contact. Health care professionals should be aware of emerging STIs. Educational initiatives should emphasize the importance of vaccinations, safe sexual practices, and regular testing.

Recent Advance on Biological Activity and Toxicity of Arecoline in Edible Areca (Betel) Nut: A Review

Areca nut (Areca catechu L. AN), which is the dried, mature seed of the palm species Areca catechu L., is consumed by over 600 million individuals, predominantly in South Asia, East Africa, and certain regions of the tropical Pacific. The International Agency for Research on Cancer (IARC) has classified it as a species carcinogenic to humans and designated it as a Group 1 human carcinogen. Arecoline, which has attracted attention for its therapeutic potential in the treatment of mental illness and the relief of gastrointestinal disorders, is the main active alkaloid in the areca nut. However, in 2020, the IARC said that arecoline might be a “probable human carcinogen”. Arecoline can cause various types of cellular damage, primarily leading to the destruction of cell morphology, reduced survival rates, abnormal physiological functions, and even cell apoptosis. The research on its toxic mechanisms includes several aspects, such as increased levels of reactive oxygen species, autophagy, epigenetic dysregulation, and immune dysfunction, but these research findings are scattered and lack systematic integration. This article summarizes the effect mechanisms of arecoline on the oral cavity, neurological and cardiovascular systems, and other organs, as well as embryogenesis, and provides detailed and valuable insights for the clinical practice and targeted therapy of arecoline.