East Africa Research Articles

Metagenomic Detection of Bacterial Zoonotic Pathogens among Febrile Patients, Tanzania, 2007-20091.

Bacterial zoonoses are established causes of severe febrile illness in East Africa. Within a fever etiology study, we applied a high-throughput 16S rRNA metagenomic assay validated for detecting bacterial zoonotic pathogens. We enrolled febrile patients admitted to 2 referral hospitals in Moshi, Tanzania, during September 2007-April 2009. Among 788 participants, median age was 20 (interquartile range 2-38) years. We performed PCR amplification of V1-V2 variable region 16S rRNA on cell pellet DNA, then metagenomic deep-sequencing and pathogenic taxonomic identification. We detected bacterial zoonotic pathogens in 10 (1.3%) samples: 3 with Rickettsia typhi, 1 R. conorii, 2 Bartonella quintana, 2 pathogenic Leptospira spp., and 1 Coxiella burnetii. One other sample had reads matching a Neoerhlichia spp. previously identified in a patient from South Africa. Our findings indicate that targeted 16S metagenomics can identify bacterial zoonotic pathogens causing severe febrile illness in humans, including potential novel agents.

Epidemiology of Trichomonas vaginalis infection in the Middle East and North Africa: systematic review, meta-analyses, and meta-regressions

Trichomoniasis, caused by the parasite Trichomonas vaginalis (TV), remains an underappreciated sexually transmitted infection (STI), primarily due to inadequate understanding of its epidemiology and public health implications. This study aimed to characterize TV epidemiology in the Middle East and North Africa (MENA). Systematic review and analysis of evidence sourced from international, regional, and national databases were conducted. Findings were reported following PRISMA guidelines. Random-effects meta-analyses and meta-regressions were performed to determine pooled mean prevalence, investigate associations with prevalence, and identify sources of between-study heterogeneity. The review identified 263 relevant publications, encompassing 462TV prevalence measures. The pooled mean TV prevalence was estimated as follows: 4.7% (95% CI: 3.9-5.6%) in the general population of women, 17.2%(95% CI: 5.4-33.6%) among intermediate-risk populations, 10.3% (95% CI: 6.2-15.3%) among female sex workers, 13.9% (95% CI: 12.3-15.6%) among symptomatic women, 7.4% (95% CI: 1.9-15.5%) among infertility clinic attendees, 2.3% (95% CI: 0.1-6.3%) among women with miscarriages or ectopic pregnancies, and 1.6%(95% CI: 0.8-2.7%) among STI clinic attendees. Limited data were found for men. Multivariable meta-regressions explained >40% of the prevalence variation, unveiling a hierarchical prevalence pattern by population type, an inverse correlation with national income, and a prevalence decline at a rate of 1% per calendar year. Despite conservative sexual norms, MENA has a substantial TV prevalence, comparable to the global TV prevalence. The unexpectedly high prevalence of this curable infection may, in part, be attributed to limited access to and underutilization of STI screening and treatment services. This work was supported by the Qatar Research, Development, and Innovation Council [ARG01-0522-230273] and by the Biomedical Research Program at Weill Cornell Medicine-Qatar.

Editorial: Multi-level socio-economic determinants of mobile money adoption in the Middle East and North Africa (MENA): introduction to the thematic collection

Editorial: Multi-level socio-economic determinants of mobile money adoption in the Middle East and North Africa (MENA): introduction to the thematic collection

Range dynamics of Anopheles mosquitoes in Africa suggest a significant increase in the malaria transmission risk.

Despite a more than 100-year effort to combat malaria, it remains one of the most malignant infectious diseases globally, especially in Africa. Malaria is transmitted by several Anopheles mosquitoes. However, until now few studies have investigated future range dynamics of major An. mosquitoes in Africa through a unified scheme. Through a unified scheme, we developed 21 species distribution models to predict the range dynamics of 21 major An. species in Africa under future scenarios and also examined their overall range dynamic patterns mainly through suitability overlap index and range overlap index. Although future range dynamics varied substantially among the 21 An. species, we predicted large future range expansions for all 21 An. species, and increases in suitability overlap index were detected in more than 90% of the African continent for all future scenarios. Additionally, we predicted high range overlap index in West Africa, East Africa, South Sudan, Angola, and the Democratic Republic of the Congo under future scenarios. Although the relative impacts of land use, topography and climate variables on the range dynamics depended on species and spatial scale, climate played the strongest roles in the range dynamics of most species. Africa might face an increasing risk of malaria transmissions in the future, and better strategies are required to address this problem. Mitigating climate change and human disturbance of natural ecosystems might be essential to reduce the proliferation of An. species and the risk of malaria transmissions in Africa in the future. Our strategies against their impacts should be species-specific.

Coffee sustainability: leveraging collaborative breeding for variety improvement

The sustainability of global coffee supply is threatened by production challenges worsening with every decade since the turn of the 21st century. Coffee is among the most popular beverages in the world, and its production supports livelihoods of millions of people, mostly smallholder farmers. With a global market value exceeding US$130 billion, the coffee industry is a source of export revenue for producing countries, the majority of which are developing nations in the Global South. Climate change, pests, and diseases continue to hamper productivity, profitability, and countries’ competitiveness in the global market. At the same time, the global demand for coffee continues to rise. A crucial pillar to safeguarding the future of coffee is continuously developing improved varieties suitable for the changing environment, and that address the needs of farmers and the industry. Yet, most national breeding programs are grossly out of touch with climate change reality and market dynamics. Working in isolation, these programs are constrained by unstable funding, limited sources of genetic variability, and inaccessibility of modern technologies necessary to accelerate the breeding process. We review here key production challenges, status of genetic diversity, and breeding approaches. Additionally, we explore opportunities in leveraging a pre-competitive collaborative breeding approach encompassing sharing of germplasm, and cross-border multi-environment trials in developing next-generation cultivars. We argue that breeding efforts should be informed by the needs of all the stakeholders in the supply chain including researchers, smallholder farmers, small and medium-sized enterprises investing in coffee processing and roasting, and consumers. Using emerging and reviving producers in Southeast Asia and Eastern Africa as a model, we explore how a paradigm shift in coffee breeding from the historically nation-centric approach to a more forward-looking collaborative model could improve the efficiency of variety improvement in face of climate change and growing market demand.

Technical Progress and Endogenous Growth: An Econometric Analysis Using Panel Data on the MENA Region

From the dawn of the Christian era until the Industrial Revolution, the standard of living saw little to no change and remained relatively stable during this period. However, since the Industrial Revolution, living standards have experienced sustained growth up to the present day. The Solow model attributes this growth to technical progress, but where does this progress come from? To truly understand economic growth, we must therefore go beyond the Solow model and attempt to explain technical progress itself. The objective of this work is to identify and specify the factors that may explain technical progress (in other words, what causes growth in A (PGF)?). To this end, initially, we relied on a set of theoretical works ( (Romer, 1990; Lucas, 1988; Barro, 1990; Aghion, Blundell, Griffith, Howitt, & Prantl, 2009), among others) which led us to a set of recommendations. Therefore, in a second step, we proceed to an empirical analysis using panel data to test the significance of the impact of this set of recommendations on technical progress in the Middle East and North Africa (MENA) region. Our econometric results show that there is still much to be done in the MENA region to catch up with the United States, Sweeden, Switzerland, Japan, Germany or France: the establishment of a research and innovation system based on the needs of economic and social development, an increase in the budget allocated to research, massive investment by the private sector in universities, the strengthening and creation of institutions, etc.

Does neighborhood matter? An analysis of HIV prevalence in Sub-Saharan African countries

ABSTRACT Over two-thirds of the population living with HIV were concentrated in Eastern, Southern, Western, and Central Africa in 2021. This paper employs data from the Demographic and Health Survey to assess the relationship between HIV prevalence and its socio-economic and demographic drivers at the neighborhood (macro-cluster) level. Additionally, the study examines the existence of differences in such relationships among countries. The results of the fractional logistic regression models highlight that highly educated neighborhoods are less likely to be affected by HIV. A greater average number of children, potentially due to programs that promote access to preventive antenatal care and prevention, is associated with a lower likelihood of residents living with HIV. Notably, HIV testing coverage is prevalent in neighborhoods with a high prevalence of HIV. It is also evident that there are notable differences between countries, which demonstrate national context plays a crucial role in the association between education, number of children, testing coverage, and HIV prevalences.

Current Themes in the Archaeology of East Africa

East Africa boasts one of the longest histories of humankind. From hominid origins to the present, people have roamed, interacted with one another, and influenced the environment in innumerable ways. To teach about the archaeology of East Africa is to engage with the deepest history of humankind, from Hominin evolution to historical archaeology and the archaeology of listening. Each topic has developed its own peculiar and complex analytical methodologies that require varied resources and degrees of intensity and investment in training and mentoring. This review discusses advances made over the past two decades in the research and dissemination of archaeological knowledge about East Africa. Beyond the major issues that stimulate scientific research and debates, what debates have been settled? Which emerging threats must East African archaeologists overcome to ensure a sustained practice of archaeology in the future?

Ant-following behavior is correlated with plumage traits in African understory birds

Ant-following behavior is a common phenomenon in birds of Neotropical and Afrotropical rainforests but yet little is known from Central Africa. We here report on the phenomenon in lowland rainforest in Cameroon, quantifying the strength of the interaction of different ant-following bird species with driver ants and test the hypothesis that higher levels of specialization in ant-following behavior are associated with dominance or aggression-dependent plumage and other morphological traits. Flock size varied between 1 and 11 individuals with a mean size of 5.34 ± 2.68 (mean ± SD) individuals occurring at the same time. The maximum number of species present during one raid observed was ten, whereas the minimum number was four with an overall species richness of 6.89 ± 2.1 species. The 21 attending bird species strongly varied in the degree of ant-following behavior. In an interspecific comparison, plumage traits such as the presence of a colored crown, eyespots, and bare skin around the eye, in combination with metatarsus length and weight, were significantly correlated with ant-following behavior. These results suggest that—in size and identity of species—ant-following bird assemblages in Central Africa are similar to those reported from East Africa. They also suggest that ant following favors the selection of traits that signal dominance in interactions between individuals struggling for valuable food resources in the forest understory.

Exploring Machine Learning Algorithms to Predict Diarrhea Disease and Identify its Determinants among Under-Five Years Children in East Africa.

The second most common cause of death for children under five is diarrhea. Early Predicting diarrhea disease and identify its determinants (factors) using an advanced machine learning model is the most effective way to save the lives of children. Hence, this study aimed to predict diarrheal diseases, identify their determinants, and generate some rules using machine learning models. The study used secondary data from the 12 east African countries for DHS dataset analysis using Python. Machine learning techniques such as Random Forest, Decision Tree (DT), K-Nearest Neighbor, Logistic Regression (LR), wrapper feature selection and SHAP values are used for identify determinants. The final experimentation results indicated the random forest model performed the best to predict diarrhea disease with an accuracy of 86.5%, precision of 89%, F-measure of 86%, AUC curve of 92%, and recall of 82%. Important predictors' identified age, countries, wealth status, mother's educational status, mother's age, source of drinking water, number of under-five children immunization status, media exposure, timing of breast feeding, mother's working status, types of toilet, and twin status were associated with a higher predicted probability of diarrhea disease. According to this study, child caregivers are fully aware of sanitation and feeding their children, and moms are educated, which can reduce child mortality by diarrhea in children in east Africa. This leads to a recommendation for policy direction to reduce infant mortality in East Africa.

Effect of male partners' involvement and support on reproductive, maternal and child health and well-being in East Africa: A scoping review.

East African countries have high rates of maternal and child mortality and morbidity. Studies have shown that the involvement of male partners in reproductive health can benefit maternal and child health (MCH). This scoping review aims to provide an overview of the evidence across East Africa that describes male partner involvement and its effect on maternal, reproductive, and child well-being. Ten databases were searched to identify quantitative data on male's involvement in East Africa. Studies reporting qualitative data, "intention to use" data or only reporting on male partner's education or economic status were excluded. Studies were organized into five a priori categories: antenatal care (ANC), human immunodeficiency virus, breastfeeding, family planning, and intimate partner violence with further categories developed based on studies included. A total of 2787 records were identified; 644 full texts were reviewed, and 96 studies were included in this review. Data were reported on 118,967 mothers/pregnant women and 15,361 male partners. Most of the studies (n = 83) were reported from four countries Ethiopia (n = 49), Kenya (n = 14), Tanzania (n = 12) and Uganda (n = 10). The evidence indicates that male partner involvement and support is associated with improved reproductive, MCH across a wide range of outcomes. However, the studies were heterogeneous, using diverse exposure and outcome measures. Also, male partners' lack of practical and emotional support, and engagement in violent behaviors towards partners, were associated with profound negative impacts on MCH and well-being. The body of evidence, although heterogeneous, provides compelling support for male involvement in reproductive health programs designed to support MCH. To advance research in this field, an agreement is needed on a measure of male partner "involvement." To optimize benefits of male partners' involvement, developing core outcome sets and regional coordination are recommended.

Association of a rapidly selected 4.3kb transposon-containing structural variation with a P450-based resistance to pyrethroids in the African malaria vector Anopheles funestus.

Deciphering the evolutionary forces controlling insecticide resistance in malaria vectors remains a prerequisite to designing molecular tools to detect and assess resistance impact on control tools. Here, we demonstrate that a 4.3kb transposon-containing structural variation is associated with pyrethroid resistance in central/eastern African populations of the malaria vector Anopheles funestus. In this study, we analysed Pooled template sequencing data and direct sequencing to identify an insertion of 4.3kb containing a putative retro-transposon in the intergenic region of two P450s CYP6P5-CYP6P9b in mosquitoes of the malaria vector Anopheles funestus from Uganda. We then designed a PCR assay to track its spread temporally and regionally and decipher its role in insecticide resistance. The insertion originates in or near Uganda in East Africa, where it is fixed and has spread to high frequencies in the Central African nation of Cameroon but is still at low frequency in West Africa and absent in Southern Africa. A marked and rapid selection was observed with the 4.3kb-SV frequency increasing from 3% in 2014 to 98% in 2021 in Cameroon. A strong association was established between this SV and pyrethroid resistance in field populations and is reducing pyrethroid-only nets' efficacy. Genetic crosses and qRT-PCR revealed that this SV enhances the expression of CYP6P9a/b but not CYP6P5. Within this structural variant (SV), we identified putative binding sites for transcription factors associated with the regulation of detoxification genes. An inverse correlation was observed between the 4.3kb SV and malaria parasite infection, indicating that mosquitoes lacking the 4.3kb SV were more frequently infected compared to those possessing it. Our findings highlight the underexplored role and rapid spread of SVs in the evolution of insecticide resistance and provide additional tools for molecular surveillance of insecticide resistance.

Climate cycling did not affect haplotype distribution in an abundant Southern African avian habitat generalist species, the familiar chat (Oenanthe familiaris).

Avian species diversity in Southern Africa is remarkably high, yet the mechanisms responsible for that diversity are poorly understood. While this is particularly true with respect to species endemic to the subregion, it is unclear as to how more broadly distributed African species may have colonized southern Africa. One process that may in part account for the high bird species diversity in southern Africa is a "species pump" model, wherein the region was repeatedly colonized by lineages from areas further north: a pattern related to climate cycling and the eastern African arid corridor. Once occupying southern Africa, with its many varied biomes, it is possible that climate cycling further affected lineages by generating genetic diversity in multiple refugia, a pattern recently shown for several southern African bird species. Here, we used mtDNA to address these questions in a widespread, sedentary habitat generalist bird species, the familiar chat (Oenanthe familiaris). The phylogenetic structure suggests a north-to-south colonization pattern, supporting the "species pump" model. Haplotype diversity was partitioned into two distinct clusters: southern Africa and Malawi (East Africa). Southern African haplotypes were not geographically partitioned, and we hypothesize that this pattern has arisen because this species is a habitat generalist, and as such resilient to habitat-altering climate perturbations. Based on our phylogenetic results, we discuss the validity of currently recognized subspecies.

Ageing and migration. Reflection on an emerging nexus and application to the Middle East and northern Africa

Ageing and migration. Reflection on an emerging nexus and application to the Middle East and northern Africa

Perception, Usability, and Satisfaction with Telemedicine in the United Arab Emirates.

Background: Telemedicine has become a global tool for enhancing health care accessibility. However, its widespread adoption is still limited by technological illiteracy, lack of appropriate devices, slow internet services, and privacy concerns. In the Middle East and North Africa, including the United Arab Emirates (UAE), there is a dearth of telemedicine research. This study aimed to understand the perceptions and satisfaction levels of the UAE population regarding telemedicine. Methods: Between June and September 2023, a cross-sectional study was undertaken, using an online questionnaire distributed among UAE citizens and residents aged 18 years and above. The survey aimed to gauge the perceptions, usability, and satisfaction levels of telemedicine users, alongside identifying barriers hindering its acceptance. Data analysis was performed using Python 3, using Matplotlib v3.3.4 and Pandas v1.2. Results: The data analysis encompassed 1,013 participants, among whom 66.9% (678/1,013) were familiar with telemedicine. From this group, 29.8% (202/678) had previously utilized it. Of these users, 92.3% (186/202) found it to be useful or highly useful, whereas 83.1% (168/202) expressed overall satisfaction with their telemedicine experience. Among those who had not used telemedicine (47%, 476/1,013), the predominant concerns were a preference for in-person health care consultations for better care (77%, 367/476) and uncertainty about the quality of care offered through telemedicine (62%, 296/476). Conclusions: Despite high awareness of telemedicine in the UAE, its actual usage remains limited, highlighting the necessity for increased promotional efforts. Nevertheless, positive feedback suggests considerable potential for broad adoption. Future studies should address participants' concerns to enhance telemedicine utilization in the region.

The legal, policy, institutional and programmatic context for protecting children against online sexual exploitation in Tunisia

AbstractEvidence is absent in the legal, policy and programmatic landscape of online child sexual exploitation in countries in the Global South. Our work begins to contribute to filling this literature gap, drawing evidence from Tunisia, one of the least studied countries in the Middle East and North Africa (MENA). We reviewed legal and policy documents directly or indirectly connected to online child sexual exploitation, complemented with interviews from diverse actors in the child protection space at the national and sub‐national levels. We note that Tunisia is a signatory to several international and regional treaties and conventions that can be leveraged to tackle online sexual exploitation of children. Still, these have yet to be fully exploited for the benefit of children. Furthermore, we observed several disparate laws at the country level. These laws are scattered in many legal documents, and some aspects could be more specific, but currently not, which poses significant legal challenges to protecting children. Finally, many institutions implementing programmes in this space create less coordination and sometimes confusion. At best, interventions seem ad hoc without any clear mandate of specificity in institutional leadership. The implications of the findings for policies and programmes are highlighted.

Investigating the footprint of post-domestication dispersal on the diversity of modern European, African and Asian goats

BackgroundGoats were domesticated in the Fertile Crescent about 10,000 years before present (YBP) and subsequently spread across Eurasia and Africa. This dispersal is expected to generate a gradient of declining genetic diversity with increasing distance from the areas of early livestock management. Previous studies have reported the existence of such genetic cline in European goat populations, but they were based on a limited number of microsatellite markers. Here, we have analyzed data generated by the AdaptMap project and other studies. More specifically, we have used the geographic coordinates and estimates of the observed (Ho) and expected (He) heterozygosities of 1077 European, 1187 African and 617 Asian goats belonging to 38, 43 and 22 different breeds, respectively, to find out whether genetic diversity and distance to Ganj Dareh, a Neolithic settlement in western Iran for which evidence of an early management of domestic goats has been obtained, are significantly correlated.ResultsPrincipal component and ADMIXTURE analyses revealed an incomplete regional differentiation of European breeds, but two genetic clusters representing Northern Europe and the British-Irish Isles were remarkably differentiated from the remaining European populations. In African breeds, we observed five main clusters: (1) North Africa, (2) West Africa, (3) East Africa, (4) South Africa, and (5) Madagascar. Regarding Asian breeds, three well differentiated West Asian, South Asian and East Asian groups were observed. For European and Asian goats, no strong evidence of significant correlations between Ho and He and distance to Ganj Dareh was found. In contrast, in African breeds we detected a significant gradient of diversity, which decreased with distance to Ganj Dareh.ConclusionsThe detection of a genetic cline associated with distance to the Ganj Dareh in African but not in European or Asian goat breeds might reflect differences in the post-domestication dispersal process and subsequent migratory movements associated with the management of caprine populations from these three continents.

Multilateral financial flows and state–business relations in Morocco

ABSTRACT Political economy explanations of regime resilience often look at domestic support bases and patronage systems. Foreign aid to the state is seen as a direct form of propping up regimes. This article attempts to track the flow of foreign assistance to one part of the domestic support base of a regime, namely the economic elite, thereby making a connection between domestic explanations and foreign support explanations of regime resilience. The core argument of this article is that multilateral financial flows from Western dominated institutions may preserve regimes in the Middle East and North Africa. Multilateral flows from the World Bank Group, the European Investment Bank, and the European Bank for Reconstruction and Development went to regime insiders and thus potentially strengthened existing economic elites during the time in which the former Islamist opposition party led a coalition government. I draw on the linkage dimension of Levitsky and Way’s model to show the importance of specifying the nature and destination of multilateral financial ties with Morocco’s private sector. This contribution helps us link the international dimension to the domestic political economy. It thus potentially adds to our understanding of monarchical regime resilience post-Arab Spring by highlighting how multilateral financial institutions support an important part of the economic elite.

Chains of extraction: shifting bioeconomies in India and East Africa

Since the early 2000s, India has been a world leading hub for cross border reproductive treatments, in particular surrogacy, with the nation positioning itself as the “mother destination” for transnational commercial surrogacy, offering “First world services at Third world prices”. State policies, lack of legal regulation, state of the art medical infrastructure and a steady supply of women ready to take on the role as surrogate mothers against meager remuneration have been key factors behind the Indian success story. Yet, a gradual process of regulation in recent years, culminating in the introduction of the Surrogacy (Regulation) Bill 2020, has forced the industry to reinvent itself in order to maintain its role as a market leader in a booming global bioeconomy. This article takes the 2020 bill as a starting point for an exploration of the key trajectories that the Indian reproductive industry has taken since. This includes moving into new market segments, such as the unregulated practice of oocyte donation, and expanding globally into new geo-political contexts. Through these practices, India has successfully rebranded itself as a world leading “pre-conception assemblage hub” where embryos are assembled and implanted into surrogates who carry their pregnancies to term in countries with no protective legislation. The article begins to map the emerging links between the reproductive industry in India and East Africa - where diasporic networks are mobilized in the creation of new reproductive markets, dominated by Indian IVF providers. In particular, we discuss the current expansion in Kenya, which we situate against the backdrop of the colonial entanglements between the two countries. While the ART industry in Kenya is still young, we suggest that these emerging developments illuminate the effect of the ban on commercial surrogacy in India, which appears to have resulted in a partial relocation to countries that lack regulation, shifting the precarious conditions of surrogates in India to other women, elsewhere, in ways that rearticulate colonial racial hierarchies and migration patterns.

Multilevel factors associated with overweight and obesity in East Africa: Comparative analysis in five countries from 2003 to 2016

Rising rates of overweight/obesity in sub-Saharan Africa (SSA) are a growing concern. Regional analysis of sociodemographic factors associated with overweight/obesity, as is common, may mask nationally specific associations. We examine the spatiotemporal trends of overweight/obesity in women (15–49 years) using 13 years of data (2003–2016) from Demographic and Health Surveys in five East African countries. Multivariable logistic regression reveals that urbanization and individual education, wealth, employment, marital status, and age are linked to overweight/obesity in the region, but their influence varied between nations. Variations in sociodemographic risk factors across nations underscore the need for tailored surveillance and interventions to address the increasing burden of overweight/obesity in East Africa.