sub-Saharan Research Articles

An Empirical Analysis on Institutional Quality, Fiscal Policy and Debt Sustainability in Sub-Saharan Africa (SSA)

Many Sub-Saharan African (SSA) countries are finding it difficult to fulfill their massive debt repayment obligations, which bilateral financial institutions have declared to be unmanageable. Government institutions are to blame for such disparities in the budgetary components, which have been empirically confirmed to be detrimental. Part of the reason for SSA's income generation and debt management problems is related to fiscal policy components where there has been an unwarranted exaggeration of government expenditure. Accordingly, the current study used a panel Autoregressive Distributed Lag (ARDL) to examine how fiscal policy and institutional quality affected the sustainability of debt in 48 SSA nations between 2008 and 2022. The study’s findings suggested that the elements of fiscal policy (expenditure and revenue) as well as indicators of institutional quality (governance), such as control of corruption, effectiveness of government, political stability, absence of violence, regulatory quality, the rule of law, voice, and accountability, were important in explaining the long-term sustainability of public debt. The speed of adjustment to the long-run equilibrium was slow, which may be related to the unstable governance in each of the cross-sectional nations. Hence, the study concluded that the interactive effects of institutional quality and fiscal policy significantly influenced debt sustainability in the long run. The study’s conclusions can be very helpful to policymakers, particularly in those nations where major fiscal and external imbalances are being generated by low ratings for key institutional quality indices.

Harvesting the sun twice: Energy, food and water benefits from agrivoltaics in East Africa

Food, energy and water insecurity are concomitant challenges facing many communities in East Africa. Agrivoltaic systems – agriculture integrated with photovoltaic panels – address all three challenges, providing low carbon electricity, food production and water conservation on the same land area. Agrivoltaics have proven benefits for the food-energy-water nexus in the USA, Europe and Asia, but research is lacking in sub-Saharan Africa, where energy access remains low, and climate change and water scarcity threaten food systems. This study presents evidence for concomitant electricity generation, food production and water conservation from agrivoltaic systems in Tanzania and Kenya, demonstrating the viability of these systems for both grid-tied agribusinesses and rural, off-grid communities. Performance of some crops improved under agrivoltaics, generating higher incomes for farmers and agribusinesses while reducing energy bills and/or enhancing energy supply. Crop survivability during a warm period was greater under the agrivoltaic system, indicating potential for climate change resilience. Panel shading reduced irrigation demand, thus some crops achieved greater yields while needing less water input. Rainwater harvesting from panel runoff further reduced irrigation needs. Combining energy infrastructure with agriculture enhanced land productivity for all crops at both sites. Agrivoltaics, whether grid-tied or off-grid, could address multiple Sustainable Development Goals in East Africa simultaneously by contributing to energy security, climate change-resilient food production, and water conservation in the region.

Vitamin D Status and Oxidative Stress in Children with Sickle Cell Anaemia in Sagamu, Nigeria

Objectives: Sickle cell anaemia (SCA) is characterized by nutritional deficiencies and oxidative stress. Vitamin D possesses antioxidant properties but its role in SCA in sub-Saharan Africa has not been fully understood. The relationship between Vitamin D status, oxidative stress and antioxidants status in children with SCA was investigated for its possible role in reducing complications arising from oxidative stress in SCA. Methods: Case-control study involving 100 HbS genotype and 100 HbA genotype children (control) of comparable age (5-12 years). Baseline characteristics were obtained and serum vitamin D, calcium, CAT, SOD, GPX, GST and XO levels were quantified by standard laboratory methods. Results: Serum levels of vitamin D, calcium, CAT, SOD, GPX and GST were significantly lower in SCA group compared to the control, while the XO level was significantly higher in the HbS group compared with control. There was positive correlation between vitamin D, CAT and SOD (r = 0.821, 0.869), weak positive association between vitamin D and Ca (r = 0.545) and no significant relationship between vitamin D and other measurands in the SCA group. Conclusion: Sufficient vitamin D status might impact positively on the antioxidant status in SCA individuals thereby reducing associated complications.

The impact of information and communication technologies on international trade: A case of Sub-Saharan Africa

The aim of this research is to analyze the effect of information and communication technologies (ICT) on the bilateral trade flows of the countries of Sub-Saharan Africa (SSA). We use the method of generalized least squares (GLS) panel to correct for correlation and heteroskedasticity problems. We have employed the gravity model extended to ICT to examine the effects of key ICT indicators on bilateral exports and imports. The sample includes 44 African countries of the subcontinent, including 43 countries as partners (importers/exporters) and one reporter country (exporter/importer) and covers the period 2010 to 2019. The results show that access to mobile telephony and the internet, as well as the development of e-commerce, have a great potential for improving intra-African bilateral trade and that the effect of ICT is not unequivocal according to the category of flow considered. However, it emerges from these results that the development of ICT as it is today has not yet succeeded in overturning the argument of physical distance as a barrier to trade in sub-Saharan Africa. The key conclusion is that the establishment of better-quality ICT services and infrastructure is more critical to intra-African trade. African policymakers should accommodate sufficient support to establish the ICT infrastructure and expand ICT penetration by reducing the costs of communication, transactions and access to ICT.

Determinants of fertility experience among reproductive women age (15-49) in Ethiopia: Application of count regression models.

Fertility refers to the average number of children born to a woman over her reproductive years. Due to cultural norms, economic development, education, access to healthcare, and government policies, fertility rates vary significantly across different countries and regions of the world. Ethiopia is one of the developing countries in Sub-Sahara Africa and its fertility rate has consistently been one of the highest in the world. Hence the main goal of this study was to identify the leading factors for the total number of children born per mother in Ethiopia. This study used the most recent secondary data obtained from the 2019 Ethiopia Mini Demographic and Health Survey. A total weighted sample of 8885 women aged 15 to 49 was included in the study. The primary outcome variable in this study was the number of children born per mother, and different socio-demographic and economic factors that could influence fertility experience were included. The analysis was performed using STATA version 17 software. Negative Binomial regression model was used to assess the association between outcome and predictor variables. A p-value <0.05 was considered to be statistically significant. From a total of 8885 women, on average approximately 2.73 children were born per mother. Age of mothers (IRR = 1.08, 95% CI: (1.077, 1.082)), religion for Muslim (IRR = 1.13, 95% CI: (1.08, 1.18)) and others (IRR = 1.16, 95% CI: (1.11, 1.22)), level of education secondary and above (IRR = .61, 95% CI: (.58, .65)) and primary (IRR = .84, 95% CI: (.81, .87)), household member of six to nine (IRR = 1.24, 95% CI: (1.20, 1.28)) and household members more than nine people (IRR = 1.14, 95% CI: (1.07, 1.21)), wealth index for rich (IRR = .94, 95%, CI: (.91, .98)), marital status for not married (IRR = .49, 95%, CI: (.48, .51)), pregnant mothers (IRR = 1.08, 95%, CI: (1.02, 1.13)) and contraceptive users (IRR = 1.12, 95%, CI: (1.09, 1.16)) were the signficant variables for number of children ever born per mother. In Ethiopia, the average number of children born per mother was approximately 2.73. Poisson and Negative Binomial regression models were compared, and we found the Negative Binomial regression model to be better to identify the determinants of fertility experience in Ethiopia. Age of mothers, religion, current pregnancy, use of contraceptive methods, mothers' education level, household members, wealth index, number of children aged five and under, region (Somali, Gambela, and Addis Ababa), and marital status were the determinants responsible for fertility experience among mothers in Ethiopia. These findings are helpful for policymakers and healthcare professionals for developing targeted interventions and programs aimed at improving the high fertility rate experience in Ethiopia.

Content and design of respectful maternity care training packages for health workers in sub-Saharan Africa: Scoping review.

Training health workers might facilitate respectful maternity care (RMC); however, the content and design of RMC training remain unclear. To explore the content and design of RMC training packages for health workers in sub-Saharan Africa. MEDLINE, EMBASE, CINAHL Complete, Web of Science Core Collections, SCOPUS, and grey literature sources (including websites of RMC-focused key organizations and Ministries of Health) were searched for journal papers, reports, and training guides from January 2006 up to August 2022. There were no restrictions on study designs, language, or health-worker cadre. Two reviewers independently screened results. Key data, including training content and methods used, were extracted and summarized. Thirty-two citations from 26 studies/programs were identified (24 journal papers, 5 manuals/guides, 2 reports and 1 PhD thesis), with 27 citations from 22 studies informing the review findings. About half of all conducted studies were from East Africa. The most common topics in RMC trainings were communication, privacy and confidentiality, and human resources. Most trainings were multicomponent and appear to be largely in-service training. Health workers providing direct care to women, compared with non-clinical staff such as receptionists and cleaners, were the only recipients of training in most studies (81.8%). Two broad categories of training methods/tools were identified: workshop-based and action-based. Over 90% of the studies assessed impact of the training, with a majority focused on impacts on maternal health and care; however, half of the latter studies did not appear to have feedback mechanisms in place for implementing change. The content and design of RMC training in sub-Saharan Africa are multifaceted, suggesting the complexity of implementing/promoting RMC. Some progress has been made; however, missed opportunities in training remain with respect to study populations, training topics, cadres, and feedback mechanisms.

Sensorineural hearing loss among hypertensive patients attending cardiac institute in Tanzania: A cross-sectional study

INTRODUCTION Hypertension is among non-communicable diseases worldwide and it has been associated with sensorineural hearing loss. Almost 1.39 billion people (1 out of 4 adults) have hypertension and this figure is expected to increase. In Sub-Saharan Africa, hypertension is the leading cause of death and disability. Hypertension is associated with sensorineural hearing loss by compromising the blood supply in the cochlea. MATERIALS AND METHODS An assessment of the proportion and patterns of sensorineural hearing loss among hypertensive patients was conducted. 191 patients aged 18 years and above were recruited. History and physical examination including blood pressure, and otoscopy were done. Pure tone audiometry (PTA) was conducted. RESULTS Patients aged from 36 to 88 years with a mean age of 60 years and a standard deviation of 10. The patients aged between 61–76 years accounted for 85 (44.5%), whereas 29–44 and &gt; 76 years accounted for 12 (6.3%) each. The female-to-male ratio was 1:1. Sensorineural hearing loss was detected in 144 (75.4%), commonly above 76 years of age which was 11 (91.7%. Mild sensorineural hearing loss was the most common degree revealed. There was no relationship between the degree of sensorineural hearing loss and the grades of hypertension (p-value of 0.113). No relationship between the duration of hypertension with the severity of hearing loss, p-value =0.369. CONCLUSION The prevalence of sensorineural hearing loss among hypertensive patients was 75.4%. The bilateral and mild degree was the commonest presentation. Increasing age was found to be associated with increased hearing loss. The duration and grade of hypertension were not related to the severity of hearing loss.

Phenotypic characterization of different seed coat color of cowpea cultivars, Vigna unguiculata (L). Walp. in West-Central Côte d'Ivoire

Cowpea is a widely consumed legume in sub-Saharan Africa. Several cowpea cultivars based on seed coat color are widely observed. Consumers' choice of cultivar varies from one region to another. However, the lack of improved varieties and the limited availability of information on the productive potential of these cultivars is one of the constraints on the development of cowpea production. Thus, red, white, black and brown seed coat widely consumed were evaluated in the field over two consecutive years, 2022 and 2023 on a plot following a randomized complete block design with four replications. Morphological and agronomic parameters showed that there were two groups of cultivars with interesting agronomic characteristics. The first group composed of the black, brown and red cultivars had a relatively short reproductive time, averaging 66 days. These cultivars are considered early. The number of fruits of these cultivars was also high, with an average of 12 fruits per plant. The second group, consisting exclusively of the white seed coat cultivar produced high biomass and plant length. It had also twice the pod and seed weight of the other cultivars. It would be possible to develop hybrids in the future, seeking, for example, to improve the seed weight of the red cultivar with a short reproductive cycle by crossing with the white seed coat cultivar, with a view to creating an early variety with a high yield.

Impact of Bilharziasis on Public Health in the Urban Community of Tchiamba Nzassi Around Cayo Lake

Background &amp; Objective: Schistosomiasis remains a public health problem, particularly in sub-Saharan Africa. The disease is closely linked to poverty and environmental factors. Populations who are highly exposed to the fresh water of Cayo Lake on a daily basis are likely to sustain the transmission of the disease. It is therefore necessary to investigate their frequencies in order to combat the perpetuation of schistosomiasis. Methods: This was a cross-sectional study carried out in August 2024 around Lac Cayo, among the inhabitants of Sandza and Tchianda in the urban community of TChiamba Nzassi in Pointe Noire. Schistosoma haematobium was systematically tested in urine samples. Results: This study revealed a 13.6% prevalence of bilharziasis among the 110 individuals tested. The frequency of Schistosomiasis in SANDZA was 05(11.10%) positive out of 45 screened, and 10(15.40%) positive out of 65 screened in Tchianda. Conclusion: Populations living along the shores of Lac Cayo are exposed to and maintain Schistosomiasis caused by Schistosoma haematobium.

Phenotypic Characterization of Subtype A and Recombinant AC Transmitted/Founder Viruses from a Rwandan HIV-1 Heterosexual Transmission Cohort

HIV-1 subtypes have distinct geographical distributions, with subtypes A, C, and D and inter-subtype recombinants circulating in sub-Saharan Africa. Historically, individuals living with subtype A viruses exhibit slower CD4 decline and progression to AIDS diagnosis. Despite this, there are few authentic infectious molecular clones (IMCs) of subtype A or AC recombinant transmitted founder (TF) viruses with which to investigate viral impacts on pathogenesis. In this study, we constructed 16 authentic subtype A1 and 4 A1C recombinant IMCs from the IAVI Rwandan Protocol C acute infection cohort and characterized these viruses phenotypically. The virus replicative capacity (RC) scores varied over 50-fold, but the natural substitution of non-consensus amino acids in the p17(MA) domain of Gag was generally linked to higher RC levels. Sensitivity to a panel of broadly neutralizing antibodies (bNAbs) showed that all but one TF was sensitive to N6, which targets the CD4 binding site, while bNAbs PG16 and PGT 128 had a similar level of potency but reduced breadth against our panel of viruses. In contrast, bNAb 10E8V4 revealed high breadth but much lower potency. This panel of well-characterized, authentic subtype A and AC recombinant IMCs provides a resource for studies on the role of the virus subtype in HIV-1 transmission, pathogenesis, and vaccine design.

The Relationship between Access to Safe Water and Sanitation and Women’s Health in the Self-produced Settlements

Access to safe water and sanitation in self-produced settlements is a significant societal problem. Yet, there is a notable gap in understanding and evaluating the impact on women’s health, and how this intersects with public space. In Sub-Saharan Africa, nearly half of the urban population lives in self-produced settlements. These are complex environments that are continuously growing and are home to almost two-thirds of the population in cities such as Nairobi. Mathare, one of the largest self-produced settlements in Nairobi, exhibits notably poor health outcomes, with women experiencing diarrhoea at twice the average rate of Nairobi. In such a precarious context, the health of its inhabitants requires a specific approach. This paper devises a multidimensional framework for analysing and evaluating the key spatial and socioeconomic factors affecting women’s health in these self-produced settlements. It connects women’s health and well-being to broader structural disadvantages, such as insecure tenure, poor housing conditions, low monthly income and a lack of access to basic services. This case study emphasizes the critical importance of access to safe water and sanitation. Women's daily routines often revolve around water, exposing them to heightened risks of waterborne diseases such as diarrhoea or typhoid fever. Moreover, many women can only access water and sanitation in public spaces in Mathare, where they are particularly vulnerable to violence. This research also concludes how these risks perpetuate a cycle of poverty and vulnerability among women in these communities and emphasises the critical importance of implementing multidisciplinary policies and tailored approaches to enhance the health and well-being of women living in self-produced settlements.

Paediatric cerebral palsy in South Africa: Prevention and care gaps at hospital level.

Population-based data show high proportions of severe cases of cerebral palsy (CP) in resource-poor regions such as sub-Saharan Africa, where most children have potentially preventable risk factors (factors that may increase the likelihood of CP occurrence but can be mitigated through medical interventions). This study aimed to describe the demographic and clinical profile of children living with CP accessing services at Tygerberg Hospital over a period of 10 years (2010-2020), identify the potential gaps in care (proportion of individuals in a country requiring but not receiving suboptimal or inadequate care), and comparison with a similar study at the same centre two decades ago. This 10-year retrospective study investigated causes and morbidities in children with CP, attending a central hospital in the Western Cape, South Africa. A total of 613 children with CP were identified. Perinatal causes were predominant, especially in 57.7% (n = 354) of the cohort: perinatal asphyxia (41.1%) and preterm birth (16.6%). Postnatal causes constituted 15.2% (n = 93), which included tuberculous meningitis (3.6%) and bacterial meningitis (3.6%). The most common complications were intellectual impairment (61.8%; n = 379); epilepsy (30.8%; n = 189) and visual impairment (54.7%; n = 234). A third of the cohort had severe CP, classified as Gross Motor Function Classification System IV and V (38%). Most of the previously documented main drivers of CP are still present and the implementation of healthcare prevention strategies remains inadequate. This study provides longitudinal evidence to confirm that CP in a South African setting is associated with a high burden of potentially preventable causes.

Incidence and factors associated with immediate adverse neonatal outcomes among emergency obstetric referrals in labor at a tertiary hospital in Uganda: a prospective cohort study

BackgroundHigh rates of adverse neonatal outcomes in resource-limited settings are multifactorial, varying by country, region, and institution. In sub-Saharan Africa, the majority of adverse neonatal outcomes are intrapartum related, and studies in Uganda have shown that referral in labor is a major determinant of adverse neonatal outcomes. This study aimed to assess the incidence and factors associated with immediate adverse neonatal outcomes among emergency obstetric referrals in labor at a tertiary hospital in Eastern Uganda.Materials and methodsThis was a prospective cohort study involving 265 women who were referred in labor to Jinja Regional Referral Hospital in Uganda with emergency obstetric complications. The exposure of interest was being referred with obstetrical emergency, and the outcome variable was adverse neonatal outcomes. The study was conducted between July 5, 2023, and October 5, 2023. Consecutive sampling was used, and data on sociodemographic and obstetric factors, referral related factors, as well as the primary outcome variable (adverse neonatal outcome) were collected via interviewer-administered questionnaires. The data were then cleaned, coded, and analyzed using STATA version 14. Log-binomial regression determined risk ratios and associations for factors related to adverse neonatal outcomes. Variables with p-values < 0.2 in bivariable analysis were included in the multivariable analysis, where significance was set at p < 0.05.ResultsOf the 265 women exposed to emergency obstetrical referrals, 40% experienced adverse neonatal outcomes, a composite measure including neonatal intensive care admission (27.6%), low Apgar score (23.8%), fresh stillbirth (11.3%), early-onset neonatal infection (6.8%), and early neonatal death (2.3%). Factors significantly associated with adverse neonatal outcomes were; maternal age ≥ 35 years (aRR = 1.72, CI:1.194–2.477, p value = 0.004), APH (aRR = 2.48, CI: 1.859–3.311, p-value < 0.001), and non-reassuring fetal status (aRR = 1.90, CI: 1.394–2.584, p-value < 0.001).ConclusionsThe study found a high rate of adverse neonatal outcomes among emergency obstetric referrals, with 40% of participants facing issues like ICU admissions, low Apgar scores and fresh stillbirth. Key factors included maternal age over 35, antepartum hemorrhage, and non-reassuring fetal status. These results highlight the urgent need for targeted interventions in emergency obstetric care. Strategies should enhance referral systems, improve facility preparedness, train healthcare providers, and educate communities on timely referrals and managing high-risk pregnancies.

Development of KSHV vaccine platforms and chimeric MHV68-K-K8.1 glycoprotein for evaluating the in vivo immunogenicity and efficacy of KSHV vaccine candidates.

Kaposi's sarcoma-associated herpesvirus (KSHV)/human herpesvirus 8 is an etiological agent of Kaposi's Sarcoma, multicentric Castleman's disease, and primary effusion lymphoma. Considering the high seroprevalence reaching up to 80% in sub-Saharan Africa, an effective vaccine is crucial for preventing KSHV infection. However, vaccine development has been limited due to the lack of an effective animal model that supports KSHV infection. Murine Herpesvirus 68 (MHV68), a natural mouse pathogen persisting lifelong post-infection, presents a promising model for KSHV infection. In this study, we developed KSHV vaccine and a chimeric MHV68 carrying the KSHV glycoprotein, serving as a surrogate challenge virus for testing KSHV vaccines in a mouse model. Among KSHV virion glycoproteins, K8.1 is the most abundant envelope glycoprotein with the highest immunogenicity. We developed two K8.1 vaccines: K8.1 mRNA-lipid nanoparticle (LNP) vaccine and K8.126-87-Ferritin (FT) nanoparticle vaccines. Both induced humoral responses in immunized mice, whereas K8.1 mRNA LNP also induced T cell responses. Using BACmid-mediated homologous recombination, the MHV68 M7 (gp150) gene was replaced with KSHV K8.1 gene to generate chimeric MHV68-K-K8.1. MHV68-K-K8.1 established acute and latent infection in the lungs and spleens of infected mice, respectively. Mice immunized with K8.1 mRNA LNP or K8.126-87-FT showed a reduction of MHV68-K-K8.1 titer but not MHV68 wild type (WT) titer in the lung. In addition, viral reactivation of MHV68-K-K8.1 was also significantly reduced in K8.1 mRNA LNP-immunized mice. This study demonstrates the effectiveness of two vaccine candidates in providing immunity against KSHV K8.1 and introduces a surrogate MHV68 system for evaluating vaccine efficacy in vivo.IMPORTANCEKaposi's sarcoma-associated herpesvirus (KSHV) is a prevalent virus that establishes lifelong persistent infection in humans and is linked to several malignancies. While antiretroviral therapy has reduced Kaposi's Sarcoma (KS) complications in people with HIV, KS still affects individuals with well-controlled HIV, older men without HIV, and transplant recipients. Despite its significant impact on human health, however, research on KSHV vaccine has been limited, mainly due to the lack of interest and the absence of a suitable animal model. This study addresses these challenges by developing KSHV K8.1 vaccine with two platforms, mRNA lipid nanoparticle (LNP) and FT nanoparticle. Additionally, chimeric virus, MHV68-K-K8.1, was created to evaluate KSHV vaccine efficacy in vivo. Vaccination of K8.1 mRNA LNP or K8.126-87-FT significantly reduced MHV68-K-K8.1 titers. Developing an effective KSHV vaccine requires an innovative approach to ensure safety and efficacy, especially for the immunocompromised population and people with limited healthcare resources. This study could be a potential blueprint for future KSHV vaccine development.

Recurrence of cholera epidemics in South Africa: inadequate sanitary facilities, poor environmental monitoring practices, and climate change as possible contributing factors

Cholera is an acute infectious disease caused by two toxin-producing strains, namely Vibrio cholerae O1, and Vibrio cholerae O139. Its recorded history stretches as far back as 1817, in Bengal, India, yet it continues to be a public health threat to this present day. Although cholera epidemics are now a relatively rare phenomenon in developed countries, frequent epidemics continue to be experienced in sub-Saharan Africa. Africa accounted for 63.33% of the 223 370 cases of and 4 159 deaths from cholera that were reported globally in 2020. Furthermore, of the 342 900 cholera cases and 3 304 cholera deaths reported globally in 2022, 40.28% of the cases and 77.85% of the deaths were in Africa. Inadequate sanitation infrastructure as well as inadequate provision of quality, safe drinking water in South Africa still creates conducive conditions for the transmission of cholera. In addition, climate change is increasingly becoming a risk factor towards the spread of V. cholerae pathogens in inland regions. To make recommendations on how South Africa, and potentially the Southern African region as a whole, can minimise the resurgence of cholera, this review addressed the following questions: Does South Africa have adequate sanitation infrastructure to curb the spread of cholera? Is there enough intentional surveillance of environmental water sources for vibrios as a cholera outbreak predictive tool? What is the impact of climate change on the resurgence of cholera in South Africa? And, what needs to be done to curb the resurgence of cholera in South Africa?

Optimizing cervical cancer classification using transfer learning with deep gaussian processes and support vector machines

BackgroundCervical cancer is the fourth most frequent cancer in women worldwide. Even though cervical cancer deaths have decreased significantly in Western countries, low and middle-income countries account for nearly 90% of cervical cancer deaths. While Western countries are leveraging the powers of artificial intelligence (AI) in the health sector, most countries in sub-Saharan Africa are still lagging. In Uganda, cytologists manually analyze Pap smear images for the detection of cervical cancer, a process that is highly subjective, slow, and tedious. Machine learning (ML) algorithms have been used in the automated classification of cervical cancer. However, most of the MLs have overfitting limitations which limits their deployment, especially in the health sector where accurate predictions are needed.MethodsIn this study, we propose two kernel-based algorithms for automated detection of cervical cancer. These algorithms are (1) an optimized support vector machine (SVM), and (2) a deep Gaussian Process (DGP) model. The SVM model proposed uses an optimized radial basis kernel while the DGP model uses a hybrid kernel of periodic and local periodic kernel.ResultsExperimental results revealed accuracy of 100% and 99.48% for an optimized SVM model and DGP model respectively. Results on precision, recall, and F1 score were also reported.ConclusionsThe proposed models performed well on cervical cancer detection and classification, and therefore suitable for deployment. We plan to deploy our proposed models in a mobile application-based tool. The limitation of the study was the lack of access to high-performance computational resources.

Critical Evaluation of Neglected Consensus Risk Factors Causing the Recurrent Upsurge of Cholera Outbreaks in Some Regions in Cameroon: A Systematic Review

Background: Cameroon is a developing nation and has been enlisted amongst the several countries in sub-Sahara Africa situated in West and Central Africa to be experiencing the recurrent cholera outbreaks. The World Health Organization (WHO), Cameroon health authorities and others researchers have considered a few risk factors that are believed to be contributing to the current and on-going cholera outbreaks in Cameroon. These risk factors include the wide circulation of Vibrio cholerae in the country, limited access to safe-drinking water in some areas, a seasonal pattern of cholera re-occurrence and inadequate water, sanitation and hygienic (WASH) conditions, unstable political atmosphere that have resulted to internally displayed persons, very poor and vulnerable persons, refugees and humanitarian crises and continued unnecessary imposed lock-downs and road-blocks. However, despite these enormous efforts made by Cameroon health authorities so far and its partners over the past decades in responding and tackling all these risk factors, the recurrent outbreak of cholera in Cameroon still remained a great challenge and potential humanitarian crisis, an unendingly reality with bewilderment amid uncertainty, threatening and vulnerability to many affected regions. Aim: This systematic review seeks to critically evaluate, identify and classify some previously overlooked consensus risk factors driving cholera endemicity, pandemicity or epidemicity in Cameroon. By highlighting these neglected factors, this review hopes to inform evidenced -based intervention to finally combat the persistence recurrent upsurge and burden of future outbreaks of cholera in Cameroon. Methodology: The current Systematic reviews gathered information from various sources using different search engines provide a comprehensive overview of existing research. These include Academic Search Engines, Specialized Search Engines, Grey Literature, Primary Sources, Secondary Sources, Registers and Repositories, Open Access Sources, Hand Searching and Other Sources. Results: The current systematic review gathered information from diverse sources and identified and classified six groups of neglected consensus risk factors, along with their associated variables, contributing to cholera outbreaks in Cameroon. Additionally, the review assessed the level of intervention and preventive measures offered by the Cameroon health authorities and other stakeholders, categorizing them as either low or high, for both documented and undocumented strategies. All data sources were thoroughly referenced accordingly ensuring transparency and accountability. Conclusion: In spite of extensive research by the World Health Organization and Cameroonian health authorities identifying and documenting numerous risk factors contributing to Cameroon's ongoing cholera outbreaks, these efforts have not prevented or eradicated recurring episodes. Decades of enormous work and efforts by Cameroonian health authorities have been incapable to eradicate cholera. This systematic review unequivocally shows that without addressing the neglected consensus risk factors and variables, Cameroon could face a high likelihood of continued cholera outbreaks. Therefore, this review underscores the urgent need for Cameroon health authorities to adopt a multifaceted approach, addressing the identified neglected consensus risk factors and variables. Implementation of targeted interventions, strengthened health infrastructure, and community engagement are crucial to prevent future cholera outbreaks. Future research should focus on developing context-specific solutions, enhancing existing strategies, and evaluating the effectiveness of interventions.

E-learning and sustainability of higher education in Sub-Saharan Africa: a review and synthesis

Purpose This study aims to examine the state of literature on the role of e-learning in the sustainability of higher education institutions in Sub-Saharan Africa, with the goal of identifying explored thematic areas, finding out the deficiencies in extant literature and recommending areas of future research work. Design/methodology/approach The research used a systematic literature review, examining articles published between 2012 and 2022. In total, 52 publications were identified and subjected to analysis. Findings The findings reveal that few studies have explored the relationship between e-learning and the sustainability of higher education in Sub-Saharan Africa, with larger economies in the region dominating research output. In addition, traditional technology adoption and social learning theories dominate the theoretical frameworks in this area. Moreover, the authors observed limited adaptation of these theories to local contexts, leading to outcomes with limited contextual details or lack of the same. Despite its potential, e-learning has yet to be fully embraced as a strategic tool for the sustainability of higher education in Sub-Saharan Africa. Originality/value Although various systematic literature reviews exist in the field of sustainability in higher education, there seem to be no reviews specifically focused on e-learning within the context of Sub-Saharan Africa. This review sheds some light on potential future research paths regarding the theory, content and context of e-learning for the sustainability of higher education in Sub-Saharan Africa, and by extension, in developing countries worldwide.

Prevalence and predictors of malaria in pregnant women in Sub-Saharan Africa: a systematic review and meta-analysis

Malaria remains a significant threat to pregnant women in sub-Saharan Africa. This systematic review and meta-analysis aims to estimate the prevalence and identify predictors of malaria infection among pregnant women in the region. Following preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines, a comprehensive search of PubMed Central, Google Scholar, EMBASE, ScienceDirect, and Cochrane Library was conducted, including 15 studies published between 2013 and 2023. The pooled prevalence of malaria, calculated using a random-effects model, was 19.0% (95% CI: 0.13-0.26), with heterogeneity (I²=81.9%) reflecting geographical and climatic diversity. Prevalence rates ranged from 6.4% in Burkina Faso to 36.4% in Tanzania. Asymptomatic cases had a prevalence of 19.0% (95% CI: 0.10-0.38), while symptomatic cases were slightly lower at 17.0% (95% CI: 0.12-0.23). Predictors of malaria included maternal age, parity, insecticide-treated net usage, intermittent preventive treatment, trimester-specific risk, and education level. These findings underscore the need for targeted, context-specific interventions to mitigate malaria risk among pregnant women in sub-Saharan Africa and inform effective malaria control strategies.

Air pollution and under-5 child mortality: linking satellite and IPUMS-DHS data across 41 countries in South Asia and Sub-Saharan Africa

BackgroundDespite progress, under-five mortality remains high, especially in Sub-Saharan Africa and South Asia, where around 13,400 children die daily. Environmental pollutants, including PM2.5 from outdoor air and household air pollution, significantly contribute to these preventable deaths.MethodsThis cross-country study combined satellite data with 113 surveys from the IPUMS-DHS dataset (1998–2019) to examine under-five child mortality in 41 developing countries. The integration of Global Annual Particulate Matter with a diameter of 2.5 micrometres or less (PM2.5) Grids from Socioeconomic Data and Applications Center (SEDAC) and geospatial data from the DHS Program enabled a focused analysis of the association between indoor and outdoor air pollution, particularly PM2.5, and child mortality rates using both logistic and multilevel logistic regression models, as well as estimating Population Attributable Fractions (PAF) to quantify the mortality burden attributable to these pollutants.ResultsOutdoor air pollution, measured by a one standard deviation increase in PM2.5, significantly increased the risk of child mortality (Odds Ratio [OR]: 1.14; 95% Confidence Interval [CI]: 1.10–1.18; p < 0.001). Moderate and high household air pollution exposure also heightened this risk, with increases of 37% (OR: 1.37; 95% CI: 1.24–1.53; p < 0.001) and 40% (OR: 1.40; 95% CI: 1.26–1.56; p < 0.001), respectively, compared to no exposure. Multilevel models (Models 5a and 10a) produced similar estimates to standard logistic regression, indicating robust associations. Additionally, Population Attributable Fraction analysis revealed that approximately 11.9% of under-five mortality could be prevented by reducing ambient PM2.5 exposure and 12.0% by mitigating household air pollution. The interaction between indoor and outdoor pollution revealed complex dynamics, with moderate and high household exposure associated with a reduction in mortality risk when combined with PM2.5. Geographical disparities were observed, with stronger correlations between outdoor air pollution and child mortality in Africa compared to Asia, and more pronounced impacts in low-income countries. However, household air pollution had stronger association with child mortality in Africa and lower- and middle-income countries.ConclusionsOur findings could serve as a guide for policy development aimed at reducing under-five mortality, ultimately contributing to the attainment of the Sustainable Development Goal (SDGs).