Africa Region Research Articles

Róg Afryki jako pole rywalizacji pomiędzy państwami regionu Zatoki Perskiej w latach 2014-2023

THE HORN OF AFRICA AS THE FIELD OF RIVALRY BETWEEN THE GULF STATES 2014-2023 The Horn of Africa region gained particular importance for the Gulf states after the Arab Spring, and especially after the outbreak of the civil war in Yemen. While the Gulf states mainly sought to use their financial resources to pursue security interests and strengthen their position in the international arena, the governments of the Horn of Africa countries cooperated primarily for the benefit of domestic policy. Building on the theory of regional security complexes, the article attempts to answer the question of how the rivalry between the Gulf states influenced their policies towards the countries of the Horn of Africa and what effects it had on the stability and security in this region.

Shaping the Future of Digital Health in MENA

There are many forms of digital health. Some are purely to improve the healthcare system such as health information systems and computerized disease registries. Others are to improve healthcare through patients; like education and behavior change are mostly delivered through telephonic means. E-health is also gaining momentum in MENA, as the region is known for its high mobile penetration and many e-health solutions are mobile-based. This could be anything from SMS appointment reminders to complex mobile health apps. All forms of digital healthcare in the future have the potential to improve the health and healthcare of the people in the MENA region.The content will be assessing the future of digital health within the Middle East and North Africa region. Digital health is still in its infancy in MENA, yet is growing rapidly. There is a need to forecast how this field will progress so that healthcare providers, governments, and other institutions can make informed decisions and investments. Digital health is defined as a field which employs IT and wireless solutions to improve healthcare, whether it be the delivery of healthcare itself or the way medical information is stored and exchanged.

High-fidelity simulation versus case-based tutorial sessions for teaching pharmacology: Convergent mixed methods research investigating undergraduate medical students' performance and perception.

Medical educators strive to improve their curricula to enhance the student learning experience. The use of high-fidelity simulation within basic and clinical medical science subjects has been one of these initiatives. However, there is paucity of evidence on using simulation for teaching pharmacology, especially in the Middle East and North Africa region, and the effectiveness of this teaching modality, relative to more traditional ones, have not been sufficiently investigated. Accordingly, this study compares the effects of high-fidelity simulation, which is designed in alignment with adult and experiential learning theories, and traditional case-based tutorial sessions on the performance and perception of undergraduate Year 2 medical students in pharmacology in Dubai, United Arab Emirates. This study employed a convergent mixed methods approach. Forty-nine medical students were randomly assigned to one of two groups during the 16-week pharmacology course. Each group underwent one session delivered via high-fidelity simulation and another via a case-based tutorial. A short multiple-choice question quiz was administered twice (immediately upon completion of the respective sessions and 5 weeks afterwards) to assess knowledge retention. Furthermore, to explore the students' perceptions regarding the two modes of learning delivery (independently and in relation to each other), an evaluation survey was administered following the delivery of each session. Thereafter, the iterative joint display analysis was used to develop a holistic understanding of the effect of high-fidelity simulation in comparison to traditional case-based tutorial sessions on pharmacology learning in the context of the study. There was no statistically significant difference in students' knowledge retention between high-fidelity simulation and case-based tutorial sessions. Yet, students expressed a greater preference for high-fidelity simulation, describing the corresponding sessions as more varied, better at reinforcing learning, and closer to reality. As such, the meta-inferences led to expansion of the overall understanding around students' satisfaction, to both confirmation and expansion of the systemic viewpoint around students' preferences, and lastly to refinement in relation to the perspective around retained knowledge. High-fidelity simulation was found to be as effective as case-based tutorial sessions in terms of students' retention of knowledge. Nonetheless, students demonstrated a greater preference for high-fidelity simulation. The study advocates caution in adapting high-fidelity simulation, where careful appraisal can lend itself to identifying contexts where it is most effective.

Phylogeography and reassortment patterns of human influenza A viruses in sub-Saharan Africa

The role of sub-Saharan Africa in the global spread of influenza viruses remains unclear due to insufficient spatiotemporal sequence data. Here, we analyzed 222 codon-complete sequences of influenza A viruses (IAVs) sampled between 2011 and 2013 from five countries across sub-Saharan Africa (Kenya, Zambia, Mali, Gambia, and South Africa); these genomes were compared with 1209 contemporaneous global genomes using phylogeographical approaches. The spread of influenza in sub-Saharan Africa was characterized by (i) multiple introductions of IAVs into the region over consecutive influenza seasons, with viral importations originating from multiple global geographical regions, some of which persisted in circulation as intra-subtype reassortants for multiple seasons, (ii) virus transfer between sub-Saharan African countries, and (iii) virus export from sub-Saharan Africa to other geographical regions. Despite sparse data from influenza surveillance in sub-Saharan Africa, our findings support the notion that influenza viruses persist as temporally structured migrating metapopulations in which new virus strains can emerge in any geographical region, including in sub-Saharan Africa; these lineages may have been capable of dissemination to other continents through a globally migrating virus population. Further knowledge of the viral lineages that circulate within understudied sub-Saharan Africa regions is required to inform vaccination strategies in those regions.

Assessing the dynamics of land use and land cover change in semi‐arid savannah: A focus on woody plant encroachment utilising historical satellite data

AbstractThe encroachment of woody plants into grassland and the conversion of grasslands to woodlands is a worldwide phenomenon and has been regarded as a major global problem for decades. The rate of woody plant encroachment (WPE) varies across biomes and can be influenced by land use activities and climate conditions. As a result, the current study assessed the spatial distribution of woody plants and land use and land cover (LULC) change within the Letaba River catchment in the Limpopo province of South Africa's subtropical region. Landsat Thematic Mapper (TM) and Operational Land Imager (OLI) satellite data sets were used to map and quantify WPE and other LULC changes in the Letaba River catchment over a 30‐year period (1989–2019). Random forest classifier was used to determine of the rate of change of WPE and LULC within the study area. The results indicated that the Letaba River catchment has undergone a significant change with an increase in woody plant species. The woody plant cover had increased from 36,014 ha in the year 1989 to approximately 561,493 ha by 2019. Meanwhile, grassland has declined by 486,322 ha (33.7%) from 1989 to 2019. The overall classification accuracy (OA) ranged between 91.7% and 95.5%. The study findings will provide critical insights and baseline information about the state of WPE in semi‐arid environments, as well as provide catchment managers with the information they need to take the necessary actions to manage the rapid increase in woody plants. However, fire and herbivory are important factors that influences the WPE, and this might have also played an important role in the findings. The study suggests that WPE is an ongoing process and management strategies are required to mitigate and maintain the intensity of woody plants.

Competency level and determinants among infection prevention and control staff in the Middle East and North Africa region

BackgroundCompetency of the staff working in infection prevention and control (IPC) is the cornerstone of successful IPC programs. The objective was to assess competency level and associated factors among IPC staff working in the Middle East and North Africa (MENA) region.MethodsA cross-sectional study was carried out in 2019 among active IPC staff who were members of the Arab Countries Infection Control Network. The questionnaire covered demographic and professional characteristics of IPC staff and characteristics of work facilities and IPC programs. A competency score was created from self-perceived responses to 8 competency domains. The competency score was then transformed into 100-scale and categorized into two groups (≥ median and < median).ResultsA total of 176 participants completed the survey. Participants were mostly female (65.7%), and the mean age was 40.2 ± 8.3 years. The mean competency score was 61.4%. It was slightly variable between domains, being highest with preventing transmission of infection (65%) and lowest with sterilization and disinfection (59%). Higher (≥ median) competency score was associated with having CBIC certification (p < 0.001). It was also associated with facilities having IPC plan (p = 0.005), IPC committee (p = 0.049), regular meetings of IPC committee (p < 0.001), and IPC plan included communications with healthcare workers (p < 0.001). Domain-specific competency scores were significantly associated with receiving same domain-specific training (p < 0.05 for all).ConclusionsThe competency levels of IPC staff in the MENA region is still suboptimal. The current finding calls for more regional and national investment in IPC staff by providing up-to-date customized educational and training opportunities.

Energy Transition Agenda in Tanzania Within the Auspice of Sub-Saharan Africa: A Review of the Power Sector

The energy transition is on the high agenda in the global space to allow the international communities to meet the global objectives of lowering anthropogenic emissions that cause global warming. The international community is guided by the scientific evidence of increasing climate change impacts and is working under the auspice of the Paris Agreement, which aims to limit GHG emissions. As one of the significant contributors to GHG emissions, energy will play a critical role by shifting from dependence on fossil-based sources to renewables and using technologies to decarbonize the sources. Energy transition in the power sector is primarily associated with shifting towards directing investments in renewable energy. Sub-Saharan Africa (SSA) is still a niche market in the power sector with substantial suppressed demand, and where only about half of its population still does not have access to electricity. The region also strives to power its economic activities to support economic growth. The region is endowed with renewables and fossil fuels to support its economic transformation. Investment in renewable energy entails high capital costs, which makes it hard for the countries in the region with financial constraints to afford it. Renewables also have some limitations in supplying baseloads and are inherent to issues of dispatchability. Countries in SSA have been approaching the energy transition agenda with care to address local needs while supporting international climate change concerns. The energy transition agenda in countries like Tanzania considers multidimensional factors when investing in the power sector, primarily fostering universal access to electricity for its population, attaining security of supply, and accelerating industrial development. This paper reviews what the transition entails in the context of sources and technologies that will support the sustainable transition; it discusses renewable energy and energy efficiency. It also touches upon the role of fossil fuels in the energy transition agenda. The paper also reviews the policies and politics around the energy transition landscape, looking at the global context and its effects in the developing world, notably the sub-Saharan Africa region. The review concludes by analyzing different potential factors that contribute to decision-making on energy transition policies using the system thinking theory, looking at how various factors are interlinked.

Employing child-focused evaluation methods across West and Central Africa – A UNICEF Experience

Background: This article explores the strategies that the UNICEF West and Central Africa Regional Office (WCARO) has implemented in order to fulfil children’s rights through evaluations.Objectives: It intends to support evaluation managers and practitioners by discussing challenges and proposed corrective actions encountered when adapting adult-centric evaluation processes into child-friendly ones, both in development and humanitarian settings.Method: The UNICEF WCARO leveraged on insights shared by evaluation practitioners, academics, and children’s organisation representatives during the 2019 Symposium on Child-Centred Evaluations held in Senegal. Three years later, it led to a series of reflective sessions between UNICEF evaluation managers and external consultants to capture lessons learned and insights to improve evaluation practice.Results: The UNICEF WCARO’s evaluation practice has shifted from a rather marginal integration of child-focused methods in its evaluations to a more substantial mainstreaming of such methods. This article highlights how important it is to engage children during all key phases, while keeping ethical considerations into account.Conclusion: Implementing child-focused evaluations enhances the inclusivity of evaluation processes under the prism of 2030 Sustainable Development Goals. Moreover, this article underscores the significance of integrating children’s perspectives to strengthen equity-based approaches in contemporary evaluation and enhance the validity of evaluation results.Contribution: This article contributes practical insights and tips on adapting data collection tools for children, fostering active participation, and navigating ethical considerations. UNICEF WCARO’s experience serves as a valuable reference for organisations seeking to amplify the voices of the most vulnerable in their evaluation processes.

Assessment of psycho-oncology in the Middle East and North Africa region: a systematic review and meta-analysis.

The Middle East and North Africa (MENA) region is expected to witness a significant increase in the burden of cancer. Contrary to Western literature, the burden of psycho-oncology is yet to be established within the MENA region. This study reviews all available evidence characterizing the psychological burden among patients with cancer across the MENA region. We systematically explored the PubMed/MEDLINE, Cochrane/CENTRAL, and Web of Science (WoS)databases for reports on the psychiatric burden among patients with cancer residing within the MENA region from January 2000until January 2023. Raw proportion were extracted and analyzed using a random-effects model. Eighty-three studies comprised of 16 810 participants, representing 14 countries, met our inclusion criteria. Across the MENA region, the prevalence of depression, anxiety, and distress were 44% (95% CI, 39%-50%), 47% (95% CI, 40%-54%), and 43% (95% CI, 30%-56%), respectively. Prevalence of depression was significantly different across countries, with Palestine (73%; 95% CI, 42%-91%) reporting the highest rate while Morocco (23%; 95% CI, 7%-56%) reported the lowest. Similarly, anxiety significantly differed across MENA nations ranging from 64% (95% CI, 3%-99%) in Morocco to 28% (95% CI, 18%-42%) in Tunisia. Rates of depression and anxiety were significantly different across measurement tools but not between Arabic-speaking versus Persian/Farsi-speaking countries. Meta-regression models showed that neither publication year nor age affected the prevalence of both anxiety and depression (P = .374 and .091 for depression and P = .627, and .546 for anxiety, respectively). We report an abnormally high rate of psychiatric burden among patients with cancer in the MENA region. Thus, establishing appropriate psycho-oncologic interventions within the MENA region is of utmost importance.

Tracing the origin of NDM-1-producing and extensively drug-resistant Pseudomonas aeruginosa ST357 in the Netherlands

BackgroundIn the hospital environment, carbapenemase-producing Pseudomonas aeruginosa (CPPA) may lead to fatal patient infections. However, the transmission routes of CPPA often remain unknown. Therefore, this case study aimed to trace the origin of CPPA ST357, which caused a hospital-acquired pneumonia in a repatriated critically ill patient suffering from Guillain-Barré Syndrome in 2023.MethodsAntimicrobial susceptibility of the CPPA isolate for 30 single and combination therapies was determined by disk-diffusion, Etest or broth microdilution. Whole-genome sequencing was performed for three case CPPA isolates (one patient and two sinks) and four distinct CPPA ST357 patient isolates received in the Dutch CPPA surveillance program. Furthermore, 193 international P. aeruginosa ST357 assemblies were collected via three genome repositories and analyzed using whole-genome multi-locus sequence typing in combination with antimicrobial resistance gene (ARG) characterization.ResultsA Dutch patient who carried NDM-1-producing CPPA was transferred from Kenya to the Netherlands, with subsequent dissemination of CPPA isolates to the local sinks within a month after admission. The CPPA case isolates presented an extensively drug-resistant phenotype, with susceptibility only for colistin and cefiderocol-fosfomycin. Phylogenetic analysis showed considerable variation in allelic distances (mean = 150, max = 527 alleles) among the ST357 isolates from Asia (n = 92), Europe (n = 58), Africa (n = 21), America (n = 16), Oceania (n = 2) and unregistered regions (n = 4). However, the case isolates (n = 3) and additional Dutch patient surveillance program isolates (n = 2) were located in a sub-clade of isolates from Kenya (n = 17; varying 15–49 alleles), the United States (n = 7; 21–115 alleles) and other countries (n = 6; 14–121 alleles). This was consistent with previous hospitalization in Kenya of 2/3 Dutch patients. Additionally, over half of the isolates (20/35) in this sub-clade presented an identical resistome with 9/17 Kenyan, 5/5 Dutch, 4/7 United States and 2/6 other countries, which were characterized by the blaNDM-1, aph(3’)-VI, ARR-3 and cmlA1 ARGs.ConclusionThis study presents an extensively-drug resistant subclone of NDM-producing P. aeruginosa ST357 with a unique resistome which was introduced to the Netherlands via repatriation of critically ill patients from Kenya. Therefore, the monitoring of repatriated patients for CPPA in conjunction with vigilance for the risk of environmental contamination is advisable to detect and prevent further dissemination.

Factors associated with poor perceptions of the COVID-19 pandemic in Africa

This study examines factors associated with an increasingly poor perception of the novel coronavirus in Africa using a designed electronic questionnaire to collect perception-based information from participants across Africa from twenty-one African countries (and from all five regions of Africa) between 1 and 25 February 2022. The study received 66.7% of responses from West Africa, 12.7% from Central Africa, 4.6% from Southern Africa, 15% from East Africa, and 1% from North Africa. The majority of the participants are Nigerians (56%), 14.1% are Cameroonians, 8.7% are Ghanaians, 9.3% are Kenyans, 2% are South Africans, 2.1% are DR-Congolese, 1.6% are Tanzanians, 1.2% are Rwandans, 0.4% are Burundians, and others are Botswana’s, Chadians, Comoros, Congolese, Gambians, Malawians, South Sudanese, Sierra Leoneans, Ugandans, Zambians, and Zimbabweans. All responses were coded on a five-point Likert scale. The study adopts descriptive statistics, principal component analysis, and binary logistic regression analysis for the data analysis. The descriptive analysis of the study shows that the level of ignorance or poor “perception” of COVID-19 in Africa is very high (87% of individuals sampled). It leads to skepticism towards complying with preventive measures as advised by the WHO and directed by the national government across Africa. We adopted logistic regression analysis to identify the factors associated with a poor perception of the virus in Africa. The study finds that religion (belief or faith) and media misinformation are the two leading significant causes of ignorance or poor “perception” of COVID-19 in Africa, with log odd of 0.4775 (resulting in 1.6120 odd ratios) and 1.3155 (resulting in 3.7265 odd ratios), respectively. The study concludes that if the poor attitude or perception towards complying with the preventive measures continues, COVID-19 cases in Africa may increase beyond the current spread.

Development of two competitive ELISAs based on monoclonal antibodies for the serological detection of Bovine ephemeral fever virus

Bovine ephemeral fever virus (BEFV) is a member of the genus Ephemerovirus in the family Rhabdoviridae. It is an arthropod-borne virus transmitted by many species of midges and mosquitoes. It can cause severe economic consequences due to losses in milk production and the general condition of cattle and water buffalo. BEF occurs in some tropical, subtropical and warm temperate regions of Africa, Australia, the Middle East and Asia with seasonal outbreaks, but its possible spread to other areas (e.g. Europe) cannot be excluded. Therefore, using and developing rapid diagnostic methods with optimal performance is essential for identifying emerging pathogens and their control. In the present study, we developed two competitive serological ELISAs based on monoclonal antibodies (mAbs), designed by using BEFV inactivated antigen and the BEF recombinant nucleoprotein (N), respectively. A panel of 77 BEF-positive and 338 BEF-negative sera was used to evaluate the two tests. With a diagnostic sensitivity of 97.4 % using the inactivated virus and 98.7 % using the recombinant N, and a diagnostic specificity of 100 % using both antigens, our results suggest that these tests are suitable for the serological diagnosis of BEF.

Remote Sensing and Sustainable Management of Soil Organic Carbon in the Sahelian Area, Senegal, West Africa

The mapping of soil organic carbon (SOC) variability was carried out in a Sahelian region of Senegal by testing the effectiveness to include the Sentinel 2 remote sensed data in the characterization of the soil properties. Ordinary kriging (OK) applied under ArcGIS is compared with multiple linear regression (MLR) calibrated under R software. The results showed a slight decrease of the root mean square error ranging from 0.18 with kriging to 0.16 for multiple linear regression. Carbon variability was also detailed at a finer scale with multiple linear regression at the pixel scale from 10 to 20 m. Spectral bands situated in the visible wavelength, NDWI and NDVI were the most discriminating explanatory variables in the spatial modeling of organic carbon by multiple linear regression. Specific locations that require inputs of manure or compost were also geo-localized with multiple linear regression in order to ensure sustainable management of soil organic carbon. The use of remote sensed data also puts into perspective the possibility of spatializing the physical and chemical properties of the soil on larger areas and correcting the lack of information on soil mapping in the Sahelian regions of Africa.

Remote Sensing and Sustainable Management of Soil Organic Carbon in the Sahelian Area, Senegal, West Africa

The mapping of soil organic carbon (SOC) variability was carried out in a Sahelian region of Senegal by testing the effectiveness to include the Sentinel 2 remote sensed data in the characterization of the soil properties. Ordinary kriging (OK) applied under ArcGIS is compared with multiple linear regression (MLR) calibrated under R software. The results showed a slight decrease of the root mean square error ranging from 0.18 with kriging to 0.16 for multiple linear regression. Carbon variability was also detailed at a finer scale with multiple linear regression at the pixel scale from 10 to 20 m. Spectral bands situated in the visible wavelength, NDWI and NDVI were the most discriminating explanatory variables in the spatial modeling of organic carbon by multiple linear regression. Specific locations that require inputs of manure or compost were also geo-localized with multiple linear regression in order to ensure sustainable management of soil organic carbon. The use of remote sensed data also puts into perspective the possibility of spatializing the physical and chemical properties of the soil on larger areas and correcting the lack of information on soil mapping in the Sahelian regions of Africa.

Behind the scenes of research ethics committee oversight: a qualitative research study with committee chairs in the Middle East and North Africa region

BackgroundResearch cites shortcomings and challenges facing research ethics committees in many regions across the world including Arab countries. This paper presents findings from qualitative in-depth interviews with research ethics committee (REC) chairs to explore their views on the challenges they face in their work with the oversight of research involving human populations.MethodsVirtual in-depth interviews were conducted with chairs (n = 11) from both biomedical and/or social-behavioral research ethics committees in six countries, transcribed, coded and subject to thematic analysis for recurring themes.ResultsTwo sets of recurring themes impede the work of the committees and pose concerns for the quality of the research applications: (1) procedures and committee level challenges such as heavy workload, variations in member qualification, impeding bureaucratic procedures, member overwork, and intersecting socio-cultural values in the review process; (2) inconsistencies in the researchers’ competence in both applied research ethics and research methodology as revealed by their applications.ConclusionsNarratives of REC chairs are important to shed light on experiences and issues that are not captured in surveys, adding to the body of knowledge with implications for the region, and low- and middle-income countries (LMICs) in other parts of the world. International research collaborations could benefit from the findings.

Crisis Management Strategy for Emergency Response Team for Indonesian Diaspora in Middle East and North Africa (MENA)

The Middle East and North Africa (MENA) region has unique characteristics compared to other regions in the world, such as Asia, the US, and Europe, including fewer natural disasters but more conflicts that lead to wars, which can significantly impact the Indonesian diaspora communities residing in the area. Indonesian citizens need to prepare to anticipate crises that require good strategies and collaboration involving the diaspora and the Indonesian government. This research aims to explore the importance of crisis management strategies for the Emergency Response Team (ERT) of the Indonesian diaspora in MENA. This study utilizes a qualitative approach involving in-depth interviews with experts, competent individuals, or members of the Indonesian diaspora ERT in the MENA region. Both primary and secondary data will be collected and analyzed using the Soft Systems Management (SSM) analysis method. Analysis using brainstorming and PESTLE will also be conducted to assist decision-making, as well as Incident Management Systems. The research will also identify challenges faced by the Indonesian Diaspora Emergency Response Team, the Embassy of the Republic of Indonesia, and the Indonesian Community Association in facing crises in the MENA region and analyze effective crisis management strategies that can be used to enhance readiness and response to emergency situations. This includes analysis and case studies on the evacuation of Indonesian citizens due to crises in Yemen, Libya, and Tunisia. The results of this study are expected to develop an understanding of crisis management for the Indonesian diaspora in MENA and provide practical recommendations to strengthen their ERT capacity in dealing with emergency situations, both in MENA and other regions. This study emphasizes the importance of proactive, network-based, and stakeholder engagement strategies and provides useful insights for policy-making and emergency response planning for the Indonesian diaspora community.

Significant Increase in African Water Vapor over 2001–2020

Atmospheric water vapor is not only a key element of the global hydrological cycle but also the most abundant greenhouse gas. The phase transition and transportation of water vapor are essential for maintaining global energy balance and regulating hydrological processes. However, due to insufficient meteorological observational data, climate research in Africa faces significant limitations despite its substantial contribution to changes in global precipitable water vapor (PWV). In this study, we used MODIS near-infrared (NIR) PWV products and Berkeley temperature data to depict the spatial–temporal variability in PWV across Africa from 2001 to 2020. The results reveal a significant increasing trend in PWV over Africa, with an increase of 0.0158 cm/year. Nearly 99.96% of Africa shows an increase in PWV, with 88.95% of these areas experiencing statistically significant changes, particularly in central regions of Africa. The increase in PWV is more pronounced in high-value months compared to low-value months. The equatorial region of the Congo Basin exhibits higher PWV, which gradually decreases as latitude increases. Despite significant warming (0.0162 °C/year) in Africa, there is no consistent positive correlation between temperature and water vapor. A positive relationship between PWV and temperature is observed in western Africa, while a negative relationship is noted in eastern and southern Africa on an annual scale. Additionally, an increasing trend in precipitation (4.6669 mm/year) is observed, with a significant positive correlation between PWV and precipitation across most of Africa, although this relationship varies by month. These findings provide valuable insights into the comprehension of the hydrothermal variation in Africa amidst climate warming.

New insights on hidradenitis suppurativa phenotypes and treatment response: An exploratory automated analysis of the SUNSHINE and SUNRISE trials.

Defining hidradenitis suppurativa (HS) subtypes was previously limited by small sample sizes and poor interrater reliability; no study has investigated subtype treatment responses. The objective of this analysis was to characterize HS clusters in adult patients with moderate to severe HS and evaluate secukinumab treatment responses between clusters. Clusters were identified via an unsupervised machine learning clustering analysis using baseline data from the randomized, placebo-controlled SUNSHINE (NCT03713619) and SUNRISE (NCT03713632) phase 3 trials. To assess treatment responses, patients received secukinumab every 2 (SECQ2W) or 4 weeks (SECQ4W) or placebo, for 16 weeks, after which, placebo patients randomly switched to SECQ2W/SECQ4W, and SECQ2W/SECQ4W patients maintained their original treatment, until week 52. Baseline outcomes included patient characteristics, disease characteristics and severity, HS-associated comorbidities and previous treatment exposures. Treatment response was assessed via the HS clinical response (HiSCR), abscess and inflammatory nodule (AN) count, flares and NRS30 (skin pain). Based on baseline data, three clusters were identified from 1084 patients (Cluster 1: 54.1%, Cluster 2: 17.8%, Cluster 3: 28.1%). Cluster 1 was predominantly female (65.4%) and was characterized by milder HS. Cluster 2 had more patients from the Asia Pacific, Middle East and Africa region (58.5%) and was characterized by moderate HS. Cluster 3 had the highest rates of previous exposure to biologics (45.9%) and prior HS-related surgeries (47.5%) and was characterized by severe HS. SECQ2W and SECQ4W demonstrated efficacy versus placebo in all clusters at week 16; SECQ2W and SECQ4W efficacy was maintained to week 52. SECQ2W treatment showed a trend for greater efficacy versus SECQ4W in Cluster 3 through week 52. Three HS clusters were identified. Secukinumab demonstrated benefit over placebo in all clusters. However, patients with more severe disease may take longer to respond and more frequent secukinumab dosing may be required for these patients. SUNSHINE (NCT03713619) and SUNRISE (NCT03713632).

Practical considerations in diagnosing inborn errors of immunity according to the Middle East and North Africa guidelines.

The rate of inborn errors of immunity (IEI) in the Middle East and North Africa (MENA) region is generally higher than in other parts of the world. IEI patients in MENA exhibit more severe disease phenotypes. One of the most important reasons for this is delayed diagnosis. In this review, we examine issues pertinent to primary, secondary, and tertiary physicians in diagnosing IEI in children and discuss the key points for pediatricians according to the MENA guideline. Protocols and stepwise approaches designed by a panel of clinical immunologists included in the MENA-IEI registry network can help physicians facilitate the diagnosis of patients with IEI by providing recommendations. These recommendations for diagnostic approaches improve the care of patients within the MENA region and can also be applied to IEI patients in other parts of the world other regions. Physicians in the MENA region should be aware of IEI, obtain a detailed family history, request tests that can be ordered in primary care when IEI is suspected, and refer patients to clinical immunologists without delay. Primary and secondary care physicians should be aware that patients with IEI may present with noninfectious manifestations and increased infection frequency, severity, and atypical infections.

Dynamics of Neisseria gonorrhoeae transmission among female sex workers and clients: A mathematical modeling study

BackgroundThis study aimed to examine the transmission dynamics of Neisseria gonorrhoeae (NG) in heterosexual sex work networks (HSWNs) and the impact of variation in sexual behavior and interventions on NG epidemiology. MethodsThe study employed an individual-based mathematical model to simulate NG transmission dynamics in sexual networks involving female sex workers (FSWs) and their clients, primarily focusing on the Middle East and North Africa region. A deterministic model was also used to describe NG transmission from clients to their spouses. ResultsNG epidemiology in HSWNs displays two distinct patterns. In the common low-partner-number HSWNs, a significant proportion of NG incidence occurs among FSWs, with NG prevalence 13 times higher among FSWs than clients, and three times higher among clients than their spouses. Interventions substantially reduce incidence. Increasing condom use from 10 % to 50 % lowers NG prevalence among FSWs, clients, and their spouses from 12.2 % to 6.4 %, 1.2 % to 0.5 %, and 0.4 % to 0.2 %, respectively. Increasing symptomatic treatment coverage among FSWs from 0 % to 100 % decreases prevalence from 10.6 % to 4.5 %, 0.8 % to 0.4 %, and 0.3 % to 0.1 %, respectively. Increasing asymptomatic treatment coverage among FSWs from 0 % to 50 % decreases prevalence from 8.2 % to 0.4 %, 0.6 % to 0.1 %, and 0.2 % to 0.0 %, respectively, with very low prevalence when coverage exceeds 50 %. In high-partner-number HSWNs, prevalence among FSWs saturates at a high level, and the vast majority of incidence occurs among clients and their spouses, with a limited impact of incremental increases in interventions. ConclusionNG epidemiology in HSWNs is typically a "fragile epidemiology" that is responsive to a range of interventions even if the interventions are incremental, partially efficacious, and only applied to FSWs.