Rural Areas Of sub-Saharan Africa Research Articles

A bridge to clean cooking? The cost-effectiveness of energy-efficient biomass stoves in rural Senegal

Rural areas of sub-Saharan Africa have experienced limited progress towards the sustainable development goal of universal access to clean cooking. Energy-efficient biomass cookstoves (EEBCs) are considered a potential bridge technology, but EEBC models vary widely, and there is a lack of understanding about their real-world use implications. We conduct a randomized controlled trial in rural Senegal to compare a low-cost, locally produced stove designed to achieve fuel savings and an expensive, imported stove shown to be more efficient and emissions-reducing in the laboratory. We find that the two EEBCs perform similarly: both reduce fuel consumption but have no significant impact on cooking time and fuel collection, emissions, or objective health measures. We conclude that the technically advanced option is not cost effective for most of our sample, while the low-cost EEBC can be seen as a stop-gap solution that primarily reduces fuel use. The findings underpin the importance of customizing EEBC dissemination to local context and baseline cooking patterns.

Study of a new biocoagulant/bioflocculant mixture based on Boscia senegalensis seeds powder and Aloe vera leaves extract for the treatment of raw water intended for human consumption in rural areas of Sub-Saharan Africa

Study of a new biocoagulant/bioflocculant mixture based on Boscia senegalensis seeds powder and Aloe vera leaves extract for the treatment of raw water intended for human consumption in rural areas of Sub-Saharan Africa

Improving the performance of PV/diesel microgrids via integration of a battery energy storage system: the case of Bilgo village in Burkina Faso

BackgroundPV/diesel microgrids are getting more popular in rural areas of sub-Saharan Africa, where the national grid is often unavailable. Most of the time, for economic purposes, these hybrid PV/diesel power plants in rural areas do not include any storage system. This is the case in the Bilgo village in Burkina Faso, where a PV/diesel microgrid without any battery storage system has been set up. This power plant is composed of three diesel generators operating in parallel (two of 16 kW and one of 24 kW), coupled with a photovoltaic field of 30 kWp. It was observed that for such power plants, the grid management is not always efficient due to constantly fluctuating solar output and loads. This inconsistency in energy output raises the question if integrating battery energy storage systems could improve the grid's performance. While many studies in the literature focus on hybrid energy systems, only a few of them have tackled the optimization of existing and operational systems.MethodsThis study investigated three scenarios based on the existing microgrid's characteristics: conventional standalone diesel generators, PV/diesel without battery storage and PV/diesel with a battery storage system which are the main technologies used for off-grid rural electrification in Burkina Faso. The levelized cost of electricity (LCOE) was used to assess the economic performance of each scenario, and the calculations were made using the HOMER software.ResultsIt was found that the best among the scenarios considered is the PV/diesel/battery configuration which has the lowest LCOE of US$ 0.524/kWh. The battery storage system for the optimal configuration has a capacity of 182 kWh with about 8 h of autonomy.ConclusionsIt can be inferred from this study that a storage unit is necessary for an optimal management of a PV/diesel microgrid. Indeed, the storage unit significantly reduces the operating and maintenance costs associated with running diesel generators, as well as the excess electricity. The storage system also allows for a greater reduction in CO2 emissions compared to systems without storage.

The elimination of human African trypanosomiasis: Monitoring progress towards the 2021-2030 WHO road map targets.

Human African trypanosomiasis (HAT) is a neglected tropical disease that usually occurs in rural areas in sub-Saharan Africa. It caused devastating epidemics during the 20th century. Sustained, coordinated efforts by different stakeholders working with national sleeping sickness control programmes (NSSCPs) succeeded in controlling the disease and reducing the number of cases to historically low levels. In 2012, WHO targeted the elimination of the disease as a public health problem by 2020. This goal has been reached and a new ambitious target was stated in the WHO road map for NTDs 2021-2030 and endorsed by the 73rd World Health Assembly: the elimination of gambiense HAT transmission (i.e. reducing the number of reported cases to zero). The interruption of transmission was not considered as an achievable goal for rhodesiense HAT, as it would require vast veterinary interventions rather than actions at the public health level. Data reported to WHO by NSSCPs were harmonized, verified, georeferenced and included in the atlas of HAT. A total of 802 cases were reported in 2021 and 837 in 2022. This is below the target for elimination as a public health problem at the global level (< 2000 HAT cases/year); 94% of the cases were caused by infection with T. b. gambiense. The areas reporting ≥ 1 HAT case/10 000 inhabitants/year in 2018-2022 cover a surface of 73 134 km2, with only 3013 km2 at very high or high risk. This represents a reduction of 90% from the baseline figure for 2000-2004, the target set for the elimination of HAT as a public health problem. For the surveillance of the disease, 4.5 million people were screened for gambiense HAT with serological tests in 2021-2022, 3.6 million through active screening and 0.9 million by passive screening. In 2021 and 2022 the elimination of HAT as a public health problem was validated in Benin, Uganda, Equatorial Guinea and Ghana for gambiense HAT and in Rwanda for rhodesiense HAT. To reach the next goal of elimination of transmission of gambiense HAT, countries have to report zero cases of human infection with T. b. gambiense for a period of at least 5 consecutive years. The criteria and procedures to verify elimination of transmission have been recently published by WHO. HAT elimination as a public health problem has been reached at global level, with seven countries already validated as having reached this goal. This achievement was made possible by the work of NSSCPs, supported by different public and private partners, and coordinated by WHO. The new challenging goal now is to reach zero cases by 2030. To reach this goal is crucial to maintain the engagement and support of donors and stakeholders and to keep the involvement and coordination of all partners. Along with the focus on elimination of transmission of gambiense HAT, it is important not to neglect rhodesiense HAT, which is targeted for elimination as a public health problem in the WHO road map for NTDs 2021-2030.

Diagnosis of female genital schistosomiasis and other genital infections in young South African women: challenges in the syndromic approach

IntroductionFemale genital schistosomiasis is a common but neglected disease, which results in symptoms similar to sexually transmitted infections in Schistosoma haematobium-endemic areas of Africa and Middle East. In primary healthcare of low-income countries, healthcare professionals use syndromic management protocols for guidance when treating symptoms of genital infection, due to lack of laboratory resources. These protocols do not include treatment for female genital schistosomiasis, despite the overlap of symptoms. Women are at risk of not receiving the appropriate treatment. The aim of this study was to investigate challenges and missed opportunities when using syndromic management protocols for sexually transmitted infections in female genital schistosomiasis-endemic areas.MethodsThis is a secondary analysis of data from a large cross-sectional prevalence study conducted in 2011 in KwaZulu-Natal, South Africa. Young women in schistosomiasis-endemic areas were asked about genital symptoms and underwent laboratory testing and gynecological examinations to look for common genital infections including female genital schistosomiasis. We used the current South African syndromic management protocols as the basis and analyzed the associations between the reported genital symptoms and the differential diagnoses with logistic regression.ResultsBy use of the syndromic approach the conditions gonorrhea, trichomoniasis and herpes could be identified. The symptom “lower abdominal pain” was significantly associated with documented female genital schistosomiasis. However, the same association was not found with gonorrhea or chlamydia. We found no significant association between reported vaginal discharge syndrome and female genital schistosomiasis or between genital ulcer syndrome and female genital schistosomiasis.DiscussionFemale genital schistosomiasis frequently co-exists with, and mimics other genital infections in rural areas of Sub-Saharan Africa. The management protocols in schistosomiasis endemic countries should include advice on how to diagnose and manage this chronic, waterborne genital condition. There is an urgent need to upscale laboratory and diagnostic resources in low-and middle-income countries and specifically schistosomiasis-endemic areas, to diagnose these common genital infections more accurately and to treat affected women accordingly.

Inter-facility transfers for emergency obstetrical and neonatal care in rural Madagascar: a cost-effectiveness analysis

ContextThere is a substantial lack of inter-facility referral systems for emergency obstetrical and neonatal care in rural areas of sub-Saharan Africa. Data on the costs and cost-effectiveness of such systems...

Household milk production, milk purchase and child nutrition:Panel data evidence from rural Uganda

The burden of low-quality diets and childhood undernutrition is widespread in rural areas in SubSaharan Africa, where households rely mostly on agriculture. Various empirical studies have shown the relative importance of the market, and hence food purchases, compared with farm diversification in raising dietary diversity. But are these findings applicable to all food markets? In the case of highly perishable milk, which characterises its production in rural Africa, and the low community ownership of cows, an important research question is whether milk is available in markets and whether milk purchases contribute to the nutrition of children in smallholder households. Using panel data from rural Uganda, we estimate conditional mixed-process models and find positive effects of both household milk production and milk purchases on height-for-age z-scores. We find that milk purchases and milk production are complements, and therefore a strategy combining increases in milk productivity, dairy market development and social protection programmes to increase economic access to milk markets could improve child nutrition.

The NLR SkinApp: Testing a Supporting mHealth Tool for Frontline Health Workers Performing Skin Screening in Ethiopia and Tanzania.

Background: The prevalence of skin diseases such as leprosy, and limited dermatological knowledge among frontline health workers (FHWs) in rural areas of Sub-Saharan Africa, led to the development of the NLR SkinApp: a mobile application (app) that supports FHWs to promptly diagnose and treat, or suspect and refer patients with skin diseases. The app includes common skin diseases, neglected tropical skin diseases (skin NTDs) such as leprosy, and HIV/AIDS-related skin conditions. This study aimed to test the supporting role of the NLR SkinApp by examining the diagnostic accuracy of its third edition. Methods: A cross-sectional study was conducted in East Hararghe, Ethiopia, as well as the Mwanza and Morogoro region, Tanzania, in 2018-2019. Diagnostic accuracy was measured against a diagnosis confirmed by two dermatologists/dermatological medical experts (reference standard) in terms of sensitivity, specificity, positive predictive value, and negative predictive value. The potential negative effect of an incorrect management recommendation was expressed on a scale of one to four. Results: A total of 443 patients with suspected skin conditions were included. The FHWs using the NLR SkinApp diagnosed 45% of the patients accurately. The values of the sensitivity of the FHWs using the NLR SkinApp in determining the correct diagnosis ranged from 23% for HIV/AIDS-related skin conditions to 76.9% for eczema, and the specificity from 69.6% for eczema to 99.3% for tinea capitis/corporis. The inter-rater reliability among the FHWs for the diagnoses made, expressed as the percent agreement, was 58% compared to 96% among the dermatologists. Of the management recommendations given on the basis of incorrect diagnoses, around one-third could have a potential negative effect. Conclusions: The results for diagnosing eczema are encouraging, demonstrating the potential contribution of the NLR SkinApp to dermatological and leprosy care by FHWs. Further studies with a bigger sample size and comparing FHWs with and without using the NLR SkinApp are needed to obtain a better understanding of the added value of the NLR SkinApp as a mobile health (mHealth) tool in supporting FHWs to diagnose and treat skin diseases.

Total intravenous anaesthesia in rural sub-Saharan Africa: report of 25 cases.

Total intravenous anesthesia (TIVA) is a potential solution for safe and effective anesthesia administration in rural regions of sub-Saharan Africa, where access to inhalational anesthesia may be limited. However, challenges such as equipment and medication availability, as well as a shortage of trained anesthesiologists, can limit the use of TIVA. In this study, the safety and efficacy of TIVA were evaluated in a case series of 25 female patients undergoing thyroid surgery in a rural area of sub-Saharan Africa. The TIVA protocol involved the use of propofol, fentanyl, rocuronium, and sugammadex. Results showed that TIVA was a safe and effective method of anesthesia administration in this setting, with no major adverse events reported. The use of TIVA may offer advantages such as faster recovery times, reduced incidence of postoperative nausea and vomiting, and reduced risk of environmental pollution compared to inhalational anesthesia. However, the cost and monitoring requirements of TIVA may pose challenges in resource-limited settings. Further research is needed to determine the optimal use of TIVA in this context.

Geospatial disparities and predictors of anaemia among pregnant women in Sub-Saharan Africa

BackgroundAnaemia has become a major public health concern among women in Sub-Saharan Africa (SSA). However, little is known about the spatial disparities in anaemia prevalence and their associated factors among pregnant women in the region. This study analysed the spatial disparities in anaemia and their associated factors among pregnant women in rural and urban settings in SSA.MethodsThis is a secondary analysis of the most recent demographic and health surveys of 26 countries in SSA. Spatial autocorrelation and hotspot assessment were conducted, while a multivariate logistic regression model was used to identify demographic factors associated with anaemia.ResultsAnaemia was reported among ~50% of pregnant women in urban and rural areas of SSA. The hotspot analysis identified the West African sub-region as having a higher concentration of anaemia cases in rural settings. In urban areas, the odds of anaemia were significantly higher among pregnant women in their second trimester (Adjusted OR = 2.39, CI = 1.99, 2.76). On the other hand, pregnant women in their third trimester (Adjusted OR = 1.98, CI = 1.77, 2.22) and those who had taken intestinal parasite drugs (Adjusted OR = 1.12 CI = 1.02, 1.23) had a higher likelihood of having anaemia in rural areas. Pregnant women aged 35–39 years (Adjusted OR = 0.52, CI = 0.33, 0.81) and those aged 40–44 years (Adjusted OR = 0.69, CI = 0.50, 0.95) had a lesser likelihood of having anaemia compared to women aged 15–19 years in urban and rural areas respectively. Compared to Congo DR, Benin (OR = 2.22, CI = 1.51, 3.28) and Mali (OR = 3.71, CI = 2.73, 5.05) had higher odds of anaemia in urban and rural areas respectively.ConclusionsSpatial disparities in anaemia persist among pregnant women in rural and urban settings in SSA. Prevailing spatial variations in anaemia may be addressed by specialised interventions considering the contextual residential settings and socio-economic factors highlighted in this study.

The Fascinating Cross-Paths of Pathogenic Bacteria, Human and Animal Faecal Sources in Water-Stressed Communities of Vhembe District, South Africa.

Access to clean and safe drinking water still remains a major challenge in the developing world, causing public health risks in terms of waterborne infections, especially in rural areas of sub-Saharan Africa. This study aimed to track and detect enteric pathogens (Salmonella enterica subsp. enterica serovar Typhimurium str. LT2, Shigella flexneri, and Campylobacter jejuni subsp. jejuni) in rural water sources. It also sought to establish a correlation between these pathogens and the sources of faecal pollution. Multiplex qPCR and specific primers and probes were used for detection and tracking. The study successfully correlated the occurrence of target pathogens with sources of human and animal faecal contamination using host-specific genetic markers (BacHum and HF183 for humans, BacCow for cows, Pig-2-Bac for pigs, Cytb for chickens, and BacCan for dogs). The study revealed that enteric pathogens were found in 47.69% and 32.80% of samples during the wet and dry seasons, respectively. These pathogens were associated with human or animal faecal contamination. Correlations between pathogens and contamination sources were significant (p ≤ 0.05), with varying strengths during the wet and dry seasons. The findings emphasize the importance of identifying faecal contamination sources to protect rural communities from waterborne infections.

Sustainability and affordability of Chinese-funded renewable energy project in sub-Saharan Africa: a hybridized solid oxide fuel cell, temperature sensors, and lithium-based solar system approach.

Renewable energy projects are at the crux of all Chinese-funded investment in sub-Saharan Africa, which accounts for some 56% of all Chinese-led investments globally. However, the prevailing problem is that about 568 million people were still without electricity access in 2019 across urban and rural areas in sub-Saharan Africa, which does not commensurate with the United Nations Sustainable Development Goal (SDG7) of ensuring affordable and clean energy for all. Previous studies have assessed and improved the efficiency of integrated power generation systems often combined on three levels, power plant, solar panel, and fuel cells, and integrated into national grids or off-grid systems for a sustainable supply of power. This study has included a lithium-ion storage system as a key component in a hybridized renewable energy generation system for the first time that has proven to be efficient and investment worthy. The study also examines the operational parameters of Chinese-funded power plant projects in sub-Saharan Africa and their effectiveness in achieving SDG-7. The novelty of this study is evident in the proposed integrated multi-level hybrid technology model of solid oxide fuel cells, temperature point sensors, and lithium batteries powered by a solar system and embedded in thermal power plants as an alternative electrical energy system for domestic and industrial use in sub-Saharan Africa. Performance analysis of the proposed power generation model indicates its complementary capacity of generating additional energy output with thermodynamics energy and exergy efficiencies of 88.2% and 67.0% respectively. The outcome of this study draws the attention of Chinese investors, governments in sub-Saharan African countries, and top industry players to the following: to consider refocusing their energy sector policy initiatives and strategies towards exploring the lithium resource base in Africa, optimizing energy generation cost, recouping optimal profit from their renewable energy technology investments, and making electricity supply clean, sustainable, and affordable for use in sub-Saharan Africa.

A New Electrification Model to End Energy Poverty: An example from a novel rural electrification approach in Madagascar

Highlighted by the United Nations sustainable Development Goals to ensure universal access to clean, reliable, and modern energy services by 2030, the world is increasingly becoming concerned by energy poverty and its consequences on human development and the environment. Yet, even if numerous initiatives and a significant amount of money are directly addressed to tackle the energy-access challenges, a billion people are still denied access to basic and modern electricity services, especially in rural areas of sub-Saharan Africa and Southeast Asia. In the past two decades, the African continent has seen an encouraging improvement as the number of people gaining access to electricity rose from 9 million per year between 2000 and 2013 to 20 million per year between 2014 and 2019, outpacing population growth for the first time. However, most of those recent improvements are restricted mainly to urban and peri-urban areas of a small number of countries located in eastern or western Africa. Also, the population without access to electricity in Africa is expected to increase in the coming years following the health crisis and economic downturn caused by COVID-19. This definitely proves the fragility and poor resilience of the electrification solutions favored today. While grid extension and conventional microgrids suffer from low inclusivity and replicability, solar home systems are only a stopgap measure and fail to boost socioeconomic development. A third way must be proposed to combine quick and affordable access to basic electricity services and community uplift through socioeconomic development, answering the two greatest challenges that developing countries are struggling to cope with today. With this objective in mind, Nanoé, a French–Malagasy social company, is developing the <italic xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink">lateral electrification model</i> , based on the collaborative and progressing building of electric infrastructures, which is presented in this article, first from a general point of view and then through a focus on Nanoé’s experience in Madagascar.

Effectiveness of hermetic bag storage technology to preserve physical quality attributes of shea nuts

Shea nuts are a nutritionally and economically important tree crop harvested seasonally in rural areas of sub-Saharan Africa. Storage losses are a major constraint in the shea nut value chain, with substantial amounts lost prior to processing and marketing. Hermetic bags have proven to be a viable technology for the effective storage of grains, oilseeds and pulses in sub-Saharan Africa due to their efficacy, low cost, and commercial availability. However, hermetic bag storage technology has not been investigated for the preservation of shea nut quality. In this study, shea nut storage in hermetic bags was compared to storage in jute sacks and woven polypropylene (PP) bags. Shea nuts had an initial moisture content of 7.3% (w.b.) and insect damage of 28%. Each storage treatment consisted of 12 bags of 20 kg shea nuts with samples taken from 3 bags every 6 weeks over a 30-week storage period. As ambient temperature and relative humidity conditions varied over time, moisture content varied within 1 percentage point in hermetic bags compared to 3 percentage points in the jute sacks and PP bags. Insect damage was maintained below 30% in hermetic bags, compared to 80% and 82% in PP bags and jute sacks, respectively. Weight loss due to insect damage was 4.5% in the hermetic bags compared to 10.1% and 11.6% in the jute sacks and PP bags, respectively. Carbon dioxide concentration in the hermetic bags remained below 6% over 30 weeks, indicating low insect and microbial activity. The results of this study have proven hermetic bag storage technology to be a viable option for the quality preservation of dry shea nuts, which should be strongly considered for adoption in the shea nut value chain.

The Role of Rural Health Centres in the Detection and Management of Malaria Outbreaks in a Low Transmission Setting of Choma District, Zambia

The Southern Province of Zambia has been afflicted with malaria for many years, but in recent times, with the success of the national malaria control programme, malaria transmission has declined significantly and is now at low ebb. This success has been attributed to the effective use of indoor residual spraying, proper use of insecticide-treated mosquito nets provided to the people, as well as the use of artemisinin combination therapies in all rural health centres (RHCs) to treat clinical malaria cases at health facilities as well as in the communities by trained community health workers (CHWs). Despite this success and in trying to understand the epidemiology and control of malaria in rural areas of sub-Saharan Africa, it has been clear that local elimination is most unlikely due many challenges such as lack of incentives for CHWs who are the first link of the community to the health care system, inability of the officially approved rapid diagnostic tests to detect low level parasitemia in asymptomatic individuals, and anti-malaria stock-outs in RHCs, especially during the rainy season when most areas are unreachable due to impassable roads. This paper discusses the role of RHCs in the detection and management of malaria outbreaks in low transmission settings and the challenges of achieving elimination in Choma District, Southern Province, Zambia. These challenges could adversely impact malaria elimination if they remain unanswered.

The effect of community champions on modern contraceptive knowledge, attitude and use among women of reproductive age group in rural local government areas in Lagos state

Background: The uptake of contraceptives is still low especially in rural areas in Sub-Saharan Africa. This study aimed to assess the effect of the use of community champions on knowledge, attitude and use of modern contraceptive among women of reproductive age group in rural local government areas in Lagos State.Methods: A quasi-experimental study was done among two groups. The study population were 399 women of reproductive age group per group who live in rural local government areas of Lagos state. The intervention group had community champions assigned to them while the control group did not. Multi-stage sampling method was done. It was a mixed method study. Data were collected using interviewer-administered questionnaires and from family planning registers of the health facilities in the study areas. The data were analysed using the IBM statistical products and services solutions version 23.Results: Results at post-intervention showed that there was a significant increase in the percentage of respondents with good knowledge of modern contraceptive by 22.2% (p&lt;0.05), positive attitude towards modern contraceptives by 10.4% (p&lt;0.05) and current use of any method of modern contraceptive by 14.3% (p&lt;0.05) in the intervention group. While in the control group, there was no statistically significant increase in the percentage of respondents with good knowledge of modern contraceptives, positive attitude towards modern contraceptives and current use of any method of modern contraceptives. (p&gt;0.05).Conclusions: The study concluded that the use of community champions was an effective tool for improving knowledge, attitude and use of modern contraceptives.

Impact of a Cryptococcal meningitis diagnosis and treatment program at Lira Regional Referral Hospital in rural, Northern Uganda.

In rural areas of sub-Saharan Africa, infrastructure and resources for treatment of cryptococcal meningitis (CM) are often lacking. We introduced a CM diagnosis and treatment program (CM-DTP) at Lira Regional Referral Hospital (LRRH) in rural Uganda to determine if implementing high-quality standard of care protocols would improve outcomes. Information extracted from hospital charts and clinical record forms at LRRH were used to compare diagnoses, treatments, and outcomes for all patients diagnosed with meningitis (n = 281) over a two-year period after initiation of the CM-DTP in February of 2017 to all patients diagnosed with meningitis (n = 215) in the two preceding years. After implementation of the CM-DTP, we observed increased confirmed diagnoses of CM from 22.2% (48 of 215) to 35.2% (99 of 281), (p = 0.002) among all patients diagnosed with meningitis. Among all patients treated for CM, the proportion who received standard of care treatment with amphotericin B plus fluconazole increased from 63 of 127 (49.6%) to 109 of 146 (74.7%), (p <0.001) and mortality improved from 66 of 127 (52.0%) to 57 of 146 (39.0%), (p = 0.04) after implementation of the CM-DTP. Implementation of the CM-DTP was associated with increased number of lumbar punctures and decreased use of antibiotics in patients with CM, as well as decreased mortality among patients with meningitis from all causes. Improved diagnosis, treatment, and mortality were observed following implementation of the CM-DTP. Our results demonstrate that quality treatment of CM in rural Uganda is feasible.

Republication de : Allergie à l’arachide en Afrique sub-saharienne

Peanut was imported from South America into West Africa first during the XVIth century, but its culture and its use as a source of oil and proteins expanded in Africa only in the mid-XIXth century. In rural areas of sub-Saharan Africa, the extent of peanut sensitisation and clinical allergy is very low compared to populations living in Europe and the U.S.A. This could be due to the protective effect of anti-CCD IgE and IgG, which can cross-react between peanut and parasites’ carbohydrate epitopes. These anti-CCD IgE are cause of false positive results for anti-peanut IgE tests, when whole peanut extracts are used in place of non-glycosylated molecular allergens. Several studies in southern Africa have used oral food challenges and show that the low incidence of peanut allergy is limited to rural areas and do not exist among African urban populations. No influence of ethnicity was found. This suggests that environmental factors related to urban living are crucial for the incidence of peanut allergy and probably also for food allergies in general.

Developing a novel tool for assessing water service sustainability in rural areas of sub-Saharan Africa

Abstract The present study aimed to develop a tool for assessing water service sustainability in rural areas of sub-Saharan Africa. This tool is called the ‘Water Service Assessment Tool’ (WaSAT) and is based on the Water Service Sustainability Index (WSSI) which consists of 21 indicators grouped into six dimensions (economic, environmental, social, technical, institutional, and governance). The WaSAT was developed using Microsoft Excel and PowerApps platforms. This tool provides a solid baseline on the sustainability of water services and identifies priority actions to be taken to move services toward sustainability.

Delays to essential surgery at four faith based hospitals in rural Sub-Saharan Africa.

Data regarding delays for emergency surgery in Sub-Saharan Africa is limited. We have therefore decided to undertake an evaluation of delays in patients seeking care, reaching care and receiving care for emergency surgery at four rural faith-based hospitals in this region over a 3 month period. This is a cross-sectional, multi-center, international study at four rural faith-based hospitals in Madagascar, Gabon, Cameroon and Burundi. All patients presenting at these hospitals between 10 February and 1 May 2020 for one of the three Bellwether procedures (caesarean delivery, emergency laparotomy, management of open fracture) were to be enrolled in this study. Data was collected in the form of a questionnaire administered to the patient or the patient's caregiver within 24 h of admission to the hospital. After analysis of data for 148 patients, we found that the median [quartiles] delay in seeking care overall was 3.5 [0.5, 17.6] h, in reaching care 7.6 [2.3, 33.6] h and in receiving care 3.6 [1.7, 6.8] h. In 72% (107/148) of cases, the second delay was more than 2h. Sixty-five percent of patients who were delayed reported that their delay was because care was sought elsewhere before arrival at one of our Bellwether-capable sites. Our results suggest that the majority of patients needing emergency surgical care in the rural areas of Sub-Saharan Africa where our study was conducted are frequently delayed, with the largest delay being in reaching care. Further investigations into the reasons for these delays should be conducted.