South Africa Research Articles

Speaking of Hunger: Food Shortages, Poverty and Community Assistance in Urban South Africa

ABSTRACT How people speak of hunger extends beyond statements about food adequacy; people’s remarks may reflect experiences of poverty and feelings of vulnerability, and may be used to request help. In this article, we build on the idea of idioms of distress to conceptualize hunger talk as expressing more than an empty belly. We draw on ethnographic data gathered in two settings in South Africa: one a peri-urban area under traditional jurisdiction in the Eastern Cape Province; the other an inner-city suburb of the largest city, Johannesburg, in Gauteng. Hunger-related idioms of distress help illustrate the complex interplay of social, economic, and cultural factors, and allow people to speak of various affective and material aspects of their lives.

Usefulness of accounting information systems for small business profitability in South Africa: A systematic literature review

Accounting information systems are an important instrument in the hands of administrators seeking to maintain a competitive edge in the face of fast technological innovation, having the knowledge, and demanding expectations from customers and business owners. The objective of the study is to investigate the empirical literature pertaining to accounting information systems and companies. This study uses a systematic literature review method to provide responses to the research issue, and the bulk of the research was conducted in industrialized economies where computerized accounting system approaches were widely adopted. The selected method of inquiry consists of the following phases: study choice, development of both inclusion and exclusion guidelines, research designation, quality of research assessment, data collection, and data compilation. Based on the paper’s findings, most small businesses fail to implement accounting information systems in their operations, resulting in low-efficiency levels because of the difficulty of preserving company information records. Furthermore, this systematic literature review adds to the prior literature in three ways: (1) it indicates the usefulness of accounting information systems; (2) it expresses the suggestions that might be implemented to boost the accounting information system; and (3) it describes the research gaps that require to be filled to encourage an improved adoption of accounting information systems for small business profitability.

COVID-19 governance and decision-making at provincial level in South Africa

COVID-19 governance and decision-making at provincial level in South Africa

Market participation of irrigated smallholder vegetable farming in the Eastern Cape, South Africa

Market participation of irrigated smallholder vegetable farming in the Eastern Cape, South Africa

One Health: The Future of Ecosystem Health and Where to Start

Highly relevant to our current and future global state is the need for ecosystem conservation. Rewilding, the process of introducing wildlife to degraded areas, is one such method of conservation. Rewilding is primarily applied from an ecological point of view and largely fails to consider the public health and systemic implications of habitat restoration. As such, a new conservation paradigm is warranted. One Health is a global health approach that considers the complex interplay between humans, animals, and their shared environment. While One Health examines the social, political, and economic context of degraded areas to prioritize systemic advancement and disease prevention in conjunction with conservation, the large scope and transdisciplinary nature of One Health make it challenging to implement. Rewilding efforts conducted by the Conservation Landscape Institute (CLI) in South Africa’s Eastern Cape is an ideal candidate for a One Health approach. With stable funding, infrastructure, and institutional support, CLI is prime for a transition to a One Health framework that can serve as a model for One Health implementation worldwide. As concerns about systemic inequality, disease prevalence, and ecosystem degradation increase, it is necessary to take advantage of the opportunity provided at CLI to establish the new global health paradigm that is One Health.

Rational gaze: Presenting the open-source HYPEtools R package for analysis, visualization, and interpretation of hydrological models and datasets

The open-source HYPEtools R package aims to address current challenges in hydrological modeling and data analysis by providing a suite of tools for data management, visualization, interpretation, and exploration. Originally developed as a supporting toolbox for the HYPE hydrological model, HYPEtools has since evolved into a standalone package with features ranging from diverse aggregation and evaluation routines to interactive apps and mapping. Specifically, functions are included for data manipulation and conversion, data summarization, plotting and mapping, and interactive data exploration. Two case studies are provided to highlight how HYPEtools can simplify hydrological workflows and analyses both independently of and within HYPE modeling contexts. First, HYPEtools is used for data exploration and mapping of water transfers in South Africa. Then, a case study for the Baltic Sea region of a pan-European HYPE model setup illustrates how HYPEtools can assist model calibration and validation.

Subclinical tuberculosis linkage to care and completion of treatment following community-based screening in rural South Africa

BackgroundTuberculosis (TB), a leading cause of infectious death, is curable when patients complete a course of multi-drug treatment. Because entry into the TB treatment cascade usually relies on symptomatic individuals seeking care, little is known about linkage to care and completion of treatment in people with subclinical TB identified through community-based screening.MethodsParticipants of the Vukuzazi study, a community-based survey that provided TB screening in the rural uMkhanyakude district of KwaZulu-Natal from May 2018 – March 2020, who had a positive sputum (GeneXpert or Mtb culture, microbiologically-confirmed TB) or a chest x-ray consistent with active TB (radiologically-suggested TB) were referred to the public health system. Telephonic follow-up surveys were conducted from May 2021 – January 2023 to assess linkage to care and treatment status. Linked electronic TB register data was accessed. We analyzed the effect of baseline HIV and symptom status (by WHO 4-symptom screen) on the TB treatment cascade.ResultsSeventy percent (122/174) of people with microbiologically-confirmed TB completed the telephonic survey. In this group, 84% (103/122) were asymptomatic and 46% (56/122) were people living with HIV (PLWH). By self-report, 98% (119/122) attended a healthcare facility after screening, 94% (115/122) started TB treatment and 93% (113/122) completed treatment. Analysis of electronic TB register data confirmed that 67% (116/174) of eligible individuals started TB treatment. Neither symptom status nor HIV status affected linkage to care. Among people with radiologically-suggested TB, 48% (153/318) completed the telephonic survey, of which 80% (122/153) were asymptomatic and 52% (79/153) were PLWH. By self-report, 75% (114/153) attended a healthcare facility after screening, 16% (24/153) started TB treatment and 14% (22/153) completed treatment. Nine percent (28/318) of eligible individuals had TB register data confirming that they started treatment.ConclusionsDespite high rates of subclinical TB, most people diagnosed with microbiologically-confirmed TB after community-based screening were willing to link to care and complete TB treatment. Lower rates of linkage to care in people with radiologically-suggested TB highlight the importance of streamlined care pathways for this group. Clearer guidelines for the management of people who screen positive during community-based TB screening are needed.

Deployment of carbon removal technologies could reduce the rapid and potentially disruptive pace of decarbonization in South Africa's climate ambitions

As a developing country, South Africa faces the risk of having to undertake disruptive actions to meet its internationally pledged emission reduction targets. It has become necessary to find alternative measures for South Africa to meet its climate targets without such a disruptive and aggressive transformation of its energy sector. To truly reach net-zero CO2 emissions, South Africa must ensure that residual emissions from its recalcitrant sectors are equally compensated by carbon dioxide removal (CDR). Given the potential for CDR technologies to delay the need for rapid emissions cuts, we leverage this characteristic to explore their role in helping South Africa achieve its climate targets on time, but through a less disruptive and overly aggressive pace of energy system decarbonization. Using an integrated assessment model, we show that while reaching its emission reduction targets, the presence of novel CDR (nCDR) approaches could significantly reduce South Africa's mitigation costs to $155-240/tCO2 instead of $190–590/tCO2 by 2050 in the absence of nCDR. Furthermore, the availability of nCDR may allow for a more gradual transition towards renewable and nuclear power generation compared to scenarios without nCDR. Importantly, we reveal that nCDR could help avoid asset stranding of up to 4–6 GW and $15–25 billion in associated costs between 2016 and 2050. However, this comes at the cost of higher residual greenhouse gas emissions due to the continued reliance on fossil fuels under nCDR availability. Overall, South Africa's priority must remain on decarbonization, especially in sectors where fuel switching and energy efficiency are feasible. Nonetheless, the complementary role of nCDR must not be underestimated, and South Africa should begin investing in these emerging technologies to support its ambitious climate goals.

Economic implications of novel regimens for tuberculosis treatment in three high-burden countries: a modelling analysis.

With numerous trials investigating novel drug combinations to treat tuberculosis, we aimed to evaluate the extent to which future improvements in tuberculosis treatment regimens could offset potential increases in drug costs. In this modelling analysis, we used an ingredients-based approach to estimate prices at which novel regimens for rifampin-susceptible and rifampin-resistant tuberculosis treatment would be cost-neutral or cost-effective compared with standards of care in India, the Philippines, and South Africa. We modelled regimens meeting targets set in the WHO's 2023 Target Regimen Profiles (TRPs). Our decision-analytical model tracked cohorts of adults initiating rifampin-susceptible or rifampin-resistant tuberculosis treatment, simulating their health outcomes and costs accumulated during and following treatment under standard-of-care and novel regimen scenarios. Price thresholds included short-term cost-neutrality (considering only savings accrued during treatment), medium-term cost-neutrality (additionally considering savings from averted retreatments and secondary cases), and cost-effectiveness (incorporating willingness-to-pay for improved health outcomes). Total medium-term costs per person treated using standard-of-care regimens were estimated at US$450 (95% uncertainty interval 310-630) in India, $560 (350-860) in the Philippines, and $730 (530-1090) in South Africa for rifampin-susceptible tuberculosis (current drug costs $46) and $2100 (1590-2810) in India, $2610 (2090-3280) in the Philippines, and $3790 (3090-4630) in South Africa for rifampin-resistant tuberculosis (current drug costs $432). A rifampin-susceptible tuberculosis regimen meeting the optimal targets defined in the TRPs could be cost-neutral in the short term at drug costs of $140 (90-210) per full course in India, $230 (130-380) in the Philippines, and $280 (180-460) in South Africa. For rifampin-resistant tuberculosis, short-term cost-neutral thresholds were higher with $930 (720-1230) in India, $1180 (980-1430) in the Philippines, and $1480 (1230-1780) in South Africa. Medium-term cost-neutral prices were approximately $50-100 higher than short-term cost-neutral prices for rifampin-susceptible tuberculosis and $250-550 higher for rifampin-resistant tuberculosis. Health system cost-neutral prices that excluded patient-borne costs were 45-70% lower (rifampin-susceptible regimens) and 15-50% lower (rifampin-resistant regimens) than the cost-neutral prices that included patient costs. Cost-effective prices were substantially higher. Shorter duration was the most important driver of medium-term savings with novel regimens, followed by ease of adherence. Improved tuberculosis regimens, particularly shorter regimens or those that facilitate better adherence, could reduce overall costs, potentially offsetting higher prices. WHO.

Hydraulic fracturing potential of tight gas reservoirs: A case study from a gas field in the Bredasdorp Basin, South Africa

The issue of hydraulic fracturing in the onshore Karoo Basin has triggered an intense political, social and environmental debate in South Africa. This research paper proposes the relatively under-explored F–O tight gas field in South Africa as a demonstration site that can shed light on the ongoing debate on the use of hydraulic fracturing in the Karoo Basin. By combining petrographic and geomechanical analyses with critical velocity experiments and rock mechanics testing, a step-by-step guide for assessing the hydraulic fracturing potential of tight gas reservoirs was presented. K-Means clustering was used to improve the sampling strategy and to capture reservoir heterogeneity. The results obtained showed that K-Means clustering improves reservoir characterisation by revealing heterogeneous intervals, thus optimising petrographic and geomechanical analyses. In addition, the hydraulic fracturing fluid was found not to cause formation damage in the reservoir at a critical velocity of 0.155 ml/min. The elastic properties also showed that the F–O Tight Gas Field has a high degree of brittleness with good hydraulic fracturing potential. Finally, the characterisation of the fractures shows that partially open fractures are prevalent, which can dilate under the high differential stresses in the reservoir. Although further investigation is required, this study has shown that the F–O gas field is a promising candidate for hydraulic fracturing.

Ubuntu or Compliance? Knowledge, Attitudes, and Practices of Owners of Small- Medium-Sized Enterprises in Johannesburg, South Africa Regarding Corporate Social Responsibility

ABSTRACT There is a paucity of studies demonstrating how small and medium-sized enterprises (SMEs) adopt CSR interventions to enhance social and economic conditions of communities within which they operate. There is also a prevailing stereotype that Corporate Social Responsibility is only applicable to big, multinational companies. The study therefore explored the knowledge, attitudes, and practices of 10 owners of SMEs in Johannesburg, South Africa regarding CSR. Guided by a social development lens, the study adopted a qualitative case study research design. Thematic analysis of interview responses revealed that most of these owners considered their SMEs to be practising CSR, and were motivated primarily by the intrinsic spirit of Ubuntu rather than extrinsic compliance with regulatory requirements. While some CSR interventions (such as skills-transfers as empowerment) were found to be consistent with the social development approach, others, such as philanthropy, were not necessarily developmental but nevertheless important in a developing country such as South Africa with its high levels of poverty. The key contributions of the study to knowledge are first, that it debunks the misconception in the literature that SMEs are too small and financially incapable of implementing CSR interventions; and second, that it enhances understanding from a developing world perspective of the factors motivating SME owners to engage in CSR.

Longitudinal Trajectories of Antiretroviral Treatment Adherence and Associations With Durable Viral Suppression Among Adolescents Living With HIV in South Africa.

Compared with other age groups, adolescents living with HIV (ALHIV) are estimated to have lower levels of adherence to antiretroviral treatment. Despite this, we lack evidence on adolescents' adherence patterns over time to inform the customization of intervention strategies. Eastern Cape province, South Africa. We analyzed data from a cohort of ALHIV (N = 1046, aged 10-19 years at baseline) recruited from 53 public health facilities. The cohort comprised 3 waves of data collected between 2014 and 2018 and routine viral load data from the National Institute for Communicable Disease data warehouse (2014-2019). Durable viral suppression was defined as having suppressed viral load (<1000 copies/mL) at ≥2 consecutive study waves. Group-based multitrajectory model was used to identify adherence trajectories using 5 indicators of self-reported adherence. Logistic regression modeling evaluated the associations between adherence trajectories and durable viral suppression. Overall, 933 ALHIV (89.2%) completed all 3 study waves (55.1% female, mean age: 13.6 years at baseline). Four adherence trajectories were identified, namely, "consistent adherence" (49.8%), "low start and increasing" (20.8%), "gradually decreasing" (23.5%), and "low and decreasing" (5.9%). Adolescents experiencing inconsistent adherence trajectories were more likely to be older, live in rural areas, and have sexually acquired HIV. Compared with the consistent adherence trajectory, the odds of durable viral suppression were lower among adolescents in the low start and increasing (adjusted odds ratio [aOR]: 0.62, 95% CI: 0.41 to 0.95), gradually decreasing (aOR: 0.40, 95% CI: 0.27 to 0.59), and the low and decreasing adherence (aOR: 0.25, 95% CI: 0.10 to 0.62) trajectories. Adherence to antiretroviral treatment remains a challenge among ALHIV in South Africa. Identifying adolescents at risk of nonadherence, based on their adherence trajectories may inform the tailoring of adolescent-friendly support strategies.

A techno-economic assessment of the viability of a photovoltaic-wind-battery storage-hydrogen energy system for electrifying primary healthcare centre in Sub-Saharan Africa

Healthcare facilities in isolated rural areas of sub-Saharan Africa face challenges in providing essential health services due to unreliable energy access. This study examines the use of hybrid renewable energy systems consisting of solar PV, wind turbines, batteries, and hydrogen storage for the electrification of rural healthcare facilities in Nigeria and South Africa. The study deployed the efficacy of Hybrid Optimization of Multiple Energy Resources software for techno-economic analysis and the Evaluation based on the Distance from Average Solution method for multi-criteria decision-making for sizing, optimizing, and selecting the optimal energy system. Results show that the optimal configurations achieve cost-effective levelized energy costs ranging from $0.336 to $0.410/kWh for both countries. For the Nigeria case study, the optimal energy system includes 5 kW PV, 10 kW fuel cell, 10 kW inverter, 10 kW electrolyzer, and 16 kg hydrogen tank. South Africa’s optimal configuration has 5 kW PV, 10 kW battery, 10 kW inverter, and 7.5 kW rectifier. Solar PV provides more than 90 % of energy, with dual axis tracking yielding the highest output: 8,889kWh/yr for Nigeria and 10,470kWh/yr for South Africa. The multi-criteria decision-making analysis reveals that Nigeria’s preferred option is the hybrid system without tracking. In contrast, the horizontal axis, weekly adjustment tracking configuration is optimal for South Africa, considering technical, economic, and environmental criteria. The findings highlight the importance of context-specific optimization for hybrid renewable energy systems in rural healthcare facilities to accelerate Sustainable Development Goals 3 and 7.

Colistin utilization at a tertiary hospital in South Africa: an opportunity for antimicrobial stewardship practices.

Introduction. Colistin (polymyxin E) has emerged as a last-resort treatment option for multidrug-resistant infections.Hypothesis/Gap Statement. Studies on the use, safety and efficacy of colistin in South Africa are limited.Aim. This study aims to describe the use of colistin and its clinical outcomes at a tertiary public hospital in South Africa.Methodology. We conducted a retrospective review of adult and paediatric patients who received parenteral colistin between 2015 and 2019.Results. A total of 69 patients (26 adults, 13 children and 30 neonates) were reviewed. Acinetobacter baumannii was the most common causative pathogen isolated (70.1 %). Colistin was predominately used to treat septicaemia (75.4 %). It was primarily administered as definitive therapy (71.0 %) and as monotherapy (56.5 %). It was used in 11.5 % of adults with infections susceptible to other antibiotics. Loading doses of intravenous colistin were administered in only 15 (57.7 %) adult patients. Neurotoxicity and nephrotoxicity occurred in 5.8 % and 43.5 % of patients, respectively. Clinical cure was achieved in 37 (53.6 %) patients. On multivariate logistic regression analysis, adults [adjusted odds ratio (aOR), 25.54; 95 % CI, 2.73-238.65; P < 0.01] and children (aOR, 8.56; 95 % CI, 1.06-69.10; P < 0.05) had higher odds of death than neonates.Conclusion. The study identified significant stewardship opportunities to improve colistin prescription and administration. Achieving optimal patient outcomes necessitates a multidisciplinary approach and vigilant monitoring of colistin use.

Costs of home-delivered antiretroviral therapy refills for persons living with HIV: evidence from a pilot randomized controlled trial in KwaZulu-Natal, South Africa.

Antiretroviral therapy (ART) is needed across the lifetime to maintain viral suppression for people living with HIV. In South Africa, obstacles to reliable access to ART persist and are magnified in rural areas, where HIV services are also typically costlier to deliver. A recent pilot randomized study (the Deliver Health Study) found that home-delivered ART refills, provided at a low user fee, effectively overcame logistical barriers to access and improved clinical outcomes in rural South Africa. In the present costing study using the payer perspective, we conducted retrospective activity-based micro-costing of home-delivered ART within the Deliver Health Study and when provided at-scale (in a rural setting), and compared to facility-based costs using provincial expenditure data (covering both rural and urban settings). Within the context of the pilot Deliver Health Study which had an average of three deliveries per day for three days a week, home-delivered ART cost (in 2022 USD) $794 in the first year and $714 for subsequent years per client after subtracting client fees, compared with $167 per client in provincial clinic-based care. We estimated that home-delivered ART can reasonably be scaled up to 12 home deliveries per day for five days per week in the rural setting. When delivered at scale, home-delivered ART cost $267 in the first year and $183 for subsequent years per client. Average costs of home delivery further decreased when increasing the duration of refills from three-months to six- and 12-month scripts (from $183 to $177 and $135 per client, respectively). Personnel costs were the largest cost for home-delivered refills while ART drug costs were the largest cost of clinic-based refills. When provided at scale, home-delivered ART in a rural setting not only offers clinical benefits for a hard-to-reach population but is also comparable in cost to the provincial standard of care.

Morbidity amongst South African Hajj pilgrims in 2023—a retrospective cohort study

South Africans are not accustomed to the dry arid climate and sweltering heat in Saudi Arabia. We conducted a retrospective cohort study to identify the common health conditions pre-Hajj, during the 5 days of Hajj and on return to South Africa from Hajj amongst the 2023 pilgrims. A QR code and a mobile link to a self-administered questionnaire was sent to all 3500 South African pilgrims. Five hundred and seventy-seven pilgrims returned the completed surveys. Mean age of the participants was 48 years (SD 12) with a higher female representation (3:2). Forty eight percent (279) had pre-existing chronic conditions. Forty five percent (259) reported being ill during their stay in the Kingdom, 20% (115) reported having an illness during the main 5 days, whilst 51% (293) reported having an illness within 7 days of returning to South Africa. Only six pilgrims were admitted to hospital after their return home. Respiratory tract linked symptoms were the most frequently reported (95% pre Hajj and 99% post Hajj). Participants who reported having a chronic condition (AOR 1.52 95% CI 1.09–2.11) and engaging in independent exercising prior to Hajj (AOR 1.52–1.07–2.10) were at an increased likelihood of developing an illness within 7 days of returning home. Post travel surveillance swabs to identify potential pathogens that the returning pilgrims are incubating should be explored to guide further interventions.

Associations between HIV infection status, psychosocial factors, and adjuvant endocrine therapy adherence among South African women with early-stage breast cancer.

522 Background: South African (SA) women living with comorbid estrogen receptor positive (ER+) breast cancer (BC) and HIV have higher mortality than other SA women with ER+ BC. We aimed to evaluate for associations between HIV status, psychosocial factors, and adjuvant endocrine therapy (AET) adherence as a potential contributor to this disparity. Methods: From Chris Hani Baragwanath Hospital, Johannesburg, we enrolled adult women with stage I-III ER+ BC in remission and currently prescribed tamoxifen or an aromatase inhibitor to a prospective cohort study. We performed AET pill counts at enrollment, 12 weeks, and 24 weeks, and calculated adherence ratios from the difference in pills between visits divided by the number of days between visits. Women completed questionnaires on sources of social support, beliefs about medication, health literacy, and self-efficacy at enrollment and questionnaires about mental health (depression, anxiety, and acute stress) symptom burden and AET-related side effects at the 12- and 24-week visits. We also collected household wealth data and clinical data on BC and HIV. AET adherence ratios were compared between women with and without comorbid HIV using Wilcoxon rank sum testing. We also used structural equation modeling techniques to refine and evaluate an a priori model of AET adherence with latent variables for mental health, socioeconomic (SES) status, healthcare savvy, and AET side effect burden and subgroup analyses of the resulting model in women with and without HIV. Results: Between April 26, 2022, and July 11, 2023, we enrolled 239 women, 63 (26.4%) of whom had co-morbid HIV. Adherence data was available from 106 women at 12 and 24 weeks, from 22 women at 12 weeks only, and from 111 women at 24 weeks only. Comparing women with and without HIV, median AET adherence ratio was 0.88 vs 0.89, respectively (p = 0.65). Our final model of AET adherence achieved good fit (comparative fit index = 0.96, RMSEA 90% CI: 0.03-0.06). In the full cohort, SES quintile showed a trend towards association with AET adherence (β 0.02, SE 0.01, p=0.09); mental health, healthcare savvy, and side effect burden latent variables were not significantly associated with adherence. In the subgroup of women living with HIV, SES quintile (β 0.04, SE 0.02, p=0.08) and mental health (β -0.02, SE 0.01, p=0.10) showed trends toward association with adherence; these relationships did not persist for women without HIV. Conclusions: HIV status is not predictive of AET adherence among SA women with ER+ BC, but in women with both diagnoses, decreasing SES status and increasing mental health symptoms trended towards an association with decreased adherence. Interventions to improve the mental health of SA breast cancer patients living with HIV may promote AET adherence.

Advancing inclusive research (AIR) in Africa: Strengthening healthcare systems to enhance access on the continent through the Africa AIR site alliance model.

e13778 Background: While Africa makes up 17% of the total world population, it has 24% of the global disease burden. Furthermore, although Africa is rich in genomic diversity, Africans make up &lt;4% of the patients in global pharma studies and 1% of the global genomic database. In 2020 there were only 63 African patients in Roche global clinical trials. The Africa AIR Site Alliance model was undertaken to address the growing importance of interventional clinical trials with advanced diagnostics and therapies in Africa, as well as the lack of representation of the African population in global datasets, which contribute to continued health disparities, poor outcomes and existing inequities. Methods: In countries with a legal research framework, no clinical trial holds and who have conducted at least 1 Roche clinical trial during the last 5 years potential Centers of Excellence for the Africa AIR Site Alliance were identified. For patients, sites had invoiceable services to ensure they were supported and could potentially include education about clinical trial participation, reasonable travel and accommodation, or covering the cost of missed work or childcare. Sites participated in training on how to conduct clinical trials, including opportunities to share best practices across sites. Results: Four pilot countries were selected and had Centers of Excellence identified to work as partners with Roche for global clinical trials: Morocco (Marrakech University Hospital Center), Nigeria (University College Hospital Ibadan), Kenya (University of Nairobi Institute of Tropical and Infectious Diseases) and South Africa (Limpopo Cancer Research Institute). After entering the Africa AIR Site Alliance, sites reported consistent application of standard operating procedures and manuals, trained and empowered staff, increased organization and appropriate patient support, plus knowledge and experience with industry trials. Sites are successfully participating in an increased number of global clinical trials in various therapeutic areas with 23 patients enrolled at the Africa AIR Site Alliance sites in oncology and ophthalmology studies. Conclusions: The Africa AIR Site Alliance model is a groundbreaking initiative that has the potential to revolutionize clinical research in Africa with a positive long-term impact on the African healthcare ecosystem and clinical care delivery. Limited diversity and representation in genomic, safety and efficacy data have hampered scientific and medical progress on the continent. The Africa AIR Site Alliance provides critical support, knowledge and skills for conducting clinical trials and assists in removing barriers for underrepresented patients to participate in these trials. Future work will focus on expanding to additional countries in Africa and creating a robust network of Centers of Excellence for innovative research.

Cancer survival in sub-Saharan Africa (SURVCAN-3): a population-based study

The Cancer Survival in Africa, Asia, and South America project (SURVCAN-3) of the International Agency for Research on Cancer aims to fill gaps in the availability of population-level cancer survival estimates from countries in these regions. Here, we analysed survival for 18 cancers using data from member registries of the African Cancer Registry Network across 11 countries in sub-Saharan Africa. We included data on patients diagnosed with 18 cancer types between Jan 1, 2005, and Dec 31, 2014, from 13 population-based cancer registries in Cotonou (Benin), Abidjan (CÔte d'Ivoire), Addis Ababa (Ethiopia), Eldoret and Nairobi (Kenya), Bamako (Mali), Mauritius, Namibia, Seychelles, Eastern Cape (South Africa), Kampala (Uganda), and Bulawayo and Harare (Zimbabwe). Patients were followed up until Dec 31, 2018. Patient-level data including cancer topography and morphology, age and date at diagnosis, vital status, and date of death (if applicable) were collected. The follow-up (survival) time was measured from the date of incidence until the date of last contact, the date of death, or until the end of the study, whichever occurred first. We estimated the 1-year, 3-year, and 5-year survival (observed, net, and age-standardised net survival) by sex, cancer type, registry, country, and human development index (HDI). 1-year and 3-year survival data were available for all registries and all cancer sites, whereas availability of 5-year survival data was slightly more variable; thus to provide medium-term survival prospects, we have focused on 3-year survival in the Results section. 10 500 individuals from 13 population-based cancer registries in 11 countries were included in the survival analyses. 9177 (87·4%) of 10 500 cases were morphologically verified. Survival from cancers with a high burden and amenable to prevention was poor: the 3-year age-standardised net survival was 52·3% (95% CI 49·4-55·0) for cervical cancer, 18·1% (11·5-25·9) for liver cancer, and 32·4% (27·5-37·3) for lung cancer. Less than half of the included patients were alive 3 years after a cancer diagnosis for eight cancer types (oral cavity, oesophagus, stomach, larynx, lung, liver, non-Hodgkin lymphoma, and leukaemia). There were differences in survival for some cancers by sex: survival was longer for females with stomach or lung cancer than males with stomach or lung cancer, and longer for males with non-Hodgkin lymphomas than females with non-Hodgkin lymphomas. Survival did not differ by country-level HDI for cancers of the oral cavity, oesophagus, liver, thyroid, and for Hodgkin lymphoma. For cancers for which population-level prevention strategies exist, and with relatively poor prognosis, these estimates highlight the urgent need to upscale population-level prevention activities in sub-Saharan Africa. These data are vital for providing the knowledge base for advocacy to improve access to prevention, diagnosis, and care for patients with cancers in sub-Saharan Africa. Vital Strategies, the Martin-Luther-University Halle-Wittenberg, and the International Agency for Research on Cancer. For the French and Portuguese translations of the abstract see Supplementary Materials section.

The importance of birth cohort studies to low and middle income countries

ABSTRACT In order to discern the causes of the health and developmental problems of children, and thence develop preventative strategies, longitudinal cohort studies offer major advantages. They can monitor the consequences of exposure to physical and psychological events and thence identify antecedents of various disorders. We describe the historical background to the development in the UK of this study design, and the uptake of longitudinal birth cohorts in low- and middle-income countries (LMICs), using the cohorts in Jamaica, South Africa and Brazil as exemplars. We describe the benefits of such studies and show how undertaking longitudinal cohort studies can have major health and financial benefits to the populations concerned. Additionally, the paper outlines the advantages of collaboration between studies and the pooling of data.