African Women Research Articles

Feminist identity crisis in Africa

Feminist movement in Africa lacks capable guardians to steer the development of feminine identity or theory, and to operationalize the feminist agenda. The apparent lack of a national or continental feminist theory has not helped to elevate the status of the majority of women beyond the patriarchal controls, particularly in the rural and peri-urban communities, despite improved social modernization. Africa’s feminist crisis involves the lack of leadership, ideological vacuity, absence of structure or movement, and the non-application of cultural; political; class; religious and tribal identities in developing feminist theory. In search of capable feminist guardians, the tendency of feminist groups is to co-opt self-actualized African women into feminism with or without their consent, and without regard to the accidental coincidence of those personalities’ narratives with feminist epistemology. Feminism in Africa is in search of relevance within the public space. This paper interrogates these issues and uses the narrative of several self-actualized women in Africa, who have, apparently, been co-opted into feminism as a result, to discuss aspects of the crisis and the delimiting public policy and legislation against, perhaps, the development of feminine identity.

Representation, Identity, and Resistance in Two Selected Cameroonian Literary Texts by Victor Epie Ngome and Rosemary E. Ekosso

Representation and identity are complex concepts with diverse connotations that involve the binaries ‘the self’’ and ‘the other’. These oppositions could either be referring to an individual, a group, or a particular sex. However, some concepts like Hanna Fenichel Pitkin’s ‘Concept of Representation’, Edward Saïd’s discourse on Orientalism, and Michel Foucault’s Concepts of Power and Resistance present a contradiction in the notion of representation, identity, and resistance. What then is a true representation, a real identity? Is resistance always predetermined or an entity in its own right? This article seeks to examine the relationship in these concepts in two Anglophone Cameroonian literary texts notably, Victor Epie Ngome’s What God Has Put Asunder and Rosemary Ekosso’s House of Falling Women and to assess the validity of the textual representation of a union between two parties and the representation of the African woman in Ngome’s and Ekosso’s texts respectively. The methodology employed is comparative, analytical, and descriptive. The study tentatively concludes that, in as much as paradox abounds in the treatment of representation and true identity, it is observed that the self is in the best position to present itself, that representation, identity, and resistance are intrinsically intertwined, and that Ngome and Ekosso are actively engaged in a textual representation of the grievances of the Minority Anglophones and the unfavourable treatment of the woman in a patriarchal setting respectively. Otherness is found as the root cause of power dynamics.

Courting The Id in Dystopian Fiction: A Freudian Study of J.M. Coetzee’s Disgrace

This article explored the moral decadence in post-Apartheid South Africa and examined the injuries that such immorality had on the psyche of the post-apartheid South African woman. It further analysed the necessary shifts in perception and interpretation that depressed South African woman had to grapple with in the face of the immoralities that ensued and identified the new vision of self, art and the world which women invent to liberate themselves from the shackles of morally decay societies. From this perspective, the work anchors on the hypothesis that most post-colonial African societies build immoral societal boundaries which give room to high level of immorality, thus creating avenues for varied philosophies and new modes of survival. Written against the backdrop of Pyscho-Analytic theory, the work concludes that there is the dire need for the moralization and reconstruction of public institutions for mental stability and nation building.

An analytical framework for breast cancer public policies in Sub-Saharan Africa: results from a comprehensive literature review and an adapted policy Delphi

BackgroundBreast cancer is the leading cause of death from cancer in women and is a major public health problem worldwide. Despite the lower incidence rates of breast cancer in resource-limited settings, especially sub-Saharan Africa, there is a higher mortality rate compared to high-resource countries where the disease has a higher incidence. This makes breast cancer the second deadliest cancer in African women. These poor results reflect the weakness in public health policies. The aim of this paper is to contribute to the effective control of breast cancer by designing a framework for a comprehensive and systemic analysis of these policies in Sub-Saharan Africa.MethodsThis research is based on a literature review that adopted a systematic approach followed by a modified policy Delphi involving breast cancer experts in Sub-Saharan Africa. We included narrative reviews and systematic reviews/meta-analyses published between 2015 and 2022 as well as official documents in the analysis. We integrated the World Health Organization’s health system building blocks with Walt and Gilson’s policy analysis triangle to analyse the information collected and develop our analytical framework.ResultsA total of 22 reviews and documents were included in the study. Sixteen breast cancer experts from Sub-Saharan Africa participated in the first Delphi round, and nine participated in the second round. The different components identified for a comprehensive and systemic analysis of effective breast cancer policies can be classified into policy content divided according to the health system building blocks and related policy processes; individual, organized national and international policy stakeholders; and policy contexts.ConclusionThis study enabled the design of a framework suitable for the comprehensive and systemic analysis of breast cancer control policies in Sub-Saharan Africa. This framework can be used as a checklist for stakeholders to guide the planning, implementation and evaluation of policies and specific breast cancer control programmes at the national and facility levels.

Association between Variants of the TRPV1 Gene and Body Composition in Sub-Saharan Africans.

In humans, the transient receptor potential vanilloid 1 (TRPV1) gene is activated by exogenous (e.g., high temperatures, irritating compounds such as capsaicin) and endogenous (e.g., endocannabinoids, inflammatory factors, fatty acid metabolites, low pH) stimuli. It has been shown to be involved in several processes including nociception, thermosensation, and energy homeostasis. In this study, we investigated the association between TRPV1 gene variants, sensory perception (to capsaicin and PROP), and body composition (BMI and bioimpedance variables) in human populations. By comparing sequences deposited in worldwide databases, we identified two haplotype blocks (herein referred to as H1 and H2) that show strong stabilizing selection signals (MAF approaching 0.50, Tajima's D > +4.5) only in individuals with sub-Saharan African ancestry. We therefore studied the genetic variants of these two regions in 46 volunteers of sub-Saharan descent and 45 Italian volunteers (both sexes). Linear regression analyses showed significant associations between TRPV1 diplotypes and body composition, but not with capsaicin perception. Specifically, in African women carrying the H1-b and H2-b haplotypes, a higher percentage of fat mass and lower extracellular fluid retention was observed, whereas no significant association was found in men. Our results suggest the possible action of sex-driven balancing selection at the non-coding sequences of the TRPV1 gene, with adaptive effects on water balance and lipid deposition.

Perceived Barriers to Pap Screening Influence Adherence to Screening Recommendations Among Black Women.

Objectives: The aim of this study was to determine the Health Belief Model (HBM) constructs associated with Pap screening adherence among a sample of African American and sub-Saharan African immigrant women in the United States. Methods: A descriptive cross-sectional study was conducted via an online survey. Participants were recruited from central Kentucky counties. Ninety-one eligible women participated (mean age 38 ± 12 years), 49.5% identified as African American. Twenty-nine percent indicated never being screened or not being up-to-date. Self-reported demographic data, HBM constructs for Pap screening, and Pap screening history were collected. Bivariate and logistic regressions were performed. Results: There was a significant negative association between perceived barriers and being up-to-date. For every one-point increase in perceived barriers, the odds of being up-to-date decreased by 81%, (p = 0.004; CI: 0.06-0.60), findings from further evaluation of the barrier construct showed that barriers significantly associated with screening include items related to lack of knowledge about where to get a Pap screening, lack of time to attend the screening, screening-associated shame and pain, negligence, and age. There were no other significant HBM constructs associated with up-to-date Pap screening status. There was no difference in perceived barriers between African American and sub-Saharan African women. Conclusions: Despite public health efforts to decrease screening barriers, a perception of barriers exists among Black women. Continued efforts to address screening barriers as well as the perception of barriers are warranted among Black women.

Development of normal reference intervals for renal function in pregnancy: a secondary analysis of clinical trial data

Background Due to its potential nephrotoxicity, screening for pre-existing renal function disorders has become a routine clinical assessment for initiating Tenofovir diphosphate fumarate (TDF)-containing antiretroviral treatment (ART) or pre-exposure prophylaxis (PrEP) in pregnant and non-pregnant adults. We aimed to establish reference values for commonly used markers of renal function in healthy pregnant women of African origin. Methods Pregnant women ≥18 years, not living with HIV, and at 14–28 weeks gestation were enrolled in a PrEP clinical trial in Durban, South Africa between September 2017 and December 2019. Women were monitored 4-weekly during pregnancy until six months postpartum. We measured maternal weight and serum creatinine (sCr) at each visit and calculated creatinine clearance (CrCl) rates using the Cockcroft–Gault (CG) and Modification of Diet in Renal Disease (MDRD) formulae. Reference ranges for sCr and CrCl by CG and MDRD calculations were derived from the mean ± 2SD of values for pregnancy and postdelivery. Results Between 14-–and 40 weeks gestation, 249 African women not exposed to TDF-PrEP contributed a total of 1193 renal function values. Postdelivery, 207 of these women contributed to 800 renal function values. The normal reference range for sCr was 30–57 and 32–60 umol/l in the 2nd and 3rd trimesters of pregnancy. Normal reference ranges for CrCl using the MDRD calculation were 129–282 and 119–267 ml/min/1.73m2 for the 2nd and 3rd trimesters, respectively. Using the CG method of calculation, normal reference ranges for CrCl were 120—304 and 123–309 ml/min/1.73m2 for the 2nd and 3rd trimesters respectively. In comparison, the normal reference range for sCr, CrCl by MDRD and CG calculations postpartum was 40–77 umol/l, 92–201, and 90–238 ml/min/1.73m2, respectively. Conclusions In African women, the Upper Limit of Normal (ULN) for sCr in pregnancy is approximately 20% lower than 6 months postnatally. Inversely, the Lower Limit of Normal (LLN) for CrCl using either MDRD or CG equation is approximately 35% higher than 6 months postnatally. We provide normal reference ranges for sCr and CrCl for both methods of calculation and appropriate for the 2nd and 3rd trimesters of pregnancy in African women.

The geography of women’s informal entrepreneurial activities in urban Zambia: place, mobility and locational decision-making

Informal entrepreneurship constitutes an essential source of income for women in sub-Saharan Africa. Research has indicated the importance of location to the productivity of informal enterprises, yet we know little about the geography of African women’s entrepreneurial activities and associated decision-making. This article studies how female slum dwellers in Lusaka organise their entrepreneurial activities spatially and how they justify associated locational choices. The study found a substantial variety in spatial arrangements although proximity to the home often took precedence over other business-related considerations. The ability to overcome or take advantage of geography when carrying out business was clearly bound up in wider relationships pertaining to gender, poverty and regulatory frameworks. Important factors contributing to satisfying business-related locational needs included a strong intra-household bargaining position, the ability to outsource reproductive work, social networks, access to financial resources and uneven regulation of space in the residential settlement. This article was published open access under a CC BY licence: https://creativecommons.org/licences/by/4.0 .

Afroqueerness, Heteropatriarchy, and Transnationality: Nana Darkoa Sekyiamah’s The Sex Lives of African Women

In her anthology, The Sex Lives of African Women (2021), Ghanaian writer and blogger Nana Darkoa Sekyiamah includes thirty-two stories of Black African and Afro-descendant women of different ages and sexual orientations to openly discuss queer and identity issues, family and religious dynamics, sexual freedom and pleasure, and abuses and resistance against heteropatriarchal structures. In this paper, I will first introduce Sekyiamah as a newly emerging African voice in the contemporary writing panorama and briefly examine her story collection. Second, I will discuss how gender and sex were conceived in Africa in precolonial times and how queerness and lesbianism are interpreted in the African feminist tradition. Third, I will show how Sekyiamah’s anthology can be read as a transnational Afroqueer archive by discussing some of the stories included in her volume. Significantly, I will draw on Chantal Zabus’s conceptualisation of “margins” (Zabus 31-32) to capture those spaces of free expression, openness, and resistance against colonial, nationalist, and heteropatriarchal power structures from which Afrosporic women express and manifest their often “dissenting” identities, exercise their agency, and fight for their fundamental human rights.

Associations between HIV infection status, psychosocial factors, and adjuvant endocrine therapy adherence among South African women with early-stage breast cancer.

522 Background: South African (SA) women living with comorbid estrogen receptor positive (ER+) breast cancer (BC) and HIV have higher mortality than other SA women with ER+ BC. We aimed to evaluate for associations between HIV status, psychosocial factors, and adjuvant endocrine therapy (AET) adherence as a potential contributor to this disparity. Methods: From Chris Hani Baragwanath Hospital, Johannesburg, we enrolled adult women with stage I-III ER+ BC in remission and currently prescribed tamoxifen or an aromatase inhibitor to a prospective cohort study. We performed AET pill counts at enrollment, 12 weeks, and 24 weeks, and calculated adherence ratios from the difference in pills between visits divided by the number of days between visits. Women completed questionnaires on sources of social support, beliefs about medication, health literacy, and self-efficacy at enrollment and questionnaires about mental health (depression, anxiety, and acute stress) symptom burden and AET-related side effects at the 12- and 24-week visits. We also collected household wealth data and clinical data on BC and HIV. AET adherence ratios were compared between women with and without comorbid HIV using Wilcoxon rank sum testing. We also used structural equation modeling techniques to refine and evaluate an a priori model of AET adherence with latent variables for mental health, socioeconomic (SES) status, healthcare savvy, and AET side effect burden and subgroup analyses of the resulting model in women with and without HIV. Results: Between April 26, 2022, and July 11, 2023, we enrolled 239 women, 63 (26.4%) of whom had co-morbid HIV. Adherence data was available from 106 women at 12 and 24 weeks, from 22 women at 12 weeks only, and from 111 women at 24 weeks only. Comparing women with and without HIV, median AET adherence ratio was 0.88 vs 0.89, respectively (p = 0.65). Our final model of AET adherence achieved good fit (comparative fit index = 0.96, RMSEA 90% CI: 0.03-0.06). In the full cohort, SES quintile showed a trend towards association with AET adherence (β 0.02, SE 0.01, p=0.09); mental health, healthcare savvy, and side effect burden latent variables were not significantly associated with adherence. In the subgroup of women living with HIV, SES quintile (β 0.04, SE 0.02, p=0.08) and mental health (β -0.02, SE 0.01, p=0.10) showed trends toward association with adherence; these relationships did not persist for women without HIV. Conclusions: HIV status is not predictive of AET adherence among SA women with ER+ BC, but in women with both diagnoses, decreasing SES status and increasing mental health symptoms trended towards an association with decreased adherence. Interventions to improve the mental health of SA breast cancer patients living with HIV may promote AET adherence.

Physical Profiles of All-Rounders, Batters, and Bowlers in Sub-Elite Women's Cricket.

Jacobs, J, Olivier, B, Brandt, C, and Jafta, G. Physical profiles of all-rounders, batters, and bowlers in sub-elite women's cricket. J Strength Cond Res 38(6): 1095-1102, 2024-The unique physical profile of each player's role in sub-elite women's cricket is vital for optimizing performance as these players progress to the elite levels. This quantitative, cross-sectional study investigates the physical profiles of sub-elite women's cricket players as a group and compares these profiles across different player roles. Sub-elite female cricket players in the South African domestic women's cricket league were included in this study. A battery of physical assessments were conducted at the start of the 2022/23 season. The physical assessments included body composition, individual muscle strength testing using dynamometry, 2-km time trial (TT), countermovement jump (CMJ), single-leg jump (SLJ), isometric mid-thigh pull, push-up, and hop test on force plates. A total of 44 female players (20.86 ± 1.6 years) were included in the study. Differences were found in muscle mass (p = 0.004) and peak power (p = 0.040) for all-rounders and bowlers. Player roles presented with different dominant (p = 0.006) and non-dominant (p = 0.066) knee flexion strength. The bowlers' body composition and physical strength profile are compromised compared with batters and all-rounders. There were several physical strength and power differences between pace and spin bowlers in CMJ and SLJ tests for jump height (p = 0.009) and peak power (p = 0.006). Batters performed the best in the 2-km TT. Body composition and musculoskeletal profiles for each player role can be baseline markers in sub-elite women's cricket. Stakeholders can use this information to guide physical preparation for players advancing to elite levels.

Career Development Activities for African Women, Students, and Young Professionals in Geoscience and Remote Sensing [Idea Committee

Career Development Activities for African Women, Students, and Young Professionals in Geoscience and Remote Sensing [Idea Committee

Ketosis-prone Diabetes Presenting with Acute Esophageal Necrosis or “Black Esophagus”: An Intriguing New Clinical Association

Background:: Ketosis-prone diabetes (KPD) is an intermediate subtype of diabetes mellitus, usually affecting Afro-American adults, presenting with diabetic ketoacidosis (DKA), without the classic phenotype of autoimmune type 1 diabetes. Patients require insulin therapy at onset for the acute decompensation, then usually remain insulin-free for prolonged periods with diet alone or with other antidiabetic drugs. DKA can be rarely complicated by upper gastrointestinal bleeding and mucosal necrosis, a severe complication named acute esophageal necrosis (AEN) burdened by high mortality. The association of KPD presenting with DKA complicated by AEN is here reported for the first time, to the knowledge of the authors, in the medical literature. Case Presentation:: Here we report an interesting case of middle-aged African woman, newly diagnosed with KPD, presenting with DKA hematemesis. The patient was first treated at Intensive Care Unit for the ketoacidosis with intravenous fluids combined with continuous insulin infusion, and then switched to subcutaneous regimen. At the same time, esophagogastroduodenoscopy (EGD) was performed to diagnose acute esophageal necrosis, which was promptly managed with proton pump inhibitors infusion, fasting, and parenteral nutrition. After the correct clinical evaluation, the patient was switched to oral antidiabetic and basal insulin at discharge and an EGD follow-up was scheduled. Conclusions:: KPD remains an under-recognized and under-diagnosed type of diabetes which can present as DKA. Since DKA could be a possible trigger of AEN, a rare but potentially lifethreatening condition, that clinicians should be aware of, in patients presenting with upper gastrointestinal bleeding and ketoacidosis. The prompt management and classification of DKA, combined with the EGD execution for early AEN diagnosis and follow-up, is essential.

Flirtations with Eros from a Black-Eyed Squint: Romantic Love in the Oeuvre of Ama Ata Aidoo

ABSTRACT: What's love got to do with it? Everything—suggests Ama Ata Aidoo, whose oeuvre, virtually without exception, foregrounds romantic love as part of a woman's well-being, obstacles to which constitute a decidedly feminist concern. Throughout Aidoo's career, her fiction highlights romantic love as the human relationship that has the greatest potential to achieve social justice, since it often transgresses boundaries of ethnicity, race, class, and various social taboos. At a personal level, union through love represents a reconciliation of broader political differences. In this sense, as in a range of others to be considered, the personal is shown to be political. Romantic love in Aidoo's project, furthermore, has the catalytic potential to transform and bring into congruence disjunct social relations, which, in a postcolonial context, disproportionately impact the lives of African women. The earliest recognition of the significance of eros in Aidoo's meditation was an unconscious one, where she echoed the dominant assumption of the African literary scene at the time, which saw love as a trivial personal concern. In a provocative self-critique, Aidoo reverses her earlier position when she acknowledges her own preoccupation with love across her career. A careful study of Aidoo's work suggests, however, that despite its power, romantic love finally is beset by obstacles to its realization, which leave social barriers in place and patriarchal structures untransformed. This black-eyed squint clearly does not see the world through rose-tinted glasses.

Resistance, Transformation, and Empowerment: The Development of Feminine Identities in Mokámbo, aromas de Libertad and Kanga, la tierra de los sueños by Victoria Evita Ika

Abstract: Equatoguinean female authors have experienced a sort of Boom in literary production in the 21st century. Although there is still a relatively small number of women authors, they have made a significant impact on the Equatoguinean literary scene. Victoria Evita Ika explores the complexity of the formation of the multifaceted identity of a contemporary African woman in her novels Mokámbo, aromas de libertad (2010) and Kanga, la tierra de los sueños (2016). This analysis aims to explore how these two novels transform the development of identities of the modern Equatoguinean woman through surviving horizontal violence into a call for resistance and change. Her ability to learn from her experiences leads to finding a voice of resistance which is analyzed through the lens of the postmodern concept of "radical Black subjectivity." The struggle to negotiate between victimization and activism in order to realize her dreams, challenges the protagonist to make difficult choices. Both novels champion the resilience of women in their ability to adapt to the constant challenges they face in modern day Equatorial Guinea. This flexibility in the spirit of women is the true success and what ultimately keeps hope alive for the future of Equatorial Guinea.

Variations in pelvic floor thickness in relation to bony dimensions in South African women: using computed tomography scans

Pelvic floor disorders (PFDs) are a common reason for urogynaecological consultation around the world, especially in elderly women. These disorders have been associated with disruption to the structural integrity of the pelvic floor. This study explored whether there are variations in pelvic floor muscle (PFM) thickness in relation to parity, population group and age. Additionally, the study explored whether there were any correlations between PFM thickness and the bony pelvic parameters measured. This was a quantitative retrospective analysis of computerised tomography (CT) scans. A total of 125 CT scans of women belonging to black and white South African population groups were sampled from a tertiary hospital in Pretoria, South Africa. Statistical analyses were performed using Paleontological Statistics (PAST). A thicker pelvic floor was noted in black compared to white women. Pelvic floor thickness decreased with parity and age in both population groups. The intertuberous diameter, as well as the surface areas of the urogenital triangle and the perineum, were statistically significantly larger in white than in black women. Correlations between PFM thickness and bony dimensions were statistically significant for anteroposterior (AP) pelvic outlet diameter, where a greater AP outlet was associated with thinner PFMs in black women. Bony correlations with parity showed that the interspinous diameter in black women increased significantly with parity. The variations in bony pelvic dimensions and pelvic floor muscle thicknesses noted between population groups, in addition to the co-factors of parity and aging, will contribute to a better understanding of the anatomical reasons for incontinence.

Inflammatory markers in pregnancy are associated with postpartum weight in South African women living with HIV on antiretroviral therapy.

Postpartum weight (PPW) contributes to long-term obesity, a growing concern in persons with HIV (PWH). We investigated whether inflammatory markers in pregnancy may be involved in postpartum (PP) obesity in PWH. A total of 57 pregnant PWH enrolled at ≤14 weeks gestation (T1) in Gugulethu antenatal care clinic in Cape Town and followed through 48 weeks PP were included. Plasma soluble (s) CD14, sCD163, leptin, tumour necrosis factor receptor 1 (TNFR-1), resistin, adiponectin, and interleukin-6 (IL-6) were assayed in duplicate using the Luminex platform. We considered each inflammatory marker at T1 (n=57) and T3 (29-36 weeks gestation, n=31) as a separate exposure of interest. Linear mixed effects models were fit to examine whether each exposure was associated with average PPW and PPW trajectories; linear regression was used for associations with PPW change between T1 and 48 weeks. Median age was 32 years (IQR, 29-35), 98% were multigravida, and 49% had a BMI≥30 kg/m2. Higher T1 sCD14 levels were associated with higher average weight through 48 weeks PP (ß = 0.002, p=0.04), and T3 sCD14 with higher PPW gain (ß = 0.007, p=0.04). Leptin (ß = 0.414, p<0.01), TNFR-1 (ß = 11.048, p<0.01) and resistin (ß = 0.714, p=0.01) at T3 were associated with higher average PPW, and IL-6 (ß = 2.266, p=0.02) with PPW gain. These findings suggest that low-grade inflammation in pregnancy may play a role in postpartum obesity, pointing to potential mechanisms with implications for long-term cardiometabolic health in PWH.

Gestational weight gain and adverse birth outcomes in South African women with HIV on antiretroviral therapy and without HIV: a prospective cohort study.

Outside of pregnancy, evidence shows that persons with HIV initiating or switching to dolutegravir (DTG)-based antiretroviral therapy (ART) experience greater weight gain compared to those on other ART classes. However, there are few data on the impact of DTG-based ART on gestational weight gain (GWG) in sub-Saharan Africa where HIV is most common. According to the National Academy of Medicine (NAM), GWG below and above NAM guidelines is associated with adverse birth outcomes. Therefore, the objective of this study was to describe GWG by HIV status and ART regimen, and examine the associations with adverse birth outcomes. We enrolled pregnant women with HIV (WHIV) and without HIV (≥18 years) in a peri-urban primary healthcare facility in Cape Town, South Africa between 2019 and 2022. GWG was study-measured at 24-28 (baseline) and 33-38 weeks gestation and converted to GWG rate (kg/week) in accordance with NAM guidelines. GWG z-scores were generated using the INTEGROWTH-21 and US standards to account for differing lengths of gestation. Birth outcome data were obtained from medical records. Associations of GWG z-score with adverse birth outcomes were assessed using multivariable linear or log-binomial regression. Among 292 participants (48% WHIV), median age was 29 years (IQR, 25-33), median pre-pregnancy body mass index (BMI) was 31 kg/m2 (IQR, 26-36) and 20% were primiparous at baseline. The median weekly rate of GWG was 0.30 kg/week (IQR, 0.12-0.50), 35% had GWG below NAM standards (59% WHIV) and 48% had GWG above NAM standards (36% WHIV). WHIV gained weight more slowly (0.25 vs. 0.37 kg/week, p<0.01) than women without HIV. Weekly rate of GWG did not differ by ART regimen (DTG-based ART 0.25 vs. efavirenz-based ART 0.27 kg/week, p = 0.80). In multivariable analyses, GWG z-score was positively associated with continuous birth weight (mean difference = 68.53 95% CI 8.96, 128.10) and categorical high birth weight of >4000 g (RR = 2.18 95% CI 1.18, 4.01). Despite slower GWG among WHIV, nearly half of all women gained weight faster than recommended by the NAM. GWG was positively associated with infant birth weight. Interventions to support healthy GWG in sub-Saharan Africa are urgently needed.

Kisspeptin signalling and its correlation with placental ultrastructure and clinical outcomes in pregnant South African women with obesity and gestational diabetes

IntroductionGestational diabetes mellitus (GDM) is a major pregnancy metabolic disorder and is strongly linked with obesity. Kisspeptin is a hormone that increases several thousand-fold in the maternal circulation during human pregnancy, with placenta as its main source. Studies have suggested that kisspeptin regulates trophoblast invasion and promotes pancreatic insulin secretion and peripheral insulin sensitivity. MethodsIn a well-characterized cohort of pregnant South African women and molecular and histological techniques, this study explored the impact and interaction of maternal obesity and GDM on kisspeptin (KISS1) signalling in relation to placental morphology and maternal and neonatal parameters. ResultsWe found that GDM had no effect on placental KISS1 and KISS1R (KISS1 receptor) mRNA and/or protein expression. However, obesity reduced placental KISS1R mRNA expression even though overall KISS1 protein abundance or localization was not different from the non-obese group. Maternal and cord circulating KISS1 concentrations did not vary with obesity or GDM, but maternal circulating KISS1 was positively correlated with placenta weight in non-GDM obese women, and negatively correlated with placental intervillous space volume in non-GDM non-obese women. Cord serum KISS1 was positively correlated with infant weight in GDM obese women, but negatively correlated with maternal BMI in the non-obese GDM group. Placental syncytiotrophoblast extracellular vesicles exhibited detectable KISS1 and its abundance was ∼50 % lower in those from obese GDM compared to non-GDM women. DiscussionThis study shows maternal obesity and GDM can modulate placental kisspeptin signalling and placental morphological development with potential pathophysiological implications for clinically-relevant pregnancy and perinatal outcomes.

Mapping the evidence on factors related to postpartum contraception among sub-Saharan African immigrant and refugee women in the United States of America: A scoping review protocol.

Postpartum contraception is essential to sexual and reproductive health (SRH) care because it encourages healthy spacing between births, helps women avoid unwanted pregnancies, and lessens the risks of health problems for mothers and babies. Sub-Saharan African immigrant and refugee populations are rapidly increasing in the United States, and they come from a wide range of cultural, linguistic, religious, and social origins, which may pose challenges in timely access to culturally acceptable SRH care, for preventing mistimed or unwanted childbearing. The objective of this scoping review is to assess the extent of the available literature on postpartum contraception among sub-Saharan African immigrant and refugee women living in the United States. We developed preliminary search terms with the help of an expert librarian, consisting of keywords including birth intervals, birth spacing, contraception, postpartum contraception or family planning, and USA or America, and sub-Saharan African immigrants, or emigrants. The study will include the following electronic databases: PubMed/MEDLINE, PsycINFO, CINAHL, EMBASE, and the Global Health Database. The sources will include studies on postpartum care and contraceptive access and utilization among sub-Saharan African immigrants living in the US. Citations, abstracts, and full texts will be independently screened by two reviewers. We will use narrative synthesis to analyze the data using quantitative and qualitative methods. Factors associated with postpartum contraception will be organized using the domains and constructs of the PEN-3 Model as a guiding framework. This scoping review will map the research on postpartum contraception among sub-Saharan African immigrant and refugee women living in the US. We expect to identify knowledge gaps, and barriers and facilitators of postpartum contraception in this population. Based on the findings of the review, recommendations will be made for advocacy and program and policy development toward optimizing interpregnancy intervals in sub-Saharan African immigrants living in the US. Review registration Open Science Framework: https://osf.io/s385j.