Rates In sub-Saharan Africa Research Articles

Impact of Globalization, Women's Empowerment, and Maternal Health in Sub-Saharan Africa (SSA)

Purpose of the study : Women's empowerment nowadays refers to encouraging women's feeling of self-worth, their ability to make their own decisions, and the right to impact their own and others' well-being. This research aims to look at the impact of globalization and women's empowerment on maternal health in Sub-Saharan Africa. Methodology : The econometric method is based on a dynamic panel model that was applied to a sample of 37 Sub-Saharan African countries from 2000 to 2017. For a deep analysis, the sample is separated into four subgroups. The results for the African context were obtained using the GMM estimator, whereas the results for the regions were obtained using the LSDV-corrected estimator. Main Findings : The study's findings show that foreign direct investment and women's empowerment have a significant impact on lowering maternal mortality rates in Sub-Saharan Africa's West, East, Center, and South. According to this study, globalisation is no longer limited to the exchange of goods and services between countries but also includes technological exchange, migration, and impacts on all sectors of activity. Research limitation : The study's main limitation is that it appears impossible to determine the exact impact of liberalising these services on health. The lack of data on a long series is also a challenge in this study. Future research will need to consider the long-term implications. Novelty/Originality of the study : This study is distinct from others in that it is not restricted to the general context of SSA. It captures the specific effect of various regions by employing econometric tools tailored to each region. This study adds to the empirical literature on the impact of globalisation and women's empowerment on maternal health in SSA countries.

Structural quality of labor and delivery care in government hospitals of Ethiopia: a descriptive analysis

BackgroundEthiopia has low skilled birth attendance rates coupled with low quality of care within health facilities contributing to one of the highest maternal mortality rates in Sub-Saharan Africa, at 412 deaths per 100,000 live births. There is lack of evidence on the readiness of health facilities to deliver quality labor and delivery (L&D) care. This paper describes the structural quality of routine L&D care in government hospitals of Ethiopia.MethodsA facility-based cross-sectional study design, involving census of all government hospitals in Southern Nations Nationalities and People’s Region (SNNPR) (N = 20) was conducted in November 2016 through facility audit using a structured checklist. Data collectors verified the availability and functioning of the required items through observation and interview with the heads of labor and delivery case team. An overall mean score of structural quality was calculated considering domain scores such as general infrastructure, human resource and essential drugs, supplies, equipment and laboratory services. Summary statistics such as proportion, mean and standard deviation were computed to describe the degree of adherence of the hospitals to the standards related to structural quality of routine labor and delivery care.ResultsOne third of hospitals had low readiness to provide quality routine L&D care, with only two approaching near fulfilment of all the standards. Hospitals had fulfilled 68.2% of the standards for the structural aspects of quality of L&D care. Of the facility audit criteria, the availability of essential equipment and supplies for infection prevention scored the highest (88.8%), followed by safety, comfort and woman friendliness of the environment (76.4%). Availability skilled health professionals and quality management practices scored 72.5% each, while availability of the required items of general infrastructure was 64.6%. The two critical domains with the lowest score were availability of essential drugs, supplies and equipment (52.2%); and laboratory services and safe blood supply (50%).ConclusionSubstantial capacity gaps were observed in the hospitals challenging the provision of quality routine L&D care services, with only two thirds of required resources available. The largest gaps were in laboratory services and safe blood, and essential drugs, supplies and equipment. The results suggest the need to ensure that all public hospitals in SNNPR meet the required structure to enable the provision of quality routine L&D care with emphases on the identified gaps.

Barriers to accessing follow up care in post-hospitalized trauma patients in Moshi, Tanzania: A mixed methods study.

Disproportionately high injury rates in Sub-Saharan Africa combined with limited access to care in both the acute injury phase and for injury patients requiring continued care after hospital discharge remains a challenge. We aimed to characterize barriers to transportation and access to care in a cohort of post-hospitalized injury patients in Moshi, Tanzania. This was a mixed-methods study of a prospective cohort of trauma registry patients presenting to Kilimanjaro Christian Medical Center between August 2018 and January 2020. We conducted standardized patient/family surveys and in-depth interviews at a 2-week follow up visit after hospital discharge, and focus groups with healthcare providers. Quantitative results were analyzed using descriptive statistics and multivariable logistic regression using R statistical software. Qualitative results were analyzed using thematic analysis through an iterative process using NVivo software. A total of 1,365 patients were enrolled in the trauma registry, with 169 patients followed up at 2 weeks. Over half of patients at follow-up, 101 (59.8%), reported challenges in traveling. The majority of patients were male (80.3%). Difficulty in traveling since injury was associated with female gender (aOR 5.85 [95% CI 1.20-33.59]) and a need for non-family members escorts for travel (aOR 7.10 [95% CI 1.43-41.66]). Those who reported assault or fall as the mechanism of injury as compared to road traffic injury and had health insurance were less likely to report challenges in traveling (aOR 0.19 [95% CI 0.03-0.90]), 0.11 [95% CI 0.01-0.61], 0.14 [95% 0.02-0.80]). Transportation barriers that emerged from qualitative data included inability to use regular means of transportation, financial challenges, physical barriers, rigid compliance to physician orders, access to healthcare, and social support barriers. Our findings demonstrate several areas to address transportation barriers for post-injury patients in Tanzania. Educational interventions such as clarification of doctors' orders of strict bedrest, provision of vouchers to support financial challenges and alternate means of transportation given physical barriers and reliance on social support may address some of these barriers.

Learning from maternal deaths due to uterine rupture: review of cases from peri-urban Uganda

BACKGROUNDMaternal deaths from uterine rupture continue to occur globally, with particularly high rates in sub-Saharan Africa. Maternal death reviews have been shown to be an effective part of cohesive strategies to prevent future deaths.OBJECTIVEThis study aimed to conduct maternal death reviews for all deaths following uterine rupture in the study center, to assess preventability, and to synthesize key learning points that may help to prevent future maternal deaths following uterine rupture.STUDY DESIGNThorough case reviews of all maternal deaths from 2016 to 2018 at the study center (a national referral hospital in urban Uganda) were conducted by trained multidisciplinary panels of obstetricians and midwives. Medical records of women who died following uterine rupture (n=37, 10.6% of all maternal deaths) were extracted for further analysis.RESULTSMost maternal deaths due to uterine rupture (36/37, 97%) were preventable, with most having been still potentially preventable after the women reached the study center (24/36, 67%). Obstructed labor was the leading cause of uterine rupture, accounting for 73% (27/37) of cases. Previous cesarean delivery was confirmed in 38% (14/37) of cases. The incidence of grand multiparity was 11% (4/37), and 11% (4/37) were primiparous. Most women (28/37, 76%) died within 24 hours of admission. On arrival at the study center, 19 (51%) were critically ill. Exploratory laparotomy was performed in 54% (20/37) of cases, and a further 35% (13/37) died while awaiting laparotomy. Four women died shortly after arrival at the study center (within 1 hour) and received basic resuscitative treatment; 27% (10/37) of women who died had received antenatal planning or preparation.CONCLUSIONMost deaths due to uterine rupture were preventable. The key lessons that emerged from the reviews were: (1) careful birth preparation and complication awareness for women with known risk factors, (2) early recognition of obstructed labor, (3) close monitoring of obstetrical interventions known to be associated with uterine rupture, and (4) treating incipient or suspected uterine rupture as a time-critical obstetrical emergency. The recommendations emerging from our narrative reviews are suitable for implementation in low-resource obstetrical settings, where high numbers of deaths involving uterine rupture occur.

The Influence of Breastfeeding Promotion Programs on Exclusive Breastfeeding Rates in Sub-Saharan Africa: A Systematic Review and Meta-Analysis.

The benefits of breastfeeding in promoting child survival are well recognized. As one of the nutritional interventions for children, exclusive breastfeeding protects babies from various diseases that contribute to infant morbidity and mortality. However, no systematic review and meta-analysis has examined the influence of breastfeeding promotion programs on exclusive breastfeeding rates in sub-Saharan Africa. We examined the influence of breastfeeding promotion programs on exclusive breastfeeding rates at < 1 month, and at 1-5 months of breastfeeding in sub-Saharan countries including Ghana, Burkina Faso, Uganda, South Africa, Guinea-Bissau, Kenya, Tanzania, and the Democratic Republic of Congo. A systematic review and meta-analyses study of randomized controlled trials and quasi-experimental studies was conducted by searching in electronic databases and articles' reference lists. Two investigators independently evaluated and extracted the data. A total of 131 studies were identified using five databases. Of the 10 studies meeting the inclusion criteria for systematic review, seven studies were included in the meta-analysis. We used a random-effects model to pool studies together and performed a subgroup analysis. Breastfeeding promotion programs resulted in significantly higher exclusive breastfeeding rates at < 1 month (OR = 1.60, 95% CI [1.36,1.86]). However, there was no significant effect observed for exclusive breastfeeding at 1-5 months. Combined interventions were more effective in improving exclusive breastfeeding rates than individual counseling or home-based counseling alone. Breastfeeding promotion programs in sub-Saharan Africa are effective in increasing exclusive breastfeeding rates at 6 months after birth.

High-resolution disease maps for cancer control in low-resource settings: A spatial analysis of cervical cancer incidence in Kampala, Uganda.

BackgroundThe global burden of cervical cancer is concentrated in low-and middle-income countries (LMICs), with the greatest burden in Africa. Targeting limited resources to populations with the greatest need to maximize impact is essential. The objectives of this study were to geocode cervical cancer data from a population-based cancer registry in Kampala, Uganda, to create high-resolution disease maps for cervical cancer prevention and control planning, and to share lessons learned to optimize efforts in other low-resource settings.MethodsKampala Cancer Registry records for cervical cancer diagnoses between 2008 and 2015 were updated to include geographies of residence at diagnosis. Population data by age and sex for 2014 was obtained from the Uganda Bureau of Statistics. Indirectly age-standardized incidence ratios were calculated for sub-counties and estimated continuously across the study area using parish level data.ResultsOverall, among 1873 records, 89.6% included a valid sub-county and 89.2% included a valid parish name. Maps revealed specific areas of high cervical cancer incidence in the region, with significant variation within sub-counties, highlighting the importance of high-resolution spatial detail.ConclusionsPopulation-based cancer registry data and geospatial mapping can be used in low-resource settings to support cancer prevention and control efforts, and to create the potential for research examining geographic factors that influence cancer outcomes. It is essential to support LMIC cancer registries to maximize the benefits from the use of limited cancer control resources.

Discontinuation, suboptimal adherence, and reinitiation of oral HIV pre-exposure prophylaxis: a global systematic review and meta-analysis.

Poor adherence to oral HIV pre-exposure prophylaxis (PrEP) diminishes its clinical and public health benefits. This study synthesises evidence regarding discontinuation, adherence, and reinitiation of PrEP among geographically diverse PrEP users. We did a systematic review and meta-analysis evaluating studies published in MEDLINE, Embase, and Cochrane Central Register of Controlled Trials from inception to Dec 18, 2020. We included longitudinal studies that presented data for PrEP discontinuation, defined as investigator-reported loss to follow-up or participant self-reported PrEP stoppage. Data were extracted from published reports and assessed for risk of bias. We used a random-effects meta-analysis to pool estimates of discontinuation and I2 and τ2 to evaluate heterogeneity. This study is registered with PROSPERO, CRD42020155675. We identified 4129 records, of which 59 articles were included (n=43 917 participants). 41·0% (95% CI 18·8-63·5) of participants discontinued PrEP within 6 months, with the highest rates in observational studies. The discontinuation rate in sub-Saharan Africa (47·5%, 95% CI: 29·4-66·4%) was higher than in other regions (p<0·001). Discontinuation rates were lower in studies with adherence interventions than in those without (24·7% vs 36·7%, p=0·015). Gay or bisexual men who have sex with men and transgender women offered daily or non-daily dosing options had lower discontinuation rates than those offered daily dosing alone (21·6% vs 31·5%; p<0·001). The pooled suboptimal adherence within 6 months was 37·7% (95% CI 8·4-66·9). Among people who discontinued PrEP, 47·3% (95% CI 31·5-63·2) reinitiated PrEP within 1 year of PrEP initiation. The included studies had poor quality in terms of study design, with a moderate risk of bias. Strategies to encourage reinitiating PrEP for new or persistent risk should be a focus of future PrEP implementation strategies. National Institutes of Health and Nature Science Foundation of China.

Cancer cervix: Epidemiology and disease burden.

Cervical cancer remains a major public health problem, ranking as the fourth most common cause of cancer incidence and mortality in women worldwide. Wide variations in cervical cancer incidence and mortality were observed with highest incidence rates in Sub Saharan Africa and with 85% of deaths occurring in developing regions of the world. Non-existent or inadequate screening in public health care settings and limited access to the standard treatment options explains the large geographic variation in cervical cancer rates. Persistent infection with high-risk Human papillomavirus (HPV) types is the major risk factor for cervical cancer. High parity, long-term use of oral contraceptive pills, tobacco consumption, co-infection with other sexually transmitted agents, lifestyle factors such as multiple sexual partners, younger age at first sexual intercourse, immunosuppression, and diet have been identified as the co-factors most likely to influence the risk of acquisition of HPV infection and its further progress to cervical carcinogenesis. Differential screening rates and changes in epidemiological patterns have contributed to decreasing trends in cervical cancer in some developed regions of the world. Lower rates were also observed in North Africa and the Middle East, which may be attributed to cultural norms and conservative sexual behaviors. Across world regions, HPV prevalence was highest in women younger than 35 years of age, declining to a plateau in middle age and showed significant association between national age standardized incidence rates and corresponding estimates of HPV prevalence. The five most common HPV types in HPV-positive women worldwide were HPV16, HPV18, HPV31, HPV58, and HPV52, representing 50% of all HPV infections with HPV-16 and HPV-18 infections accounting for about 70% of the total infection burden. Tracking changing trends in the cervical cancer epidemiological patterns including HPV genotypes will immensely contribute toward effective prevention and control measures for cervical cancer elimination.

Climate anomalies and birth rates in sub-Saharan Africa

Climate anomalies and birth rates in sub-Saharan Africa

Abstract P3-12-17: Breast cancer treatment related survival gains in the African breast cancer - Disparities in outcomes study

Abstract Background: Breast cancer (BC) survival in Low and Middle Income Countries (LMICs), and particularly Sub Saharan Africa (SSA), is low and incidence rates are increasing. Accordingly, an almost 90% increase in annual BC mortality is projected to occur until 2040. The WHO Breast Cancer Global Initiative named comprehensive breast cancer treatment as one of three main pillars to reduce BC mortality. Here, we present the urgently needed up-to-date benchmark estimates of treatment effects on BC survival in SSA using data from the African Breast Cancer Disparities in Outcomes (ABC-DO) study.Methods: Since 2014 the hospital-recruited ABC-DO cohort follows-up women diagnosed with BC in five SSA countries. Socio-demographic, diagnostic, treatment and mortality data were obtained from medical records and via three-monthly follow-up calls with the patient. Cox proportional hazard models were fitted to estimate 5-year overall survival related to treatment initiation (surgery or systemic therapy) and treatment completion as time varying variates (surgery and systemic therapy completed) stratified by country and ethnicity and separate for localised and regional tumours. All models were adjusted for age, tumour grade, tumour size, node positivity, HIV status, and socioeconomic status. Results: Of 1699 ABC-DO women with invasive non-metastatic BC, 89% initiated BC treatment (from 72% in Nigeria to 100% in South African white women). Potentially curative treatment (surgery plus systemic therapy) was initiated by 63%, 22% initiated systemic treatment and 5 % only surgery. Initiated systemic therapy was completed by 49% of patients (from 16% in Nigeria to 70 % in South African black women). Median time to first treatment was 1.4 (IQR: 0.8–3) months and differed between countries (from 1.1 (0.6–1.7) in Namibian non-black to 3 (1.5–4.3) in Uganda). After 5 years, 49% (0.44 (CI: 0.31 – 0.62) ) of women initiating any treatment and 59% (0.39 (0.27 – 0.56) of women receiving surgery and initiating systemic treatment were still alive compared to 20% of women receiving no treatment. Conclusion: Timely and comprehensive BC treatment are needed to increase the very low survival rates in SSA. Citation Format: Milena Foerster, Eva Kantelhardt, MD, Pauline Boucheron, Isabel dos-Santos-Silva, PhD, Valerie McCormack, the ABC-DO study team. Breast cancer treatment related survival gains in the African breast cancer - Disparities in outcomes study [abstract]. In: Proceedings of the 2021 San Antonio Breast Cancer Symposium; 2021 Dec 7-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2022;82(4 Suppl):Abstract nr P3-12-17.

Trends and effects of antiretroviral therapy coverage during pregnancy on mother-to-child transmission of HIV in Sub-Saharan Africa. Evidence from panel data analysis

BackgroundAntiretroviral therapy for pregnant women infected with HIV has evolved significantly over time, from single dosage antiretroviral and zidovudine alone to lifelong combination of antiretroviral therapy, but the effect of the intervention on population-level child HIV infection has not been well studied in sub-Saharan Africa. Therefore, this study aimed to establish the trend and effect of ART coverage during pregnancy on mother-to-child HIV transmission in sub-Saharan Africa from 2010 to 2019.MethodsCountry-level longitudinal ecological study design was used. Forty-one sub-Saharan Africa countries were included using publicly available data from the United Nations Programme on HIV/AIDS, World Health Organization, and World Bank. We created a panel dataset of 410 observations for this study from the years 2010–2019. Linear fixed effects dummy variable regression models were conducted to measure the effect of ART coverage during pregnancy on MTCT rate. Regression coefficients with their 95% confidence intervals (CIs) were estimated for each variable from the fixed effects model.ResultsART coverage during pregnancy increased from 32.98 to 69.46% between 2010 and 2019. Over the same period, the rate of HIV transmission from mother to child reduced from 27.18 to 16.90% in sub-Saharan Africa. A subgroup analysis found that in southern Africa and upper-middle-income groups, higher ART coverage, and lower MTCT rates were recorded. The fixed-effects model result showed that ART coverage during pregnancy (β = − 0.18, 95% CI − 0.19–− 0.16) (p < 0.001) and log-transformed HIV incidence-to-prevalence ratio (β = 5.41, 95% CI 2.18–8.65) (p < 0.001) were significantly associated with mother-to-child HIV transmission rate.ConclusionsART coverage for HIV positive pregnant women and HIV incidence-to-prevalence ratio were significantly associated with MTCT rate in sub-Saharan Africa. Based on these findings we suggest countries scale up ART coverage by implementing varieties of proven strategies and control the HIV epidemic to achieve the global target of eliminating MTCT of HIV in the region.

Use of a deep learning and random forest approach to track changes in the predictive nature of socioeconomic drivers of under-5 mortality rates in sub-Saharan Africa

ObjectivesWe used machine learning algorithms to track how the ranks of importance and the survival outcome of four socioeconomic determinants (place of residence, mother’s level of education, wealth index and...

The effect of economic growth on banking system performance: An interregional and comparative study of Sub-Saharan Africa and developed economies

As an important part of the financial sector, banking systems play a critical role in economic development as well as in improving the quality of life of the people of sub-Saharan Africa (SSA). However, little evidence exists in the literature about the performance of the banking systems in SSA compared with developed economies. This paper investigates the effects of economic development on banking performance across 23 SSA countries and 14 developed countries between 1981 and 2018. Using estimation models such as feasible general least squares, fixed-effects estimation with Driscoll-Kraay standard errors, and system and difference generalized method of moments, our findings show that in SSA as a whole, economic development has a positive impact on commercial bank lending, raises lending rates, increases the amount of domestic credit to the private sector (DCPS), and reduces the number of nonperforming loans (NPLs). In developed countries, economic development has a positive impact on lending rates, DCPS, and the number of NPLs. However, although economic development in developed economies has mostly positive effects on banking performance, SSA countries have more performance issues in banking as a whole and in regional pockets. A careful reassessment of SSA’s interregional banking system is therefore highly recommended. An increase in the number of NPLs in East and Southern Africa, a decline in deposit rates offered in Southern, West, and Central Africa, and increasing real interest rates in SSA despite economic growth are some of the concerns that require careful reassessment and policy adjustments.

Burden and outcome of neonatal surgical conditions in Nigeria: A countrywide multicenter cohort study

Background: Despite a decreasing global neonatal mortality, the rate in sub-Saharan Africa is still high. The contribution and the burden of surgical illness to this high mortality rate have not been fully ascertained. This study is performed to determine the overall and disease-specific mortality and morbidity rates following neonatal surgeries; and the pre, intra, and post-operative factors affecting these outcomes. Methods: This was a prospective observational cohort study; a country-wide, multi-center observational study of neonatal surgeries in 17 tertiary hospitals in Nigeria. The participants were 304 neonates that had surgery within 28 days of life. The primary outcome measure was 30-day postoperative mortality and the secondary outcome measure was 30-day postoperative complication rates. Results: There were 200 (65.8%) boys and 104 (34.2%) girls, aged 1-28 days (mean of 12.1 ± 10.1 days) and 99(31.6%) were preterm. Sepsis was the most frequent major postoperative complication occurring in 97(32%) neonates. Others were surgical site infection (88, 29.2%) and malnutrition (76, 25.2%). Mortality occurred in 81 (26.6%) neonates. Case-specific mortalities were: gastroschisis (14, 58.3%), esophageal atresia (13, 56.5%) and intestinal atresia (25, 37.2%). Complications significantly correlated with 30-day mortality (p &lt;0.05). The major risk predictors of mortality were apnea (OR=10.8), severe malnutrition (OR =6.9), sepsis (OR =7. I), deep surgical site infection (OR=3.5), and re-operation (OR=2.9). Conclusion: Neonatal surgical mortality is high at 26.2%. Significant mortality risk factors include prematurity, apnea, malnutrition, and sepsis.

Assessing Business Failures in Ghana; Case Study of Selected Businesses

Unemployment rate in Sub-Saharan Africa is on the ascendancy and the surest way to resolve this problem is by ensuring the sustenance of businesses. The success of businesses is, therefore, of paramount importance to a nation like Ghana; where many businesses fail by their fifth anniversary. Hence, it is of utmost importance to research into the failure of businesses in Ghana in order to safeguard jobs. The writer has, therefore, decided to conduct research into the causes of business failures in Ghana by interacting with some entrepreneurs whose businesses had collapsed, also by obtaining data on some businesses that suffered such fate. In this work, the researcher obtained primary and secondary data from selected businesses that collapsed in Ghana and analysed the causes of the collapse of these businesses. The research showed that the major reasons for the collapse of the selected businesses were; liquidity problems, lack of marketing strategies and lack of market research. Other important factors were diversion of funds and use of short term funds to finance long term (non-current) assets. He has also sought to suggest some remedies to that effect. Nonetheless, he has observed that few businesses that have applied best business practices have been outstanding in performance. The researcher, therefore, has commented on the performance of one of such businesses and advised others to emulate its way of doing business in order to be successful.

Admissions to a Low-Resource Neonatal Unit in Malawi Using a Mobile App and Dashboard: A 1-Year Digital Perinatal Outcome Audit.

Introduction: Understanding the extent and cause of high neonatal deaths rates in Sub-Saharan Africa is a challenge, especially in the presence of poor-quality and inaccurate data. The NeoTree digital data capture and quality improvement system has been live at Kamuzu Central Hospital, Neonatal Unit, Malawi, since April 2019.Objective: To describe patterns of admissions and outcomes in babies admitted to a Malawian neonatal unit over a 1-year period via a prototype data dashboard.Methods: Data were collected prospectively at the point of care, using the NeoTree app, which includes digital admission and outcome forms containing embedded clinical decision and management support and education in newborn care according to evidence-based guidelines. Data were exported and visualised using Microsoft Power BI. Descriptive and inferential analysis statistics were executed using R.Results: Data collected via NeoTree were 100% for all mandatory fields and, on average, 96% complete across all fields. Coverage of admissions, discharges, and deaths was 97, 99, and 91%, respectively, when compared with the ward logbook. A total of 2,732 neonates were admitted and 2,413 (88.3%) had an electronic outcome recorded: 1,899 (78.7%) were discharged alive, 12 (0.5%) were referred to another hospital, 10 (0.4%) absconded, and 492 (20%) babies died. The overall case fatality rate (CFR) was 204/1,000 admissions. Babies who were premature, low birth weight, out born, or hypothermic on admission, and had significantly higher CFR. Lead causes of death were prematurity with respiratory distress (n = 252, 51%), neonatal sepsis (n = 116, 23%), and neonatal encephalopathy (n = 80, 16%). The most common perceived modifiable factors in death were inadequate monitoring of vital signs and suboptimal management of sepsis. Two hundred and two (8.1%) neonates were HIV exposed, of whom a third [59 (29.2%)] did not receive prophylactic nevirapine, hence vulnerable to vertical infection.Conclusion: A digital data capture and quality improvement system was successfully deployed in a low resource neonatal unit with high (1 in 5) mortality rates providing and visualising reliable, timely, and complete data describing patterns, risk factors, and modifiable causes of newborn mortality. Key targets for quality improvement were identified. Future research will explore the impact of the NeoTree on quality of care and newborn survival.

Preventing death following unsafe abortion: a case series from urban Uganda

BACKGROUNDMaternal deaths from unsafe abortion continue to occur globally, with particularly high rates in Sub-Saharan Africa where most abortions are classified as unsafe. Maternal death reviews are an effective part of cohesive strategies to prevent future deaths while abortion remains illegal.OBJECTIVEThis study aimed to conduct maternal death reviews for all deaths occurring following unsafe abortion during the study period, to assess preventability, and to synthesize key learning points that may help to prevent future maternal deaths following unsafe abortions.STUDY DESIGNFull case reviews of all maternal deaths (350 cases from Jan 2016 to Dec 2018) at the study center (a national referral hospital in urban Uganda) were conducted by specially trained multidisciplinary panels of obstetricians and midwives. We extracted the reviews of women who died following unsafe abortions (13 [2.6%]) for further analysis.RESULTSMost maternal deaths owing to unsafe abortion were found to be preventable. The key recommendations that emerged from the reviews were (1) that clinicians should maintain a high index of suspicion for delayed presentation and rapid decompensation in cases where unsafe abortion has occurred, (2) that a low threshold for early intravenous antibiotic therapy should be applied, and (3) that any admission with complications following an unsafe abortion merits review by an experienced clinician as soon as possible.CONCLUSIONPostabortion care is part of essential emergency medical care and should be provided with high standards, especially in areas where there is limited or no legal access to abortion care. Implementing the recommended learning points is likely to be feasible even in low-resource obstetrical settings and, given the high rates of preventability found in maternal deaths owing to unsafe abortion, is likely to be effective.

Institutional and Political Determinants of Statutory Tax Rates: Empirical Evidence from Sub-Saharan Africa

ABSTRACT This paper investigates the extent to which institutional and political factors explain statutory tax rates in sub-Saharan Africa (SSA). In particular, it examines the effect of regulatory quality, political accountability, political fragmentation, the electoral cycle, and ideological orientation on corporate income tax (CIT) rates as well as top marginal personal income tax (PIT) rates during 1990–2017. Different from advanced economies, our results suggest that in SSA institutional (structural) factors are more important than political (conjunctural) ones. Better institutions (proxied by higher regulatory quality) are associated with lower tax rates, whereas weak political accountability (proxied by longer government tenures) and greater fragmentation (linked to polarization) lead to higher tax rates. The electoral cycle is weakly associated with higher CIT, and contrary to findings in advanced economies, the ideological orientation of the government does not appear to influence statutory tax rates in SSA.

Effectiveness of teacher-based nutrition interventions in addressing malnutrition among sub-Saharan children

Introduction: To address the high malnutrition rates in Sub Saharan Africa, most programs addressing malnutrition have continuously been streamlined through the health system, yet this has not yielded results as expected. On the other hand, the education sector has shown an immense capacity to address some challenges, such as eliminating short-term hunger through School feeding programs. Yet, little attention has been given to teachers as far as implementing health and nutrition interventions. With an increased school enrolment rate in Sub Saharan Africa, teachers present huge potential as change agents.Objectives: To consolidate evidence about the effectiveness of teacher-based interventions in addressing malnutrition in Sub- Saharan Africa.Methods: A search strategy through online databases including EBSCO, PubMed, BASE, Cochrane, Google Scholar, LILACS, Project MUSE, TRIP Database, and Emerald Insight gave rise to 95,734 studies. These were identified and taken through a series of screening stages such that the most eligible were included to answer the review question.Results: Three studies fulfilled the inclusion criteria. Results showed that teacher-based interventions such as school lunch, deworming, vitamin A supplementation, and nutrition education positively affect the nutrition status of primary school children, school attendances, are sustainable and reach many children.Conclusion: There is a need to actively involve teachers in the primordial and primary prevention stages of malnutrition through strengthening nutrition education, supplementary programs and school gardening. Teachers have an essential role to play in the fight against Malnutrition in Sub Saharan Africa. Â

Remittances, financial development and poverty reduction in Sub-Saharan Africa: Implications for post-COVID-19 macroeconomic policies

To design and implement effective post-COVID-19 macroeconomics policies to tackle poverty in sub-Saharan Africa (SSA), policymakers need to understand the factors shaping poverty in the region. This paper investigates the effect of international remittances and financial development on poverty alleviation in 44 sub-Saharan African SSA countries from 2010 to 2019. The instrumental variable generalised method of moment technique results indicated that while remittances increase poverty, financial development contributes significantly to poverty reduction. The results consistently revealed that remittances increase both male and female poverty rates, while financial development significantly reduces male and female poverty rates. Other factors such as economic growth, foreign direct investment, and trade openness contributed significantly to reducing poverty. In contrast, government expenditure and foreign aid were found to increase poverty rate in SSA. These results are robust to the Lewbel two-stage least squares estimator. The practical implications of these findings for post-COVID-19 macroeconomic policies in SSA are discussed.