African Countries Research Articles

Child marriage and well-being in Central and Western Africa: A scoping review of costs and potential benefits for girls.

Child marriage is practiced widely in West and Central Africa with established links to several negative outcomes, particularly for girls. Although some reviews on predictors of the practice of child marriage exist, to date no review has focused on the costs and potential benefits to girls who have experienced child marriage. We conducted a scoping review of PubMed, African Index Medicus, Embase, PsycINFO, Web of Science, and Global Health and in the grey literature for studies on child marriage and adjustment up to October 2023. Studies were included if they assessed marriages where the female was younger than 18 at the time of marriage, were conducted in Central and Western African countries, explored positive and/or negative indicators of well-being and mental health in the context of child marriage, were written in English, were published in a peer-reviewed journal, or was a published thesis or dissertation, grey literature, or technical report, were conducted between 2014 and 2023, and presented qualitative, quantitative, or mixed-method data. Based on the inclusion criteria, we included nine qualitative and four quantitative studies. Using the lens of Self-Determination Theory, we found that overall child marriage compromised needs for autonomy, competence, and relatedness. Further, child marriage was linked to negative mental health outcomes. However, for some girls, child marriage was associated with some benefits including social recognition and elevated status in society. Future research on adjustment within the context of child marriage should focus on all aspects of well-being as well as the processes associated with adjustment for girls.

Routine health data use for decision making and its associated factors among primary healthcare managers in dodoma region

BackgroundData demand and use culture have a tremendous impact on the proper allocation of scarce resources and evidence-based decision making. However, primary healthcare managers in the majority of Sub-Saharan African countries continue to struggle with using routine health data for decision-making.Purpose/objectiveThis study aimed to assess routine health data use for decision making among primary healthcare managers in Dodoma region.MethodsCross-sectional study design involved 188 primary healthcare managers from Dodoma City Council, Kondoa Town Council and Bahi District Council was conducted. A self-administered questionnaire adapted from the Performance of Routine Information System Management (PRISM) tools was used to collect the data. Data was analysed by using the Statistical Package for Social Science (SPSS) program. Principal Component Analysis was used to find the level of routine health data use, binary logistic regression analysis was used to determine factors associated with routine health data use for decision making among primary healthcare managers. The study was conducted from May to June, 2022.ResultsThe level of adequate routine health data use for decision making among healthcare managers was 63.30%. Factors associated with adequate routine health data use for decision making among healthcare managers were; respondents characteristics: years of working experience (OR = 1.955, 95% CI= [0.892,4.287]), district surveyed (OR = 4.760, 95%CI= [1.412,16.049]), level of health facility (OR = 3.867, 95%CI= [1.354,7.122]) and male gender (OR = 1.901, 95%CI= [1.027,3.521]). Individual factors: comparing data with strategic objectives (OR = 2.986, 95%CI= [1.233–7.229]), decision based on health needs (OR = 7.330, 95%CI= [1.968–27.295]) and decision based on detection of outbreak (OR = 3.769, 95%CI= [1.091–13.019]). Technical factors: ability to check data accuracy (OR = 3.120, 95%CI= [1.682–5.789]), ability to explain findings and its implication (OR = 2.443, 95%CI= [1.278–4.670]) and ability to use information to identity gaps and targets (OR = 2.621, 95%CI= [1.381–4.974]). Organizational factors: organizational support (OR = 3.530, CI= [1.397–8.919]), analyse data regularly (OR = 2.026, 95%CI= [1.075–3.820]) and displays information on key performance indicators (OR = 3.464, 95%CI= [1.525–7.870]).Conclusion and recommendationThe level of routine health data use for decision making among primary healthcare managers was found to be modest. The level of data demand and use culture may increase more quickly if capacity building is strengthened and issues that de-motivate primary health care managers from using data are addressed.

OTHR-14 THE AFRICAN NEURO-ONCOLOGY ACCESS DISPARITY (ANAD) INDEX: A PUBLIC DATA-DRIVEN APPROACH TO MAPPING NATIONAL VARIATIONS IN NEURO-ONCOLOGY CARE BARRIERS

Abstract INTRODUCTION The burden of central nervous system tumors is unevenly distributed globally. In Africa, this burden is further compounded by a lack of cancer-focused health system strengthening. The authors sought to quantify these system-level challenges with a novel index. METHODS This prototype index was developed from publicly available data provided by the World Health Organization’s Global Health Observatory, the World Bank Group’s Country Database, and the Institute For Health Metrics and Evaluation’s Global Burden of Disease database. Metrics were selected based on their ability to represent health system components including workforce, service delivery, infrastructure, information management, health financing, and governance. The metrics were normalized either using standardization or min-max scaling. Next, they were weighted iteratively based on importance, relative impact, and expert judgment. Also, the weighted metrics were grouped into facilitators or obstructors. The difference between obstructors and facilitators for each country was percentile ranked to obtain the index score between 0 and 100. Finally, sensitivity analysis was conducted to test best- and worst-case scenarios based on uncertainty values. The t-test and ANOVA were used to evaluate association between country subregion/income and the index. RESULTS Data was found for 51 African countries. Ethiopia (98), Madagascar (96), and Mali (94) had the highest ANAD Index score whereas Gabon (0), Seychelles (2), and Mauritius (4) had the lowest scores. North African countries had lower ANAD Index scores than sub-Saharan African countries (mean (SD) 19 (4) vs. 54 (4), p=0.005). Also, low-income countries had higher ANAD Index scores than lower-middle- and upper-middle-income countries (72 (19) vs. 37 (27) vs. 9 (12), p<0.001). CONCLUSION This prototype will be further tested for face, construct, content, and criterion validity. The authors anticipate that expanding this metric globally will improve its validity while facilitating advocacy and allowing for impact assessment at the system level.

Targeted opportunities to mitigate water scarcity, inequality, and inequity embedded in international food trade for vulnerable countries

International food trade reshapes regional water scarcity through virtual water transfers (VWT), influencing water use equality and equity. This study examines eight populous yet impoverished countries in Africa and Asia, representing 30 % of the global poor population and contributing 20 % to agricultural VWT. Despite their significant role, these countries have been understudied due to a lack of data or attention. By integrating multiple datasets and models, we assess how international food trade impacts water scarcity, inequality, and inequity within these countries and identify the driving factors. Our findings reveal varied outcomes: Uganda and Ethiopia benefit from reduced water scarcity (∼40 % and ∼7 %) and improved equality and equity (∼90 % and ∼68 %), while India and Pakistan face exacerbated scarcity (∼4 % and ∼2 %) and widening inequality and inequity (∼4 % and ∼7 %). The effects are largely driven by critical trade flows of staple and cash crops like rice, sugar cane, and cotton among developing countries, propelled by comparative advantages in agricultural production, econo-geography, food demand, and water endowment between importers and exporters. Addressing these water challenges involves diversifying import channels to reduce reliance on detrimental trade flows, such as India's rice exports to Iran, while promoting beneficial flows, like Bangladesh's cotton imports from India, through trade agreements. Additionally, implementing pro-poor water policies (e.g., providing water subsidies) and water-saving techniques (e.g., adopting drip irrigation) is crucial, though caution is needed to avoid unintendedly marginalizing vulnerable groups through large-scale water projects.

Comparative analysis of data protection regulations in East African countries

Purpose Protection of personal data is integral to the digital economy, ensuring trust and privacy as its foundational elements. The purpose of this study is to analyze data protection laws in Tanzania, Kenya, Uganda and Rwanda to understand their legal frameworks and identify challenges hindering their effective implementation. Design/methodology/approach This study uses a comparative exploratory case study approach, analyzing legal frameworks of four East African (EA) countries through examination of legal documents, official reports and academic articles. The dimensions of analysis include registration, supervisory authority, data subject rights and cross-border data transfer regulations. Findings While all four EA countries are in the process of enacting data protection acts, they differ in scope, provisions and enforcement; more needs to be done to ensure mature data protection in these countries. The commonalities and distinctions in the legal frameworks are underscored, providing a mapping of data protection regulations in the EA region. Moreover, this study reports implementation constraints and areas for improvement. Practical implications The findings of this study provide valuable insights for policymakers, highlighting areas where data protection regulations can be improved. The results of this study can guide harmonizing regional data protection laws, ensuring consistent and effective enforcement. This study offers a foundation for future policy development and regional cooperation on data protection issues. Social implications The social implications of this research lie in its potential to shape public attitudes on data protection and privacy rights. By highlighting these concerns, this study may influence societal norms and values, encouraging a more informed and conscientious public discourse on inclusive policies that consider the diverse needs of different regional populations. Originality/value This study provides a pioneering comparative analysis of data protection regulations across four EA countries, offering unique insights into the regional variations and commonalities in legal frameworks. Its value lies in informing future policy development, enhancing regional cooperation and contributing to the harmonization of data protection practices in the selected EA countries, which remains an under-explored area in existing literature.

The epidemiological declining in the human fertility rate in the arab world for 10 years period 2011–2021

Recently, there has been worldwide growing interest on profiling the human fertility of populations because there has been a noticeable global decline in fertility rate, leading to increased attention toward reproductive health and fertility.The decline in fertility of population of the Arab World was investigated for the 10 years period between 2011–2021. The Arab World was classified into three regional blocks; Block-1 Arabian Peninsula countries: Bahrain, Kuwait, Saudi Arabia, Oman, Qatar, United Arab Emirates (UAE), Yemen. Block-2 Fertile Crescent Arab countries: Iraq, Jordan, Lebanon, Syria, West Bank and Gaza. Block-3 African Arab countries: Algeria, Comoros, Djibouti, Egypt, Libya, Mauritania, Morocco, Somalia, Sudan, Tunisia. Data on fertility rates for the 10 years period between 2011–2021 were collected from the World Bank for Arab countries. Statistical analysis along with decline in the fertility rates were determined. Results: Fertility rates varied across Arab countries in 2011 and 2021, with notable decline ranging from 24.3% to 3.8%, except for Algeria, with zero decline. Countries that exhibited significant decline were Jordan (24.3%) followed by Iraq (22.2%) then Yemen (19.1%); Whereas, countries that exhibited slight fertility decline were Libya (3.8%), followed by Tunisia (4.5%), Lebanon (4.5%) and Kuwait (4.5%). On another note, lowest fertility rate was observed in UAE as maintained between 1.7% and 1.5% and the highest fertility rate was observed in Somalia as maintained between 7.3% and 6.3% for 2011 and 2021 respectively. Conclusion: The present study reveals the declining-trend in fertility rate across Arab countries, influenced by variable factors. Therefore, we recommend to the Council of the Health Ministries in the Arab-League to focus on investigating the fertility decline as an important parameter for public health in the Arab world to maintain natural balanced fertility rate.As some non-biological factors surrounding the Arabian region, such as instability, war, migration, the present study did not aim to include the influence of war and migration on fertility because both war and migration are non-biological external factors and both are not among the WHO criteria for fertility determination which based of the population growth rate of population under normal living conditions.

Effect of lycopene on prostate cancer among native African men: A protocol for an open-label randomized clinical trial in Tanzania

Background Prostate cancer (PCa) is the most common cancer and the fifth leading cause of death in men worldwide. The treatment of PCa depends on the clinical stage of the disease, prostate-specific antigen (PSA) level, and histology. Lycopene is a bright red carotenoid found in tomatoes, which enhances apoptosis in prostate cells, but its effectiveness has not been studied in East African countries. This study aimed to determine the effectiveness of lycopene from tomato extracts in reducing PSA levels, disease progression, and apoptosis in the prostate glands of men with PCa in Tanzania. Methods This study will be a randomized phase III clinical trial of men diagnosed with PCa in Tanzania. In total, 400 men will be randomized in a 1:1 ratio to receive intervention (n=200) and control (n=200) and followed for 12 months. The intervention arm will receive tomato paste for daily use in addition to the standard treatment, whereas the control arm will only follow the standard of care. The primary endpoints will be a reduction in PSA levels, improved clinical status, and apoptosis of the prostate gland. Data analysis was performed based on the intention-to-treat principle. Descriptive statistics were used to compare average lycopene and PSA levels in the intervention group using T-test and Chi-squared tests. Generalized linear mixed models will be used to further assess the effect of lycopene on PCa progression, urinary symptoms, and PSA reduction. All statistical tests were two-sided at an alpha level of <0.05. Discussion The study used a food supplement as a drug/intervention with minimal or no adverse reactions. However, there is a fear that the control group may not adhere to the protocol after learning the benefits of tomato paste. The study findings will promote the consumption of tomato paste in males diagnosed with PCa to improve the clinical status and reduce disease progression. Trial registration The study has been registered at the Pan African Clinical Trial Registry with registration No PACTR202405488763956.

A-270 Evaluation of a multiplex panel to determine antibody profile to monkeypox virus in vaccinated, exposed, and naïve individuals

Abstract Background Monkeypox Virus (MPXV) is a double-stranded DNA virus of the Orthopoxvirus genus that causes Mpox disease with symptoms such as swollen lymph nodes, chills, exhaustion, and blisters that appear on the face, inside the mouth, hands, feet etc. The genus orthopoxvirus (OPXV) has four species, namely, MPXV, smallpox-causing variola major virus (VARV), variola minor virus, and cowpox virus (CPXV), that cause disease in humans. In 1980, the World Health Assembly declared that smallpox had been eradicated due to a successful global vaccination program. This vaccine also provided cross-protection against other OPXV. Historically, the pox disease was rarely seen outside West and Central Africa. The first case of Mpox was identified in 1970 in a 9-year-old boy from the Democratic Republic of Congo (DRC), two years after the smallpox vaccination was discontinued. Since then, it has been reported in 11 African countries. In 2003, the first Mpox outbreak outside of Africa was in the USA and was linked to contact with infected pet prairie dogs. The recent 2022-2023 Mpox outbreak has generated renewed interest in the scientific community to understand the level of OPXV-specific immunity in the various geographic regions, among different age groups, and especially in the risk groups and its impact on future outbreaks by using integrated serosurveillance. To meet the need of the hour, we developed a novel multiplex assay for the detection of human IgG antibodies using Luminex® xMAP® technology for the detection of the human IgG profiles. Methods We have evaluated 11 different recombinant antigens from VARV, Vaccinia virus (VACV), and MPXV in a multiplex assay for detecting human IgG antibodies to OPXV using Luminex® xMAP® technology. We have covalently coupled magnetic fluorescent microspheres to three recombinant proteins from VARV, three from VACV, and five from MPXV to interrogate IgG responses. This 15-plex assay also includes four internal controls that assure the assay and reagent performance. In this preliminary evaluation, we have tested 84 de-identified serum and plasma from healthy subjects. We evaluated 24 serum samples of MPXV-exposed individuals procured commercially. We performed principal component analysis to determine which of these 11 antigens contributed the maximum differential and a result analysis algorithm was developed to predict these individuals' positive and negative antibody outcomes. Results The healthy subjects that were assumed to have been vaccinated showed positive response to A35R of MPXV; A36R of VARV, A33R of VACV, the homologous proteins in the three species and were distinct from unvaccinated younger individuals. There was some reactivity with B6R of MPXV protein. In MPXV-exposed subjects, we observed strong positive antibody responses to A35R of MPXV, A36R of VARV, A33R of VACV, and B6R of MPXV proteins in 19 out of 24 individuals. Fifteen individuals showed a moderate positive response to the A27L protein of VACV, and 8 out of 24 showed a weak positive response to the A29 protein of MPXV. Conclusions This panel is a useful tool to understand the level of OPXV-specific immunity by measuring IgG profiles for successful serosurveillance programs for public health.

Gender of a manager and firm performance in Africa: Does the business environment play a moderating role?

AbstractThis study explores the moderating role of the business environment in the relationship between top manager gender and firm performance, using firm‐level data from 29 African countries. Controlling for endogeneity and country fixed effects, we find that female‐managed firms generally underperform male‐managed firms, except among large firms where female managers excel. The performance gap is exacerbated by a weak business environment, highlighting the need for reforms to close the managerial gender gap in Africa. Strengthening the business environment is essential for improving female‐led firm performance and by extension promoting gender equality in African business leadership.

How does community health feature in Global Financing Facility planning documents to support reproductive, maternal, newborn, child and adolescent health and nutrition (RMNAH-N)? insights from six francophone West African countries

ABSTRACT Background Community health is key for improving Reproductive, Maternal, Newborn, Child, and Adolescent Health and Nutrition (RMNCAH-N). However, how community health supports integrated RMNCAH-N service delivery in francophone West Africa is under-researched. Objective We examined how six francophone West African countries (Burkina Faso, Côte d’Ivoire, Guinea, Mali, Niger, and Senegal) support community health through the Global Financing Facility for Women, Children and Adolescents (GFF). Methods We conducted a content analysis on Investment Cases and Project Appraisal Documents from selected countries, and set out the scope of the analysis and the key search terms. We applied an iterative hybrid inductive-deductive approach to identify themes for data coding and extraction. The extracted data were compared within and across countries and further grouped into meaningful categories. Results In country documents, there is a commitment to community health, with significant attention paid to various cadres of community health workers (CHWs) who undertake a range of preventive, promotive and curative roles across RMNCAH-N spectrum. While CHWs renumeration is mentioned, it varies considerably. Most community health indicators focus on CHWs’ deliverables, with few related to governance and civil registration. Challenges in implementing community health include poor leadership and governance and resource shortages resulting in low CHWs performance and service utilization. While some countries invest significantly in training CHWs, structural reforms and broader community engagement are lacking. Conclusions There is an opportunity to better prioritize and streamline community health interventions, including integrating them into health system planning and budgeting, to fully harness their potential to improve RMNCAH-N.

Prevalence and management of ectopic and molar pregnancies in 17 countries in Africa and Latin America and the Caribbean: a secondary analysis of the WHO multi-country cross-sectional survey on abortion

IntroductionThere are limited global data on ectopic pregnancy (EP) and molar pregnancy (MP), making it important to understand their epidemiology and management across different regions. Our study aimed to describe...

Balancing growth and preservation: Unravelling Africa’s carbon-economic nexus through the environmental Kuznets curve.

Africa is vulnerable to the challenges of global climate change, which poses a significant obstacle to achieving economic development while protecting the environment. Despite numerous Environmental Kuznets Curve (EKC) studies, evidence remains inconclusive, especially in African countries. This study delves into the carbon-economic nexus within the EKC framework across 46 African countries from 1990 to 2020. Utilizing advanced econometric techniques such as Auto-Regressive Distributed Lag (ARDL) modeling based on the Pooled Mean Group (PMG) estimator, Common Correlated Effects Pooled Mean Group (CCE-PMG), appropriate U-test, and Dumitrescu and Hurlin causality test, the research uncovers significant insights into how GDP, energy consumption, and urbanization impact CO2 emissions across different income groups. The findings strongly support the EKC hypothesis for lower-middle-income (LMI) and upper-middle- and high-income (UM&HI) countries, where economic growth initially worsens environmental degradation but eventually leads to improvements as incomes rise. However, in low-income (LI) countries, the study reveals a U-shaped relationship, suggesting that early economic growth may reduce emissions, but continued development could lead to increased environmental stress. Energy consumption is identified as a persistent driver of CO2 emissions across all income groups, while urbanization shows mixed impacts, with negative environmental consequences in LI countries and potential environmental benefits in LMI and UM&HI countries. These findings carry important policy implications for African countries as they seek to balance economic growth with environmental preservation. The research calls for targeted policies that promote green technologies, enhance energy efficiency, and implement sustainable urban planning to ensure that Africa’s development trajectory is environmentally sustainable.

Medical Tourism for Cancer Treatment: Trends, Trajectories, and Perspectives From African Countries.

Cancer continues to be a significant public health concern. Sub-Saharan Africa (SSA) struggles with a lack of proper infrastructure and adequate cancer care workforce. This has led to some countries relying on referrals of cancer care to countries with higher income levels. In some instances, patients refer themselves. Some countries have made it their goal to attract patients from other countries, a term that has been referred to as medical tourism. In this article, we explore the current status of oncology-related medical tourism in SSA. This was a cross-sectional study. The study participants included oncologists, surgeons, and any other physicians who take care of patients with cancer. A predesigned questionnaire was distributed through African Organization for Research and Training in Cancer member mailing list and through study team personal contacts and social media. A total of 52 participants from 17 African countries with a 1.6:2 male to female ratio responded to the survey. Most (55.8%) of the respondents were from Eastern African countries. The majority (92%) of study participants reported that they knew patients who referred themselves abroad, whereas 75% referred patients abroad, and the most common (94%) referral destination was India. The most common (93%) reason for referral was perception of a higher quality of care in foreign health institutions. The findings suggest the need to improve local health care systems including building trust of the system among general population. The study highlights potential financial toxicity, and it adds to the current emphasis on return of investment on homegrown workforce and cancer treatment infrastructure.

Long Covid: a global health issue – a prospective, cohort study set in four continents

IntroductionA proportion of people develop Long Covid after acute COVID-19, but with most studies concentrated in high-income countries (HICs), the global burden is largely unknown. Our study aims to characterise...

Relationship Between Substance Use Disorder And Clinical Depression Among Women Kenya

Kenya is the fourth country in Africa with the highest number of people suffering depression, with 1.9 million diagnosed cases. However, few local studies have explored on whether clinical depression is linked to substance use disorder among women in Kenya. The aim of this study was to the evaluation of the relationship between substance use disorder and clinical depression among women in Kenya. This study used a descriptive research design with 12 rehabilitation centres and 217 participants. The Patient Health Questionnaire was used to assess the incidences of clinical depression. The ASSIST test was used in the study to measure substance use disorder. Results of the study illustrated that more than 84 percent of women in these centres experience clinical depression as a result of substance use. There was a positive relationship (β=0.236, T-value =1.221, p=0.002<0.05) between clinical depression and substance use. The study concluded that the level of high percentages of clinical depression in women was a critical sign of substance use. It was recommended that the government, NGOs should collaborate to prevent, control and contain increase in substance abuse and especially illicit alcohol

Machine Learning to Predict Interim Response in Pediatric Classical Hodgkin Lymphoma Using Affordable Blood Tests

PURPOSE Response assessment of classical Hodgkin lymphoma (cHL) with positron emission tomography-computerized tomography (PET-CT) is standard of care in well-resourced settings but unavailable in most African countries. We aimed to investigate correlations between changes in PET-CT findings at interim analysis with changes in blood test results in pediatric patients with cHL in 17 South African centers. METHODS Changes in ferritin, lactate dehydrogenase (LDH), erythrocyte sedimentation rate (ESR), albumin, total white cell count (TWC), absolute lymphocyte count (ALC), and absolute eosinophil count were compared with PET-CT Deauville scores (DS) after two cycles of doxorubicin, bleomycin, vinblastine, and dacarbazine in 84 pediatric patients with cHL. DS 1-3 denoted rapid early response (RER) while DS 4-5 denoted slow early response (SER). Missing values were imputed using the k-nearest neighbor algorithm. Baseline and follow-up blood test values were combined into a single difference variable. Data were split into training and testing sets for analysis using Python scikit-learn 1.2.2 with logistic regression, random forests, naïve Bayes, and support vector machine classifiers. RESULTS Random forest analysis achieved the best validated test accuracy of 73% when predicting RER or SER from blood samples. When applied to the full data set, the optimal model had a predictive accuracy of 80% and a receiver operating characteristic AUC of 89%. The most predictive variable was the differences in ALC, contributing 21% to the model. Differences in ferritin, LDH, and TWC contributed 15%-16%. Differences in ESR, hemoglobin, and albumin contributed 11%-12%. CONCLUSION Changes in low-cost, widely available blood tests may predict chemosensitivity for pediatric cHL without access to PET-CT, identifying patients who may not require radiotherapy. Changes in these nonspecific blood tests should be assessed in combination with clinical findings and available imaging to avoid undertreatment.

Molecular characterization of Peste des petits ruminants virus (PPRV) in sheep and goats and risk factors associated with it in selected districts of Khyber Pakhtunkhwa-Pakistan.

Peste des Petits Ruminants (PPR) is an economically significant transboundary viral disease of sheep and goats caused by the PPRV virus, affecting annual losses of 1.45-2.10 billion US dollars globally. We designed the current study to evaluate the positive cases, molecular characterization, phylogenetic analysis, and risk factors correlated with the disease in various districts of Khyber Pakhtunkhwa, Pakistan, with the aim of contributing to these strategies. A total of 384 samples from three selected districts, i.e., Peshawar, Charsadda and Chitral (n = 128 each), were collected, and the virus was investigated by using the sandwich ELISA, while the N gene of the virus was used as a target for molecular detection via RT-PCR. The confirmed samples were then sequenced, and phylogenetic analysis was performed. According to our findings, the highest positive cases was found in district Peshawar (50.87%), followed by Charsadda and Chitral (24.56%), respectively, while risk factor analysis showed that certain categories, such as species, sex, and age less than two years, have higher risk (P < 0.05) in contrast to their respective categories. Furthermore, sequencing and phylogenetic analysis of representative samples showed that the PPRV strains in the current study clustered in lineage IV, which is circulating in the small ruminant population of Asia, the Middle East, and African countries. Comparative residue analysis highlighted the mutation by representing 242 variable sites out of 371 locations. PPRV has foremost importance in Pakistan because the virus was detected in a considerable number of samples, and most of which were sourced from subsidiary areas where veterinary services are not prioritized.

Racial representation in multicenter clinical trials leading to drug approvals for gynecological cancer indications by the US Food and Drug Administration (FDA).

66 Background: Enrollment disparities in gynecologic (Gyn) cancer clinical trials in the United States (US) are well-documented. However, there is limited data evaluating how recruitment sites in international clinical trials contribute to racial representation, specifically in Gyn cancers. Here, we examined racial enrollment and geographic location in clinical trials that have led to approval for Gyn cancer applications. Methods: Agents approved by the FDA for Gyn cancer treatment and corresponding clinical trials were identified from the FDA Drug Approvals and Databases. Enrollment data were abstracted from ClinicalTrials.gov then cross-checked with published manuscripts and FDA labels. Using Gyn disease site prevalence from the 2021 SEER database, we calculated expected enrollment proportions by race and compared these to actual clinical trial enrollment data. The binomial test was used to compare expected vs. observed proportions with White patients as the reference group. Results: From 2014 to 2024, 9 drugs received 22 FDA approvals for ovarian (n=13), endometrial (n=4), or cervical cancer (n=5). These approvals were based on 28 clinical trials enrolling a total of 13,763 patients (75.7% White, 3.4% Black, 12.0% Asian, 8.9% Other/Unknown). These trials included 1 (3.6%) US only study, 3 (10.7%) non-US, primarily Europe-based studies (PAOLA-1, AURELIA, STUDY42 [Europe + Australia]), and 24 (85.7%) international studies across the US and 46 other countries. Considering the distribution of race (White: 86.3%, Black: 8.4%, Asian: 4.9%) of Gyn cancers in the US, Black patients had lower enrollment (45% of expected enrollment) vs. White patients (95% of expected enrollment, P&lt;0.0001). African countries were rarely included among the recruitment sites. Two international trials reported patient recruitment from South Africa (3.2% Black, 6/188 patients, 38% of expected enrollment).However, Asian patients had higher enrollment (269% of expected enrollment, P&lt;0.0001) compared to White patients. In 13 trials that included study sites in East Asia, Asian patients comprised 16% of the trial population (1310/8205 patients; 327% of expected enrollment) vs. 3.2% in trials that did not open in Asia (n=15) (181/5558 patients; 67% of expected enrollment). Conclusions: Black patients were underrepresented in pivotal trials that led to FDA approvals for Gyn cancers. Overrepresentation of Asian patients was likely due to international enrollment from East Asia. Post-marketing retrospective studies or additional studies focused on underrepresented groups are needed to assess true drug efficacy and safety in US populations that are disproportionately affected by Gyn cancer mortality.

The Fertility Transition in Sub-Saharan Africa: The Role of Structural Change.

Despite recent economic growth and reductions in child mortality in many African countries, the region has experienced a slow fertility transition. In this study, we explore whether the slow structural economic change on the continent can explain this discrepancy. We construct a unique panel dataset combining Demographic and Health Surveys and nighttime light intensity data (an indicator of industrialization) from 57 countries at the subnational region level over three decades to analyze the drivers of fertility transitions across low- and middle-income countries. Our results confirm that household wealth, reduced child mortality, and female primary education are crucial for fertility declines. However, our analysis also highlights the importance of indicators of structural economic change, including the share of labor in nonagricultural occupations, industrialization, the share of women with higher education, and the formalization of the economy. Our simulations suggest that if high-fertility countries in sub-Saharan Africa underwent structural economic transformations comparable to those of other low- and middle-income countries with low fertility rates, their fertility levels could fall by 1 to 1.6 children.

Spirometric reference equations and lung function testing in adults from Southwestern Tanzania.

The increasing relevance of lung function testing in diagnosing and treating pulmonary diseases globally requires adequate spirometric reference equations. However, locally derived reference standards from African countries are widely missing. This cross-sectional study was conducted in Southwestern Tanzania. Participants underwent a socio-demographic interview, anthropometric measurements and standardised spirometric lung function testing. Regression modelling was used to generate Tanzanian prediction equations for spirometry parameters forced vital capacity (FVC), forced expiratory volume in 1 sec (FEV1) and the FEV1/FVC ratio. Out of 400 recruited participants, 343 had usable spirometry results with respect to the American Thoracic Society (ATS)/European Respiratory Society (ERS) reproducibility and acceptability criteria. The mean age of participants was 32.65 years (SD 12.11), and 44,9% were females. Spirometric parameters increased with height but decreased with older age. The coefficients of our new prediction equations for spirometry parameters differed substantially from those of existing reference standards. This study provides prediction equations for spirometric lung function in a non-smoking Tanzanian population. The differences in existing equations underline the heterogeneity of locally derived reference equations in Africa and contribute insights and data to discussing global respiratory health care reference standards.