New Partnership For Africa Research Articles

‘Nothing has changed, South Africa’s sub-imperialist role has been reinforced’: Samir Amin’s durable critique of apartheid/post-apartheid political economy

ABSTRACT Samir Amin’s critiques of both apartheid-era and post-apartheid political economy contributed to his scathing view of the crucial ‘semi-peripheral’ layer of the world system, a perspective typically ignored in binary formulations of Global North and Global South. Amin’s 1977 article ‘The future of South Africa’ was among his first statements of how, using that era’s dependency theory language, ‘South African capital requires an outward policy of expansionism, so that ultimately, internal colonialism becomes coterminous with sub-imperialism’. Amin also labeled post-apartheid South Africa sub-imperialist because of the domination of ‘monopoly capital’ in the extractive-industry circuits (depleting what Marx called ‘free gifts of nature’) and the below-survival-level wages that have long shaped the economic structure. Two other coterminous factors were Pretoria’s imposition of continent-wide neoliberalism through the New Partnership for Africa’s Development and the Brazil-Russia-India-China-South Africa BRICS network – both of which proved incapable of transcending neoliberal economic policies insisted upon by contemporary imperialism. Following the BRICS 2023 Sandton summit’s elite failure to advance de-dollarisation or other ‘delinking’ strategies, Amin would nod, knowingly, when hearing the term ‘sub-imperial’ to describe the bloc – and look for inspiration instead to successes of grassroots campaigners.

Influence of Geo-Technologies Integration on the Learning of Geography among Public Secondary Schools

Technology integration has become critical globally in pursuit of transforming education. In Siaya County, a persistent dismal mean of scores in Geography subjects among public secondary schools from 2016-2022 at Kenya Certificate of Secondary Examination has been blamed on the learning approaches. The data from the seven sub-counties indicated that very little learning occurred. Further, no known study has addressed rote learning in Geography using an explanatory research design about Siaya County. The study sought the influence of integrating geo-technologies on learning in Geography among public secondary schools in Siaya County. This study focused on Geo-technology integration influencing learning among public secondary schools in Siaya County, Kenya. The objective that guided this study was to explore the influence of a geo-technology integrated classroom environment on learning Geography among public secondary schools in Siaya County, Kenya. The study sought to answer the question; during 2016-2022, how did the integration of geo-technology in the classroom environment influence the learning of Geography in public Secondary Schools in Siaya County? The study adopted interviews, questionnaires, and observational checklists to collect data. The study employed social cognitive constructivism theory to envision effective learning. The study sampled 102 respondents from 262 public secondary schools based on Krejcie and Morgan’s table. The choice of Siaya County was based on the fact that it is the only county in the larger Nyanza where technology integration was piloted by New Partnership for Africa’s Development (NEPAD) for quality learning. This study employed a mixed method and explanatory design to carry out the study. The study adopted interviews, questionnaires, and observational checklists to collect primary and secondary data.

Post-Cold War International Relations and Foreign Policies in Africa: New Issues and New Challenges

AbstractThis paper argues that international relations in Africa have changedespecially in content since the abatement of the Cold War. These changeshave been accelerated by the pressures unleashed by the internationalenvironment, including the reality of Africa’s marginalisation and the forcesof globalisation. These, along with domestic factors, including debt, internalconflicts, the impact of the ubiquitous structural adjustment programmes(SAPs), HIV/AIDS and human insecurity in general have combined tounderscore foreign aid and economic assistance as key driving forces ofthe continent’s foreign policies and diplomacy towards the North. Yet, thenew thrust of foreign policies, informed by the need for foreign aid, has notoccurred without a price. Among other things it has elevated technocrats incentral or reserve banks and finance ministries to positions of prominencevis-à-vis officials from foreign ministries and in the process introduced extra-African actors into the foreign policy making process of the continent. Thisin turn has undermined Africa’s increasingly tenuous economic sovereignty.But above all, it has led to the strengthening of ties with the North andinternational creditors in particular at the cost of intra-African relations.The New Partnership for Africa’s Development (NEPAD) and the AfricanUnion (AU) recently inaugurated, promise to open a new chapter in Africa’sinternational relations. It is argued, however, that against a background of aconfluence of factors, these new continental projects will make only a minimalimpact in terms of mitigating the consequences of the aid-driven foreignpolicies and thus altering the donor-oriented postures of African states

NEPAD and the Challenge of Africa’s Development:

Abstract:The critical necessity of development for Africa in the 21ˢᵗ century is an issue around which there is considerable consensus. There is, however, little agreement on the nature of the crisis, the required development framework, and the ‘desired state’. In the context of the debate, the New Partnership for Africa’s Development (NEPAD) has been promoted by its authors and sponsors as Africa’s development blueprint for meeting its development challenges. Much of the criticism of NEPAD has focused, procedurally, on the lack of consultation in its drafting, and, paradigmatically, on its neo- liberal content, the same set of policy instruments that have damaged Africa over the last 20 years. The latter underscores the sense of betrayal that comes through civil society resistance to NEPAD. The question though is this: Why would a group of African leaders, who seem genuine in their concerns, take responsibility for such policy framework? The paper seeks an explanation in the complex interaction between a set of developments since 1980: the neo-liberal hegemony at the level of state policymaking, internal policy atrophy, coercive power of compliance, but equally the new constituencies (class forces) that have been thrown up in the last two decades – within the state, economy, and importantly the civil society in sub-Saharan Africa. Much of the latter is premised on the ‘death of the emancipatory project’ and the dominant politics of the petty bourgeois class in Africa. It is in this sense that we understanding NEPAD as a class project, hence, its import.Introduction

Harnessing Capacity in Southern Africa to Support and Develop Human Resources for Nursing and Midwifery in Africa – Part 2: Case Studies from the DRC and Mozambique

Human resources for health has been the centre of attention for many decades as more African countries fail to meet health targets even though there is no shortage of country-specific policies and strategies to improve these resources. The WHO Africa region has a critical shortage of nurses and midwives, which will remain unresolved as long as funding and policy implementation challenges persist. In the interim, the profession itself must find innovative and collaborative ways to make inroads into the nursing shortages – specifically in areas where advanced clinical skills are needed. Harnessing capacity from within universities in southern Africa is posited as one of the ways to bolster the education of nurses and midwives. Presented in part 1, the New Partnership for Africa’s Development project aimed to increase the number and enhance the quality of postgraduate education and clinical training of nurses and midwives to improve the quality of healthcare services with particular reference to the reduction of maternal and neonatal mortality rates. In fulfilling this aim, clinical master’s programmes were developed and implemented in seven African countries. In this article, we chose illustrative case studies to describe the master’s programme design and roll-out, in line with the health profile of the Democratic Republic of the Congo and the Republic of Mozambique. We explain the programme electives, enrolments and throughput, including outputs and outcomes. From experiences gained and lessons learnt, we extrapolate implications for future cases that employ pan-African and south-to-south university partnerships.

THE AFRICAN UNION’S AGENDA 2063 FOR AFRICA’S DEVELOPMENT: POSSIBILITY OR RUSE?

When Africa emerged from the chains of colonialism, there was great hope for post-colonial African leaders to consolidate the spirit of Pan-Africanism and use Africa's vast resources to spur inclusive socioeconomic development. The Organization of African Unity also supported this vision, as did the Lagos Plan of Action and the New Partnership for Africa's Development. Great emphasis was placed on continental integration and African unity. However, post-colonialism, Africa has been engulfed by never conflict, fragmentation of governance, political instability, and unstable relations between African countries, thus defeating the need for unity and collective development. The African Union Agenda 2063 is Africa's blueprint for achieving inclusive and sustainable socioeconomic development. It seeks to ensure, amongst others, peace and economic and political stability. However, there have been questions about whether the AU can achieve this. This doubt has been driven by the plethora of socioeconomic and political problems currently consuming Africa. This paper reviews current literature to examine the practicality of AU agenda 2063. It seeks to understand whether this agenda can be a possibility or just another plan with little if no substance. The following question will guide this paper: to what extent can the AU's agenda 2063 become realizable, considering the current socioeconomic and political challenges engulfing Africa?

Harnessing Capacity in Southern Africa to Support and Develop Human Resources for Nursing and Midwifery in Africa: Part 1 Project Description

The New Partnership for Africa’s Development (NEPAD) Project on Nursing and Midwifery Education in Africa is designed to respond to critical health skill concerns and a pledge made by the Heads of State and Government of the African Union (AU) in Uganda in 2010 (AU 2010). Ten years later, the State of the World’s Nursing Report (SoWN) (WHO 2020) estimates a shortage of 5.9 million nurses, with the greatest gap (89%) found in low- and lower middle-income countries. To achieve the Sustainable Development Goals (SDGs) relating to health and well-being, World Health Organisation (WHO) member states would have to educate enough nurses to eliminate global shortages and to meet changing healthcare needs. In low- and lower middle-income countries, addressing nursing shortages requires an average increase in the number of graduates of 8.8% per year from 2018 to 2030 and an uptake of at least 70% into the workforce. The production and uptake burden facing southern Africa is a double-edged sword; a project such as this attempts to address this dual burden by adopting a novel approach to build nursing and midwifery capacity that espouses the values of collaboration, self-reliance and humanness. In this paper, we report on South-South collaboration as one of the strategies to develop nursing and midwifery education in the context and challenges of universities in southern Africa. The paper outlines the principles and values of the project; rooted in Ubuntu as a theoretical framework, it articulates the project vision, goals, objectives and implementation methodology, concluding with the profile of six NEPAD projects.

Mass media and the challenge of xenophobia in promoting the ideals of the New Partnership for Africa’s Development (NEPAD)

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After All Is Said and Done: On Fluid Solidarity and Survival

After All Is Said and Done: On Fluid Solidarity and Survival

New Partnership for Africa’s Development (NEPAD) and the Challenges of Good Governance in Africa: An Appraisal of the Nigeria’s Democratic Journey in the Fourth Republic (1999-Date)

Though, Nigeria’s attempt to democratize its political space in the wake of the virtual continent-wide embrace of democracy following the demise of the cold-war was greeted with some attendant political stalemates. The impasse of the June 12th 1993 and the elongated transition to civil-rule programs of the Nigerian military government marked some turning points in the Nigeria’s journey towards democratic governance. The eventual departure of the Nigerian military from the political stage in 1999 and the birthing of democratic government only came into after the abrupt end of the cold war and the bipolar world system which, marked the triumphant emergence of the western liberal democracy, the final withdrawal of the Nigerian military from politics in 1999 and the formation of a democratic administration took over a decade to materialize. However, Nigeria , a leading proponent member-nation of the African home-grown initiative of NEPAD is today, challenged by a myriad of contending problems, arising paradoxically from some of the agenda with which NEPAD as a multilateral platform for the African nations has been put in place to address . This paper is essentially literature-based and therefore, attempts to historicize the Nigeria’s journey and its travails of democratization, as well as, the contradictions, which have also put to interrogation, the country’s democratic credentials amidst its crises of governance. The paper noted that, for Nigeria as a leading country on the continent, there is need for the self cleansing of its domestic polity and the civic space in keeping faith to the sacred creed of sowing the seed of democracy and consolidating such on the African continent.

Fate of Africa faced with the proliferation of development models: Critical analysis of the Lagos Action Plan and the New Partnership for Africa's Development

Le développement a toujours été la question majeure depuis la fin de la deuxième guerre mondiale. C’est ainsi qu’en 1948 et 1949, les Nations-Unies vont consacrer des réunions et des résolutions au problème de sous-développement. Sur ce, les conférences de Bandoeng tenues en 1955 et 1961, réunissant les pays de tiers monde, les organismes internationaux ont affiché le souci majeur d’éviter une irréversible dégradation de la situation des pays pauvres. Ces organismes vont décider de consacrer la période de 1960 à 1970, la « décennie du développement ». Les années 1980 que l’on considère parfois comme les années de rupture, n’ont pas été une exception à cette règle. Quelles sont les différentes contraintes internes et externes qui sont à la base de non-émergence de l’Afrique ? L’objet de notre étude est de saisir la société globale, afin d’appréhender les causes des échecs, des différentes stratégies des modèles de développement proposées pour le décollage du continent d’Afrique. Nous nous sommes servis de la méthode comparative qui a été complétée par la technique documentaire. En définitive, la comparaison étalée sur les faits concrets, a permis de confirmer l’inadéquation des solutions proposées à la situation spécifique de l’Afrique. L’exclusion de la population africaine à la résolution de leurs problèmes, ainsi que le manque de fonds propres et de volonté politique à la situation des dirigeants africains, ont fait marquer à ces modèles le caractère endogène et autogéré. Le résultat est fort décevant, car les stratégies fondées sur un modèle occidental n’ont pu répondre aux besoins immédiats des africains en alimentation, éducation, santé communautaire, infrastructures socio-économiques de base et routières, etc. Mots clés : Géopolitique, partenariat, émergence, développement, États africains.

Nepad and the Struggle to Improve the Efficacy of Africa’s Public Sector: A Case Study of Nigeria’s Servicom

This paper evaluates Nigeria's Service Compact with All Nigerians (SERVICOM) policy as a derived policy of the New Partnership for Africa's Development (NEPAD) project to generalize the advancement of Africa's public sectors' functionality in the 21st century. The cardinal policy thrust of NEPAD, of which SERVICOM is consequentially from, is partly to ensure that the continent's public services are poised to deliver accelerated social, economic and political development, as well as ensure the facilitation of good governance. Anchored on Max Weber's bureaucratic theory, the paper notes the lack of political will to commit to purposeful public sector reforms, which undermine the realization of the SERVICOM-cum-NEPAD initiative for public sector effectiveness and efficiency. It also notes that Nigeria‘s public sectors in the 21st century have tended towards underperformance due in part to the abandonment of the tenets of Weber‘s bureaucratic theory in their operations. The paper concludes that greater politics-administration cooperation than dichotomy will improve adherence to the precepts of Weber‘s bureaucratic theory as well as the modernization of public servants through investments in training and re-training. It also concludes that the public should seek to resolutely pursue remedies for infractions by public servants rather than overlook ineffectual operational performances as a way to strengthen attainment of the SERVICOM objectives for accelerated capacity development of public servants.

An appeal for practical social justice in the COVID-19 global response in low-income and middle-income countries

An appeal for practical social justice in the COVID-19 global response in low-income and middle-income countries

Vitamin D Deficiency in Young African Children

Background: Vitamin D deficiency is linked to infections, rickets, and poor child development. However, data on the vitamin D status of African children are limited. We examined the prevalence and predictors of low vitamin D status in young African children. Methods: We measured 25-hydroxyvitamin D (25OHD), C-reactive protein (CRP), malaria parasitaemia, and anthropometry among 3880 children aged 0-8 years living in Kenya, Uganda, Burkina Faso, and South Africa. We evaluated associations between vitamin D status and country, age, sex, anthropometric indices, inflammation and malaria parasitaemia in regression analyses and structural equation models. Findings: The overall prevalence of vitamin D deficiency using 25OHD cut-offs of <30 nmol/L and <50 nmol/L was 0·7% (95% CI 0·5, 1·0) and 7·4% (95% CI 6·6, 8·3) respectively, while 35·4% (95% CI 33·9, 36·9) of children had levels between 50–75 nmol/L. Overall geometric mean 25OHD level was 78·1 nmol/L (95% CI 77·3, 78·9) and median age was 22·1 months (interquartile range 12·1, 25·2). Vitamin D deficiency was more prevalent in South African and in older children. 25OHD levels were lower in children with malaria parasitaemia and higher in those with inflammation, but were not associated with sex, stunting, underweight or wasting. Interpretation: Only 1% and 7% of children were vitamin D deficient as defined by 25OHD levels <30 nmol/L and <50 nmol/L, respectively. Latitude, age and prevalence of inflammation and malaria should be considered in strategies to assess and manage vitamin D deficiency in young children living in Africa. Funding Statement: This work was funded by Wellcome [grant numbers SHA 110255, TNW 202800, AJM 106289 and AME 064693, 079110, 095778], and with core awards to the KEMRI-Wellcome Trust Research Programme [203077]. AA is supported by the Intramural Research Program of the National Institutes of Health in the Center for Research on Genomics and Global Health (CRGGH). The CRGGH (1ZIAHG200362) is supported by the National Human Genome Research Institute, the National Institute of Diabetes and Digestive and Kidney Diseases, the Center for Information Technology, and the Office of the Director at the National Institutes of Health. RMM and JMM are supported through the Developing Excellence in Leadership, Training and Science (DELTAS) Africa Initiative [DEL-15-003]. The DELTAS Africa Initiative is an independent funding scheme of the African Academy of Sciences (AAS)’s Alliance for Accelerating Excellence in Science in Africa (AESA) and supported by the New Partnership for Africa’s Development Planning and Coordinating Agency (NEPAD Agency) with funding from Wellcome [107769] and the UK government. Declaration of Interests: We declare no competing interests. Ethics Approval Statement: Informed written consent was obtained from all children’s parents or guardians before inclusion in the study. Ethical approvals were granted by the Scientific Ethics Review Unit of the Kenya Medical Research Institute (KEMRI/SERU/CGMR-C/046/3257) in Kenya, the Uganda Virus Research Institute (GC/127/12/07/32) and Uganda National Council for Science and Technology (MV625) in Uganda, by Ministere de la Recherche Scientifique et de l’Innovation (reference 2014-12-151) in Burkina Faso, the University of Witwatersrand Human Research (M130714) in South Africa and in the UK by the London School of Hygiene and Tropical Medicine (A340) and the Oxford Tropical Research Ethics Committees (39-12, 41-12, 42-14, and 1042-13).

Dimensions of Governance and Child Health in Sub-Saharan Africa: A Subnational Analysis

There is broad consensus in the literature on development that effective governance is one of the keys to development. It is against this background of the relationship between good governance and socioeconomic development that the African Union (AU), following its establishment in 2000, indicated good governance in its constitutive act as part of its policy framework for member states in line with the tenets of the New Partnership for Africa’s Development (NEPAD) and the African Peer Review Mechanism (APRM). The present study examined the relationship between good governance and less child deprivation using pooled data from Afrobarometer surveys and Demographic and Health Surveys conducted in sub-Saharan countries since 2000. The study examined the relationship between such dimensions of governance as democracy, voting, effectiveness and transparency as measured by trust and corruption as well as measures of child outcomes such as availability of toilet facilities, vaccinations, nutrition and mortality. The study found that the relationship between regional governance and children’s well-being was weak and inconsistent. It indicated that although a deepening of democracy might lead to improvements in the long-term outcomes of nutrition and child survival, these improvements would be relatively small. Further, results suggested that, in terms of good governance, trust was not particularly helpful and that corruption was not as harmful as many would suggest.

Open Data Impact Narratives – Stories of Impact of Open Data in Agriculture and Nutrition

The GODAN Action project examined the current state of the art of impact evaluation in the field of open data, developed an impact evaluation framework accounting for the specifics of open data use in developing countries, and performed a mix of desktop research and empirical work on case studies to test and underpin its research. This document describes the outcomes of these case studies, examining the potential of open data through the analysis of impact narratives in three thematic topics: weather data, land data and nutrition data. Three use cases per thematic topic have been selected that best illustrated the contexts, impact mechanisms, main actors and barriers towards the achievement of impact. Each thematic topic describes their use cases following a different structure adapted to the specifics of the domain. All cases, however, show the pathways to impact within the different topics and contexts of study, and specific Theories of Change have been developed for each of them. For the weather data case studies, the focus was on the important role of information and service intermediaries as key value chain partner to achieve impact. These case studies are: NOAA Open weather data (United States), a portal that provides weather data information and forecasts including yield predictions; the CommonSense project, which provides Ethiopian farmers with weather forecasts and farm management advice (e.g. based on earth observations and geographic data), to help them make more informed decisions on farming activities; and the GEOBIS project, which provides farmers in Bangladesh with weather related information and advice on farm management (usage of seeds, sowing, irrigation, fertilizers, among others). Land data impact narratives are described according to the different data aggregator levels: local, regional and global. On the global level and working towards a more inclusive data ecosystem, it analyses the work between Land Portal (a free online platform working towards a more accessible land governance information landscape) and Land Conflict Watch (a research-based data journalism project in India). At a regional level and related to the ‘enabling’ factor of data ecosystems, the impact narrative focuses on the Open Development Mekong, an open knowledge platform that advocates for transparency and promotes debate over basic data. Data mapping is described at a grassroots level through the example of NRMC, an advisory firm in India that attempts to bridge information gaps, create evidence-based advocacy and build platforms for connection among land stakeholders. Open nutrition data impact pathways have been assessed by examining the work of an open data intermediary, the Global Nutrition Report (GNR) and its relevance for national and regional policy actors. The GNR is a flagship publication which weaves together (open) data from a variety of sources to create a snapshot of the state of nutrition worldwide and capture progress towards the SDGs. The examination of GNR’s work highlights some additional opportunities and challenges of placing open data at the heart of sense-making and action. The cases of two national/regional initiatives, the Tanzanian Food and Nutrition Centre (TFNC) and the New Partnership for Africa’s Development (NEPAD) illustrate how such initiatives use data of global aggregators in the work they undertake.

Problem formulation for gene drive mosquitoes designed to reduce malaria transmission in Africa: results from four regional consultations 2016\u20132018

BackgroundGene drive mosquitoes have been proposed as a possible means to reduce the transmission of malaria in Africa. Because this technology has no prior use-history at this time, environmental risk assessments for gene drive mosquitoes will benefit from problem formulation—an organized and ordered process to identify protection goals and potential pathways to harm to the environment, or animal or human health. Recognizing this need, the New Partnership for Africa’s Development (NEPAD), with support from African and international partners, organized four regional consultative workshops in Africa to initiate this process.MethodsThe workshops were attended by a diverse set of participants and stakeholders, including scientists, ethicists, health professionals, government regulators in the fields of environment health and biosafety as well government policymakers, who met for 4 days to deliberate on protection goals and pathways relevant to the use of gene drive mosquitoes for malaria control. The goal of the workshops was not to produce a comprehensive and detailed environmental risk assessment of gene drive mosquitoes, but rather to introduce problem formulation as a tool to the stakeholder community, and to serve as a starting point for conducting systematic environmental risk assessments in the future, identifying protection goals related to gene drive mosquitoes that are particular to African stakeholders.ResultsParticipants in the workshops frequently identified human health and biodiversity as being relevant broad protection goals. Results of the deliberations provide insight into the concerns of African participants at an early stage in the development of gene drive organism/products that should be instructive to developers using this technology.ConclusionsIn general, the African participants of the consultations had a precautionary perspective with regard to environmental risk assessment of gene drive technology. As gene drive technology develops, protection goals will become further refined and candidate products will be further defined. These workshops represent only the beginning of a continuing process that will ultimately inform environmental risk assessment for gene drive mosquitoes to control malaria in Africa.

Prevalence and Correlates of Posttraumatic Stress Disorder and Common Mental Disorders in Lay Health Workers Working on the Friendship Bench Program in Zimbabwe

Background: Task-shifting using lay health workers (LHWs) to reduce the treatment gap for mental, neurological and substance use disorders is a common feature in health care systems in low and middle-income countries where medical professionals are scarce. The Friendship Bench is a collaborative stepped care intervention for common mental disorders delivered by LHWs in over 70 primary health care facilities in Zimbabwe. In recent years there has been concern about the mental health of over 300 LHWs delivering the intervention due to the stressful nature of the work on the FB and their exposure to vicarious trauma. This study aimed to establish the prevalence and factors associated with common mental disorders such as depression and anxiety (CMD) and post-traumatic stress disorder (PTSD) among the LHWs. Methods: A random sample of LHWs (n=182) working for the FB for more than 2 years had the previously validated Posttraumatic Stress Disorder Checklist (PCL-5) and the Shona Symptom Questionnaire (SSQ-14) administered to them by independent and trained research assistants. Outcomes: 11 LHWs presented with low probable PTSD (6%), CMD was found in 17 cases (11%). Interpretation: The prevalence of PTSD and CMD of LHWs is significantly lower than their clients' despite the stressful nature of their work and the burden of being exposed to the same risk factors. There is need for further studies to understand the protective mechanisms that may be associated with this work. Funding Statement: This study was funded by Grand Challenges Canada, award number 0087-04, awarded to Prof Dr Dixon Chibanda. Declaration of Interests: The authors declare that they have no conflict of interest except for DC who is supported through the DELTAS Africa Initiative [DEL-15-01]. The DELTAS Africa Initiative is an independent funding scheme of the African Academy of Sciences (AAS)’s Alliance for Accelerating Excellence in Science in Africa (AESA) and supported by the New Partnership for Africa’s Development Planning and Coordinating Agency (NEPAD Agency) with funding from the Wellcome Trust [DEL-15-01] and the UK government. The views expressed in this publication are those of the author(s) and not necessarily those 63 of AAS, NEPAD Agency, Wellcome Trust or the UK government. Ethical Approval Statement: The study was approved by the Medical Research Council of Zimbabwe and by the Health Research Ethics Committee at Stellenbosch University in line with the ethical principles stated by the Helsinki Declaration. Informed consent was obtained from all individual participants included in the study.

Xpert MTB/Rif Ultra for the Diagnosis of HIV-Associated Tuberculous Meningitis: A Prospective Validation

Introduction: Tuberculous meningitis accounts for 1-5% of tuberculosis (TB) cases. Diagnostic delay contributes to poor outcomes. We evaluated the performance of the new Xpert MTB/Rif Ultra (Ultra) for TB meningitis diagnosis. Methods: In a prospective diagnostic accuracy study, we tested the cerebrospinal fluid (CSF) of adults presenting with sub-acute meningitis to Mulago and Mbarara Hospitals, Uganda. We centrifuged the CSF, resuspended the cell pellet in 2mL CSF and tested 0.5ml aliquots with Ultra, Xpert, and mycobacterial growth indicator tube (MGIT) culture. We quantified diagnostic performance against 1) the uniform case definition of probable or definite TB meningitis and 2) a composite microbiological reference standard. Findings: From November 2016 to January 2019, we screened 466 adults with suspected meningitis and tested 204 for TB meningitis. Uniform clinical case definition classified 51 participants as probable/definite TB meningitis. Against this uniform case definition, Ultra had 76% sensitivity (39/51) compared with Xpert 56% (25/45; P=0·001) or culture 61% (27/44; P=0·02). Against the composite reference standard, Ultra had sensitivity of 93% (39/42), higher than Xpert at 66% (25/38; p=0·006) or culture at 72% (27/37; p=0·09). Ultra detected nine TB meningitis cases missed by Xpert and culture. In multivariate analysis, decreasing CSF glucose was a predictor of definite TB meningitis (P=0.001). Interpretation: Ultra detects TB meningitis with higher sensitivity than Xpert and culture in this HIV-positive population. However, with a negative predictive value of 93% Ultra cannot be used as a 'rule out' test. Clinical judgement and novel highly sensitive point of care tests are still required. Funding Statement: This research was made possible through support from the National Institute of Neurologic Disorders and Stroke (R01NS086312), the Fogarty International Center (K01TW010268, K43TW010718), and National Institute of Allergy and Infectious Diseases (T32AI055433). Declaration of Interests: FVC is supported through a Wellcome Trust Clinical PhD Fellowship (Grant no. 210772/Z/18/Z). FVC is an honorary fellow of the Makerere University – Uganda Virus Research Institute Centre of Excellence for Infection and Immunity Research and Training (MUII-plus). MUII-plus is supported through the DELTAS Africa Initiative (Grant no. 107743). The DELTAS Africa Initiative is an independent funding scheme of the African Academy of Sciences (AAS), Alliance for Accelerating Excellence in Science in Africa (AESA) and supported by the New Partnership for Africa's Development Planning and Coordinating Agency (NEPAD Agency) with funding from the Wellcome Trust (Grant no. 107743) and the UK Government. The MRC/UVRI and LSHTM Uganda Research Unit is jointly funded by the UK Medical Research Council (MRC) and the UK Department for International Development (DFID) under the MRC/DFID Concordat agreement and is also part of the EDCTP2 programme supported by the European Union. All other authors have nothing to disclose. Ethics Approval Statement: Institutional review board and Uganda National Council of Science and Technology approvals were obtained and informed consent was obtained from participants or their surrogate (in patients with altered mental status). The study was conducted in line with the Standards for Reporting Diagnostic Accuracy Studies.

Infrastructure for Agricultural &amp; Rural Development in Sub Saharan Africa: Need for a Comprehensive Program and Adequate Investment

This study unanimously confirms that rural infrastructure is a sine qua non for significantly improving the quality of human life and phenomenally accelerating the process of agricultural development in Africa. Infrastructure projects, however, involve huge initial capital investments, long gestation periods, high incremental capital output ratio, high risk, and low rate of returns on investments. Rural infrastructure has direct and strong relationship with farmers’ access to institutional finance and markets, and increasing crop yields, thereby promoting agricultural growth. Agricultural infrastructure has the potential to transform the existing traditional agriculture or subsistence farming into a most modern, commercial and dynamic farming system in Sub Saharan Africa. Increase in investment of agricultural infrastructure leads to increase in output and employment, a full investment formulation that meets the needs of domestic or external (multilateral and bilateral) funding sources will have to be carried out. Overall, a flexible, participatory approach will be needed, with full national and local involvement and commitment, while international partners, including Food and Agricultural Organization (FAO), give initial assistance to New partnership for Africa’s Development (NEPAD) in this process. The paper therefore recommends that technical and financial assistance will be required to help build capacity in African countries to face the challenges and take full advantage of the opportunities flowing from the multilateral trading systems.