Low-income Countries In sub-Saharan Africa Research Articles

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.

Estimating the Prevalence of Cerebral Palsy in a Semi-Urban City in Benin: A Door-to-Door Community-Based Study

Introduction: Cerebral palsy (CP) is the most common cause of pediatric motor disability. While epidemiological data are widespread in high-income countries, corresponding data in low-income countries in sub-Saharan Africa are still rare. This study aimed to estimate the prevalence of CP in Northern Benin, a French-speaking low-income country in sub-Saharan Africa. Methods: This study was a community-based door-to-door study involving children younger than 18 years old, in Parakou, a semi-urban city in Benin. We used a two-stage procedure. The first one consisted on children screening to identify potential cases of CP. During the second stage, suspected children were examined by neurologists with high experience with CP. Results: In total, 2,630 children were screened with 10 confirmed cases of CP, resulting in a crude prevalence (95% confidence interval) of 3.8 (1.4, 6.15) per 1,000 children. Of the 10 confirmed cases, six were younger than 5 years old, and five were male. Eight children over ten were spastic with six bilateral spastic subtype according to the Surveillance of Cerebral Palsy in Europe classification system. Seven children had a Gross Motor Function Classification System level III–V, and six were classified level III to V of the manual ability classification system. Conclusion: CP is highly prevalent in semi-urban area in Northern Benin. Large studies on potential risk factors are needed for the development of effective preventive strategies.

Measuring palliative care integration in Malawi through service provision, access, and training indicators: the Waterloo Coalition Initiative

BackgroundFewer than 1 in 20 people on the African continent in need of palliative care receive it. Malawi is a low-income country in sub-Saharan Africa that has yet to achieve advanced palliative care integration accompanied by unrestricted access to pain and symptom relieving palliative medicines. This paper studied the impact of Malawi’s Waterloo Coalition Initiative (WCI) – a local project promoting palliative care integration through service development, staff training, and increased service access.MethodsInterdisciplinary health professionals at 13 hospitals in southern Malawi were provided robust palliative care training over a 10-month period. We used a cross-sectional evaluation to measure palliative care integration based on 11 consensus-based indicators over a one-year period.Results92% of hospitals made significant progress in all 11 indicators. Specifically, there was a 69% increase in the number of dedicated palliative care rooms/clinics, a total of 253 staff trained across all hospitals (a 220% increase in the region), substantive increases in the number of patients receiving or assessed for palliative care, and the number of hospitals that maintained access to morphine or other opioid analgesics while increasing the proportion of referrals to hospice or other palliative care programs.ConclusionPalliative care is a component of universal health coverage and Sustainable Development Goal 3. The WCI has made tremendous strides in establishing and integrating palliative care services in Malawi with notable progress across 11 project indicators, demonstrating that increased palliative care access is possible in severely resource-constrained settings through sustained models of partnership at the local level.

Plant-based nanoparticles targeting malaria management.

Malaria is one of the most devastating diseases across the globe, particularly in low-income countries in Sub-Saharan Africa. The increasing incidence of malaria morbidity is mainly due to the shortcomings of preventative measures such as the lack of vaccines and inappropriate control over the parasite vector. Additionally, high mortality rates arise from therapeutic failures due to poor patient adherence and drug resistance development. Although the causative pathogen (Plasmodium spp.) is an intracellular parasite, the recommended antimalarial drugs show large volumes of distribution and low-to no-specificity towards the host cell. This leads to severe side effects that hamper patient compliance and promote the emergence of drug-resistant strains. Recent research efforts are promising to enable the discovery of new antimalarial agents; however, the lack of efficient means to achieve targeted delivery remains a concern, given the risk of further resistance development. New strategies based on green nanotechnologies are a promising avenue for malaria management due to their potential to eliminate malaria vectors (Anopheles sp.) and to encapsulate existing and emerging antimalarial agents and deliver them to different target sites. In this review we summarized studies on the use of plant-derived nanoparticles as cost-effective preventative measures against malaria parasites, starting from the vector stage. We also reviewed plant-based nanoengineering strategies to target malaria parasites, and further discussed the site-specific delivery of natural products using ligand-decorated nanoparticles that act through receptors on the host cells or malaria parasites. The exploration of traditionally established plant medicines, surface-engineered nanoparticles and the molecular targets of parasite/host cells may provide valuable insights for future discovery of antimalarial drugs and open new avenues for advancing science toward the goal of malaria eradication.

Epidemiology of multimorbidity in low-income countries of sub-Saharan Africa: Findings from four population cohorts.

We investigated prevalence and demographic characteristics of adults living with multimorbidity (≥2 long-term conditions) in three low-income countries of sub-Saharan Africa, using secondary population-level data from four cohorts; Malawi (urban & rural), The Gambia (rural) and Uganda (rural). Information on; measured hypertension, diabetes and obesity was available in all cohorts; measured hypercholesterolaemia and HIV and self-reported asthma was available in two cohorts and clinically diagnosed epilepsy in one cohort. Analyses included calculation of age standardised multimorbidity prevalence and the cross-sectional associations of multimorbidity and demographic/lifestyle factors using regression modelling. Median participant age was 29 (Inter quartile range-IQR 22-38), 34 (IQR25-48), 32 (IQR 22-53) and 37 (IQR 26-51) in urban Malawi, rural Malawi, The Gambia, and Uganda, respectively. Age standardised multimorbidity prevalence was higher in urban and rural Malawi (22.5%;95% Confidence intervals-CI 21.6-23.4%) and 11.7%; 95%CI 11.1-12.3, respectively) than in The Gambia (2.9%; 95%CI 2.5-3.4%) and Uganda (8.2%; 95%CI 7.5-9%) cohorts. In multivariate models, females were at greater risk of multimorbidity than males in Malawi (Incidence rate ratio-IRR 1.97, 95% CI 1.79-2.16 urban and IRR 2.10; 95%CI 1.86-2.37 rural) and Uganda (IRR- 1.60, 95% CI 1.32-1.95), with no evidence of difference between the sexes in The Gambia (IRR 1.16, 95% CI 0.86-1.55). There was strong evidence of greater multimorbidity risk with increasing age in all populations (p-value <0.001). Higher educational attainment was associated with increased multimorbidity risk in Malawi (IRR 1.78; 95% CI 1.60-1.98 urban and IRR 2.37; 95% CI 1.74-3.23 rural) and Uganda (IRR 2.40, 95% CI 1.76-3.26), but not in The Gambia (IRR 1.48; 95% CI 0.56-3.87). Further research is needed to study multimorbidity epidemiology in sub-Saharan Africa with an emphasis on robust population-level data collection for a wide variety of long-term conditions and ensuring proportionate representation from men and women, and urban and rural areas.

Pharmaco-Invasive Therapy is a Critical Option in Nigerian Stemi Treatment: A Review

Primary percutaneous coronary intervention (PCI) is the recommended reperfusion approach in patients with ST-segment elevation myocardial infarction (STEMI), When conducted in a timely and by skilled operators. This technique, however, has proven to have limitations in areas without PCI facilities and with long wait times between the initial medical contact and balloon because to logistical issues and a lack of skilled operators. In STEMI patients, pre-treatment with a fibrinolytic prior to PCI has the potential to give early pharmacologic reperfusion before definitive PCI. According to current evidence, assisted PCI has no advantage over main PCI. The role for pharmaco-invasive reperfusion, defined as pharmacological re-perfusion followed by rapid transfer for routine delayed coronary angiography and PCI may still be considered in centers without on-site PCI capability.&#x0D; Patients presenting with STEMI in Nigeria have a lot of challenges which include delay in decision making, cost of revascularization, religious believes, ignorance and availability of cardiac catheterization and the skillful personnel for the operation. To meet with the demand and challenges of Myocardial infarction in Nigeria, we need the mode of treatment that is beneficial, cost effective and lifesaving. Hence, pharmaco-invasive is the way for Nigeria and other low-income countries of sub-Saharan Africa.

Employers Feedback on Psychosocial Counselling Graduates' Performance in Selected Healthcare Facilities in Malawi.

Psychosocial counselling is vital for addressing mental health challenges in Malawi, a low-income country in sub-Saharan Africa. However, there is a shortage of qualified mental health professionals, including Psychosocial counsellors. The Saint John of God College of Health Sciences aims to produce competent graduates in psychosocial counselling, but there is a lack of information on the quality of graduates and their ability to meet employer expectations. This qualitative study aimed to explore employers' feedback on psychosocial counselling graduates' performance in selected healthcare facilities in Malawi. This qualitative approach employed an explorative research design. Eighteen participants were selected purposefully from ten healthcare facilities across three regions of Malawi. They were interviewed independently using a semi-structured interview guide. The data were analysed thematically using content analysis approach. The study reveals the assigned responsibilities of psychosocial counselling graduates, including providing HIV/AIDS therapeutic services, individual and group counselling, crisis intervention, and coordinating referrals. Employers recognize the graduates' competence in communication skills, empathy, theoretical knowledge, and professionalism. However, some weaknesses were identified, such as difficulties in maintaining boundaries, limited knowledge of health-related terms, and a lack of proactivity. Suggestions for improvement include teaching professionalism, incorporating health-related terms in the curriculum, following up with graduates, continuing the practicum aspect, establishing partnerships, and expanding training in evidence-based practices. The study explored employer feedback on psychosocial counselling graduates from Saint John of God College of Health Sciences in Malawi. The study to identified strengths, areas for improvement, and recommendations were made to improve the Psychosocial counselling academic programme. Implementing them can improve graduates quality and mental health outcomes in Malawi.

United Kingdom aid cuts: implications for financing health systems.

The United Kingdom (UK) used to be the second largest bilateral provider of official development assistance (ODA) for health. However, in 2021 the UK government cut its annual aid budget by 30%. We aim to understand how these cuts might affect financing for health systems in UK aid recipient countries. We conducted a retrospective analysis of domestic and external funding for 134 countries that received UK aid for the 2019-2020 budget year. We grouped countries into two cohorts: those that continued to receive aid in 2020-2021 ("budget") and those that did not ("no budget"). Data was collected from publicly available datasets and we compared UK's ODA, UK's health ODA with total ODA, general government expenditures and domestic general government health expenditure to assess the donor dependency and donor concentration of budget and no budget countries. Budget countries are more reliant on external aid to finance their governments and health systems than no budget countries, with a handful of exceptions. While the UK does not appear to be a major ODA contributor among most no budget countries, it is in many budget countries. Two no budget countries in particular may be faced with health systems financing challenges given their high ratios of UK health aid to domestic government health expenditures: the Gambia (1.24:1) and Eritrea (0.33:1). Although "safe" for this budget cycle, a number of low-income countries in Sub-Saharan Africa have very high ratios of UK health aid to domestic government health expenditures, including South Sudan (3.15:1), Sierra Leone (0.48:1), and the Democratic Republic of Congo (0.34:1). The 2021-2022 UK aid cuts could have negative impacts in a few countries highly dependent on UK health aid. Its departure could leave these countries with rather large funding gaps to fill and create a more concentrated donor climate.

Bacterial Contamination of Antiseptics, Disinfectants, and Hand Hygiene Products Used in Healthcare Settings in Low- and Middle-Income Countries—A Systematic Review

We conducted a systematic review of healthcare-associated outbreaks and cross-sectional surveys related to the contamination of antiseptics, disinfectants, and hand hygiene products in healthcare settings in low- and middle-income countries (PROSPERO CRD42021266271). Risk of bias was assessed by selected items of the ORION and MICRO checklists. From 1977 onwards, 13 outbreaks and 25 cross-sectional surveys were found: 20 from Asia and 13 from Africa. Products most associated with outbreaks were water-based chlorhexidine, chlorhexidine-quaternary ammonium compound combinations (7/13), and liquid soap products (4/13). Enterobacterales (including multidrug-resistant Enterobacter cloacae, Klebsiella pneumoniae, and Serratia marcescens) and non-fermentative Gram-negative rods were found in 5 and 7 outbreaks and in 34.1% and 42.6% of 164 isolates, respectively, from cross-sectional surveys. Risk factors included preparation (place, utensils, or tap water high and incorrect dilutions), containers (reused, recycled, or inadequate reprocessing), and practices (topping-up or too long use). Potential biases were microbiological methods (neutralizers) and incomplete description of products’ identity, selection, and denominators. External validity was compromised by low representativeness for remote rural settings and low-income countries in sub-Saharan Africa. Outstanding issues were water quality, biofilm control, field-adapted containers and reprocessing, in-country production, healthcare providers’ practices, and the role of bar soap. A list of “best practices” to mitigate product contamination was compiled.

Public health expenditure and under-five mortality in low-income Sub-Saharan African countries

IntroductionIn the year 2019 whiles the total world under-five mortalities was estimated at about 5.2 million, Sub-Saharan Africa contributed about 55% of these global under-five mortalities. In other words, the region alone recorded about 2.8 million under-five deaths out of the global 5.2 million under-five mortalities in 2019. On the other hand, public health expenditure in Sub-Saharan Africa though very low as compared to other regions has also seen a steady increase over the years. This has resulted in an increased interest of researchers and policymakers in scrutinizing the effect of healthcare spending on health status in Sub-Saharan Africa. Thus, the purpose of this study is to investigate the association between public healthcare spending and the under-five mortality rate in low-income countries of Sub-Saharan Africa. This has become necessary due to the impact of healthcare spending on the quality and quantity of the health system and the long-run effect on health outcomes and its overall link to economic growth and development. MethodsA balanced panel of data from twenty low-income countries in Sub-Saharan Africa was sourced from the World Development Indicators dataset spanning the year 2000–2019. The under-5 mortality rate was used as the outcome variable whereas domestic health expenditure was used as the independent variable of interest. Total fertility rate, percentage population of females, the practice of open defecation, and immunization against diphtheria-pertussis-tetanus (DPT) were considered potential confounding variables. The static model was applied. To arrive at the appropriate model for the study, the robust Hausman test was employed to aid in the selection between the random effect estimator and the fixed effect estimator, and the results led to the selection of the fixed effect estimator. ResultsThe results showed that domestic health spending has a significantly negative relationship (Fixed Effects = −5.275; p < 0.05) with the under-five mortality rate in low-income countries of Sub-Saharan Africa. For every additional percentage increase in domestic health spending, it is likely to result in about 5.3 units fall in under-five mortality rate. Total fertility rate, female population, and rural people practicing open defecation were positively associated while immunization against DPTwas negatively associated (p < 0.01) with an under-5 mortality rate. ConclusionThe study revealed a strong relationship between domestic health spending and the under-five mortality rate. We conclude that a sustained increase in health expenditure and improvement in social conditions are required to reduce under-5 mortalities within low-income countries of Sub-Saharan Africa.

Effectiveness of the Asset Price Channel as a Monetary Policy Transmission Mechanism in Malawi: Evidence from Time Series Data

This paper first, investigates the responsiveness of stock prices to changes in interest rates in Malawi, a low-income country in sub-Saharan Africa. Secondly, determines whether Gross Domestic Product of such economies respond significantly to changes in stock prices. Time series data from January 2001 to December 2019 are utilised. Unit root tests indicate that each variable is integrated of order one and the Johansen test for cointegration reveal that the variables are cointegrated, with one cointegrating equation. Therefore, a vector error correction model has been adopted to investigate the short and long-run dynamic relationship among the variables. Results of Granger causality tests and impulse response analysis indicate that stock prices do respond to changes in interest rates. Moreover, Gross Domestic Product also responds to changes in stock prices. Thus, contrary to previous studies, this paper finds that an asset price channel operating through stock prices exists in Malawi. More specifically, this study finds that variations in interest rates cause significant changes in stock prices which in turn cause changes in Gross Domestic Product. Among others, the study recommends that the monetary authorities should raise public awareness on investment opportunities available in stock markets.

Evaluating the impacts of foreign aid on low-income countries in Sub-Saharan Africa

Foreign aid comprises of a provision of financial resources or commodities such as food parcels or technical advice and training. The most prevalent type of foreign aid, particularly in developing countries, is Official Development Assistance (ODA) that strives to promote development and combat poverty. In Sub-Saharan Africa, there is a significant dependency on foreign aid which prompts the question; Is foreign aid completely necessary in developing African countries? With a high reliance on foreign aid the focus tends to shift from developing into self-sufficient economies and combating poverty to being dependent states. The paper explores the impact of foreign aid on the development in Sub-Saharan Africa. Because low-income countries are significantly reliant on aid, the study took a qualitative approach using the case study method featuring case studies from Kenya, Togo, and Zimbabwe. From the literature of the study, it is evident that the three countries had become dependent on foreign Aid. Conclusions drawn from the study show that foreign has become a recipe for dependency syndrome. Based on the findings from the literature, there is a need for private investments.

Injury characteristics and their association with clinical complications among emergency care patients in Tanzania.

Over 5 million people annually die from injuries and millions more sustain non-fatal injuries requiring medical care. Ninety percent of injury deaths occur in low- and middle-income countries (LMICs). This study describes the characteristics, predictors and outcomes of adult acute injury patients presenting to a tertiary referral hospital in a low-income country in sub-Saharan Africa. This secondary analysis uses an adult acute injury registry from Kilimanjaro Christian Medical Centre (KCMC) in Moshi, Tanzania. We describe this patient sample in terms of socio-demographics, clinical indicators, injury patterns, treatments, and outcomes at hospital discharge. Outcomes include mortality, length of hospital stay, and functional independence. Associations between patient characteristics and patient outcomes are quantified using Cox proportional hazards models, negative binomial regression, and multivariable logistic regression. Of all injury patients (n=1365), 39.0% were aged 30 to 49 years and 81.5% were men. Most patients had at least a primary school education (89.6%) and were employed (89.3%). A majority of injuries were road traffic (63.2%), fall (16.8%), or assault (14.0%) related. Self-reported comorbidities included hypertension (5.8%), HIV (3.1%), and diabetes (2.3%). Performed surgeries were classified as orthopedic (32.3%), general (4.1%), neurological (3.7%), or other (59.8%). Most patients reached the hospital at least four hours after injury occurred (53.9%). Mortality was 5.3%, median length of hospital stay was 6.1 days (IQR: 3.1, 15.0), self-care dependence was 54.2%, and locomotion dependence was 41.5%. Our study sample included primarily young men suffering road traffic crashes with delayed hospital presentations and prolonged hospital stays. Being older, male, and requiring non-orthopedic surgeries or having HIV portends a worse prognosis. Prevention and treatment focused interventions to reduce the burden of injury mortality and morbidity at KCMC are needed to lower injury rates and improve injury outcomes.

Multi-Criteria Selection of Waste-to-Energy Technologies for Slum/Informal Settlements Using the PROMETHEE Technique: A Case Study of the Greater Karu Urban Area in Nigeria

Slum/informal settlements are an integral part of a city, with a population projected to reach 3 billion by 2030. It is also expected that the rate of waste generation will more than triple by 2050 in the cities of low-income countries of sub-Saharan Africa. At this rate, the risk to the environment and health of inhabitants are enormous, because the current waste management practices are not guided by legislation on proper use and disposal. This paper proposes the conversion of waste to energy as a solution to this problem. The aim of this study is to apply the PROMETHEE technique with a combination weighting method to obtain the most appropriate waste-to-energy technology for the slum/informal settlements of the Greater Karu Urban area in Nigeria. The findings reveal that the gasification technology outperformed the other technologies, and the affordability of electricity supply from this technology was determined by a general survey conducted on the slum/informal settlements.

The UK's foreign aid cuts: implications for financing health systems globally

BackgroundThe UK is a major provider of official development assistance (ODA) to low-income and middle-income countries (LMICs). The UK recently announced that 102 countries and territories would not receive an ODA budget for the 2021–22 year. Given that the UK is the second largest health ODA donor, these cuts could have serious implications for health systems in LMICs. We aimed to understand how these cuts might affect financing for health systems in countries receiving UK aid. MethodsWe analysed domestic and external funding for 134 countries that received UK ODA in 2019–20 that had data available. Our goal was to understand the differences between countries that will continue to receive aid in 2020–21 (termed budget safe, n=34) and those that will not (termed budget cut, n=100) and quantify the role the UK plays in financing health systems among both cohorts. Findings53 (53%) of 100 budget-cut countries are LMICs, and sub-Saharan Africa is the region with the largest share (27 countries [27%]). The UK makes up less than 10% of health ODA for almost all budget-cut countries (95 [95%]). The health systems of two budget-cut countries in particular might be faced with financing challenges given their high ratios of UK health aid to domestic government health expenditures: The Gambia (1·24:1) and Eritrea (0·33:1). Although most budget-safe countries are LMICs (26 [76%]), a quarter (eight [24%]) are upper-middle-income or high-income, signalling the geostrategic importance of some wealthier countries to the new UK aid agency. The UK is a large health donor among budget-safe countries: it contributes more than 10% of the health ODA budget in 11 (32%) of 34 countries. Many low-income budget-safe countries in sub-Saharan Africa also exhibit high ratios of UK health ODA to domestic government health expenditures (eg, South Sudan [3·15:1], Sierra Leone [0·48:1], and the Democratic Republic of the Congo [0·34:1]). InterpretationThe 2021–22 UK budget cuts might not be as catastrophic for as many health systems as expected, although some countries might be affected more than others. The UK is a major player in most budget-safe countries, and several countries, particularly low-income countries in sub-Saharan Africa, show high ratios of reliance on UK health aid. Our analysis focused on financing for health systems, but we did not consider the potential effect on funding cuts to health outcomes, analysed potential country responses to these cuts, or propose mechanisms for closing funding gaps. FundingNone.

STRUCTURAL TRANSFORMATION VERSUS ENVIRONMENTAL QUALITY: THE EXPERIENCE OF THE LOW-INCOME COUNTRIES IN SUB SAHARAN AFRICA

Structural transformation has been recognized as a critical mechanism for improving living standards for developing countries in Africa. However, the growing evidence indicates that such change is associated with considerable damage to the environment quality and, hence, challenging sustainable development. The present study investigates industrialization's influence on the environment quality for 20 low-income countries in Sub-Saharan Africa during 1980-2018. We employed two measurements for environmental quality, which are CO2 and nitrous dioxide emissions. Likewise, the study applied the Fully modified OLS and the Dynamic OLS as the most modern and suitable techniques related to the panel data analysis. Overall, the FMOL and DOLS results show that industrialization has an insignificant influence on environmental quality. The results also show that these countries' population size is the main driver for environmental quality changes. This finding implies that these countries should continue in their current efforts regarding promoting the industrial sector without wondering about sustainable development.Keywords: EKC; industrialization; Low-income countries; FMOL; DOLS.JEL Classifications: Q560, Q580, O140, O550DOI: https://doi.org/10.32479/ijeep.11516

Acceptance and Commitment Therapy in a Low-Income Country in Sub-Saharan Africa: A Call for Further Research

A worsening trend of critical shortages in senior health care workers across low- and middle-income countries (LMICs) in sub-Saharan Africa has been documented for decades. This is especially the case in Ethiopia that has severe shortage of mental health professionals. Consistent with the WHO recommended approach of task sharing for mental health care in LMICs, Acceptance and Commitment Therapy (ACT), which is an empirically validated psychological intervention aimed at increasing psychological flexibility, may be delivered by trained laypersons who have a grassroots presence. In this paper, we discuss the need for and potential role of ACT to be delivered by health extension workers (HEWs) to address mental health care needs across Ethiopia. To this end, we also reviewed previous studies that have examined the effectiveness of ACT-based interventions in African countries including in Nigeria, Sierra Leone, Uganda, and South Africa. All studies revealed significant improvements of various mental health-related outcome measures such as decreased psychological distress and depressive symptoms, or increased subjective wellbeing and life satisfaction in the groups that received an ACT-based intervention. However, to date, there is no study that applied ACT in Ethiopia. Thus, more research is warranted to examine the effectiveness and, if proven successful, to scale up a task sharing approach of an ACT-based intervention being delivered by trained HEWs at a grassroots level, possibly paving the way for an innovative, sustainable mental health service in Ethiopia as well as other African LMICs.

Stepped care for depression at integrated chronic care centers (IC3) in Malawi: study protocol for a stepped-wedge cluster randomized controlled trial

BackgroundMalawi is a low-income country in sub-Saharan Africa that has limited resources to address a significant burden of disease—including HIV/AIDS. Additionally, depression is a leading cause of disability in the country but largely remains undiagnosed and untreated. The lack of cost-effective, scalable solutions is a fundamental barrier to expanding depression treatment. Against this backdrop, one major success has been the scale-up of a network of more than 700 HIV clinics, with over half a million patients enrolled in antiretroviral therapy (ART). As a chronic care system with dedicated human resources and infrastructure, this presents a strategic platform for integrating depression care and responds to a robust evidence base outlining the bi-directionality of depression and HIV outcomes.MethodsWe will evaluate a stepped model of depression care that combines group-based Problem Management Plus (group PM+) with antidepressant therapy (ADT) for 420 adults with moderate/severe depression in Neno District, Malawi, as measured by the Patient Health Questionnaire-9 (PHQ-9) and Mini-International Neuropsychiatric Interview (MINI). Roll-out will follow a stepped-wedge cluster randomized design in which 14 health facilities are randomized to implement the model in five steps over a 15-month period. Primary outcomes (depression symptoms, functional impairment, and overall health) and secondary outcomes (e.g., HIV: viral load, ART adherence; diabetes: A1C levels, treatment adherence; hypertension: systolic blood pressure, treatment adherence) will be measured every 3 months through 12-month follow-up. We will also evaluate the model’s cost-effectiveness, quantified as an incremental cost-effectiveness ratio (ICER) compared to baseline chronic care services in the absence of the intervention model.DiscussionThis study will conduct a stepped-wedge cluster randomized trial to compare the effects of an evidence-based depression care model versus usual care on depression symptom remediation as well as physical health outcomes for chronic care conditions. If determined to be cost-effective, this study will provide a model for integrating depression care into HIV clinics in additional districts of Malawi and other low-resource settings with high HIV prevalence.Trial registrationClinicalTrials.govNCT04777006. Registered on 1 March, 2021

Widening the focus of school readiness for children with disabilities in Malawi: a critical review of the literature

ABSTRACT In recent years, school readiness has become increasingly contested by early childhood researchers resulting in a lack of agreement on how it should be conceptualised and assessed, particularly in relation to children with disabilities. This article responds to some of these arguments by carrying out a critical examination of the literature surrounding early childhood education and care, assessment procedures, and cultural background in relation to school readiness. Evidence from the review revealed that there are few assessment instruments that capture the contextual aspects of children’s early learning and development, such as their cultural background, linguistic diversity or level of impairment or disability. We draw on the evidence to propose a holistic model of school readiness that can be used to help us to understand the transition of children with disabilities into primary educational settings in a low-income country in sub-Saharan Africa. We conclude that children’s assessment instruments should provide an accurate yet nuanced picture of children, within their context, alongside information that can support them into primary school. In doing this, it is vital to use contextual measures that are inclusive of children with different abilities and consider the constraints that may prevent them from going to school.

Postpartum Family Planning Use and Its Determinants among Women of the Reproductive Age Group in Low-Income Countries of Sub-Saharan Africa: A Systematic Review and Meta-Analysis.

Background Postpartum family planning is the initiation and use of family planning services within the first 12 months following childbirth. Postpartum contraceptives reduce maternal and infant mortality by preventing unplanned and unwanted pregnancies and by spacing pregnancies at least two years after the previous birth. Thus, it is usually designed as an integral part of reproductive and maternal and child health programs. Therefore, the aim of this systematic review and meta-analysis is to estimate the pooled prevalence of postpartum modern contraceptive use and identify its determinants in low-income countries of sub-Saharan Africa. Methods A systematic review and meta-analysis of published and unpublished studies were used. PubMed, HINARI, ScienceDirect, Cochrane Library, Wiley Library, ETH Library, and Google Scholar were used to search all articles. STATA 14 software was used for data analysis. Funnel plots and Egger's test were used to examine the risk of publication bias. Heterogeneity was checked by using Cochran's Q test and I2 test. A random effect model was computed to estimate the pooled prevalence. Results A total of 33 articles were included. The pooled prevalence of postpartum contraceptive use in low-income countries of sub-Saharan Africa was 37.41%, 95% CI: (31.35, 43.48%). Secondary and above level of education (AOR 2.09, 95% CI: (1.52, 2.86)), discussion with husband (AOR 3.68, 95% CI: (1.96, 6.89)), resumption of menses (AOR: 3.98, 95% CI: (2.62, 6.03)), ANC follow-up (AOR; 5.10, 95% CI: (3.57, 7.29)), knowledge of modern family planning (AOR: 5.65, 95% CI: 3.58, 8.93)), and family planning counseling during ANC (AOR =5.92, 95% CI: (2.54, 13.79)) were found to be determinants of postpartum contraceptive utilization. Conclusion In this systematic review and meta-analysis, the prevalence of postpartum modern contraceptive use was found to be low compared to the existing global recommendations. Therefore, empowering maternal education, delivering adequate counseling, and strengthening existing integrated maternal and child health services are highly recommended to increase postpartum contraceptive use. This trial is registered with CRD42020160612.