Rural Areas Of sub-Saharan Africa Research Articles

Community-based prevalence of rheumatic heart disease in rural Ethiopia: Five-year follow-up

As little is known about the prevalence and clinical progression of subclinical (latent) rheumatic heart disease (RHD) in sub-Saharan Africa, we report the results of a 5 year follow-up of a community based, echocardiographic study of the disease, originally carried out in a rural area around Jimma, Ethiopia. Individuals with evidence of RHD detected during the baseline study as well as controls and their family members were screened with a short questionnaire together with transthoracic echocardiography. Of 56 individuals with RHD (37 definite and 19 borderline) in the original study, 36 (26 definite and 10 borderline) were successfully located 57.3 (range 44.9-70.7) months later. At follow-up two thirds of the definite cases still had definite disease; while a third had regressed. Approximately equal numbers of the borderline cases had progressed and regressed. Features of RHD had appeared in 5 of the 60 controls. There was an increased risk of RHD in the family relatives of borderline and definite cases (3.8 and 4.0 times respectively), notably among siblings. Compliance with penicillin prophylaxis was very poor. We show the persistence of echocardiographically demonstrable RHD in a rural sub-Saharan population. Both progression and regression of the disease were found; however, the majority of the individuals who had definite features of RHD had evidence of continuing RHD lesions five years later. There was an increased risk of RHD in the family relatives of borderline and definite cases, notably among siblings. The findings highlight the problems faced in addressing the problem of RHD in the rural areas of sub-Saharan Africa. They add to the evidence that community-based interventions for RHD will be required, together with appropriate ways of identifying active disease, achieving adequate penicillin prophylaxis and developing vaccines for primary prevention.

English

Nonfarm employment is an increasing form of employment in rural areas in Sub-Saharan Africa. This is partly because many of the workers in developing countries especially in Sub-Saharan Africa are self-employed workers.  Most women in Uganda do not own land since customary land ownership system deprives women of owning land. This has pushed women to nonfarm employment in urban areas, semi-rural, and rural areas. This paper explored the implications of nonfarm rural employment on the social and economic empowerment of women in rural areas. The findings revealed that nonfarm rural employment boosts women’s income, puts women in leadership positions in women’s groups such as the savings groups, and empowers women to become independent by reducing economic dependence on men or their husbands while also providing women with decision making power both in the community and households. Additionally, successful women in nonfarm employment, especially self-employed women, are role models and a motivation to other rural women to venture into nonfarm employment. Being successful as a woman in nonfarm employment also comes along with leadership roles and high social status in the community.   Key words: Nonfarm employment, women empowerment, rural nonfarm economy, Uganda.

Accurate Machine-Learning-Based classification of Leukemia from Blood Smear Images

BackgroundConventional identification of blood disorders based on visual inspection of blood smears through microscope is time consuming, error-prone and is limited by hematologist's physical acuity. Therefore, an automated optical image processing system is required to support the clinical decision-making. Materials and MethodsBlood smear slides (n = 250) were prepared from clinical samples, imaged and analyzed in Jimma Medical Center, Hematology department. Samples were collected, analyzed and preserved from out and in-patients. The system was able to categorize four common types of leukemia's such as acute and chronic myeloid leukemia; and acute and chronic lymphoblastic leukemia, through a robust image segmentation protocol, followed by classification using the support vector machine. ResultsThe system was able to classify leukemia types with an accuracy, sensitivity, specificity of 97.69%, 97.86% and 100%, respectively for the test datasets, and 97.5%, 98.55% and 100%, respectively, for the validation datasets. In addition, the system also showed an accuracy of 94.75% for the WBC counts that include both lymphocytes and monocytes. The computer-assisted diagnosis system took less than one minute for processing and assigning the leukemia types, compared to an average period of 30 minutes by unassisted manual approaches. Moreover, the automated system complements the healthcare workers’ in their efforts, by improving the accuracy rates in diagnosis from ∼70% to over 97%. ConclusionImportantly, our module is designed to assist the healthcare facilities in the rural areas of sub-Saharan Africa, equipped with fewer experienced medical experts, especially in screening patients for blood associated diseases including leukemia.

Factors influencing uptake of schistosomiasis research findings in ingwavuma area, uMkhanyakude District, Kwazulu-Natal, South Africa.

BackgroundResearch uptake is concerned with spreading ideas across multiple levels of the community. Barriers such as poverty, lack of infrastructure, illiteracy and culture prevent information sharing in arid rural areas of sub-Saharan Africa.ObjectiveThis study explores the factors influencing schistosomiasis research uptake and the available channels for the uptake of research findings from a transdisciplinary and eco-health research project on schistosomiasis in Ingwavuma area, uMkhanyakude district, KwaZulu-Natal province in South Africa.MethodsThis case study conducted in 2017 involved 78 primary school children and 73 heads of household recruited through convenience and purposive sampling. Data were collected through focus group discussions, then transcribed and analysed by the researcher using thematic analysis.ResultsFactors such as poor knowledge, water and sanitation problems, and lack of sufficient health workers hindered the uptake of schistosomiasis research findings. Participants recommended several platforms to share schistosomiasis research findings with the community, including: door to door visits; social gatherings such as sports events, talent shows, and religious gatherings; mass media platforms such as radio and television; social media platforms such as WhatsApp, Facebook and Twitter; and printed media such as posters, booklets and pamphlets.ConclusionsThere is a need to train health workers and peer educators in this area of South Africa to educate people about schistosomiasis infection, screening and treatment through home visits or social events. Schistosomiasis research findings must be synthesised and packaged in different forms for dissemination via multimedia media-based communication channels.

An analysis of the learning performance gap between urban and rural areas in sub-Saharan Africa

The learning gap between urban and rural areas is a persistent problem in many sub-Saharan African countries. Previous studies have found that the urban-rural learning gap is attributed to the fact that student characteristics and school resources are different in urban and rural areas. Our study updates this finding by using the latest dataset and further examines the changes in the attributed sources over time. Using 15 educational systems in sub-Saharan Africa, we examined 4 potential sources of the gap: student, family, teacher, and school characteristics. Our results reveal that the urban-rural learning gap in recent years is attributed mostly to differences in school and family characteristics. We also found that the attribution remains the same over time from 2004 to 2011 and that the attribution to family characteristics’ differences became slightly greater than the one to school characteristics’ differences.

Inefficient cooking systems a challenge for sustainable development: a case of rural areas of Sub-Saharan Africa

The use of low efficient cookstoves has several severe negative impacts. Burning solid fuels kills about 4 million people every year, a number which is higher than the combined impact of HIV-AIDS, malaria and tuberculosis. Moreover, most of the people affected are located in rural areas of Sub-Saharan Africa and other developing countries, where over 80% of the population still relies on biomass as their primary source of energy, being the electricity access only 43%. Low-efficiency cooking systems are also a major source of greenhouse gas emissions since solid fuel cooking in Sub-Saharan Africa accounts for 1.2 and 6% of global CO2 and black carbon emissions, respectively. Furthermore, widespread biomass collection by an increasing population in Sub-Saharan Africa is unsustainable, contributing to deforestation. Therefore, the impact of using traditional cooking systems is a challenge for the achievement of sustainable development targets in Sub-Saharan Africa and as a whole globally. There are several cooking technologies used in those rural locations, but there are no clear frameworks or polices to support sustainable cooking options, as well as a guide for users. This paper assesses several cooking technologies with its associated fuels and evaluated each technology in terms of energy consumption, CO2 emissions, health impacts and costs. It was concluded that compared with traditional wood fuel cookstoves, electric cookstoves can reduce the energy consumption by 95.7%, CO2 emissions by 100% (assuming renewable carbon-free electricity) and the life cycle cost by 94%, also avoiding over 180 mg/m3 PM2.5 concentrations per/household per year. Also, this paper indicates that a strong and collective effort is necessary from key stakeholders to switch from traditional and unsustainable cooking technologies and fuels to cleaner and sustainable cooking systems.

Mitigation of the Water Crisis in Sub-Saharan Africa: Construction of Delocalized Water Collection and Retention Systems

This paper presents the results of a three-year research project aimed at addressing the issue of water shortage and retention/collection in drought-affected rural areas of Sub-Saharan Africa. The project consisted in the design, construction, and the upgrade of existing barrages near Kita, the regional capital of Kayes in Mali. The effort was led by the Department of Architecture of Roma Tre University in partnership with the Onlus Gente d’Africa (who handled the on-the-ground logistics), the Department of Architecture of the University of Florence and the École Supérieure d’Ingénierie, d’Architecture et d’Urbanisme of Bamako, Mali. The practical realization of the project was made possible by Romagna Acque Società delle Fonti Ltd., a water utility supplying drinking water in the Emilia-Romagna region (Italy) that provided the financing as well as the operational contribution of AES Architettura Emergenza Sviluppo, a nonprofit association operating in the depressed areas of the world. The completion of the research project resulted in the replenishment of reservoirs and renewed presence of water in the subsoil of the surrounding areas. Several economic activities such as fishing and rice cultivation have spawned from the availability of water. The monitoring of these results is still ongoing; however, it is already possible to assess some critical issues highlighted, especially with the progress of the COVID-19 pandemic in the research areas.

The role of piped water supplies in advancing health, economic development, and gender equality in rural communities.

In rural areas of sub-Saharan Africa, one in eight households obtain drinking water from a piped system; the rest fetch water from improved and unimproved sources located at some distance from their homes. This task falls primarily to women and girls, creating time poverty and risks to safety and health. In this paper, we present a conceptual model that elaborates the mechanisms linking access to piped water with food security and long-term economic impacts. These hypotheses were tested in a quasi-experimental study of four villages in rural Zambia using a combination of household surveys, Global Positioning System transponders, and water meters to measure time spent fetching water, water consumption, and how water was being utilized for domestic and productive activities. Households receiving the piped water intervention spent a median of 3.8h per week less fetching water, savings that accrued primarily to women and girls. Household water consumption increased 32%, which was used for both domestic and productive uses. Increases in the frequency of gardening and the size of garden plots in treatment households were observed. Households receiving piped water reported being happier, healthier, and having more time to participate in work inside or outside the home. We find that piped water supplies can promote the economic development and well-being of rural households, with particular benefits to women and girls, conditional upon pricing and management models that ensure sustainable service.

Patterns, determinants, and outcomes of antenatal care services utilization among rural and urban women in north-western Nigeria: A comparative analysis

Background: Antenatal care (ANC) services have been globally lauded as having positive effects on pregnancy outcomes and reducing maternal and perinatal mortalities. However, the utilization of ANC is not uniform among its target population, particularly in rural areas of sub-Saharan Africa and south Asia. Objective: The objective is to ascertain and compare the patterns, determinants, and outcomes of ANC utilization among rural and urban women of child-bearing age in Kaduna State, north-western Nigeria by using a comparative, community-based, cross-sectional, descriptive study design among 340 women in a rural (n = 170) and an urban (n = 170) community. Materials and Methods: Respondents were selected by cluster sampling and multistage sampling methods in the rural and urban areas, respectively. Data were collected by using a structured, self-administered questionnaire and analyzed by using Statistical Package for Social Sciences (SPSS), version 25. Results were presented in tables, and associations were tested by using chi-square (x2) test. Results: Most of the respondents were between 25 and 29 years, more than 80% were married, and only 23.5% (rural) and 38.8% (urban) had a post-secondary level of education. The ANC attendance was 61.8%, representing 210 out of the 340 respondents (rural 40.6%, urban 82.9%). Among the ANC attendees, 71% initiated ANC in the first trimester (rural 60.9%, urban 75.9%) and 61.4% had at least four visits (rural 56.5%, urban 63.8%). The determinants of ANC utilization were mainly levels of education and incomes of the respondents and/ or their husbands. Conclusion: A consistent pattern of rural–urban disparities was demonstrated in diverse aspects of ANC utilization, including the determinants and outcomes thereof, with better indices among urban women relative to rural women. These findings underscore the need to bridge the gap between rural and urban areas. Priority attention needs to be given to the spatial (geographical) siting of health facilities, literacy, and financial standing of both women and their husbands.

Rice and Malaria in Africa: A Systematic Review and Meta-Analysis

Background: Rice fields in Africa are major breeding sites for malaria vectors. Surprisingly, when reviewed in the 1990s, in settings where transmission was more or less intense, there was no tendency for malaria indices to be higher in villages with irrigated rice. Since then, there has been a massive scale-up of intervention coverage in sub-Saharan Africa, and malaria infection prevalence has halved. It is therefore time to re-examine this rice-malaria relationship to find out whether nowadays, with lower malaria transmission, malaria risk is greater in rice areas. Methods: For this systematic review and meta-analysis, EMBASE, Global Health, PubMed, Scopus, and Web of Science were searched to identify observational studies published from 1 January 1900 to 18 September 2020. Studies were considered eligible if they were observational community-based studies comparing rice- and non-rice-growing rural areas in sub-Saharan Africa. A standardised data extraction form was used to collect epidemiological and entomological information from eligible studies. We did random-effects meta-analyses to obtain and compare pooled prevalences of malaria infection before and after 2003. Findings: Of 2913 studies screened, 53 studies with 113 160 participants from 14 African countries were eligible for inclusion. All included studies were observational, with very low quality evidence, as evaluated by the GRADE approach. In studies performed before 2003, malaria infection prevalence was not higher in rice communities (RR 0·82, 95% CI 0·63–1·06) but was 70% higher in those performed after 2003 (RR 1·73, 95% CI 1·01–2·96). Potential limitations of this study include its basis on observational studies as well as its omission for the effects of seasonality and type of rice being cultivated. Interpretation: Irrigated rice communities in Africa are exposed to greater malaria risk, as well as more mosquitoes. The two development aims (rice production and malaria elimination) cannot be reconciled by ignoring the problem. There is an urgent need to improve methods for growing rice without growing mosquitoes. Registration Information: The study is registered with PROSPERO, number CRD42020204936. Funding Information: CGIAR Agriculture for Nutrition and Health. Declaration of Interests: We declare no competing interests.

Improved storage mitigates vulnerability to food-supply shocks in smallholder agriculture during the COVID-19 pandemic

Millions of smallholder farmers in low-income countries are highly vulnerable to food-supply shocks, and reducing this vulnerability remains challenging in view of climatic changes. Restrictions to limit the spread of the COVID-19 pandemic produced a severe supply-side shock in rural areas of Sub-Saharan Africa, including through frictions in agricultural markets. We use a large-scale field experiment to examine the effects of improved on-farm storage on household food security during COVID-19 restrictions. Based on text message survey data we find that the prevalence of food insecurity increased in control group households during COVID-19 restrictions (coinciding with the agricultural lean season). In treatment households, equipped with an improved on-farm storage technology and training in its use, food insecurity was lower during COVID-19 restrictions. This underscores the benefits of improved on-farm storage for mitigating vulnerability to food-supply shocks. These insights are relevant for the larger, long-term question of climate change adaptation, and also regarding trade-offs between public health protection and food security.

Mini-Grids for the Sustainable Electrification of Rural Areas in Sub-Saharan Africa: Assessing the Potential of KeyMaker Models

Solar hybrid mini-grid systems possess the potential to substantially support electrification in sub-Saharan Africa. While their technical reliability has been proven, their financial viability is achieved only by heavy subsidization as of now. Due to the growing importance of results-based financing, we ask whether newly developed business models leveraging on the value added of electricity supply in rural areas (such as the KeyMaker Model) bare the potential to substantially reduce amount of grants required to finance the initial capital investment and thus contribute to a sustainable form of development. The principle of the KeyMaker Model is based on utilizing the locally supplied mini-grid electricity to establish a local agro-processing project, the revenues of which are an additional income stream for the mini-grid operator, while the project creates an end-market for the local farmers to sell their produce. We have developed two scenarios (without and with KeyMaker Model) for four rural villages in Nigeria as a case study to scientifically assess the potential of KeyMaker Models. We simulated and optimized the mini-grid systems using the software tool HOMER. We then assessed their financial viability. Our analysis demonstrates grant finance requirements ranging from 82% to 99% of the total investment for the base-case mini-grid projects without consideration of the KeyMaker Model. We find that a well-selected KeyMaker Model such as cocoa bean processing reduced the grant requirement by 68 percentage points, while processes based on maize, palm oil and cassava processing achieved reductions of 36, 26 and 8 percentage points, respectively. Hence, we conclude that the value added by the introduction of new local business models bares the potential to reduce grant requirements for the socially and economically necessary electrification across the Global South.

Optimal Sizing and Techno-Economic Analysis of Hybrid Renewable Energy Systems—A Case Study of a Photovoltaic/Wind/Battery/Diesel System in Fanisau, Northern Nigeria

Hybrid Renewable Energy Systems (HRESs) have been touted as an appropriate way for supplying electricity to remote and off-grid areas in developing countries, especially in sub-Saharan Africa (SSA), where rural electrification challenges are the most pronounced. This study proposes a two-step methodology for optimizing and analyzing a stand-alone photovoltaic/wind/battery/diesel hybrid system to meet the electricity needs of Fanisua, an off-grid and remote village of northern Nigeria. In the first step, the MATLAB environment was used to run simulations and optimize the system via the genetic algorithm. Then, techno-economic and emissions analysis was carried out in the second step to compare the proposed system to the existing traditional modes of rural electrification in sub-Saharan Africa, namely, the grid-extension and diesel generator. The break-even distance parameter was adopted in the comparison with grid-extension. Besides, the hypothetical project of replacing the diesel generator by the optimal system was analyzed using the Simple Payback Period (SPP) and Net Present Value (NPV) parameters. The resulting optimal design architecture included an 89.271-kW photovoltaic array, a 100.31-W diesel generator, and 148 batteries with a total annualized cost (TAC) and cost of energy (COE) of USD 43,807 and USD 0.25/kWh, respectively. The break-even distance found was 16.2 km, while the NPV and SPP of the hypothetical project were USD 572,382 and 2.8 years, respectively. The savings in carbon dioxide (CO2) emissions of the proposed system compared to the grid extension and the diesel generator were found to be 85,401.08 kg/year and 122,062.85 kg/year, respectively. This study highlighted the role that solar PV-based HRESs could play in the sustainable electricity supply in rural areas of sub-Saharan Africa.

The Food Security Conundrum of sub-Saharan Africa

National food security in countries of sub-Saharan Africa requires an abundant supply of cheap and nutritious food for the burgeoning population. At the same time agriculture is a major contributor to the balance of payments for African economies. So agricultural production in Africa needs to increase strongly to meet the demands of both national and international markets. Yet fragmentation of land due to population pressure in rural areas, and the low prices farmers are paid for their produce, mean that in many rural areas in sub-Saharan Africa the farms are already too small to provide food security or a living income for the household. There is a high dependency on off-farm income and little incentive to intensify production. Thus rural households are often ‘reluctant’ farmers, lacking resources or the economic incentives to invest in agriculture. The conundrum that must be addressed is how to provide cheap, nutritious food to feed the growing urban and rural populations while creating incentives to stimulate increased agricultural production. This will require major transformations of the smallholder farming systems alongside creation of alternative employment.

Seasonal, annual, and spatial variation in cereal prices in Sub-Saharan Africa

Local food prices are key indicators of food security and market conditions. Yet price data are often not available, particularly for rural areas of Sub-Saharan Africa. We compiled data from 168 markets to study spatial and temporal price variation. We found that prices slightly increase when the preceding growing season was dry. Across the continent, there is pronounced seasonal variation, with lowest prices 2–3 months after harvest and highest prices just before harvest. A predictive model explained 42% of the spatial variation in prices. Our results show that spatial and temporal price variation can be generalized and that prices can be estimated for unsampled locations or months. Such estimates may be used to improve the targeting of food security interventions and strengthen empirical policy-oriented research.

Evolution of Customary Land Tenure Institutions in Zambia: The Case of Lufwanyama District in the Copperbelt Province

Customary norms, as informal institutions, contribute to social order and stability, which support economic growth and agricultural production in most rural areas of sub-Saharan Africa. Customary r...

Demand-Side Management of Solar Microgrid Operation: Effect of Time-of-Use Pricing and Incentives

Over 17% of the world’s population lack access to electricity, the majority being in rural areas of sub-Saharan Africa and South Asia. Microgrid technologies are a promising solution towards rural and remote area electrification; however, ever-increasing electricity demand remains a big challenge leading to pronounced power outages. Demand-side management is an indispensable tool towards addressing the challenges. This paper employs a mathematical model based on incentives and time-of-use rates to simulate daily power usage pattern of residential customers using data collected from an isolated village Ngurdoto solar microgrid, Arusha, Tanzania. Customer responsiveness on the increase in price was evaluated based on the concept of price elasticity of demand. Using two demand response strategies, namely, load shifting (LS) and scheduled load reduction (SLR), the results reveal that LS can achieve up to 4.87% energy-saving, 19.23% cost-saving, and about 31% and 19% peak reduction and power factor improvement, respectively. SLR method resulted in about 19% energy-saving, 49% cost-saving, and 24% power factor improvement. Thus, the results presented in this study may lead to a more efficient and stable system than the current state in developing countries’ utility.

Loss to follow-up and opportunities for reengagement in HIV care in rural Mozambique: A prospective cohort study.

Patients lost to follow-up (LTFU) over the human immunodeficiency virus (HIV) cascade have poor clinical outcomes and contribute to onward HIV transmission. We assessed true care outcomes and factors associated with successful reengagement in patients LTFU in southern Mozambique.Newly diagnosed HIV-positive adults were consecutively recruited in the Manhiça District. Patients LTFU within 12 months after HIV diagnosis were visited at home from June 2015 to July 2016 and interviewed for ascertainment of outcomes and reasons for LTFU. Factors associated with reengagement in care within 90 days after the home visit were analyzed by Cox proportional hazards model.Among 1122 newly HIV-diagnosed adults, 691 (61.6%) were identified as LTFU. Of those, 557 (80.6%) were approached at their homes and 321 (57.6%) found at home. Over 50% had died or migrated, 10% had been misclassified as LTFU, and 252 (78.5%) were interviewed. Following the visit, 79 (31.3%) reengaged in care. Having registered in care and a shorter time between LTFU and visit were associated with reengagement in multivariate analyses: adjusted hazards ratio of 3.54 [95% confidence interval (CI): 1.81-6.92; P < .001] and 0.93 (95% CI: 0.87-1.00; P = .045), respectively. The most frequently reported barriers were the lack of trust in the HIV-diagnosis, the perception of being in good health, and fear of being badly treated by health personnel and differed by type of LTFU.Estimates of LTFU in rural areas of sub-Saharan Africa are likely to be overestimated in the absence of active tracing strategies. Home visits are resource-intensive but useful strategies for reengagement for at least one-third of LTFU patients when applied in the context of differentiated care for those LTFU individuals who had already enrolled in HIV care at some point.

Proposing a Paradigm Shift in Rural Electrification Investments in Sub-Saharan Africa through Agriculture

Almost one billion people in the world still do not have access to electricity. Most of them live in rural areas of the developing world. Access to electricity in the rural areas of Sub-Saharan Africa is only 28%, roughly 600 million people. The financing of rural electrification is challenging and, in order to accomplish higher private sector investments, new innovative business models have to be developed. In this paper, a new approach in the financing of microgrid electrification activities is proposed and investigated. In this approach, agriculture related businesses take the lead in the electrification activities of the surrounding communities. It is shown that the high cost of rural electrification can be met through the increased value of locally produced products, and cross-subsidization can take place in order to decrease the cost of household electrification. The approach is implemented in a case study in Rwanda, through which the possibility of local agricultural cooperatives leading electrification activities is demonstrated.

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.