Resources In sub-Saharan Africa Research Articles

A Review of the Effects of Climate Change on Water Resources in Sub-Saharan Africa

Water provides different goods and services like handcraft and fishing materials, water supply for domestic use, businesses, agriculture, transport, washing, drinking, and eco-tourism. However, few studies have assessed the effects of climate change on water resources in recent years. This study investigated the relationship between water resources and climate change in Sub-Saharan Africa. In the first segment, Vos-Viewer was used to map, study the literature, and identify any gaps in order to evaluate the interdependence between water resources and climate. The study was guided by specific objectives, which include assessing the adaptation and mitigation strategies for the effects of climate on water resources. Searches for the keywords “climate change” and “water resources” were conducted to obtain literature for this study. A total of 125 papers were selected for this study from 1945–2022, from Scopus, Google Scholar, Science Direct, and Web of Science, that were found relevant for this study and were selected and discussed. Thus, the worldwide literature was used to provide a real understanding of the effects of climate change on water resources, adaptation, and mitigation measures. According to the findings of the study, cooperation networks in developing countries were not as prominent as research networks in developed countries. It was shown that irregular rainfall affects water quality and quantity by giving the water a muddy, acidic, and turbid appearance. Therefore, all stakeholders should facilitate prudent water resource usage by 695 million people who still use unimproved water facilities in sub-Saharan Africa

Letter: Evaluating Brain Tumor Surgical Management Capacity in Sub-Saharan Africa.

Letter: Evaluating Brain Tumor Surgical Management Capacity in Sub-Saharan Africa.

A spatial econometric analysis of the environment Kuznets curve and pollution haven hypothesis in Sub-Saharan Africa

The aim of this study is to test the environment Kuznets curve (EKC) and pollution haven (PH) hypotheses in Sub-Saharan Africa (SSA). An important methodological point that has been over-looked by many studies is that environmental quality is not only correlated in time but also in space. For this purpose, the study applies spatial panel econometric analysis using a balanced panel of 35 SSA nations from 2002 to 2015 to examine the EKC and PH hypotheses. Both spatial interdependence and individual heterogeneity are accounted for through the application of the spatial Durbin model (SDM) so as to avoid potential bias and inefficiencies in parameter estimates. As proxies for environmental quality, panel data aggregates on carbon dioxide (CO2) emissions and the depletion of natural resources are utilised. The findings offer proof for the EKC theory about the depletion of natural resources in SSA. The EKC theory, however, does not apply to CO2 emissions. Moreover, the study finds that the positive scale effect of trade outweighs the negative technique effect of trade, which indicates that trade liberalisation has a negative effect on both environmental quality indices. This discovery supports the PH theory. The study also demonstrates positive spatial spill-over for natural resource depletion between neighbouring countries and negative spatial spill-over for carbon dioxide emission between close countries.

Implementation of medicines pricing policies in sub-Saharan Africa: systematic review

BackgroundHigh medicine prices contribute to increasing cost of healthcare worldwide. Many patients with limited resources in sub-Saharan Africa (SSA) are confronted with out-of-pocket charges, constraining their access to medicines. Different medicine pricing policies are implemented to improve affordability and availability; however, evidence on the experiences of implementations of these policies in SSA settings appears limited. Therefore, to bridge this knowledge gap, we reviewed published evidence and answered the question: what are the key determinants of implementation of medicines pricing policies in SSA countries?MethodsWe identified policies and examined implementation processes, key actors involved, contextual influences on and impact of these policies. We searched five databases and grey literature; screening was done in two stages following clear inclusion criteria. A structured template guided the data extraction, and data analysis followed thematic narrative synthesis. The review followed best practices and reported using PRISMA guidelines.ResultsOf the 5595 studies identified, 31 met the inclusion criteria. The results showed thirteen pricing policies were implemented across SSA between 2003 and 2020. These were in four domains: targeted public subsides, regulatory frameworks and direct price control, generic medicine policies and purchasing policies. Main actors involved were government, wholesalers, manufacturers, retailers, professional bodies, community members and private and public health facilities. Key contextual barriers to implementation were limited awareness about policies, lack of regulatory capacity and lack of price transparency in external reference pricing process. Key facilitators were favourable policy environment on essential medicines, strong political will and international support. Evidence on effectiveness of these policies on reducing prices of, and improving access to, medicines was mixed. Reductions in prices were reported occasionally, and implementation of medicine pricing policy sometimes led to improved availability and affordability to essential medicines.ConclusionsImplementation of medicine pricing policies in SSA shows some mixed evidence of improved availability and affordability to essential medicines. It is important to understand country-specific experiences, diversity of policy actors and contextual barriers and facilitators to policy implementation. Our study suggests three policy implications, for SSA and potentially other low-resource settings: avoiding a ‘one-size-fits-all’ approach, engaging both private and public sector policy actors in policy implementation and continuously monitoring implementation and effects of policies.Systematic review registrationPROSPERO CRD42020178166

How local communities access, utilise and evaluate inland fisheries, and their influence on fishery conservation status in northern Zimbabwe

The conservation status of inland fishery resources is vulnerable worldwide, and this threatens the livelihoods of fishing-dependent communities. This case study aimed to: (i) establish the use and perception of fisheries and ecosystem services by locals, (ii) undertake a monetary valuation of the fisheries, (iii) determine the potential threats to the fisheries, and (iv) examine the social drivers and barriers for citizen science involvement. Lastly, (v) we evaluated how the above factors affected the conservation of fisheries at Mushumbi Pools, Zimbabwe. A cross-sectional survey of 69 households was conducted. Results of the study showed that locals utilised 17 fish species for social, economic, cultural and religious purposes. Locals attach high intrinsic socio-economic value to the fisheries resources and wetland ecosystem services provided by the Mushumbi Pools. Despite the sustained income from fisheries, the local market in Mushumbi Pools is actually undervaluing fisheries resources, as the fish prices in the area are very low compared to standard market prices countrywide. A larger proportion of the respondents (65%) cited poor land-tilling practices, heavy application of agropesticides and use of unsustainable fish harvesting methods as the main threats to fish diversity in Mushumbi Pools. Relaxed fishing concessions for women and children in specific fishing zones were key drivers for community participation in fisheries conservation. However, strict enforcement of fishing bans in breeding and nursery zones and restricted access to some parts of the Mushumbi Pools were the main barriers for local involvement in the conservation of fisheries resources. Without the fishing community’s participation there is no guaranteed sustainability of the fishery resources in the pools. Legitimising community access, ensuring fair valuation and utility rights is a key driver for successful management of inland fisheries resources in Sub-Saharan Africa.

Mental health disorders among post graduate residents in Kenya during the COVID-19 pandemic.

BackgroundHealthcare workers, including residents, are prone to various mental health disorders especially given the context of the COVID-19 pandemic. Residents, particularly, are already under undue stress due to their respective training program demands.MethodsThis cross-sectional, online survey-based study from August to November 2020 collected demographic and mental health measurements from all residents at the Aga Khan University Hospital, Nairobi. The questionnaire investigated demographic variables, information regarding direct care of COVID-19 patients, prior history of mental health and mental health outcomes using the Patient Health Questionnaire, Generalized Anxiety Disorder scale, Insomnia Severity Index, Impact of Event Scale–Revised Questionnaire and Stanford Professional Fulfillment Index Questionnaire.ResultsA total of 100 residents completed the survey (participation rate 77.5%). Participants were about equal in gender (women [53%]), with a median age of 31.28 years, and majority were single (66.7%). A total of 66 participants (66%) were directly engaged in COVID-19 care. Depression: 64.3%, anxiety: 51.5%, insomnia: 40.5%, distress: 35.4%, and burnout: 51.0% were reported in all participants. Statistical significance was found in median depression, professional fulfillment and interpersonal disengagement when comparing frontline resident directly involved in care of COVID-19 patient versus second line residents.ConclusionResidents directly involved with caring for COVID-19 patients had statistically higher incidences of depression and interpersonal disengagement and lower professional fulfillment compared to second line residents. Keeping in mind the limited resources in sub-Saharan Africa, urgent and geographically specific strategies are needed to help combat mental health disorders in this specific population.

Tuberculosis, HIV/AIDS and Malaria Health Services in sub-Saharan Africa – A Situation Analysis of the Disruptions and Impact of the COVID-19 Pandemic

BackgroundThe unprecedented and ongoing COVID-19 pandemic has exposed weaknesses in African countries’ health systems. The impact of shifted focus on COVID-19 for the past 2 years on routine health services, especially those for the epidemics of Tuberculosis, HIV/AIDS and Malaria, have been dramatic in both quantity and quality. MethodsIn this article, we reflect on the COVID-19 related disruptions on the Tuberculosis, HIV/AIDS and Malaria routine health services across Africa. ResultsThe COVID-19 pandemic resulted in disruptions of routine health services and diversion of already limited available resources in sub-Saharan Africa. As a result, disease programs like TB, malaria and HIV have recorded gaps in prevention and treatment with the prospects of reversing gains made towards meeting global targets. The extent of the disruption is yet to be fully quantified at country level as most data available is from modelling estimates before and during the pandemic. ConclusionsAccurate country-level data is required to convince donors and governments to invest more into revamping these health services and help prepare for managing future pandemics without disruption of routine services. Increasing government expenditure on health is a critical part of Africa's economic policy. Strengthening health systems at various levels to overcome the negative impacts of COVID-19, and preparing for future epidemics will require strong visionary political leadership. Innovations in service delivery and technological adaptations are required as countries aim to limit disruptions to routine services.

Do Natural Resources Really Cause Civil Conflict? Evidence from the New Global Resources Dataset

Scholars have long examined the relationship between natural resources and conflict at the country level. More recently, researchers have turned to subnational analyses, using either individual countries or subnational data for a small number of resources in sub-Saharan Africa. We introduce a new sub-national dataset of [Formula: see text] resources that adds many resource types, locations, and countries from Africa, the Middle East, Asia, Latin America, and Europe. To demonstrate the value of the new dataset, we examine how conflict incidence varies with the value of the collective set of resources in a given location using world prices. We then introduce new country-specific price data, which are more relevant for conflict dynamics. Since country-specific prices can be endogenous to conflict, we instrument country-specific prices using U.S. and world prices. We find that sub-national resource wealth is associated with higher levels of conflict using some specifications, though the results vary widely by data source and world region. Using an instrumental variables strategy lends the strongest support to this positive relationship, but only for African countries. Notably, across all of our models, we find that resources are negatively associated with conflict in Latin America, suggesting heterogeneity of effects worth future exploration.

Transparency and natural resources in sub-Saharan Africa

The resource curse has drawn much attention from economists and policymakers. An effort to resolve this curse is the Extractive Industries Transparency Initiative (EITI), a global standard to improve transparency and accountability in resource-abundant countries. This study theoretically and empirically assesses the impact of EITI on natural resource rents. We present a simple model to describe the collusion between politicians and resource companies. Our model reveals that monitoring both politicians and resource companies under schemes such as EITI is effective in preventing illegal transactions. Then, using data for sub-Saharan African countries from 1991 to 2015, we show that EITI implementation increases total natural resource rents and mineral rents, although it has no significant impact on oil and natural gas rents.

Assessing the effects of mining projects on child health in sub-Saharan Africa: a multi-country analysis

BackgroundThe African continent hosts many industrial mining projects, and many more are planned due to recent prospecting discoveries and increasing demand for various minerals to promote a low-carbon future. The extraction of natural resources in sub-Saharan Africa (SSA) represents an opportunity for economic development but also poses a threat to population health through rapid urbanisation and environmental degradation. Children could benefit from improved economic growth through various channels such as access to high-quality food, better sanitation, and clean water. However, mining can increase food insecurity and trigger local competition over safe drinking water. Child health can be threatened by exposure to mining-related air, noise, and water pollution. To assess the impact of mines on child health, we analyse socio-demographic, health, and mining data before and after several mining projects were commissioned in SSA.ResultsData of 90,951 children living around 81 mining sites in 23 countries in SSA were analysed for child mortality indicators, and 79,962 children from 59 mining areas in 18 SSA countries were analysed for diarrhoea, cough, and anthropometric indicators. No effects of the launch of new mining projects on overall under-five mortality were found (adjusted Odds Ratio (aOR): 0.88; 95% Confidence Interval (CI): 0.68–1.14). However, activation of mining projects reduced the mortality risk among neonates (0–30 days) by 45% (aOR: 0.55; 95% CI: 0.37–0.83) and risk for a child to develop diarrhoeal diseases by 32% (aOR: 0.68; 95% CI: 0,51–0.90). The timing analysis of observed changes showed that there is a significant decline in the risk for childhood diarrhoea (aOR: 0.69; 95% CI: 0.49–0.97), and the mean height-for-age z-scores by 28 percentage points, during the prospection and construction phase; i.e., within four years to the initiation of extraction activity. No effects were found for cough and weight-for-height.ConclusionThe results presented suggest that the impacts of mining on child health vary throughout the mine’s life cycle. Mining development likely contributes positively to the income and livelihoods of the impacted communities in the initial years of mining operations, particularly the prospection and construction phase; these potential benefits are likely to be at least partially offset by food insecurity and environmental pollution during early and later mining stages, respectively. Further research is warranted to better understand these health impacts and to identify policies that can help sustain the positive initial health impacts of mining projects in the long term.

Access to Healthcare and Spatialisation of Resources in Sub-saharan Africa: A GIS Solution to Mobility and Treatment of Patients in the West Region of Cameroon

Access to health and availability of sanitary resources is a major deterrent to mobility and treatment in sub-Saharan African towns. If it is not a problem of distance, perhaps it will be that of existing health infrastructure and know-how. This article posits that the incongruence in the availability of health units and unsatisfactory alertness has affected care in the West Region. A physical- access-ratio analysis was done to determine the distance between the health resources and population through a GPS and WGS 84 for the presentation of results. Some 120 questionnaires were administered to patients and health personnel to have first-hand information on the ratio and health need of the area. Results from findings divulge an unequal distribution of health units in the West with 51.3% concentrated in five districts and 48.7% in fifteen. The ratio of population to available health unit is 2,543 inhabitants per unit which is commendable to the WHO 10,000 inhabitants per unit standard. Unfortunately this ratio is unevenly distributed within the region as districts with a high prevalence level of diseases possess less health units. The region is 78.6% accessible in the distance of households to health unit of 5km maximum of WHO standard with 21.4% of some areas at 20km away. With an uneven distribution of inhabitants to health personnel in the region, there is a need to re-adjust the ratio. This paper advocates for a health unit and resources map to facilitate mobility and reduce health discrepancies at best in the area.

Problematizing Indigeneity in sub-Saharan Africa: Implications for natural resource management

There is considerable evidence in the literature of the nature of Indigeneity in Africa, yet few studies explore the complexity of definitions of the concept at different spatial scales. This paper builds on existing scholarship by problematizing ‘Indigeneity’ at both regional and national scales through a critical analysis and synthesis of contemporary literature across sub-Saharan Africa, in association with a specific case study from northern Ghana. In generating the review, the concomitant implications for natural resource management and associated conflicts are analyzed. The paper argues that the definitions and conceptualizations of Indigeneity are heterogeneous with numerous ambiguities and complexities at regional and national scales, which have contemporary implications for both acute and prolonged issues of natural resource allocation and management. Claims of Indigeneity in relation to climate change-driven migration and settlement processes are facilitating support for resource access and utilization, but also generating a myriad of problems linked to overlapping and disputed claims. The ambiguity of claims of Indigeneity by vulnerable individuals and groups also has latent implications. Political misunderstandings or conflicts over natural resources are becoming more widespread across Africa during a period of environmental change. Understanding the complexity of Indigeneity at both regional and national scales will provide important opportunities to inform effective policy for the sustainable and equitable distribution and management of resources in sub-Saharan Africa.

Genetic resources of bottle gourd (Lagenaria siceraria (Molina) Standl.] and citron watermelon (Citrullus lanatus var. citroides (L.H. Bailey) Mansf. ex Greb.)- implications for genetic improvement, product development and commercialization: A review

Bottle gourd (Lagenaria siceraria (Molina) Standl.] and citron watermelon (Citrullus lanatus var. citroides (L.H. Bailey) Mansf. ex Greb.) are amongst the widely grown yet under-researched cucurbits genetic resources in sub-Saharan Africa (SSA). Fresh immature leaves, fruit and seed are used for food and medicinal purposes in the region. Furthermore, both species are used as rootstock and donors of novel genes for commercial production and breeding of sweet dessert watermelon cultivars. Despite their economic value and contribution to food and nutrition security in the region, bottle gourd and citron watermelon genetic resources remain under-utilized and largely un-explored for commercial product development. The objective of this review was to document the unique values of bottle gourd and citron watermelon for genetic improvement and development of value-added food and non-food products, and to highlight regional and global efforts on conservation, production, processing, commercialization and various enterprise development of these important indigenous species. The review discussed on the value of both crops as a rootstock to improve fruit yield and quality of cultivated watermelon. This is followed by important summaries on phenotypic and genetic variation of bottle gourd and citron watermelon genetic resources and implications for new cultivar design. Finally, the review highlighted value-added non-food and food-based products developed based on indigenous knowledge systems in SSA and availability and access to genetic resources of bottle gourd and citron watermelon for breeding, product design and deployment.

Strategic accountability for sustainability of natural resources – public discharge and optimism in sub-Saharan Africa

PurposeThis study aims to explore individual perceptions about how the government, as the main architect of policies and regulations, discharges strategic accountability in Ghana’s oil and gas sector and, in so doing, promotes resource sustainability.Design/methodology/approachThe study reports on a series of interviews with key actors using institutional theory as a lens for discussion and interpretation of results. This approach forms the basis for a number of specific contributions to knowledge regarding strategic accountability around natural resource discoveries.FindingsWhilst many deeply-set problems appear to persist, the paper reports some favourable movement in public perceptions regarding institutional accountability that has not been identified previously. The empirical findings demonstrate how the three elements of institutional theory work together in an emerging country’s natural resource industry to drive a potentially holistic strategic institutional legitimacy, contrary to the existing pervasive picture of detrimental regulative, normative and cognitive institutionalism found within the region.Practical implicationsThe findings suggest that, contrary to existing regional evidence regarding institutional financial accountability practices around natural resources, Ghana has made favourable strides in terms of strategic accountability discharge. This discovery implies that with persistence and commitment, a meaningful degree of intelligent strategic accountability can be achieved and, with appropriate empirical methodology, identified and rationalised.Social implicationsThe persistent coercive pressure from the Ghanaian society that caused the government to listen to overtime and take positive steps in the institutionalisation of their strategic accountability process which translated into a holistic institutional legitimacy that has eluded the sub-region for decades, is a glimmer of hope for other societies within the sub-Saharan region that all is not lost.Originality/valueThe paper suggests an empirically driven approach to understanding the institutionalisation of strategic accountability practices and their impact on sustainability around natural resources in sub-Saharan Africa. The focus on the strategic aspect of accountability – rather than the financial as in most prior work – and the consideration of opinions at more than a single point in time permits the identification of novel evidence regarding accountability in emerging economies.

Meta-analysis of factors affecting prevalence estimates of HIV-associated neurocognitive disorder in sub-Saharan Africa

Successful treatment of HIV with anti-retroviral therapy (ART) is resulting in more people living with HIV-associated neurocognitive disorder (HAND). In sub-Saharan Africa, this calls for strategic planning and judicious allocation of scarce resources, which requires an accurate estimate of the prevalence of HAND. Estimates of the prevalence of HAND in sub-Saharan Africa vary greatly, between 18.8% and 88.3%. This variability may be explained by factors such as different diagnostic approach, neuromedical examination, ART status, sampling method, substance abuse, assessors’ qualification, depression and outcome measure. Different methods of diagnosing HAND, different outcome measures and non-random sampling techniques make it almost impossible to accurately estimate the prevalence of HAND in sub- Saharan Africa, often resulting in overestimation of the burden of disease. Consumers of health research should consider certain study characteristics and exercise appropriate caution when interpreting burden of disease in sub-Saharan Africa, especially when pursuing policy shift. Underestimating the prevalence of HAND will certainly affect the capacity and speed of containment, while overestimating will draw unnecessary attention and result in the misallocation of scarce resources. Significance: The high prevalence of HAND in sub-Saharan Africa as estimated in this review calls for further research on the impact of HAND on activities of daily living and putative therapeutic modalities. We highlight which study characteristics should be critically checked when using prevalence estimates for the purpose of health policy and distribution of scarce resources in sub-Saharan Africa. By favouring certain factors, this review will guide HIV health researchers in which techniques should be used to estimate the burden of HAND. These factors may also apply to estimating the burden of other diseases in sub-Saharan Africa.

Scalp Swelling and Headache in a 12-year-old Boy

1. Kathryn Westphal, MD* 2. Respicius Bakalemwa, MD† 3. Elizabeth Groothuis, MD, MPH* 1. *Department of Pediatrics, Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, IL 2. †Department of Pediatrics, Bugando Medical Centre, Mwanza, Tanzania A 12-year-old boy with sickle cell disease (SCD) is admitted to a hospital in Mwanza, Tanzania, with acute onset of periorbital and scalp swelling. Associated symptoms include fever, headache, difficulty breathing, and back pain. Because resources in sub-Saharan Africa are limited, access to comprehensive care for patients with SCD is variable. The general principles of management focus on early diagnosis, parental education, prevention of infection with vaccinations and prophylactic medications, prompt treatment of infection and pain, the use of hydroxyurea for stroke prevention, and blood transfusions for life-threatening anemia. This patient has a known diagnosis of SCD but has infrequent pain episodes and no previous transfusions. He is not receiving hydroxyurea or prophylaxis against bacterial infections or malaria. He has no history of stroke and no known head trauma. On presentation he is afebrile and his heart rate is 120 beats/min, respiratory rate is 40 breaths/min, and blood pressure is 105/75 mm Hg. His oxygen saturation is 92% in room air. Physical examination is significant for pallor, periorbital edema, scalp edema, dyspnea without adventitious lung sounds, and splenomegaly with diffuse abdominal tenderness. His scalp edema is fluctuant and extends posteriorly from the periorbital region, encompassing the entire scalp. Swelling is most prominent in the frontal and parietal areas. The overlying skin is nonerythematous and nontender but is warm to the touch. His neurologic examination has no focal findings, although generally he appears tired. Initial laboratory results demonstrate a white blood cell count of 84,000/μL (84×109/L) with a lymphocytic predominance (57%), a hemoglobin level of …

Ethnic heterogeneity of knowledge on termites and human consumption in southern Cameroon

Termites are both pests and non-conventional food resources in Sub-Saharan Africa. Many are reluctant to eat them, and the reasons for this rejection are poorly known. This study examined level of knowledge, and acceptance by members of the 10 main ethnic groups of southern Cameroon. Most respondents (86 percent) were aware of termites as food with sixteen vernacular names in the study areas. Acceptance among ethnic groups for consumption varied between 96 percent and 8 percent of people in a group. Barriers included being raised to not eat termites, not having many opportunities to eat termites, and dislike of the taste.

Andersen\u2019s utilization model for cataract surgical rate and empirical evidence from economically-developing areas

BackgroundUn-operated cataract is the leading cause of vision loss worldwide, responsible for 33% of visual impairment, and half of global blindness. The study aimed to build a fast evaluation method utilizing Andersen’s utilization framework and identify predictors of cataract surgical rate in sub-Saharan Africa and China.MethodsThe study was a cross-over ecological epidemiology study with a total of 19 countries in sub-Saharan Africa, and 31 provinces in China. Information was extracted from public data and published studies. Linear regression and structural equation modeling with Bootstrap were used to analyze predictors of CSR and their pathways to impact in sub-Saharan Africa and China separately.ResultsCataract surgical resources in sub-Saharan Africa were linearly correlated with CSR (β = 0.74, 95% CI: 0.09, 0.91), while GDP/P didn’t impact cataract surgical resources (β = 0.29, 95% CI: − 0.12, 0.75). In China, residents’ average ability to pay was confirmed as the mediator between GDP/P and CSR (p = 0.32, RMSEA = 0.07; βCSR-paying = 0.77, 95% CI: 0.25, 0.90; βpaying-GDP/P = 0.89, 95% CI: 0.82, 0.93).ConclusionsIn sub-Saharan Africa, CSR is determined by health care provision. Local economic development may not directly influence CSR. Therefore, international assistance aimed to providing free cataract surgery directly is crucial. In China, CSR is determined principally by health care demand (ability to pay). To increase CSR in underserved areas of China, ability to pay must be enhanced through social insurance, and reduced surgical fees.

Comparing the cost of non-metastatic breast cancer care in a low-income vs a high-income country: A plea for an optimal allocation of health resources in Sub-Saharan Africa

Breast cancer incidence is rising in low-income countries, but there is limited information regarding health resource allocation for its care. We assessed the cost of care during the first three years after diagnosis in a low-income country (Mozambique; n = 162 women) and compared it with a high-income country (Portugal, n = 703 women). Local currency prices were converted to 2019 international dollars (Int$). In Mozambique, the median cost was lower than in Portugal (2888 vs 18,533 Int$, respectively) and did not vary across stage or tumor subtype. These findings may help improving resource allocation for breast cancer care in Sub-Saharan Africa, despite reflecting an underfunding of treatment in this setting.

Stewardship of Wild and Farmed Edible Insects as Food and Feed in Sub-Saharan Africa: A Perspective.

Edible insects have gained popularity as alternative food resources in the face of climate change and increasing carbon and environmental footprints associated with conventional agricultural production. Among the positive attributes that make edible insects suitable as food and feed substrates include rapid reproduction, high energy conversion efficiency, wide distribution, diversity, reduced greenhouses gases and ammonia emissions, possibility to reduce waste and high nutritional composition. In Sub-Saharan Africa, considerable scientific data exist on use of insects as food and livestock feed. However, coherent policies regarding safety, sustainability, trade and regulation of insects as food and animal feed are lacking. The benefits associated with edible insects are likely to accrue in Sub-Saharan Africa through use of a combination of approaches such as ensured sustainable utilization of edible insects in the wild, preservation of traditional conservation, harvesting and consumption practices, development of captive mass production schemes and strengthening robust value chains to incentivise indigenous participants. Collectively these approaches are referred to as the steward and use of insects as food and animal feed. This paper examines the policy frameworks that exist to support the use of edible insects as food and feed on the African continent. This investigation employed a literature review focussing on national policies in selected African countries to assess the relevance to edible insects. Using a baseline of more than 10 edible insect species consumed, 10 country cases in Sub-Saharan Africa were used to support our in-depth examination of the policy situation that may support good stewardship of edible insects as food and feed. Focus on how policies encompassing biodiversity, natural resources, culture, education, research, technology development, trade, health and nutrition and how that could be improved to support inclusivity of edible insects is discussed. We conclude by proposing a pathway that may accelerate recognition and valorisation of edible insects as important food and feed resources in Sub-Saharan Africa including improving policies to support good stewardship of these resources for sustainability.