Practice In Sub-Saharan Africa Research Articles

The expanding movement of primary care physicians operating at the first line of healthcare delivery systems in sub-Saharan Africa: A scoping review.

In sub-Saharan Africa (SSA), the physicians' ratio is increasing. There are clear indications that many of them have opted to work at the first-line of healthcare delivery systems, i.e. providing primary care. This constitutes an important change in African healthcare systems where the first line has been under the responsibility of nurse-practitioners for decades. Previous reviews on primary care physicians (PCPs) in SSA focused on the specific case of family physicians in English-speaking countries. This scoping review provides a broader mapping of the PCPs' practices in SSA, beyond family physicians and including francophone Africa. For this study, we defined PCPs as medical doctors who work at the first-line of healthcare delivery and provide generalist healthcare. We searched five databases and identified additional sources through purposively selected websites, expert recommendations, and citation tracking. Two reviewers independently selected studies and extracted and coded the data. The findings were presented to a range of stakeholders. We included 81 papers, mostly related to the Republic of South Africa. Three categories of PCPs are proposed: family physicians, "médecins généralistes communautaires", and general practitioners. We analysed the functioning of each along four dimensions that emerged from the data analysis: professional identity, governance, roles and activities, and output/outcome. Our analysis highlighted several challenges about the PCPs' governance that could threaten their effective contribution to primary care. More research is needed to investigate better the precise nature and performance of the PCPs' activities. Evidence is particularly needed for PCPs classified in the category of GPs and, more generally, PCPs in African countries other than the Republic of South Africa. This review sheds more light on the institutional, organisational and operational realities of PCPs in SSA. It also highlighted persisting gaps that remain in our understanding of the functioning and the potential of African PCPs.

Does attitude towards wife beating determine infant feeding practices during diarrheal illness\xa0in sub-Saharan Africa?

BackgroundInappropriate feeding practices of children during illness remains a public health problem globally, particularly in sub-Saharan Africa (SSA). One strategy to improve child health outcomes is through women empowerment—measured by wife beating attitude. However, the role of attitude towards wife beating in child feeding practices has not been comprehensively studied. Therefore, we investigated the association between women's attitude towards wife beating and child feeding practices during childhood diarrhea in 28 countries in SSA.MethodsWe analyzed data from the Demographic and Health Survey on 40,720 children under 5 years. Bivariate and multivariate binary logistic regression analyses were applied to assess the association between women's attitude towards wife beating and child feeding practices. The results were presented using adjusted odds ratio (aOR) with 95% confidence intervals (CIs).ResultsThe pooled results showed that appropriate feeding practices during diarrheal illness among under-five children was 9.3% in SSA, varying from 0.4% in Burkina Faso to 21.1% in Kenya. Regarding regional coverage, the highest coverage was observed in Central Africa (9.3%) followed by East Africa (5.5%), Southern Africa (4.8%), and West Africa (4.2%). Women who disagreed with wife-beating practices had higher odds of proper child feeding practices during childhood diarrhea compared to those who justified wife-beating practices (aOR = 2.02, 95% CI; 1.17–3.48).ConclusionThe findings suggest that women’s disagreement with wife beating is strongly associated with proper child feeding practices during diarrheal illness in SSA. Proactive measures and interventions designed to change attitudes towards wife-beating practices are crucial to improving proper feeding practices in SSA.

Associations between women's empowerment and child development, growth, and nurturing care practices in sub-Saharan Africa: A cross-sectional analysis of demographic and health survey data.

Approximately 40% of children 3 to 4 years of age in low- and middle-income countries have suboptimal development and growth. Women's empowerment may help provide inputs of nurturing care for early development and growth by building caregiver capacity and family support. We examined the associations between women's empowerment and child development, growth, early learning, and nutrition in sub-Saharan Africa (SSA). We pooled data on married women (15 to 49 years) and their children (36 to 59 months) from Demographic and Health Surveys that collected data on child development (2011 to 2018) in 9 SSA countries (N = 21,434): Benin, Burundi, Cameroon, Chad, Congo, Rwanda, Senegal, Togo, and Uganda. We constructed a women's empowerment score using factor analysis and assigned women to country-specific quintile categories. The child outcomes included cognitive, socioemotional, literacy-numeracy, and physical development (Early Childhood Development Index), linear growth (height-for-age Z-score (HAZ) and stunting (HAZ <-2). Early learning outcomes were number of parental stimulation activities (range 0 to 6) and learning resources (range 0 to 4). The nutrition outcome was child dietary diversity score (DDS, range 0 to 7). We assessed the relationship between women's empowerment and child development, growth, early learning, and nutrition using multivariate generalized linear models. On average, households in our sample were large (8.5 ± 5.7 members) and primarily living in rural areas (71%). Women were 31 ± 6.6 years on average, 54% had no education, and 31% had completed primary education. Children were 47 ± 7 months old and 49% were female. About 23% of children had suboptimal cognitive development, 31% had suboptimal socioemotional development, and 90% had suboptimal literacy-numeracy development. Only 9% of children had suboptimal physical development, but 35% were stunted. Approximately 14% of mothers and 3% of fathers provided ≥4 stimulation activities. Relative to the lowest quintile category, children of women in the highest empowerment quintile category were less likely to have suboptimal cognitive development (relative risk (RR) 0.89; 95% confidence interval (CI) 0.80, 0.99), had higher HAZ (mean difference (MD) 0.09; 95% CI 0.02, 0.16), lower risk of stunting (RR 0.93; 95% CI 0.87, 1.00), higher DDS (MD 0.17; 95% CI 0.06, 0.29), had 0.07 (95% CI 0.01, 0.13) additional learning resources, and received 0.16 (95% CI 0.06, 0.25) additional stimulation activities from their mothers and 0.23 (95% CI 0.17 to 0.29) additional activities from their fathers. We found no evidence that women's empowerment was associated with socioemotional, literacy-numeracy, or physical development. Study limitations include the possibility of reverse causality and suboptimal assessments of the outcomes and exposure. Women's empowerment was positively associated with early child cognitive development, child growth, early learning, and nutrition outcomes in SSA. Efforts to improve child development and growth should consider women's empowerment as a potential strategy.

Provider Barriers and Facilitators of Breast Cancer Guideline-Concordant Therapy Delivery in Botswana: A Consolidated Framework for Implementation Research Analysis.

IntroductionSystemic treatment for breast cancer in sub‐Saharan Africa (SSA) is cost effective. However, there are limited real‐world data on the translation of breast cancer treatment guidelines into clinical practice in SSA. The study aimed to identify provider factors associated with adherence to breast cancer guideline‐concordant care at Princess Marina Hospital (PMH) in Botswana.Materials and MethodsThe Consolidated Framework for Implementation Research was used to conduct one‐on‐one semistructured interviews with breast cancer providers at PMH. Purposive sampling was used, and sample size was determined by thematic saturation. Transcribed interviews were double‐coded and analyzed in NVivo using an integrated analysis approach.ResultsForty‐one providers across eight departments were interviewed. There were variations in breast cancer guidelines used. Facilitators included a strong tension for change and a government‐funded comprehensive cancer care plan. Common provider and health system barriers were lack of available resources, staff shortages and poor skills retention, lack of relative priority compared with HIV/AIDS, suboptimal interdepartmental communication, and lack of a clearly defined national cancer control policy. Community‐level barriers included accessibility and associated transportation costs. Participants recommended the formal implementation of future guidelines that involved key stakeholders in all phases of planning and implementation, strategic government buy‐in, expansion of multidisciplinary tumor boards, leveraging nongovernmental and academic partnerships, and setting up monitoring, evaluation, and feedback processes.DiscussionThe study identified complex, multilevel factors affecting breast cancer treatment delivery in Botswana. These results and recommendations will inform strategies to overcome specific barriers in order to promote standardized breast cancer care delivery and improve survival outcomes.Implications for PracticeTo address the increasing cancer burden in low‐ and middle‐income countries, resource‐stratified guidelines have been developed by multiple international organizations to promote high‐quality guideline‐concordant care. However, these guidelines still require adaptation in order to be successfully translated into clinical practice in the countries where they are intended to be used. This study highlights a systematic approach of evaluating important contextual factors associated with the successful adaptation and implementation of resource‐stratified guidelines in sub‐Saharan Africa. In Botswana, there is a critical need for local stakeholder input to inform country‐level and facility‐level resources, cancer care accessibility, and community‐level barriers and facilitators.

Protocol for a scoping review of neonatal emollient therapy and massage practices throughout sub-Saharan Africa

Background: Serious infections and other complications from very low birth weight and prematurity are the leading causes of death for neonates worldwide. Infections partly result from the compromised skin barrier function in preterm neonates. Optimal skin care practices for neonates, especially in settings with limited access to adequate hygienic conditions, hold potential to reduce infection and avoid these preventable preterm neonatal deaths. The purpose of this protocol is to support a scoping review of neonatal skin care, emollient therapy and massage practices throughout sub-Saharan Africa. Protocol: The proposed review will follow a methodological framework consisting of the following five steps: (i) identifying the research question, (ii) identifying relevant studies, (iii) selection of eligible studies, (iv) charting the data, and (v) collating and summarizing the results. In addition, we will reflect on the implications of the findings for the feasibility and design of randomized controlled trials to examine the impact of emollient therapy on survival, growth, infection and neurodevelopment of very low birth weight infants in sub-Saharan Africa. We will search domestic and international databases for literature published in English between January 1, 2000, and July 12, 2021. Articles will be chosen based on standardized inclusion criteria. The primary criteria for inclusion will be a report on skin care practices administered to neonates in Africa. Conclusions: Documentation of common neonatal skin care practices throughout Africa has the potential to highlight opportunities for skin care intervention and future research on neonatal skin care practices in sub-Saharan Africa, and support the development of future emollient intervention trials for preterm and low birthweight neonates in low- and middle-income countries.

A holistic sustainability assessment of organic (certified and non-certified) and non-organic smallholder farms in Kenya

The introduction of organic farm management practices in sub-Saharan Africa could act as a lever for supporting regional sustainable development. In this study, we sought to assess the sustainability performance of organic (certified and non-certified) and non-organic farms in the dry Kajiado County and the wet Murang’a County in Kenya, based on four sustainability dimensions: Good Governance, Environmental Integrity, Economic Resilience and Social Well-Being. We collected household survey data from 400 smallholder farms, which were formally characterized into five types (mixed organic and conventional, certified organic, organic, conventional, and subsistence farms). We used multivariate analysis of variance, linear fixed-effects and general linear models to examine differences in sustainability performance. Model results indicate that all farms lack reliable farm management information and that only limited knowledge, skills and social security exist for farmers and farm workers. Comparison of the five farm types indicates no significant differences in their sustainability performance. Nonetheless, certified organic farms had better sustainability performance than non-certified farms due to higher economic resilience, environmental integrity, better support and training for workers. However, except for avoiding the use of agrochemicals in certified farms, there is relatively little difference in the farm management practices across farm types. Our results also indicate that farms in Murang’a were more sustainable than those in Kajiado due to better regional land-tenure security and conflict resolution mechanisms, soil and water conservation measures, and farm commercial viability. Nonetheless, unlike Kajiado, farms in Murang’a showed a tendency toward poor animal husbandry practices which affects overall animal welfare, limited credit uptake and market involvement. The results of this study can support decision making to identify appropriate interventions for improving sustainability in smallholder farms.

Protocol for a scoping review of neonatal emollient therapy and massage practices throughout sub-Saharan Africa.

Background: Serious infections and other complications from very low birth weight and prematurity are the leading causes of death for neonates worldwide. Infections partly result from the compromised skin barrier function in preterm neonates. Optimal skin care practices for neonates, especially in settings with limited access to adequate hygienic conditions, hold potential to reduce infection and avoid these preventable preterm neonatal deaths. The purpose of this protocol is to support a scoping review of neonatal skin care, emollient therapy and massage practices throughout sub-Saharan Africa. Protocol: The proposed review will follow a methodological framework consisting of the following five steps: (i) identifying the research question, (ii) identifying relevant studies, (iii) selection of eligible studies, (iv) charting the data, and (v) collating and summarizing the results. In addition, we will reflect on the implications of the findings for the feasibility and design of randomized controlled trials to examine the impact of emollient therapy on survival, growth, infection and neurodevelopment of very low birth weight infants in sub-Saharan Africa. We will search domestic and international databases for literature published in English between January 1, 2000, and July 12, 2021. Articles will be chosen based on standardized inclusion criteria. The primary criteria for inclusion will be a report on skin care practices administered to neonates in Africa. Conclusions: Documentation of common neonatal skin care practices throughout Africa has the potential to highlight opportunities for skin care intervention and future research on neonatal skin care practices in sub-Saharan Africa, and support the development of future emollient intervention trials for preterm and low birthweight neonates in low- and middle-income countries.

Recurrent Focal Segmental Glomerulosclerosis After Kidney Transplantation in African Americans: Review of the Current Evidence.

In many countries of sub-Saharan Africa, the most common causes of end-stage kidney disease are hypertension, chronic glomerulonephritis, and diabetes mellitus. So far, literature on recurrent focal segmental glomerulosclerosis in sub-Saharan African populations is limited. With the intention of providing guidance for best practices in sub-Saharan Africa, we reviewed available evidence for African Americans, a population with a similar genetic background. We chose this population as a pseudo-population to show how similar genetic backgrounds can predict disease occurrence in similar populations residing in different continents. Our extended PubMed and Scopus literature search used these key words: "focal segmental glomerulosclerosis in African Americans" (search 1), "recurrent focal segmental glomerulosclerosis after kidney transplantation" (search 2), "risk factors for recurrent focal segmental glomerulosclerosis" (search 3); and "APOL1 gene and kidney transplantation" (search 4). Search 1 yielded 4 articles, search 2 yielded 44 articles, search 3 yielded 6 articles, and search 4 yielded 8 articles. African Americans were shown to be disproportionately predisposed to endstage kidney disease, traceable to focal segmental glomerulosclerosis (the most common cause of glomerulonephritis leading to end-stage kidney disease). Apolipoprotein L1 presence in 22% of African Americans explained the odds ratio of 17 in developing focal segmental glomerulosclerosis and 8 times lifetime risk of end-stage kidney disease. Focal segmental glomerulosclerosis recurred in 30% of kidney transplant recipients; risk factors included young age, rapid progression to end-stage kidney disease, and White race recipient. Circulating permeability factors played a central role in primary and recurrent focal segmental glomerulosclerosis. For recurrent cases, transplant biopsy has remained the gold standard for diagnosis, with treatment involving a multi-modal approach, often resulting in partial or complete remission of proteinuria; allograft loss can occur if treatment is not successful. More randomized clinical trials are needed to chart the way forward for prolonged allograft function.

Menopausal Management Practices in Sub-Saharan Africa: A Cross Sectional Study of Cameroonian Women

Background Menopause is a physiological state which induce deep changes in women’s life. Although the climacteric syndrome is very little studied within sub-Saharan women, certainly because of the impact of traditional culture, it have a considerable impact on the quality of life of post-menopausal women. The present study aims at evaluating menopausal management practices during menopause in Cameroonian women. Methods This study is a cross-sectional and analytical survey of a representative sample of 327 Cameroonian menopausal women. The main inclusion criteria was natural menopause. Investigation form was administrated to woman after their informed consent. Comparison of proportions and student t-test with a significance threshold of less than 0.05 was used. Results Women exhibit the majority of climacteric syndrome symptoms: hot flushes (57.80 %), night sweats (47.09%), sleep disturbances (59.63 %) and libido decline (66.67 %) among others. 69.72 % of menopausal women were not followed up although the majority of women (58.88 %) wished such medical care. 34.25 % of women of the study used self-medication to ease their symptoms. Attitude facing climacteric period is indifferent for 27.83 %. Socio-economic level was positively correlate to the attitude at menopause (Correlation index = 0.1644; p < 0.05) while professional statute was negatively correlate to medical care (Correlation index =-0.1610; p < 0.05). Conclusion Cameroonian women managed mainly climacteric symptoms by self-medication. Their socio-economic statute has a positive impact on their attitude during menopause. Furthermore, their professional statute is a decisive factor for medical care of climacteric symptoms.

To bend without breaking: a qualitative study on leadership by doctors in Sierra Leone.

Strong leadership capabilities are essential for effective health services, yet definitions of leadership remain contested. Despite the acknowledged contextual specificity of leadership styles, most leadership theories draw heavily from Western conceptualizations. This cultural bias may attenuate the effectiveness of programmes intended to transform healthcare practice in Sub-Saharan Africa, where few empirical studies on health leadership have been conducted. This paper examines how effective leadership by doctors was perceived by stakeholders in one particular context, Sierra Leone. Drawing together extensive experience of in-country healthcare provision with a series of in-depth interviews with 27 Sierra Leonean doctors, we extended a grounded-theory approach to come to grips with the reach and relevance of contemporary leadership models in capturing the local experiences and relevance of leadership. We found that participants conceptualized leadership according to established leadership models, such as transformational and relational theories. However, participants also pointed to distinctive challenges attendant to healthcare provision in Sierra Leone that required specific leadership capabilities. Context-specific factors included health system breakdown, politicization in the health sector and lack of accountability, placing importance on skills such as persistence, role modelling and taking initiative. Participants also described pressure to behave in ways they deemed antithetical to their personal and professional values and also necessary in order to continue a career in the public sector. The challenge of navigating such ethical dilemmas was a defining feature of leadership in Sierra Leone. Our research demonstrates that while international leadership models were relevant in this context, there is strong emphasis on contingent or situational leadership theories. We further contribute to policy and practice by informing design of leadership development programmes and the establishment of a more enabling environment for medical leadership by governments and international donors.

Ojú l’ọ̀rọ̀ọ́ wà: The Praise Gaze in Oríkì Performance

Living traditions of praise-singing are found throughout sub-Saharan Africa, bridging orality, literacy, digital media and the internet. The transcribed text has been the primary focus of scholarship on African oral traditions. Because of the growing number of digital audiovisual recordings available on streaming and social media platforms, it is possible to analyse more modalities of praise- singing. Along with fieldwork observations, this article reports on a multimodal analysis that was applied to music videos and field recordings to study the role of gaze in oríkì, or praise poetry, a cultural phenomenon amongst Yorùbá speakers of West Africa. The Yorùbá proverb “Ojù l’òṛ òó ̣ wà” suggests that “the meaning of the words is in the eyes of the speaker”. Although scholars have addressed the visual imagery included in oríkì texts, to date, no scholar has made gaze the focus of a research study on praise-singing performance practice. To theorise the praise gaze, the analysis drew on a small but growing body of psychological literature on gaze in Western music (and Indian classical music) and, also, participant-observation. Research has shown that the direction of the performer's head, face and eyes plays a role in the reception of Western concert music. However, in praise-singing traditions, such as oríkì, gaze plays a more important role where the singer looking at the addressee identifies the focal point for the audience. If the addressee returns the gaze, forming a mutual gaze, this is likely to increase the “head-swelling” effect of the praise. These preliminary findings on the topic of gaze in praise-singing, specifically Yorùbá oríkì, are intended to be a basis for further research on a central aspect of performance practice in sub-Saharan Africa. It is expected that as research on this topic expands, variation and nuance in the gaze modality will be revealed.

Mothers' perceptions of the practice of kangaroo mother care for preterm neonates in sub-Saharan Africa: a systematic review of qualitative evidence.

ABSTRACT Objective: The objective of this review was to explore the experiences of mothers with the practice of kangaroo mother care for preterm neonates at home in sub-Saharan Africa. Introduction: Newborn deaths globally have remained high despite the significant reductions in deaths among under-fives over the past few decades. More than 7000 deaths occur daily around the globe, but mostly in sub-Saharan Africa. Of these deaths, 60% to 80% are due to preterm birth and low birth weight. Kangaroo mother care is known to offer a cheap and effective way to care for low birth weight, preterm neonates; however, its practice is still low. There is limited evidence on the factors that hinder or facilitate the practice of kangaroo mother care at the community level. Inclusion criteria: The review considered studies conducted in sub-Saharan Africa on the perceptions and experiences of mothers who had given birth to preterm babies and had practiced kangaroo mother care wholly or in part at home. Qualitative studies in English and French conducted from January 1979 to March 2019 were considered for inclusion if they exclusively used qualitative research methods including, but not limited to, phenomenology, grounded theory, ethnography, action research, or feminist research. Methods: PubMed, Embase, Web of Science, Scopus, African Index Medicus (AIM), Academic Search Complete, CINAHL Complete, Education Source, and Health Source: Nursing/Academic Edition were searched in March 2019. Eligible studies were critically appraised using the standardized JBI tool. Findings were pooled using the meta-aggregative approach, and confidence was assessed according to the ConQual approach. Results: Following the systematic search and critical appraisal process, six studies were included in the review for data extraction and synthesis of findings. Three of the six studies were based on in-depth individual interviews, while two employed both individual interviews and focus group discussions, and one study used only focus group discussions. Twenty-six primary findings were generated from the review process that were aggregated into 10 categories, which generated four meta-synthesized findings: Conclusions: There is a link between the perceptions and experiences of kangaroo mother care that influences its practice in sub-Saharan Africa. The health care systems have failed to create awareness among communities before the birth of a preterm neonate. The traditional practices make kangaroo mother care stigmatizing at the community level, and the practice is perceived to be difficult and cumbersome, requiring substantial social support. Strategies to make the practice less cumbersome need to be devised, focusing on the comfort of mothers. Further qualitative studies are needed to explore community-level experiences of kangaroo mother care in sub-Saharan Africa.

Data Journalism Practice in Sub-Saharan African Media Systems: A Cross-National Survey of Journalists’ Perceptions in Zambia and Tanzania

ABSTRACT This study explores the state of data-driven journalism practices in Sub-Saharan Africa. It aims at examining journalists’ perceptions of data-driven journalism in Zambia and Tanzania as it attempts to redefine and demystify the concept. We base our hypotheses on the notion that most journalists in Zambia and Tanzania perceive data journalism as a field that cannot be defined outside quantitative methods—approaches mostly emphasized by western scholarship. Our cross-national survey findings suggest that journalists from Zambia and Tanzania do not consider themselves as data journalists even when they practice it. This is because of the lack of advanced computer-assisted reporting equipment and the dwindling skills in advanced quantitative methods that are mostly accompanied by statistical software. Findings also suggest that female journalists showed more scepticism of data journalism practice, leading to fewer women with interest in pursuing data journalism in Zambia and Tanzania

Review on Ethnoveterinary Practices in Sub-Saharan Africa.

Background: Livestock represents an important sector for the livelihood of sub-Saharan African countries’ inhabitants. In these countries, farmers raise livestock to meet household food demands and as additional sources of incomes, but its production is hampered by rampant animal diseases. The impact of animal diseases is particularly severe for poor communities that, although relying heavily on livestock, have limited access to modern veterinary services and therefore rely on indigenous medicines for the treatment of livestock ailments. Methods: The current review focuses on the ethnoveterinary health management practices found amongst livestock producers in sub-Saharan Africa. Documents were sourced from Google databases. Results: A total of 56 documents were reviewed, most of which were published recently (after 2000). The documents revealed the wide use of ethnoveterinary medicines among livestock producers in sub-Saharan African countries because of their cost and accessibility, threats to ethnomedicinal plant species through improper harvesting methods, overexploitation, the existence of inappropriate ethnoveterinary practices, and methods of conserving ethnomedicinal species. Conclusions: Given the persistent threats posed to ethnoveterinary medicine and/or practices in developing countries of sub-Saharan Africa, the findings of this review highlight the importance of integrating and promoting the use of ethnoveterinary medicine that is likely to be lost if it is not given enough importance. It is also important to obtain an overview of recent publications on ethnoveterinary medicines to identify the gaps and scope required to be filled by future studies. It is envisaged that the review will stimulate further ethnoveterinary research among livestock disease management practices, which could lead to new pharmaceuticals in the region.

Dynamics of fractionated rhizosphere soil P and plant P uptake under maize/P-mobilizing legumes intercropping in strongly weathered soil of Tanzania

ABSTRACT Intercropping with cereal and phosphorus (P)-mobilizing leguminous crops is a traditional agricultural practice in Sub-Saharan Africa. It is essential to evaluate the effect of intercropping (i.e., rhizosphere sharing) on fractionated rhizosphere soil P dynamics under the various soil P conditions and legumes, to improve the soil-plant P dynamics in this region. This study aimed to identify the effect of rhizosphere sharing of maize (MZ)/P-mobilizing legumes intercropping on fractionated rhizosphere soil P dynamics and plant P uptake under different P fertilization rates in strongly weathered cropland soil of Tanzania. We conducted 60-day MZ and P-mobilizing legumes intercropping pot experiments under different P-fertilized conditions (0, 50, and 100 kg P ha−1) with two legumes (pigeon pea (PP) and groundnut (GN)) by using three different root-separation treatments (no separation (NS) for rhizosphere sharing, nylon mesh separation (MS), and complete separation (CS)), to compare the effect of rhizosphere sharing in one pot. We evaluated the Hedley-fractionated P of rhizosphere soil and plant P uptake in each pot. We found that both P-efficient legumes did not clearly decrease the less labile P (NaOH-P) of rhizosphere soil in no P treatment, while these clearly decreased the less labile P in 100 kg P ha−1 treatment. It indicates that P-efficient legumes can solubilize the fertilized P but not native less labile P of the soil. The NS treatment increased the labile P of rhizosphere compared with CS by solubilizing the fertilized P, except for MZ/GN intercropping at 50 kg P ha−1. Relative to CS, MZ/PP intercropping increased the total plant P uptake per pot (20%–40%) under P-fertilized conditions, whereas MZ/GN intercropping decreased it (17%) at 50 kg P ha−1 or showed no change at 100 kg P ha−1. MZ/PP intercropping improved P fertilizer recovery efficiency, whereas MZ/GN intercropping did not. Enhanced P use efficiency through intercropping with P-mobilizing legumes is dependent on P-solubilizing characteristics of each P-mobilizing legume.

The Inspired Life Program: Development of a multicomponent positive psychology intervention for rural adults in Ghana.

Although several theories and studies have explored human strengths and mental well-being at the global level, these insights are rarely tested and translated into practice in sub-Saharan Africa. This study aims to describe the development of a 10-session multicomponent positive psychology intervention, the Inspired Life Program (ILP), designed to promote mental health and reduce symptoms of depression and negative affect in rural adults in Ghana. Guided by the Medical Research Council's framework for developing complex interventions, a seven-step iterative community-based participatory research approach was adopted to develop the ILP, based on constructs and principles of positive psychology and cognitive-behavioral model. The final intervention components included a 10-session, two-hourly, once-weekly manualized program designed to promote meaningful and purposeful living, self-acceptance, personal growth, goal-setting and problem-solving skills, and positive thinking through group discussion and activity sessions. We describe the program theory and implementation strategy of the final intervention, and reflect on the challenges and lessons learned from applying this framework in the study context. The development of strengths-based interventions and practicality of methods to promote positive mental health in rural adults are feasible, and have important policy implications for mental health and social care in sub-Saharan Africa.

Combined application of the EM-DEA and EX-ACT approaches for integrated assessment of resource use efficiency, sustainability and carbon footprint of smallholder maize production practices in sub-Saharan Africa

The goal to improve food security in sub-Saharan Africa (SSA) through domestic, resource efficient and low carbon agriculture is importance. Interventions to produce more food could impact the resource-base and lead to increase in greenhouse gas (GHG) emissions from agroecosystems. Unfortunately, existing methods are limited in analyzing small-scale agricultural systems, and this situation is an obstacle to decision making which aims at sustainable agriculture. In this paper, we showcase the recently developed Emergy-Data Envelopment Analysis (EM-DEA) approach to assess the resource use efficiency (RUE) and sustainability in maize production systems in Ghana, SSA. Using the Agricultural Production Systems sIMulator (APSIM), five land use and resource management scenarios were modeled to represent practices as decision making units (DMUs) in small-scale maize systems. The carbon footprint of the systems was assessed using an approach, which we adapted from the FAO Ex-Ante Carbon balance Tool (EX-ACT). The overall trend of the results showed that the yield, total emergy, GHG emissions and carbon footprint all increased with increase in urea application intensity. However, the relationship between the yield and urea intensity was not always linear. A system that used more renewable or fewer resources to produce a yield equal to that of its peer was considered more efficient and sustainable in relative terms. In particular, the business-as-usual scenario (12 kg/ha/yr NPK input to rainfed maize system, i.e. Extensive12) was inefficient when compared to the four contrasting scenarios. The ecological intensive scenario (20 kg/ha/yr urea input to rainfed maize-legume intercropping system, i.e. Intercrop20) achieved the greatest marginal yield, better RUE and sustainability. The high input scenario (100 kg/ha/yr urea input plus supplemental irrigation to maize monoculture, i.e. Intensive100) produced the greatest yield, but the demand for purchased inputs as well as GHG emissions and carbon footprint were greatest. The no external input scenario (0 kg/ha/yr urea input to rainfed maize system, i.e. Extensive0), and the moderate input scenario (50 kg/ha/yr urea input plus supplemental irrigation to maize monoculture, i.e. Intensive50) showed the greatest and least yield gaps relative to Intensive100, respectively. Based on these results and trade-off analysis, it was evident that Intercrop20 and Intensive50 were the two best case scenarios. As such, land use policy that aims at sustainable agriculture could recommend Intercrop20 and Intensive50 for implementation in low and high input maize production systems, respectively. Comparison between our results and other existing empirical studies revealed similarities that confirm our results. We conclude that the information derived using the EM-DEA and EX-ACT approaches could be useful when making informed decisions that aim at sustainable agriculture. Despite the limitation caused by scarcity of data, the use of the EM-DEA approach led to inclusive information on RUE and sustainability of the DMUs. Hence, the EM-DEA approach represents a way forward to better assess energy footprint in agricultural land use as a whole.

The impact of Covid-19 on gold and gemstone artisanal and small-scale mining in sub-Saharan Africa: The case of Ghana and Kenya

ABSTRACT Artisanal and small-scale miners are facing unprecedented challenges due to the novel coronavirus (Covid-19) pandemic. The paper adopts a practice-based approach to examine the impact of Covid-19 on gold and gemstone artisanal and small-scale mining (ASM) practices in sub-Saharan Africa. It highlights the informality of ASM and discusses how the Ghana and Kenya governments’ measures have significantly increased the vulnerabilities of the miners and mining communities. Based on a document analysis of the governments’ responses to Covid-19, mining industry reports, and interviews with 29 mining stakeholders in Ghana and Kenya, the paper identifies the economic and social impacts of the Covid-19 pandemic on gold and gemstone ASM in both countries. We highlight the key policy challenges and suggest actions that can help mitigate the negative impacts the pandemic has had on ASM, which include the need to address informality in the ASM sub-sector.

Double-Shift Schooling Practice in Sub-Saharan Africa: Benefits and Dysfunctions

Double-Shift Schooling Practice in Sub-Saharan Africa: Benefits and Dysfunctions

Overview of surgical and anesthesia practice in sub-Saharan Africa during the 19th century: the example of the people of Bunyoro.

In 1879, during a missionary expedition in the actual Uganda, the British medical student Robert Felkin witnessed a cesarean delivery surgery under general anaesthesia performed by Bunyoro´s doctors. On this occasion he saw how Bunyoro´s medicine was well elaborate in comparison with other sub-Saharan African cultures but also with occidental medicine. Through his report, Felkin brought to light the high scientific medical level of the Bunyoro´s doctors far away from the prejudice of a traditional African medicine surrounded by superstition and witchcraft.