Priority In Africa Research Articles

Attribution of extreme weather events in Africa: a preliminary exploration of the science and policy implications

Extreme weather events are a significant cause of loss of life and livelihoods, particularly in vulnerable countries and communities in Africa. Such events or their probability of occurring may be, or are, changing due to climate change with consequent changes in the associated risks. To adapt to, or to address loss and damage from, this changing risk we need to understand the effects of climate change on extreme weather events and their impacts. The emerging science of probabilistic event attribution can provide scientific evidence about the contribution of anthropogenic climate change to changes in risk of extreme events. This research has the potential to be useful for climate change adaptation, but there is a need to explore its application in vulnerable developing countries, particularly those in Africa, since the majority of existing event attribution studies have focused on mid-latitude events. Here we explain the methods of, and implications of, different approaches to attributing extreme weather events in an African context. The analysis demonstrates that different ways of framing attribution questions can lead to very different assessments of change in risk. Crucially, defining the most appropriate attribution question to ask is not a science decision but one that needs to be made in dialogue with those stakeholders who will use the answers. This is true of all attribution studies but may be particularly relevant in a tropical context, suggesting that collaboration between scientists and policy-makers is a priority for Africa.

Offline: Delivering a new future for Africa

Post-Ebola, commentators have been given permission to say in public what they have thought in private for a long time—namely, that WHO's Regional Office for Africa (AFRO) has a record and reputation for failure second to none in global health today. In advance of an unprecedented meeting convened by the new Regional Director for WHO AFRO, Dr Matshidiso Moeti, earlier this month, I asked a group of Africa health experts for their views on WHO's work on the continent. WHO AFRO does have strengths. Most importantly of all, its country offices. Africa has one of the fastest growing collections of national economies in the world today. It has progressively expanding scientific capacities. Yet for all of these advantages, WHO AFRO is not well respected. Its performance has been a persistent disappointment. It can claim no important or substantive wins from its work. It is seen as a large bureaucracy with little impact. There has been no effective leadership for decades. Staff are “decent but unambitious”, and are therefore not respected for their competency. One disadvantage is the location of the Regional Office in Brazzaville, Congo. It is isolated, distant, and remote, characteristics that are said to be true of the entire organisation. WHO AFRO needs to be brutally honest with itself, our advisers suggested. A poor history of Regional Directors. A low talent pool across the organisation. Corrupt appointments made as rewards for past service, instead of on merit. Donor voices that dominate because there is no clear strategy from WHO AFRO's leadership. And basic public health functions in countries that have been ignored or neglected. To worsen WHO AFRO's influence still further, the Regional Office has a poor relationship with WHO's headquarters in Geneva. WHO AFRO has the largest regular budget of any WHO region, but there is little or no accountability about how its funds are spent. The prospects for WHO AFRO are bleak: an accelerating brain drain, declining self-determination as a continent, and a chronic erosion of trust and confidence. Yet for all of these dismal weaknesses, the country devastation and institutional crises precipitated by Ebola have created a remarkable opportunity—to lead change, and to promote transparency and accountability, around a clear set of new priorities for Africa. Does such a vision suggest a rationally optimistic outlook or simplistic radical naivety? There is one reason to be hopeful: a new Regional Director for WHO AFRO, Dr Moeti, who is motivated for change. She wants to strengthen health and economic security in Africa, and she intends to deliver on the promise of the Sustainable Development Goals for the continent. She knows that her first priority must be to re-establish confidence in WHO AFRO among key partners, especially those who might consider investing in WHO's work. One decision shows her commitment to working differently. She has appointed an Independent Advisory Group, chaired by Francis Omaswa and Helene Gayle, to give her strategic advice on WHO AFRO and “on mechanisms to support improved health systems performance of Member States towards better health outcomes”. The group met for the first time earlier this month in Johannesburg (full disclosure: I am one of 16 members). Two important strands of work emerged. First, to embark on ambitious internal reforms, changing the culture of WHO AFRO to one of accountability for results and resources. Second, to implement a 10-year African Health Transformation Programme. One aim of this initiative is to deliver universal health coverage across 47 countries. Dr Moeti and her Advisory Group want to make Africa a destination for leadership in health. The Lancet will make its contribution to this vision through our Commission on the Future of Health in Sub-Saharan Africa. This Commission, chaired by Peter Piot, includes leading African voices on health and medical science. Last week in London, Tumani Corrah, Peter Lamptey, Nelson Sewankambo, Alex Ezeh, Bongani Mayosi, Bright Simons, and Nduku Kilonzo met with Peter Piot and others to consider what they could do to add value to existing efforts to scale up action on health in Africa. The Commission will complete its work this year, and we plan to launch its findings early in 2016. The next few years will be decisive for Africa. There is also every prospect that a new Director-General of WHO, succeeding Margaret Chan in July, 2017, will come from the continent. Now is therefore not the time for armchair criticism of WHO AFRO or African efforts to advance health on the continent. Now is a moment to join hands and get to work for Africa.

Part I: cancer in Sudan—burden, distribution, and trends breast, gynecological, and prostate cancers.

Despite the growing burden of cancer worldwide, it continues to receive low priority in Africa, across the continent and specifically in Sudan. This is due to political unrest, limited health resources, and other pressing public health issues such as infectious diseases. Lack of awareness about the magnitude of the current and future cancer burden among policy makers play a major role as well. Although, the real scope of cancer in Sudan is not known, the reported cases have increased from 303 in 1967–6303 in 2010. According to Globocan estimates, the top most common cancers in both sexes are breast, non-Hodgkin lymphoma, leukemia, esophagus, and colorectum. This review is the first of four papers that focuses on cancer, its distribution and trend as well as the risk factors most common in Sudan. It is expected that cancer will increase in Sudan as a result of migration of people from rural areas to urban cities in the pursuit of a better standard of living, which has resulted in lifestyle and behavioral changes that include tobacco chewing and smoking, unhealthy dieting, and a lack of physical activity. These changes are further exacerbated by the aging population and have made the country vulnerable to many diseases including cancer. These reviews are meant to provide a better understanding and knowledge required to plan appropriate cancer-control and prevention strategies in the country.

Proceedings of the 2013 AFENET Scientific Conference - Posters sessions

Biennially, trainees and graduates of Field Epidemiology and Laboratory Training Programs (FELTPs) are presented with a platform to share investigations and projects undertaken during their two-year training in Applied Epidemiology. The African Field Epidemiology Network (AFENET) Scientific Conference, is a perfect opportunity for public health professionals from various sectors and organizations to come together to discuss issues that impact on public health in Africa. This year's conference was organized by the Ethiopian Health and Nutrition Research Institute in collaboration with the Ethiopia Ministry of Health, Ethiopian Public Health Association (EPHA), Ethiopia Field Epidemiology Training Program (EFETP), Addis Ababa University (AAU), Training Programs in Epidemiology and Public Health Interventions Network (TEPHINET) and AFENET. Participants at this year's conference numbered 400 from over 20 countries including; Angola, Burkina Faso, Cameroon, Central African Republic, Democratic Republic of the Congo, Ethiopia, Ghana, Indonesia, Kenya, Mozambique, Namibia, Nigeria, Rwanda, South Africa, Sudan, Tanzania, Uganda, Yemen and Zimbabwe. The topics covered in the 58 presentations include: emergency response, immunization, outbreak investigation and public health surveillance. The theme for the 5th AFENET Scientific Conference was; “Addressing Public Health Priorities in Africa through FELTPs.” Previous AFENET Scientific conferences have been held in: Accra, Ghana (2005), Kampala, Uganda (2007), Mombasa, Kenya (2009) and Dar es Salaam, Tanzania (2011).

Proceedings of the African Field Epidemiology Network (AFENET) Scientific Conference 17-22 November 2013 Addis Ababa, Ethiopia: plenaries and oral presentations.

Biennially, trainees and graduates of Field Epidemiology and Laboratory Training Programs (FELTPs) are presented with a platform to share investigations and projects undertaken during their two-year training in Applied Epidemiology. The African Field Epidemiology Network (AFENET) Scientific Conference, is a perfect opportunity for public health professionals from various sectors and organizations to come together to discuss issues that impact on public health in Africa. This year's conference was organized by the Ethiopian Health and Nutrition Research Institute in collaboration with the Ethiopia Ministry of Health, Ethiopian Public Health Association (EPHA), Ethiopia Field Epidemiology Training Program (EFETP), Addis Ababa University (AAU), Training Programs in Epidemiology and Public Health Interventions Network (TEPHINET) and AFENET. Participants at this year's conference numbered 400 from over 20 countries including; Angola, Burkina Faso, Cameroon, Central African Republic, Democratic Republic of the Congo, Ethiopia, Ghana, Indonesia, Kenya, Mozambique, Namibia, Nigeria, Rwanda, South Africa, Sudan, Tanzania, Uganda, Yemen and Zimbabwe. The topics covered in the 144 oral presentations included: global health security, emergency response, public health informatics, vaccine preventable diseases, immunization, outbreak investigation, Millennium Development Goals, Non-Communicable Diseases, and public health surveillance. The theme for the 5th AFENET Scientific Conference was; “Addressing Public Health Priorities in Africa through FELTPs.” Previous AFENET Scientific conferences have been held in: Accra, Ghana (2005), Kampala, Uganda (2007), Mombasa, Kenya (2009) and Dar es Salaam, Tanzania (2011).

A return-on-investment framework to identify conservation priorities in Africa

Environmental conservation activities must continue to become more efficient and effective, especially in Africa where development and population growth pressures continue to escalate. Recently, prioritization of conservation resources has focused on explicitly incorporating the economic costs of conservation along with better defining the outcomes of these expenditures. We demonstrate how new global and continental data that spans social, economic, and ecological sectors creates an opportunity to incorporate return-on-investment (ROI) principles into conservation priority setting for Africa. We suggest that combining conservation priorities that factor in biodiversity value, habitat quality, and conservation management investments across terrestrial, freshwater, and coastal marine environments provides a new lens for setting global conservation priorities. Using this approach we identified seven regions capturing interior and coastal resources that also have high ROI values that support further investment. We illustrate how spatially explicit, yet flexible ROI analysis can help to better address uncertainty, risk, and opportunities for conservation, while making values that guide prioritization more transparent. In one case the results of this prioritization process were used to support new conservation investments. Acknowledging a clear research need to improve cost information, we propose that adopting a flexible ROI framework to set conservation priorities in Africa has multiple potential benefits.

Patterns of adherence to antiretroviral therapy and HIV drug resistance over time in the Stratall ANRS 12110/ESTHER trial in Cameroon

The emergence of HIV drug resistance is a crucial issue in Africa, where second-line antiretroviral therapy (ART) is limited, expensive and complex. We assessed the association between adherence patterns and resistance emergence over time, using an adherence measure that distinguishes low adherence from treatment interruptions, in rural Cameroon. We performed a cohort study among patients receiving nonnucleoside reverse transcriptase inhibitor (NNRTI)-based ART in nine district hospitals, using data from the Stratall trial (2006-2010). Genotypic mutations associated with antiretroviral drug resistance were assessed when 6-monthly HIV viral loads were > 5000 HIV-1 RNA copies/mL. ART adherence data were collected using face-to-face questionnaires. Combined indicators of early (1-3 months) and late (6 months to t - 1; t is the time point when the resistance had been detected) adherence were constructed. Multivariate logistic regression and Cox models were used to assess the association between adherence patterns and early (at 6 months) and late (after 6 months) resistance emergence, respectively. Among 456 participants (71% women; median age 37 years), 45 developed HIV drug resistance (18 early and 27 late). Early low adherence (< 80%) and treatment interruptions (> 2 days) were associated with early resistance [adjusted odds ratio (95% confidence interval) 8.51 (1.30-55.61) and 5.25 (1.45-18.95), respectively]. Early treatment interruptions were also associated with late resistance [adjusted hazard ratio (95% confidence interval) 3.72 (1.27-10.92)]. The emergence of HIV drug resistance on first-line NNRTI-based regimens was associated with different patterns of adherence over time. Ensuring optimal early adherence through specific interventions, adequate management of drug stocks, and viral load monitoring is a clinical and public health priority in Africa.

The Status of Conservation Education in Africa

There are 5 global eco-regions regarded as top conservation priorities in Africa, and each one has a center for conservation studies. Established in 1962, the College of Wildlife Management at Mweka, Tanzania, has trained more than 5000 wildlife managers from 52 countries till date in the Eastern Arc Montane eco-region. The Upper and Lower Guinea eco-region is represented by the Sapo Conservation Center (SCC) in the eponymous National Park in Liberia and the A.P. Levenits Ornithological Research Institute (APLORI), Jos, Nigeria. The SCC offers training programs of up to 2 weeks duration, 2 to 3 times a year for students and academic instructors from the University of Liberia, Monrovia, Forestry Training Institute, Tubmanburg and Nimba County Community College, Nimba. The APLORI, founded in 2002, is a premier institute of ornithological research and conservation training in West Africa, and 66 graduates have left its portals to take up crucial responsibilities in the government, civil society and academia in Africa. The Cape Fynbos eco-region famed for its restioid, ericoid and proteoid components hosts the Southern African Wildlife College (SAWC) for training managers and conservationists in diverse fields such as such as nature-based tourism, trans-frontier conservation area management and capacity building at the community level. SAWC is situated in South Africa in a natural low veld environment, 10km west of the Orpen Gate of the Kruger National Park. The Albertine Rift Montane eco-region with flagship endangered species such as the Mountain and Eastern Lowland gorillas, saw the launch of a conservation primary school in Ilima, Democratic Republic of Congo (DRC) in September 2013; building 14 other unique primary schools over a period of 10 years in key landscapes in Africa is a commitment of the African Wildlife Foundation (AWF). Last but not the least, the Ethiopian highlands eco-region, houses species like the Ethiopian wolf and is served by the Wondo Genet College of Forestry in southern Ethiopia to train conservation professionals in the Horn of Africa region and beyond.

Whole-of-Government Approaches to Fragile States in Africa

For a number of years fragile states have been high on the foreign policy agendas of the USA and the EU. Both actors look upon fragile states with great concern and consider them as security threats. Officially they give priority to ‘whole-of-government approaches’ (wga) when addressing the threats from these states. However, there is a gap between the policy declarations and the policies implemented by the two actors. The missing link in the implementation of wga in Africa is explained by two variables: on the one hand, material interests in the continent and, on the other hand, the institutions in Washington and Brussels involved in policy making. It is the lack of a strong foreign policy priority for Africa that explains the inadequate US implementation of wga. In the case of the EU, it is the multitude of institutions and institutional interests that explains the lack of implementation, rather than a lack of European interests in the fragile states on continent.

The African cancer advocacy consortium: shaping the path for advocacy in Africa

Although there is significant evidence of a cancer epidemic in Africa, there is limited awareness about cancer in most African countries. By partnering with international organizations and institutions such as the University of Florida and the Prostate Net, the African Organisation for Research and Training in Cancer (AORTIC) is committed to improving cancer advocacy in Africa. This paper presents some of the recent efforts on cancer advocacy in Africa, including the results of a SWOT analysis conducted for the cancer advocacy workshop and the guidelines developed by cancer advocates on best practices for cancer advocacy in Africa. One of the outcomes of these efforts is the African Cancer Advocates Consortium (ACAC) founded by cancer advocates in Africa to, “Make Cancer a Top Priority in Africa”. While we have started the work to strengthen cancer advocacy in Africa, we still have a long way to go. Our goal of making cancer a priority in Africa can mainly be achieved by: (1) increasing the manpower for cancer advocacy through education and training; and (2) strengthening the network of cancer advocates across the continent.

Proceedings of the International Workshop on Cancer Advocacy for African Countries

Proceedings of the International Workshop on Cancer Advocacy for African Countries

Perspective of an advocate: best practices for Community Outreach Advocacy

Of all the different types of advocacy, Community Outreach Advocacy (COA) is the best methodology. This methodology is the prolegomena to the achievement of all other advocacies including political, fundraising, research, support and education. This is because the outcome of COA awareness work is an informed group of people. Such people can comprehend and tackle any other initiatives in addressing the issue at stake and so prevent and control unnecessary suffering and deaths caused by cancer! At the end of the day, the African Cancer Advocates Consortium (ACAC) will achieve its mission to “Make Cancer a Top Priority in Africa” through informed people.

Inclusion of vulnerable groups in health policies: Regional policies on health priorities in Africa.

BackgroundIf access to equitable health care is to be achieved for all, policy documents must mention and address in some detail different needs of groups vulnerable to not accessing such health care. If these needs are not addressed in the policy documents, there is little chance that they will be addressed at the stage of implementation.ObjectivesThis paper reports on an analysis of 11 African Union (AU) policy documents to ascertain the frequency and the extent of mention of 13 core concepts in relation to 12 vulnerable groups, with a specific focus on people with disabilities.MethodThe paper applied the EquiFrame analytical framework to the 11 AU policy documents. The 11 documents were analysed in terms of how many times a core concept was mentioned and the extent of information on how the core concept should be addressed at the implementation level. Each core concept mention was further analysed in terms of the vulnerable group in referred to.ResultsThe analysis of regional AU policies highlighted the broad nature of the reference made to vulnerable groups, with a lack of detailed specifications of different needs of different groups. This is confirmed in the highest vulnerable group mention being for ‘universal’. The reading of the documents suggests that vulnerable groups are homogeneous in their needs, which is not the case. There is a lack of recognition of different needs of different vulnerable groups in accessing health care.ConclusionThe need for more information and knowledge on the needs of all vulnerable groups is evident. The current lack of mention and of any detail on how to address needs of vulnerable groups will significantly impair the access to equitable health care for all.

Maternal and Child Health: A Priority in Africa

The reproductive health plays a major role in the health system. However, although it is defined as “a state of physical, mental, and social well-being in all matters relating to the reproductive system, its functions, its operation and not merely the absence of disease or infirmity”, it is nevertheless left a link still worrying in its shutters relative to the mother and to the child in sub-Saharan Africa.

No physical health without mental health: lessons unlearned?

Dr Brock Chisholm, the first Director-General of the World Health Organization (WHO), was a psychiatrist and shepherded the notion that mental and physical health were intimately linked. He famously stated that “without mental health there can be no true physical health”.1 Half a century later, we have strong evidence elucidating the bidirectional relationship between mental illnesses – specifically depression and anxiety – and physical health outcomes. However, policy continues to lag behind the evidence in this regard, as demonstrated by our global noncommunicable disease response. Over a decade ago, the World Health Assembly adopted a global strategy for the prevention and control of noncommunicable disease. At the time, these were limited to the following four illness types: cardiovascular disease, diabetes, respiratory illness and cancers. Such a categorization would set a precedent for the exclusion of mental illnesses from all future WHO discussions on noncommunicable diseases. It is not surprising then, that in the 2008–2013 action plan for the global strategy for the prevention and control of noncommunicable diseases mental illnesses were relegated to a footnote, with the justification that they do not share risk factors with the other four types of illnesses.2 We take issue with this viewpoint, as mental illnesses are themselves risk factors that affect the incidence and prognosis of diseases traditionally classified as “noncommunicable”. Patients with type II diabetes mellitus, for example, are twice as likely to experience depression as the general population,3 and those patients with diabetes who are depressed have greater difficulty with self-care.4 Patients suffering from mental illness are twice as likely to smoke cigarettes as other people, and in patients with chronic obstructive pulmonary disease mental illness is linked to poorer clinical outcomes.5,6 Up to 50% of cancer patients suffer from a mental illness, especially depression and anxiety,7 and treating symptoms of depression in cancer patients may improve survival time.8 Similarly, in patients who are depressed, the risk of having a heart attack is more than twice as high as in the general population;9 further, depression increases the risk of death in patients with cardiac disease.10 Moreover, treating the symptoms of depression after a heart attack has been shown to lower both mortality and re-hospitalization rates.11 In light of this evidence, how can we possibly address the burgeoning epidemic of noncommunicable diseases without tackling co-morbid mental illnesses? Mental illnesses were declared a regional priority in Africa during the WHO African Region Ministerial Consultation on Noncommunicable Diseases, held in Brazzaville, Congo, in April 2011. Later that month the WHO’s African Member States and India reiterated this priority at the first Global Ministerial Conference on Healthy Lifestyles and Noncommunicable Disease Control, held in Moscow, Russia.12 As a result, mental illnesses were featured prominently in the preambles of the Moscow Declaration, as well as in the political declaration issued by the United Nations General Assembly at the high-level meeting on noncommunicable diseases held in New York City in September 2011.13 Despite this progress, however, mental illnesses received no mention at all in the resolution on noncommunicable diseases that WHO’s Member States adopted during the 130th session of WHO’s Executive Board.14 Mental illnesses were also omitted from WHO’s proposed monitoring framework, indicators and voluntary targets for the prevention and control of noncommunicable diseases, which was released in November 2012.15 The 2008–2013 action plan for the global strategy for the prevention and control of noncommunicable diseases will be revised over the coming year, and the WHO’s Executive Board and World Health Assembly are preparing their deliberations for 2013. During this critical time we urge Member States to recognize the importance of co-morbid mental illnesses as amplifiers of the burden of other noncommunicable diseases. To this end, we call on Member States to assess and monitor co-morbid mental illnesses in primary care settings, prioritize the training of professionals in mental health care, and, critically, incorporate mental health interventions within chronic disease programs as part of a vigorous global response to noncommunicable diseases. We now know that addressing mental illnesses in primary care settings will delay progression, improve survival outcomes, and reduce the health care costs of other noncommunicable diseases. The time has now come to do away with the artificial divisions between mental and physical health, as WHO’s first Director-General championed so many decades ago.

An estimate of the prevalence of dementia in Africa: A systematic analysis

BackgroundThe burden of non–communicable diseases is growing, particularly in developing countries. The greatest economic burden is due to dementia, the prevalence of which is rising with increasing longevity. In Africa, where the rate of increase of elderly persons is the fastest in the world, dementia is normally dismissed as a part of normal ageing. The lack of awareness means that many patients are suffering undiagnosed. This review aims to assess the information on the prevalence of dementia in Africa in order to estimate the current burden.MethodsA parallel search of Medline, EMBASE and Global Health limited to post–1980 found only 10 relevant studies. Data on prevalence and risk factors were extracted and analysed. We modelled the available information and used the UN population figures for Africa to determine the age–specific and overall burden of dementia.ResultsThe overall prevalence of dementia in adults older than 50 years in Africa was estimated to be about 2.4%, which translates to 2.76 million people living with a disease in 2010. About 2.10 millions of them live in Sub–Saharan Africa. Prevalence was the highest among females aged 80 and over (19.7%) and there was little variation between regions. Alzheimer disease was the most prevalent cause of dementia (57.1%) followed by vascular dementia (26.9%). The main risk factors were increasing age, female sex and cardiovascular disease.ConclusionsInformation on dementia prevalence in Africa is very limited. Further research will not only provide a more reliable estimate of prevalence, and consequently the burden of disease, but will also raise awareness of the problem. This is critical in promoting help–seeking behaviour and generating the political commitment to make dementia a public health priority in Africa.

Public health priorities in Africa

Public health priorities in Africa

Increasing the priority of mental health in Africa: findings from qualitative research in Ghana, South Africa, Uganda and Zambia

Despite the high prevalence of mental illness, mental health remains a low priority in Africa. There has been no investigation of the views of stakeholders in Africa on why this is and what can be done. This paper reports a comparison of the views of stakeholders in Ghana, South Africa, Uganda and Zambia, focusing on the priority given to mental health by the government at the national and regional/province levels. We conducted semi-structured interviews with key stakeholders and used a two-stage approach to analysis: firstly framework analysis in each study country, followed by comparative analysis of the country data. Mental health was largely considered a low priority at national and regional/provincial levels in all four countries. We identified nine factors affecting the priority of mental health, which were grouped into three categories: legitimacy of the problem, feasibility of response and support for response. Respondents put forward a range of experiences and suggestions for increasing the priority given to mental health. We conclude with broad suggestions to raise the priority of mental health. These suggestions are particularly relevant as mental health increases in priority on the international agenda, in order to inform advocacy for increased priority for mental health in Africa.

Roadside conditions as predictor for wildlife crossing probability in a Central African rainforest

AbstractThe negative effects of roads on wildlife in tropical rainforests are poorly understood. Road construction has high priority in Africa, while negative impacts of roads on wildlife movement often are neglected. This study aims at providing information on the effects of roads on crossing behaviour of rainforest wildlife. The probability that wildlife would cross forest roads was analysed for association with ten different factors that were linked to road presence or construction. Factors were divided into three classes: vegetation cover, topography and human influence. A trackplot survey was done in southern Cameroon, Africa. Trackplots were laid along a 32 km unpaved logging road that intersects Campo‐Ma’an National Park. Tracks of several species were found frequently (e.g. genets and porcupines); while others were found only sporadically (e.g. forest duikers and apes). The actual physical obstacles found along the road (e.g. logs, banks, etc.) were highly negatively correlated with crossing probabilities. For all wildlife species high vegetation cover was positively correlated to crossing probability. This study indicates that roads have a large impact on wildlife, and suggests which factors could be altered during road construction and maintenance in order to mitigate these impacts.

Public Health and Policy Issues of Hernia Surgery in Africa

Inguinal hernia repair has been overlooked as a public health priority in Africa, with its high prevalence largely unrecognized, and traditional public health viewpoints assuming that not enough infrastructure, human resources, or financing capacity are available for effective service provision. Emerging evidence suggests that inguinal hernias in Ghana are approximately ten times as prevalent as in high-income countries, are much more long-standing and severe, and can be repaired with low-cost techniques using mosquito net mesh through international collaboration. Outcomes from surgery are comparable to published literature, and potential exists for scaling up capacity. Special attention must be paid to creating financing systems that encourage eventual local self-sustainability.