sub-Saharan African Region Research Articles

Quality of urban infrastructural service accessibility and human well-being in Sub-Saharan Africa

Urban infrastructure critically influences how urban people carry their lives and mediates how services central to human well-being are accessed. Therefore, the main of this study is twofold: One, the study interrogates how the quality of urban infrastructural service accessibility influences human well-being, and two, how governance interactively with urban infrastructural services affects human well-being using balanced panel data from 2000 to 2020 from 22 Sub-Saharan African countries. Applying the Driscoll-Kraay and Two-Step Instrumental Variable Generalized Method of Moments (2SIV-GMM) in panel dynamic model setup, we uncover that increasing the quality of accessing urban infrastructural services results in enhanced human well-being. Interrogating the role of governance on human well-being, the findings depict a significant detrimental interactive effect between governance and urban infrastructural services on human well-being. Accounting for rapid urbanization in the Sub-Saharan African region, the results illustrate significant negative control effects of urbanization rate and aftermath urban agglomeration on human well-being. Conclusively, effective government policies that influence higher levels of human well-being in regions with large urban agglomerations are paramount. Thus, effective government investments in urban infrastructural services in Sub-Saharan Africa remain a vital sustainability policy agenda.

Time to Treatment Failure and Its Predictors Among Second-Line ART Clients in Amhara Region, Ethiopia: A Retrospective Follow-Up Study.

Second-line antiretroviral treatment failure has become a major public health issue, and the time to treatment failure among second-line ART clients varies globally, and the Sub-Saharan African region having a high rate of second-line ART treatment failures. In addition, after the ART treatment guideline changed there is limited information on Ethiopia. Therefore, this study aimed to assess time to treatment failure and its determinants among second-line ART clients in Amhara Region, Ethiopia. A multi-centered retrospective follow-up study was conducted. A random sample of 860 people on second-line ART was selected by using a computer-generated simple random sampling technique from January 30, 2016, to January 30, 2021, at the University of Gondar Compressive Specialized Hospital, Felege Hiwot Compressive Specialized Referral Hospital, and Debre Tabor Compressive Specialized Referral Hospital, in Amhara region, Ethiopia. Data was captured using a checklist. A total of 81 (9.4%) ART clients developed second-line treatment failure, with a median follow-up time of 29 months with an interquartile range (IQR: 18, 41]. The risk of second-line treatment failure is higher among patients aged 15 to 30 years (adjusted hazard ratio (AHR) = 2.01, 95% confidence interval (CI): [1.16, 3.48]). Being unable to read and write (AHR = 1.312, 95% CI: [1.068, 1.613]), and poor ART drug adherence (AHR = 3.067, 95% CI: [1.845, 5.099]) were significant predictors of second-line ART treatment failures. In the current study, the time to second-line ART treatment failure was high compared with a previous similar study in Ethiopia. Factors like being younger age, ART clients who are not being able to read and write, and having poor ART drug adherence was significant predictors of second-line ART treatment failure.

Multilevel multinomial regression analysis of factors associated with birth weight in sub-Saharan Africa

Birth weight significantly determines newborns immediate and future health. Globally, the incidence of both low birth weight (LBW) and macrosomia have increased dramatically including sub-Saharan African (SSA) countries. However, there is limited study on the magnitude and associated factors of birth weight in SSA. Thus, thus study investigated factors associated factors of birth weight in SSA using multilevel multinomial logistic regression analysis. The latest demographic and health survey (DHS) data of 36 sub-Saharan African (SSA) countries was used for this study. A total of a weighted sample of 207,548 live births for whom birth weight data were available were used. Multilevel multinomial logistic regression model was fitted to identify factors associated with birth weight. Variables with p-value < 0.2 in the bivariable analysis were considered for the multivariable analysis. In the multivariable multilevel multinomial logistic regression analysis, the adjusted Relative Risk Ratio (aRRR) with the 95% confidence interval (CI) was reported to declare the statistical significance and strength of association. The prevalence of LBW and macrosomia in SSA were 10.44% (95% CI 10.31%, 10.57%) and 8.33% (95% CI 8.21%, 8.45%), respectively. Maternal education level, household wealth status, age, and the number of pregnancies were among the individual-level variables associated with both LBW and macrosomia in the final multilevel multinomial logistic regression analysis. The community-level factors that had a significant association with both macrosomia and LBW were the place of residence and the sub-Saharan African region. The study found a significant association between LBW and distance to the health facility, while macrosomia had a significant association with parity, marital status, and desired pregnancy. In SSA, macrosomia and LBW were found to be major public health issues. Maternal education, household wealth status, age, place of residence, number of pregnancies, distance to the health facility, and parity were found to be significant factors of LBW and macrosomia in this study. Reducing the double burden (low birth weight and macrosomia) and its related short- and long-term effects, therefore, calls for improving mothers' socioeconomic status and expanding access to and availability of health care.

Independent Correlates of Glycemic Control among Adults with Diabetes in South Africa.

Globally, the prevalence of diabetes is increasing, especially in low- and middle-income countries (LMICs), including those in the sub-Saharan African region. However, the independent socioeconomic correlates of glycemic control as measured by hemoglobin A1C have yet to be identified. Therefore, the aim of this analysis was to understand the independent correlates of glycemic control in South Africa. Data from the 2016 South Africa Demographic and Health Survey on adults with diabetes were used for this analysis. The dependent variable, glycemic control, was defined using hemoglobin A1c (HbA1c). Independent variables included: age, gender, ethnicity, marital status, region, urban/rural residence, ability to read, education, insurance, wealth, occupation, and employment in the last year. Analysis of variance was used to test for differences in mean HbA1c for each category of all independent variables, and a fully adjusted linear regression model was used to identify independent correlates of glycemic control (HbA1c). Among the 772 people included in this analysis, there were significant differences in mean HbA1c by age (p < 0.001), ethnicity (p < 0.001), place of residence (p = 0.024), wealth index (p = 0.001), and employment in the last year (p = 0.008). Independent correlates of HbA1c included age, ethnicity, and wealth index. This study used data from a large diverse population with a high prevalence of diabetes in sub-Saharan Africa and provides new evidence on the correlates of glycemic control and potential targets for interventions designed to lower HbA1c and improve diabetes-related health outcomes of adults in South Africa.

Remittance inflows in a digital economy: A Sub-Saharan African experience

The undeniable importance of migrants’ remittances to the welfare of developing countries was again demonstrated during the COVID-19 pandemic. This has therefore led to a significant shift in attention to the relevance of remittances and has likewise spurred research interest in factors that motivate the inflows of remittances. However, in spite of the increasing recognition of the roles of digital technology in the macroeconomic performance of developed and developing economies alike, empirical analysis of its possible impacts on remittance inflows has not been well explored in the literature. Therefore, pooling the annual data of 35 sub-Saharan African (SSA) countries from 2011 to 2020, this study investigates the nexus between digital technology and remittance inflows within the generalized method of moments (GMM) framework. Using two measures of digital technology infrastructure—internet usage and mobile cellular subscription—the study finds a positive relationship between digital technology and remittances inflow. In addition, the findings indicate that the magnitude of the effect is relatively higher for internet usage. The study thus shows that the increased rate of remittance mobilization constitutes a significant pathway through which digital technology impacts the economies of the SSA region. Moreover, it offers further insight on the importance of digital technology in the socioeconomic development of developing countries. From a policy standpoint, governments and policymakers in SSA countries should intensify efforts to promote the diffusion and penetration of digital infrastructure.

Review of Genetic and Artificial Intelligence approaches to improving Gestational Diabetes Mellitus Screening and Diagnosis in sub-Saharan Africa.

Background: Adverse outcomes from gestational diabetes mellitus (GDM) in the mother and newborn are well established. Genetic variants may predict GDM and Artificial Intelligence (AI) can potentially assist with improved screening and early identification in lower resource settings. There is limited information on genetic variants associated with GDM in sub-Saharan Africa and the implementation of AI in GDM screening in sub-Saharan Africa is largely unknown. Methods: We reviewed the literature on what is known about genetic predictors of GDM in sub-Saharan African women. We searched PubMed and Google Scholar for single nucleotide polymorphisms (SNPs) involved in GDM predisposition in a sub-Saharan African population. We report on barriers that limit the implementation of AI that could assist with GDM screening and offer possible solutions. Results: In a Black South African cohort, the minor allele of the SNP rs4581569 existing in the PDX1 gene was significantly associated with GDM. We were not able to find any published literature on the implementation of AI to identify women at risk of GDM before second trimester of pregnancy in sub-Saharan Africa. Barriers to successful integration of AI into healthcare systems are broad but solutions exist. Conclusions: More research is needed to identify SNPs associated with GDM in sub-Saharan Africa. The implementation of AI and its applications in the field of healthcare in the sub-Saharan African region is a significant opportunity to positively impact early identification of GDM.

Severity of environmental degradation and the impact on quality of life in Africa

Considering the mounting impacts of environmental degradation on the global ecosystem, this study offers an empirical contribution to the debate on whether there exists a significant nexus between environmental degradation and quality of life in Africa. Towards this end, we employ several econometric techniques to account for cross-sectional dependence, causality, and also present results based on IV-Lewbel 2SLS regression. Using a sample of African countries, the results indicate cross-sectional dependence due to spill-over effects from common factors in Africa, while the panel cointegration test affirms that environmental degradation have long-term consequences for quality of life only in sub-Saharan African region. Moreover, our results reveal a unidirectional causality between environmental degradation variables and quality of life at both the continent and sub-Saharan African region levels while a bi-directional causality between these variables are revealed for North Africa. On this evidence, our conjecture is that increased mineral extraction, greenhouse gas emissions, and deforestation, amongst other factors, may be driving this result. Hence, improvement in environmental quality in the continent would have an increasingly beneficial effects on the well-being and survival of the populace. The varied impacts across regions also suggest that policy initiatives toward mitigating the effects of environmental degradation should consider regional dynamics of the continent.

The Status of Implementation Research in Exit and Post-Exit Human Trafficking Interventions in Sub-Saharan Africa

ABSTRACT Conservative estimates place the number of individuals affected by human trafficking in the sub-Saharan African region at close to nine million. While there has been growing attention paid to innovative prevalence estimation approaches, and development of evidence-based interventions in the region, literature examining how these interventions are adapted, implemented, and delivered across multiple sectors, populations, and geo-political settings remains nascent at best. This critical gap in implementation research stymies the scale-up of effective anti-trafficking approaches. The central aim of this scoping review is to contribute to the anti-trafficking knowledge base by describing the current state of implementation research in this region based on 12 identified peer-reviewed human trafficking studies in sub-Saharan Africa. While none of the retrieved studies focuses solely on the implementation of a human trafficking intervention, the studies identified and discussed the acceptability and cost impacts of their implementation efforts. We conclude that advancing trafficking knowledge and praxis would require the synergistic and concurrent pursuit of both implementation and intervention strategies.

Comparative examination of breast cancer burden in sub-Saharan Africa, 1990–2019: estimates from Global Burden of Disease 2019 study

ObjectivesIn view of the widening gap in survival data between high-income and low-income countries, this study aimed to evaluate the most up-to-date burden of female breast cancer and analyse the...

The potential for cascading failures in the international trade network.

In our study, we introduce indicators that quantify the influence of each country in complex trade scenarios involving the exchange of raw materials, intermediate goods, and final products across multiple countries. We systematically employ an agent-based model to simulate the propagation of failures from one node to the entire network. This approach allows for the assessment of the impact of each country and the identification of patterns of interaction in the multi-step trade network. Unlike conventional analyses of trade networks, which depict straightforward single-step import/export transactions, our approach captures the intricate realities of processes like raw material procurement, production, and sales in numerous countries from a macroscopic perspective. The findings of our analysis of trade data spanning from 1990 to 2022 reveal several key insights. Firstly, sensitivity to changes in trade volume leading to global failures within interconnected networks has intensified over time. The potential of failure propagation across countries has increased over time, as has the interconnectedness of countries in the global trade landscape. Secondly, despite the increased sensitivity to changes in global trade volume, many countries have become less vulnerable to the influence of others within their multi-step trade networks. This trend aligns with deglobalization, which is evidenced by events such as Brexit and the surge in protectionist measures; these changes indicate a shift in the balance of influence within global trade networks. Thirdly, the results of our analysis of the relationship between load changes and global failures from a regional perspective reveal an intriguing phenomenon: despite limited direct trade connectivity, the interaction between the Latin American and Sub-Saharan African regions is considerable. This suggests the existence of hidden connections between intermediary countries, such that one region's actions can alter the load sensitivity of another, impacting them in unforeseen ways. Furthermore, intra-regional interactions are diminishing in East Asia, while Europe is experiencing a gradual increase in interactions. These trends reflect evolving regional influence, the dynamics of geographic proximity, and the results of economic integration efforts. Additionally, even though the observed period was not long enough to confirm a long-term trend, the previous trend direction was affirmed to persist despite a temporary decrease in trading and reduced sensitivity due to the COVID-19 pandemic. Our study highlights the complexity of global trade dynamics and the need to consider multi-step trade networks and their potential cascading effects when analyzing trade patterns and vulnerabilities.

The Malaria Burden: A South African Perspective.

Malaria is a deadly disease caused by protozoan pathogens of the Plasmodium parasite. Transmission to humans occurs through the bite of an infected female Anopheles mosquito. According to the World Health Organization (WHO), an estimated 247 million cases of malaria were recorded worldwide in 2021, with approximately 619 000 malaria deaths. The initial signs of malaria can be mild and challenging to diagnose due to the signs and symptoms being similar to those of other illnesses. The malaria burden remains largely concentrated in the WHO sub-Saharan African region and has been recognised as a significant contributor to morbidity and mortality. This review aims to contribute to the existing knowledge on malaria in South Africa, a region within sub-Saharan Africa, focusing on the epidemiology and life cycle of the malaria parasite as well as diagnostic approaches for detecting malaria. In addition, nonpharmacological and pharmacological interventions for treating and preventing malaria infections will also be discussed herein. While there has been a significant reduction in the global burden of this disease, malaria remains a public health issue in South Africa. As such, the implementation of effective preventative measures and strategies, early diagnosis, and appropriate treatment regimens are crucial to reducing the malaria burden in South Africa.

Mapping factors influencing initiation of antiretroviral treatment among adolescents living with HIV/AIDS in sub-Saharan Africa: A scoping review protocol.

Since the Start Free, Stay Free, and AIDS-Free launch, UNAIDS targets intended to promote interventions to prevent HIV transmission and promote access to ART among adolescents and children, of which none were achieved in 2020. In the sub-Saharan African region, the number of adolescents initiated on ART drugs remained consistently low, with approximately100 000 adolescents succumbing to AIDS-related causes in 2022. Although HIV prevalence among adolescents had been reduced, several HIV- positive adolescents died without being initiated on ART drugs. Therefore, this scoping review protocol aims to map factors influencing the initiation of ART drugs among adolescents living with HIV in sub-Saharan Africa. The methodological framework for scoping reviews will guide this scoping protocol. A search strategy will be used to search literature in electronic databases, including EBSCOhost (PubMed/MEDLINE), Google Scholar, Science Direct, Scopus, BioMed Central, and the World Health Organization library for citations and literature using keywords and the Medical Subjects Heading (MeSH). The electronic databases will be supplemented by hand-searching references on the included studies. The search will be from Jan 01, 2012, to Dec 31, 2022. Articles will be searched and assessed for eligibility by two screeners uploaded on the Endnote software, and duplicates will be identified and removed before the abstract screening. The two screeners will assess the eligibility of the abstracts and the complete articles of the selected studies using the inclusion and exclusion criteria. A third screener will intervene when there is a lack of consensus between the two screeners. The selection process will be documented by following and using the PRISMA flow diagram (Fig 1). A thematic content analysis will present a narrative account of the extracted data. The results of this review will identify and describe factors influencing the initiation of Antiretroviral treatment among adolescents living with HIV in the Sub-Saharan African region. The findings will guide future research and inform tailored interventions and strategies for initiating ART among adolescents. Open Science Framework. https://doi.org/10.17605/OSF.IO/RNF2T.

Towards ICT diffusion and trade liberalisation on inclusive growth in Sub-Saharan Africa

AbstractWhile the debate over the nexus between trade liberalization and inclusive growth is progressively reaching some consensus in emerging and developing economies, the empirical findings are mixed for sub-Saharan African (SSA) countries. Some of the SSA countries experience rapid growth in information and communication technology (ICT) diffusion manifesting in increased green wealth via the invention of new ideas, access to wider markets like the African Continental Free Trade Area (AfCFTA), promoting accountability, social inclusion, and e-governance among others. The present study critically assesses how ICT diffusion modulates trade liberalization on inclusive growth throughout the 2005–2020 periods for 48 SSA countries. This study contributes empirically and methodologically to literature, specifically on the construction of the ICT index, inclusive growth index, and adoption of a better befitting econometric model. The study explores the direct impacts of ICT diffusion and trade liberalization, and their indirect impacts using an interaction term on inclusive growth. Contrary to the prior expectations, trade liberalization does not lead to inclusive growth in the SSA region, but ICT diffusion has a positive and significant impact on inclusive growth. However, the interaction term of ICT and trade liberalization improves inclusive growth. Therefore, the study advocates for policies that would build a knowledge-based human capital, stimulate innovation in socio-economic systems, and develop ICT infrastructure and its penetration among others, with the expectation that as AfCFTA takes effect, ICT diffusion will facilitate intra-regional trade, enhancing inclusive growth in the African region among other sound policy suggestions.

The Current State of International Academic Partnerships in Orthopaedic Surgery Between High-Income and Low and Middle-Income Countries: A Systematic Review.

Orthopaedic academic partnerships between high-income countries (HICs) and low and middle-income countries (LMICs) are an effective method to increase research and scholarly support. The purpose of this study was to perform a systematic literature review of the current state of partnerships worldwide and assess the quality, quantity, and content of their research output. A systematic review was conducted using 4 academic databases: PubMed, MEDLINE, Embase, and CENTRAL. Article eligibility criteria included articles published between January 2017 and 2022, with orthopaedic authors from at least 1 HIC and LMIC. Articles related to global orthopaedic surgery with exclusively HIC or LMIC authors were excluded. The database search yielded 25,928 articles, and after deduplication, 21,145 articles were included in the screening. After title and abstract screening, 408 articles underwent full-text review for eligibility. The final list of eligible articles for extraction included 310 publications in 127 journals. Published articles increased over time (46 in 2017 to 88 in 2021) and were most commonly published in the Journal of Bone and Joint Surgery (20, 6.5%). Open-access articles (203, 65.5%) had a significantly greater Journal Citation Indicator (p = 0.024) than non-open-access articles. Most studies (40.7%) were observational, with few (3.6%) randomized controlled trials. Orthopaedic trauma (38.1%) was the most common subspecialty, followed by spine (14.8%) and pediatrics (14.2%). Most partnerships were sponsored by North American authors in 65 LMICs, primarily China, India, and the sub-Saharan African region. This study identified 310 articles published by orthopaedic international academic partnerships in 106 countries over the past 5 years, demonstrating that collaborations between LMIC/HIC partners nearly doubled over the study period. Sixty-five percent of the articles were published in open-access journals.

Neuro-oncology access in Sub-Saharan Africa: A literature review of challenges and opportunities.

Ensuring equitable access to treatments and therapies in the constantly evolving field of neuro-oncology is an imperative global health issue. With its unique demographic, cultural, socioeconomic, and infrastructure characteristics, Sub-Saharan Africa faces distinct challenges. This literature review highlights specific barriers to neuro-oncology care in the region and explores potential opportunities for enhancing access. Predetermined keyword searches were employed to screen titles and abstracts using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses framework. Inclusion criteria were studies published between January 1, 2003, and June 20, 2023, specifically addressing the capacity and challenges of neuro-oncology in the Sub-Saharan African region. The data sources queried were PubMed and Google Scholar. Systematic reviews and meta-analyses were deliberately excluded. All authors conducted independent screening and structured data extraction meticulously. Our paper identified multiple challenges that impede access to quality treatment for brain tumors. These include constrained resources, insufficient training of healthcare professionals, certain cultural beliefs, and a general lack of awareness about brain tumors, all contributing to delayed diagnosis and treatment. Furthermore, the lack of detailed data on the incidence and prevalence of primary central nervous system tumors impairs the accurate assessment of disease burden and precise identification of areas requiring improvement. However, we discovered that ongoing research, advocacy, enhanced training, mentorship, and collaborative efforts present valuable opportunities for substantial progress in neuro-oncology access. While we provide a glimpse of the current state, we hope these results will help stimulate dialogue and catalyze initiatives to surmount highlighted obstacles and improve neuro-oncology outcomes across Sub-Saharan Africa.

Analysing governance‐led infrastructural development nexus in sub‐Saharan Africa: Does the moderating role of institutional quality matter?

AbstractGovernments engage in infrastructural developments across the globe, and the level of success often colligates with institutional quality levels. However, despite the presence of governance, the lack of well‐developed infrastructure has bedevilled sub‐Saharan African (SSA) countries for decades. Therefore, this study investigates the governance‐led infrastructural development hypothesis for the SSA region from an institutional quality perspective towards addressing the infrastructural deficit challenges of the region. A combination of advanced panel econometric techniques was applied to data collected from the African Development Bank, World Bank World Development Indicator, and International Monetary Fund (IMF) to investigate the governance‐led infrastructural development hypothesis in SSA while controlling for financial development, economic growth, and industrialization in the region. The findings show that the interaction of institutional quality measures and governance indicators significantly and positively induces infrastructure in sub‐Saharan Africa (SSA). Additionally, while economic growth and financial development yield no expected significant influence on infrastructural developments, industrialization plays a crucial role, as its spillover effects are not confined to boosting economic growth alone but also to infrastructural transformations. Thus, the provision of policy frameworks by authorities to strengthen institutions and promote good governance is vital for articulating and facilitating infrastructural development plans for SSA.

Azithromycin during Routine Well-Infant Visits to Prevent Death

BackgroundMass distribution of azithromycin to children 1 to 59 months of age has been shown to reduce childhood all-cause mortality in some sub-Saharan African regions, with the largest reduction seen among infants younger than 12 months of age. Whether the administration of azithromycin at routine health care visits for infants would be effective in preventing death is unclear.MethodsWe conducted a randomized, placebo-controlled trial of a single dose of azithromycin (20 mg per kilogram of body weight) as compared with placebo, administered during infancy (5 to 12 weeks of age). The primary end point was death before 6 months of age. Infants were recruited at routine vaccination or other well-child visits in clinics and through community outreach in three regions of Burkina Faso. Vital status was assessed at 6 months of age.ResultsOf the 32,877 infants enrolled from September 2019 through October 2022, a total of 16,416 infants were randomly assigned to azithromycin and 16,461 to placebo. Eighty-two infants in the azithromycin group and 75 infants in the placebo group died before 6 months of age (hazard ratio, 1.09; 95% confidence interval [CI], 0.80 to 1.49; P=0.58); the absolute difference in mortality was 0.04 percentage points (95% CI, −0.10 to 0.21). There was no evidence of an effect of azithromycin on mortality in any of the prespecified subgroups, including subgroups defined according to age, sex, and baseline weight, and no evidence of a difference between the two trial groups in the incidence of adverse events.ConclusionsIn this trial conducted in Burkina Faso, we found that administration of azithromycin to infants through the existing health care system did not prevent death. (Funded by the Bill and Melinda Gates Foundation; CHAT ClinicalTrials.gov number, NCT03676764.)

Foreign Aid and Economic Growth in the Sub-Saharan African Countries

ABSTRACT: Official Development Assistance (ODA) remains an important tool for nurturing economic growth in Sub-Saharan African (SSA) countries. This is evidenced by numerous studies that have investigated the ODA-growth nexus in SSA region. However the existing studies on the relationship between ODA and economic growth is subject to identification issues. More specifically, the issue of distributional heterogeneity has not been given the attention it deserves in this field. In other words, the issue of whether ODA-growth nexus differ among developing nations with different economic growth levels has not been meticulously explored. This study aims to examine the heterogeneous impact of ODA on economic growth across 24 SSA countries over a 38-year period. To achieve this, an attempt is made in this study to investigate how the effect of ODA varies along the conditional economic growth distribution by employing the Moment of Moments Quantile Regression (MM-QR) approach, an approach that is able to capture the diverse effects of ODA across different levels of growth distribution. Moreover, this study explores the role of social infrastructure and institutional quality in shaping this relationship. The results suggest that ODA has a positive impact on economic growth in the SSA region, with a larger positive impact in countries with high levels of economic growth. This finding is key as it underlines the important idea that though ODA positively influence growth, it doesn’t homogeneously affect all nations; but instead, it remarkably enhance it in areas with relatively robust and healthy economic conditions. The study also finds a positive and significant relationship between social infrastructures and institutions quality and economic growth, particularly in the 50th, 75th, and 95th quantiles, thereby highlighting the fact that well-developed social infrastructures and high-quality institutions play a pivotal role in nurturing economic progress, particularly at the mid to higher percentiles of economic development. The inclusion of institutions quality and interaction terms in the model influences the effect of aid on economic growth, with ODA being effective in countries located within the 25th and 50th quantiles. The findings suggest that aid can be strategically used to stimulate economic growth in SSA countries, particularly low-income countries.

Differences in Breastfeeding Duration by Maternal HIV Status: A Pooled Analysis of Nationally Representative Surveys in Sub-Saharan Africa.

Breastfeeding improves child survival but is a source of mother-to-child HIV transmission among women with unsuppressed HIV infection. Estimated HIV incidence in children is sensitive to breastfeeding duration among mothers living with HIV (MLHIV). Breastfeeding duration may vary according to maternal HIV status. Sub-Saharan Africa. We analyzed pooled data from nationally representative household surveys conducted during 2003-2019 that included HIV testing and elicited breastfeeding practices. We fitted survival models of breastfeeding duration by country, year, and maternal HIV status for 4 sub-Saharan African regions (Eastern, Central, Southern, and Western). Data were obtained from 65 surveys in 31 countries. In 2010, breastfeeding in the first month of life ("initial breastfeeding") among MLHIV ranged from 69.1% (95% credible interval: 68-79.9) in Southern Africa to 93.4% (92.7-98.0) in Western Africa. Median breastfeeding duration among MLHIV was the shortest in Southern Africa at 15.6 (14.2-16.3) months and the longest in Eastern Africa at 22.0 (21.7-22.5) months. By comparison, HIV-negative mothers were more likely to breastfeed initially (91.0%-98.7% across regions) and for longer duration (median 18.3-24.6 months across regions). Initial breastfeeding and median breastfeeding duration decreased during 2005-2015 in most regions and did not increase in any region regardless of maternal HIV status. MLHIV in sub-Saharan Africa are less likely to breastfeed initially and stop breastfeeding sooner than HIV-negative mothers. Since 2020, UNAIDS-supported HIV estimates have accounted for this shorter breastfeeding exposure among HIV-exposed children. MLHIV need support to enable optimal breastfeeding practices and to adhere to antiretroviral therapy for HIV treatment and prevention of postnatal mother-to-child transmission.

Utilisation of mobile phone interventions to improve the delivery of maternal health services in sub-Saharan Africa: A scoping review protocol.

There has been significant progress in maternal health outcomes in the sub-Saharan African region since the early 1990s, in part due to digital and mobile health interventions. However, critical gaps and disparities remain. Mobile phones in particular have potential to reach underserved, hard-to-reach populations with underdeveloped infrastructure. In spite of the opportunities for mobile phones to address maternal mortality in the region, there is no extensive mapping of the available literature on mobile phone interventions that aim to improve access of maternal care in sub-Saharan Africa. The proposed scoping review aims to map literature on the nature and extent of mobile phones interventions designed to improve maternal care health services in the region. Conduct of this scoping review will be guided by the Joanna Briggs Institute approach. Literature searches will be conducted in multiple electronic databases, including MEDLINE, Embase, CINAHL, APA PsycInfo, Cochrane Central Register of Controlled Trials, Global Health, African Index Medicus, Web of Science, and Applied Social Sciences Index & Abstracts. Grey literature will also be identified. Keyword searches will be used to identify articles. Two reviewers will independently screen eligible titles, abstracts and full articles with a third reviewer to help resolve any disputes. We will extract data on general study characteristics, population characteristics, concept, context, intervention details, study results, gaps and recommendations. Understanding use of mobile phones among underserved, hard-to-reach populations with underdeveloped infrastructure to address maternal mortality in developing countries is very critical to informing health systems on potential effective strategies. This review will complement the evidence base on utilisation of mobile phone interventions to improve the delivery of maternal health services in sub-Saharan Africa.