Studies In sub-Saharan Africa Research Articles

Identification of Suicidal Ideation and Support for Families in Sub-Saharan Africa

Over 77% of global suicides related to life stress in 2019 occurred in low-income and middle-income countries. However, few studies in sub-Saharan Africa have focused on mental health and suicidal behaviors. Less than 10% of African countries have reported suicide rates (WHO, 2021). This article intends to raise awareness of the current global problem of suicide, especially in Africa, and its impact on families in Africa. This includes the pervasive nature of suicidal behavior and how it has been addressed in various parts of Africa. This research established that multiple studies from outside Africa, including high-income countries, address suicide symptoms and treatment. However, discussing this topic within an African cultural context is necessary. Psychoeducation and innovations such as telepsychiatry increase public awareness and access to services, and are essential aspects of addressing the problem of suicide in Africa. Family support, suicide prevention strategies, and psychotherapeutic interventions may also provide critical assistance before and during crises. This research highlights a traditionally taboo subject in sub-Saharan Africa, attempts to destigmatize it, and includes care, recommendations, and family coping skills.

Value of volunteering in pursuit of improved employability in the sport for development sector: A case study in Sub-Saharan Africa

Volunteers are integral to the delivery of sport at a community level and the main implementers of many sport for development (SfD) programmes. However, research into this phenomenon in the global south is lacking. This exploratory study investigated the value of volunteering in pursuit of improved employability in the SfD sector through a case study analysis. Participants were traced from 67 ex-volunteers who had volunteered at an SfD organisation delivering programmes in impoverished communities in South Africa, Namibia and Zambia between 2012 and 2020. Thirty-eight were recruited for the study – 23 from South Africa, 10 from Namibia and 5 from Zambia, and they completed a questionnaire as part of sequential multi-method approach. Twelve ex-volunteers, three in-country managers and two managers from the organisation’s head office were interviewed. The volunteering experience was found to have contributed to a 65% employment rate and a high level of perceived employability, and met expectations of personal development, networking, active citizenship and social validation. It is against the reality of youth unemployment and the quest for survival that the role of volunteering found special meaning as a pathway to socio-economic empowerment and delivered on the aspirations and outcomes of volunteering in an SfD organisation.

A review of research on learning support in mathematics education in Sub-Saharan Africa: The case of Botswana, Namibia, Zambia and Zimbabwe.

All learners have different educational needs, and learners taking mathematics are no exception. This review paper focuses on the recent studies in Sub-Saharan Africa in four countries: Namibia, Botswana, Zimbabwe, and Zambia in mathematics education. These countries perform poorly in mathematics according to all SACMEQ (Southern and Eastern Africa Consortium for Monitoring Educational Quality) reports, though there has been an incremental improvement. The methodology of the study incorporated research studies on mathematics learning disabilities and difficulties, however, only limited research was found in Namibia and none in the other countries using this terminology. In all four countries, the inclusive education policies do not specifically mention MLD. As a result, this study was expanded to include learners’ performance in mathematics in general. The articles sought were research-based articles and were mainly empirical for the period 2010 to 2021. Most research focuses on problems related to poor performance of learners, teachers' and learners’ perceptions and attitudes, and teacher training in mathematics education. These issues are compared and contrasted in different countries. The limited research found on MLD focuses on beliefs, misconceptions, barriers in teaching and learning mathematics, and learning support. We recommend that in these four countries, more research is needed on learners with MLD within the general mathematics population. The focus area should include early identification of learners with MLD, support based on the diagnosed learning needs, and teacher training on MLD, appropriate teaching and learning strategies.

A census from heaven: Unraveling the potential of deep learning and Earth Observation for intra-urban population mapping in data scarce environments

Urban population distribution maps are vital elements for monitoring the Sustainable Development Goals, appropriately allocating resources such as vaccination campaigns, and facilitating evidence-based decision making. Typically, population distribution maps are derived from census data from the region of interest. Nevertheless, in several low- and middle-income countries, census information may be unreliable, outdated or unsuitable for spatial analysis at the intra-urban level, which poses severe limitations in the development of urban population maps of adequate quality. To address these shortcomings, we deploy a novel framework utilizing multisource Earth Observation (EO) information such as Sentinel-2 and very-high-resolution Pleiades imagery, openly available building footprint datasets, and deep learning (DL) architectures, providing end-to-end solutions to the production of high quality intra-urban population distribution maps in data scarce contexts. Using several case studies in Sub-Saharan Africa, namely Dakar (Senegal), Nairobi (Kenya) and Dar es Salaam (Tanzania), our results emphasize that the combination of DL and EO data is very potent and can successfully capture relationships between the retrieved image features and population counts at fine spatial resolutions (100 meter). Moreover, for the first time, we used state-of-the-art domain adaptation methods to predict population distributions in Dar es Salaam and Nairobi (R 2 = 0.39, 0.60) that did not require national census or survey data from Kenya or Tanzania, but only a sample of training locations from Dakar. The DL architecture is based on a modified ResNet-18 model with dual-streams to analyze multi-modal data. Our findings have strong implications for the development of a new generation of urban population products that are an output of end-to-end solutions, can be updated frequently and rely completely on open data. • An EO-DL framework to model intra-urban population in the face of data scarcity. • Building footprints is a key variable to ensure transferability in areas with no local data. • A consistency-based domain adaptation enhances the transferability outcome. • Sentinel-2 imagery has good potential to retrieve fine-scale population patterns.

Assessing soil erosion risk in a peri-urban catchment of the Lake Victoria basin.

Soil erosion and sedimentation contribute to deteriorating water quality, adverse alterations in basin hydrology and overall ecosystem biogeochemistry. Thus, understanding soil erosion patterns in catchments is critical for conservation planning. This study was conducted in a peri-urban Inner Murchison Bay (IMB) catchment on the northern shores of Lake Victoria since most soil erosion studies in Sub-Saharan Africa have been focused on rural landscapes. The study sought to identify sediment sources by mapping erosion hotspots using the revised universal soil loss equation (RUSLE) model in appendage with field walks. RUSLE model was built in ArcGIS 10.5 software with factors including: rainfall erosivity, soil erodibility, slope length and steepness, land cover and support practices. The model was run, producing an erosion risk map and field assessments conducted to ground-truth findings and identify other hotspots. The percentage areas for RUSLE modelled erosion rates were: 66.8% for 0-2 tha-1year-1; 10.8% for 2-5 tha-1year-1; 10.1% for 5-10 tha-1year-1; 9% for 10-50 tha-1year-1 and 3.3% for 50-100 tha-1year-1. Average erosion risk was 7 tha-1year-1 and the total watershed erosion risk was 197,400 tyear-1, with croplands and steep areas (slope factor > 20) as the major hotspots (> 5 tha-1year-1). Field walks revealed exposed soils, marrum (gravel) roads and unlined drainage channels as other sediment sources. This study provided the first assessment of erosion risk in this peri-urban catchment, to serve as a basis for identifying mitigation priorities. It is recommended that tailored soil and water conservation measures be integrated into physical planning, focusing on identified non-conventional hotspots to ameliorate sediment pollution in Lake Victoria.

The social and sexual lives of Black sexual minority men 30 years of age and older in South Africa

BackgroundBlack sexual minority men (SMM) ages 30 and older are under-represented in HIV studies in sub-Saharan Africa, despite being at increased risk of HIV infection and contributing to potential onward HIV transmission. To better understand the social and sexual lives of older Black South African SMM, we conducted in-depth interviews with SMM who were > 30 years old.MethodsFrom March–September 2016, we recruited a convenience sample of 37 SMM ages 30 and older by partnering with an LGBTQ+ organization in Tshwane, Pretoria. Men were interviewed about various aspects of their lives, including their sexual orientation, social connectedness, experiences with stigma and perspectives on participating in research.ResultsParticipants described their experiences with their sexual identities, cultural and social implications of disclosure, and their perspective on South Africa’s political perspectives on the LGBTQ+ community. Men described how these experiences influence their trust in research and comfort participating in studies.ConclusionsInferences drawn from these findings provide direction on how to improve middle-aged SMM’s representation in research, such as recruiting a higher proportion of older and middle-aged SMM to serve as seed participants and building stronger community partnerships to disseminate study findings to settings where data collection is conducted.

Improving quality of surgical and anaesthesia care in sub-Saharan Africa: a systematic review of hospital-based quality improvement interventions

ObjectivesTo systematically review existing literature on hospital-based quality improvement studies in sub-Saharan Africa that aim to improve surgical and anaesthesia care, capturing clinical, process and implementation outcomes in order to...

Effect of Soil Mixtures on Early Growth Performance of Grevillea robusta and Cupressus lusitanica Seedlings in the Highlands of Kenya

Seedling production nurseries have been receiving much attention because of increasing demand for seedlings. In sub-Saharan Africa studies have showed over 50% of smallholder seedlings planted were sourced in tree nurseries. This has caused a rise in need to improve quality of seedlings especially focused on production level. The focus on most studies on early growth performance of selected key species important either for commercial plantation or agroforestry has been varied on length of the study periods and measurement parameters, with the focus never being to compare the farmer practices with the industry. This study main objective is to determine the effect of growing media on early growth performance of Grevillea robusta and Cupressus lusitanica seedlings in the highlands of Kenya. These species from literature have shown abundance in terms of demand and availability in smallholder tree nurseries and received complaints on varied performance. The parameters under observation were height, branch numbers, leaf numbers and survival of the seedlings of these species over a six-month period. There were 13 treatments which included various soil mixtures as follows: Agricultural soil (A), Forest soil (FS), Farmyard Manure (FYM), and Sand (S) and their combinations. The study employed a Completely Randomized Design with total of 390 seedlings per species. The performance showed that the soil mixture with the combined mean cumulative highest survival was FS 78±3.2% and combined mean lowest cumulative survival was A+S+FYM (37±4.2%). Cupressus lusitanica performed better in survival (70±1.2%), height (171±8.1mm), branch numbers (25±1.1), and leaf numbers (119±12.1), when compared to Grevillea robusta survival (38±1.6%), height (57±4.0mm), branch numbers (2±0.2), and leaf numbers (13±1.1%) in the nursery. Different soil mixtures had performed differently for each of the parameters in the study with key observation was FS+FYM+S was the best performing for C. lusitanica height, branching, leaf numbers and survival. The study also observed FS was best performing for the survival of G. robusta in the nursery. This study demonstrates that seedlings in the nursery for these two species require different soil mixtures to ensure survival and high growth performance.

Maasai women hearing voices: Implications for global mental health.

There is a sparse literature on women who hear voices globally, even though there are documented gendered dimensions of distress in the context of globalization and climate change and research indicates that trauma and psychosocial stress may be related to an increased prevalence of voice-hearing or auditory verbal hallucinations (AVHs). There is also a gap in the cultural phenomenology of voice-hearing in general, as well as idioms of distress for non-western peoples. This article presents results of a mixed methods study that: 1) estimated community prevalence of voice-hearing among Maasai women in northern Tanzania; 2) examined any demographic correlates and two specific hypothesized correlates (i.e., psychological stress and potentially traumatic events); and 3) engaged women in semi-structured interviews about their everyday lives and the phenomenological experience of voice-hearing. The prevalence of voice-hearing (39.4%) in this nonclinical sample (n = 71) was quite high compared to other studies in sub-Saharan Africa. Most women also reported high psychosocial stress and traumatic life events. They also talked about gendered conditions of social adversity in a context of rapid social, economic, and climate change. Women who reported hearing voices had a statistically significantly higher level of psychological distress, met criteria for severe psychological distress, and reported more potentially traumatic life events. In a logistic regression model, psychosocial stress predicted voice-hearing. The presence of distressing voices may offer a straightforward way to quickly identify people in the community experiencing the most extreme levels of psychosocial stress and traumatic events-a potentially simple but effective screening tool for health workers on the ground.

Aetiology and prognosis of community-acquired pneumonia at the Adult University Teaching Hospital in Zambia.

BackgroundCommunity-acquired pneumonia (CAP) is a frequent cause of death worldwide, and in sub-Saharan Africa particularly. Human immunodeficiency virus infection (HIV) and tuberculosis (TB) influence pathogen distribution in patients with CAP. Previous studies in sub-Saharan Africa have shown different frequencies of respiratory pathogens and antibiotic susceptibility compared to studies outside Africa. This study aimed to investigate the aetiology, presentation, and treatment outcomes of community-acquired pneumonia in adults at the University Teaching Hospital in Lusaka, Zambia.Materials and methodsThree-hundred-and-twenty-seven patients were enrolled at the University Teaching Hospital in Lusaka between March 2018 and December 2018. Clinical characteristics and laboratory data were collected. Sputum samples were tested by microscopy, other TB diagnostics, and bacterial cultures.ResultsThe commonest presenting complaint was cough (96%), followed by chest pain (60.6%), fever (59.3%), and breathlessness (58.4%). The most common finding on auscultation of the lungs was chest crackles (51.7%). Seventy percent of the study participants had complaints lasting at least a week before enrolment. The prevalence of HIV was 71%. Sputum samples were tested for 286 patients. The diagnostic yield was 59%. The most common isolate was Mycobacterium tuberculosis (20%), followed by Candida species (18%), Klebsiella pneumoniae (12%), and Pseudomonas aeruginosa (7%). Streptococcus pneumoniae was isolated in only four patients. There were no statistically significant differences between the rates of specific pathogens identified in HIV-infected patients compared with the HIV-uninfected. Thirty-day mortality was 30%. Patients with TB had higher 30-day mortality than patients without TB (p = 0.047).ConclusionMycobacterium tuberculosis was the most common cause of CAP isolated in adults at the University Teaching Hospital in Lusaka, Zambia. Gram-negative organisms were frequently isolated. A high mortality rate was observed, as 30% of the followed-up study population had died after 30 days.

Comparison of the prevalence of kidney disease by proteinuria and decreased estimated glomerular filtration rate determined using three creatinine-based equations among patients admitted on medical wards of Masaka Regional Referral Hospital in Uganda: a prospective study

BackgroundDespite estimated glomerular filtration rate (eGFR) being the best marker for kidney function, there are no studies in sub-Saharan Africa comparing the performance of various equations used to determine eGFR. We compared prevalence of kidney disease determined by proteinuria of ≥ + 1 and or kidney disease improving global outcomes (KDIGO) eGFR criteria of < 60 ml/minute/1.73m2 determined using three creatinine-based equations among patients admitted on medical ward of Masaka Regional Referral Hospital.MethodsThis was a prospective study conducted among adult patients admitted on medical wards between September 2020 to March 2021. Spot urine samples were collected to assess for proteinuria and blood samples were collected to assess serum creatinine levels. Kidney disease was defined as proteinuria of ≥ 1 + on spot urine dipstick and or KDIGO eGFR criteria of < 60 ml/minute/1.73m2. Estimated glomerular filtration rate was calculated using three creatinine-based equations: a) Full Age Spectrum equation (FAS), b) chronic kidney disease-Epidemiology collaboration (CKD-EPI) 2021 equation, c) CKD EPI 2009 (without and with race factor) equation. CKD was determined after followed up at 90 days post enrollment to determine the chronicity of proteinuria of ≥ + 1 and or KDIGO eGFR criteria of < 60mls /minute/1.73m2. We also compared prevalence of CKD determined by KDIGO eGFR criteria of < 60mls /minute/1.73m2 vs age adapted eGFR threshold criteria for defining CKD.ResultsAmong the 357 patients enrolled in the study, KDIGO eGFR criteria of < 60mls / minute determined using FAS and CKD-EPI 2009 without race factor equations and or proteinuria of ≥ + 1 showed the highest overall prevalence of kidney disease at 27.2%.Prevalence of confirmed CKD at 90 days was highest with proteinuria ≥ + 1 and or KDIGO eGFR criteria of < 60mls/min determined using CKD EPI 2009 without race factor Equation (15.1%).ConclusionsUse of KDIGO eGFR criteria of < 60mls / minute /1.73m2 using FAS and CKD-EPI 2009 without race equations identifies the largest number of patients with CKD. Health care systems in sub-Saharan Africa should calculate eGFR using FAS equations or CKD-EPI 2009 without race equations during basic screening and management protocols.

Real-world use and outcomes of dolutegravir-containing antiretroviral therapy in HIV and tuberculosis co-infection: a site survey and cohort study in sub-Saharan Africa.

IntroductionDolutegravir is being scaled up globally as part of antiretroviral therapy (ART), but for people with HIV and tuberculosis co‐infection, its use is complicated by a drug–drug interaction with rifampicin requiring an additional daily dose of dolutegravir. This represents a disadvantage over efavirenz, which does not have a major drug–drug interaction with rifampicin. We sought to describe HIV clinic practices for prescribing concomitant dolutegravir and rifampicin, and characterize virologic outcomes among patients with tuberculosis co‐infection receiving dolutegravir or efavirenz.MethodsWithin the four sub‐Saharan Africa regions of the International epidemiology Databases to Evaluate AIDS consortium, we conducted a site survey (2021) and a cohort study (2015–2021). The cohort study used routine clinical data and included patients newly initiating or already receiving dolutegravir or efavirenz at the time of tuberculosis diagnosis. Patients were followed from tuberculosis diagnosis until viral suppression (<1000 copies/ml), a competing event (switching ART regimen; loss to program/death) or administrative censoring at 12 months.ResultsIn the survey, 86 of 90 (96%) HIV clinics in 18 countries reported prescribing dolutegravir to patients who were receiving rifampicin as part of tuberculosis treatment, with 77 (90%) reporting that they use twice‐daily dosing of dolutegravir, of which 74 (96%) reported having 50 mg tablets available to accommodate twice‐daily dosing. The cohort study included 3563 patients in 11 countries, with 67% newly or recently initiating ART. Among patients receiving dolutegravir (n = 465), the cumulative incidence of viral suppression was 58.9% (95% confidence interval [CI]: 54.3–63.3%), switching ART regimen was 4.1% (95% CI: 2.6–6.2%) and loss to program/death was 23.4% (95% CI: 19.7–27.4%). Patients receiving dolutegravir had improved viral suppression compared with patients receiving efavirenz who had a tuberculosis diagnosis before site dolutegravir availability (adjusted subdistribution hazard ratio [aSHR]: 1.47, 95% CI: 1.28–1.68) and after site dolutegravir availability (aSHR 1.28, 95% CI: 1.08–1.51).ConclusionsAt a programmatic level, dolutegravir was being widely prescribed in sub‐Saharan Africa for people with HIV and tuberculosis co‐infection with a dose adjustment for the drug–drug interaction with rifampicin. Despite this more complex regimen, our cohort study revealed that dolutegravir did not negatively impact viral suppression.

PURPOSe study: understanding the burden of stillbirths in south Asia

PURPOSe study: understanding the burden of stillbirths in south Asia

Methodology and reporting quality of 544 studies related to ageing: a continued discussion in setting priorities for ageing research in Africa

Background The quality assessment provides information on the overall strength of evidence and methodological quality of a research design, highlighting the level of confidence the reader should place on the findings for decision making. This paper aimed to assess the quality (methodology and quality of reporting) of ageing studies in Sub-Saharan Africa (SSA). Method This paper is the second of a Four-Part Series paper of a previous systematic mapping review of peer-reviewed literature on ageing studies conducted in SSA. We updated the literature search to include additional 32 articles, a total of 544 articles included in this paper. Downs &amp; Black checklist, Case Report guidelines checklist, the 45-items Lundgren et al. checklist, and the Mixed Method Appraisal Tool were used to assess the methodological quality of quantitative, case reports, qualitative, and mixed-method studies. Quality assessment was piloted and conducted in pairs for each study type. Depending on the checklist, each study was classified as excellent, good, fair, or poor. Result Of the 544 articles, we performed the quality assessment of a total of 451 quantitative studies [Randomized control trials (RCTs) and pre-post (n=15), longitudinal (n=122), case-control (n=15) and cross-sectional (n=300); 4 case reports, 74 qualitative and 15 mixed-method studies. Only 20.4% (n=111) articles were of high quality [one RCT, 27 longitudinal, 4 case-control, 48 cross-sectional studies, 19 qualitative, and 12 mixed-method studies]. The remaining 433 were rated as moderate quality (n=292, 53.7%), fair quality (n = 96, 17.7%) and poor quality (n = 45, 8.2%). Most (80%) quantitative articles’ sample size is small, resulting in insufficient power to detect a clinically or significant important effect. Three-quarter (75%) of the qualitative studies did not report their research team characteristics and a reflexivity component of the 45-items Lundgren et al. checklist. Mixed-method studies with low quality did not report the qualitative studies properly. Conclusion We conclude that the methodological and quality reporting of published studies on ageing in SSA show variable quality, albeit primarily moderate quality, against high quality. Studies with a large sample size are recommended, and qualitative researchers should provide a section on research team members’ characteristics and reflexivity in their paper or as an appendix.

Optic neuritis: A South African hospital-based prospective study protocol

BackgroundOptic neuritis is a relatively common disease with an estimated lifetime risk of 0.6 per 1000; the estimated prevalence is 1–5 per 100 000/year. It occurs because of inflammation of the optic nerve from a variety of causes. The diagnosis of the disorder is established clinically and current literature is predominantly based on white patients from high-income countries. Optic neuritis presents differently in black patients compared to white patients. This study aims to assess the presentation and outcome of optic neuritis patients in a South African setting.MethodsThis is a prospective, hospital-based cohort study that will enrol patients with optic neuritis presenting to either the neurology department at Chris Hani Baragwanath Academic Hospital or the ophthalmology department at St John Eye Hospital, both in Johannesburg, South Africa. The specific aetiologies, clinical presentation and radiological findings will be studied, and the patient’s course over one year will be documented in three-monthly follow-up visits. A specific group of patients with Neuromyelitis Optica Spectrum Disorders (NMOSD) and Myelin Oligodendrocyte Glycoprotein Associated Disorders (MOGAD) optic neuritis will be followed up for 5 years at yearly intervals.DiscussionThis study represents one of the few cohort studies in Sub-Saharan Africa that seeks to investigate optic neuritis. Our hope is that it will lead to better insights regarding the presentation, course and outcome of this condition. We will also analyse the data with a view of developing a predictive model for good visual outcome.

Factors associated with health insurance ownership among women of reproductive age: A multicountry study in sub-Saharan Africa.

BackgroundPromoting the coverage and ownership of health insurance constitutes a key strategy to achieving universal healthcare, thereby meeting the Sustainable Development Goal (SDG 3.8) of safeguarding the vulnerable population from financial risk resulting from catastrophic health expenditures. In sub-Saharan Africa, accessing medical services is particularly challenging among women due to inadequate opportunities for socio-economic empowerment and meeting their unique healthcare needs. The present study aimed to explore the sociodemographic factors associated with health insurance ownership among women in selected countries in sub-Saharan Africa.MethodsWe extracted cross-sectional data on health insurance ownership and conceptually relevant sociodemographic variables on women aged 15–49 years from Demographic and Health Surveys on five selected countries in sub-Saharan Africa (n = 55,438), including Burkina Faso, DR Congo, Cameroon, Gabon and Kenya. Data were analyzed using descriptive and multivariate regression analysis, and the associations were reported in terms of average marginal effects.ResultsData revealed considerable cross-country variation in health insurance ownership: Gabon (57.9%), Kenya (6.1%), DR Congo (2.8%), Cameroon (1.1%), Burkina Faso (0.4%). In the multivariate regression analysis, women’s age, marital status, place of residency, educational level, household wealth status, employment, and media access were significant predictors of insurance ownership. The associations were generally similar across the five countries, with higher age, better educational level and wealth status showing a consistently positive relationship with insurance ownership.ConclusionOur findings revealed striking inequality in health insurance ownership among the studied countries, which should be given due attention to achieving universal healthcare-related goals. There also exist considerable sociodemographic disparities in health insurance ownership among women that should be addressed using context-specific programmatic interventions. Our findings revealed striking inequality in health insurance ownership among the studied countries, which should be given due attention to achieving universal healthcare-related goals. There also exist considerable sociodemographic disparities in health insurance ownership among women that should be addressed using context-specific programmatic interventions.

Semiparametric marginal regression for clustered competing risks data with missing cause of failure.

Clustered competing risks data are commonly encountered in multicenter studies. The analysis of such data is often complicated due to informative cluster size (ICS), a situation where the outcomes under study are associated with the size of the cluster. In addition, the cause of failure is frequently incompletely observed in real-world settings. To the best of our knowledge, there is no methodology for population-averaged analysis with clustered competing risks data with an ICS and missing causes of failure. To address this problem, we consider the semiparametric marginal proportional cause-specific hazards model and propose a maximum partial pseudolikelihood estimator under a missing at random assumption. To make the latter assumption more plausible in practice, we allow for auxiliary variables that may be related to the probability of missingness. The proposed method does not impose assumptions regarding the within-cluster dependence and allows for ICS. The asymptotic properties of the proposed estimators for both regression coefficients and infinite-dimensional parameters, such as the marginal cumulative incidence functions, are rigorously established. Simulation studies show that the proposed method performs well and that methods that ignore the within-cluster dependence and the ICS lead to invalid inferences. The proposed method is applied to competing risks data from a large multicenter HIV study in sub-Saharan Africa where a significant portion of causes of failure is missing.

Techno-economic and environmental feasibility study with demand-side management of photovoltaic/wind/hydroelectricity/battery/diesel: A case study in Sub-Saharan Africa

This paper presents an optimal design and selection made on four energy systems or configurations with criteria Loss of Power Supply Probability, Cost of Energy, Total Emission and the Diesel Contribution Factor using a Multi-objective Particle Swarm Optimization technique; for some rural communities selected from five different countries in the Sub-Saharan Africa region. These communities include BOGO, BOGOMORO, DANTIKA, GARA-ALI and KASSOUALA. Energy conservation demand-side management strategy is also applied in this study. The results obtained reveal that considerable savings are made with the demand-side management strategy and that Configuration 1 with demand-side management is the best energy system for the communities of BOGO, GARA-ALI and KASSOUALA; Configuration 2 with demand-side management is the best energy system for the communities of DANTIKA and BOGOMORO. For the case of BOGO, the best configuration consists of 196 solar panels, 10 wind turbines, 1 micro hydro generator, 1.5 days of storage system autonomy and 1 diesel generator with Cost of Energy 0.096 $/kWh, 15080.47 kg of Total Emission and 0.0002% of Diesel Contribution Factor. In DANTIKA, the best configuration 174 solar panels, 9 wind turbines, 1 micro hydro generator, 1.3 days of storage system autonomy with Cost of Energy 0.088 $/kWh and 10524.474 kg of Total Emission. Moreover, the results of this study can provide a good framework in the development of Hybrid renewable energy systems to solve the problem of energy deficit in poor rural communities.

Composition and capacity of Institutional Review Boards, and challenges experienced by members in ethics review processes in Addis Ababa, Ethiopia: An exploratory qualitative study.

Few studies in sub-Saharan Africa evaluate Institutional Review Boards (IRBs) capacity. The study aims to explore the composition of IRBs, training, and challenges experienced in the ethics review processes by members of research institutions and universities in Addis Ababa, Ethiopia. Our findings indicate that most IRBs members were trained on research ethics and good clinical practice. However, majority perceived the trainings as basic. IRB members faced several challenges including: investigators wanting rapid review; time pressure; investigators not following checklists; limited expertise in reviewing clinical trials, studies on genetics, and traditional medicine; lack of IRB offices for administrative work; competing tasks; limited staffing and the lack of a standardized review system. There is need for advanced training on research ethics to meet the evolving research needs. In addition, investments in IRBs are needed in terms of funding, and physical and human resources in Addis Ababa and Ethiopia in general.

Men missing from the HIV care continuum in sub-Saharan Africa: a meta-analysis and meta-synthesis.

IntroductionMen are missing along the HIV care continuum. However, the estimated proportions of men in sub‐Saharan Africa meeting the UNAIDS 95‐95‐95 goals vary substantially between studies. We sought to estimate proportions of men meeting each of the 95‐95‐95 goals across studies in sub‐Saharan Africa, describe heterogeneity, and summarize qualitative evidence on factors influencing care engagement.MethodsWe systematically searched PubMed and Embase for peer‐reviewed articles published between 1 January 2014 and 16 October 2020. We included studies involving men ≥15 years old, with data from 2009 onward, reporting on at least one 95‐95‐95 goal in sub‐Saharan Africa. We estimated pooled proportions of men meeting these goals using DerSimonion‐Laird random effects models, stratifying by study population (e.g. studies focusing exclusively on men who have sex with men vs. studies that did not), facility setting (healthcare vs. community site), region (eastern/southern Africa vs. western/central Africa), outcome measurement (e.g. threshold for viral load suppression), median year of data collection (before vs. during or after 2017) and quality criteria. Data from qualitative studies exploring barriers to men's HIV care engagement were summarized using meta‐synthesis.Results and discussionWe screened 14,896 studies and included 129 studies in the meta‐analysis, compiling data over the data collection period. Forty‐seven studies reported data on knowledge of serostatus, 43 studies reported on antiretroviral therapy use and 74 studies reported on viral suppression. Approximately half of men with HIV reported not knowing their status (0.49 [95% CI, 0.41–0.58; range, 0.09–0.97]) or not being on treatment (0.58 [95% CI, 0.51–0.65; range, 0.07–0.97]), while over three‐quarters of men achieved viral suppression on treatment (0.79 [95% CI, 0.77–0.81; range, 0.39–0.97]. Heterogeneity was high, with variation in estimates across study populations, settings and outcomes. The meta‐synthesis of 40 studies identified three primary domains in which men described risks associated with engagement in HIV care: perceived social norms, health system challenges and poverty.ConclusionsPsychosocial and systems‐level interventions that change men's perceptions of social norms, improve trust in and accessibility of the health system, and address costs of accessing care are needed to better engage men, especially in HIV testing and treatment.