sub-Saharan African Context Research Articles

Toward a conceptualization of decent work in Africa: Development and cross-cultural validation of the Decent Work Triad (DWT) in Burkina Faso, Switzerland, and Togo.

Psychology of Working theorists recommend supplementing the Decent Work Scale (DWS) with subjective investigations of decent work across different cultural contexts. Building on this, the present study developed and validated the Decent Work Triad (DWT) for assessing the subjective aspects of decent work in a sub-Saharan African context. Using a Burkinabe sample for exploratory (N = 303) and confirmatory (N = 494) analyses, it consists of 8 items assessing three moral and value-based dimensions: Dignity, Corruption-Free, and Shamelessness. The scale showed good psychometric properties and invariance across country and gender in Burkina Faso (N = 494), Switzerland (N = 590), and Togo (N = 812). It also showed incremental validity in predicting work and life satisfaction beyond the DWS and discriminant validity along with constructs of marginalization and economic constraints, underscoring its robustness. The DWT's utility in understanding the subjective and cultural dimensions of decent work and its implications were discussed.

Private commercial companies sharing health-relevant consumer data with health researchers in sub-Saharan Africa: an ethical exploration

ABSTRACT Sharing large digital-first datasets, including for purposes for which they were not originally intended, is a hallmark of the “big data revolution”. Through their routine operations, private commercial companies collect massive amounts of diverse data from their customers, some of which may interest those working in the public sector, such as health researchers. Researchers and government agencies worldwide have been increasingly using data from commercial entities (such as Google, Microsoft, Apple, Facebook/Meta, Twitter/X and Amazon, among others) to generate health-related insights. This article explores ethical issues raised by the practice of commercial companies sharing consumer data with third parties for the purposes of promoting health in the sub-Saharan African (SSA) context. First, as an illustrative example, it examines some of the ways telecommunication (telecom) companies in SSA shared mobility data from cellphone users with public health researchers during the COVID-19 pandemic. Second, it examines a recent debate about the ethical responsibilities of companies that collect, process and share user-generated data, drawing implications for the SSA context. Finally, since this is a relatively understudied subject, we point out some areas where future conceptual and empirical work could contribute to the development of relevant ethics guidance and regulatory governance in SSA.

The Interplay Between Social Entrepreneurial Knowledge, Prosocial Motivation, Perceived Access to Finance and Social Entrepreneurial Intention

Building on insights from human capital and self-determination theories, this study examines the chain mediating effect of prosocial motivation and perceived access to finance in the linkage between social entrepreneurial knowledge and social entrepreneurial intention. Using survey data from 330 university students from Nigeria, the findings show that social entrepreneurial knowledge is positively linked with social entrepreneurial intention, and that prosocial motivation mediates this relationship. Perceived access to finance also positively intervened in the link between social entrepreneurial knowledge and social entrepreneurial intention. Finally, prosocial motivation and perceived access to finance had a significant serial mediating effect on the influence of social entrepreneurial knowledge on social entrepreneurial intention of university students. The study concludes with academic and practical implications for educators and policymakers in under-researched Sub-Saharan African contexts like Nigeria.

Geographical location as a determinant of caregiver burden: a rural-urban analysis of the informal caregiving, health, and healthcare survey in Ghana

BackgroundThe caregiving scholarship widely acknowledges informal caregivers’ contributions to maintaining older adults’ health and well-being. However, informal caregivers encounter economic, physical, social, financial and psychological challenges when caring for older adults. The caregiving literature has shown variations in caregiving intensity and motivation between rural and urban informal caregivers of older adults. This situation is likely to result in rural-urban disparities in caregiver burden. However, the literature on predictors of caregiver burden is more focused on demographic, socio-economic, caregiving and health-related factors with very little attention to geographical dynamics. For this reason, the effects of demographic, socio-economic, caregiving, and health-related factors on the variations in caregiver burden between rural and urban informal caregivers of older adults are yet to be known in the sub-Saharan African context, including Ghana. Notably, the impact of geographical location on caregiver burden is mainly missing in the informal caregiving literature in Ghana. Situated within the stress process model, we determine the association between geographical location and caregiver burden among informal caregivers of older adults in Ghana.MethodsThis study employed data from a large cross-sectional survey on informal caregiving, health, and healthcare among caregivers of older adults aged 50 years or above (N = 1,853) in Ghana. We selected the World Health Organization Impact of Caregiving Scale to measure caregiver burden. Generalized multivariable linear regression models were employed to determine the association between geographical location and caregiver burden among informal caregivers of older adults. We reported beta values and standard errors with significance levels of 0.05 or less.ResultsThe results showed that rural informal caregivers of older adults significantly have a decreased caregiver burden compared to urban informal caregivers (β = -1.64; SE = 0.41). Also, participants across all the self-rated health categories (poor/very poor: β = 12.63; SE = 1.65; fair: β = 9.56; SE = 1.07; good: β = 11.00; SE = 0.61, very good: β = 7.03; SE = 0.49) have a significantly increased caregiver burden for the full sample and for both rural (poor/very poor: β = 13.88; SE = 2.4; fair: β = 6.11; SE = 1.62; good: β = 9.97; SE = 0.96, very good: β = 6.06; SE = 0.71) and urban (poor/very poor: β = 11.86; SE = 2.25; fair: β = 12.33; SE = 1.42; good: β = 11.80; SE = 0.79, very good: β = 7.90; SE = 0.67) participants. This study further revealed that participants with no financial support needs reported a decreased caregiver burden compared to those with financial support needs for the full sample (β = -2.92, p-value < 0.01) and for both rural (β = -3.20; p-value < 0.01) and urban (β =-2.70; p-value < 0.01) participants.ConclusionThe findings from this study underscore geographical location differences in caregiver burden among informal caregivers of older adults in Ghana. Given these findings, the need to consider geographical location variations in providing welfare and health support programs to lessen caregiver burden among informal caregivers of older adults is welcomed. In line with the stress process model, such welfare and health programs should consider background, context, and stressor factors that contribute to variations in caregiver burden between rural and urban informal caregivers of older adults in Ghana and other sub-Saharan African countries.

Factors Associated With Survival Among Patients With Multiple Myeloma in Northeastern Tanzania.

This study sought to delineate the clinical, laboratory, and imaging characteristics during multiple myeloma (MM) diagnosis, outline the treatment modalities administered, and ascertain the survival rates among patients with MM over a comprehensive 5-year span in Tanzania. This retrospective cohort study investigated patients diagnosed with MM at the Cancer Care Clinic, Kilimanjaro Christian Medical Centre, between January 2017 and June 2022. Demographic data, clinical profiles, and survival outcomes were collected. The study employed the Kaplan-Meier method to determine overall survival (OS) and survival rates, supported by univariate analysis and a multivariate Cox regression model with significance of P < .05. In this study of 76 patients with MM, bone pain was the most common complaint (76.3%), and patients were age typically older than 50 years (82.5%). Laboratory tests showed frequent abnormalities, such as anemia (51.3%) and hypercalcemia (23.9%). Most patients were at stage III according to Durie Salmon Staging (82.7%), with imaging revealing various bone abnormalities. The median OS was 18.0 months, with 46.1% of patients passing away during the study period. Factors linked to shorter survival included anemia, renal failure, and bone involvement. Infection was the primary cause of death among these patients. The presenting complaint of bone pain significantly affected survival outcomes. This study provides a comprehensive understanding of MM within the Sub-Saharan African context, highlighting age-related disparities in diagnosis, predominant presenting symptoms like bone pain, factors contributing to delayed diagnoses, and the impact on survival rates. The findings underscore the critical need for early recognition, improved diagnostics, and tailored interventions to enhance outcomes for patients with MM in this region.

Value chain management practices and value creation in sub-Saharan African apparel firms

Purpose: This study explores value chain management (VCM) practices in the sub-Saharan African apparel industry, developing a strategic framework to enhance value creation.Design/methodology/approach: A quantitative research design was adopted, surveying 430 managers across the apparel value chain. Data were analysed using factor, correlation, and regression analyses to ascertain the impact of VCM practices on value creation. However, it is essential to notice that the study’s findings are limited to the sub-Saharan African context and may not directly apply to other regions.Findings/results: The analysis revealed a strong correlation between specific VCM practices, such as information sharing, incentive realignment, agile manufacturing, and value creation. These practices help firms to navigate the industry’s complexities and leverage regional opportunities.Practical implications: The study provides a valuable framework for managers, highlighting customer-centricity and strategic sourcing strategies. These strategies are crucial for enhancing operational efficiency and competitive positioning in the global market.Originality/value: The study offers original insights by empirically validating VCM practices and their contribution to value creation within the sub-Saharan apparel sector. The strategic framework fills a gap in the literature and aids the sector’s integration into the global value chain.

The scale effects of agricultural credits, institutional governance and microfinance sustainability in Sub-Saharan African countries

PurposeThe study examines the synthesized influences of institutional governance and the scale effects of agricultural credits on the sustainability of microfinance institutions (MFIs) in Sub-Saharan Africa.Design/methodology/approachUsing a sample of 840 MFIs (300 independent and 540 networked), the study applied Generalized Method of Moments (GMM) and Lewbel’s estimator.FindingsResults indicate positive effects of financial structure, efficiency and agricultural credit scale on sustainability, with a non-linear U-shaped relationship between agricultural credit size and microfinance sustainability. Depending on institutional governance quality, a threshold is identified where agricultural credit scale significantly enhances the quality of Portfolio at Risk (lnPAR) in independent MFIs and Returns on Assets (lnROA) in networked MFIs.Research limitations/implicationsStudy suggests strengthening governance for transparency and operating within optimal size for enduring sustainable performance. While focused on Sub-Saharan Africa, future research could expand to various economies or introduce additional variables for a comprehensive analysis.Practical implicationsMFIs can achieve sustainability by implementing management guided by better institutional norms, innovative financial transformations better suited to financing agricultural activities and techniques and an organizational structure more aligned with their performance targets.Social implicationsBroader and more reliable access to financial services, particularly in the agricultural sector, can stimulate production and alleviate poverty.Originality/valueThe study’s originality lies in its contribution to the literature by examining the role of institutional governance in microfinance institution performance and evaluating microfinance in a broader Sub-Saharan African context, proposing threshold limits where agricultural microcredit compromises performance.

Assessment of Heat Exposure and Health Outcomes in Rural Populations of Western Kenya by Using Wearable Devices: Observational Case Study.

Climate change increasingly impacts health, particularly of rural populations in sub-Saharan Africa due to their limited resources for adaptation. Understanding these impacts remains a challenge, as continuous monitoring of vital signs in such populations is limited. Wearable devices (wearables) present a viable approach to studying these impacts on human health in real time. The aim of this study was to assess the feasibility and effectiveness of consumer-grade wearables in measuring the health impacts of weather exposure on physiological responses (including activity, heart rate, body shell temperature, and sleep) of rural populations in western Kenya and to identify the health impacts associated with the weather exposures. We conducted an observational case study in western Kenya by utilizing wearables over a 3-week period to continuously monitor various health metrics such as step count, sleep patterns, heart rate, and body shell temperature. Additionally, a local weather station provided detailed data on environmental conditions such as rainfall and heat, with measurements taken every 15 minutes. Our cohort comprised 83 participants (42 women and 41 men), with an average age of 33 years. We observed a positive correlation between step count and maximum wet bulb globe temperature (estimate 0.06, SE 0.02; P=.008). Although there was a negative correlation between minimum nighttime temperatures and heat index with sleep duration, these were not statistically significant. No significant correlations were found in other applied models. A cautionary heat index level was recorded on 194 (95.1%) of 204 days. Heavy rainfall (>20 mm/day) occurred on 16 (7.8%) out of 204 days. Despite 10 (21%) out of 47 devices failing, data completeness was high for sleep and step count (mean 82.6%, SD 21.3% and mean 86.1%, SD 18.9%, respectively), but low for heart rate (mean 7%, SD 14%), with adult women showing significantly higher data completeness for heart rate than men (2-sided t test: P=.003; Mann-Whitney U test: P=.001). Body shell temperature data achieved 36.2% (SD 24.5%) completeness. Our study provides a nuanced understanding of the health impacts of weather exposures in rural Kenya. Our study's application of wearables reveals a significant correlation between physical activity levels and high temperature stress, contrasting with other studies suggesting decreased activity in hotter conditions. This discrepancy invites further investigation into the unique socioenvironmental dynamics at play, particularly in sub-Saharan African contexts. Moreover, the nonsignificant trends observed in sleep disruption due to heat expose the need for localized climate change mitigation strategies, considering the vital role of sleep in health. These findings emphasize the need for context-specific research to inform policy and practice in regions susceptible to the adverse health effects of climate change.

The dynamics of African traditional justice systems: Perspectives and prospective

ABSTRACT This study investigates the dynamics of African traditional justice systems in four African countries: Sierra Leone, Malawi, Uganda, and Zimbabwe. These countries have a rich history of traditional justice systems deeply rooted in their respective societies. These systems are regarded as essential elements of African communities, embodying unique philosophies, rituals, and practices that have historically played a crucial role in resolving conflicts and fostering peace. The evolution of law and order in these African countries has been heavily influenced by these traditional justice systems, contributing to the establishment of a robust governance structure. By conducting an analysis of customary justice frameworks in the sub-Saharan African context, this study examines the perceptions of local populations regarding the traditional justice system as a legitimate institution. It explores how the traditional justice system can function as an alternative or complementary form of justice within traditional societies. Drawing on previous research conducted in Sierra Leone, Malawi, Uganda, and Zimbabwe, this study reveals the challenges associated with integrating traditional justice systems into the broader legal framework. Nevertheless, it concludes that the integration of these systems can contribute to a comprehensive approach to sustainable peace-building, conflict resolution, and the establishment of a just rule of law in these African countries.

Anaerobic digestion or composting? Small-scale plants design and holistic evaluations in a Sub-Saharan African context

In small developing settings, is it worth building anaerobic digestion (AD) or composting plants? This study explores the economic, management, and environmental dimensions of two small-scale alternatives for organic fraction municipal solid waste (OFMSW) treatment within the context of Lacor Hospital (Uganda): aerated static pile composting (S1) and AD with digestate composting (S2), both designed to manage approximately 347.5 tOFMSW annually. In the optimistic scenario, S1 achieves a cost savings of about −2.9 USD tOFMSW−1, while S2 incurs costs of 2.1 USD tOFMSW−1. In the pessimistic scenario, S1's costs rise to 3.9 USD tOFMSW−1, while S2 becomes more expensive at 9.5 USD tOFMSW−1. Management analysis underlines S2's complexity due to AD operations and digestate drying. Total normalized environmental impacts of S1 can be quantified with about 0.125 mPt tOFMSW−1, whereas S2 is equal to about −6.163 mPt tOFMSW−1. However, in an optimistic scenario, climate change endpoint category results are similar. On balance, the LCA analysis indicates that AD can be better than standalone composting. However, in developing settings serving approximately 3000 inhabitants, it is crucial to prioritize economic and management sustainability that can be obtained only by small-scale composting plants. These findings provide definite insights for small-scale waste management projects in low-income regions, offering valuable data and references for plant design and their replicability. The study sets the ultimate definition of the most feasible option to treat OFMSW in low-income settings: community composting. Unfortunately, economic barriers remain the main challenge: citizens should pay for the service and landfill management fees should be set by local governments.

The psychological experience of sickle cell disease in a Cameroonian adolescent living with her grandparents

Sickle cell disease, the most widespread genetic disorder globally, is characterized by chronic and painful crises and high treatment costs, particularly in the Sub-Saharan African context where the disease is often associated with imminent death. This study aims to understand the experiences of an adolescent in Cameroon living with this disease and residing with her grandparents. Through in-depth interviews, we reveal how therapy non-compliance—particularly evident in medication delays—and the ambivalent behavior of her grandparents impact her disease management. The grandparents exhibit behaviors that are sometimes overprotective and at times aggressive, which not only affect how this adolescent understands and manages her condition but also hinder the process of subjectivation of her disease. These findings highlight the need to provide a space for grandparents to express their understanding of their granddaughter's illness and to assume their role in the care process. This study extends our understanding of family dynamics in managing sickle cell disease and demonstrates the importance of supporting grandparents as crucial resources in healthcare within this context.

Victimisation in the life of persons with severe mental illness in Uganda: a pluralistic qualitative study.

Victimisation of persons with severe mental illness is recognised as an urgent global concern, with literature pointing to higher rates of violent victimisation of persons with severe mental illness than those of the general population. Yet, for low income countries, there is a huge gap in the literature on the risk, character and victims' in-depth experiences of victimisation of persons with severe mental illness. We explore the lived experiences and meanings of victimisation of persons with severe mental illness in Uganda, and discuss their implications for care of the mentally ill. A pluralistic qualitative study was undertaken to explore victimisation among patients with severe mental illness. Patients who had suffered victimisation were purposively sampled from Butabika National Referral Mental Clinic and Masaka Regional Referral Hospital, following confirmation of symptom remission. In-depth interviews were held with 18 participants, comprising 13 females and 5 males from low to moderate socioeconomic status. Interpretative phenomenological analysis and thematic content analysis were conducted. Victimisation was exhibited in three main forms: (a) psychological, expressed in attitudes towards mentally ill family members as valueless and dispensable, and stigmatisation, (b) physical, as manifested in beatings, indoor confinement and tethering mostly by family members and (c) sexual victimisation, particularly rape. Also observed were victim's various responses that pointed to the negative impact of victimisation, including a heightened risk of suicide, social withdrawal, a sense of hatefulness and a predisposition to more victimisation. The family environment plays a predominant role in perpetrating victimisation of the mentally ill in some sub-Saharan African contexts such as Uganda. We propose a holistic framework for mental health interventions, incorporating biomedical but notably also social determinants of mental health, and targeted at improving familial relationships, social support and a sense of belongingness both within the family and the broader community.

Vitamin A supplementation coverage and associated factors for children aged 6 to 59 months in integrated and campaign-based delivery systems in four sub-Saharan African countries

BackgroundVitamin A deficiency (VAD) is a leading contributor to the poor health and nutrition of young children in sub-Saharan Africa. Funding constraints are compelling many countries to shift from longstanding campaigns to integrating vitamin A supplementation (VAS) into routine health services. We assessed child VAS coverage and associated factors for integrated delivery systems in Mozambique, Senegal, and Sierra Leone and for a campaign-based delivery strategy in Tanzania.MethodsData were obtained using representative household surveys administered to primary caregivers of N = 16,343 children aged 6–59 months (Mozambique: N = 1,659; Senegal: N = 7,254; Sierra Leone: N = 4,149; Tanzania: N = 3,281). Single-dose VAS coverage was assessed and bivariate and multivariable associations were examined for child VAS receipt with respect to rural or urban residence; child age and sex; maternal age, education, and VAS program knowledge; and household wealth.ResultsVAS coverage for children aged 6–59 months was 42.8% (95% CI: 40.2, 45.6) in Mozambique, 46.1% (95% CI: 44.9, 47.4) in Senegal, 86.9% (95% CI: 85.8, 87.9) in Sierra Leone, and 42.4% (95% CI: 40.2, 44.6) in Tanzania and was significantly higher for children 6–11 vs. 24–59 months in Mozambique, Senegal, and Tanzania. In Sierra Leone, children aged 12–23 months (aOR = 1.86; 95% CI: 1.20, 2.86) and 24–59 months (aOR = 1.55; 95% CI: 1.07, 2.25) were more likely to receive VAS, compared to those 6–11 months. Maternal awareness of VAS programs was associated with higher uptake in Mozambique (aOR = 4.00; 95% CI: 2.81, 5.68), Senegal (aOR = 2.72; 95% CI: 2.35, 3.15), and Tanzania (aOR = 14.50; 95% CI: 10.98, 19.17). Increased household wealth was associated with a higher likelihood of child VAS in Senegal and Tanzania.ConclusionsOur findings indicate routine delivery approaches for VAS are not achieving the level of coverage needed for public health impact in these settings. Intensive outreach efforts contributed to the higher coverage in Sierra Leone and highlight the importance of reducing the burdens associated with seeking supplementation at health facilities. As countries move towards incorporating VAS into routine health services, the essentiality of informed communities and potential losses for older children and socio-economically disadvantaged populations are key considerations in the sub-Saharan African context.

Vulnerability and adaptation of maize smallholder farmers to climate change: a Sub-Saharan African context

This study analyzed smallholder maize farmers' perceptions of climate change vulnerability and adaptation strategies in the eastern Democratic Republic of the Congo. The study used a cross-sectional quantitative approach, with smallholder farmers selected based on farm size (less than 10 hectares). Using simple random sampling techniques, 210 smallholder farmers in South Kivu Province was selected from October and November 2021. The data were analyzed using frequency analysis, non-parametric Mann–Whitney U-tests, Tobit regression model and structural equations modeling, which demonstrated that demographic and socioeconomic factors influenced smallholder farmers' perceptions and adaptation strategies to climate change. The findings revealed that the level of education, size of the field, and activities of smallholder farmers had significant effects on climate change perception and adaptation strategies. Smallholder farmers' perceptions had a negative (p < 1%) influence on maize smallholder farmers' adaptation to climate change. Common efforts should be made to encourage smallholder farmers to feel committed enough to implement climate change adaptation measures that are effective in mitigating or preventing climate change risk. The results of this study would have implications for policies to support maize smallholder farmers in their efforts to mitigate and resilient to climate change in sub-Saharan Africa. Firstly, the promotion of climate literacy must be sufficient to provide farmers with information on climate and forecasting. Secondly, to empower smallholder farmers with means and resources to prevent and reduce the effects of climate change. Lastly, enhancing the current environment for the agriculture sector will advance community inclusivity and food security.

Strangulated groin hernia prognosis in adults in sub-Saharan African context: Retrospective study at Zinder, Niger

Background In our context, hernial strangulation has a high incidence. The aim of this work was to investigate prognostic factors in adults diagnosed with strangulated groin hernia. Patients and Methods This was a retrospective cross-sectional study conducted at Zinder National Hospital between 1 January 2016 and 31 December 2022 (7 years). Clinical and prognostic data were collected. Results Out of 568 patients who underwent surgery for groin hernia, 230 cases were strangulated (40.49%). Mean age was 47.8±16.6 years. The proportion of males was 86.65%, i.e. the sex ratio was 5.96. Inguinal hernia accounted for 85.2% (n=196). The median operative time was 7 h. The Bassini procedure was the most common with 83.5% (n=192). Small bowel was the content of the hernia sac in 80% (n=184). Intestinal necrosis occurred in 10.9% (n=25). This was associated with femoral location (OR=5.39, P=0.00003). Intestinal resection was performed in 13.9% (n=32) and stoma in 1.7% (n=4). Postoperative complications occurred in 25.2% (n=58). The overall mortality (grade V) was 6.5% (n=15). Mortality was statistically associated with age &gt; 60 years (OR=5.16; P=0.0016), admission time (OR=3.20; P=0.028), time to surgery &gt; 8 h (OR=4.20; P=0.005) and occurrence of necrosis (OR=9.39; P=0.000). Conclusion Strangulated groin hernia is a common surgical emergency. Its prognosis is associated with advanced age, femoral location, and diagnostic and therapeutic delay.

The Microbiological Profile and Antibiotic Susceptibility of Fracture Related Infections in a Low Resource Setting Differ from High Resource Settings: A Cohort Study from Cameroon.

Fracture-related infection (FRI) is a common and devastating complication of orthopedic trauma in all settings. Data on the microbiological profile and susceptibility of FRI to antibiotics in low-income countries are scarce. Therefore, this study aimed to investigate the microbial patterns and antimicrobial susceptibility of FRI in a sub-Saharan African setting in order to provide guidance for the formulation of evidence-based empirical antimicrobial regimens. We conducted a retrospective analysis of patients treated for FRI with deep tissue sampling for microbiological culture from January 2016 to August 2023 in four tertiary-level hospitals in Yaoundé, Cameroon. There were 246 infection episodes in 217 patients. Cultures were positive in 209 (84.9%) cases and polymicrobial in 109 (44.3%) cases. A total of 363 microorganisms from 71 different species were identified, of which 239 (65.8%) were Gram-negative. The most commonly isolated pathogens were Staphylococcus aureus (n = 69; 19%), Enterobacter cloacae (n = 43; 11.8%), Klebsiella pneumoniae (n = 35; 9.6%), Escherichia coli (n = 35; 9.6%), and Pseudomonas aeruginosa (n = 27; 7.4%). Coagulase-negative staphylococci (CoNS) were isolated in only 21 (5.9%) cases. Gram-negative bacteria accounted for the majority of the infections in early (70.9%) and delayed (73.2%) FRI, but Gram-positive bacteria were prevalent in late FRI (51.7%) (p < 0.001). Polymicrobial infections were more frequent in the early (55.9%) and delayed (41.9%) groups than in the late group (27.6%) (p < 0.001). Apart from Staphylococcus aureus, there was no significant difference in the proportions of causative pathogens between early, delayed, and late FRI. This study found striking resistance rates of bacteria to commonly used antibiotics. MRSA accounted for 63% of cases. The most effective antibiotics for all Gram-positive bacteria were linezolid (96.4%), vancomycin (92.5%), clindamycin (85.3%), and fucidic acid (89.4%). For Gram-negative bacteria, only three antibiotics displayed a sensitivity >50%: amikacin (80.4%), imipenem (74.4%), and piperacillin + tazobactam (57%). The most effective empirical antibiotic therapy (with local availability) was the combination of vancomycin and amikacin or vancomycin and imipenem. In contrast to the literature from high-resource settings, this study revealed that in a sub-Saharan African context, Gram-negative bacteria are the most common causative microorganisms of FRI. This study revealed striking resistance rates to commonly used antibiotics, which will require urgent action to prevent antimicrobial resistance in low and middle-income countries.

Treatment burden and regimen fatigue among patients with HIV and diabetes attending clinics of Tikur Anbessa specialized hospital

Nascent studies showed that patients with chronic medical illnesses such as diabetes mellitus (DM) and HIV/AIDS are highly vulnerable to face both treatment burden and regimen fatigue. However, an attempt made so far in this sphere in sub-Saharan African health care context is dearth. Thus, this study aimed to determine the level of treatment burden and regimen fatigue of diabetic and HIV patients attending adult diabetic and ART clinics of TASH and explore patients’ and health care workers’ propositions to reduce treatment burden and regimen fatigue. An explanatory sequential mixed methods study was conducted at the adult HIV and DM clinics of TASH, Addis Ababa, Ethiopia from February 01-March 30, 2022. Simple random and purposive sampling techniques were employed to select participants for quantitative and qualitative studies, respectively. Descriptive analysis was done to summarize the quantitative data. Logistic and linear regression analyses were performed to identify predictors of treatment burden and regimen fatigue, respectively. P value < 0.05 was considered statistically significant. Qualitative data was analyzed by using a thematic analysis. A total of 300 patients (200 diabetes and 100 HIV) were included in the quantitative study. For the qualitative study, 14 patients and 10 health care workers (six nurses and four medical doctors) were included. Participants' mean global Treatment Burden Questionnaire (TBQ) and Treatment Regimen Fatigue Scale (TRFS) score were 28.86 ± 22.13 and − 42.82 ± 17.45, respectively. Roughly, 12% of patients experienced a high treatment burden. The presence of two or more comorbidities (adjusted odds ratio [AOR] = 7.95, 95% confidence interval [CI] 1.59–39.08), daily ingestion of more than five types of prescribed medications (AOR = 6.81, 95%CI 1.59–29.14), and good knowledge about DM and/or HIV (AOR = 0.33, 95%CI 0.12–0.92) were predictors of treatment burden. Poor availability of medications (β = 0.951, p < 0.001) was the only predictor of regimen fatigue. Patients and health care workers primarily proposed to foster self-care efficacy, advance administrative services of the clinic and hospital, and improve healthcare system provision. The findings of this study unveiled that a considerable proportion of patients experienced low levels of treatment burden and regimen fatigue. This study showed that boosting the patients’ self-care efficacy, upgrading administrative services of the clinic and hospital, and promoting the healthcare system provision had enormous significance in reducing treatment burden and regimen fatigue. Therefore, when designing patient-specific healthcare interventions for both HIV and diabetic patients’ various factors affecting both treatment burden and regimen fatigue should be considered to achieve the desired goals of therapy.

"The targets…are driving the agenda and that probably needs to change": stakeholder perspectives on HIV partner notification in sub-Saharan Africa.

Voluntary assisted partner notification (VAPN) in HIV contact tracing is a globally recommended strategy to identify persons who have been exposed to HIV and link them to HIV testing and follow-up. However, there is little understanding about how VAPN is experienced by stakeholders in sub-Saharan African (SSA) contexts. We conducted a multi-level and multi-national qualitative analysis evaluating stakeholder perspectives surrounding VAPN implementation to inform the development of future VAPN policies. We conducted in-depth interviews (IDIs) with VAPN stakeholders at global (n = 5), national (n = 6), and community level (n = 4) across a total of seven SSA countries. Eligible participants were ≥ 18years old and had experience developing, implementing, or overseeing VAPN policies in SSA. We sought to understand stakeholder's perspectives on policy development, implementation, and perceived outcomes (barriers and facilitators). Interviews were audio recorded, transcribed, and analyzed thematically using a combination of inductive and deductive approaches. Between December 2019 and October 2020 we conducted 15 IDIs. While participants agreed that VAPN resulted in a high yield of people newly diagnosed with HIV; they noted numerous barriers surrounding VAPN implementation across global, national, and community levels, the majority of which were identified at community level. Barriers at global and national level included high target setting, contradictory laws, and limited independent research disenfranchising the experiences of implementing partners. The barriers identified at community level included client-level challenges (e.g., access to healthcare facilities and fear of adverse events); healthcare worker challenges (e.g., high workloads); limited data infrastructure; and cultural/gender norms that hindered women from engaging in HIV testing and VAPN services. In response to these barriers, participants shared implementation facilitators to sustain ethical implementation of VAPN services (e.g., contact tracing methods) and increase its yield (e.g., HIV self-testingintegrated with VAPN services). Overall, stakeholders perceived VAPN implementation to encounter barriers across all implementation levels (global to community). Future VAPN policies should be designed around the barriers and facilitators identified by SSA stakeholders to maximize the implementation of (ethical) HIV VAPN services and increase its impact in sub-Saharan African settings.

Prevalence and factors associated with maternal and neonatal sepsis in sub-Saharan Africa: a systematic review and meta-analysis.

This study aimed to determine the prevalence and factors associated with maternal and neonatal sepsis in sub-Saharan Africa. This systematic review and meta-analysis used the PRISMA guideline on sepsis data in sub-Saharan Africa. The bibliographic search was carried out on the following databases: Medline/PubMed, Cochrane Library, African Index Medicus, and Google Scholar. Additionally, the reference lists of the included studies were screened for potentially relevant studies. The last search was conducted on 15 October 2022. The Joanna Briggs Institute quality assessment checklist was applied for critical appraisal. Estimates of the prevalence of maternal and neonatal sepsis were pooled using a random-effects meta-analysis model. Heterogeneity between studies was estimated using the Q statistic and the I2 statistic. The funnel plot and Egger's regression test were used to assess the publication bias. A total of 39 studies were included in our review: 32 studies on neonatal sepsis and 7 studies on maternal sepsis. The overall pooled prevalence of maternal and neonatal sepsis in Sub-Saharan Africa was 19.21% (95% CI, 11.46-26.97) and 36.02% (CI: 26.68-45.36), respectively. The meta-analyses revealed that Apgar score < 7 (OR: 2.4, 95% CI: 1.6-3.5), meconium in the amniotic fluid (OR: 2.9, 95% CI: 1.8-4.5), prolonged rupture of membranes >12 h (OR: 2.8, 95% CI: 1.9-4.1), male sex (OR: 1.2, 95% CI: 1.1-1.4), intrapartum fever (OR: 2.4, 95% CI: 1.5-3.7), and history of urinary tract infection in the mother (OR: 2.7, 95% CI: 1.4-5.2) are factors associated with neonatal sepsis. Rural residence (OR: 2.3, 95% CI: 1.01-10.9), parity (OR: 0.5, 95% CI: 0.3-0.7), prolonged labor (OR: 3.4, 95% CI: 1.6-6.9), and multiple digital vaginal examinations (OR: 4.4, 95% CI: 1.3-14.3) were significantly associated with maternal sepsis. The prevalence of maternal and neonatal sepsis was high in sub-Saharan Africa. Multiple factors associated with neonatal and maternal sepsis were identified. These factors could help in the prevention and development of strategies to combat maternal and neonatal sepsis. Given the high risk of bias and high heterogeneity, further high-quality research is needed in the sub-Saharan African context, including a meta-analysis of individual data.Systematic review registration: PROSPERO (ID: CRD42022382050).

The hidden burden of Pediatric urology in Sub-Saharan Africa: an analysis of hospital admission data from three East African Health Centres.

Specialist facilities for children are still unavailable in some Sub-Saharan African contexts. It is the case of pediatric urology, whose recent advances are still largely unshared. Prenatal diagnosis of urinary abnormalities (CAKUT) is largely unknown. Early recognition and referral of Undescended testis (UDT), Hypospadia, bladder exstrophy epispadias complex, ambiguous genitalia, stone disease, and tumours are uncommon in rural areas. Missed diagnosis is not uncommon and delayed management is associated with poor outcomes. We present a cross-sectional, descriptive study about the epidemiology of Pediatric urological admissions to three sub-Saharan East African Hospitals. All the urological cases between 0-18 years referred to three distinct East African Hospitals over 124 weeks were considered. Prevalence of different groups of diseases, age, and mode of presentation were reported. We found 351 cases (M/F 127/24) out of 2543 surgical referrals (13%). Seventy percent of cases were Hypospadias and UDT. Fifty percent of UDT were beyond 6, and most Hypospadias were between 4 and 7 yrs. CAKUT had a very low prevalence (4.84%), and about 50% of Wilms Tumours came too late to be resectable. In many African contexts, urology is still a tiny portion of the pediatric surgical workload compared to the 25% of European and American reports. There are also differences in the epidemiology of genitourinary conditions. A hidden burden of diseases may be presumed, remaining undiagnosed due to the shortage of specialist facilities.