African Setting Research Articles

Developing and planning country-specific integrated knowledge translation strategies: experiences from the GELA project in Malawi, Nigeria, and South Africa.

The Global Evidence, Local Adaptation (GELA) project aims to maximise the impact of research on poverty-related diseases by increasing researchers' and decision-makers' capacity to use global research to develop locally relevant guidelines for newborn and child health in Malawi, Nigeria and South Africa. To facilitate ongoing collaboration with stakeholders, we adopted an Integrated Knowledge Translation (IKT) approach within GELA. Given limited research on IKT in African settings, we documented our team's IKT capacity and skills, and process and experiences with developing and implementing IKT in these countries. Six IKT champions and a coordinator formed the GELA IKT Working Group. We gathered data on our baseline IKT competencies and processes within GELA, and opportunities, challenges and lessons learned, from April 2022 to March 2023 (Year 1). Data was collected from five two-hour Working Group meetings (notes, presentation slides and video recordings); [2] process documents (flowcharts and templates); and [3] an open-ended questionnaire. Data was analysed using a thematic analysis approach. Three overarching themes were identified: [1] IKT approach applied within GELA [2], the capacity and motivations of IKT champions, and [3] the experiences with applying the GELA IKT approach in the three countries. IKT champions and country teams adopted an iterative approach to carry out a comprehensive mapping of stakeholders, determine stakeholders' level of interest in and influence on GELA using the Power-Interest Matrix, and identify realistic indicators for monitoring the country-specific strategies. IKT champions displayed varying capacities, strong motivation, and they engaged in skills development activities. Country teams leveraged existing relationships with their National Ministries of Health to drive responses and participation by other stakeholders, and adopted variable communication modes (e.g. email, phone calls, social media) for optimal engagement. Flexibility in managing competing interests and priorities ensured optimal participation by stakeholders, although the time and resources required by IKT champions were frequently underestimated. The intentional, systematic, and contextualized IKT approach carried out in the three African countries within GELA, provides important insights for enhancing the implementation, feasibility and effectiveness of other IKT initiatives in Africa and similar low- and middle-income country (LMIC) settings.

Fluoride Varnish Intervention for Caries Prevention in Resource-Limited African Settings- A review

Background: Fluoride may not be available to some children in African countries due to the non-use of fluoride containing toothpaste, parental perception and awareness of the benefits of fluoride in caries prevention and non-availability of fluoride in community and school water. Fluoride may also not be affordable for children of low socio-economic status in remote areas, slums areas and rural areas. Topical and systemic sources of fluoride, like fluoride drops, fluoride gel,fluoride solution, fluoride mouthrinses, fluoride tablets, and fluoride lozenges, may not be available in resource-poor countries. Method: An electronic literature search in Google Scholar, African journals online, Science direct and Google was done in August , 2023 using the Population, Concept and Context framework. Search terms and keywords were combined by Boolean operators. Two independent investigators screened titles, abstracts and accessible full texts of publications on fluoride varnish use among African children. Results: Full text was screened using inclusion criteria. Three articles were included as they were assessed to meet the aim of the review. They were hospital based and school-based studies with comparative, prospective, interventional, and randomized clinical trial and cluster-randomized controlled community trials, respectively Conclusion: Fluoride varnish can be an intervention for underserved children with white spot carious lesion in remote areas, slums areas and rural areas, and for non-cavitated carious lesions in resource poor settings. It is simple to use with simple armamentarium, More studies from diverse ethnic population in African countries will fill the gaps in knowledge. Update Dent. Coll. j: 2024; 14(1):28-30

Chronic immune activation and accelerated immune aging among HIV-infected adults receiving suppressive antiretroviral therapy for at least 12 years in an African cohort

BackgroundHIV-associated alterations innate and adaptive immune cell compartments are reminiscent of the process of immune aging. ObjectivesWe described immune aging phenotypes among ART-treated HIV-infected adults relative to age-matched HIV-negative counterparts. MethodsIn a cross-sectional comparative study of HIV-infected adults with CD4≥500 cells/μl after at least 12 years of suppressive ART and age-and-gender-matched HIV-negative individuals, immune activation and immune aging phenotypes were measured, using multi-color flowcytometry. ResultsART-treated HIV-infected individuals had higher body mass index (P = 0.004), waist-hip circumference (P = 0.041), hip circumference (P < 0.001), and diastolic blood pressure (P = 0.012) and immune activation (CD4+CD38+HLADR+; median 4.15,IQR(1.030,14.6)] relative to the HIV-negative age-matched individuals [median 3.14,IQR(1.030, 6.68)]; P=0.0034. Immune aging markers [CD4+CD57+T-cells; median 13.00 IQR (0.45,64.1)] were higher among HIV-infected ART-treated adults<50 years relative to HIV-negative<50 years[median 8.020,IQR(0.004,21.2)]; P=0.0010. Naïve CD4 T-cells, Central memory CD4 T-cells, Terminal Effector Memory T cells (TEMRA: CD27−CD45RA + CCR7-) and immune senescence CD4/CD8+CD28-/CD57+ T-cells were similar among ART-treated HIV-infected individuals<45 years relative to 60 years-and-older HIV-negative counterparts≥; p = 0.0932, p = 0.05357, p = 0.0950 and p = 0.5714 respectively. ConclusionART-treated adults are immunologically two decades older than their HIV-negative counterparts. Accelerated immune aging among individuals aging with HIV underscores the need for an HIV cure to avert the unprecedented complications of accelerated immune senescence and the associated NCD risk in African settings with protracted exposure to endemic co-infections.

Cross-border data sharing through the lens of research ethics committee members in sub-Saharan Africa.

Several factors thwart successful data sharing-ambiguous or fragmented regulatory landscapes, conflicting institutional/researcher interests and varying levels of data science-related expertise are among these. Traditional ethics oversight mechanisms and practices may not be well placed to guarantee adequate research oversight given the unique challenges presented by digital technologies and artificial intelligence (AI). Data-intensive research has raised new, contextual ethics and legal challenges that are particularly relevant in an African research setting. Yet, no empirical research has been conducted to explore these challenges. We explored REC members' views and experiences on data sharing by conducting 20 semi-structured interviews online between June 2022 and February 2023. Using purposive sampling and snowballing, we recruited representatives across sub-Saharan Africa (SSA). We transcribed verbatim and thematically analysed the data with Atlas.ti V22. Three dominant themes were identified: (i) experiences in reviewing data sharing protocols, (ii) perceptions of data transfer tools and (iii) ethical, legal and social challenges of data sharing. Several sub-themes emerged as: (i.a) frequency of and approaches used in reviewing data sharing protocols, (i.b) practical/technical challenges, (i.c) training, (ii.a) ideal structure of data transfer tools, (ii.b) key elements of data transfer tools, (ii.c) implementation level, (ii.d) key stakeholders in developing and reviewing a data transfer agreement (DTA), (iii.a) confidentiality and anonymity, (iii.b) consent, (iii.c) regulatory frameworks, and (iii.d) stigmatisation and discrimination. Our results indicated variability in REC members' perceptions, suboptimal awareness of the existence of data protection laws and a unanimously expressed need for REC member training. To promote efficient data sharing within and across SSA, guidelines that incorporate ethical, legal and social elements need to be developed in consultation with relevant stakeholders and field experts, along with the training accreditation of REC members in the review of data-intensive protocols.

Leveraging growth of savings and credit cooperatives through innovative practices-cases from Uganda

PurposeThis paper explores how the growth of selected Savings and Credit Cooperatives (SACCOs) in an African setting was nurtured through innovative practices that enabled them to fulfill their roles.Design/methodology/approachThe paper applies an exploratory qualitative approach using face-to-face interviews and observation to obtain in-depth primary data. Data were then examined using thematic and matrix analyses to understand the key resources, innovative practices and growth strides in the cases studied. FindingsThe SACCOs undertook a variety of innovative practices based on resources, which included: creating teams, focusing on community needs, involving top management and all SACCOS’ members and having visionary entrepreneurial leaders. This led to an increase in outreach and savings.Originality/valueWhereas the concept of innovative practices has been widely studied, there is scanty literature on how such practices within SACCOs are developed based on the resources of SACCOs in Africa. This paper further provides new insights based on empirical data from SACCOs that applied innovative practices and were able to grow.

Cultural Revival Among Kikuyu Christians: Impact and Implications in the 21st Century

The Kikuyu people were exposed to Christianity in the year 1900 following the arrival of Reverend McGregor. Subsequently, an overwhelming majority of individuals have adopted Christianity, with more than 90% identifying themselves as Christians. Nevertheless, the amalgamation of Western and Christian cultures throughout history has posed difficulties for the revival of Kikuyu traditional rituals. However, Anglican Christians have observed a revival of Kikuyu cultural traditions in Murang'a County, Kenya, during the twenty-first century. This return signifies a deliberate embrace of traditions that were previously forsaken. The objective of this study is to discover and examine the revived cultural traditions within the Anglican community, such as the reverence of ancestors, the categorization of individuals by age, the act of sacrificing animals, traditional marriage ceremonies, and the use of traditional brew. The study investigates the impact of cultural revival on Kikuyu Christianity through qualitative methodologies, including observation and interviews. The primary findings indicate that cultural revitalization entails both benefits and drawbacks. On one side, it assists in resolving identity challenges and enhances relationships with the community and family. Nevertheless, it also cultivates duplicity, undermines the Christian belief system, and engenders discord within the Christian community. These findings emphasize the necessity for dialogue among Kikuyu Christians to reconcile traditional behaviors with Christian principles. This will promote an authentic African Christianity that embraces Christian values while recognizing and integrating indigenous heritage. This study adds to the current discussion on the relationship between culture and religion in modern African settings by examining the intricacies and impacts of cultural resurgence in Christian communities.

A Cross-Country Study of Cigarette Affordability and Single-Stick Purchases Using Survey Data From African Countries.

Reducing cigarette affordability is paramount for reducing cigarette consumption. Measuring affordability requires data on cigarette prices. Unlike the commonly used retail price of a 20-pack of the most-sold cigarette domestically, survey-derived cigarette prices reflect differences arising from the brand variety and the types of packaging in which cigarettes are purchased. This paper uses self-reported cigarette price data from the eight African countries that have implemented the Global Adult Tobacco Survey (GATS) to construct country-level Relative Income Prices. The relationship between cigarette affordability, cigarette smoking prevalence, and cigarette smoking intensity, is examined using logit models for smoking participation (N = 51122) and generalized linear models for conditional cigarette demand (N = 2443). GATS data are also used to produce nationally representative estimates of the prevalence of single-stick cigarette purchases in the sampled countries. The estimated affordability elasticity of cigarette smoking participation is -0.245 (95% CI = -0.411 to -0.078). The estimated affordability elasticity of smoking intensity is -0.155 (95% CI = -0.286 to -0.023). Single-stick cigarette sales dominate all-markets. The proportion of smokers who reported buying cigarettes in the form of single sticks during their most recent cigarette purchase exceeds 90% in Kenya, Tanzania, and Uganda. The results point to the need for governments in the countries sampled to increase excise taxes in a manner that renders cigarettes less affordable over time, and to enact and enforce legislation that prohibits the sale of single cigarettes. These findings highlight that measures to reduce both the demand and supply of cigarettes will be required to reduce their use in the region. This study is the first to examine the prevalence of single-stick cigarette purchases, and the association between cigarette affordability and smoking outcomes, in the African setting, using data from the GATS. Findings provide local evidence for the countries sampled, which represent over half of sub-Saharan Africa's adult population (aged 15 and older), on the importance of implementing excise tax increases that reduce cigarette affordability over time. They also highlight the need to enact and enforce legislation that prohibits the sale of single cigarettes.

Effect of Rural Trauma Team Development on the Outcomes of Motorcycle Accident-Related Injuries (Motor Registry Project): Protocol for a Multicenter Cluster Randomized Controlled Trial.

Injury is a global health concern, and injury-related mortality disproportionately impacts low- and middle-income countries (LMICs). Compelling evidence from observational studies in high-income countries shows that trauma education programs, such as the Rural Trauma Team Development Course (RTTDC), increase clinician knowledge of injury care. There is a dearth of such evidence from controlled clinical trials to demonstrate the effect of the RTTDC on process and patient outcomes in LMICs. This multicenter cluster randomized controlled clinical trial aims to examine the impact of the RTTDC on process and patient outcomes associated with motorcycle accident-related injuries in an African low-resource setting. This is a 2-arm, parallel, multi-period, cluster randomized, controlled, clinical trial in Uganda, where rural trauma team development training is not routinely conducted. We will recruit regional referral hospitals and include patients with motorcycle accident-related injuries, interns, medical trainees, and road traffic law enforcement professionals. The intervention group (RTTDC) and control group (standard care) will include 3 hospitals each. The primary outcomes will be the interval from the accident to hospital admission and the interval from the referral decision to hospital discharge. The secondary outcomes will be all-cause mortality and morbidity associated with neurological and orthopedic injuries at 90 days after injury. All outcomes will be measured as final values. We will compare baseline characteristics and outcomes at both individual and cluster levels between the intervention and control groups. We will use mixed effects regression models to report any absolute or relative differences along with 95% CIs. We will perform subgroup analyses to evaluate and control confounding due to injury mechanisms and injury severity. We will establish a motorcycle trauma outcome (MOTOR) registry in consultation with community traffic police. The trial was approved on August 27, 2019. The actual recruitment of the first patient participant began on September 01, 2019. The last follow-up was on August 27, 2023. Posttrial care, including linkage to clinical, social support, and referral services, is to be completed by November 27, 2023. Data analyses will be performed in Spring 2024, and the results are expected to be published in Autumn 2024. This trial will unveil how a locally contextualized rural trauma team development program impacts organizational efficiency in a continent challenged with limited infrastructure and human resources. Moreover, this trial will uncover how rural trauma team coordination impacts clinical outcomes, such as mortality and morbidity associated with neurological and orthopedic injuries, which are the key targets for strengthening trauma systems in LMICs where prehospital care is in the early stage. Our results could inform the design, implementation, and scalability of future rural trauma teams and trauma education programs in LMICs. Pan African Clinical Trials Registry (PACTR202308851460352); https://pactr.samrc.ac.za/TrialDisplay.aspx?TrialID=25763. DERR1-10.2196/55297.

Financial medicine: A multi-dimensional concept moving towards contextually specific working definitions for use in the South African prehospital setting

IntroductionThe phenomenon that has been described as Financial Medicine has been occurring within the South African Healthcare sector for at least the last decade. Despite the ongoing effect of this phenomenon, there is no organised body of knowledge or formulated working definitions to guide knowledge sharing and theorisation within this research focus area. The practice of Financial Medicine exerts a deleterious effect on the South African prehospital healthcare system, and represents an area in dire need of focused research efforts. Establishing appropriate working definitions and associated taxonomy is an important first step in supporting further research efforts into this aspect of South African prehospital healthcare systems. MethodsA qualitative research methodology following a constructivist grounded theory design was used. Participants voluntarily consented to be enrolled into one-on-one in-depth interviews, and were selected using purposive and theoretical sampling techniques. Data was subjected to validated coding procedures and analysed using the constant comparative analysis approach, analytical diagramming, and supported by researcher theoretical sensitivity. ResultsA working definition for Financial Medicine is provided. Six new terms are introduced, with associated working definitions, namely Financial Medicine Practices, Treatment-based profiteering, Cost-of-care-aversion, Personal-gain-at-patient-expense, Money-racketeering-in-healthcare, and Impoverishing-healthcare-earning. ConclusionThe working definitions and suggested taxonomy presented in this article are the first step in formally conceptualising and theorising the phenomenon of Financial Medicine, in order to support further research and collaboration in this space.

Dyslipidemia in Adults with Type 2 Diabetes in a Rural Community in Ganadougou, Mali: A Cross-Sectional Study.

Dyslipidemia is a disorder where abnormally lipid concentrations circulate in the bloodstream. The disorder is common in type 2 diabetics (T2D) and is linked with T2D comorbidities, particularly cardiovascular disease. Dyslipidemia in T2D is typically characterized by elevated plasma triglyceride and low high-density lipoprotein cholesterol (HDL-C) levels. There is a significant gap in the literature regarding dyslipidemia in rural parts of Africa, where lipid profiles may not be captured through routine surveillance. This study aimed to characterize the prevalence and demo-graphic profile of dyslipidemia in T2D in the rural community of Ganadougou, Mali. We performed a cross-sectional study of 104 subjects with T2D in Ganadougou between November 2021 and March 2022. Demographic and lipid profiles were collected through cross-sectional surveys and serological analyses. The overall prevalence of dyslipidemia in T2D patients was 87.5% (91/104), which did not differ by sex (P = .368). High low-density lipoprotein cholesterol (LDL-C) was the most common lipid abnormality (78.9%, [82/104]). Dyslipidemia was associated with age and hypertension status (P = .013 and.036, respectively). High total and high LDL-C parameters were significantly associated with hypertension (P = .029 and .006, respectively). In low-resource settings such as rural Mali, there is a critical need to improve infrastructure for routine dyslipidemia screening to guide its prevention and intervention approaches. The high rates of dyslipidemia observed in Gandadougou, consistent with concomitant increases in cardiovascular diseases in Africa suggest that lipid profile assessments should be incorporated into routine medical care for T2D patients in African rural settings.

A meta-theory of ubuntu: Implications for responsible leadership in Africa

Purpose: This study provides an outline of a meta-theory of ubuntu to illuminate how responsible leadership might be understood and enacted in African settings.Design/methodology/approach: This study presents an initial theory on ubuntu and appeals to realist philosophical principles to provide an approach to understand the structures that make ubuntu possible. The study tests and refines that initial theory using evidence about reconciliation in Africa where ubuntu has been revealed. It then discusses the key concepts of responsible leadership using ubuntu as a lens.Findings/results: Ubuntu is an important basis for responsible leadership in many African communities. It can manifest, to varying extents, when individuals engage with their environments and are exposed to an apology. Apology reveals the rights, privileges, obligations and responsibilities of individuals. It provides an environment for transformative conversations that improve understanding and promote harmony.Practical implications: Theories of responsible leadership based on ubuntu will prioritise engagement with African cultures and issues in a holistic manner. Leaders who activate ubuntu will be less interested in stakeholder management and more in citizenship. This approach decentres organisations and foregrounds humanity.Originality/value: This study contributes to the theory of ubuntu and proposes that it can support the conceptualisation and implementation of responsible leadership in African settings. It clarifies the nature of responsibility and indicates to whom that responsibility is owed. It helps bridge African and Western ideas to reverse the marginalisation of African systems of thought by positioning ubuntu as an important socio-philosophical idea.

Transferring paternalistic entrepreneurial leadership behaviours (PELB): Chinese organisations in sub-Saharan Africa

This article evaluates the processes of transferring managerial and leadership practices of Chinese entrepreneurs in sub-Saharan Africa (SSA). From the lens of paternalism, we investigate Chinese entrepreneurs’ behaviours towards their African employees in Kenya, Zambia, and South Africa (SA). Through 148 interviews (with 127 interviewees) from 78 organisations, we explain how the Chinese paternalistic entrepreneurial leadership behaviours (PELB) are legitimised, transformed, and resisted in African settings. Chinese leaders adopt a nurturing approach to transfer managerial and leadership behaviours within paternalistic cultures in the development of their organisations in SSA. We articulate the types of Chinese PELB that help to sustain Chinese organisational development and those that hinder this process in SSA.

Epithelial-mesenchymal transition dysregulation in prostate cancer: Insights from molecular unraveling and epidemiological analyses in Tunisia, North Africa.

The progression of prostate cancer (PCa) has been linked worldwide, including in African populations, to the dysregulation of the epithelial-mesenchymal transition (EMT). To clarify the connection among EMT markers, clinicopathological parameters, and epidemiological factors, we analyzed 35 PCa specimens from patients in Tunisia, a country in North Africa, arranged by stages. We also carried out extensive molecular and epidemiological analyses. Significant dysregulation of EMT genes was found, with an overexpression of ZEB-1, Twist, Snail-1, and Vimentin (p<0.05) and underexpression of E-cadherin and β-catenin (p<0.05). Positive correlations were observed between transcription factors and the mesenchymal marker Vimentin (p<0.001, r=0.574; p=0.029, r=0.411; and p<0.001; r=0.506) according to Spearman correlation analyses, whereas negative correlations were found between epithelial markers (E-cadherin, β-catenin) and Vimentin (p<0.05; r<0). Higher PSA, Gleason scores, and metastasis were all correlated with the dysregulation of EMT (p<0.05). Notably, there was a positive correlation between higher consumption of tobacco (≥20 Packets per year) and Vimentin expression (p<0.001, r=0.854), suggesting a relationship between smoking and EMT activation in the Tunisian population. Moreover, Twist showed a positive correlation with diabetes (p<0.001, r=0.385), whereas no significant correlations were found between EMT markers and comorbidities such as hypertension and coronary insufficiency. These results demonstrate the intricate connection between molecular changes, epidemiological factors, and disease progression, and they emphasize the crucial role that EMT plays in promoting PCa aggressiveness in African populations, particularly in Tunisia. In summary, understanding these correlations could help develop focused treatment plans and enhance patient outcomes for PCa management in African settings.

Renal transplant recipient and deceased-donor risk profiles at Wits Donald Gordon Medical Centre, Johannesburg, South Africa: A 9-year review.

Renal transplantation is the gold-standard therapy for end-stage renal disease. Decision-making around the acceptance of deceased-donor organs is complex and time sensitive. Risk scoring systems for both donors and recipients attempt to simplify the allocation of renal grafts to the most appropriate recipient. To investigate the role of these transplant risk scores in the South African (SA) setting. A total of 188 adult deceased-donor organ referrals over the 9-year period 1 January 2013 - 31 December 2021 were included. The Kidney Donor Risk Index (KDRI) and the UK KDRI were calculated for each donor. Recipients who were allocated these grafts were characterised, and the Hennepin Transplant Risk Score and the Kidney Transplant Morbidity Index (KTMI) were calculated. The median (interquartile range) KDRI was 1.2 (0.9 - 1.6), confirming that low- to average-risk donors were being utilised. Similarly, the median UK KDRI was 0.9 (0.8 - 1.2). Both these scores performed poorly in predicting graft and patient survival, with a C-statistic of 0.5. Renal recipient risk scores also demonstrated low- to average-risk patients being transplanted, with a median Hennepin score of 2 - 4 points and a KTMI of 2 points. These recipient scores predict increased recipient mortality at high scores, albeit with low sensitivity, and were not significantly associated with graft survival. Deceased-donor and renal recipient risk scores commonly used internationally performed poorly in predicting graft survival in our cohort, and should be used with caution in the SA setting. A conservative approach to organ donor referral and utilisation as well as renal transplant recipient listing was noted.

ABO-incompatible kidney transplantation using immunoadsorption columns: First experiences in South Africa.

ABO-incompatible kidney transplantation gives patients with chronic kidney disease requiring dialysis and without a blood group-compatible donor an alternative option for a kidney transplant. To describe our first experiences and outcomes with 3 patients using Glycosorb ABO immunoadsorption (IA) columns in performing ABO-incompatible living-donor kidney transplants. This is the first time this technique has been used in Africa. As per the protocol, patients needed between 1 and 4 sessions of IA and received rituximab ~ one month before transplantation. All the patients achieved the target isohaemagglutinin antibody titre of 1:4 pretransplant. Only 1 patient with the highest initial screening titre (1:256) needed IA post-transplant. None of the patients experienced clinical rejection, and all had good graft kidney function at discharge and at the time of writing. Glycosorb ABO IA is an effective technique in enabling ABO-incompatible living-donor kidney transplants to be performed successfully in a South African setting.

A retrospective cohort analysis of factors associated with the development of refeeding syndrome in children 0–59 months diagnosed with severe acute malnutrition in a South African setting

BackgroundRefeeding syndrome (RFS) is a life-threatening, underdiagnosed, and under-researched complication in treating children with severe acute malnutrition (SAM). This study aimed to determine the incidence and onset of RFS and identify biochemical abnormalities, clinical signs, and complications associated with RFS development in children, 0–59 months, treated with SAM in a South African public hospital setting. MethodsA retrospective cohort study was performed on hospital medical records of children aged 0–59 months, diagnosed with SAM at Rahima Moosa Mother and Child Hospital, Johannesburg, from 1/10/2014 to 31/12/2018. The onset of RFS among children included in the study was diagnosed based on published criteria for RFS. On admission, children who developed RFS and those who did not were compared concerning biochemistry and clinical signs and symptoms. ResultsA total of 148 medical records were retrieved from the hospital archives. The diagnosis of SAM based on the World Health Organization (WHO) definition was confirmed in 126 children who were then included in the study. The median age of the 126 children (63 % male) with confirmed SAM was 11.2 months (P25:7.0 months; P75:17.0 months). The in-hospital mortality rate was 18.2 %, of which 8.7 % were retrospectively diagnosed as having developed RFS during their recorded hospital stay, despite implementing the WHO treatment guidelines for SAM. A significantly higher percentage of the children who developed RFS presented on admission with hypophosphatemia (p = 0.015), hypokalemia (p = 0.001), hyponatremia (p = 0.001), an international normalized ratio (INR) of above 1.7 (p = 0.025), diarrhea (p = 0.042), dehydration (p = 0.029) and urinary tract infection (UTI) (p = 0.041), than those who did not. Children who developed RFS stayed in hospital significantly longer than those who did not (18 vs. 12 days with a p-value of 0.003). ConclusionIn this population of children with SAM treated in a South African public hospital setting, the presence on hospital admission of low levels of electrolytes, elevated INR, dehydration, diarrhea, and UTI was significantly associated with developing RFS. Recognizing these as possible red flags for developing RFS in children admitted with SAM might contribute to improved outcomes and needs further investigation.

Groundwater recharge is diffuse in semi-arid African drylands: Evidence from highly instrumented observatories

We use two comprehensively instrumented field observatories to understand groundwater recharge processes in African drylands. The observatories are located on crystalline basement geology in semi-arid parts of Ghana and Burkina Faso, aridity indices 0.43 and 0.29, respectively, and we report 2017–2019 observations. Groundwater recharge was quantified by inverse water table fluctuation models using specific yield estimates derived from magnetic resonance soundings. Evidence for recharge drivers and mechanisms comes from high resolution meteorological observations, soil moisture (logged hourly and weekly along hillslope transects), overland flow plots, river stage, and stable isotopes of O and H in rainfall events and groundwater. Groundwater recharge varied between 87 and 175 mm/y, i.e. 7–15 % of annual rainfall. Rainfall was twice the volume of water lost via actual evapotranspiration across the four peak months (Jun-Sep) of the monsoon. This seasonal water surplus of ∼ 350 mm/y is not characterised by the annual scale of the aridity index. Overland flow was rare and soil moisture deficits were overcome at all monitoring locations. Large rainfall events only produced appreciable recharge when the antecedent soil moisture was close to field capacity, yet always produced large responses in river stage. Stable isotopes of O and H in groundwater indicate no evidence of evapotranspiration prior to infiltration and their composition is akin to depleted isotopic rainfall at the monsoon peak. Stable isotopes indicate recharge season timing and not a relationship between intense rainfall and groundwater recharge. We contend that the mechanism for groundwater recharge is predominantly diffuse in these semi-arid African settings.

Diagnosis and presenting features of autoimmune hepatitis at a central referral hospital in South Africa.

Introduction Autoimmune hepatitis (AIH) has scarcely been reported on in patients of black African descent. Similarly, few studies have focused on the relationship between AIH and Human-Immunodeficiency Virus (HIV) infection. Aim We aim to describe the presenting features of AIH from a single referral centre in a Sub-Sahara African setting. We also compare the presenting features of HIV-infected and HIV-uninfected patients. Methods This study was a retrospective chart review. Patients were included if they fulfilled criteria for the International AIH Group simplified score for probable or definite AIH, were 18 years or older at inclusion, and attended the adult Gastroenterology clinic at Inkosi Albert Luthuli Central Hospital (IALCH) for the period 1/1/2015 to 31/12/2020 on at least 2 occasions. Results Forty cases were included, of which 33 (82.5%) were female and 33 (82.5%) were black African. Median age at diagnosis was 26 years. A diagnosis of a coexistent autoimmune disease was made in 22.5% of patients, with Systemic Lupus Erythematosus (SLE) being the most common (12.5%). Sixteen patients were HIV-infected, all of whom were female (p =0.03), with a significantly older age of disease onset as compared to their HIV-uninfected counterparts (median age 38 vs 17.5 years, p <0.001). Conclusion AIH is a disease most commonly affecting young females. Female sex and older age of onset is associated with AIH in HIV-infected individuals.

Immuno-allergic dermatoses in the Dermatology Department of Aristide LeDantec Hospital, Dakar, Sénégal: epidemiological, clinical, and etiological patterns

Background: Immuno-allergic dermatoses have been highly increasing for a decade in African settings. They are the first chief complaint of dermatological conditions in Senegal. Our objective was to describe their epidemiological, clinical, and etiological patterns. Methodology: We conducted a looking-forward descriptive study for 1 year ranging from April 2020 to April 2021 in the Dermatology Department of Aristide LeDantec Hospital in Dakar. We recruited both inpatients and outpatients. Results: Among 5633 patients received for consultation, 149 cases were pooled accounting for a prevalence of 2,6%. The mean age was 31,42 years old. Atopic dermatosis was the first immuno-allergic dermatosis representing 66,4%. They were followed by toxidermia in 16,1% of cases, contact dermatitis in 12,75% of cases, and urticaria in 4,69%. For patients with atopic dermatosis, a respiratory prick test was carried out in 14,1% of patients with a positivity in 57,1% of cases. Of the patients with urticaria and/or angioedema, the main triggering factor was drug use in 57,14% of cases. In our study, antibiotics were the first drug-related toxidermia in our patients accounting for 41,7% of cases. They were followed by herbal therapy in 29,2% of cases and paracetamol in 16,7% of cases. Conclusion: To date, immuno-allergic dermatoses constitute the first chief complaint in our structure and are by far dominated by atopic dermatitis. Automedication and herbal therapy are public health concerns. By causing toxidermia, often in their most serious patterns, they can have a vital prone-threat involvement.

Exploring mental health problems and support needs among pregnant and parenting teenagers in rural areas Of Limpopo, South Africa

BackgroundGlobally, teenage pregnancy is among the most social problems, affecting 21 million adolescents aged 15–19. Due to the increased responsibility of prenatal and postnatal care for their infants without support, pregnant and parenting teenagers, tend to experience mental health problems. Factors contributing to these problems among pregnant and parenting teenagers in rural African settings have hardly received scholarly attention and, therefore, are less understood. The purpose of the study was to explore mental health and challenges among pregnant and parenting teenagers,.Method(s)The study adopted a qualitative descriptive, exploratory, and phenomenological design. Purposive sampling was used to select 22 pregnant and parenting teenagers 18 years or older. Data were collected in ten selected clinics within the Demographic Surveillance Systems (HDSS) of DIMAMO and analysed using qualitative content analysis.ResultsThe findings reveal that pregnant and parenting teenagers in rural areas experience various mental challenges such as depression. These challenges are caused by social problems such as stigmatisation, lack of support from families and friends, as well as parenting demands that contribute to poor progress at school or dropouts. Pregnant teens expressed concerns about the lack of spousal support resulting from abandoning their partners.ConclusionsStress and depression were self-reported as mental problems among participants with various psychosocial implications, such as school dropout and miscarriage. There are various contributing factors to the mental health problems identified among pregnant and parenting teenagers, including inadequate family and spousal support. Access to integrated reproductive, psychosocial, and mental health services could be essential for these pregnant and parenting teenagers, to improve their mental well-being and improve the support system.