Studies In sub-Saharan Africa Research Articles

Characteristics of longitudinal maternal health studies in sub-Saharan Africa: A systematic mapping of literature between 2012 and 2022.

High maternal mortality rates in sub-Saharan Africa necessitate the need for aligned research focusing on prevalent causes and neglected conditions in the region. This mapping review aimed to describe the characteristics of longitudinal maternal health studies between 2012 and 2022 in sub-Saharan Africa and identify gaps in priority conditions or geographical locations. We identified references through a Medline (PubMed) search covering September 2012 to June 2022. We included prospective cohort or clinical trials that enrolled at least 1000 pregnant women, with a study site in sub-Saharan Africa, and published in English or French. Screening and data extraction were done in duplicate using EPPI-reviewer software. Descriptive analysis was used to summarize the results, identifying patterns in studies across time, country, study design, topics, and funders. We identified 213 eligible studies, which were covered in 534 publications. We identified studies in 33 of the 48 sub-Saharan African countries, with the majority in east and southern Africa. The predominant study topics were HIV (36.4%), nutrition (20%), and malaria (16.3%), with very few publications on hypertensive disorders of pregnancy (6.4%), ante/postpartum hemorrhage (3.7%), and sexually transmitted infections (3.2%). More studies were cohorts (115/213; 54%) than clinical trials. The National Institutes of Health (31.5%), Bill and Melinda Gates Foundation (22.1%), and USAID (10.8%) were the largest research funders. Identifying research trends and mismatches between research topics and disease burden provides useful information for guiding future research prioritization. In particular, gaps exist for studies on hypertensive disorders of pregnancy and ante/postpartum hemorrhage, among the top causes of maternal mortality in sub-Saharan Africa.

REASSURED evaluation of the Bioline HCV point-of-care testing for diagnosing hepatitis C virus infection in primary healthcare settings of Ghana: a study protocol

IntroductionHepatitis C virus (HCV) infection is a silent epidemic that needs a comprehensive and contextualised approach to manage. Access to readily available, affordable and acceptable HCV point-of-care (POC) in vitro...

Women's Perspectives on the Unique Benefits and Challenges of Self-Injectable Contraception: A Four-Country In-Depth Interview Study in Sub-Saharan Africa.

Implementing self-injection (SI) of subcutaneous depot-medroxyprogesterone acetate (DMPA-SC) is a key self-care strategy for sexual and reproductive health, but SI uptake remains low, and assertions about the potential of SI to increase women's control over contraceptive use lack evidence. We sought to qualitatively explore how women with diverse contraceptive experiences-including those with and without experience using SI-view the benefits and challenges of SI as compared to other methods. We conducted 241 in-depth interviews with women across four sub-Saharan African countries and found alignment between the perceived and experienced benefits of SI across our diverse sample. Through the benefits of privacy, easier access, and self-management, we found SI can promote greater control over the contraceptive experience by facilitating a woman's ability to act on her preferences and control who is involved in or aware of her contraceptive use. Interviews revealed SI's potential is, however, constrained by inherent limitations in the method; for example, it is often not private or accessible enough and many fear injecting themselves. SI has the most potential when implemented with programmatic solutions that mitigate challenges women experience or anticipate and allow more women to benefit from the privacy, easier access, and self-management that SI offers.

Poverty Reduction and Family Functioning: Results from an Experimental Study in Sub-Saharan Africa

The study tests the effect of poverty-reduction intervention on family functioning reported by AIDS-orphaned children in extended families in Southern Uganda by asking two questions: (1) based on children’s reports, how does poverty reduction intervention affect family functioning? and (2) to what extent do these effects vary by a child’s gender and orphanhood status? Informed by the social causation theory, family stress model, and asset theory, the study aims to address the existing knowledge gap on effects of poverty reduction interventions on family functioning in low-income families caring for AIDS orphaned children in Uganda. We ran multilevel regression models using longitudinal data collected in a cluster-randomized controlled trial from N = 1410 children (n = 621 boys and n = 789 girls) recruited from 48 rural primary schools in Uganda. Survey data was collected every 12 months over the course of 5 years. The average age of children at enrollment was 13 years. We found significant positive effects of the intervention on family cohesion, family communication, and child-caregiver relationship. Effects vary by child’s gender and orphanhood category. Intervention improves family communication for boys, while improving family cohesion and quality of child-caregiver relationship for girls. Single maternal orphans reported improved family communication, while single paternal orphans reported improved child-caregiver relationship. Poverty reduction interventions are important to improve family functioning for low-income families. Variations by child’s gender and orphanhood status have not been reported in previous studies, and our findings underscore the importance of continued research in this area.

Interest in Oral Pre-exposure Prophylaxis Among Men Who Have Sex with Men and Transfeminine Persons in HPTN 075, a Multi-center HIV Prevention Study in Sub-Saharan Africa (2015-2017).

Use of oral pre-exposure prophylaxis (O-PrEP) for HIV prevention has not been fully utilized in sub-Saharan Africa, especially among key populations with high HIV incidence and prevalence, including men who have sex with men (MSM) and transgender women (TGW). We examined correlates of interest in O-PrEP among participants in the HIV Prevention Trials Network (HPTN) Study 075, a prospective cohort study, conducted between 2015 and 2017, across 4 sites in Kenya, Malawi, and South Africa. The study included persons assigned male sex at birth, between 18 and 44 years of age, who reported anal intercourse with a man in the past 3 months. Interest in O-PrEP and potential correlates were assessed among 297 participants who were HIV negative. 52% of the participants reported being aware of PrEP and 73% indicated interest in PrEP once informed about it. PrEP interest was not significantly associated with any of the surveyed demographic or psychosocial variables except study site. Our findings suggest a broad and general interest in O-PrEP among MSM and TGW in sub-Saharan Africa, despite relatively low awareness. While the situation around PrEP will have changed in the included countries, major questions about successful implementation still need to be addressed.

Challenges with communication of critical laboratory results in a resource-limited setting in South Africa.

Critical laboratory results are test results suggesting a patient is in immediate danger unless treatment is administered promptly. There is a paucity of studies in sub-Saharan Africa on clinicians' utility of these results and affected patients' outcomes. In our resource-limited setting in South Africa, we rely on telephonic communication to convey critical results. The aim of this study was to determine the average time for clinicians to acknowledge these results on the laboratory information system and to determine the outcome of affected patients. A retrospective descriptive audit at Tygerberg Academic Hospital was conducted between 01 October 2021 and 31 March 2022. Critical results and the time of acknowledgement by clinicians on the laboratory information system were obtained from inpatients and outpatients. One hundred and twenty inpatient critical results were randomly selected for a folder review to determine patient outcome. Overall, 2514 critical results were reported, and 63 results were excluded. The remaining 2451 results were obtained from 1346 patients. The majority (94.5%) of results were obtained from inpatients, where 1681 (68.6%) were acknowledged within 24 h. The folder audit of 120 patients determined that 40 (33.3%) patients demised. In 82 (68.3%) patients, communication of a critical result did not alter clinical management. Critical laboratory results are crucial to patient care. This study found that approximately one-third of critical laboratory results were not used within 24 h. Engaging clinicians in current practice and implementing a means of improved communication of critical results is required. The study adds to the evidence of challenges experienced with communicating critical results to clinicians which could impact patient care. This is especially true in resource-limited settings; clinicians need to be made aware of the importance of these results, and communication modes need to be improved.

Enhancing burned area monitoring with VIIRS dataset: A case study in Sub-Saharan Africa

Since 2001, the Moderate Resolution Imaging Spectroradiometer (MODIS) sensor on board the Aqua and Terra platforms has made great strides in providing information on global burned areas (BA). However, the MODIS mission is nearing its end. The Visible Infrared Imaging Radiometer Suite (VIIRS) sensors, presented as the MODIS Aqua heritage, could be an excellent alternative to ensure the temporal continuity of this information at a moderate resolution. This paper describes and evaluates the effectiveness of our developed hybrid algorithm, which utilizes VIIRS reflectance and active fire products on the Google Earth Engine platform, in producing efficient information about BA. The study investigates the algorithm's performance in sub-Saharan Africa as the region of interest in 2019, using biweekly outputs and a spatial resolution of 250 m. The algorithm encompasses several steps, including pre-processing individual scenes, creating cloud-free composites, generating binary reference data for burned and non-burned areas, conducting a supervised classification using random forest, and performing region shaping. The VIIRS-BA final product, which includes three confidence levels (low, moderate, and high) known as the uncertainty layer, is compared to four other burned area products. The validation is conducted against 27 reference sampling units from the Sentinel-2 Burned Area Reference Database dataset, allowing for a comprehensive uncertainty assessment across five various biomes. The VIIRS-BA product identified 5.1 million km2 of BA, which was significantly larger than other global coarse resolution BA products such as FireCCI51, FireCCIS310, and MCD64A1 and close to the fine resolution FireCCISFD20 with a difference of 7.3%. The differences were less significant in biomes such as “Tropical Savannas” and “Temperate Grasslands” which are characterized by persistent biomass burning. Based on a stratified random sampling, the validation results demonstrate varying levels of accuracy for the VIIRS-BA product across different confidence levels. The commission error (CE) ranges from 7.8% to 23.4%, while the omission error (OE) falls between 29.4% and 58.8%. Notably, there is a significant reduction in OE (ranging from 40.7% to 50.5%) compared to global BA products like FireCCI51, FireCCIS310, and MCD64A1. When compared to VIIRS-BA, the FireCCISFD20 regional product has a 37% better OE performance. While VIIRS-BA shows great potential in detecting fires that global products miss, the VIIRS-BA with low confidence level tends to overestimate BA in regions with high fire activity. To address this, future versions of the algorithm will integrate the updated VIIRS reflectance data alongside VIIRS active fire from the National Oceanic and Atmospheric Administration to reduce CE and improve understanding spatial patterns.

Women with disabilities' use of maternal care services in sub-Saharan Africa.

Quality maternal health care is central to the Sustainable Development Goals efforts to reduce maternal mortality, yet there remain limited quantitative data on maternal care inequities for women with disabilities in sub-Saharan Africa. This study aims to understand the differences in maternal care providers for women with and without disabilities. We used Multiple Indicator Cluster Surveys from 13 sub-Saharan African countries conducted between 2017-2020. We used logistic and multinomial logistic regression to examine the relationship between disability (Washington Group definition) and antenatal care attendance and the type of care provider for antenatal care, skilled birth attendance, and postnatal and postpartum checks. All analyses were adjusted for age, wealth, country, and location. The sample included 10 021 women, including 306 (3.1%) women with disabilities. There were small absolute and no relative differences in antenatal care attendance, qualified antenatal care provider, postnatal, and postpartum checks, for disabled and women without disabilities. Women with disabilities had some evidence of higher odds of having a doctor at their birth compared to women without disabilities (aOR = 1.52, 95% CI: 0.99-2.33). This study shows small absolute and no relative differences between women with and without disabilities for antenatal access and provider types for maternal care, though these findings are limited by a small sample and no data on care quality, acceptability, or outcomes. More research on care quality and outcomes is needed. This study is the first quantitative, multi-country study in sub-Saharan Africa to examine maternal care seeking patterns, demonstrating important data on maternal health indicators for women with disabilities.

Health technology assessment for sexual reproductive health and rights benefits package design in sub-Saharan Africa: A scoping review of evidence-informed deliberative processes

Background Health technology assessment uses a multidisciplinary approach to support health benefits package design towards universal health coverage. The evidence-informed deliberative process framework has been used alongside Health technology assessment to enhance stakeholder participation and deliberations in health benefits package design. Applying the evidence-informed deliberative framework for Health assessment could support the morally diverse sexual reproductive health and rights (SRHR) benefits package design process. However, evidence on participation and deliberations for stakeholders in health technology assessment for SRHR benefits package design has not been curated in sub-Saharan Africa. This study synthesises literature to fill this gap. Methods This scoping review applies the preferred reporting items for systematic reviews and meta-analyses extension for scoping reviews, and deductive analysis following the evidence-informed deliberative processes framework. The search strategy uses the Guttmacher–Lancet Commission-proposed comprehensive definition of SRHR and the World Health Organisation’s universal health coverage compendium of SRHR interventions to generate search terms. Six databases and biographical hand searches were used to identify studies in Sub-Saharan Africa from 1994. Results A total of 14 studies met the inclusion criteria. Evidence for yearly public budgets and explicit SRHR health technology assessment processes was not found. In 12 of the studies reviewed, new advisory committees were set up specifically for health technology assessment for SRHR priority-setting and benefits package design. In all decision-making processes reviewed, the committee member roles, participation and deliberations processes, and stakeholder veto powers were not clearly defined. Patients, the public, and producers of health technology were often excluded in the health technology assessment for the SRHR benefits package design. Most health technology assessment processes identified at least one decision-making criterion but failed to use this in their selection and appraisal stages for SRHR benefits design. The identification, selection, and scoping stages in health technology assessment for SRHR were non-existent in most studies. In 11 of the 14 processes of the included studies, stakeholders were dissatisfied with the health policy recommendation from the appraisal process in health technology assessment. Perceived benefits for evidence-informed deliberative processes included increased stakeholder engagement and fairness in decision-making. Conclusion To support the integration of diverse social values in health technology assessment for fairer SRHR benefits package design, evidence from this review suggests the need to institutionalise health technology assessment, establish prioritisation decision criteria, involve all relevant stakeholders, and standardise the process and assessment methodological approaches.

Have we bothered to ask? Exploration of the attitude of teachers toward participating in inclusive education research

ObjectiveThe importance of research cannot be overemphasized. Research findings serve as a guide for the enactment of development policies and legislation. However, not all members of the target population willingly participate in a study. The current study explored the reasons why some individuals refused to partake in inclusive education research in a developing country, Ghana. The journaling helped to capture the voices of 87 participants who refused to take part in a larger inclusive education survey study.ResultsThe study found that the participants did not take part in the research because of reasons such as lack of financial gain, bad experience with previous research, lack of direct benefit, and lack of time. The findings of the study and its implication for policymaking in Ghana and research studies in sub-Saharan Africa are discussed.

Co-occurrence of and factors associated with health risk behaviors among adolescents: a multi-center study in sub-Saharan Africa, China, and India

Despite lifelong and detrimental effects, the co-occurrence of health risk behaviors (HRBs) during adolescence remains understudied in low- and middle-income countries. This study examines the co-occurrence of HRBs and its correlates among adolescents in sub-Saharan Africa, China, and India. A multi-country cross-sectional study was conducted in 2021-2022, involving 9697 adolescents (aged 10-19 years) from eight countries, namely Burkina Faso, China, Ethiopia, India, Ghana, Nigeria, Tanzania, and Uganda. A standardized questionnaire was administered to examine five types of HRBs-physical inactivity, poor dietary habits, smoking, alcohol consumption, and risky sexual behavior. Latent class analysis was employed to identify clustering patterns among the behaviors, and logistic regression was used to identify the correlates of these patterns. Three clusters of HRBs were identified, with Cluster 1 (27.73%) characterized by the absence of any specific risky behavior, Cluster 2 (68.16%) characterized by co-occurrence of physical inactivity and poor dietary habits, and Cluster 3 (4.11%) characterized by engagement in smoking, alcohol consumption, and risky sexual behavior. Relative to Cluster 1, being in Cluster 2 was associated with being female (aOR 1.20, 95% CI 1.09-1.32), not enrolled in education (aOR 0.84, 95% CI 0.71-0.99), and not engaged in paid work (aOR 1.23, 95% CI 1.08-1.41). Compared with those Cluster 1, adolescents in Cluster 3 were less likely to be female (aOR 0.41, 95% CI 0.32-0.54), be engaged in paid work (aOR 0.54, 95% CI 0.41-0.71), more likely to be older (aOR 7.56, 95% CI 5.18-11.03), not be enrolled in educational institution (aOR 1.74, 95% CI 1.27-2.38), and more likely to live with guardians other than parents (aOR 1.56, 95% CI 1.19-2.05). The significant clustering patterns of HRBs among adolescents in sub-Saharan Africa, China, and India highlights the urgent need for convergent approaches to improve adolescent health behaviors. Early life and school-based programs aimed at promoting healthy behaviors and preventing risky and unhealthy behaviors should be prioritized to equip adolescents with the tools and skills for lifelong well-being. Fondation Botnar (Grant #INV-037672) and Harvard T.H. Chan School of Public Health, partially funded this study.

The Status of Implementation Research in Exit and Post-Exit Human Trafficking Interventions in Sub-Saharan Africa

ABSTRACT Conservative estimates place the number of individuals affected by human trafficking in the sub-Saharan African region at close to nine million. While there has been growing attention paid to innovative prevalence estimation approaches, and development of evidence-based interventions in the region, literature examining how these interventions are adapted, implemented, and delivered across multiple sectors, populations, and geo-political settings remains nascent at best. This critical gap in implementation research stymies the scale-up of effective anti-trafficking approaches. The central aim of this scoping review is to contribute to the anti-trafficking knowledge base by describing the current state of implementation research in this region based on 12 identified peer-reviewed human trafficking studies in sub-Saharan Africa. While none of the retrieved studies focuses solely on the implementation of a human trafficking intervention, the studies identified and discussed the acceptability and cost impacts of their implementation efforts. We conclude that advancing trafficking knowledge and praxis would require the synergistic and concurrent pursuit of both implementation and intervention strategies.

Epidemiology of Non-Traumatic Lower Extremities Amputations in West Africa: Nationwide Data from Togo

Non-traumatic lower limb amputation (NT-LLA) has consequences at individual and public health levels. Population based studies in sub-Saharan Africa are scarce and often related to single centre series. This study aimed to estimate the incidence of NT-LLA (minor and major) and to describe epidemiological, clinical, and prognostic aspects in Togo. This was a population based observational study conducted among all patients who underwent NT-LLA. Traumatic amputations were excluded. Sociodemographic, clinical, and work up data were collected from clinical files in any Togolese health centre from 1 January 2016 to 31 December 2021. Incidence rates were adjusted for age. Over the six year period, 352 patients (59% males) underwent NT-LLA (mean ± standard deviation age 60 ± 15.7 years). The average age adjusted incidence rate of NT-LLA was 8.5 per million/year (95% confidence interval [CI] 7.6 - 9.4). Men were 1.7 times more likely to undergo a NT-LLA than women. The relative risk of NT-LLA was 48 times higher in patients with diabetes than in patients without diabetes. Around 61.0% of the NT-LLAs occurred within the 50 - 74 age group and 54.3% had diabetes mellitus. Among amputees, 54.5% had a diagnosis of peripheral artery disease (PAD) and 52.8% had diabetic ulcers, with co-existence of several factors. Less than 5% of participants had a history of smoking tobacco. Average length of hospital stay was 12 days. The in hospital mortality rate was 8.8% (9.0% for major, 6.7% for minor amputations). Only 18.2% had duplex ultrasound performed and 1.7% angiography prior to amputation. No patient underwent vascular intervention prior to amputation. This is the first study to report nationwide and contemporary epidemiological data on NT-LLAs in West Africa, highlighting several specificities. Large scale interventions are needed to ameliorate the care of diabetes and PAD and improve facilities for optimal management of patients at risk of amputation in Africa.

Reported antibiotic use among patients in the multicenter ANDEMIA infectious diseases surveillance study in sub-saharan Africa

BackgroundExposure to antibiotics has been shown to be one of the drivers of antimicrobial resistance (AMR) and is critical to address when planning and implementing strategies for combatting AMR. However, data on antibiotic use in sub-Saharan Africa are still limited. Using hospital-based surveillance data from the African Network for Improved Diagnostics, Epidemiology and Management of Common Infectious Agents (ANDEMIA), we assessed self-reported antibiotic use in multiple sub-Saharan African countries.MethodsANDEMIA included 12 urban and rural health facilities in Côte d’Ivoire, Burkina Faso, Democratic Republic of the Congo, and Republic of South Africa. Patients with acute respiratory infection (RTI), acute gastrointestinal infection (GI) and acute febrile disease of unknown cause (AFDUC) were routinely enrolled, and clinical, demographic, socio-economic and behavioral data were collected using standardized questionnaires. An analysis of ANDEMIA data from February 2018 to May 2022 was conducted. Reported antibiotic use in the ten days prior to study enrolment were described by substance and by the WHO AWaRe classification (“Access”, “Watch”, “Reserve”, and “Not recommended” antibiotics). Frequency of antibiotic use was stratified by location, disease syndrome and individual patient factors.ResultsAmong 19,700 ANDEMIA patients, 7,258 (36.8%) reported antibiotic use. A total of 9,695 antibiotics were reported, including 54.7% (n = 5,299) from the WHO Access antibiotic group and 44.7% (n = 4,330) from the WHO Watch antibiotic group. The Watch antibiotic ceftriaxone was the most commonly reported antibiotic (n = 3,071, 31.7%). Watch antibiotic use ranged from 17.4% (56/322) among RTI patients in Côte d’Ivoire urban facilities to 73.7% (630/855) among AFDUC patients in Burkina Faso urban facilities. Reported antibiotic use included WHO Not recommended antibiotics but no Reserve antibiotics.ConclusionsReported antibiotic use data from this multicenter study in sub-Saharan Africa revealed a high proportion of WHO Watch antibiotics. Differences in Watch antibiotic use were found by disease syndrome, country and health facility location, which calls for a more differentiated approach to antibiotic use interventions including further evaluation of accessibility and affordability of patient treatment.

Mehlich 3 as an indicator of grain nutrient concentration for five cereals in sub-Saharan Africa

Context or ProblemSoil testing for available nutrients is an important tool to determine fertilizer rates, however many standard methods test the availability of a single nutrient only. In contrast, Mehlich 3 (M3) is a multi-element test for predicting crop yield responses to the addition of macro and micronutrients. However, the M3 test has rarely been validated against crop nutrient concentrations, which limits its application for dietary improvement studies in sub-Saharan Africa. Objective or Research QuestionThe primary objective was to test how well the M3 nutrient concentrations corresponds to grain nutrient concentrations as an indicator of plant nutrient status and grain quality. A secondary objective was to compare the performance of the M3 test with other extraction tests. MethodsThis study used 1096 paired soil and crop samples of five cereals: maize, rice, sorghum, teff and wheat, covering a broad range of soil types and soil properties in Ethiopia and Malawi (e.g., pH 4.5 - 8.8; Olsen P < 1 - 280 ppm). The samples were selected from a larger collection based on “high” or “low” grain nutrient concentrations in the crop, and the respective soil available nutrients were measured with M3 and other extraction tests: CaCl2 (P, K, Mg, Mn), Ca(NO3)2 (K and Mg), Olsen P, sequential extraction (S), and DTPA (Mn, Fe and Zn). ResultsThe M3 concentrations followed the trend of the “high” and “low” grain concentrations in nearly all nutrients and crops, and this was statistically significant in teff and wheat for all nutrients. The results were best for macronutrients, and slightly less good for micronutrients, probably because the concentration of micronutrients in the selected soil samples was generally quite low. Compared to the other multi-element extractant (CaCl2), the M3 test corresponded better to grain concentrations of K and Mg, and equally well to Olsen P, sequential extraction (S), and DTPA predictions of P, S, Zn and Fe, respectively. M3 extracted much greater concentrations than the other tests, and this was more pronounced in alkaline soils. ConclusionsGiven that the M3 test corresponded well to grain nutrient concentrations across a range of soils and crops in sub-Saharan Africa (SSA), we conclude that it can be considered a universal test for plant nutrients. We also proposed thresholds for M3 values, defining below optimum, optimum and above optimum soil fertility status. Implications or SignificanceThese results validate the use of the M3 test to assess soil fertility and develop fertilizer recommendations for improved produce quality to enhance diets in SSA.

The future of PrEP: novel long-acting HIV prevention agents for adolescent women.

Adolescent girls and young women in Africa are at high risk of HIV and should be considered a key population for HIV prevention initiatives. Oral Tenofovir/Emtricitabine as pre-exposure prophylaxis (PrEP) has been shown to be effective on an individual and population level among key populations in Europe, Australia, and the US. However, studies in sub-Saharan Africa in a generalised epidemic have been less promising with adherence to daily tablets identified as a major problem. Long-acting PrEP drugs are being developed as a response to this problem. The first of these long-acting agents, injectable Cabotegravir given every two months has shown superiority to oral PreP and has been approved by the US Food and Drug Administration (FDA). Another long-acting PrEP drug in development is Lenacapavir which is an investigational, first-in-class long-acting HIV-1 capsid inhibitor that can be given as a six-monthly injection. These long-acting drugs could be a highly effective public health HIV prevention intervention. If made readily available to a vulnerable population of adolescent young women who are at high risk of HIV they could play an important role in protecting this key population against HIV and potentially reduce the population level risk of HIV.

A decade of maize yield gap studies in sub-Saharan Africa: how are farm-level factors considered?

ABSTRACT The study of yield gaps has become more complex, prompting the use of varied approaches to measure yields and a wider range of factors to explain these gaps. In the Global North, the focus is on precision farming, whereas in sub-Saharan Africa (SSA), a broader perspective is necessary due to pronounced variability in farmland conditions. While biogeophysical and management factors have been traditional focal points in yield gap analyses, socio-economic and institutional factors are increasingly recognized as significant, especially in SSA. This review synthesizes research from the past decade in SSA that integrates biogeophysical, management, farm characteristics, and institutional factors in yield gap discussions. The findings indicate a slow shift in including socio-economic factors, with management, particularly nutrient supply and crop management, remaining predominant. However, there is a growing trend towards methodological diversity, such as the adoption of remote sensing and GIS in recent years. Case studies from Kenya and Ghana, utilizing field surveys, interviews, panel data, and spatial analysis, highlight how a multifaceted approach can enhance our understanding of the various elements influencing maize yield gaps in SSA.

The State of Gerontological and Geriatric Studies in Sub-saharan Africa and Ghanaian Studies: Literature Review

The field of gerontological and geriatric studies in Sub-Saharan Africa, particularly in Ghana, has gained significant attention in recent years. This literature review aimed to provide an overview on the state of research in this area. Several key themes emerge from the reviewed literature. Firstly, there is a growing recognition of the unique challenges faced by older adults in Sub-Saharan Africa, including poverty, limited access to healthcare, and social isolation. Researchers have highlighted the need for targeted interventions and policies to address these issues. Secondly, there is a dearth of empirical studies focusing specifically on gerontological and geriatric studies in Ghana. Most existing research tends to be qualitative or anecdotal in nature, highlighting the need for more rigorous scientific investigations. Lastly, there is a call for interdisciplinary collaboration and knowledge exchange between researchers from different disciplines such as sociology, psychology, and public health. This would help build a comprehensive understanding of aging-related issues and facilitate evidence-based interventions. In conclusion, while progress has been made in gerontological and geriatric studies in Sub-Saharan Africa and Ghana specifically, further research is needed to address the unique challenges faced by older adults in this region. Interdisciplinary collaboration can play a crucial role in advancing knowledge and improving the well-being of older adults.

Influence of Gender Norms on Education Participation among Secondary School Girls in Homa Bay County

Several studies in sub-Saharan Africa have looked at the impact of gender norms on the education of girls. Nevertheless, on a national level, limited studies have attempted to directly investigate the girls’ views and their experiences of these norms. Therefore, this study is intended to investigate the influence of gender norms on the education participation of secondary school girls in Homa Bay County (HBC). The study adopted a concurrent transformative research design, majorly quantitative with an embedded qualitative bit. The population of interest comprised all secondary school girls in HBC. Purposive sampling was applied to limit the sample population to the three sub-counties of Rachwonyo South, Rachwonyo East, and Ndhiwa. Solvin’s formula was used to arrive at a sample size of 393. Respondents were selected using a proportionate stratified sampling method. Additionally, one guidance/counselling teacher, one principal, and one area education director from the participating schools were purposefully included in the study to provide complementary qualitative data. Data from female students was collected by means of questionnaires. Interview schedules were used to collect data from the other participants. The validity of the test was established through expert input and the adaptation of tests used in similar studies. Instrument reliability was confirmed by a test-retest test that returned a correlation coefficient of 0.766. The quantitative data was coded and analysed using SPSS version 24.0. Linear regression was run between education participation and gender norms, and the outcome was an equation model. Qualitative data provided evaluative references in the discussion. The relationship between the independent variables and the dependent variable was found to be statistically significant (t = 1.295, p &lt;.001). The study found that the gender norms of most secondary school girls in Homa Bay County are disposed to unquestioning submissiveness to men and over-involvement in domestic chores. The study recommends that school authorities use parental gatherings to create awareness that focuses girls’ attention on career development. Interventions to improve girls’ education participation will benefit from these findings. Similar studies are needed to establish the plausibility of generalizing the findings beyond Homa Bay County.

Health literacy in low- and middle-income countries

Health literacy (HL) is defined as a person’s ability to access, understand, appraise, and apply health information in order to make sound health decisions. It has emerged as a key determinant of health outcomes, more particularly in noncommunicable diseases (NCDs). Low HL has been associated with lower use of health-care services and poorer health outcomes, including increased morbidity and mortality. During the second meeting of the EMAC-AOC Group (Epidemiology of Chronic Diseases – Central and Western Africa), HL and NCDs in low- and middle-income countries (LMICs) were discussed to explore options for interventional studies in sub-Saharan Africa on NCDs’ prevention and control. We reviewed how HL is defined, how it is associated with health outcomes and health inequities, and what instruments are available to assess it. Several published studies, systematic reviews, especially in LMICs, as well as national and international recommendations were discussed to explore potential approaches to improve HL in a study evaluating interventions for the prevention and control of NCDs in Africa.