Low-income African Countries Research Articles

Impact of estimated glomerular filtration rate (eGFR) on in-hospital mortality: an age- and HIV status-specific retrospective cohort study in Uganda

BackgroundLimited studies have explored the relationship between estimated Glomerular Filtration Rate(eGFR) and in-hospital mortality(IHM) in low-income sub-Saharan African countries. This study aimed to explores this association, offering insights into its impact in resource-limited settings.Methods and resultsWe retrospectively included 226 patients(age 45.35 ± 18.85yrs, 54.4% women) admitted to Naguru-referral hospital between January 1st and June 30th, 2024. Baseline demographics and clinical variables, including eGFR, were recorded at admission. Patients were followed from date of admission to discharge and primary outcome was IHM.Multivariable Hazard regression analysis assessed the association between eGFR and IHM, respectively. During follow-up, 45(19.9%) of patients died. Per-standard deviation(SD) increase in eGFR(48.60 mL/min/1.73m2) was associated with Hazard Ratio(HR) of 0.46[95%CI: 0.282–0.759, p = 0.002, β = -0.77] for IHM in fully adjusted models. When stratified by eGFR quartiles, using highest quartile(≥ 120 mL/min/1.73m2) as reference, HR was 1.08[95%CI: 0.276–4.226, p = 0.912, β = + 0.08] for 99.0–120 mL/min/1.73m2; 4.08[95%CI: 1.284–12.954, p = 0.017, β = + 1.41] for 66.8–99.0 mL/min/1.73m2, and 4.08[95%CI: 1.284–12.954, p = 0.037, β = + 1.25] for < 66.8 mL/min/1.73m2. Among age stratification-subgroups: age < 40yrs: 0.93[95%CI: 0.89–0.97, p < 0.001, β = -0.07]; 40-60yrs: 0.98[95%CI: 0.966–0.999, p = 0.039, β = -0.02]; ≥ 60yrs, p < 0.005 with p-value-interaction for age = 0.046; and HIV-positive: 0.94[95%CI: 0.905–0.974, p < 0.001, β = -0.06] with p-value-interaction = 0.021. Significant Pearsons-correlation(r) was observed only in: [< 40yrs, HIV(-)] with p = 0.016, r = -0.275; [40-60yrs, HIV( +)] with p = 0.020, r = -0.397; and [≥ 60yrs,HIV( +)] with p = 0.003, r = -0.997.ConclusionsWe report that eGFR was associated with in-hospital mortality, with a stronger association observed in HIV-negative patients(< 40yrs) and HIV-positive patients (aged ≥ 60yrs yrs). Further research is warranted to validate these findings.

Prevalence and correlates of child labour in five low-income countries: a descriptive study based on UNICEF Multiple Indicator Cluster Surveys 6 (MICS6)

BackgroundThe Convention on the Rights of the Child states that children need to be protected from ‘any work that is likely to be hazardous or to interfere with the child’s...

Scales of accountability: Solar mini-grids and clean energy for all in Uganda

There is great hope pinned on solar mini-grids to fulfil universal rural electrification targets and enable clean energy access, especially in low-income African countries such as Uganda. Yet Ugandan realities are complex, with many unelectrified households in villages the electric grid serves, and varied experiences with the few solar mini-grids implemented in recent years, indicating limited downward accountability. Crucially, large solar plants have arrived, making it timely to resolve the dilemma of just clean energy provision both in and from rural areas. Yet little research on energy transitions in this context exists to explain its political economic complexity. We draw on field visits to three solar mini-grids with contrasting performances, to Uganda's largest 20 MW solar plant, through dozens of villages, and on meetings with the regional utility and the Ministry of Energy and Mineral Development. This is supplemented by knowledge of Uganda's energy policy through document analysis and lived experience. We adapt accountability analysis to deploy a novel ‘scales of accountability’ framework at multiple spatial scales of solar deployment. Our analysis offers insights on the challenges Uganda must address to achieve the potential associated with solar mini-grids and multi-scalar solar energy transitions to achieve universal clean energy access.

Sustainability of lending diversification of sub-Saharan African low-income countries

The momentum in sub-Saharan low-income countries is leading to diversifying their funding sources to cover large infrastructure expenditures. This situation meets the expectations of international investors who are still willing to explore new opportunities. Recent access to the Eurobond market by these new players has resulted in the growing substitution of traditional concessional loans by market ones in countries with low-debt portfolios. Thus, a new sustainability approach is required to include risk premiums and potentially versatile investor behaviors. First, we use a theoretical model to show that in a context of low international interest rates, debtor countries can continue to stabilize their level of debt either through budget deficit, if it remains below a given sustainability threshold, or through budget surplus in a downturn context (high-interest rates and spreads). Second, the versatile behavior of investors could be challenging. Third, global liquidity greatly influences the debt dynamics of SSA countries so it matters more for bond spreads than domestic factors. As our empirical study shows that the current debt situation of sub-Saharan African low-income countries increasingly involved in the Eurobond market remains under control. To avoid the worst-case scenario, strong institutions should be a priority, along with appropriate management tools and methods of debt monitoring to cope with all potential vulnerability caused by undesirable side effects of such unstable behaviors.

Underweight and associated factors among children under age of five in low and lower-middle income African countries: hierarchical analysis of demographic and health survey data.

Globally, nearly half of all deaths among children under the age of five are linked to undernutrition. These tragic outcomes are most prevalent in low- and middle-income countries. The far-reaching impact of malnutrition affects not only individuals but also their families, communities, and entire nations. By examining underweight, we gain valuable insights into the intricate network of factors influencing child health. Therefore, this study aims to assess underweight prevalence and its associated factors among under-five children in low and lower-middle-income African countries. We conducted a secondary analysis of standard demographic and health surveys in 30 low and lower-middle-income African countries spanning from 2012 to 2022. Our analysis included a total sample of 200,655 children under the age of 5 years. We employed a three-level hierarchical model to assess the determinants of underweight among children in this age group. Measures of association were evaluated using adjusted odds ratios with a 95% confidence interval. Explanatory variables with a p-value less than the level of significance (0.05) were considered statistically significant. The pooled prevalence of underweight among children under the age of five in low and lower-middle income African countries was estimated at 17.60%, with a 95% confidence interval (CI) ranging from 17.44 to 17.77%. The hierarchical analysis identified several factors significantly associated with underweight, including male gender, birth size, maternal body mass index, maternal educational level, household wealth index, antenatal care (ANC) visits, community poverty level, and income level of countries. The high prevalence of underweight among children under the age of five in low and lower-middle income African countries underscores the need for targeted interventions. By addressing individual, community, and country-level factors, we can work toward improving child nutrition and well-being.

Prevalence of group B Streptococcus colonisation in mother–newborn dyads in low-income and middle-income south Asian and African countries: a prospective, observational study

Rectovaginal group B Streptococcus (GBS) colonisation in pregnant individuals at the time of labour is a major risk factor for invasive GBS disease by age 7days (early-onset disease). We aimed to investigate the prevalence of rectovaginal GBS colonisation at the time of labour among pregnant women and vertical transmission to their newborns across selected low-income and middle-income African and south Asian countries. This prospective, observational study was undertaken at 11maternity and obstetric care facilities based in Ethiopia, Kenya, Mozambique, Nigeria, Mali, South Africa, Bangladesh, India, and Bhutan. HIV-negative pregnant women aged 18-45years who were in the early stages of labour and at least 37weeks' gestation were eligible for inclusion. Lower vaginal and rectal swabs and urine were collected from the women, and swabs of the umbilicus, outer ear, axillary fold, rectum, and throat were obtained from their newborns, for GBS culture. Standardised sampling and culture using direct plating and selective media broth for detection of GBS colonisation was undertaken at the sites. Serotyping of GBS isolates was done in South Africa. The primary outcome was the prevalence of rectovaginal GBS among pregnant women, analysed in participants with available data. This study is registered with the South African National Clinical Trials Register, number DOH-27-0418-4989. 6922pregnant women were enrolled from Jan 10, 2016, to Dec 11, 2018, of whom 6514 (94·1%; 759-892per country) were included in the analysis; data from Bhutan were not included in the study due to issues with specimen collection and processing. Overall, the prevalence of maternal GBS colonisation was 24·1% (95% CI 23·1-25·2; 1572of 6514); it was highest in Mali (41·1% [37·7-44·6]; 314of 764) and lowest in Ethiopia (11·6% [9·5-14·1]; 88of 759). Theoverall rate of vertical transmission of GBS from women with rectovaginal GBS colonisation was 72·3% (70·0-74·4; 1132of 1566); it was highest in Mozambique (79·2% [73·3-84·2]; 168of 212) and lowest in Bangladesh (55·8%, 47·5-63·8; 77of 138). The five most common GBS colonising serotypes were Ia (37·3% [34·9-39·7]; 586of 1572), V(28·5% [26·3-30·8]; 448of 1572), III (25·1% [23·0-27·3]; 394of 1572), II (9·2% [7·8-10·7]; 144of 1572), and Ib(6·5% [5·4-7·8]; 102of 1572). There was geographical variability in serotype proportion distribution; serotype VIIwas the third most common serotype in India (8·6% [5·3-13·7]; 15of 174) and serotype VI was mainly identified in Bangladesh (5·8% [3·0-11·0]; eight of 138) and India (5·7% [3·2-10·3]; ten of 174). Our study reported a high prevalence of GBS colonisation in most settings, with some geographical variability even within African countries. Our findings suggest that serotypes not included in current multivalent capsular-polysaccharide GBS vaccines prevail in some regions, so vaccine efficacy and post-licensure effectiveness studies should assess the effect of vaccination on maternal GBS colonisation given the potential for replacement by non-vaccine serotypes. Bill & Melinda Gates Foundation.

Fiscal multipliers in Low-income Sub-Saharan African countries

This study estimates country-specific government consumption multipliers for 20 Low-Income Countries in Sub-Saharan Africa. Using a Bayesian random effect PVAR model, we find heterogeneous fiscal multipliers. Our results challenge the prevailing idea of limited fiscal stimulus effectiveness in these economies.

Health promoting palliative care interventions in African low-income countries: a scoping review

BackgroundPalliative care (PC) has advanced rapidly since 2005, when the World Health Assembly posited it as an urgent humanitarian need. Over the same period, the principles of the Ottawa Charter...

Six in ten female youths in low-income East African countries had problems in accessing health care: a multilevel analysis of recent demographic and health surveys from 2016–2021

BackgroundAccess to health care services is a basic human right, and an individual’s health and overall quality of life may suffer as a result of barriers to accessing health services. Access to comprehensive and quality health care is fundamental for promoting and maintaining health, preventing and treating diseases, and reducing premature deaths. However, only half of the African population has access to modern health services. Therefore, this study aimed to assess the health care access and associated factors among female youths in low-income East African countries.MethodsThis study used secondary data from 2016 to 2021 demographic and health surveys of 7 low-income East African countries. A total weighted sample of 51,064 youths was included. A multilevel binary logistic regression was employed to identify the associated factors of access to health care since the data has a hierarchical structure. Adjusted Odds Ratio (AOR) with a 95% confidence interval (CI) at a p-value less than 0.05 was used to measure the association of variables whereas Intra-class correlation coefficient (ICC), Median Odds Ratio (MOR), and proportional change in variance (PCV) were used to measure random effects.ResultThe overall magnitude of access to healthcare among female youths in low-income East African countries was 38.84% (95% CI: 38.41, 39.26). Youth’s educational level, rich wealth status, media exposure, and community level education were the positive while higher youth’s age and rural residence were the negative predictors of access to healthcare among female youths. Besides, living in different countries compared to Burundi was also an associated factor for accessing healthcare in low-income East African countries.ConclusionAbout six in ten female youths were not accessing health care in low-income East African countries. Therefore, to increase healthcare access, health managers and policymakers needed to develop strategies to improve the poor household wealth index, and redistribution of health services for rural residents. The decision-makers and program planners should also work on increasing access to education and media exposure for youths. Further research including health system and quality of service-related factors for accessing healthcare should also be considered by researchers.

Prevalence of childhood stunting and determinants in low and lower-middle income African countries: Evidence from standard demographic and health survey.

Undernutrition poses a significant global public health challenge, adversely affecting childhood cognitive and physical development while increasing the risk of disease and mortality. Stunting, characterized by impaired growth and development in children due to insufficient psychological stimulation, frequent infections, and inadequate nutrition, remains a critical issue. Although economic growth alone cannot fully address the prevalence of stunting, there exists a robust correlation between a country's income level and childhood stunting rates. Countries with higher incomes tend to have lower rates of childhood stunting. Notably, while childhood stunting is declining worldwide, it remains persistent in Africa. Consequently, this study aims to assess the prevalence of childhood stunting and its determinants in low- and lower-middle-income African countries. This study conducted a secondary analysis of standard demographic and health surveys in low- and lower-middle-income African countries spanning the period from 2010 to 2022. The analysis included a total sample of 204,214 weighted children under the age of five years. To identify the determinants of stunting, we employed a multilevel mixed-effect model, considering the three levels of variables. The measures of association (fixed effect) were determined using the adjusted odds ratio at a 95% confidence interval. Significance was declared when the association between the outcome variable and the explanatory variable had a p-value less than 0.05. In low and lower-middle-income African countries, 31.28% of children under five years old experience stunting, with a 95% confidence interval ranging from 31.08% to 31.48%. The results from a multilevel mixed-effect analysis revealed that 24 months or more of age of child, male gender, low and high birth weight, low and high maternal BMI, no and low maternal education, low household wealth index, multiple (twin or triplet) births, rural residence, and low income of countries were significantly associated with childhood stunting. Stunting among children under five years of age in low- and lower-middle-income African countries was relatively high. Individual, community, and country-level factors were statistically associated with childhood stunting. Equally importantly, with child, maternal, and community factors of stunting, the income of countries needs to be considered in providing nutritional interventions to mitigate childhood stunting in Africa.

Analyzing Macroeconomic Indicators that May Affect Economic Growth in Sub-Saharan African Countries: A Panel Data Analysis in the Context of Income Level Classification (1990-2019)

The purpose of the study was to ascertain whether the export-import coverage ratio (EXIM), the income of natural resources (NATR), labour force participation rate (LFPR), and foreign direct investment (FDI) had a positive or negative impact on economic growth for 34 Sub-Saharan African countries using data from 1990 to 2019. The change in Gross Domestic Product Per Capita (%) is used in the study as a proxy for the economic growth variable, and Sub-Saharan African nations were categorized based on the United Nations' income classification system to create more homogeneous groups and consequently more accurate analysis results. To do this, 34 Sub-Saharan African nations were divided into three income categories: lower-middle-income, upper-middle-income, and low-income. The income categories established by the UN were considered while drawing this distinction. This divide led to the analysis of 18 low-income nations, 12 lower-middle-income countries, and 4 upper-middle-income countries. One of the dynamic panel data analysis techniques, the two-step system GMM panel data analysis, was used as the econometric analysis approach. According to the estimations, FDI in lower-middle-income sub-Saharan African countries was statistically significant and inversely related to economic growth; it was observed that the coverage ratio of exports to imports has a statistically significant and linear relationship. None of these independent variables were found to influence economic growth in low-income sub-Saharan African countries. There is a statistically significant correlation between the LFPR and NATR and economic development in the upper-middle income category of nations analyzed. As a result, the influence of factors varied and fluctuated on economic growth based on the income levels of different groups.

Four Years Since COVID-19 Day Zero: A Time to Evaluate Past and Future Pandemic Control Policies and Practices in Sub-Saharan Africa?

Four years after the first case of COVID-19, the world is still determining how best to prevent and control the long-term effects of SARS-CoV-2 infection. Non-pharmaceutical interventions (NPIs) were employed at the start of the pandemic as the only available options, prior to effective vaccines and antiviral agents. The World Health Organization recommended dual vaccination for 70% worldwide as the threshold for a return to "normal" community life. Immunization rates needed to increase in all global regions, irrespective of socioeconomic status, necessitating more equitable access. During the pandemic, wealthier countries hoarded vaccine supplies even when their citizens were immunized. This highlights the already enormous difficulties in healthcare provision faced by low-income sub-Saharan African countries, which remain at risk as industrialized nations have progressed to a post-pandemic era. Thus, in addition to redoubling vaccination efforts public health policymakers should consider ongoing and future use of NPIs. In this narrative account, we advocate that various NPI practices should not be shelved; rather, more research is needed to evaluate their impact in parallel with booster vaccination. This especially applies to so-called "long COVID". Lessons learned from implementing best practices in resource-limited settings should be incorporated into preparedness guidelines for future infectious disease outbreaks.

Respiratory adenovirus infections in children: a focus on Africa.

Lower respiratory tract infections (LRTIs) are an important cause of child morbidity and mortality globally, especially in children under the age of 5 years in Africa. Respiratory viruses, including human adenoviruses (HAdVs), are common causes of LRTIs in children. This review aims to shed light on the epidemiology, clinical manifestations, sequelae, and treatment options specific to adenovirus respiratory infections in African children. Recent evidence has challenged the perception that adenovirus is a negligible cause of LRTIs. Studies show HAdV emerging as the third most common viral pathogen in fatal pneumonias among under-5 children in low-income and middle-income African countries, contributing to 5.5% of all pneumonia deaths and ranking second in hospital-associated viral pneumonia deaths. Predominant HAdV serotypes associated with disease differ by country and region, and have changed over time. Risk factors for increased disease severity and long-term respiratory sequelae in previously healthy African children with HAdV LRTIs are not well established. Although respiratory viruses, including HAdV, are recognized contributors to LRTIs, the prevalence and impact of adenovirus infections have been under-recognized and understated. Available data suggests that African children, particularly those under 5 years old, are at risk of severe sequelae from respiratory HAdV infections. Long-term sequelae, including bronchiectasis and postinfectious bronchiolitis obliterans, further underscore the significant impact of HAdV infections. However, the scarcity of comprehensive data hampers our understanding of the extent of the impact of HAdV infections on child lung health in Africa. We recommend scaled-up HAdV surveillance, ensuring its consistent inclusion in population-level LRTI assessments, and expanded and equitable access to diagnostics for early recognition of African children at risk of developing chronic sequelae and death. Enhanced understanding of adenovirus epidemiology and clinical outcomes and the availability of therapeutic options are essential for informed public health strategies and clinical care.

Exploring the potential role of decentralised biogas plants in meeting energy needs in sub-Saharan African countries: a techno-economic systems analysis

To achieve the Sustainable Development Goals by 2030, low-income sub-Saharan African countries urgently need to electrify. Biogas production from anaerobic digestion could make a contribution to a solution to improved electricity generation and access in these regions. This study evaluates its feasibility using Malawi as a case study. The aim is to provide households with a continuous supply of gas for cooking and electricity. The study examines different sizes of fixed dome reactors (3, 6, 12 m3) and assumes individual household ownership of 2, 4, and 6 cows. Several feedstocks and conditions are considered, such as cow dung alone, co-generation of cow dung with human faeces, cow dung with grass, and cow dung with maize residue. The economic benefits of selling biogas and fertilisers are calculated, and the cost of construction for different sizes of reactors is determined. Results show that co-generation of cow dung and grass silage in the reactor of 12 m3 with six cows has a positive net present value (NPV) of $8962, while for a small farm with a 6 m3 reactor capacity, co-digestion of cow dung with maize residue is preferable. The feasibility of the technology depends heavily on current national economic conditions, such as inflation, electricity prices, and construction material costs. A sensitivity analysis estimated that a 25% increase in the cost of electricity could increase the net present value (NPV) from − $3345 to $1526 for the generation of biogas from cow dung alone. Overall, this technology could have a significant impact on the lives of low-income households in sub-Saharan Africa by improving their access to electricity and providing a source of income through the sale of biogas and digestate.

The impact of China’s financing to Africa on bilateral trade intensity under the Belt and Road Initiative

ABSTRACT Based on panel data from 2000 to 2021 covering African 52 countries under the Belt and Road Initiative (BRI), and utilizing a system generalized method of moments with instrumental variables, the study finds that China’s financing has played a positive role in both export and import intensities of African countries with China. However, the impacts of different financing types on trade intensities vary by different country groups and periods. First, Chinese outward foreign direct investment (OFDI) has a much bigger impact on both export intensity and import intensity, and aid has a much bigger impact on export intensity in resource-rich African countries than other countries. Second, Chinese OFDI has a much bigger impact on export intensity and aid has a much bigger impact on both export and import intensities in low-income African countries than other countries. Third, the regression results from different periods indicate that Chinese financing has enhanced the bidirectional trade relations between China and Africa since BRI launch. The study is conducive to the exploration of multinational corporations and foreign aid’s role in trade relations and will help African countries use Chinese capital to promote bilateral cooperation and get rid of poverty.

Income Diversification, Bank Volatility Risk and Performance in Low- and Middle-income African Countries: Evidence from Normal and Crisis Periods

Using panel data from 2000 to 2019 for low-income and middle-income African countries, this study examined what determines income diversification and its impact on bank risk and performance. Based on the system’s generalized method of moments and least square dummy variable results, high volatility risk, profitability, cost efficiency and high GDP encourage banks to diversify their income. While having lower leverage, a high net interest margin, and during inflationary times, banks are less encouraged to pursue income diversification. Moreover, income-diverse approaches improve profitability in regular and crisis periods for low-income and middle-income countries. However, income diversification does not lower volatility risks during crisis times. The study shows that increasing the cost efficiencies, higher liquidity and leverage ratios positively affects profitability and reduces volatility risk during the non-crisis period. The net interest margin positively influences risk during and after a crisis. The results show that GDP positively connects to a bank’s profitability. The link between profitability and inflation varies based on the analysis’s emphasis (i.e., before, during or after the crisis) and income level (i.e., low income or middle income). This study’s results have significant implications for bankers, regulators and the banking literature on the determinant, merits and risks of income diversification.

Determinants of knowledge of the highest conception probability period among reproductive age women in Low-Income African countries: A multilevel analysis based on the recent Demographic and Health Survey.

Adequate knowledge about the highest conception probability period in the reproductive cycle allows individuals and couples to attain or avoid their fertility probabilities. Poor knowledge of conception probability period leads to undesirable outcomes like unwanted pregnancy, miscarriage, and abortion. Determinants of knowledge of highest conception probability period were not well studied on economically disadvantaged countries. Therefore, our study aimed to identify individual and community level factors of knowledge of the highest conception probability period among women of reproductive age in low income African countries. The appended and latest Demographic and Health Survey datasets of 15 low-income African countries was used for analysis. Model fitness was done using the Intraclass correlation coefficient, median odds ratio, and deviance. A model with the lowest deviance (model-III) was selected as the best model. Multilevel logistic regression model was used to identify determinant factors of knowledge of the highest conception probability period. In the final model, adjusted odds ratio with 95% confidence interval was reported and variables with p<0.05 were considered as statistically significant with knowledge of the highest conception probability period. Total weighted sample of 235,574 reproductive aged women with a median age of 27 years were included. The correct knowledge of the highest conception probability period among the study participants was 24.04% (95%CI = 23.87-24.22%). Maternal age groups ((20-24 (AOR = 1.49; 95%CI = 1.44-1.55), 25-29 (AOR = 1.62; 1.56-1.68), 35-39 (AOR = 1.76; 1.68-1.84), 40-44 (AOR = 1.75; 1.67-1.83), and 45-49 (AOR = 1.83; 1.74-1.93)), marital status((currently in union (AOR = 1.75; 1.16; 1.13-1.20), formerly in union (AOR = 1.75; 1.11; 1.06-1.16)), better educational status ((secondary (AOR = 2.08; 2.01-2.14) and higher(AOR = 3.36; 3.18-3.55)), higher wealth index ((middle (AOR = 1.08; 1.04-1.12), richer (AOR = 1.24; 1.20-1.28), and richest (AOR = 1.51; 1.45-1.57)), knowledge of contraceptive methods (AOR = 2.63; 2.49-2.77), current contraceptive use (AOR = 1.14; 1.11-1.16), and urban residency (AOR = 1.26; 1.21-1.29) were statistically significant with knowledge of the highest conception probability period. In this study, knowledge of the highest conception probability period among women of reproductive age in low-income African countries was low. Therefore, improving the fertility awareness through comprehensive reproductive education or counseling could be one of the operational ways to control unintended pregnancy.

Service users' perceptions of recovery from recent-onset psychosis and their long journey to and through psychiatric treatment.

A growing body of evidence highlights that individuals' understanding of mental illness and recovery influences their mental health care preferences. Journeys to psychiatric care settings vary across regions with different socio-economic and developmental characteristics. However, these journeys in low-income African countries have not been well explored. This descriptive qualitative study aimed to describe service users' journeys to and through psychiatric treatment and explore their conceptualizations of recovery from recent-onset psychosis. Nineteen adults with recent-onset psychosis were recruited from three hospitals in Ethiopia for an individual semi-structured interview. Data from in-depth face-to-face interviews were transcribed and thematically analysed. Participants' conceptualizations of recovery are summarized into four themes; "domination over the disturbance of psychosis", "complete medical treatment course and stay normal", "stay active in life with optimal functioning", and "reconcile with the new reality and rebuild hope and life". These perceptions of recovery were reflected in their accounts of the long and hurdled journey to and through conventional psychiatric care settings. Participants' perceptions of psychotic illness, treatment, and recovery seemed to result in delayed or limited care in conventional treatment settings. Misunderstandings about only requiring a limited period/course of treatment for a full and permanent recovery should be addressed. Clinicians should work alongside traditional beliefs about psychosis to maximize engagement and promote recovery. Integrating conventional psychiatric treatment with spiritual/traditional healing services may make an important contribution to early treatment initiation and improving engagement.

Improving Energy Access in Low-Income Sub-Saharan African Countries: A Case Study of Malawi

The inaccessibility of modern energy in low-income countries (LIC), especially in the Sub-Saharan African (SSA) region, continues to be a problem in the 21st century. The lack of access to modern energy has led to an inability to implement developmental structures and initiatives. While considerable progress and successes have been realised in the last three decades with increased activities and global commitments from international governments and multinational agencies through electrification projects in the SSA region, SSA countries remain off-track in their efforts to achieve the UN Sustainable Development Goal (SDG) 7. This is mainly demonstrated in sparsely populated rural regions where the high cost of centralised power generation, poor transmission and distribution infrastructures and economic factors have been a major barrier to electricity expansion. Although the use of RES (i.e., decentralised or stand-alone systems) have been acknowledged by the International Energy Agency (IEA) to be the least expensive route to improving access, its impact has not been effectively demonstrated regionally. Decentralised RES use in SSA countries have not seen significant uptake and/or enjoyed long-term sustainability owing to a number of factors. Malawi, despite its significant hydropower resources and the favourable proximity of its inhabitants to grid infrastructures, still has one of the lowest levels of access to electricity globally, with 86% of the population having no access to electricity. The country provides a good case study to investigate factors limiting electricity access in SSA countries. This paper explores the main issues that have historically hindered the uptake and sustainable operation of decentralised RES in the country. Recommendations to facilitate a potential improvement in RES use as a pathway to improved universal energy access are then put forward.

China-Africa Relations from the Perspective of the Belt and Road Initiative: Motivations, Characteristics and Prospects

The Belt and Road Initiative is a major diplomatic strategy implemented by the Chinese government and a public good of worldwide significance. Africa has unique advantages such as abundant strategic resources and considerable market potential, and has become the focus of major countries. Strengthening China-Africa cooperation is of great significance to building a new type of international relations and building a community with a shared future for mankind. In recent years, China has become a major force in promoting Africa’s development. With its huge size and increasing strategic influence, China is playing an increasingly important role in global development with global development initiatives and the Belt and Road Initiative as its starting point. This is especially true in Africa: activities such as Chinese investment in Africa, as well as cooperation with other countries such as the United States, will enhance the capacity of low-income African countries to achieve sustainable development.