Practice In Sub-Saharan Africa Research Articles

Regulatory Standards and Guidance for the Use of Health Apps for Self-Management in Sub-Saharan Africa: Scoping Review.

Health apps are increasingly recognized as crucial tools for enhancing health care delivery. Many countries, particularly those in sub-Saharan Africa, can substantially benefit from using health apps to support self-management and thus help to achieve universal health coverage and the third sustainable development goal. However, most health apps published in app stores are of unknown or poor quality, which poses a risk to patient safety. Regulatory standards and guidance can help address this risk and promote patient safety. This review aims to assess the regulatory standards and guidance for health apps supporting evidence-based best practices in sub-Saharan Africa with a focus on self-management. A methodological framework for scoping reviews was applied. A search strategy was built and applied across the following databases, gray literature sources, and institutional websites: PubMed, Scopus, World Health Organization (WHO) African Index Medicus, OpenGrey, WHO Regional Office for Africa Library, ICTworks, WHO Directory of eHealth policies, HIS Strengthening Resource Center, International Telecommunication Union, Ministry of Health websites, and Google. The search covered the period between January 2005 and January 2024. The findings were analyzed using a deductive descriptive content analysis. The policy analysis framework was adapted and used to organize the findings. The Reporting Items for Stakeholder Analysis tool guided the identification and mapping of key stakeholders based on their roles in regulating health apps for self-management. The study included 49 documents from 31 sub-Saharan African countries. While all the documents were relevant for stakeholder identification and mapping, only 3 regulatory standards and guidance contained relevant information on regulation of health apps. These standards and guidance primarily aimed to build mutual trust; promote integration, inclusion, and equitable access to services; and address implementation issues and poor coordination. They provided guidance on systems quality, software acquisition and maintenance, security measures, data exchange, interoperability and integration, involvement of relevant stakeholders, and equitable access to services. To enhance implementation, the standards highlight that legal authority, coordination of activities, building capacity, and monitoring and evaluation are required. A number of stakeholders, including governments, regulatory bodies, funders, intergovernmental and nongovernmental organizations, academia, and the health care community, were identified to play key roles in regulating health apps. Health apps have huge potential to support self-management in sub-Saharan Africa, but the lack of regulatory standards and guidance constitutes a major barrier. Hence, for these apps to be safely and effectively integrated into health care, more attention should be given to regulation. Learning from countries with effective regulations can help sub-Saharan Africa build a more robust and responsive regulatory system, ensuring the safe and beneficial use of health apps across the region. RR2-10.1136/bmjopen-2018-025714.

Consumption and adverse reaction reporting of herbal medicines among people living with HIV at University teaching hospitals in Blantyre, Malawi and Ibadan, Nigeria

Background Consumption of herbal medicines among people living with HIV is a common practice in Sub-Saharan Africa. The utilization of herbal medicines was at 17.5% and 67.9% in Malawi and Nigeria, respectively. There is inadequate data on use and adverse reactions (ADRs) reporting of herbal medicines among people living with HIV (PLWHIV). This study was designed to investigate use and ADRs reporting of herbal medicines among PLWHIV at the University Teaching Hospitals in Blantyre, Malawi and Ibadan, Nigeria.MethodologyA cross-sectional study was conducted among PLWHIV attending Antiretroviral Therapy (ART) clinic at Queen Elizabeth Central Hospital, Blantyre, Malawi and University College Hospital, Ibadan, Nigeria. A structured questionnaire was administered to 360 and 370 participants in Blantyre and Ibadan respectively, through face-to-face interviews after obtaining their informed consent. Results The prevalence of herbal medicines use among PLWHIV in Malawi and Nigeria was at 80.6% and 55.7% (p<0.001), respectively. The most frequently used herbal medicines in Malawi were Aloe vera (14.0%), Moringa oleifera (14.0%), Zingiber officinale (13.0%) and Allium sativum (7.0%). Likewise, in Nigeria, the most commonly used herbal medicines were Zingiber officinale (15.0%), Vernonia amygdalina (14.0%), Moringa oleifera (9.0%), and Allium sativum (11.0%). The major reason for herbal medicines’ use in Malawi was ready availability (42.1%) and perception that it boosts immunity (44.6%) in Nigeria. The PLWHIV reported experiencing suspected herbal medicine ADRs in Malawi (3.9%) and in Nigeria (8.0%).Conclusion A higher percentage of people living with HIV are using herbal medicines in Malawi as well as in Nigeria. In both countries, a few participants reported experiencing suspected ADRs related to herbal medicines.

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.

Simulation-based education to facilitate clinical readiness in nursing and midwifery programmes in sub-Saharan Africa: a meta-synthesis

Purpose The purpose of this study was to explore the clinical readiness of simulation-based education (SBE) in preparing nursing and midwifery students for clinical practice in sub-Saharan Africa. This study has synthesised the findings from existing research studies and provides an overview of the current state of SBE in nursing and midwifery programs in the region.Design/methodology/approach A qualitative meta-synthesis of previous studies was conducted using the following steps: developing a review question, developing and a search strategy, extracting and meta-synthesis of the themes from the literature and meta-synthesis of themes. Five databases were searched for from existing English literature (PubMed, Cumulative Index for Nursing and Allied Health Professional Literature [CINAHL], PsycINFO, EMBASE and ScienceDirect Medline, CINAHL and Science Direct), including grey literature on the subject. Eight qualitative studies conducted in sub-Saharan Africa between 2014 and 2022 were included. Hawker et al.'s framework was used to assess quality.Findings The following themes emerged from the literature. Theme 1: Improved skills and competencies through realism and repetition. Theme 2: Improved skills and competencies through realism and repetition. Theme 3: Improved learning through debriefing and reflection. Theme 4: Constraints of simulation as a pedagogical teaching strategy.Research limitations/implications The qualitative meta-synthesis intended to cover articles from 2012 to 2022. Between 2012 and 2013, the authors could not identify purely qualitative studies from sub-Saharan Africa. The studies identified were either mixed methods or purely quantitative. This constitutes a study limitation.Practical implications Findings emphasise educator training in SBE. Comprehensive multidisciplinary training, complemented by expertise and planned debriefing sessions, serves as a catalyst for fostering reflective learning. Well-equipped simulation infrastructure is essential in preparing students for their professional competencies for optimal patient outcomes. Additional research is imperative to improve the implementation of SBE in sub-Saharan Africa.Originality/value The originality and value of SBE in nursing and midwifery programs in sub-Saharan Africa lie in its contextual relevance, adaptation to resource constraints, innovative teaching methodologies, provision of a safe learning environment, promotion of interprofessional collaboration and potential for research and evidence generation. These factors contribute to advancing nursing and midwifery education and improving healthcare outcomes in the region. This study fills this gap in the literature.

Correction: Combining organic and mineral fertilizers as a climate-smart integrated soil fertility management practice in sub-Saharan Africa: A meta-analysis

Correction: Combining organic and mineral fertilizers as a climate-smart integrated soil fertility management practice in sub-Saharan Africa: A meta-analysis

Current pediatric pain practice in Nigeria, South Africa, Uganda, and Zambia: A prospective survey of anesthetists.

Children in hospital experience significant pain, either inherent with their pathology, or caused by diagnostic/therapeutic procedures. Little is known about pediatric pain practices in sub-Saharan Africa. This survey aimed to gain insight into current pain management practices among specialist physician anesthetists in four sub-Saharan African countries. A survey was sent to 365 specialist physician anesthetists in Nigeria, South Africa, Uganda and Zambia. Content analysis included descriptive information about the respondents and their work environment. Thematic analysis considered resources available for pediatric pain management, personal and institutional pain practices. One hundred and sixty-six responses were received (response rate 45.5%), with data from 141 analyzed; Nigeria (27), South Africa (52), Uganda (41) and Zambia (21). Most respondents (71.83%) worked at tertiary/national referral hospitals. The majority of respondents (130/141, 91.55%) had received teaching in pediatric pain management. Good availability was reported for simple analgesia, opioids, ketamine, and local anesthetics. Just over half always/often had access to nurses trained in pediatric care, and infusion pumps for continuous drug delivery. Catheters for regional anesthesia techniques and for patient-controlled analgesia were largely unavailable. Two thirds (94/141, 66.67%) did not have an institutional pediatric pain management guideline, but good pharmacological pain management practices were reported, in line with World Health Organization recommendations. Eighty-eight respondents (62.41%) indicated that they felt appropriate pain control in children was always/often achieved in their setting. This survey provides insight into pediatric pain practices in these four countries. Good availability of a variety of analgesics, positive pain prescription practices, and utilization of some non-pharmacological pain management strategies are encouraging, and suggest that achieving good pain control despite limited resources is attainable. Areas for improvement include the development of institutional guidelines, routine utilization of pain assessment tools, and access to regional anesthesia and other advanced pain management techniques.

Employee perception of electronic human resource management and COVID-19 restrictions in public organizations: the experience of Ghana Revenue Authority, Bono Region

AbstractThe purpose of this study was to find out what measures were taken to manage human resources during the COVID-19 pandemic by the Ghana Revenue Authority in Ghana. This was necessary because, even though electronic human resource practices have been implemented in most public organizations in the country, it was uncertain whether or not these practices were vital in delivering public service during the peak of the pandemic at the regional level due to government restrictions implemented to curb the spread of the virus. The study used 78 employees of the Ghana Revenue Authority in the Bono Regional Office of the Ghana Revenue Authority. The study used inferential statistics by employing Pearson correlation and multiple regression techniques to test the effect of employee perceptions, electronic human resource management practices, and COVID-19 practices on electronic human resource adoption. The findings revealed that e-human resource practices had the strongest effect on e-human resource adoption with a beta value of 0.781 and a p value of 0.000, followed by employee perception with a beta value of 0.272 and a p value of 0.004. Significantly, the entire effect of the COVID-19 practices was statistically insignificant yet positive. Overall, the four regression models were significant (p < 0.01), with the fourth model indicating R2 to be 0.677 points. Based on the findings, the study recommends that the Ghana Revenue Authority focuses more on transformational human resource management strategies to increase employee adoption of electronic systems. Furthermore, it is suggested that the organization includes employees in new technologies that improve their performance. Our findings are significant because the outbreak of COVID-19 made scholars focus more on flextime, health and safety, and remote working practices. Little has been done to determine whether or not the new normal has impacted how electronic human resource practices have been implemented in public sector organizations compared to the private sector. So, this study stands out as one of the critical studies in electronic human resource management practices in sub-Saharan Africa. Graphical Abstract

Assessing the Impact of Farmer-to-Farmer Communication Networks on Knowledge Sharing and Adoption of Sustainable Agricultural Practices in Africa

This study explores the role of farmer-to-farmer communication networks in promoting knowledge sharing and sustainable agricultural practices in sub-Saharan Africa. Smallholder farmers in the region face challenges in achieving sustainable agricultural development due to limited access to information, resources, and markets. The study reviews research, reports, and publications on communication networks among farmers in Africa and highlights their importance in improving farming techniques. Various networks like informal networks, extension services, mobile-based platforms, and farmer cooperatives are evaluated for their strengths, weaknesses, and usage levels. However, limited access to technology, insufficient funding, and lack of institutional support hinder the effectiveness of these networks. The study recommends addressing these challenges by improving technology access, increasing funding, and strengthening institutional support. The findings highlight the significance of farmer-to-farmer communication networks in bridging the knowledge gap and improving agricultural productivity. Continued research and collaboration are crucial for the sustainability and success of these networks in promoting sustainable practices in sub-Saharan Africa.

Lesson observations in sub-Saharan Africa: bringing learners into focus

ABSTRACT This article considers different approaches to lesson observation and their potential for understanding and evaluating classroom practice in sub-Saharan Africa. We start with a critical appraisal of Teach, a recent World Bank initiative. The evidence and assumptions underpinning this teacher-focused instrument are considered alongside its affordances and limitations. Following this, we review evidence from school-based research from the region to identify four salient aspects of conditions for learning: the use of languages; the role of peers; the use of resources to support learning; and differentiated support. An alternative framework for lesson observations is proposed as a means of developing understandings of these conditions through a spotlight on the activities of individual learners; learners’ interactions with teachers and peers; and the classroom environment. In conclusion we consider how this framework may be used alongside existing instruments for deeper insights into the nature and quality of education in the region.

Simulation-based education in classroom and clinical settings in sub-Saharan Africa: a systematic review

PurposeThe purpose of this systematic review was to explore the benefits and challenges in the implementation of simulation-based education (SBE) in the classroom and clinical settings in sub-Saharan Africa. The objectives of this systematic review were to identify the benefits of utilising SBE in the classroom and clinical practice in sub-Saharan Africa and to assess the challenges in the implementation of SBE in the classroom and clinical practice in sub-Saharan Africa.Design/methodology/approachFive databases were searched for existing English literature (Medline, CINAHL and Science Direct), including grey literature on the subject. Out of 26 eligible studies conducted in sub-Saharan Africa between 2014 and 2021, six studies that used mixed-methods design were included. Hawker et al.’s framework was used to assess the quality of the studies. Quantitative data were presented using descriptive and inferential statistics in the form of means and standard deviations while qualitative data were analysed and presented thematically.FindingsQuantitative findings showed that participants rated SBE highly in terms of teaching (93.2%), learning (91.4%) and skill acquisition (88.6%). SBE improved the clinical skill competency from 30% at baseline to 75% at the end. On the other hand, qualitative findings yielded themes namely: improved confidence and competence; knowledge acquisition and critical thinking; motivation and supervision; independent, self-paced learning; simulation equipment and work schedules; and planning and delivery of simulation activity. Pedagogical skills, competence and confidence are some of the elements that determine the feasibility of implementing SBE in the classroom and clinical settings.Practical implicationsSBE could help to bridge the gap between theory and practice and improve the quality of care provided by nurses. Simulation-based training is effective in improving the clinical skills of midwives and increasing their confidence in providing care. However, SBE trainees require motivation and close supervision in classroom settings if simulation is to be successfully implemented in sub-Saharan Africa. Furthermore, careful planning of scenarios, students briefing and reading of content prior to implementation facilitate effective simulation.Originality/valueWhile there may be a lack of literature on the use of SBE for training nurses and midwives in the developing world, there is growing evidence that it can be an effective way to improve clinical skills and quality of care. However, there are also significant challenges to implementing simulation-based training in resource-limited settings, and more research is needed to understand how best to address these challenges. This study fills this gap in the literature.

Exploring The Nexus Between Crop Diversification

Following the effects of climate change, there has been a resurgence of interest in promoting crop diversification as a climate-smart agricultural practice in Sub-Saharan Africa to improve food security, increase income, and reduce vulnerability to external shocks. This practice is considered an effective risk management strategy and consumption smoothing strategy in a context characterized by repeated exposure to shocks. Agricultural production in Kenya is mainly dependent on rain-fed cultivation, with maize as the principal staple food crop. However, staple crops face major challenges and therefore, a diversification from over-reliance on staples will be important as part of progress toward achieving food security. The Kenyan government has, for a long time, been promoting crop diversification to improve household welfare and minimize risks associated with heavy dependence on maize. A decline in maize yields associated with the emergence of new pests and diseases, such as maize lethal necrosis disease (MLND) in Borabu sub-county, emphasized the need for maize farmers to diversify away from maize production. Although this strategy is in use, there is no clear evidence of the impact it has on the livelihoods of vulnerable households. Thus, the study sought to find out the nexus between crop diversification and household welfare among small-scale farming households in Borabu sub-county. Multi-stage sampling procedure was used to select a representative sample size of 385 small-scale farmers. Primary data was collected using observations and interviews with the help of a semi-structured questionnaire. The data were analyzed using the STATA computer program. This paper adopted the Endogenous Switching Regression Model to determine the nexus between crop diversification and household welfare, with household welfare being proxied by household financial savings. The findings indicate that smallholder maize farmers who practiced crop diversification experienced an enhanced ability to save than a random individual would have experienced. Keywords: Crop diversification, household welfare, Maize Lethal Necrosis Disease, Endogenous Switching Regression Model. DOI: 10.7176/JBAH/13-8-07 Publication date: May 31 st 2023

Exploring the Nexus Between Crop Diversification and Household Welfare, in Borabu Sub-County, Kenya

Following the effects of climate change, there has been a resurgence of interest in promoting crop diversification as a climate-smart agricultural practice in Sub-Saharan Africa to improve food security, increase income, and reduce vulnerability to external shocks. This practice is considered an effective risk management strategy and consumption smoothing strategy in a context characterized by repeated exposure to shocks. Agricultural production in Kenya is mainly dependent on rain-fed cultivation, with maize as the principal staple food crop. However, staple crops face major challenges and therefore, a diversification from over-reliance on staples will be important as part of progress toward achieving food security. The Kenyan government has, for a long time, been promoting crop diversification to improve household welfare and minimize risks associated with heavy dependence on maize. A decline in maize yields associated with the emergence of new pests and diseases, such as maize lethal necrosis disease (MLND) in Borabu sub-county, emphasized the need for maize farmers to diversify away from maize production. Although this strategy is in use, there is no clear evidence of the impact it has on the livelihoods of vulnerable households. Thus, the study sought to find out the nexus between crop diversification and household welfare among small-scale farming households in Borabu sub-county. Multi-stage sampling procedure was used to select a representative sample size of 385 small-scale farmers. Primary data was collected using observations and interviews with the help of a semi-structured questionnaire. The data were analyzed using the STATA computer program. This paper adopted the Endogenous Switching Regression Model to determine the nexus between crop diversification and household welfare, with household welfare being proxied by household financial savings. The findings indicate that smallholder maize farmers who practiced crop diversification experienced an enhanced ability to save than a random individual would have experienced. Keywords: Crop diversification, household welfare, Maize Lethal Necrosis Disease, Endogenous Switching Regression Model. DOI: 10.7176/JEP/14-13-03 Publication date: May 31 st 2023

Prevalence and predictors of infant and young child feeding practices in sub-Saharan Africa.

This study assessed the prevalence and predictors of minimum dietary diversity (MDD), minimum meal frequency (MMF), and minimum acceptable diet (MAD) in sub-Saharan Africa (SSA). A sample of 87672 mother-child pairs from the 2010-2020 Demographic and Health Surveys of 32 countries in SSA was used. Multilevel binary logistic regression analysis was carried out to examine the predictors of MDD, MMF, and MAD. Percentages and adjusted odds ratios (aORs) with a 95% confidence interval (CI) were used to present the findings. The prevalence of MDD, MMF, and MAD in SSA were 25.3% (95% CI 21.7 to 28.9), 41.2% (95% CI 38.8 to 43.6), and 13.3% (95% CI 11.6 to 15.0), respectively. Children aged 18-23months were more likely to have MDD and MAD but less likely to have MMF. Children of mothers with higher education levels were more likely to have MDD, MMF, and MAD. Children who were delivered in a health facility were more likely to have MDD and MAD but less likely to have MMF. Following the poor state of complementary feeding practices for infants and young children, the study recommends that regional and national policies on food and nutrition security and maternal and child nutrition and health should follow the internationally recommended guidelines in promoting, protecting, and supporting age-appropriate complementary foods and feeding practices for infants and young children.

Appropriate feeding practice and associated factors among under-five children with diarrheal disease in sub-Saharan Africa: a multi-country analysis

BackgroundDiarrheal disease is one of the leading causes of child mortality and morbidity in low-income countries. Although the provision of more fluid and solid foods during diarrhea are important to treat the diseases, in Africa, food and fluid restrictions are common during diarrheal illness. Therefore, the aim of this study was to determine appropriate feeding practice and associated factors among under-five children with diarrheal disease in sub-Saharan Africa (SSA).MethodsWe have used the appended most recent demographic and health survey (DHS) datasets of 35 sub-Saharan countries conducted from 2010 to 2020. A total weighted sample of 42,882 living children with diarrhea were included in the analyses. Multivariable multilevel binary logistic regression was used to identify factors associated with appropriate child feeding practice in SSA. A p value of ≤ 0.05 was used as a cut of point to declare statistically significant variables.ResultsThe overall prevalence of appropriate child feeding practice in this study was 10.45% (95% CI 10.17–10.74). The odds of having appropriate child feeding practice was higher among women with primary (AOR = 1.27: 1.17–1.37), secondary (AOR = 1.38: 1.25–1.52), and higher education level (AOR = 1.52: 1.21–1.90), media exposure (AOR = 1.11: 1.11–1.29), richer (AOR = 1.23:1.01–1.26) and richest (AOR = 1.19:1.05–1.35) wealth index, and currently working (AOR = 1.12: 1.04–1.19).ConclusionThe prevalence of appropriate child feeding practice in this study was found to be very low. It advisable to reduce diarrhea-related child mortality through enhancing diarrhea management practice especially by working on the after mentioned factors.

The effect of charcoal production on carbon cycling in African biomes

AbstractUsing biomass for charcoal production in sub‐Saharan Africa (SSA) may change carbon stock dynamics and lead to irreversible changes in the carbon balance, yet we have little understanding of whether these dynamics vary by biome in this region. Currently, charcoal production contributes up to 7% of yearly deforestation in tropical regions, with carbon emissions corresponding to 71.2 million tonnes of CO2 and 1.3 million tonnes of CH4. With a projected increased demand for charcoal in the coming decades, even low harvest rates may throw the carbon budget off‐balance due to legacy effects. Here, we parameterized the dynamic global vegetation model LPJ‐GUESS for six SSA biomes and examined the effect of charcoal production on net ecosystem exchange (NEE), carbon stock sizes and recovery time for tropical rain forest, montane forest, moist savanna, dry savanna, temperate grassland and semi‐desert. Under historical charcoal regimes, tropical rain forests and montane forests transitioned from net carbon sinks to net sources, that is, mean cumulative NEE from −3.56 ± 2.59 kg C/m2 to 2.46 ± 3.43 kg C/m2 and −2.73 ± 2.80 kg C/m2 to 1.87 ± 4.94 kg C/m2 respectively. Varying charcoal production intensities resulted in tropical rain forests showing at least two times higher carbon losses than the other biomes. Biome recovery time varied by carbon stock, with tropical and montane forests taking about 10 times longer than the fast recovery observed for semi‐desert and temperate grasslands. Our findings show that high biomass biomes are disproportionately affected by biomass harvesting for charcoal, and even low harvesting rates strongly affect vegetation and litter carbon and their contribution to the carbon budget. Therefore, the prolonged biome recoveries imply that current charcoal production practices in SSA are not sustainable, especially in tropical rain forests and montane forests, where we observe longer recovery for vegetation and litter carbon stocks.

Understanding gender differences on the choices of a portfolio of climate-smart agricultural practices in sub-saharan Africa

Gender-based intra-household differences in resource ownership, management and control are important bargaining powers on the division of authority regarding agriculture-related decisions within the household. Yet, not much is known about the gender role played by intra-household resource distribution between spouses on the adoption of a portfolio of Climate-smart Agriculture (CSA) practices. In this study, we use plot-level panel data from four Sub-Saharan African countries, namely Ethiopia, Tanzania, Malawi, and Nigeria. We employ a correlated random effect Tobit regression model to examine how land ownership, plot management and control of outputs by the spouses individually and jointly influenced the rate of adoption of multiple CSA practices. We find that the gender-linked adoption of CSA practices is more likely to be made if plot management rights overlap with land ownership and control of economic rights from the land along gender lines. The result implies that women do have a role in the decision to adopt CSA practices due to their intra-household bargaining power. The findings indicate interesting nuances with respect to gender-differentiated impacts of policies to enhance resource entitlement and decision making thereby increasing adoption of a portfolio of CSA practices.

Practice of Pediatric Neurosurgery at the “Hôpital Spécialisé Mère-Enfant Blanche Gomes” in the Republic of the Congo

Introduction: Pediatric Neurosurgery is a growing specialty in its own right worldwide. Its practice in sub-Saharan Africa remains confronted with many challenges, notably the absence of a pediatric neurosurgeon, the lack of a dedicated service and the absence of multidisciplinary pediatric collaboration (neuroanesthesist, neurologist, oncologist and psychotherapist). The objective of this preliminary study is to describe the practice of pediatric neurosurgery at the HSMEBG and to present perspectives for its improvement. Methods: This is a retrospective, monocentric, descriptive study covering the period from March 2021 to March 2022 at the Pediatric Surgery Department of the HSMEBG. Résults: During the study period, 50 children were hospitalized for a neurosurgical condition. The sex ratio was 1.77. The average age was 6 years with extremes of 2 weeks and 16 years. Most children were from the emergency department (46%). Computed tomography (CT) was performed in 35 patients (70%), magnetic resonance imaging (MRI) in 4% and plain radiography in two patients (8%). Malformative, traumatic (cranial and spinal) and tumor pathology were the most frequent with 42%, 36% and 12% respectively. Twenty-six patients were operated (52%). We recorded one postoperative infection (2.5%). The overall mortality was 8% (N = 4). Conclusion: This preliminary study allowed us to identify the epidemiological and clinical profile of the patients treated in our context as well as the therapeutic approach. Malformative pathology remains the most frequent, followed by traumatic and tumor pathology. The development of the practice of this discipline remains a challenge in our working conditions and requires the training of pediatric neurosurgeons and dedicated paramedical staff.

A Review of User Vulnerabilities Associated with Shared Sanitation Practices in Sub-Saharan Africa

Aims: Shared sanitation was excluded from the basic service level due to perceived limitations of their hygiene, accessibility and safety. But how does the current body of scientific knowledge influence the narrative? This paper is aimed at reviewing data on the current status and vulnerability issues reported to be associated with shared sanitation in Sub-Saharan Africa (SSA).
 Methodology: Literature was searched using key search terms from nine databases. Peer-reviewed articles and various reports of individual country studies published in English from January 2000 to April 2022 were selected.
 Results: As at 2020, the proportion of the population sharing sanitation facilities in SSA was estimated as 19% compared to 7% globally. The review revealed a mixed opinion about issues and vulnerabilities associated with shared sanitation which may have arisen from inconsistencies in the typologies and levels of sharing of facilities among the reviewed studies. Using shared sanitation was found to be associated with an increased risk of diarrheal diseases (OR=1.06; 95%CI: 1.03-1.08) and non-partner violence against women (OR=1.52; 95%CI: 1.22-1.82). However, there is also evidence that many shared facilities, particularly those shared by a few (2-3) households, are clean, meet the needs of the users and afford them similar health outcomes as non-shared facilities.
 Conclusion: The findings of the review suggest that the outright exclusion of all forms of shared sanitation from basic sanitation potentially underestimates the global efforts and progress toward access to sanitation. There is a need to segregate communal and public toilets from privately shared facilities in future research as well as the progress reporting by the Joint Monitoring Programme (JMP). It is also recommended that steps are taken by the JMP to develop indicators for identifying and incorporating quality shared sanitation facilities into the basic sanitation service level in order to give a more realistic account of the global effort towards sanitation access.

Maximizing Laboratory Production of Aflatoxins and Fumonisins for Use in Experimental Animal Feeds.

Warm and humid climatic conditions coupled with poor agricultural practices in sub-Saharan Africa favor the contamination of food and feed by Aspergillus flavus and Fusarium verticillioides fungi, which subsequently may produce aflatoxins (AFs) and fumonisins (FBs), respectively. The growth of fungi and the production of mycotoxins are influenced by physical (temperature, pH, water activity, light and aeration), nutritional, and biological factors. This study aimed at optimizing the conditions for the laboratory production of large quantities of AFs and FBs for use in the animal experiments. A. flavus and F. verticillioides strains, previously isolated from maize in Kenya, were used. Levels of AFB1 and total FBs (FB1, FB2, and FB3) in different growth substrates were screened using ELISA methods. Maize kernels inoculated with three different strains of A. flavus simultaneously and incubated at 29 °C for 21 days had the highest AFB1 level of 12,550 ± 3397 μg/kg of substrate. The highest level of total FBs (386,533 ± 153,302 μg/kg of substrate) was detected in cracked maize inoculated with three different strains of F. verticillioides and incubated for 21 days at temperatures of 22-25 °C in a growth chamber fitted with yellow light. These two methods are recommended for the mass production of AFB1 and FBs for animal feeding trials.

Editorial Board Composition Among Pediatric Cardiology Journals: Time to Cast the Net Wider

BackgroundNo data currently exist on the diversity of editorial board members (EBMs) of pediatric cardiology journals. ObjectivesThe objective was to investigate the editorial boards of 5 pediatric cardiology journals to assess the composition of these boards in terms of the geographical, gender, and economic representation of their members. MethodsInformation on EBMs was collected directly from 5 journal websites accessed in February 2022. The following data were collected: country of practice (including World Bank geographical and income classification), institution of practice, role on editorial board, and whether an individual held a role on 1 or more of the boards included. ResultsA total of 455 EBMs were identified. A total of 369 (81%) were male. All editors-in-chief were male, and 4 were from the United States. EBMs practicing in North America accounted for 278 individuals (61%) of the editorial boards reviewed. The next majority of EBMs are practicing within Europe and Central Asia (23%, n = 103), East Asia and Pacific (7%, n = 31), Middle East and North Africa (4%, n = 18), and Latin America and Caribbean (4%, n = 16). Less than 2% (n = 9) practice in Sub-Saharan Africa and South Asia. Over 90% (n = 415) practice in high-income countries. There was no representation from low-income countries. ConclusionsWomen and pediatric cardiologists practicing in countries outside of Europe and North America were underrepresented on the editorial boards of the journals studied. Diversifying composition of editorial boards may provide greater representation of underserved areas and encourage broader avenues of investigation and research.