Regions Of sub-Saharan Africa Research Articles

Global, regional, and national burden of male breast cancer in 204 countries and territories: a systematic analysis from the global burden of disease study, 1990-2021.

Male breast cancer (MBC) is a rare malignancy that has been under-investigated, with limited global epidemiological research dedicated to it. A comprehensive estimate of the global, regional, and national burden of MBC is valuable for policy planning. This study aims to evaluate the burden of MBC across 204 countries and territories. MBC data were collected from the 2021 Global Burden of Diseases, Injuries, and Risk Factors (GBD) Study estimates spanning from 1990 to 2021. The global incidence, prevalence, deaths, and disability-adjusted life-years (DALYs) attributed to MBC, as well as corresponding age-standardized rates, were calculated. Temporal trends, projections of incidence and mortality to 2050, lifetime risk, and risk factors of MBC were also estimated according to regions and countries. In 2021, there were 38,827 (95% uncertainty interval [UI], 24,650-47,846) new cases, 320,459 (95% UI, 220,533-384,317) prevalent cases, 13,274 (95% UI, 9074-16,240) deaths, and 380,917 (95% UI, 252,922-476,417) DALYs attributed to MBC worldwide, with the highest disease burden observed in the Eastern Sub-Saharan Africa region. From 1990 to 2021, the age-standardized incidence and mortality rates of MBC significantly increased, but they are projected to decrease over the next 30 years. High-middle Socio-demographic Index (SDI) quintile had the highest lifetime risk of developing MBC, while the low SDI quintile had the highest lifetime risk of dying from MBC. Dietary risk and alcohol use were identified as important risk factors for MBC deaths and DALYs globally. The global burden of MBC significantly increased from 1990 to 2021, with notable geographic disparities. Efforts aimed at MBC prevention and control strategies should take into account the inequities in its global distribution. This study was supported by the National Natural Science Foundation of China (grant numbers 82372996 and 82202913) and the Chongqing Natural Science Foundation (grant number CSTB2023NSCQ-MSX0480).

The role of water and energy in food security among smallholder farmers in Semi-Arid Ghana

ABSTRACT Water, energy, and food (WEF) insecurities are significant issues that are being worsened by climate change. Smallholder farmers in semi-arid regions of Sub-Saharan Africa are among the most vulnerable to these insecurities. Adopting integrated approaches to address these insecurities is critical to achieving sustainable development goals (SDG6, SDG7, and SDG2). Our study takes a household-centric approach to investigate the relationship between water and energy and food insecurity. The results from ordered logistic regression show that households facing water (OR = 2.709, p < 0.001) and energy (OR = 2.690, p < 0.001) insecurity were more likely to experience food insecurity. Similarly, households with chronically ill members (OR = 2.896, p < 0.001) were more likely prone to food insecurity compared to those without. Households in which overall health was perceived as good were less likely to be food insecured (OR = 0.479, p < 0.001) compared to those with poor health. The findings highlight the interdependence of WEF, underscoring the need for integrated policies to tackle these challenges comprehensively in semi-arid regions. In this context, the focus should be on interventions that target improving water and energy security, leading to long-term improvements in food security.

A novel tool for assessing pediatric emergency care in low- and middle-income countries: a pilot study

BackgroundGlobally, most children seek emergency care at general rather than specialized pediatric emergency departments. There remains significant variation in the provision of pediatric emergency care, particularly in resource-constrained settings. The objective of this study is to pilot a self-assessment tool to evaluate pediatric emergency care capabilities in low- and middle-income country (LMIC) hospitals on the African Continent.MethodsThis was a prospective cross-sectional descriptive study using a convenience sample of sub-Saharan African hospitals. The assessment tool was developed by operationalizing the technical contents of existing standards and guidelines from international bodies including the World Health Organization and International Federation of Emergency Medicine. The pilot was conducted at emergency departments located across different regions on the African continent. Descriptive statistics were used to evaluate different domains of pediatric emergency care capabilities including pediatric triage, protocols, staffing, training, equipment, consumables, and medicines.ResultsSixteen hospitals with emergency departments completed the assessment tool (participation rate of 76%). The hospitals were in nine different countries across four regions of sub-Saharan Africa. National/academic hospitals comprised 56.3% of the participating hospitals. The majority, 44%, of these hospitals saw pediatric patient volumes of 2,000–4,999 patients per year. Dedicated pediatric triage spaces and resuscitation spaces were available at 37.5% and 56.3%, respectively. Formal pediatric resuscitation guidelines were used at 62.5%. Doctors on the self-assessment teams came from primarily pediatrics and general practitioner training backgrounds (both 68.8%). Basic respiratory and airway support equipment (e.g. oxygen, bag-valve mask devices) were available in all participating hospitals, whereas advanced airway equipment (e.g. pediatric intubation equipment) was available in 37.5% of hospitals. Most medicines from the World Health Organization Essential Medicines list were available at participating hospitals.ConclusionsTo date, this is the first assessment tool dedicated to the comprehensive evaluation of pediatric emergency care in LMICs. This pilot provides a first approach to evaluate pediatric emergency healthcare capabilities in the hospital setting with future directions to improve the tool based on qualitative feedback.

FERTILITY CARE IN LOW AND MIDDLE INCOME COUNTRIES: Embryologists' practices of care in IVF-clinics in sub-Saharan Africa.

Despite the centrality of the role of embryologists in in vitro fertilization (IVF), there is relatively little literature on the nature of their work. In this article, we draw on results from a large ethnographic study on the emerging IVF industry in South Africa and reproductive travel in sub-Saharan Africa (SSA), where IVF clinics and embryologists are scarce. Drawing on qualitative interviews with 11 embryologists, who work(ed) in SSA, we illustrate how their care practices are produced through the interaction of people and things. We emphasize the importance of context in shaping their practices, including the shortage of embryologists, the need to set up 'first' clinics in their respective countries, the paucity of trained counsellors in clinics and the mobility of IVF staff. The embryologists we interviewed performed multiple tasks on top of their laboratory work, including entrepreneurial tasks, advocacy, training, development of regulations, mentoring and patient counselling. They enacted care in several ways, towards gametes and embryos, patients, clinics and the profession. These multiple tasks and care practices make for dynamic and fulfilling careers of the interviewed embryologists but also stretch their capacities. They also raise questions about their contribution to the scarcity of embryological work in SSA. If access to IVF is to be achieved in the SSA region, more embryologists need to be trained and retained. Embryologists play a central role in IVF. Yet, there is limited knowledge about the nature of their work. We examine the work of embryologists in SSA, where IVF clinics and embryologists are scarce. Based on qualitative interviews conducted with 12 embryologists, we illustrate the multiple tasks they perform on top of their laboratory work: entrepreneurial tasks, advocacy, training, development of regulations, mentoring and patient counselling. Context is important in shaping these practices. This includes the shortage of embryologists in the SSA region, the need to set up 'first' clinics in their respective countries, the lack of trained counsellors in clinics and the mobility of IVF staff. These multiple tasks, while professionally fulfilling, raise questions about their contribution to the scarcity of embryological work in SSA, which contributes to the limited access to IVF in this region.

Pooled prevalence and subgroup variations of Tetralogy of Fallot among children and adolescents with congenital heart defect in Sub-Saharan Africa: A systematic review and meta-analysis.

Tetralogy of Fallot is one of the critical congenital heart defects needing intervention within the first year of life. This review aims to systematically assess the prevalence of Tetralogy of Fallot among children and adolescents with congenital heart defects in Sub-Saharan Africa from January 2000 to January 2024. All original observational studies focused on children and adolescent population diagnosed with congenital heart defects within Sub-Saharan Africa; reported the primary outcome of interest were included. Prisma guidelines were utilized to perform this systematic review and meta-analysis. Electronic databases including Medline (PubMed), Scopus, Google Scholar, and African Index Medicus were searched. A weighted inverse variance random-effects model was employed to estimate the pooled prevalence of Tetralogy of Fallot. Thirty-one studies included encompassing a total of 11,265 participants from 15 Sub-Saharan African countries with representation from Southern (4 studies, 619 participants), Central (5 studies, 2,220 participants), Eastern (11 studies, 3,384 participants), and Western (11 studies, 5,042 participants). Cross-sectional studies comprised (25 studies, 8,909 participants), and cohort design (6 studies, 2,356 participants). The analysis revealed a pooled prevalence of 10% (95% CI: 9%; 12%) with I2 (77%, p-value < 0.01). The subgroup analysis based on geographic regions revealed statistically significant difference. The prevalence of Tetralogy of Fallot observed was found considerably higher compared to global estimate and reports of developed countries. In a subgroup analysis based on the geographic region, a surprisingly high prevalence was reported across all regions of Sub-Saharan Africa. The substantial disparities and high prevalence observed underscores the complex interplay of factors influencing occurrence of Tetralogy of Fallot. Identifying the true scope of Tetralogy of Fallot burden may help policymakers and healthcare providers to prioritize interventions, optimize resource allocation, and potentially improve its outcomes in Sub-Saharan Africa.

Intersection between individual, household, environmental and system level factors in defining risk and resilience for children in Kenya's ASAL: A qualitative study.

Children growing up in arid and semi-arid regions of Sub-Saharan Africa (SSA) face heightened risks, often resulting in poor developmental outcomes. In Kenya, the arid and semi-arid lands (ASAL) exhibit the lowest health and developmental indicators among children. Despite these risks, some children grow up successfully and overcome the challenges. However, there is limited comprehensive data on sources of risks and resilience in these children, particularly research that incorporates community perspectives and indigenous knowledge. Systematic documentation of factors influencing child outcomes is crucial for understanding the overall burden, informing policy and implementing targeted interventions. This study aimed at bridging this gap. The study was conducted in 10 ASAL counties in Kenya. Purposive and snowballing techniques were used to recruit 11 key informants per site with varied levels of involvement in early childhood development and primary caregivers. Using a semi-structured interview guide, 103 telephonic interviews were conducted between June and August 2022, involving 68 key informants and 35 caregivers. Thematic approach was used to analyze the data, using NVIVO software. The mean age of the participants was 44years (SD = 11 years). The findings, viewed through the lens of Bronfenbrenner's ecological systems theory, reveal a complex interplay of contextual factors impacting children's development. These factors range from individual and biological aspects to family, community, systemic, and environmental level, including climatic challenges. Identified risk factors encompassed issues such as young caregiver's age, low literacy, mental health issues, drug abuse, domestic violence, malnutrition, poverty, lack of paternal involvement, early marriages, female genital mutilation, drought, heat stress, and insecurity. Nonetheless, sources of resilience include breastfeeding, immunization, responsive caregiving, family and community support, higher socio-economic status (SES), cultural practices, self-motivation, hard work, community role models, religious activities and quality service provision. Urgent attention is needed to address the multifaceted challenges faced by children in ASAL regions. The study underscores the importance of addressing the root causes of risks while harnessing community strengths and resources to safeguard and promote the holistic development of these children.

Impact of the Pentavalent Meningococcal Conjugate Vaccine(NmCV-5) Targeting Serogroups A,C,Y,W, and X on the Sub-Saharan Africa Region

Meningococcal disease poses a considerable public health burden in sub-Saharan Africa (SSA), particularly in the "meningitis belt". Although the rollout of the serogroup A meningococcal vaccine (MenAfriVac) has effectively contributed to a significant reduction in the incidence of group A meningitis, serogroups C, W, Y, and X are experiencing rising infection rates, highlighting the urgent need for new vaccines to address the threat posed by non-serogroup A Neisseria meningitidis. Considering this, Serum Institute of India Pvt Ltd., in partnership with PATH, developed a pentavalent conjugate vaccine (NmCV-5) containing capsular polysaccharides of meningococcal serogroups: A, C, W, X and Y, conjugated to a protein carrier, tetanus toxoid. In this paper, the epidemic trend of meningococcal and the development of NmCV-5 vaccine in SSA were analyzed by literature review. It has been shown that the NmCV-5 vaccine demonstrated good safety and immunogenicity against all serogars in clinical trials, especially significant protection against Neisseria meningitidis serogroup X. The single-dose schedule of the vaccine also improves roll-out feasibility in resource-limited Settings. However, the rollout of the vaccine still faces challenges such as poor infrastructure and insufficient public awareness.

Assessing the continuum of care in Sub-Saharan African hospitals performing surgery for breast cancer: a secondary analysis of the GlobalSurg 3 study

BackgroundWhile breast cancer incidence rates in Sub-Saharan Africa (SSA) are among the lowest worldwide, mortality rates remain among the highest, reflecting particularly poor survival. Only a few studies in SSA have investigated the capabilities of treatment services to adequately provide a continuum of care for breast cancer. Our aim was to assess the availability of diagnostic facilities and adjuvant therapies in hospitals performing breast cancer surgery in SSA.MethodsWe performed a secondary analysis of the GlobalSurg3 study data collected in the SSA region. The GlobalSurg 3 study is a multicenter, international, prospective, observational study of hospitals providing surgical services for cancer patients (including breast cancer) around the world. A total of 47 hospitals from 15 SSA countries and 43 cities were included between April 1, 2018, and Jan 31, 2019.ResultsOne-third of hospitals covered a population greater than two million (n = 17; 36.2%). Ultrasound was available in all hospitals; however, it was not consistently functional in 11 hospitals (23.4%). Only half of the included hospitals (n = 26, 55.3%) had access to a full-time pathologist, whilst the multidisciplinary team (MDT) approach was absent in 42.4% of hospitals. Radiotherapy equipment was only available in nine hospitals (19.1%). Only half of the hospitals (n = 25, 53.1%) had chemotherapy drugs available on site. In nine hospitals (19.1%), patients had to travel more than 50 km to access chemotherapy drugs.ConclusionsOutcomes for breast cancer patients in SSA cannot be improved without significant investments in pathology, surgical and oncological treatment pathways to provide timely diagnostic and effective treatment.

Analytical Overview of the Prevalence of Malaria in the Federal Capital Territory Abuja Nigeria

Background: Malaria continues to be a significant public health concern, particularly in sub-Saharan Africa and other regions with high endemicity. Despite ongoing efforts to control the disease, the malaria parasite remains a global health issue, presenting persistent challenges for individuals and healthcare systems in affected areas. Methods: This study investigated the distribution, prevalence, and molecular characteristics of Plasmodium falciparum among febrile patients in various healthcare facilities within the Federal Capital Territory (FCT), Nigeria. A combination of retrospective and cross-sectional designs was employed to analyse 428 blood samples collected from febrile patients across selected government hospitals. Malaria parasitaemia was detected through Giemsa-stained thick and thin blood smears, with parasite density calculated per 200 leukocytes. RDT-prevalence wax determined using a rapid lateral flow. Result: A total of 428 individuals participated in the study, comprising 49.0% males (n=210) and 50.9% females (n=218), with no statistically significant difference in gender distribution (p&gt;0.05). The age distribution showed that participants aged ≥41 years represented the largest group at 34.3% (n=147), while those aged &lt;10 years accounted for 14.0% (n=60), 11–20 years for 16.1% (n=69), 21–30 years for 19.2% (n=82), and 31–40 years for 16.4% (n=70). Microscopic examination revealed a malaria infection rate of 32% (n=137) among participants, with the highest prevalence in those aged &lt;10 years (33.6%, n=46) and the lowest in the 31–40 age group (8.8%, n=12). Gender-based analysis indicated a higher prevalence in males (52.6%) compared to females (47.4%). Facility-based prevalence was significantly higher in Wuse (30.0%, n=41) compared to other locations, with Zuba showing the lowest prevalence (8.0%, n=11). Rapid Diagnostic Test (RDT) results indicated a prevalence of 20.1%, with Wuse again exhibiting the highest rate at 38.6% (n=27/70). Age-related RDT prevalence showed the highest seroprevalence in the &lt;10 years age group (65.0%, n=39/60), followed by 11–20 years (24.6%, n=17/69), 21–30 years (12.3%, n=10/81), and ≥41 years (8.8%, n=13/147). Conclusion: The findings reveal a slight predominance of females over males, indicating that women may be more inclined to seek medical attention for malaria-related symptoms. The malaria prevalence rate of 32.0% underscores the urgent need for effective strategies to combat the disease.

Global burden of low vision and blindness due to age-related macular degeneration from 1990 to 2021 and projections for 2050

BackgroundAge-related macular degeneration (AMD) is a leading cause of blindness and low vision worldwide. This study examines the global burden and trends in AMD-related low vision and blindness from 1990 to 2021, with projections through 2050.MethodsData were obtained from the 2021 Global Burden of Disease (GBD 2021) study, covering 204 countries and regions. Key metrics, including the prevalent case numbers, annual disability-adjusted life years (DALYs), age-standardized prevalence rates (ASPR), and age-standardized DALY rates (ASDALYR), specific to low vision and blindness due to AMD, were calculated per 100,000 population. Trend analysis used the estimated annual percentage change (EAPC) method, and K-means clustering identified regions with similar burdens and trends. Autoregressive Integrated Moving Average(ARIMA) and Exponential Smoothing(ES) models provided future projections.ResultsGlobally, the total number of prevalent cases and DALYs has substantially increased. The number of prevalent cases of low vision and blindness due to AMD increased from 3,640,180 (95% UI: 3,037,098 − 4,353,902) in 1990 to 8,057,521 (95% UI: 6,705,284-9,823,238) in 2021. DALYs increased from 302,902 (95% UI: 206,475 − 421,952) in 1990 to 578,020 (95% UI: 401,241–797,570) in 2021. From 1990 to 2021, both the ASPR and ASDALYR for AMD-related low vision and blindness showed a downward trend. The ASPR was 94 (95% UI: 78.32-114.42) per 100,000 population, with an EAPC of -0.26 (95% CI: -0.31 to -0.22), and the ASDALYR was 6.78 (95% UI: 4.7–9.32) per 100,000 population, with an EAPC of -0.94 (95% CI: -1.01 to -0.88). The disease burden of AMD-related low vision and blindness increases with age, and the burden for female patients is slightly higher than for males. Regional stratification by the Socio-Demographic Index (SDI) shows that the burden of AMD-related low vision and blindness in areas with low SDI is higher than in areas with high SDI. From 1990 to 2021, notable increases in ASPR and ASDALYR were observed mainly in the southern and central regions of sub-Saharan Africa. Moreover, the increases in prevalence and DALYs vary by region, country, and level of socioeconomic development. The ARIMA model predicts that by 2050, the number of prevalent cases of low vision and blindness due to AMD will reach 13,880,610(95% CI: 9,805,575–17,955,645), and the DALYs will be 764,731(95% CI: 683,535–845,926). The ES model predicts that by 2050, the number of prevalent cases of AMD-related low vision and blindness will reach 9,323,124(95% CI: 5,222,474–13,423,774), and the DALYs will be 641,451 (95% CI: 383,588–899,318).ConclusionThis study indicates that between 1990 and 2021, the global prevalent cases and DALYs caused by AMD-related low vision and blindness have increased over the past three decades, correlating with factors such as age, gender, socioeconomic status, and geographical location. Predictive models indicate that as the population ages, the number of patients with low vision and blindness due to AMD, along with associated DALYs, will continue to rise. By 2050, it is expected that over 9 million people worldwide will be affected by AMD-related vision loss, with women being particularly impacted. These findings can provide data support for public health planning, resource allocation, and the formulation of medical policies, ensuring an effective response to the challenges posed by the future increase in AMD-related low vision and blindness.

Effects of Varietal Selection and Plant Spacing Patterns on the Growth of Maize (Zea mays L.) in Irrigated Agro-Eco-Systems of Punjab

Maize (Zea mays L; 2n=20) is one among the major cereal crops grown in the humid tropics. It has high yield potential, immense potentiality, and that is why it is also known as ‘queen of cereals’. Though it is mainly used as a food crop in India by the rural population in the form of bread and gruel, it has vast industrial potentialities as well having as many as 50 different uses. The world's corn production in 2020-2021 is 1216.87 million tons. The estimated production of maize in 2022-2023 was to reach 1,161.86 million tonnes in. The predicted global maize production for this year is the same period was 1,161.86 million tonnes, and a decrease of 55.00 million tonnes or 4.52%. The total area of maize (for dry grain) in the world is 197 M hectares, with significant regions in Asia, Latin America, and sub-Saharan Africa (SSA) (FAOStat, 2021). In India, Kharif maize accounts for about 83% of the country's total maize area, while Rabi maize accounts for 17%. The most widely used products made from maize are meal and flour, though there are many regional variations in how maize is processed and consumed.

The Role and Challenges of International Standards on Auditing in Diverse Economic Contexts

The adoption and implementation of International Standards on Auditing (ISAs) are crucial for ensuring consistent audit quality and financial reporting integrity globally. These standards, established by the International Auditing and Assurance Standards Board (IAASB), aim to provide a universal framework for auditing practices. Developed economies, such as the United States and the United Kingdom, have leveraged strong regulatory frameworks and advanced technologies to achieve high compliance with ISAs, thereby enhancing investor confidence and market stability. However, the disparity in ISA adoption between developed and emerging markets raises critical concerns about global audit reliability and financial transparency. Emerging markets, including regions in Sub-Saharan Africa, face unique challenges that hinder ISA implementation. Factors such as weak regulatory oversight, limited access to training, and cultural barriers contribute to inconsistent audit practices. In Nigeria and Cameroon for instance, inadequate enforcement mechanisms and resource constraints have led to irregularities in financial reporting, which significantly impact auditors’ ability to adhere to ISA guidelines. These systemic issues not only undermine audit quality but also erode stakeholder trust in financial systems, creating barriers to economic development and foreign investment. This study explores the role and challenges of ISAs across diverse economic contexts, focusing on the factors affecting their implementation and proposing strategies for improvement. Using a qualitative methodology, including case studies such as CBC Health Services in Cameroon, the research underscores the need for tailored approaches to bridge the gap in ISA adoption. Key recommendations include enhancing auditor training, integrating advanced auditing technologies, and strengthening regulatory frameworks to ensure uniform application of ISAs globally. Addressing these challenges is essential to achieving the overarching goal of financial stability and audit reliability worldwide.

Neonatal intracranial pathologies on ultrasound imaging in sub-Saharan Africa: a systematic review and meta-analysis.

Annually, 30 million children are affected by newborn conditions, most in low-income countries, with long-term implications for survivors. We aimed to evaluate neonatal intracranial pathologies identifiable on cranial ultrasound (CUS) in sub-Saharan Africa (SSA). This systematic review and meta-analysis explored the spectrum of neonatal intracranial pathology, in nine databases, using the Joanna Briggs Institute Systematic Review Tools. The review was registered with PROSPERO (CRD42022309249). In total, 92 studies from 14 countries were identified, with South Africa (34%) and Nigeria (28%) most represented. Of these, 38 (42%) focused on intraventricular haemorrhage (IVH), 13 (14%) on congenital brain anomalies, 11 (12%) on intracranial infection, 9 (10%) on ventriculomegaly/hydrocephalus, and 7 (8%) on neonatal encephalopathy. IVH pooled prevalence was 29% (CI 23-35%), with a quarter high-grade (24%, CI 20-29%). Higher prevalence was seen at lower gestation (<32 weeks, 38% (CI 26-50%)) and birthweight (<1500 g, 32% (CI 24-40%)). Periventricular leukomalacia was less common than IVH (9% (CI 6-13%)). A spectrum of intracranial pathology has been reported on neonatal CUS from SSA. IVH affected close to one third of at-risk neonates, and PVL one in eleven, with potentially important implications for longer term outcomes for affected children. IMPACT: Newborn conditions, like prematurity and neonatal encephalopathy, are leading causes of under-5 child mortality, with the greatest burden in sub-Saharan Africa. Intracranial pathologies relating to newborn conditions, may have important long-term consequences, yet frequently go undetected in settings with limited access to imaging. We examined the spectrum and prevalence of different neonatal intracranial pathologies detectable on cranial ultrasound imaging from the sub-Saharan Africa region. A wide spectrum of intracranial pathology was reported, including a high prevalence of intraventricular haemorrhage and periventricular leukomalacia among small and preterm neonates, with potential important implications for childhood outcomes.

The impact of the COVID-19 pandemic on HIV healthcare delivery for females in sub-Saharan Africa: A scoping review.

Throughout sub-Saharan Africa (SSA), females are disproportionately impacted by HIV and face generalized but also gendered social and economic barriers to accessing HIV healthcare and services. At the outset of the pandemic, many anticipated COVID-19 would represent a major set-back for HIV care in the region. The impact of COVID-19 on HIV health services and HIV-affected populations has been reported in specific populations but has not been synthesized for females in the SSA region. The objective of this scoping review is to investigate the impact of COVID-19 on HIV healthcare delivery and services for females in SSA. Four databases were searched to identify relevant studies. Studies included were limited to English primary research articles reporting on the interactions between COVID-19 and HIV healthcare delivery and services amongst females in SSA. Two pairs of reviewers each screened 1390 articles via abstract and full-text screening, and data extraction was facilitated with a standardized protocol. A total of 39 studies were included in this review. Through thematic analysis of the articles, we identified five major themes-accessibility, availability, affordability, clinical barriers, and psychosocial barriers-which complicated the provision of HIV care during the COVID-19 pandemic and facilitators of HIV care during the pandemic. The literature highlighted two special populations, female sex workers and pregnant females, as having unique challenges in accessing HIV care due to societal stigma and their personalized health needs. Reviewed articles indicate that the COVID-19 pandemic introduced and exacerbated barriers to the accessibility, availability, and affordability of HIV healthcare and services for females in SSA. This review should be used by healthcare workers, healthcare administrators, policymakers, and the government to better understand the current gaps in HIV service provision to females during the COVID-19 pandemic, which can support the delivery of HIV care to females for future public health emergencies.

What does it cost to expand two-way texting for post-operative follow-up? A cost analysis in routine voluntary medical male circumcision settings in South Africa.

Up to 98% of adult voluntary medical male circumcision (VMMC) clients heal without adverse events (AEs) in South Africa and in the sub-Saharan Africa (SSA) region, yet all clients in South Africa (SA) are still required to attend in-person reviews, creating added work for providers and barriers for clients. A randomized controlled trial (RCT) using our fee-free, open-source, two-way texting (2wT) approach showed that males could independently monitor their healing with support from VMMC nurse-led telehealth and that 2wT was more cost-effective than routine visits for quality post-operative monitoring. The objectives of this costing activity were to assess the additive cost of 2wT vs. SoC during a stepped wedge design (SWD) expansion trial; costing an augmentation of 2wT with dedicated personnel during peak VMMC periods; and estimate the cost savings of 2wT from the payer perspective if scaled in routine VMMC settings. Data was collected from routine financial reports and complemented by previous RCT time-motion estimates. We conducted activity-based costing of SWD and peak season periods; sensitivity analysis estimated 2wT costs at scale. We included data from 6,842 males, with 2,586 (38%) opting for 2wT. 2wT participants attended an average of zero visits; SoC males had an average of 2 visits. Under 2wT, quality care markers improved and AE ascertainment increased while loss to follow-up (LTFU) decreased. Given a VMMC population of 10,000 adults, scenario analysis suggests that: 1) 2wT becomes cost neutral with 45% 2wT enrollment; 2) 2wT saves $0.29/client with 60% 2wT enrollment; and 3) 2wT saves $0.46/client with 80% 2wT enrollment. When implemented at scale, 2wT appears to significantly reduce costs to the healthcare system while improving the quality of post-operative care and requiring no additional client costs. 2wT should be expanded for eligible males across VMMC and other post-operative contexts in South Africa.

Soluble P-selectin as an inflammatory mediator potentially influencing endothelial activation in people living with HIV in sub-rural areas of Limpopo, South Africa.

There is a growing need to understand the potential role of soluble platelet selectin (sP-selectin) in sustained endothelial activation through increased levels of soluble intercellular adhesion molecule-1 (sICAM-1) and soluble vascular adhesion-1 (sVCAM-1) in people living with HIV (PLWH) on highly active antiretroviral therapy (HAART). This was a cross-sectional study involving PLWH on HAART (n = 55), in comparison to PLWH not on treatment (HAART-naïve) (n = 29), and (iii) HIV negative controls (n = 48) from the Mankweng area in the Limpopo province, South Africa. We quantified serum levels of sP-selectin, together with sICAM-1 and sVCAM-1. Most of the HAART-exposed group were on treatment for <5 years. We further performed frequency distribution and descriptive statistics for categorical variables. Soluble P-selectin was positively correlated with sVCAM-1 (r = 0.469; p<0.001) in PLWH on HAART, even after adjusting for confounding factor such as age, BMI, and total cholesterol (r = 0.467; p<0.001). Moreover, in PLWH on HAART sP-selecting was independently associated with the release of sVCAM-1 (β = 0.445; p<0.001), even after adjusting for confounders (β = 0.475; p = 0.001). Serum levels of low-density lipoprotein cholesterol (LDL-C) (p = 0.004) and total cholesterol (p<0.001) were significantly higher in PLWH on HAART as compared to the HAART-naïve group. There is a need for more studies to investigate the role of sP-selectin in promoting endothelial activation and CVD-risk in PLWH on HAART, especially within the sub-Saharan Africa region.

Women's empowerment: A catalyst for addressing energy poverty and energy inequality in developing countries

Empowering women is acknowledged as a crucial factor for sustainable development and has significant potential in advancing health, education, economic opportunities, and other development sectors. Although previous research has explored the effects of women's empowerment in various fields, there remains a notable gap in studies addressing energy poverty and inequality in developing countries. This study examines the role of women's empowerment in mitigating energy poverty and inequality, for 94 developing nations from 2001 to 2020. The panel regression models and mediation analysis are used to assess the direct and indirect effects of women's empowerment on energy outcomes through financial development and human development. The research findings indicate that while women's empowerment significantly reduces energy poverty and inequality across different income groups and regions, its impact varies within these groups and regions. For instance, enhancing women's employment and education is effective in low-income countries and certain regions of Sub-Saharan Africa and Asia. Moreover, the mediation analysis highlights the critical role of financial development and human development in mediating the relationship between women's empowerment and energy outcomes. Policies aimed at promoting gender equality, enhancing financial access, and improving educational opportunities for women emerge as crucial strategies for achieving universal energy access and fostering sustainable development.

Mediating Effect of Delivery Capability on Public-Private Partnership Financing Structure and Geothermal Energy Development Project Completion in Kenya

Investments in Geothermal Energy Development Projects (GEPs) are still considered high-risk and capital-intensive with unpredictable completion even amidst the adoption of Public Private Partnership (PPP) financing models particularly in sub-Saharan Africa (SSA). Numerous GEP completion bottlenecks affecting timely project completion have been documented lately; these challenges have caused delayed delivery of critical path milestones, project stalling, and even outright project failures. Recent empirical studies focused more on developed countries' longitudinal secondary databases covering the wider energy sector, with minimal attention paid to the situation of GEPs in developing countries. Anchored on the positivism and pragmatism foundations, this study examined the mediating influence of delivery capability on the relationship between PPP financing structure and the completion of GEPs in Kenya. Using a census survey design, data from 48 geothermal energy projects (private sector project managers and implementation team leaders from the public sector) and key informants was collected and analyzed using mixed methods. Data triangulation and diagnostic tests were performed. The results and findings revealed that while PPP financing structure alone explains 43.9% of the variance in project completion, the inclusion of delivery capability substantially increases the explained variance to 66.1%. A balanced PPP financing structure and delivery capability have statistically significant effects on project completion outcomes, with delivery capability (β = 0.579) having a stronger isolated effect than the PPP financing structure (β = 0.326). The reduction in the PPP financing structure coefficient from the first to the second model suggests that some of its effect is shared with or mediated by delivery capability. The study concluded that completing PPP-financed GEPs requires an integrated approach that considers both predictor variables: A balanced PPP financing structure comprising private equity, commercial and concessional loans, grants and government contributions; and strong delivery capability including geological, technological, PPP modelling and agile project management competencies. Geothermal sector-specific government support measures and industry recommendations are provided to enhance the completion of PPP-financed geothermal energy development projects mainly in the SSA region.

Integrating Traditional Knowledge and Modern Technologies for Renewable Energy Adoption in Sub-Saharan Africa: Advancing Climate Resilience and Carbon Reduction Strategies

This paper explores the potential of reducing carbon footprints and greenhouse gas emissions in climate-sensitive regions of Sub-Saharan Africa by integrating traditional knowledge with modern renewable energy technologies. Drawing on a mixed-methods approach that combines quantitative energy data and qualitative insights from expert interviews and policy reviews, the study analyzes the implementation of renewable energy sources such as solar, wind, and hydro. Data from global organizations, including the International Energy Agency (IEA) and the World Bank, supports the investigation. The findings highlight renewable energy's transformative potential for emissions reduction, energy security, and economic growth, with solar energy demonstrating exceptional promise for rural electrification. Despite its benefits, adoption is hindered by financial constraints, inadequate infrastructure, and regulatory challenges. The study underscores the need for climate resilience strategies such as energy storage integration and grid upgrades to support reliable access to renewable energy. By linking renewable energy with sustainability and resilience theories, the research emphasizes the role of adaptive infrastructure in fostering economic development and environmental health. Key recommendations include improving financing mechanisms, enacting supportive policy frameworks, strengthening regional partnerships, and prioritizing energy storage and grid modernization. This study provides actionable insights for policymakers, energy stakeholders, and development organizations, emphasizing that overcoming barriers to renewable energy adoption is critical for achieving sustainable energy access, reducing emissions, and aligning with global climate goals.

The Impact of Socio-Economic, Demographic, and Geographic Factors on the Mortality of Children Under the Age of Five in Kenya, 2022.

Reducing the under-five child mortality is vital to a nation's development; global progress has been made in the past two decades. Nevertheless, substantial efforts in the Sub-Saharan Africa region are required to address critical risk factors to attain the Sustainable Development Goals (SDGs) by 2030. We aimed to identify the impact of socio-economic, demographic, and geographic factors on under-five child mortality in Kenya. This study utilized data from the 2022 Kenyan Demographic and Health Survey (KDHS). We extracted mortality data for children under the age of five and demographic, socio-economic, and household/geographic factors. Overall, 19,530 children under the age of five yr were included, with 9,950 (50.95%) males and 9,580 (49.05%) females. Amongst children, 18,836 (96.45%) were alive and 694 (3.55%) were dead. Study findings revealed a significant association between the mother's age and the child's death. Mothers aged between 15 and 19 yr of age indicate higher odds of child death. The odds of death of children not breastfed is 1.69 times that of other children. Mothers who had no child above five years old previously had higher odds of child mortality than those with at least three children above five years old. Under-five child mortality is significantly associated with breastfeeding, the mother's age, and mothers who had a child previously in Kenya. The identified significant determinants align well with the SDG 2030 targets of improving socio-economic status, healthcare systems and reducing inequality. Therefore, the study suggests that preventing underaged women's pregnancy, proper maternal nutrition among pregnant women, and breastfeeding should be practiced as they are more likely to reduce under-five child mortality.