Studies In sub-Saharan Africa Research Articles

Unintended consequences of climate change adaptation: African case studies and typologies on pitfalls and windfalls

ABSTRACT Climate change adaptation concerns mechanisms for responding to local climate change impacts to improve livelihoods of and decrease risks to affected stakeholders. In this article, we present evidence and novel insights from selected climate change adaption cases studies in Sub-Saharan Africa, shared directly by climate change practitioners. Our aim is to foster awareness and comprehension for local, national and transnational actors, enabling better decision-making, project implementation and policy design. To achieve this we describe and assess positive spillovers and negative externalities of climate change adaptation. Building on our collection of case studies, we focussed on classifying adaptation projects according to a set of typologies identified by the researchers. To further explain the typology classification related to the occurrence of (un)intended (side) effects, we identified factors that may enable sustainable adaptation scenarios based on lessons shared about the investigated projects. These systems are based on existing political economic research on the state-of-the-art ‘4E’– method (representing enclosure, exclusion, encroachment, entrenchment) evident in the literature and case study applications, which we adapted to fit our research questions. The factors include collaboration across scales, data availability and learning, bottom-up involvement/participation. We also formulated the positive counterpart of each of the four E dimensions. One finding was that the category lose-win, where the intended goal was not achieved, yet a positive spillover occurred, would be more likely to emerge with the factors ‘bottom-up participation’ as well as ‘learning across scales’ being present.

Cervical precancer and cancer incidence among insured women with and without HIV in South Africa.

HIV infection increases the risk of developing cervical cancer; however, longitudinal studies in sub-Saharan Africa comparing cervical cancer rates between women living with HIV (WLWH) and women without HIV are scarce. To address this gap, we compared cervical precancer and cancer incidence rates between WLWH and women without HIV in South Africa using reimbursement claims data from a medical insurance scheme from January 2011 to June 2020. We used Royston-Parmar flexible parametric survival models to estimate cervical precancer and cancer incidence rates as a continuous function of age, stratified by HIV status. Our study population consisted of 518 048 women, with exclusions based on the endpoint of interest. To analyse cervical cancer incidence, we included 517 312 women, of whom 564 developed cervical cancer. WLWH had an ~3-fold higher risk of developing cervical precancer and cancer than women without HIV (adjusted hazard ratio for cervical cancer: 2.99; 95% confidence interval [CI]: 2.40-3.73). For all endpoints of interest, the estimated incidence rates were higher in WLWH than women without HIV. Cervical cancer rates among WLWH increased at early ages and peaked at 49 years (122/100 000 person-years; 95% CI: 100-147), whereas, in women without HIV, incidence rates peaked at 56 years (40/100 000 person-years; 95% CI: 36-45). Cervical precancer rates peaked in women in their 30s. Analyses of age-specific cervical cancer rates by HIV status are essential to inform the design of targeted cervical cancer prevention policies in Southern Africa and other regions with a double burden of HIV and cervical cancer.

Preterm birth, birth weight, infant weight gain and their associations with childhood asthma and spirometry: a cross-sectional observational study in Nairobi, Kenya

BackgroundIn sub-Saharan Africa, the origins of asthma and high prevalence of abnormal lung function remain unclear. In high-income countries (HICs), associations between birth measurements and childhood asthma and lung function...

Managing household income and antiretroviral therapy adherence among people living with HIV in a low-income setting: a qualitative data from the HPTN 071 (PopART) trial in South Africa

BackgroundSouth Africa is reported to have the highest burden of HIV with an estimated 8.2 million people living with HIV (PLHIV) in 2021- despite adopting the World Health Organisation (WHO) universal HIV test and treat (UTT) recommendations in 2016. As of 2021, only an estimated 67% (5.5 million) of all PLHIV were accessing antiretroviral therapy (ART), as per recorded clinic appointments attendance. Studies in sub-Saharan Africa show that people living in low-income households experience multiple livelihood-related barriers to either accessing or adhering to HIV treatment including lack of resources to attend to facilities and food insecurity. We describe the interactions between managing household income and ART adherence for PLHIV in low-income urban and semi-urban settings in the Western Cape, South Africa.MethodsWe draw on qualitative data collected as part of the HPTN 071 (PopART) HIV prevention trial (2016 – 2018) to provide a detailed description of the interactions between household income and self-reported ART adherence (including accessing ART and the ability to consistently take ART as prescribed) for PLHIV in the Western Cape, South Africa. We included data from 21 PLHIV (10 men and 11 women aged between 18 and 70 years old) from 13 households. As part of the qualitative component, we submitted an amendment to the ethics to recruit and interview community members across age ranges. We purposefully sampled for diversity in terms of age, gender, and household composition.ResultsWe found that the management of household income interacted with people’s experiences of accessing and adhering to ART in diverse ways. Participants reported that ART adherence was not a linear process as it was influenced by income stability, changing household composition, and other financial considerations. Participants reported that they did not have a fixed way of managing income and that subsequently caused inconsistency in their ART adherence. Participants reported that they experienced disruptions in ART access and adherence due to competing household priorities. These included difficulties balancing between accessing care and/or going to work, as well as struggling to cover HIV care-related costs above other basic needs.ConclusionOur analysis explored links between managing household income and ART adherence practices. We showed that these are complex and change over the course of treatment duration. We argued that mitigating negative impacts of income fluctuation and managing complex trade-offs in households be included in ART adherence support programmes.

Quality of vital event data for infant mortality estimation in prospective, population-based studies: an analysis of secondary data from Asia, Africa, and Latin America

IntroductionInfant and neonatal mortality estimates are typically derived from retrospective birth histories collected through surveys in countries with unreliable civil registration and vital statistics systems. Yet such data are subject to biases, including under-reporting of deaths and age misreporting, which impact mortality estimates. Prospective population-based cohort studies are an underutilized data source for mortality estimation that may offer strengths that avoid biases.MethodsWe conducted a secondary analysis of data from the Child Health Epidemiology Reference Group, including 11 population-based pregnancy or birth cohort studies, to evaluate the appropriateness of vital event data for mortality estimation. Analyses were descriptive, summarizing study designs, populations, protocols, and internal checks to assess their impact on data quality. We calculated infant and neonatal morality rates and compared patterns with Demographic and Health Survey (DHS) data.ResultsStudies yielded 71,760 pregnant women and 85,095 live births. Specific field protocols, especially pregnancy enrollment, limited exclusion criteria, and frequent follow-up visits after delivery, led to higher birth outcome ascertainment and fewer missing deaths. Most studies had low follow-up loss in pregnancy and the first month with little evidence of date heaping. Among studies in Asia and Latin America, neonatal mortality rates (NMR) were similar to DHS, while several studies in Sub-Saharan Africa had lower NMRs than DHS. Infant mortality varied by study and region between sources.ConclusionsProspective, population-based cohort studies following rigorous protocols can yield high-quality vital event data to improve characterization of detailed mortality patterns of infants in low- and middle-income countries, especially in the early neonatal period where mortality risk is highest and changes rapidly.

Prescription patterns and compliance with World Health Organization recommendations for the management of uncomplicated and severe malaria: A prospective, real-world study in sub-Saharan Africa

BackgroundThis study aimed to evaluate the gap between guidelines and local clinical practice for diagnosis and treatment of uncomplicated and severe malaria, the patient characteristics, diagnostic approach, treatment, and compliance to standard guideline recommendations.MethodsThis was a multicentre, observational study conducted between October 2020 and March 2021 in which patients of all ages with symptoms suggestive of malaria and who visited a healthcare facility were prospectively enrolled in six countries in sub-Saharan Africa (The Democratic Republic of the Congo, Mozambique, Nigeria, Rwanda, The United Republic of Tanzania, and Zambia).ResultsOf 1001 enrolled patients, 735 (73.4%) patients had confirmed malaria (based on overall judgment by investigator) at baseline (uncomplicated malaria: 598 [81.4%] and severe malaria: 137 [18.6%]). Of the confirmed malaria patients, 533 (72.5%) were administered a malaria rapid diagnostic test. The median age of patients was 11 years (range: 2 weeks–91 years) with more patients coming from rural (44.9%) than urban (30.6%) or suburban areas (24.5%). At the community level, 57.8% of patients sought advice or received treatment for malaria and 56.9% of patients took one or more drugs for their illness before coming to the study site. In terms of early access to care, 44.1% of patients came to the study site for initial visit ≥ 48 h after symptom onset. In patients with uncomplicated malaria, the most prescribed treatments were artemisinin-based combination therapy (ACT; n = 564 [94.3%]), primarily using artemether-lumefantrine (82.3%), in line with the World Health Organization (WHO) treatment guidelines. In addition, these patients received antipyretics (85.6%) and antibiotics (42.0%). However, in those with severe malaria, only 66 (48.2%) patients received parenteral treatment followed by oral ACT as per WHO guidelines, whereas 62 (45.3%) received parenteral treatment only. After receiving ambulatory care, 88.6% of patients with uncomplicated malaria were discharged and 83.2% of patients with severe malaria were discharged after hospitalization. One patient with uncomplicated malaria having multiple co-morbidities and three patients with severe malaria died.ConclusionsThe findings of this study suggest that the prescribed treatment in most patients with uncomplicated malaria, but not of those with severe malaria, was in alignment with the WHO recommended guidelines.

Cross-country analysis of national mental health investment case studies in sub-Saharan Africa and Central, South and South-East Asia.

Despite the increasing interest in and political commitment to mental health service development in many regions of the world, there remains a very low level of financial commitment and corresponding investment. Assessment of the projected costs and benefits of scaling up the delivery of effective mental health interventions can help to promote, inform and guide greater investment in public mental health. A series of national mental health investment case studies were carried out (in Bangladesh, Kenya, Nepal, Philippines, Uganda, Uzbekistan and Zimbabwe), using standardized guidance developed by WHO and UNDP and implemented by a multi-disciplinary team. Intervention costs and the monetized value of improved health and production were computed in national currency units and, for comparison, US dollars. Benefit-cost ratios were derived. Across seven countries, the economic burden of mental health conditions was estimated at between 0.5%-1.0% of Gross Domestic Product. Delivery of an evidence-based package of mental health interventions was estimated to cost US$ 0.40-2.40 per capita per year, depending on the country and its scale-up period. For most conditions and country contexts there was a return of >1 for each dollar or unit of local currency invested (range: 0.0-10.6 to 1) when productivity gains alone are included, and >2 (range: 0.4-30.3 to 1) when the intrinsic economic value of health is also considered. There was considerable variation in benefit-cost ratios between intervention areas, with population-based preventive measures and treatment of common mental, neurological and conditions showing the most attractive returns when all assessed benefits are taken into account. Performing a mental health investment case can provide national-level decision makers with new and contextualized information on the outlays and returns that can be expected from renewed local efforts to enhance access to quality mental health services. Economic evidence from seven low- and middle-income countries indicates that the economic burden of mental health conditions is high, the investment costs are low and the potential returns are substantial.

P34 Changing patterns of skin diseases in patients attending a tertiary private hospital in central Uganda

Abstract There is scarce epidemiological data available on the prevalence of skin disorders in Uganda, a tropical country in sub-Saharan Africa. Skin diseases are a common occurrence in sub-Saharan Africa but receive less attention because they are perceived to cause less mortality. Previous studies have reported a skin disorder prevalence of 30–70% in the general population of developing countries. The majority of studies in sub-Saharan Africa reveal skin infections as the most common dermatology disorder, with a few studies reporting a changing trend toward eczematous disorders. The aim was to investigate the spectrum of skin disorders at a tertiary private healthcare hospital in central Uganda. A cross-sectional study was conducted from September 2021 to August 2022. All patients attending the outpatient skin clinic were recruited. Initial visits were considered. The diagnosis was made clinically and, where necessary, additional investigations were carried out. Data analysis was done with SPSS version 21 (IBM) and Microsoft Excel. A total of 1097 diagnoses were made in 913 patients, of whom 72.9% were adults and 27.1% were under 18 years of age. There were 488 (53.4%) females and a mean (SD) age of 28.9 (16.2) years. The top-five diagnoses were eczematous disorders (n = 223; 20.3%), adnexal disorders (n = 195; 17.8%), infections (n = 182; 16.6%), papulosquamous disorders (n = 93; 8.5%) and pigmentary disorders (n = 59; 5.4%). The results of this research show changing patterns of skin disease presentation from infections in 2016 to eczematous disorders in 2022 as the leading cause of outpatient dermatology consultation at a tertiary private hospital in central Uganda. This calls for proper replanning and budget allocation given the changing spectrum of skin disease presentation at this facility.

Development and validation of a screening tool for SPondyloArthritis Screening in Sub-Saharan Africa: SpASSS questionnaire

ObjectiveTo develop and validate a screening tool to identify patients with a high likelihood for Spondyloarthritis (SpA) in the Democratic Republic of the Congo (DR Congo).MethodsThe development of the SpA Screening questionnaire in Sub Saharian Africa (SpASSS) questionnaire followed 3 steps: The item generation was carried out by a systematic literature review according to the PRISMA guidelines on the clinical manifestations of SpA, interviewing clinical experts and the classification criteria for Spondyloarthritis. The candidate questions were tested in a population of 50 consecutive patients with confirmed diagnosis of spondyloarthritis, in a control population of rheumatic disease excluding SpA and in a group of 200 non-rheumatic participants, randomly chosen in the general population for question reduction and validation. Descriptive statistical analyses were performed to assess socio-demographic characteristics and response distribution for each item. Their diagnostic performance was investigated using ROC curves. For validation, principal component analysis was performed using factor analysis. Referral strategy score for SpA was determined by adjusted Cronbach’s alpha coefficient.ResultsMean ± SD age of SpA cases was 41.8 ± 14.4 years, 56% were men compared to diseased controls 60.0 ± 12.5 years, 28.7% men (p < 0.001). 14/20 items showed a statistically significant difference (p < 0.05) between SpA cases and control groups. All items were factorable and 6 components were identified. Only the two first components (C1 with 8 items, C2 with 3 items) showed a significant threshold for reliability in detection of suspected SpA with a Cronbach's alpha of 0.830 and 0.708. All validated items of these two components showed the global reliability threshold with α-adjusted Cronbach calculated at 66.9%. The performance for correctly screening SpA was demonstrated with an area under the curve of 0.938 (0.884–0.991) and 0.794 (0.728–0.861) for C1 and C2 respectively.ConclusionsThis validation and item reduction of the SpASSS questionnaire for SpA might identify patients to refer for case ascertainment and will help conducting future epidemiological and clinical studies in the DR Congo.Strengths and limitations of this study• To the best of our knowledge, this is the first study in Sub-Saharan Africa based on local data to develop a screening tool for SpA in the population for epidemiological and clinical use.• Referral strategies based on context-specific data are necessary to provide accurate case definition and epidemiological data, thus reducing methodological bias.• In the SpA group, no discrimination was made regarding SpA subtypes, disease duration, activity and severity.

Multivariate decisions: Modelling waste-based charcoal briquette formulation process

The current study sets out to optimize resource utilization by coupling data envelopment analysis (DEA) with the analytical hierarchy process (AHP) methodology to model sustainable binder choice without experimenting available binders. The results of the AHP showed that the cardboard pulp binder was the preferred material to use. Cardboard pulp binder, palm kernel decanter cake, and charred palm kernel shells in a ratio of 10: 20:70 was the used to manufacture composite briquettes. The values obtained for calorific value, specific fuel consumption, and average burning rate were 22.72 MJ/kg, 2.21 kg/L, and 4.87 g/min respectively for the optimal choice. The briquettes produced in this study promotes circular economy and provides a novel framework to address cooking energy poverty issues through the manufacturing of waste-based biofuels. To the best of our knowledge, this is the first study in sub-Saharan Africa to use these waste resources to create composite briquettes.

Linking household access to food and social capital typologies in Phalombe District, Malawi

Food security remains a major sustainability challenge in many parts of Sub-Saharan Africa. Food security has numerous determinants that are complex and interlinked, with one of them being social capital. Social capital reflects an individual’s, household’s, or community’s social networks, social interactions, and social support systems that can be mobilized in times of need to maintain, among others, livelihoods or food security. This study aims to further understand how typologies of social capital are associated with household food security in Southern Malawi, with a focus on access to food. We unpack social capital into three typologies, namely bonding, bridging, and linking social capital, and establish which one is most strongly associated with household access to food, and whether this varies by the gender of the household head. To achieve this, we analyze secondary data from 382 households collected through the Malawian Fourth Integrated Household Survey (IHS4), using principal axis factor analysis and logistic regression analysis. Our findings demonstrate that bonding and bridging social capital are associated with better household access to food, while linking social capital was associated with lower household access to food. Bonding social capital was most strongly associated for female-headed households and linking social capital for male-headed households, highlighting that there are differences between such households. This work confirms observations from other related studies in Sub-Saharan Africa exploring the interface of social capital and food security. It also highlights the importance of both acknowledging the gender of the household head and of unpacking social capital into its typologies when considering food security.

Health facility delivery and early initiation of breastfeeding: Cross-sectional survey of 11 sub-Saharan African countries.

Early initiation of breastfeeding (EIB) remains one of the promising interventions for preventing neonatal and child deaths. EIB is positively associated with healthcare delivery or childbirth. Meanwhile, no study in sub-Saharan Africa (SSA) appears to have investigated the relationship between health facility delivery and EIB; thus, we assessed the correlation between health facility delivery and EIB. We used data from the Demographic and Health Survey (DHS) of 64,506 women from 11 SSA countries. The outcome variable was whether the respondent had early breastfeeding or not. Two logistic regression models were used in the inferential analysis. With a 95% confidence interval (CI), the adjusted odds ratios (aORs) for each variable were calculated. The data set was stored, managed, and analyzed using Stata version 13. The overall percentage of women who initiated early breastfeeding was 59.22%. Rwanda recorded the highest percentage of early initiation of breastfeeding (86.34%), while Gambia recorded the lowest (39.44%). The adjusted model revealed a significant association between health facility delivery and EIB (aOR = 1.80, CI = 1.73-1.87). Compared with urban women, rural women had higher likelihood of initiating early breastfeeding (aOR = 1.22, CI = 1.16-1.27). Women with a primary education (aOR = 1.26, CI = 1.20-1.32), secondary education (aOR = 1.12, CI = 1.06-1.17), and higher (aOR = 1.13, CI = 1.02-1.25), all had higher odds of initiating early breastfeeding. Women with the richest wealth status had the highest odds of initiating early breastfeeding as compared to the poorest women (aOR = 1.33, CI = 1.23-1.43). Based on our findings, we strongly advocate for the integration of EIB policies and initiatives with healthcare delivery advocacy. Integration of these efforts can result in drastic reduction in infant and child mortality. Essentially, Gambia and other countries with a lower proclivity for EIB must reconsider their current breastfeeding interventions and conduct the necessary reviews and modifications that can lead to an increase in EIB.

Influence of farmers’ socio-economic characteristics on nutrient flow and implications for system sustainability in smallholdings: a review

The rise in global human population, coupled with the effects of climate change, has increased the demand for arable land. Soil fertility has been the most affected, among other things. Many approaches to soil fertility management have been proposed by studies in Sub-Saharan Africa (SSA); however, the question of sustainability remains. Nutrient monitoring (NUTMON), which combines biophysical and socio-economic features for soil fertility management, gives an in-situ soil fertility status of a given land use system, which ultimately provides guidance in proposing appropriate soil management techniques in a given land use system. In this review, the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) approach was deployed for a systematic search of the literature materials. The review evaluated various studies on nutrient monitoring in SSA soils in order to understand the socioeconomic attributes and their influence on farming systems, as well as nutrient flow and balances. The review identified two dominant smallholder farming systems in SSA: mixed crop-livestock and mixed crop farming systems. Also, this review revealed that most nutrient balance studies in SSA have been done in mixed crop and livestock farming systems. However, regardless of the farming systems, the overall mean nutrient balances in all studies, particularly those of nitrogen (N) and potassium (K), were negative, indicating significant nutrient mining. The review further revealed a vast range of biophysical soil fertility management technologies; however, their adoption has been limited by socio-economic aspects including land ownership, gender, financial position, literacy level, and access to inputs. Therefore, in view of this situation, integrating biophysical and socioeconomic disciplines could address the problem of soil nutrient depletion holistically, thus decreasing the existing negative nutrient balances in the SSA region.

Effect of Dolutegravir and multi-month dispensing on viral suppression among children with HIV.

Few studies in sub-Saharan Africa have assessed the impact of multi-month dispensing (MMD) of antiretroviral therapy (ART) and dolutegravir (DTG) beyond clinical trials among children with HIV (CWHIV). We assessed the effect of the two interventions on achieving undetectable viral load (VL) among CWHIV 0-15 years in Nigeria. We utilized longitudinal routine records, and cross-sectional survey data from caregivers of a sub-sample of children. VLs were considered suppressed at <1000 copies/ml and undetectable at <50 copies/ml. MMD was defined as ART refill for >84 days. The effect of MMD and DTG on VL levels, and associations between social factors and VL was estimated using generalized linear models, reporting adjusted relative risks (aRR)/prevalence ratios (aPR) and 95% confidence intervals (95%CI). Of 2,490 CWHIV, 52% were male, with a median age of 10 years (IQR: 6-13) and median duration on ART of 4.6 years (IQR: 2.8-7.1). Overall, 73% were on DTG and 55% received MMD. At baseline, 63% were suppressed, while 79% and 56% were suppressed and undetectable in their last VL respectively.We found no differences in undetectable VL between those on MMD and not on MMD (aRR: 1.05 [95%CI: 0.94-1.18]); and between those on DTG and not on DTG (1.07 [0.92-1.25]). In secondary analyses, poor adherence and being in a support group were associated with lower likelihood of undetectable VL (aPR: 0.85 [95%CI: 0.74-0.96], and 0.81 [0.68-0.96] respectively). MMD did not compromise treatment outcomes for CWHIV. Poor adherence however remains a barrier to achieving treatment targets.

The Role of Information and Communication Technology in Managing Supply Chains in Base-of-the-Pyramid Markets

The rapid development of information and communication technology (ICT) has created opportunities for supply chain performance improvements to address challenges in base-of-the-pyramid (BoP) contexts. The article aims to analyze how ICTs that provide information, financial access, and transaction applications serve as enablers for transaction cost (TC) reductions and supply chain management (SCM) improvements in the agricultural sector. The objectives of the article are reached by deducting explanations from a framework of existing TC and SCM theories while analyzing six exemplary case studies in Sub-Saharan Africa and South Asia. ICT enables the BoP market to improve its SCM activities. Three different ICT models can be identified: Some ICTs impact 1) information flows only, while others influence 2) financial flows or 3) material flows. TC reductions in the form of screening and selection, measurement, communication, negotiation, and coordination costs serve as explanations and theoretical foundations for these models. Future empirical research should evaluate the application of ICTs in more detail and validate the proposed framework with the help of other methods. The current study will help BoP actors, such as farmers or agricultural dealers, capture more value and reduce poverty through TC reductions and improved SCM. The findings are also applicable to other small businesses considering their industrial contexts. The main contribution of the article is that it brings together theoretical arguments from TC theory, SCM, and practical ICT developments in BoP markets. The framework provides a foundation for developing more in-depth empirical research.

Distribution of Bemisia tabaci in different agro-ecological regions in Uganda and the threat of vector-borne pandemics into new cassava growing areas

Previous studies in sub-Saharan Africa have showed the spread of cassava mosaic disease (CMD) and cassava brown streak disease (CBSD) pandemics into different cassava growing regions by high Bemisia tabaci populations. Studies did indicate that there were stark differences in some whitefly species, yet they have not looked extensively across agroecologies. Members of B. tabaci species complex termed sub-Saharan Africa 1 (SSA1) and SSA2 have been linked to the spread of CMD and CBSD viruses. During the period of a severe CMD pandemic in the 1990s, SSA2 was the most predominant until the resurgence of SSA1, particularly SSA1-subgroup1 (SSA1-SG1) from the early 2000s to date. Cassava being a drought resilient crop has become an important food security crop and has been introduced into new areas and regions. Considering the role B. tabaci in the spread of cassava virus pandemics into neighboring regions, we investigated the genetic diversity and distribution of B. tabaci in nine different agro-ecological regions of Uganda in 2017. Adult whiteflies were collected from cassava and 33 other host plants from cassava-growing areas, those with limited cassava and areas with no cassava, where it is being introduced as a food security crop. The partial sequences of the mitochondrial cytochrome oxidase 1 (mtCO1) gene (657 bp) were used to determine the phylogenetic relationships between the sampled B. tabaci. Cassava B. tabaci SSA1 (-SG1, -SG2, -Hoslundia (previously called SSA1-SG1/2), -SG3), SSA2 and SSA3; non-cassava B. tabaci SSA6, SSA10, SSA11, SSA12, SSA13, MED-ASL, MED-Q1, MEAM1, Indian Ocean; and other Bemisia species, Bemisia afer and Bemisia Uganda1 were identified in the study. SSA3, one of the key B. tabaci species that occurs on cassava in West Africa, was identified for the first time in Uganda. The SSA1-SG1 was widely distributed, predominated on cassava and was found on 17 other host-plants. The ability of SSA1-SG1 to exist in environments with limited or no cassava growing poses the risk of continued spread of virus pandemics. Therefore, measures must be put in place to prevent the introduction of diseased materials into new areas, since the vectors exist.

The phenotype of type 1 diabetes in sub-Saharan Africa.

The phenotype of type 1 diabetes in Africa, especially sub-Saharan Africa, is poorly understood. Most previously conducted studies have suggested that type 1 diabetes may have a different phenotype from the classical form of the disease described in western literature. Making an accurate diagnosis of type 1 diabetes in Africa is challenging, given the predominance of atypical diabetes forms and limited resources. The peak age of onset of type 1 diabetes in sub-Saharan Africa seems to occur after 18-20 years. Multiple studies have reported lower rates of islet autoantibodies ranging from 20 to 60% amongst people with type 1 diabetes in African populations, lower than that reported in other populations. Some studies have reported much higher levels of retained endogenous insulin secretion than in type 1 diabetes elsewhere, with lower rates of type 1 diabetes genetic susceptibility and HLA haplotypes. The HLA DR3 appears to be the most predominant HLA haplotype amongst people with type 1 diabetes in sub-Saharan Africa than the HLA DR4 haplotype. Some type 1 diabetes studies in sub-Saharan Africa have been limited by small sample sizes and diverse methods employed. Robust studies close to diabetes onset are sparse. Large prospective studies with well-standardized methodologies in people at or close to diabetes diagnosis in different population groups will be paramount to provide further insight into the phenotype of type 1 diabetes in sub-Saharan Africa.

Prevalence and associated factors with peripheral neuropathies in the general population in the rural area of Adjohoun in Benin

BackgroundPeripheral neuropathies (PN) are a group of neurological conditions related to damage to the peripheral nervous system. Due to their wide diversity, few studies in sub-Saharan Africa have explored their epidemiology in general population. Our objective was to study the prevalence and associated factors with PN in general population in Adjohoun in Benin. MethodsA cross-sectional study has been conducted from February to March 2019 and included people aged ≥ 18 years old living in Adjohoun, Benin. Following a screening phase for PN (using World Health Organization questionnaire for major neurological diseases), a neurologist made a diagnosis after in-depth clinical examinations completed in some cases by electroneuromyography. The EFNS (European Federation of Neurological Societies) 2010 criteria was used for chronic inflammatory demyelinating polyneuropathy diagnosis. Data such as age, occupation, consanguinity, alcohol consumption, diabetes, hypertension were collected. Association between independent variables and PN were investigated using multivariable logistic regression models. ResultsIn total, 1 655 participants were included, mean age 41.4 ± 16.7 years; 64.8 % are female. The overall prevalence of PN was 6.9 % (95 %CI: 5.7 %-8.2 %). The main types of PN were: polyneuropathies 4.8 % (95 %CI: 3.8 %-5.9 %); polyradiculoneuropathies 1.6 % (95 %CI: 1.0 %-2.2 %). Factors independently associated with PN were age ≥ 40 years (adjusted Odds Ratio aOR = 19.6; 95 %CI: 8.2–46.3), diabetes (aOR = 1.8; 95 %CI: 1.08–2.99) and hypertension (aOR = 1.6; 95 %CI: 1.02–2.5). ConclusionThe prevalence of PN was high in the rural commune of Adjohoun in Benin. Actions on its modifiable associated factors such as diabetes and hypertension could help reduce the proportion of PN and their potential harmful consequences.

Comprehensive Systematic Literature Review of Public Health Supply Chain Studies in Sub-Saharan Africa

The paper presents a systematic comprehensive literature review of Sub-Saharan African public health supply chain studies. It shall involve both formal academic studies and consulting studies where available in the public domain. The key focus of the literature review shall be: to create a themed catalogue of African public health supply chain studies that have been done in academia and by non – academic institutions. The specific objectives of the study shall revolve around: Conducting a systematic literature review of public health supply chain studies in sub-Saharan Africa; Conducting a systematic literature review of non- academic publications in public health supply chain studies in sub- Saharan Africa; Categorising the current publications according to supply chain functions; Determining a database of contributors to public health supply chain studies for academic and non-academic knowledge; and, proposing an approach to develop a database of research in public health supply with both academic and non-academic literature and develop a way forward. The research philosophy adopted for the study was exploratory through desk research of Public health supply chain studies conducted within the last 15 years(2007 – 2022) and themed based on the supply chain functions of the Supply Chain Operations Reference (SCOR) model. The output for the study shall entail: catalogues / documentation of Africa public health supply chain; contribution to easily searchable body of knowledge that informs public health supply chains in sub- Saharan Africa; dissemination through publications in peer reviewed academic journals ( at least 5 articles); and dissemination Through International Conferences And Symposiums.

A Two-Phase Survey of Psychiatric Morbidity among Females with Infertility in a Tertiary Hospital in North-Western Nigeria

ABSTRACT Background: The inability of couples to conceive or infertility has been identified as a major source of psychiatric morbidity. In several studies in sub-Saharan Africa, the psychological burden, often higher among females, is mostly assessed through screening measures and hardly by diagnostic instruments. This study evaluated the prevalence and clinical pattern of psychiatric morbidity among adult female patients attending Aminu Kano Teaching Hospital (AKTH) infertility clinic using the two-phase survey method. Methods: In the first phase, 281 respondents were assessed using sociodemographic, clinical, and the 12-item General Health Questionnaire (GHQ-12). The second phase was by using the World Health Organization Schedule for Clinical Assessment in Neuropsychiatry (SCAN) to interview all probable cases on the GHI-12 with a score of 3 or more, and 10% of non-cases. Psychiatric diagnosis was made in accordance with the diagnostic criteria of the 10th edition of the International Classification of Diseases (ICD-10). Results: The point prevalence of psychiatric morbidity in this study was 29.2% with a weighted prevalence rate of 64.8% projected onto the infertile population seeking medical help within the 3-month study period. Depression (21%) was the most occurring diagnosis. Generalized Anxiety Disorder and Somatisation were diagnosed in 6% and 2% respectively. There was a significant relationship between psychiatric morbidity and age, educational status, religion, and the duration of marriage (p&lt;0.05). Conclusion: About one-third of infertile women in this study had psychiatric morbidity with depression being the most prevalent diagnosis. Psychiatric morbidity was significantly associated with increasing age, high educational attainment, religion and longer duration of marriage. The study demonstrated the need to include Consultation-Liaison Mental Health Practitioners in the management of women with infertility in order to meet their unmet mental health needs.