African Region Research Articles

Prostate cancer diagnosis and management: current practices in Africa a consultant-based survey

IntroductionIn Africa, prostate cancer poses significant diagnostic and treatment challenges due to limited access to diagnostic tools and healthcare resources. This survey aimed to assess current prostate biopsy practices, patient classification methods, and available therapeutic means among African urologists to propose strategies for improved screening, diagnosis, and management.MethodsA web-based self-administered questionnaire was distributed to urologists in 58 African centres, focusing on biopsy practices, cancer diagnosis, management, and treatment protocols. After pretesting and validation, data collection spanned six weeks, followed by duplicate elimination and arithmetical analysis, with results expressed in absolute, mean, or percentage values.ResultsFeedback was received from 58 centres across diverse African regions, including Central, Southern, West, East Africa, and Madagascar, comprising general, private, and university hospitals. Prostate cancer emerged as the most frequent urological cancer in all regions studied. The assay for prostate-specific antigen (PSA) was available in nearly all centres. Biopsy techniques varied, with ultrasound-guided biopsies being the most common (30 centres), followed by digital-guided (20 centres) and MRI-guided biopsies (5 centres). One centre lacked the expertise to perform biopsies. Radiological workup availability was high, with CT available in 56 centres, MRI in 54, PET scans in 14, and scintigraphy in 29. Treatment capabilities varied, with 53.4% of centres able to perform radical prostatectomies, 86.2% offering radiotherapy, and 94.8% providing medical castration. Among the centres, 56 performed fewer than 5 radical prostatectomies per month, while only 2 centres performed between 5 and 10 per month.ConclusionIt is important to standardise prostate cancer diagnosis and treatment protocols across Africa while improving access to advanced diagnostic technologies and treatment facilities. Implementing these changes could enhance early detection, improve treatment outcomes, and reduce the burden of prostate cancer in Africa.

Swahili translation and cultural adaptation of the National Institutes of Health Stroke Scale.

Swahili translation and cultural adaptation of the National Institutes of Health Stroke Scale.

MicrobeNet: An Automated Approach for Microbe Organisms Prediction Using Feature Fusion and Weighted CNN Model

Microbial organisms are everywhere, millions residing within the human body and also cover 60% of the living earth. These microbes can pose significant health risks, causing diseases such as malaria and toxoplasmosis. Toxoplasmosis is notably prevalent, with seroprevalence rates ranging from 3.6 to 84% in an African region, underscoring the necessity for automated microorganism detection techniques. This research work aims to predict the presence of microorganisms in the human body. We propose a novel approach that combines and integrates principal-component analysis, Chi-square, and analysis-of-variance features using a weighted convolutional-neural-network model called MicrobeNet. The results highlight the efficacy of the proposed method, achieving a remarkable 99.97% in accuracy, recall, precision, and F1-score. The experiments use multiple deep and machine learning models to detect ten distinct microbial forms. The results of the proposed model are compared with those of previously published research. Additionally, k-fold cross validation confirms the robustness of these findings. This research significantly advances the field of microbiology by providing a highly accurate method for microorganism identification, facilitating early disease detection and prevention.

Clinical Spectrum of Toxocariasis: A Retrospective Study From a Tertiary Care Center in Lebanon.

Toxocariasis is a prevalent zoonotic disease worldwide caused primarily by Toxocara canis and Toxocara cati. Despite its prevalence, studies focusing on clinical manifestations, and laboratory findings of toxocariasis in the Middle East North African (MENA) region are limited, highlighting a significant gap in research. The aim of this study is to describe the spectrum of toxocariasis observed at a tertiary center in Lebanon and review the geographic distribution of infected individuals and their demographics. The medical records of 225 patients who tested positive for Toxocara IgG via ELISA between 2002 and 2022 at the American University of Beirut Medical Center (AUBMC) were reviewed. 141/225 patients had confirmed positive Toxocara-specific IgG by Western blot. These patients were mostly middle-aged, with a mean of 46 years and predominantly males. Most were Lebanese (95.3%), residing in Mount Lebanon or Beirut governates. Patients were mainly symptomatic (78.5%), and the most common presenting symptoms were neurological complaints. For those with Toxocara myelitis (23 patients), spine magnetic resonance imaging (MRI) findings showed focal lesions (54.5%) mostly at the thoracic vertebrae. Given the challenges associated with diagnosing this disease, further studies are essential to enhance our understanding of toxocariasis in the region.

Epidemiology of Coronary Atherosclerosis Among People Living With HIV in Uganda : A Cross-Sectional Study.

Data on the prevalence of coronary atherosclerotic disease (CAD) in the African region among people with and without HIV are lacking. To estimate the prevalence of CAD in Uganda and determine whether well-controlled HIV infection is associated with increased presence or severity of CAD. Cross-sectional study. Southwestern Uganda. Ambulatory people living with HIV (PWH), aged older than 40 years, taking antiretroviral therapy for 3 or more years, and population-based, age- and sex-similar people without HIV (PWoH). Participants had cardiovascular (CV) disease (CVD) risk profiling and computed tomography scanning for detection of CAD, defined as the presence of calcified or noncalcified plaque. Of 630 screened, 586 (93%) met criteria and had evaluable images. Of these, 287 (49.0%) were PWH and nearly all (272 of 287 [95%]) were virologically suppressed. Mean age (57.9 vs. 57.4 years), proportion female (49%), and median CVD risk score (4.1 vs. 3.4) did not differ by HIV serostatus. The prevalence of CAD was low overall (45 of 586 [7.7%]) and among both PWH (26 of 287 [9.1%]) and PWoH (19 of 299 [6.4%]; absolute prevalence difference, 2.7% [95% CI, -1.6% to 7.0%]). Results were similar after adjustment for CVD risk factors. Our findings may not generalize to symptomatic populations or those with greater predicted CVD risk. The study was not powered to detect small differences in CAD prevalence between HIV subgroups. Both PWH and PWoH had similar CV risk factor profiles, but residual confounding between HIV and CAD cannot be excluded. The prevalence of CAD in Uganda was low compared with population-based cohorts from the Global North with similar CVD risk profiles and was similar between HIV serostatus subgroups. Our results suggest that CAD may not be a major cause of morbidity in Uganda. National Institutes of Health.

Leishmaniasis in deployed military populations: A systematic review and meta-analysis.

Leishmaniasis affects military personnel deployed to endemic areas following exposure to sand flies infected with the protozoa Leishmania. This systematic review and meta-analysis of data specific to military populations aims to identify knowledge gaps to mitigate sand fly exposure and Leishmania transmission during deployments. The review was registered on PROSPERO (CRD42023463687). Random-effects meta-analyses and narrative synthesis were performed. Thirty-six studies were included, most of which reported on cutaneous leishmaniasis (CL), showing a mean cumulative incidence of 10% (95% CI: 5-16), suggesting higher rates in the Eastern Mediterranean region (14% [95% CI: 12-16]) compared to the African region (8%) and American region (9%). Asymptomatic Leishmania infection had a cumulative incidence of 11% (95% CI: 6-17), with higher rates in Eastern Mediterranean countries (20% [95% CI: 14-25]). Diagnosis involved parasitological, serological, and molecular methods, with L. (L) mexicana and L. (V.) braziliensis identified as the predominant CL pathogens in deployed troops in the Americas. Visceral leishmaniasis cases were less frequent, all reported from the Eastern Mediterranean and associated with the Leishmania donovani/infantum complex; whereas CL cases in the Old World were due predominantly to L. major and L. tropica. Regular use of long-lasting insecticidal nets to mitigate sand fly exposure demonstrated high potential effectiveness than other reported personal protective measures (PPMs) which yielded mixed or inconclusive results. In summary, the systematic review revealed the substantial variability between study designs and statistical integrity. There is need for more consistent and robustly designed studies including well-define controls and replication. Future studies would be advised to explore the long-term effectiveness and practicality of PPMs, both individually and in combination, across diverse deployment settings.

Context Informing the Adoption of Regional Security Initiatives for the Control of Small Arms and Light Weapons in East Africa

The proliferation of SALWs in the East African region has negatively impacted both national and regional security. Porous and expansive borders, corruption, and instability in the region, commercialization of cattle rustling, weak governments and the presence of ungoverned spaces in the region, have facilitated the proliferation of SALWs in the region. This article presents the findings on the initiatives adopted by Kenya and Uganda, both individually and collaboratively for the control of the proliferation of SALWs in East Africa. The study was guided by the regionalism theory of inter-state cooperation and a descriptive survey design. The sampled respondents totalling 55 were drawn from the security agencies, members of civil societies, foreign relation offices, non-state actors and religious leaders. Instrumentation encompassed questionnaires, focus group discussions and interviews. The findings indicate the context that entails armed robberies, cattle rustling, and conflicts between communities and in urban areas like Nairobi, illegal firearms can be purchased relatively cheaply. Similarly, SALWs are used by various non-state actors, including rebel groups and criminal gangs, which exacerbates instability and hampers peace efforts. This context forms a critical need for comprehensive strategies that address the SALW proliferation, enhance regional collaboration, and improve public awareness to effectively mitigate the associated security threats. The study recommends that the governments of Kenya and Uganda should enhance the recruitment, training, and deployment of sufficient security troops to the Northeast of Uganda and the Northwestern region of Kenya

Application of the random forest algorithm to predict skilled birth attendance and identify determinants among reproductive-age women in 27 Sub-Saharan African countries; machine learning analysis.

Maternal mortality refers to a mother's death owing to complications arising from childbirth or pregnancy. This issue is a forefront public health challenge around the globe which is pronounced in low- and middle-income countries, particularly in the sub-Saharan African regions where the burdens remain significantly high. Moreover, this problem is further complicated in developing countries due to limited access to antenatal care and the shortage of skilled birth attendants. So far, considerable improvements in the health status of many populations have been reported in developing countries. Nonetheless, the MDGs to reduce maternal and newborn mortality unmet in many SSA nations. Leveraging machine learning approaches allows us to better understand these constraints and predict skilled birth attendance among reproductive age women, providing actionable insights for policy and intervention. This study aimed to predict skill birth attendance and identify its determinants among reproductive age women in 27 SSA countries using machine learning algorithm. Using data from the Demographic and Health Surveys (2016-2024) across 27 SSA countries, we analyzed responses from 198,707 reproductive age women. The Random Forest classifier, complemented by SHAP for feature interpretability, was employed for prediction and analysis. Data preprocessing included K-nearest neighbor imputation for missing values, SMOTE for handling class imbalance, and Recursive Feature Elimination for feature selection. Model performance was evaluated using metrics such as accuracy, recall, F1 score, and AUC-ROC. The Random Forest model demonstrated robust performance, achieving an AUC-ROC of 92%, recall of 96%, accuracy of 92%, precision of 93 and F1 score of 93%. The SHAP analysis identifies key predictors of skilled birth attendance, including facility delivery, maternal education, higher wealth index, urban residence, reduced distance to healthcare facilities, media exposure, and internet use. The findings highlight the potential of machine learning to identify critical predictors of skilled birth attendance to inform targeted interventions. Addressing socioeconomic and educational disparities, enhancing healthcare access, and implementing tailored cessation programs are crucial to enhance skilled birth attendance in this vulnerable population.

Differential Vegetation Feedback on the Global Land Monsoon System during the Mid-Holocene and Last Interglacial

Abstract This study investigates the impact of vegetation–climate feedback on the global land monsoon system during the Last Interglacial (LIG, 127 000 years BP) and the mid-Holocene (MH, 6000 years BP) using the earth system model EC-Earth3. Our findings indicate that vegetation changes significantly influence the global monsoon area and precipitation patterns, especially in the North African and Indian monsoon regions. The North African monsoon region experienced the most substantial increase in vegetation during both the LIG and MH, resulting in significant increases in monsoonal precipitation by 9.8% and 6.0%, respectively. The vegetation feedback also intensified the Saharan Heat Low, strengthened monsoonal flows, and enhanced precipitation over the North African monsoon region. In contrast, the Indian monsoon region exhibited divergent responses to vegetation changes. During the LIG, precipitation in the Indian monsoon region decreased by 2.2%, while it increased by 1.6% during the MH. These differences highlight the complex and region-specific impacts of vegetation feedback on monsoon systems. Overall, this study demonstrates that vegetation feedback exerts distinct influences on the global monsoon during the MH and LIG. These findings highlight the importance of considering vegetation–climate feedback in understanding past monsoon variability and in predicting future climate change impacts on monsoon systems.

Implications of East-West Great Power Competition on Kenya’s Defense and Security Policy (2003 – 2022)

This study sought to investigate the implications of East-West Great Power Competition on Kenya’s defense and security policy between 2003 and 2022. The first section introduces the nature of East-West strategic competition and the second section analyses the implications of East-West strategic competition on Kenya defense and security policies. Four key areas of Kenya’s Defense Policies are analyzed. These are: firstly, policies on military assistance to Kenya, secondly, Kenya’s peace support operation policies, thirdly, Kenya’s policies on military and security allies and fourthly, Kenya’s counter-terrorism policies. The study is anchored on realism and the rational actor model of international relations. Review of related literature was done using various search engines utilizing the keywords of the study. A mixed research design and sampling techniques were used to generate a sample of eighty study participants from a target population that included policy makers in the Ministry of Defense, Ministry of Foreign and Diaspora Affairs, Non-governmental organizations, National Government Officials, and international relations experts. The main methods for gathering data were questionnaires and interviews. This study revealed that, the implications of East-West Strategic competition on Kenya’s Défense policy include rationality in decision making in regards to military assistance the country receives, a conscious choice of possible trading partners during procurement and acquisition of military equipment and arms, selective entry and signing of military pacts on military training and technology transfers. Moreover, the Kenya defense policy is non-aligned in regards to choice of allies. The defense policy further seeks to maintain traditional allies in the West while also courting of new allies in the East. Finally, the defense policy is assertive in fostering international peace and security as well in counter violent extremism. This study recommends Kenya defense policy strategist to maintain the status quo of balancing the East and the West so as to remain neutral in the wake revamped East West rivalry in the Horn and Eastern African region.

Evaluation of the epidemic intelligence from open sources (EIOS) system for the early detection of outbreaks and health emergencies in the African region

IntroductionPublic health today is challenged by a wide array of hazards that threaten humans, often resulting in high rates of morbidity and mortality when they strike. These events should be detected and responded to as early as possible to save lives and minimize their impact. The Epidemic Intelligence from Open Sources (EIOS) system leverages natural language processing and machine learning techniques for the early detection of public health events from open-source information using an all-hazards approach. In this study, we quantitatively evaluate the performance of the EIOS system for the early detection of outbreaks and health emergencies in the African region.MethodsWe retrospectively searched the EIOS system to determine if a signal was found on the system for each public health event notified to WHO by the 47 countries in the African region from 2018 to 2023. We computed the proportion of public health event detected by the EIOS system, its sensitivity, harmonic mean, and timeliness. We assessed the association between selected predictors (year of report, hazard type, subregion, source type, and language of source) and early detection of public health events on the EIOS system using a multivariable logistic regression model.ResultsWe found a detection proportion of 81.0% and a sensitivity of 47.4%, with a harmonic mean of 59.8%. The proportion of events detected steadily increased over the years and sensitivity increased from a baseline of 44.1% in 2018 to 47.3% in 2023. Signals for more than 80.0% of the public health events notified to WHO in 28 countries were detected on the EIOS system. In 22 countries, signals of at least 50% of the public health events were detected early, that is, before official notification from the National Authorities to WHO. The median time between detection on the EIOS system and notification to WHO was zero days. We found that the type of hazard (infectious and zoonotic), the subregion (West and Central Africa), and the type of source (medical and social media) were associated with early detection.ConclusionsWe conclude that the EIOS system performed well in detecting public health events in the African region early. However, some improvements are needed. We recommend increasing social media and local community radio sources on the EIOS system.

Suggested Improvements to the Current East African Community Medicines Regulatory Harmonization Joint Review Process and a Proposed New Review Model for this Initiative.

In 2012, the East African Community Medicines Regulatory Harmonization (EAC-MRH) initiative was established to improve access to safe, effective, and high-quality medical products to patients in the East African region. The East African Community (EAC) Partner States, the Republic ofBurundi, Democratic Republic of Congo, Republic ofRwanda, United Republicof Tanzania, Republic ofKenya, Republic ofSouth Sudan, and the Republic ofUganda, have a population of 290 million inhabitants. The timely access to medical products for this population was to be achieved through harmonisation of regulatory requirements, joint assessments, joint inspections of manufacturing sites, and the strengthening of regulatory systems. The aims of this study were (1) to investigate ways in which the regional initiative could be a well-coordinated and functioning regional assessment and inspection process on which national registration decisions can rely; (2) to investigate whether a sustainable semi-autonomous regional agency could provide regulatory guidance and coordination for the entire region; and (3) to propose a new and improved model for the EAC-MRH. Three established questionnaires were used to collect and analyse data on the EAC national regulatory authorities (NRAs) and EAC-MRH initiative 2020-2023: (1) The Optimising Efficiencies in Regulatory Agencies (OpERA) questionnaire was completed by senior officials in the seven authorities that were leading the medicine registration departments about their own respective NRA. The heads of authorities of these NRAs further validated the completed questionnaire, which documented the general organisation of the authorities in terms of their structure, organisation, resources, review process, and timelines. (2) The Process Effectiveness and Efficiency Rating (PEER) questionnaire was completed by the seven authorities to obtain the views of the individual medicines regulatory authorities of the EAC-MRH initiative to identify the strengths and challenges regarding the performance of the joint assessment of the EAC-MRH initiative. (3) The PEER questionnaire, modified for the pharmaceutical industry, was completed by the heads of regulatory units in the pharmaceutical companies that had used the EAC-MRH process for the review and approval of their applications. The number of applications received for joint reviews increased from nine applications in 2015 to 44 applications in 2023, and the median review time reduced from 553 calendar days in 2015 to 259 calendar days in 2023. A key benefit for pharmaceutical companies using the work-sharing initiative to apply for marketing authorisation was the reduced burden associated with the need to prepare only one application for submission and eventual access to several markets simultaneously. The EAC-MRH initiative can only be effective and efficient if the NRAs in the region are operating at an optimal level. Therefore, proposals were made to address the gaps identified in the regulatory review processes of the EAC NRAs and to improve effectiveness and efficiency. Importantly, a centralised submission and tracking process was proposed as the new and improved model for the EAC-MRH initiative.

Atmospheric deposition of microplastics in urban, rural, forest environments: A case study of Thulamela Local Municipality.

Microplastic (MP) pollution, a pressing environmental issue globally, has received considerable attention in marine, freshwater and terrestrial environments. However, studies on the deposition of airborne MPs, particularly in Southern African regions, have received less attention. As such, the current study aimed at investigating the atmospheric deposition of MPs across three different environments, namely urban, rural and forest in the Thulamela Local Municipality, Limpopo, South Africa. We hypothesised that MP deposition will exhibit significant differences between different environments, with the urban environment having the highest MP deposition fluxes due to the dense population in the area and high human activities. The study results showed that MP deposition fluxes varied significantly across the environments, ranging from 90.51 ± 15.19 - 355.64 ± 47.65 particles/m2/day, with an overall average of 211.87 ± 31.44 particles/m2/day. The highest deposition was recorded in urban environment, while the lowest was observed in the forested environment. The overall deposited MPs were mainly transparent fibres and polyethylene terephthalate (PET). Furthermore, MP deposition found in the forest environment demonstrated a strong positive correlation with rainfall, suggesting that rainfall events play a significant role in the transporting and deposition of MP. The study further shed light on the possible fate of urban and rural atmospheric deposition, which has implications for pristine environments, indicating the transport and potential ecological impacts of MP pollution even in less populated and isolated environments.

Comprehensive analysis of the Global Burden and epidemiological trends of meningitis from 1990 to 2021.

Despite significant advances in prevention and treatment strategies, meningitis continues to pose a substantial global health challenge. The disease burden demonstrates marked geographical disparities, with disproportionate impact in resource-limited settings, particularly within the "meningitis belt" of Sub-Saharan Africa. The global meningitis burden is influenced by a complex interplay of environmental, behavioral, and socioeconomic determinants. Leveraging the Global Burden of Disease (GBD) 2021 database, we conducted a comprehensive analysis of global meningitis burden from 1990 to 2021. The study employed DisMod-MR 2.1, an advanced Bayesian meta-regression tool, for epidemiological modeling. We implemented age-period-cohort analysis to evaluate mortality trends and utilized the Comparative Risk Assessment framework to assess risk factors. The relationship between socio-demographic index (SDI) and disease burden was examined through Spearman's rank correlation analysis. Our analysis revealed significant geographical and pathogen-specific variations in disease burden. Globally, the age-standardized incidence rate stands at 31.65 per 100,000 with a corresponding mortality rate of 2.95 per 100,000. The disease burden demonstrates a striking gradient across SDI levels, with low SDI regions experiencing the highest burden, approximately 17 times higher than high SDI regions. Neonatal mortality rates remain particularly concerning at 129.69 per 100,000, while under-5 mortality rates stand at 34.50 per 100,000. The Eastern Sub-Saharan African region emerges as an area of particular concern, with disease burden significantly exceeding global averages. Behavioral risks, child and maternal malnutrition, and low birth weight/short gestation emerged as the primary risk factors, each contributing to 0.15million deaths and 13.41million DALYs. Strong negative correlations were observed between all risk factors and SDI values (correlation coefficients ranging from - 0.55 to -0.75), indicating higher disease burden in regions with lower socio-demographic development. While substantial progress has been achieved in global meningitis control, particularly in reducing under-5 mortality rates, significant disparities persist between high and low SDI regions. Our findings emphasize the critical need for targeted interventions in resource-limited settings and continued surveillance efforts to address remaining challenges in meningitis control.

Unique features of environmental impact assessment (EIA) in protected areas (PAs) – towards best practice principles

ABSTRACT Protected areas (PAs) preserve ecological system integrity and biodiversity but are threatened by anthropogenic drivers of biodiversity loss such as land use change, direct exploitation of natural resources, land fragmentation, pollution, climate change, and invasive alien species. Internationally, environmental impact assessment (EIA) is a key policy instrument that guides development decisions that affect PAs, especially in the southern African region. This paper aims to identify unique features of EIA in PAs by using South African PAs as a case study towards developing best practice principles. We achieve this through conducting a workshop attended by 81 individuals representing six stakeholder groups, namely, consultants, government entities, protected area management, environmental NGOs, and academics. The results show that EIA within this PA context uniquely requires a more ecocentric ethical framing, rather than an anthropocentric framing of sustainable development. Moreover, PAs face unique governance arrangements, different stakeholder engagement expectations, and experience a greater likelihood of impacts being judged to be significant with limited mitigation options apart from avoidance. Five best practice principles are recommended to incorporate these unique features into EIA decision making affecting South African PAs, although they are also transferable to other similar country contexts where socio-economic development pressures threaten PAs.

Vertical transmission of hepatitis B virus in the WHO African region: a systematic review and meta-analysis.

Vertical transmission of hepatitis B virus in the WHO African region: a systematic review and meta-analysis.

PhysioCAFUN: a competency-based curriculum development guideline to strengthen physiology education in Africa.

Physiology education in Africa faces challenges due to gaps in curricula across many of its universities, such as divergent content, a lack of standardized competencies, and suitable benchmarking. Here, we describe the development of the Physiology Curriculum for African Universities (PhysioCAFUN), a competency-based curriculum development guideline, as a first step to address such shortcomings. A committee of 15 physiologists from different African regions, Europe, and the United States was constituted to draft the PhysioCAFUN, which was introduced and revised during the joint East African Society of Physiological Sciences (EASPS) and African Association of Physiological Sciences (AAPS) conference held in Tanzania late 2023. The PhysioCAFUN consists of 23 modules. Modules 1-15 cover the organ systems, including principles and concepts of physiology, molecular biology, and cell physiology. Modules 16-23 contain optional content, including environmental physiology, pharmacology, and topics related to skill development. PhysioCAFUN serves as a freely available resource document for African stakeholders regarding the desired undergraduate physiology training and competencies. It will help universities in Africa, and elsewhere to draft a curriculum suitable for their local needs where there is a dearth of physiologists or to benchmark and revise their curricula where physiology programs are already in place.NEW & NOTEWORTHY We described the development of Physiology Curriculum for African Universities (PhysioCAFUN), a competency-based curriculum development guideline to promote physiology education in Africa. This freely accessible resource document should help African universities where there is a dearth of physiologists and thus aid in drafting a curriculum suitable for their local needs. Likewise, it should assist universities globally where physiology programs are already in place to benchmark and/or revise their curriculum as may be needed.

Antiretroviral Use for HIV Prevention During Pregnancy: The Need to Strengthen Regulatory and Surveillance Systems in Africa.

HIV-prevention efforts focusing on women of child-bearing potential are needed to end the HIV epidemic in the African region. The use of antiretroviral drugs as pre-exposure prophylaxis (PrEP) is a critical HIV prevention tool. However, safety data on new antiretrovirals during pregnancy are often limited because pregnant people are excluded from drug development studies. Calls from communities, healthcare professionals, and regulators to improve the information supporting decision-making around the use of medical products during pregnancy have been increasing. Post-marketing safety surveillance is an essential tool for detecting adverse outcomes and evaluating real-world, longer-term effects of drugs. Detecting and evaluating uncommon pregnancy outcomes requires large sample sizes, highlighting the benefits of and need for safety surveillance. Surveillance systems vary widely across Africa, and the need for enhanced surveillance of PrEP use during pregnancy highlights the limitations of current regulatory and surveillance systems. Challenges include weak regulation and insufficient resources. Pooling of resources and regulatory harmonization could address resource challenges. The African Medicines Agency, as a specialized agency of the African Union, has the potential to improve African medical product regulation, including post-marketing safety surveillance. This can strengthen regulation and ensure that market authorization holders meet their responsibility to invest in post-marketing surveillance systems, such as pregnancy registries. At the same time, independent post-marketing studies are needed to ensure generation of essential safety data. The Forum for Collaborative Research has initiated a project to facilitate interactions between regulators in Africa, the USA, and Europe, as well as other stakeholders, and to work toward consensus on safety data generation from PrEP during pregnancy before and after marketing authorization.

Biome conservatism prevailed in repeated long-distance colonization of Madagascar's mountains by Helichrysum (Compositae, Gnaphalieae).

Biome conservatism prevailed in repeated long-distance colonization of Madagascar's mountains by Helichrysum (Compositae, Gnaphalieae).

Structure and strain specificity for polysaccharides from king oyster mushroom (Pleurotus eryngii) fruiting bodies.

Structure and strain specificity for polysaccharides from king oyster mushroom (Pleurotus eryngii) fruiting bodies.