Regions Of sub-Saharan Africa Research Articles

Unraveling the dynamics: macroeconomic drivers of equity market development in Sub-Saharan Africa

PurposeThe aim of this paper is to contribute to empirical research by identifying the key macroeconomic drivers of equity market development in Sub-Saharan Africa (SSA) and to ascertain if banking sector development complements equity market development in the SSA region.Design/methodology/approachThe study employed the dynamic panel data approach using the pool mean group (PMG). The sample covered is twenty-seven (27) SSA countries between the period 2000 to 2020.FindingsThe result suggests that banking sector development, economic growth, migrant remittance and trade openness are the key drivers of equity market development in the SSA region. The study also revealed that banking sector development complements equity market development in the SSA region.Originality/valueThe use of robust measure in measuring equity market development (i.e. ratio of portfolio equity to gross domestic product) in ascertaining the macroeconomic drivers of equity market development. Likewise, exploring whether banking sector development complements equity market development in the SSA region makes the paper more unique, especially using the ratio of bank credit to bank deposit as a measure banking sector development.Peer reviewThe peer review history for this article is available at: https://publons.com/publon/10.1108/IJSE-01-2024-0005

Characteristics of the Western Province, Zambia, trial site for evaluation of attractive targeted sugar baits for malaria vector control

BackgroundThe attractive targeted sugar bait (ATSB) is a novel malaria vector control tool designed to attract and kill mosquitoes using a sugar-based bait, laced with oral toxicant. Western Province, Zambia, was one of three countries selected for a series of phase III cluster randomized controlled trials of the Westham ATSB Sarabi version 1.2. The trial sites in Kenya, Mali, and Zambia were selected to represent a range of different ecologies and malaria transmission settings across sub-Saharan Africa. This case study describes the key characteristics of the ATSB Zambia trial site to allow for interpretation of the results relative to the Kenya and Mali sites.MethodsThis study site characterization incorporates data from the trial baseline epidemiological and mosquito sugar feeding surveys conducted in 2021, as well as relevant literature on the study area.Results: Characterization of the trial siteThe trial site in Zambia was comprised of 70 trial-designed clusters in Kaoma, Nkeyema, and Luampa districts. Population settlements in the trial site were dispersed across a large geographic area with sparsely populated villages. The overall population density in the 70 study clusters was 65.7 people per square kilometre with a total site population of 122,023 people living in a geographic area that covered 1858 square kilometres. However, the study clusters were distributed over a total area of approximately 11,728 square kilometres. The region was tropical with intense and seasonal malaria transmission. An abundance of trees and other plants in the trial site were potential sources of sugar meals for malaria vectors. Fourteen Anopheles species were endemic in the site and Anopheles funestus was the dominant vector, likely accounting for around 95% of all Plasmodium falciparum malaria infections. Despite high coverage of indoor residual spraying and insecticide-treated nets, the baseline malaria prevalence during the peak malaria transmission season was 50% among people ages six months and older.ConclusionMalaria transmission remains high in Western Province, Zambia, despite coverage with vector control tools. New strategies are needed to address the drivers of malaria transmission in this region and other malaria-endemic areas in sub-Saharan Africa.

Factors associated with pregnancy termination in six sub-Saharan African countries

Pregnancy termination continues to be a leading cause of maternal morbidity and mortality among young women in Africa. The sub-Saharan Africa region has the highest rate of abortion-related deaths in the world, at 185 maternal deaths per 100,000 abortions. The aim of this study is to investigate the factors associated with pregnancy termination among women aged 15 to 29 years in six sub-Saharan African countries. We used secondary data from the most recent Demographic and Health Survey of six sub-Saharan African countries: Kenya, Tanzania, Ethiopia, Burundi, Nigeria, and Rwanda. A total weighted sample of 74,652 women aged 15–29 were analyzed. A multivariable logistic regression model was used to identify the factors associated with pregnancy termination at a p-value < 0.05. Results were presented using adjusted odds ratios (AOR) with 95% confidence interval. The study showed that 6.3% of women aged 15–29 reported pregnancy termination with a higher prevalence rate in Tanzania (8.8%) and lowest in Ethiopia (4%). Highest odds of pregnancy termination occurred among women aged 20–24 as compared to women aged 15–19 in Rwanda (AOR: 4.04, 95%CI 2.05, 7.97) followed by Nigeria (AOR: 2.62, 95% CI 1.99, 3.43), Kenya (AOR: 2.33, 95%CI 1.48, 3.66), Burundi (AOR: 1.99 95%CI 1.48, 2.85), Tanzania (AOR: 1.71 95%CI 1.29, 2.27), and Ethiopia (AOR: 1.69, 95% CI 1.19, 2.42). Women with no education had 4 times higher odds of pregnancy termination compared to women with higher education in Tanzania (AOR: 4.03 95%CI 1.00, 16.13) while women with no education and primary level education were 1.58 times (AOR: 1.58 95% CI 1.17, 2.13) and 1.78 times (AOR: 1.78 95% CI 1.34, 2.37) as likely to terminate pregnancy in Ethiopia. In Tanzania, the likelihood of a pregnancy termination was associated with a relationship to the household head; head (AOR: 3.66, 95% CI (2.32, 5.78), wife (AOR: 3.68, 95% CI 2.60, 5.12), and in-law (AOR:2.62, 1.71, 4.03). This study revealed that a significant number of women had pregnancy termination. Being in the age group of 20–24 & 25–29, having a lower level of education, being a domestic employee and professional, being single/never-in-union, being in the poorest and richer wealth quantile category, and being head, wife, daughter, and in-law to the household head were the significantly associated with pregnancy termination. Taking these socio-economic factors into consideration by stakeholders and specific sexual education targeted to women aged 15 to 29 would help tackle the problem.

Development of portfolio management tools in crop breeding programs: a case study of cassava in sub-Saharan Africa

The response to the diverse needs along the cassava value chain, the urge to increase genetic gain, and the need for rapid varietal turnover will necessitate not only technological innovations but also transformation of public breeding programs in sub-Saharan Africa (SSA). We developed guiding, flexible and adaptative tools for portfolio management of cassava breeding. The cassava breeding and product development pipeline process was mapped to illustrate activities of each stage, as well as to clarify key decision points. Stakeholders involved at all stages of breeding were identified. This allowed for identification of gaps and new crucial functions. To clarify accountability and reduce complexity in the decision-making at key decision points, the roles were mapped against decision-rights at each stage-gate. Cassava crop calendars for the different regions in SSA were developed to facilitate better planning. A product advancement template was developed to guide product advancement. The tools that have been developed and stage-gate mapping, will support regional efforts to establish more structured, transparent, participatory, efficient, inclusive, and demand-driven cassava breeding in the region. These approaches could be customized to other commodities.

Understanding noma: WHO's recognition and the path forward in global health.

The World Health Organization's (WHO) designation of noma as a neglected tropical disease (NTD) on 15 December 2023 marks a crucial advancement in global health efforts. This move sheds light on a condition predominantly affecting undernourished children in isolated regions of sub-Saharan Africa. Recognized as the 21st NTD, noma, or cancrum oris, is a serious condition leading to orofacial gangrene. The disease largely impacts young children and those with compromised immune systems, including individuals with human immunodeficiency virus or leukaemia. Determining the exact prevalence of noma is complex, hindered by rapid disease progression, societal stigma and a lack of reporting, especially in impoverished areas. The WHO's acknowledgment is a significant step, emphasizing the need for more in-depth research and resources to address this overlooked disease. It highlights the critical role of multifaceted prevention strategies, including economic empowerment, improved nutrition and enhanced vaccination efforts. This recognition is pivotal in guiding international health initiatives towards better outcomes for some of the most at-risk populations globally.

The role of nurses and midwives in medical laboratory investigations in sub-Saharan Africa.

Across the globe, nurses and midwives play a crucial role in providing care to patients in healthcare facilities. They often contact the patient, providing direct care as directed by medical doctors or clinical officers. Traditionally, the role of nurses and midwives in the clinical diagnosis process is to coordinate the clinical diagnosis process-which includes laboratory diagnosis requests-from diagnosticians to the clinical laboratory. In these settings, these diagnosticians are general or specialist medical doctors. However, in some regions in sub-Saharan Africa (SSA), nurses and midwives are primary diagnosticians in healthcare facilities. We present a perspective on the role of nurses and midwives in medical laboratory investigations in SSA. We highlight how, on top of nursing and midwifery roles, nurses take up the role of diagnosticians in facilities where doctors are few or are absent and what key issues are worth consideration. Furthermore, we present how efficient collaboration between nursing midwifery and medical laboratory diagnostic systems facilitates effective patient management. Emphasizing training on laboratory test utilization for nurses and midwives in SSA is vital for enhancing healthcare outcomes.

Do board attributes influence environmental sustainability disclosure in manufacturing firms? Evidence from sub‐Saharan Africa

AbstractThe study builds and extends on the literature on the environment, corporate governance, and sustainability by examining how board attributes impact environmental sustainability disclosure (ESD) and, if so, whether each of the two strands of board attributes, namely, board diversity and structural attributes, influence ESD for manufacturing firms in the sub‐Saharan Africa (SSA) region. Based on insights drawn from the human capital theory and board composition, the study developed a model that connects board attributes with ESD. Using a sample of 200 manufacturing firms from 2010 to 2022, the study found an inverse link between gender diversity and ESD, whereas a positive connection was seen between foreign nationals and ESD. Regarding structural attributes, an inverse link was found between board size and ESD, while a positive connection exists between the separation of the board chair from the chief executive officer and ESD. In summary, the findings urge policymakers in the SSA region to strengthen policies on board diversity and structural attributes to promote ESD. Moreover, the findings advise the board of directors to ensure effective and transparent disclosure of environmental‐related issues to stakeholders to guarantee sustainable reporting practices.

ICSSD 2023 Preface

The 7th International Conference on Science and Sustainable Development (ICSSD 2023) was held at Covenant University Canaanland, Ota, Nigeria, from 15-17 November 2023. The theme for the conference is science as a catalyst for sustainable development in Sub-Saharan Africa. The conference has been running since 2016 with aim to provide an avenue to discuss and exchange scientific ideas that contributed to the Science and Sustainable Development in the world. This year’s conference witnessed significant physical and virtual international participants, exploring how science could accelerate sustainable development in the continents, particularly in Sub-Saharan Africa.In the light of the global challenges and inability of the Sub-Saharan Africa region to turn the good deposits of minerals and other natural resources in the region into wealth have necessitated the need to engage in thoughtful discourse, share groundbreaking research, and cultivate collaborative initiatives that bridge the gap between scientific innovation and the pressing needs of Sub-Saharan Africa. The abstracts were divided into four main conference categories which include Applied Science and Sustainable Development, Environmental/Built and Sustainable Development, Engineering/Geoscience and Sustainable Development, and Energy and Sustainable Development and the presentation of the papers were done across the days of the conference.This year’s conference had two keynote speakers and two plenary speakers that cover different areas of the conference sub-themes. Professor Jatin Rath (Department of Physics, DST Solar Energy Harnessing Centre, Indian Institute of Technology) presented on solar photovoltaic as sustainable power supply, Prof. Odukoya Abiodun Mary, (Department of Geosciences, University of Lagos) talked on advances in geosciences: imperative for environmental sustainability and health, Babatunde Abiodun Obadele (Department of Chemical, Materials and Metallurgical Engineering, Botswana International University of Science and Technology, Palapye, Botswana) presented on Biomaterials and Biocorrosion Study in Africa and Professor K. Srinivas Reddy (Heat Transfer and Thermal Power Laboratory, Department of Mechanical Engineering, Indian Institute of Technology, India) presented on solar energy technologies for sustainable development in tropical regions.The Vice-Chancellor, Professor Abiodun Humphrey Adebayo, ably represented by the Deputy Vice-Chancellor, Professor Olujide Adekeye, the Registrar, Mrs Regina Tobi Davis, the Dean, College of Science and Technology, Prof. Timothy Ashibel Anake delivered an insightful speech on the impact of Science and Technology in 21st century during the opening ceremony. The Head, Department of Physics, Covenant University, Dr. Maxwell Omeje, and the Head, Department of Estate Management, Covenant University, Dr. Olayinka Oloke gave their welcome address. The Chairman LOC Dr. Rasidi Sule also delivered the goodwill message to the attendees.We would like to appreciate the Management of Covenant University for being a strong pillar of encouragement and inspiration to the research efforts of the University and for the great support the conference has received since its inception. Our sincere appreciation to the reviewers for their contributions during the peer review process. We would like to thank the authors for contributing their papers in ICSSD 2023 conference proceedings. We thanked the members of the local organizing committee of ICSSD 2023 for their hard work.List of Organizing Committees, Editorial, Logistics, Exhibition/Support, Registration, Welfare and Reviewers are available in this pdf.

Examining the impact of personal freedom on income inequality: Evidence from Sub-Saharan Africa and Western European regions.

Rising income inequality has recently garnered intensive attention owing to its significance in theory and practice. This has rendered the mechanism through which inequality can be understood, even from a microscopic perspective, to institute proper policies that curtail it important. We contribute to the literature by examining the effect of freedom on income inequality using data from 34 least-free and 18 most-free countries from 2000 to 2020 in Sub-Saharan Africa and Western Europe, respectively. A novel fixed-effects panel quantile regression econometric estimator was employed, and the findings showed a non-linear relationship between personal freedom and income inequality for both regions. Again, both regions reported an inverse relationship between personal freedom and income inequality within the medium-run quantiles. However, a positive relationship was reported in the short-run and long-run quantiles of Sub-Saharan Africa and Western Europe, respectively, whereas the inverse was the same. Finally, the significant adverse relationship was more dominant in Western Europe, implying that high levels of personal freedom in the region explain the low levels of income inequality compared to Sub-Saharan Africa, which has lower levels of personal freedom and higher income inequality. Concerning the findings, it is recommended that policymakers and governments of least- and most-free regions institutionalise personal liberties that support human capital development and establish mechanisms to implement enacted freedoms.

Detection of a neglected tropical disease: Case report of Heavy <i>Tunga penetrans</i> lesions on the feet of a thirteen-year-old boy from a community in Lagos, Nigeria

Tungiasis is a neglected tropical disease (NTD) arising from an ectoparasitic infection of the skin of its host by the gravid female Tunga species. The prevalence can spike to about 60% in impoverished regions of South America, the Caribbean, and Sub-Saharan Africa. Instances of severe cases are rare. However, according to the consistent pattern of Tunga penetrans distribution, majority of lesions are carried by a few numbers of hosts. Limited research has been conducted in endemic areas of Nigeria, and in Badagry, wherein a prevalence rate of 21.2% was recently documented. In this report, we detail a severe case of Tungiasis in Jegeme, an endemic community within the Badagry Local Government area of Lagos, which was observed during part of an active surveillance conducted from August 2021 to November, 2021. The case involved a 13-year-old boy who reported several lesions containing embedded fleas on his limbs. Extraction and microscopic examination of the wound revealed eggs and adult forms of Tunga flea. This case highlights the persistence of severe tungiasis within this endemic community, underscoring the link between the infection and extreme poverty. Tungiasis is likely to remain endemic in such resource-poor setting where extreme poverty limits access required to prevent infestation. Appropriate response to infestation to reduce morbidity should be implemented. Improved links between locals in endemic populations and healthcare providers, coupled with increased awareness, and implementation of preventive measures is crucial.

Potential of low-cost PM monitoring sensors to fill monitoring gaps in areas of Sub-Saharan Africa

Recent advances in low-cost (LC) sensor technology fostered their deployment in low-income and undersampled countries such as Sub-Saharan Africa (SSA) regions, affected by the highest particulate matter (PM) concentrations and population exposure. The present study is the first addressed in Niamey, Niger, and focuses on assessing LC sensor data and global reanalysis products. Three LC PM2.5 and PM10 monitoring stations were deployed and successfully operated across ∼8 months at different (urban, suburban and rural) locations.Observed PM2.5 and PM10 concentrations revealed consistent patterns, higher during the dry Harmattan season, while appreciably lower during the humid monsoon season. In Niamey, PM2.5 mean concentrations (6.1–20.1 μg/m3) were similar to those observed over higher-income countries, confirming the hypothesis of strictly depending on urbanisation, and thus on anthropogenic activities. Conversely, PM10 concentrations (55.3–142.8 μg/m3) were remarkably higher than most of those measured elsewhere worldwide, and predominantly constituted (81–89%) by coarse fraction. PM10 origin, inferred by backtrajectory analysis, was mainly natural (Saharan dust) during the Harmattan season, and both natural and anthropogenic during the monsoon season.Low-resolution gridded estimations by the Copernicus Atmosphere Monitoring Service (CAMS) were not capable of adequately resolving the spatial variability of PM2.5 and PM10 observations in Niamey, further highlighting the importance of sensor network data to improve air quality knowledge. To tackle the harmful effects of Saharan dust on population, and create robust datasets integrated with gridded products in this challenging region, effort should be put toward creation of trans-national integrated monitoring networks based on LC sensors across SSA.

A systematic review of the epidemiology and the public health implications of stroke in Sub-Saharan Africa

BackgroundWith approximately 11 million strokes occurring annually worldwide, and over 6.5 million deaths annually, stroke has made its place as one of the major killers in the world. Although developing countries make up more than 4/5 of the global stroke burden, well-grounded information on stroke epidemiology remains lacking there. AimsThis systematic review study aimed to provide a synthesis of studies on the incidence and prevalence of stroke among adults in sub-Saharan Africa (SSA), subsequently deduce the associated risk factors and public health implications (mortality rates and economic costs) of the disease on the population of this region. MethodsA systematic review of studies carried out in the region and published on PUBMED. Eligibility criteria were established using the PEO (Population/Patient, Exposure, Outcome) format. Research articles investigating either (or all) of the following: ischemic or haemorrhagic stroke, incidence, prevalence, and risk factors of stroke in adults (≥ 18 years old), in at least one region of SSA were included. Exclusion criteria comprised studies involving populations younger than 18 years old, research conducted outside the designated research region, and articles inaccessible in full text. The PRISMA guidelines were used for the search strategy. ResultsFifty-two studies were included review. Among them, over 11 studies investigated the prevalence of the disease. Some older studies within the continent (Nigeria, 2011) showed a prevalence of 1.3 per 100 while more recent studies (Zambia, 2021) showed a prevalence of 4.3 per 1000. The highest prevalence noted in this region was in Madagascar (2017) with 48.17 per 100, while the lowest was recorded in (Zimbabwe, 2017) with 0.61 per 100. The study in Tanzania showed a crude incidence of 94·5 per 100 000 (76·0–115·0) while the study in Ghana in 2018 showed an incidence of 14.19 events per 1000 person-years [10.77–18.38]. The identified risk factors included hypertension, diabetes, smoking, alcohol consumption, physical inactivity, poor diets (more salt, less vegetables), dyslipidaemia, HIV/AIDS co-infection, heart disease (cardiomyopathies, cardiac arrhythmias), obesity, previous stroke and/or family history of stroke. Over 21 studies investigated the mortality rates due to stroke in SSA, with most of the studies being in West Africa. These studies revealed mortality rates as high as 43.3% in Ghana, and as low as 10.9% in Cameroon. Few studies reported on the economic costs of stroke in the region; two in Benin, two in Nigeria and one in Tanzania. ConclusionThe increasing incidence/prevalence, lifestyle factors and interactions with other diseases, including major communicable diseases, stroke is becoming a pressing public health problem for SSA. Reducing the incidence of stroke in Africa will surely lower mortality, morbidity, disability, and the neurological as well as cognitive aftereffects of stroke, as is clear from the experience of higher-income nations. We recommend a collective intervention involving the governments of nations, international organizations, civil society, and the private sector for greater impact and sustainable outcomes reducing the epidemiology and implications of stroke in SSA.

Why is there a gap in self-rated health among people with hypertension in Zambia? A decomposition of determinants and rural‒urban differences

BackgroundHypertension affects over one billion people globally and is one of the leading causes of premature death. Low- and middle-income countries, especially the sub-Saharan Africa region, bear a disproportionately higher share of hypertension globally. Recent evidence shows a steady shift in the burden of hypertension from more affluent and urban populations towards poorer and rural communities. Our study examined inequalities in self-rated health (SRH) among people with hypertension and whether there is a rural‒urban gap in the health of these patients. We then quantified factors driving the health gap. We also examined how much HIV accounts for differences in self-rated health among hypertension patients due to the relationship between HIV, hypertension and health in sub-Saharan Africa.MethodsWe utilized the Zambia Household Health Expenditure and Utilization Survey for data on SRH and other demographic and socioeconomic controls. District HIV prevalence information was from the Zambia Population-Based HIV Impact Assessment (ZAMPHIA) survey. We applied the Linear Probability Model to assess the association between self-rated health and independent variables as a preliminary step. We then used the Blinder-Oaxaca decomposition to identify self-rated health inequality between urban and rural patients and determine determinants of the health gap between the two groups.ResultsAdvanced age, lower education and low district HIV prevalence were significantly associated with poor health rating among hypertension patients. The decomposition analysis indicated that 45.5% of urban patients and 36.9% of rural patients reported good self-rated health, representing a statistically significant health gap of 8.6%. Most of the identified health gap can be attributed to endowment effects, with education (73.6%), district HIV prevalence (30.8%) and household expenditure (4.8%) being the most important determinants that explain the health gap.ConclusionsUrban hypertension patients have better SRH than rural patients in Zambia. Education, district HIV prevalence and household expenditure were the most important determinants of the health gap between rural and urban hypertension patients. Policies aimed at promoting educational interventions, improving access to financial resources and strengthening hypertension health services, especially in rural areas, can significantly improve the health of rural patients, and potentially reduce health inequalities between the two regions.

Substantial increase in population exposure to multiple environmental burdens in sub-Saharan Africa (2000-2019)

In the face of increasing global environmental uncertainties, sub-Saharan Africa stands as a highly vulnerable region with a massive population marked with poverty and inequalities. Moreover, different environmental risk factors can coexist simultaneously as multiple environmental burdens (MEBs); however, population exposure to MEB remains unexamined. Here, using open-access spatial data and critical thresholds, we quantify population exposure to four key environmental risk factors: hazardous fine particulate matter (PM2.5) levels, extreme temperature increase, prolonged severe droughts, and green deficit (scarcity of green trees). Further, we explore the concept of MEB, where these risk factors converge. We derive exposure for 2000 and 2019 at the pixel (1 km grid cell) level. We also check how population change, environmental change, and their interaction contribute to the total change in exposure. We found substantial changes in the population exposed from 2000 to 2019, i.e. an increase of ∼460 million people to hazardous PM2.5 levels, ∼16 million to extreme temperature increase, ∼13 million to prolonged severe droughts, and ∼246 million to green deficit. Population exposure to at least three of these four environmental risk factors (3EB) has increased by ∼246 million. In this increase in exposure to 3EB, the contribution of environmental change is higher (48%), than that of interaction and population change (36% and 15%, respectively). Notably, there are striking disparities in population exposure, its change, and the contributing effects among countries and regions of sub-Saharan Africa.

Barriers and Challenges Affecting Quality Education (Sustainable Development Goal #4) in Sub-Saharan Africa by 2030

Education is a fundamental human right and a crucial tool for sustainable human capacity development, which can advance the economic growth of a country. Yet for many children in sub-Saharan Africa (SSA), quality education remains out of reach. This study aimed to identify the barriers and challenges to enacting Sustainable Development Goal 4: “Ensuring Inclusive, Equitable, and Quality Education and the Promotion of Lifelong Learning Opportunities for All”. Through a content analysis of the relevant literature, we identified three themes: funding constraints, access and inclusion, and teacher education. Regarding funding, issues of resource allocation, technical capacity, and accountability were identified as primary factors requiring intervention strategies to become fully realized in SSA. When exploring access and inclusion, we found that incorporating students with disabilities, gender disparities, physical barriers, and inadequate curriculum are essential factors limiting quality education in SSA. Finally, teachers’ conditions and training emerged as crucial challenges to reach quality pedagogy. Some SSA countries have improved their efforts for quality education, but these barriers and challenges continue to impact education for all children. A new perspective on mitigating these impediments can address several factors responsible for the exclusion of diverse groups from accessing quality education in the SSA region.

Global and regional estimates of tuberculosis burden attributed to high fasting plasma glucose from 1990 to 2019: emphasis on earlier glycemic control

BackgroundPrevious studies have shown subjects suffering from diabetes or persistent hyperglycemia were more likely to develop tuberculosis (TB). However, the global burden of TB attributed to high fasting plasma glucose (HFPG) remains unclear. This study aimed to characterize the global, regional, and national TB burden attributed to HFPG from 1990 to 2019.MethodsWith Global Burden of Disease study 2019, the numbers and age-standardized mortality rates (ASMR) and age-standardized disability-adjusted life years (DALY) rates (ASDR) of TB attributed to HFPG at global, regional, and national levels from 1990 to 2019 were extracted. The locally weighted regression model was applied to estimate the TB burden for different socio-demographic index (SDI) regions.ResultsGlobally, the ASMR and ASDR attributed to HFPG were 2.70 (95% UI, 1.64–3.94) and 79.70 (95% UI, 50.26–112.51) per 100,000 population in 1990, respectively. These rates decreased to 1.46 (95% UI, 0.91–2.08) and 45.53 (95% UI, 29.06–62.29) in 2019. The TB burden attributed to HFPG remained high in low SDI and Central Sub-Saharan Africa regions, while it declined with most significantly in high SDI and East Asia regions. Additionally, the ASMR and ASDR of TB attributed to HFPG were significantly higher in the male and the elderly population.ConclusionsThe global TB burden attributable to HFPG decreased from 1990 to 2019, but remained high in low SDI regions among high-risk populations. Thus, urgent efforts are required to enhance the awareness of early glycemic control and TB treatment to alleviate the severe situation.

Mortality and associated factors among children admitted to an intensive care unit in muhimbili national hospital, from the time of admission to three months after discharge: a prospective cohort study

BackgroundMortality of children admitted to Intensive Care Units (ICU) is higher in low-to-middle-income countries (LMICs) as compared to high-income countries (HICs). There is paucity of information on outcomes following discharge from ICU, especially from sub-Saharan Africa region. This study was conducted to determine mortality and its associated factors among children admitted to Pediatric ICU (PICU) at Muhimbili National Hospital, from admission to three months after discharge.MethodologyThis was a hospital-based prospective cohort study conducted between July 2021 and May 2022, among children admitted to PICU who were followed up for 3-month after discharge. Structured questionnaires were used to collect data from their medical charts. Telephone interviews were made after discharge. Medical records and verbal autopsy were used to determine the cause of death after discharge. Cox regression analysis was performed to assess the association between variables. A p-value of < 0.05 was considered statistically significant. Survival after PICU discharge was estimated by Kaplan - Meier curve.ResultsOf 323 children recruited, 177(54.8%) were male, with a median age of 17 months (1-168). The leading cause of PICU admission was severe sepsis 90/323(27.9%). A total of 161/323 children died, yielding an overall mortality of 49.8%. Of 173 children discharged from PICU, 33(19.1%) died. The leading cause of death among children who died in the general ward or as readmission into PICU was sepsis 4/17(23.5%). Respiratory diseases 4/16(25.0%) were the commonest cause of death among those who died after hospital discharge. Independent predictors of overall mortality included single organ dysfunction with hazard ratio(HR):5.97, 95% confidence interval (CI)(3.05–12.26)] and multiple organ dysfunction [HR:2.77,95%CI(1.03–2.21)]. Chronic illness[HR:8.13,95%CI(2.45–27.02)], thrombocytosis [HR:3.39,95%CI(1.32–8.73)], single[HR:3.57,95%CI(1.42–9.03)] and multiple organ dysfunction[HR:3.11,95%CI(1.01–9.61)] independently predicted post-PICU discharge mortality.ConclusionOverall mortality and post- PICU discharge mortality were high and more likely to affect children with organ dysfunction, chronic illness, and thrombocytosis. The leading causes of mortality post- PICU discharge were sepsis and respiratory diseases. There is a need for a focused follow up plan of children post- PICU discharge, further research on the long term survival and strategies to improve it.

‘It’s about time’: policymakers’ and health practitioners’ perspectives on implementing fertility care in the Gambian health system

BackgroundInfertility is a major health issue worldwide, yet very few examples of interventions addressing infertility in the Global South have been documented to date. In The Gambia, West Africa, infertility is recognised as a burden and the health authorities have included it in several health policies and the new National Reproductive Health Strategy however, a detailed operationalisation plan for fertility care has not yet been established. Here, we aim to understand and document the factors that influence the implementation of fertility care in The Gambia.MethodsWe conducted 46 semi-structured interviews with policymakers, implementers, and health practitioners in both the public and private sectors from July to November 2021. The interviews were transcribed, anonymised and analysed with NVivo Pro version 1.6.1. The analysis was initially inductive, with themes arising from the coding categorised according to the WHO health systems building blocks framework.ResultsThis study identified several barriers to a successful implementation of fertility care in The Gambia, including (i) a lack of routinely collected infertility data; (ii) an absence of financial protection mechanisms for patients, and/or a specific budget for infertility; (iii) limited cooperation between the public and private sectors in the provision of fertility care; and (iv) gaps in fertility care training among health practitioners. Conversely, enablers included: (i) strong national infertility leadership; and (ii) the integration of infertility care within public reproductive health services.ConclusionThe Gambian health system is not yet in the position to support a comprehensive fertility care package in its public health facilities. Several aspects of the implementation of fertility care must be considered in operationalising the health strategy including the systematic collection of infertility data, fertility awareness, and the provision of specialised fertility care training. Furthermore, a stronger partnership between the public and private sectors must be developed. Given the increasing availability of assisted reproductive technologies in the sub-Saharan Africa region, and the tendency to locate these technologies in the private sector, further research is needed to understand and identify the processes underlying the implementation of fertility care and to foster better integration with the existing health system.

Determinants of iron-rich food deficiency among children under 5 years in sub-Saharan Africa: a comprehensive analysis of Demographic and Health Surveys

BackgroundIron deficiency is a major public health problem that affects the physical and cognitive development of children under 5 years of age (under-5 children) in sub-Saharan Africa (SSA). However, the...

Neonatal transport practices and effectiveness of the use of low-cost interventions on outcomes of transported neonates in Sub-Saharan Africa: A systematic review and narrative synthesis.

Neonatal deaths contribute significantly to under-5 mortality worldwide with Sub-Saharan Africa (SSA) alone accounting for 43% of global newborn deaths. Significant challenges in the region's health systems evidenced by huge disparities in health facility deliveries and poor planning for preterm births are major contributors to the high neonatal mortality. Many neonates in the region are delivered in suboptimal conditions and require transportation to facilities equipped for specialized care. This review describes neonatal transport across the subregion, focusing on low-cost interventions employed. We conducted a systematic review of studies on neonatal transport in SSA followed by a narrative synthesis. A search in the databases CINAHL, EMBASE, MEDLINE, Web of Science, African Index Medicus, and Google Scholar was performed from inception to March 2023. Two authors reviewed the full texts of relevant studies to determine eligibility for inclusion which was subsequently cross-checked by a third reviewer using a random 30% overlay. The quality of the included studies was assessed using the Mixed Methods Appraisal Tool. A total of 20 studies were included in this review involving 11,895 neonates from 10 countries. All studies evaluated the transfer of neonates into referral centers from the peripheries. Most neonates were transferred by public transport (n = 12), mostly in the arms of caregivers with little communication between referring facilities. Studies reporting on ambulance transfers reported pervasive inadequacies in both human resources and transport equipment. No study reported on the use of Kangaroo mother care (KMC) in the transfer process. The neonatal transport system across the SSA region is poorly planned, poorly resourced, and executed with little communication between facilities. Using cost-effective measures like KMC and improved training of community health workers may be key to improving the outcomes of transported neonates.