Rural Africa Research Articles

Katherine Lucey and Solar Sister: empowering women in sub-Saharan Africa to create clean energy businesses

Research methodology This case study was developed using data from secondary sources. The data was collected from the organization’s website, annual reports, press releases, published reports and documents available on the internet. Case overview/synopsis According to the International Energy Agency’s (IEA) World Energy Outlook (WEO), 775 million people worldwide would not have access to electricity even by 2022, with the majority of them living in sub-Saharan Africa (SSA) (Cozzi et al., 2022). In SSA, energy poverty had been a serious issue over the years. According to the IEA, 600 million people lacked access to electricity in 2019, while 900 million people cooked with traditional fuels (Cozzi et al., 2022). A World Bank report from 2018 said many SSA countries had energy access levels of less than 25% (Cozzi et al., 2022). Energy poverty in SSA hampered sustainable development and economic growth. Despite significant efforts to address this poverty, Africa remained the continent with the lowest energy density in the world. Although solar and other energy-saving products were appealing, their adoption rates were modest, and their distribution strategies were not particularly effective. The lack of electricity exacerbated a number of socioeconomic problems, as it increased the demand for and use of wood fuel, which caused serious health problems and environmental harm. While working in Uganda, Katherine Lucey (Lucey) saw that having no electricity had negatively affected women’s health in particular because it was women who were responsible for taking care of the home. These effects were both direct and indirect. The women’s reliance on potentially harmful fuels for cooking, such as firewood and charcoal, resulted in their suffering from respiratory and eye problems, in addition to other health issues. Furthermore, the distribution of energy-saving and renewable energy items was seen as the domain of men, and there was an inherent gender bias in energy decisions. Women were not encouraged to participate in energy decisions, despite the fact that they were the ones managing the home and would gain from doing so. In addition, because there was no light after dusk, people worked less efficiently. Lucey saw the economic and social difficulties that electricity poverty caused for women in rural Africa. She also witnessed how the lives of a few families and organizations changed after they started using solar products. This motivated her to start Solar Sister with the mission of achieving a sustainable, scalable impact model for expanding access to clean energy and creating economic opportunities for women. Solar Sister collaborated with local women and women-centric organizations to leverage the existing network. Women were trained, provided all the necessary support and encouraged to become Solar Sister Entrepreneurs and sell solar products in their communities and earn a commission on each sale. To provide clean energy at their customers’ doorstep, the Solar Sister Entrepreneurs received a “business in a bag” – a start-up kit containing inventory, training and marketing assistance. Solar Sister’s business model empowered the women in SSA by providing them with an entrepreneurship opportunity and financial independence. Also, the use of solar products helped them shift from using hazardous conventional cooking fuels and lead a healthy life. The children in their households were able to study after sunset, and people in the community became more productive with access to clean energy. The COVID-19 pandemic outbreak, however, had a serious impact on Solar Sister. It found it challenging to mentor and encourage new business owners due to restrictions on travel and on group gatherings. The Solar Sisters were unable to do business outside the house either. Their source of income, which they relied on to support their families, was therefore impacted. The COVID-19 outbreak also slowed down the progress achieved by the community over the years and made household energy purchasing power worse. Furthermore, the organization was also grappling with other issues like limited access to capital, lack of awareness and infrastructural challenges. Another challenge lay in monitoring and evaluating the organization’s impact on the last mile. In the absence of standardized measurement tools and issues in determining the social impact of Solar Sister, it would be interesting to see what approach Lucey will take to measure the impact of Solar Sister on the society. What measurement tool/s will Lucey implement to gauge the social impact of Solar Sister? Complexity academic level This case is intended for use in PG/Executive-level programs as part of a course on Social Entrepreneurship and Sustainability.

Prevalence, Etiology, and Impact of Hearing Loss in Pediatric Populations: A Multicenter Study in Rural Sub-Saharan Africa

This multicenter study delves into the prevalence, etiology, and impact of hearing loss among pediatric populations in rural Sub-Saharan Africa over recent decades. Drawing on a diverse array of healthcare facilities, the research incorporates a comprehensive methodology, including diagnostic tools, genetic testing, and interviews, to unravel the complexities of this often-overlooked health concern. The findings reveal a substantial prevalence of pediatric hearing loss, with infants and toddlers being particularly vulnerable. Genetic factors, infectious diseases, and environmental influences emerge as significant contributors, underlining the intricate interplay of genetic predispositions and external factors. The impact of hearing loss on affected children is profound, affecting psychosocial, educational, and developmental domains. The study emphasizes the urgent need for targeted interventions, early detection, and community-based support services. This research not only advances our understanding of pediatric hearing loss in rural Sub-Saharan Africa but also advocates for the development of context-specific interventions to improve the lives of affected children and their families.

Women empowerment and food-nutrition security in Sierra Leone: The Gender Model Family approach

BackgroundThis research is conducted in the context of an integrated food security and nutrition project implemented by the Social Enterprise Development Foundation (SEND Sierra Leone) and Agro Forestry Farmers Association (AFFA) in rural Kenema and Pujehun Districts. This paper presents a qualitative ‘baseline’ action-learning research on the impact of the Gender Model Family (GMF) approach on women empowerment and the effects on enhanced outcomes along the agriculture-nutrition pathway. Qualitative data were collected using in-depth face-to-face interviews and focused group discussion (FGD) from the GMF beneficiaries.ResultsLinking Agriculture, Natural Resource Management and Nutrition (LANN) has nutrition security as its aim, and the project objectives and indicators focus on nutrition, not gender—however, this ‘baseline’ action-learning research recognized that gender is a major underlying factor. The evidence suggests that the GMF approach fosters women empowerment and enhances outcomes in food and nutrition security as there has been a change in social rules about men taking part in domestic household work and women involvement in family decision-making.ConclusionsGiven that women play crucial roles as administrators of household food and nutrition security, empowering them is intimately related to the consolidation of household food systems, improves nutrition intake and the fight against food-nutrition insecurity in rural Africa.

Preserving Cultural Diversity in Rural Africa Using Renewable Energy.

Ninety percent of the large interior, rural part of Africa is not an abundant user of fossil fuels and is not connected to an electricity grid. This limits habitability and leads to significant migration to larger cities in attempts to improve economic and social welfare, which happens at the cost of its rich cultural diversity by inevitable adaption and mixing of societies. A direct transition from a firewood to an off-grid renewable electricity age can mitigate this detrimental development. This perspective discusses the interdisciplinary requirements linking cultural, sociological, economic, and technical aspects for a transition to modern life without loss of valuable traditions. Photovoltaic power and wind energy can provide local affordable electricity in off-grid locations. Intermediate storage for day-night cycles is catered for by novel types of batteries. Purifying and recycling water, refrigerating food and medicine, and benefitting from contact with the world via electronic media permit a tremendous increase in living conditions and significantly lower the pressure of migration into cities. Access to energy is a fundamental requirement for the preservation of the rich cultural diversity with family and tribal bindings, local languages, traditions, and religions, and allows for a more moderate transition to a modern society.

Long-term continuous cultivation of Kenyan infant fecal microbiota using the host adapted PolyFermS model

Appropriate in vitro models to investigate the impact of novel nutritional strategies on the gut microbiota of infants living in rural Africa are scarce. Here, we aimed to develop such a continuous gut fermentation model based on the PolyFermS platform, which allows controlled and stable long-term cultivation of colon microbiota in conditions akin the host. Nine immobilized Kenyan infant fecal microbiota were used as inoculum for continuous PolyFermS colon models fed with medium mimicking the weaning infant diet. Fructo-oligosaccharides (FOS) supplementation (1, 4 and 8 g/L) and cultivation pH (5.8 and 6.3) were investigated stepwise. Conditions providing a close match between fecal and in vitro microbiota (pH 5.8 with 1 g/L FOS) were selected for investigating long-term stability of four Kenyan infant PolyFermS microbiota. The shared fraction of top bacterial genera between fecal and in vitro microbiota was high (74–89%) and stable during 107 days of continuous cultivation. Community diversity was maintained and two distinct fermentation metabolite profiles of infant fecal microbiota were observed. Three propiogenic and one butyrogenic metabolite profile of infant fecal microbiota established from day 8 onwards and stayed stable. We present here the first rationally designed continuous cultivation model of African infant gut microbiota. This model will be important to assess the effect of dietary or environmental factors on the gut microbiota of African infants with high enteropathogen exposure.

Indigenous knowledge systems and drought preparedness in rural Umzingwane in Zimbabwe

Indigenous Knowledge Systems (IKS) are an essential survival tool for humans since time immemorial and have always been connected to the management of weather related hazards such as drought. However, the advancement in technology and dominant application of the western version of science in rural Africa continues to masks the significance of IKS resulting in the shrinkage of its use. Against this background, the article examines existing indigenous knowledge and the influence they have on the preparedness of vulnerable groups against drought shocks. Further, the study focuses on the perceptions of rural Umzingwane on the application of indigenous knowledge in predicting and responding to drought shocks in contemporary settings. In this context, the Drought Cycle Management Model anchored theoretical arguments on IKS and drought preparedness. The study gathered data using in-depth interviews purposively targeting spirit mediums, traditional leaders, Agriculture Technical and Extension Workers, District Development Coordinator to gain insights on IKS and its relevance in drought preparedness. The study found that IKS informs early detection of drought and response strategies in rural Umzingwane. In predicting drought hazards, communities rely on observing animal behaviour, fruiting of trees and growth of certain species in certain seasons. The study recommends documentation of IKS and the establishment of platforms to disseminate indigenous knowledge to strengthen capacities of the drought exposed to proactively deal with the hazard.

Current and future opportunities of autodissemination of pyriproxyfen approach for malaria vector control in urban and rural Africa

Despite the progress made in reducing malaria burden, new ways to address the increasing challenges of insecticide resistance and the invasion and spread of exotic malaria vectors such as Anopheles stephensi in Africa are urgently needed. While African countries are adopting larviciding as a complementary intervention for malaria vector control, the autodissemination technology has the potential to overcome barriers associated with the identification and treatment of prolific habitats that impede conventional larviciding approaches in rural settings. The autodissemination technology as a “lure and release” strategy works by exploiting the resting behavior of gravid mosquitoes to transfer lethal concentration of biological or chemical insecticide such as pyriproxyfen (PPF), an insect growth regulator (IGRs) to their oviposition sites and result in adult emergence inhibition. Despite the evidence of the autodissemination approach to control other mosquito-borne diseases, there is growing and promising evidence for its use in controlling malaria vectors in Africa, which highlights the momentous research that needs to be sustained. This article reviews the evidence for efficacy of the autodissemination approach using PPF and discusses its potential as efficient and affordable complementary malaria vector control intervention in Africa. In the previous studies that were done in controlled semi-field environments, autodissemination with PPF demonstrated its potential in reducing densities of captive population of malaria vectors such as Anopheles gambiae and Anopheles arabiensis. Of importance, empirical evidence and biology-informed mathematical models to demonstrate the utility of the autodissemination approach to control wild populations of malaria vectors under field environment either alone or in combination with other tools are underway. Among others, the key determining factors for future introduction of this approach at scale is having scalable autodissemination devices, optimized PPF formulations, assess its integration/complementarity to existing conventional larviciding, and community perception and acceptance of the autodissemination approach.

Integrating “Top-Down” and “Community-Centric” Approaches for Community-Based Flood Early Warning Systems in Namibia

The United Nations Office for Disaster Risk Reduction (UNDRR) resolutely endorses the development of people-centred early warning systems. Moreover, several scientific studies have deprecated the vast technology-driven technocratic approaches to implementing these systems, contending the prioritisation of communities and their contextualised needs for systems that ensure effective risk protection and resilience building. However, both the UNDRR and the scientific literature have failed to define appropriate means of implementation (MoI) for community-based early warning system (CBEWS) development. Floods are a major hazard annually impacting several communities in rural sub-Saharan Africa, and though several opportunities for participatory systems have been identified, investment in developing countries is often lagging, and no defined mechanism for developing these systems exists. Adopting a modified Integrated Emergency Management Framework, this study demonstrates that an impact-based CBEWS can be established by leveraging existing resources, institutions and stakeholders, essentially merging last-mile and first-mile approaches. The study further reveals that directly linking technical capacities with community-based efforts allows communities to define system development parameters, strengthen risk knowledge and response, and build resilience for improved physical, economic and environmental protection, essentially bridging the gap between first and last-mile approaches. The study also highlights the need for governments to appropriately streamline DRR to improve coordination and communication.

Impact of Technology-Aided Activity-Based Learning Approaches on Learning Outcomes: Experimental Evidence from Community Schools in Rural Zambia

We present experimental evidence on the impact of a multi-faceted program that integrates technology-aided instruction, teacher training and coaching, community ownership, and free primary education. Our setting is three districts in rural Zambia, where we randomly assigned the program across 30 treatment and 33 control schools. The results show that the program increased reading scores by 0.40 standard deviations or 3.5 percentage points, math scores by 0.21 standard deviations or 4.7 percentage points, Zambian achievement test scores by 0.15 standard deviations or 3.0 percentage points, and oral vocabulary scores by 0.25 standard deviations or 5.9 percentage points for all children eligible to enroll in first grade. Treatment Effects on the Treated showed substantially larger impacts on learning outcomes of students who regularly attended the schools in Grade 1. Our results indicate that multi-faceted technology-aided instruction programs can improve learning outcomes even in the poorest areas of rural sub-Saharan Africa.

Rural-urban differentials in the association between sex preference for children and marital dissolution in sub-Saharan Africa.

Marital dissolution, which refers to being divorced or separated, is considered one of the most dramatic demographic events that significantly disrupt families. Unearthing the factors predicting marital dissolution would support actions to reduce the incidence of this phenomenon. The present study sought to examine the association between sex preference for children and marital dissolution segregated by place of residence. Data for the study were extracted from the most recent Demographic and Health Surveys (DHS) of 25 countries in sub-Saharan Africa. Percentages were used to summarise the proportion of marital dissolution among women in sub-Saharan Africa. Binary logistic regression models were fitted to examine the association between sex preference for children and marital dissolution per place of residence. Results of the regression analysis were presented using adjusted odds ratios (aOR) with their respective 95% confidence interval (CI). The overall prevalence of marital dissolution was 5.92% (95% CI: 5.83-6.00), and this ranged from 1.63% (95% CI: 1.41-1.85) in Burkina Faso to 15.62% (95% CI: 14.70-16.54) in Mozambique. In urban sub-Saharan Africa, the overall prevalence of marital dissolution was 8.88% (95% CI:8.78-8.99), with the lowest prevalence in Mali (3.30%; 95% CI: 2.91-3.69) and the highest in Uganda (18.60%; 95% CI: 17.95-19.25). For rural sub-Saharan Africa, the pooled prevalence was 4.11% (95% CI: 4.03-4.18), with the lowest (0.80%; 95% CI: 0.65-0.95) and highest (14.40%; 95% CI: 13.51-15.29) prevalences in Burkina Faso and Mozambique, respectively. Compared to women with no sex preference, the preference for boys was less likely to result in marital dissolution (aOR = 0.87; 95%CI = 0.83-0.90) in both urban and rural areas, whereas the preference for girls was more likely to result in marital dissolution (aOR = 1.06; 95%CI = 1.02-1.10). When the results were disaggregated by place of residence, in both urban (aOR = 0.87; 95%CI = 0.80-0.95) and rural areas (aOR = 0.87; 95%CI = 0.82-0.92), women who preferred boys were less likely to experience marital dissolution compared to those who had no preference. However, the preference for girls showed no statistically significant association with marital dissolution. Our study has shown that sex preference for children has a significant association with marital dissolution in both rural and urban areas in sub-Saharan Africa. Whereas the preference for male children serves as a protective factor against marital dissolution, the preferences for females was found to increase the likelihood of marital dissolution. Thus, underscoring a need for anti-marital dissolution campaigns and initiatives to prioritise the sensitisation of society about the value of female children. Religious groups and leaders can leverage their platform to quell sex preferences and dissuade marital dissolution. Policies and programmes aimed at reducing the risk of marital dissolution in sub-Saharan Africa must also focus on enlightening the population on intimate partner violence prevention.

Sustainable home gardens in Western Kenya: A qualitative study for co-designing nutrition-sensitive interventions

Populations living in rural sub-Saharan Africa (SSA) increasingly face negative climate change impacts on their nutrition and health status. For smallholder farming families, home gardens can serve as an adaptation strategy, by offsetting climate change-related harvest losses and diversifying households' diets. The present study aimed to identify perceptions and experiences among rural caregivers of children under five years and local stakeholders working in the fields of agriculture or nutrition with regard to home gardening in Siaya County, Kenya. Thirty in-depth interviews with caregivers of young children and 26 interviews with local stakeholders were conducted, using a semi-structured interview guide. The data were analysed employing inductive content analysis. Caregivers and local stakeholders perceived home gardens as beneficial for the households’ nutrition, finances, and women empowerment. However, they also pointed to five major challenges in the process of establishing and maintaining home gardens: 1) water scarcity, 2) limited financial capital, 3) demanding physical labour, 4) limited land availability/control, and 5) lack of knowledge and technical support. For the design of sustainable home gardens, we identified four components as essential at the implementation stage: 1) locally available material and resources, 2) strong community collaboration and co-design, 3) comprehensive capacity building, 4) and lasting local partnerships. In conclusion, the establishment and sustained management of home gardens in Siaya County require a holistic, participatory and multi-actor approach. This will facilitate the provision of essential inputs and activities to ensure a sense of ownership and responsibility.

Epstein–Barr virus (EBV) antibody changes over time in a general population cohort in rural Uganda, 1992–2008

BackgroundEpstein–Barr virus (EBV) infection is ubiquitous and in sub-Saharan Africa, occurs early in life. In a population-based rural African cohort, we leveraged historical samples from the General Population Cohort (GPC) in Uganda to examine the epidemiology of infection with EBV over time, in the era of HIV.MethodsWe used 9024 serum samples collected from the GPC in 1992, 2000, 2008, from 7576 participants across the age range (0–99 years of age) and tested for anti-EBV immunoglobulin G (IgG) antibodies to EAd, VCA, and EBNA-1 using a multiplex bead-based assay. The related gammaherpesvirus, Kaposi’s sarcoma-associated herpesvirus (KSHV) seropositivity was also determined by detection of anti-KSHV IgG antibodies to K8.1 or ORF73 measured by recombinant protein enzyme-linked immunosorbent assay. Data on sex, age, and HIV serostatus were also collected. EBV seropositivity was modeled with age (excluding those under one year, who may have had maternal antibodies), sex, HIV serostatus, and KSHV serostatus using generalized linear mixed effects models to produce beta estimates.ResultsMore than 93% of children were EBV seropositive by one year of age. EBV seropositivity was significantly associated with KSHV seropositivity. Anti-EBNA-1 antibody levels decreased with increasing age and were lower on average in people living with HIV. In general, anti-EAd antibody levels increased with age, were higher in males and KSHV seropositive persons, but decreased over calendar time. Anti-VCA antibody levels increased with age and with calendar time and were higher in KSHV seropositive persons but lower in males.ConclusionsThis is the first study to identify factors associated with EBV antibodies across the entire life-course in rural sub-Saharan Africa. Consistent with other studies, EBV was near ubiquitous in the population by age one year. Patterns of antibodies show changes by age, sex and calendar time, but no association with HIV was evident, suggesting no relationship between EBV sero-epidemiology and the spread of HIV in the population over time in Uganda.

Nudging parents and teachers to improve learning and reduce child labor in Cote d’Ivoire

Whether SMS-based nudge interventions can increase parent engagement and improve child learning outcomes across diverse contexts such as rural West Africa is unknown. We conducted a school-randomized trial to test the impacts of an audio or text-message intervention (two messages per week for one school year) to parents and teachers of second and fourth grade students (N = 100 schools, 2246 students) in Cote d’Ivoire. Schools were randomly assigned to have messages sent to (i) parents only, (ii) teachers only, (iii) parents and teachers together, or (iv) control. There were statistically non-significant impacts of the parents-only treatment on learning, although with typical effect sizes (d = 0.08, p = 0.158), and marginally statistically significant increases in child labor (d = 0.11, p < 0.10). We find no impacts of the other treatment conditions. Subgroup analyses based on pre-registered subgroups show significantly larger improvements in learning for children with below-median baseline learning levels for the parents-only arm and negative impacts on learning for girls for the teachers-only arm, suggesting different conclusions regarding impacts on equity for vulnerable children.

Long-term optimal capacity expansion planning for an operating off-grid PV mini-grid in rural Africa under different demand evolution scenarios

Using real-time load data and HOMER Pro's ‘multi-year’ optimization tool, this paper investigates the long-term cost optimal capacity expansion planning (CEP) for an overloaded photovoltaic (PV) mini-grid (MG) with storage batteries in off-grid rural Ethiopia over a 20-year planning horizon. Three distinct annual energy demand growth scenarios were considered: 0 % (fulfils the minimum load requirement), 5 %, and a 15 % from productive users only. In all scenarios, the generation mix consists of only solar energy and the maximum allowable capacity shortage (MACS) is limited to 10 %. The findings reveal that, in all scenarios, the largest capacity expansion is performed on the battery and PV systems, covering up to 73 % and 35 % of the total expansion costs, respectively. The annual unmet load fraction of the expanded MG system ranges from 5.9 % in scenario-3 to 9.4 % in scenario-1, and the cost of electricity (LCOE) ranges from $0.404/kWh in scenario-3 to $0.887/kWh in scenario-1. The results indicate that the scenario-3 expansion path is comparatively cost-effective and has the highest reliability; but it still falls short of fully satisfying the required load demand and is not financially viable. Surprisingly, increasing the reliability of the scenario-3 capacity expansion from 94 % to 100 % raises the MG's Net Present Cost by 37 %. The sensitivity analysis shows that the MACS, ambient temperature, and battery's depth of discharge significantly affect the cost and performance of the capacity expansion. The study demonstrates (a) there are significant trade-offs between minimizing MG expansion costs and maximizing reliability levels; (b) capacity expansion based solely on cost-minimization without considering key constraints and uncertainties (demand, cost, PV, and battery degradations) may not provide a practical and robust solution to severe reliability issues, (c) capacity expansion that supports demand from productive users increases the cost-effectiveness and bankability of isolated MGs.

Exploring the Funding Challenges Faced by Small NGOs: Perspectives from an Organization with Practical Experience of Working in Rural Malawi.

Malawi is a small landlocked country in Southern Africa, which faces a number of development challenges. It is one of the world's poorest nations and over 70% of the population live below the International Poverty Line of $2.15 per day. Health inequalities are a well-documented problem and those most affected are women and children. Non-governmental organizations (NGOs) play a vital role in supplementing government efforts to provide health services to vulnerable people in areas that are difficult to reach. The World Medical Fund (WMF) is a small medical charity that operates in the central, rural, Nkhotakota region of Malawi where many children lack access to even basic health services. To date, WMF has successfully provided free care and treatment for over 400,000 sick children, but its initiatives, such as mobile clinics, rely entirely on external donations. Since 2000, the funding resources available to small NGOs have declined and efforts to attract funding have become increasingly competitive. Frequently, the criteria used for funding decisions are too rigid, and do not reflect the difficult operating conditions on the ground in rural Africa. As one of the world's most highly resource constrained healthcare environments, Malawi illustrates the need for more flexible funding criteria from donors so that NGOs can carry out their work to save children's lives.

Scaling up essential surgery in rural Africa: outcomes of a novel regional initiative

Introduction: South Sudan, like most of rural Africa, has a high surgical disease burden and profound unmet surgical needs. This is against a background of weak surgical service delivery systems, especially in the harder-to-reach areas. Here it is further fueled by armed conflict and poverty. The surgical service delivery models applied so far have not adequately improved surgical care. Through the Intergovernmental Authority on Development Regional Initiative for Capacity Building, a surgical team was deployed to Kuajok Hospital in Warrap state. The team mentored South Sudanese health workers for 2 years while working together with other agencies operating in the locality to improve surgical services. This paper is an account of the capacity building process for surgical service improvement at this site, from 2015 to 2017. Methods: A descriptive study of activities and patients seen over a 2-year period at this centre. Quantitatively, statistics were extracted and compiled from all areas of surgical care, including profiles of the various surgical conditions. Qualitatively, information was gathered through unstructured interviews. Results: There was a drastic increase in surgical outpatient consultations, admissions, and operations. There was an improvement in the level of surgical care and patient care systems. New facilities like operating theaters, emergency rooms, surgical consultation rooms, and surgical wards were established. Community attitude and health-seeking behavior improved, leading to improved access to care. An indirect financial benefit was experienced due to improved patient care outcomes and reduced expenditure on referrals. Conclusion: Improvement of surgical services in Africa’s hard-to-reach areas is readily attainable through partnerships and mentoring of native medical workers by personnel from fellow African countries.

Carrying Asymptomatic Malaria In Ouéllé Locality, And Surrounding Villages, In Southeastern Gabon: An Epidemiological Analysis, In Rural Central Africa

Background: Malaria remains a major public health problem in sub-Saharan Africa, and particularly in Gabon. In an epidemiological analysis in a rural area, the present study assessed asymptomatic malaria carriage in Ouéllé, and surrounding villages, in South-eastern Gabon: an epidemiological analysis, in a rural area of central Africa. Patients and method: This prospective, cross-sectional study was conducted from June 26 to 28, 2023. The sociodemographic characteristics of the participants were obtained. A small portion of blood collected by finger prick from each participant was used for qualitative detection of malaria-causing Plasmodium infection, using a Malaria Test MeriScreenTM Pf/PAN Ag lateral flow immunochromatographic assay. Results of analysis by R software version 4.0.3, were considered significant at p≤0.05.Results: Of the 321 people registered for the present study, 97 (30.22%) (95% CI: 0.25 - 0.36) (n=97), tested positive for malaria, compared with 224 (69.78%) ((95% CI: 0.64 - 0.75) (n=224). While a univariate analysis of the prevalence of malaria carriage according to gender showed no statistically significant association between the variables p=0.56, a univariate analysis of the prevalence of malaria carriage according to age group indicated that only participants aged between 28 and 57 (OR =0.17; 95% CI: [0.04 - 0.73] p=0. 007*), and according to each locality, the analysis showed that participants from Mvengué (OR =0.17; CI 95% : [0.04 - 0.73] p=0.007*), Djoutou (OR =0.17; CI 95% : [0.04 - 0.73] p=0. 007*), and Mouyabi (OR =0.17; 95% CI: [0.04 - 0.73] p=0.007*), were statistically susceptible to malaria were significantly associated with malaria carriage in the present study.Conclusion: These results, which indicate the persistence of asymptomatic malaria in Ouéllé and surrounding villages, call on Gabon's health authorities to redouble their efforts to combat malaria throughout the country.

Body mass index trends and its impact of under and overweight on outcome among PLHIV on antiretroviral treatment in rural Tanzania: A prospective cohort study.

Increased body weight is an important risk factor for cardiovascular disease and is increasingly reported as a health problem in people living with HIV (PLHIV). There is limited data from rural sub-Saharan Africa, where malnutrition usually presents with both over- and undernutrition. We aimed to determine the prevalence and risk factors of underweight and overweight/obesity in PLHIV enrolled in a cohort in rural Tanzania before the introduction of integrase inhibitors. This nested study of the prospective Kilombero and Ulanga Antiretroviral Cohort included adults aged ≥19 years initiated on antiretroviral therapy between 01/2013 and 12/2018 with follow-up through 06/2019. Body Mass Index (BMI) was classified as underweight (<18.5 kg/m2), normal (18.5-24.9 kg/m2), or overweight/obese (≥25.0 kg/m2). Stratified piecewise linear mixed models were used to assess the association between baseline characteristics and follow-up BMI. Cox proportional hazard models were used to assess the association between time-updated BMI and death/loss to follow-up (LTFU). Among 2,129 patients, 22,027 BMI measurements (median 9 measurements: interquartile range 5-15) were analysed. At baseline, 398 (19%) patients were underweight and 356 (17%) were overweight/obese. The majority of patients were female (n = 1249; 59%), and aged 35-44 years (779; 37%). During the first 9 months, for every three additional months on antiretroviral therapy, BMI increased by 2% (95% confidence interval 1-2%, p<0.0001) among patients underweight at baseline and by 0.7% (0.5-0.6%, p<0.0001) among participants with normal BMI. Over a median of 20 months of follow-up, 107 (5%) patients died and 592 (28%) were LTFU. Being underweight was associated with >2 times the hazard of death/LTFU compared to participants with normal BMI. We found a double burden of malnutrition, with underweight being an independent predictor of mortality. Monitoring and measures to address both states of malnutrition among PLHIV should be integrated into routine HIV care.

Spectrum and Pattern of Harmful Traditional Practices Affecting Children Among Mothers in Rural Sub-Saharan Africa

Spectrum and Pattern of Harmful Traditional Practices Affecting Children Among Mothers in Rural Sub-Saharan Africa

How do they pay as they go?: Learning payment patterns from solar home system users data in Rwanda and Kenya

Pay-as-you-go (PAYGo) financing models play a vital role in boosting the distribution of solar-home-systems (SHSs) to electrify rural Sub-Saharan Africa. This financing model improves the affordability of SHSs by supporting the payment flexibility required in these contexts. Such flexibility comes at a cost, and yet the assumptions that guide the PAYGo model design remain largely untested. To close the gap, this paper proposes a methodology based on unsupervised machine learning algorithms to analyse the payment records of over 32,000 Rwandan and 25,000 Kenyan SHS users from Bboxx Ltd., and in so doing gain detailed insights into users' payment behavioural patterns. More precisely, the method first applies three clustering algorithms to automatically learn the main payment behavioural groups in each country separately; it then determines the preferred customer segmentation through a validation procedure which combines quantitative and qualitative insights. The results highlight six behavioural groups in Rwanda and four in Kenya; however, several parallels can be made between the two country profiles. These groups highlight the diversity of payment patterns found in the PAYGo model. Further analysis of their payment performance suggests that a one-size-fits-all approach leads to inefficiencies and that tailored plans should be considered to effectively cater to all SHS users.