Systems In sub-Saharan Africa Research Articles

DOES WOODFUEL PRICE DISTORTION INHIBIT ECO-EFFICIENCY IN WOODFUEL EXPLOITATION SYSTEMS IN SUB-SAHARAN AFRICA? EVIDENCE FROM CAMEROON

The aim of this study is to assess the impacts of woodfuel prices distortion on the eco-efficiency of woodfuel exploitation systems. The study, conducted in Cameroon, involved 415 randomly selected woodfuel operators. To achieve this, the marginal opportunity cost approach and the stochastic specification of the production technology were used to assess the price distortion degree and the eco-efficiency indices, respectively. In doing so, the 2SLS allowed to evaluate the impacts of woodfuel prices distortion on eco-efficiency of woodfuel exploitation systems. From this study, we conclude that the woodfuel prices distortion does not encourage eco-efficient exploitation of this resource. A 1% increase in the degree of distortion results in a reduction in eco-efficiency of −0.019 points. Including the optimal price in the woodfuel pricing system will improve eco-efficiency by 0.030 points. In view of these results, a marginal opportunity cost pricing system that takes into account all the exploitation costs ignored by the market price like user costs associated with resource depletion and the external costs associated with CO2 emissions will encourage producers to adopt a sustainable woodfuel exploitation path.

Time to bring female genital schistosomiasis out of neglect.

Female genital schistosomiasis (FGS) is a chronic gynaecological disease affecting girls and women in sub-Saharan Africa (SSA), caused by the parasite Schistosoma (S.) haematobium. FGS is associated with sexual dysfunction, reproductive tract morbidity and increased prevalence of HIV and cervical precancer lesions. Key peer-reviewed published literature. FGS screening and diagnosis require costly equipment and specialized training, seldom available in resource-limited settings. FGS surveillance is not included in wider schistosomiasis control strategies. The interplay of FGS with other SRH infections is not fully understood. Integration of FGS within sexual and reproductive health (SRH) control programmes needs to be explored. There are no standardized methods for individual or population-based FGS screening and diagnosis, hindering accurate disease burden estimates and targeted resource allocation. Treatment recommendations rely on public health guidelines, without rigorous clinical evidence on efficacy. Integrating FGS screening with SRH programmes offers an opportunity to reach at-risk women with limited access to healthcare services. Home-based self-sampling coupled with handheld colposcopes operated by primary healthcare workers show promise for FGS diagnosis and surveillance at scale. There is growing interest in decentralizing strategies for FGS screening and diagnosis. The accurate predictions on the 'cost-effectiveness' of these approaches will determine their affordability and feasibility within the overburdened health systems in SSA. Clinical trials are needed to optimize FGS treatment. Longitudinal studies can expand on the epidemiological knowledge on co-morbidities and integration within other SRH interventions.

A participatory framework for prioritizing climate-smart agriculture innovations in rice-based systems: A case study of Mali

Alleviating the climate-related constraints faced by agri-food systems in sub-Saharan Africa requires an accelerated adoption of climate-smart agriculture (CSA) innovations by farmers. However, little is known about the best-bet (most appropriate) CSA innovations, and the enabling conditions for their widespread adoption in a given biophysical and socioeconomic context. The objectives of this study were to identify the best-bet CSA innovations and the barriers, incentive mechanisms, and roles of institutions in widespread adoption in the four rice growing environments in Mali (irrigated lowlands, rainfed lowlands, rainfed uplands, and submergence systems). Data were collected from stakeholder's consultations to assess CSA innovations using four climate-smart performance indicators (productivity, income, adaptation, and mitigation) and four implementation feasibility indicators (technology cost, technical feasibility, gender inclusivity, and market demand). The best-bet CSA innovations included drought- and submergence-tolerant rice varieties, perennial rice, and rice-vegetable rotation in irrigated lowlands; drought-tolerant rice varieties, rice-tuber, rice-vegetable, and rice-legume rotations in rainfed lowlands; drought-tolerant rice varieties and mulching in rainfed uplands; and submergence-tolerant rice varieties, perennial rice, and integrated rice-fish in submergence systems. The average perceived adoption level of CSA innovations by farmers in the rice-growing environments was low, ranging from 7 to 19 % due to the lack of finance, technical knowledge, machinery, fertilizer, and quality seeds. Governments, farmers’ organizations, and research and academic institutions were identified as critical actors in the wide spread adoption of CSA innovations. The framework used in this study can be used to identify and invest into locally relevant best-bet CSA innovation packages.

Strategic Framework for Development of Typology-based Fertilizer Policy and Regulatory Systems in Sub-Saharan Africa

Strategic Framework for Development of Typology-based Fertilizer Policy and Regulatory Systems in Sub-Saharan Africa

Seeking and receiving hypertension and diabetes mellitus care in Tanzania.

The rapid increase in chronic non-communicable diseases (NCDs) poses a major challenge to already strained health systems in sub-Saharan Africa. This study investigates the factors associated with seeking and receiving NCD services in Tanzania, using a household survey and client exit interview data from Kilombero and Same districts. Both districts are predominantly rural, with one semi-urban area called Ifakara town and Same town. Of the 784 household survey respondents, 317 (40.4%), 37 (4.7%), and 20 (2.5%) were diagnosed with hypertension, diabetes mellitus, and other NCDs, respectively, of whom 69% had sought care in the past six months. After controlling for covariates, those enrolled in the National Health Insurance Fund (NHIF) and those who received a user fees waiver were more likely to use health services. However, even when NCD patients managed to access the care they needed, they were likely to receive incomplete services. The main reason for not receiving all services at the health facility visited on the day of the survey was drug stock-outs. Among health care users, those registered with the improved Community Health Funds (iCHF) were less likely to receive all prescribed services at the health facility visited than uninsured patients. The findings of this study highlight the need to strengthen both primary care and social health protection systems to improve access to needed care for NCD patients.

Insecticide contamination in organic agriculture: Evidence from a long-term farming systems comparisons trial

Synthetic pesticides applied in conventional agriculture to control pests tend to compromise ecosystem services, and their residues may contaminate organic agriculture. To understand the significance of this contamination, also in small-scale farming systems in sub-Saharan Africa, quantitative data is required. Therefore, we compared synthetic insecticide and botanical/biopesticide residues in conventional and organic agricultural production systems after nine years of continuous cultivation of a maize-based crop rotation system at two sites in Kenya. Our results show high detectable concentrations of synthetic insecticide residues (imidacloprid, acetamiprid, chlorpyrifos, and chlorantraniliprole) in conventional plant produce and soil. Furthermore, the organophosphate chlorpyrifos was detected at concentrations above European Union Maximum Residue Limits (MRL) for plant produce, indicating potential risks for human health. Additionally, we detected imidacloprid, acetamiprid, chlorpyrifos, and chlorantraniliprole concentrations in the soil, indicating potential environmental harm. No residues of biopesticide/botanicals were detected in any of the production systems. However, we detected imidacloprid and chlorantraniliprole in organic plots. The findings indicate that the MRLs can be crossed even if synthetic insecticides are applied according to or below the recommended rates on the conventional plots. Thus, synthetic insecticides potentially risk human health and the environment, while botanicals and bio-pesticides represent a safe alternative.

Understanding drought risk management in vulnerable communities in dryland farming systems: Evidence from northwest Ghana

Drought intensity and associated risks are increasing in sub-Saharan Africa (SSA) with dire implications for sustainable livelihood. Yet, there is a limited comprehensive understanding of the severity of drought risks in dryland farming systems in sub-Saharan Africa including Ghana, where climate change has multiple effects on farming operations. Monitoring episodic droughts is particularly important for developing local-based adaptive interventions to sustainably improve livelihood and food systems. Drawing evidence from Northwest Ghana, this study used a Rainfall Anomaly Index (RAI), Principal Component Analysis (PCA) and Binary Logistic Regression (BLR) to understand drought indices and risks of 40 years (1981–2020), and assessed prioritized coping measures and determinants in rural farming communities. The study revealed that farmers in Northwest Ghana have been experiencing severe intermittent drought risks in the last four decades, with extreme episodes observed in 1983 and 1984. Results show that northern Ghanaian households are coping with drought risks using several strategies such as picking edible wild fruit, migration for labour work, remittances from family members and friends, livestock rearing and sale, petty trading, and basket weaving as the key coping measures by households to counteract drought risk. The BLR estimates show that socio-economic variables such as marital status, household size, market access, and farmland size are significant factors that can predict farmers’ coping interventions. The sale of livestock as a buffer to support households rebound from a climate disaster is critical. We suggest that decision-makers and policy-makers mainstream access to social safety schemes in drought-affected locations to sustain local food systems, agricultural biodiversity and livelihoods.

Rheumatology in Cameroon: History, Challenges, and Future.

Rheumatology is a medical specialty that deals with diseases of bones, joints, tendons, and muscles. It is a relatively young specialty in sub-Saharan Africa, particularly in Cameroon. We believe that current and future generations need to know the history and challenges of rheumatology in Cameroon, which not only is a mainstay of Central Africa but also reflects many other health systems in sub-Saharan Africa, to properly identify the challenges facing this specialty and define appropriate strategies for developing countries in sub-Saharan Africa.

Sustainable intensification of sorghum-based cropping systems in semi-arid sub-Saharan Africa: The role of improved varieties, mineral fertilizer, and legume integration

ProblemSustainable intensification of cereal cropping systems can contribute to reducing food insecurity while mitigating biodiversity losses thanks to land sparing. Yet, intensifying crop production with more nutrient inputs often increases sensitivity to climate hazards and yields inter-annual variability. How different options for sustainable intensification interact and how they could help achieve greater and less variable yields is not well known for key cereal cropping systems of sub-Saharan Africa. ObjectiveHere, we aim to assess the impact on productivity and its interannual variation of three contrasted strategies of crop intensification, namely i) the integration of cowpea intercropped with sorghum or as sole crop, ii) improved varieties with high harvest index and greater nitrogen use efficiency, and iii) the use of more mineral fertilizer. MethodsWe did this assessment using a calibrated soil-crop model for a case study of sorghum-based cropping systems of semi-arid southern Mali, using a historical weather series from 1980 to 2010. ResultsWe found that the incremental combinations of two or three strategies helped increase productivity in terms of energy and protein. However, greater productivity went hand in hand with greater inter-annual variability. Intercropping sorghum with cowpea helped to reduce the inter-annual variability of productivity, but only when mineral fertilizer was not added. With mineral fertilizer input, sorghum contributed the largest share of the intercrop productivity, and sorghum yield was more variable from a year to another than cowpea yield. The overall productivity of intercropping sorghum with cowpea was always greater than having the two sole crops on separate plots. This was possible thanks to the facilitation of light, water and N acquisition by the two crops in the intercropping, regardless of the specificities of the growing season with regard to water and nitrogen stress. However, the variability of productivity was smaller for the cultivation of the two sole crops on separate plots, regardless of fertilizer input. ConclusionThe often-claimed benefit of intercropping on reducing the inter-annual variability of production does not hold when the three strategies are combined. ImplicationsOur results suggest that the integration of legumes does not help cushion farmers against the risk related to the intensification of cropping systems with more nutrients and improved seeds. Careful gross margin analysis that accounts for price variability and uncertainty would be required to refine this risk assessment for specific farm contexts. We discuss the implication of these findings in light of the current research agenda for the sustainable intensification of cropping systems in sub-Saharan Africa.

Implementing Clinical Information Systems in Sub-Saharan Africa: Report and Lessons Learned From the MatLook Project in Cameroon.

Yaoundé Central Hospital (YCH), located in the capital of Cameroon, is one of the leading referral hospitals in Cameroon. The hospital has several departments, including the Department of Gynecology-Obstetrics (hereinafter referred to as "the Maternity"). This clinical department has faced numerous problems with clinical information management, including the lack of high-quality and reliable clinical information, lack of access to this information, and poor use of this information. We aim to improve the management of clinical information generated at the Maternity at YCH and to describe the challenges, success factors, and lessons learned during its implementation and use. Based on an open-source hospital information system (HIS), this intervention implemented a clinical information system (CIS) at the Maternity at YCH and was carried out using the HERMES model-the first part aimed to cover outpatient consultations, billing, and cash management of the Maternity. Geneva University Hospitals supported this project, and several outcomes were measured at the end. The following outcomes were assessed: project management, technical and organizational aspects, leadership, change management, user training, and system use. The first part of the project was completed, and the CIS was deployed in the Maternity at YCH. The main technical activities were adapting the open-source HIS to manage outpatient consultations and develop integrated billing and cash management software. In addition to technical aspects, we implemented several other activities. They consisted of the implementation of appropriate project governance or management, improvement of the organizational processes at the Maternity, promotion of the local digital health leadership and performance of change management, and implementation of the training and support of users. Despite barriers encountered during the project, the 6-month evaluation showed that the CIS was effectively used during the first 6 months. Implementation of the HIS or CIS is feasible in a resource-limited setting such as Cameroon. The CIS was implemented based on good practices at the Maternity at YCH. This project had successes but also many challenges. Beyond project management and technical and financial aspects, the other main problems of implementing health information systems or HISs in Africa lie in digital health leadership, governance, and change management. This digital health leadership, governance, and change management should prioritize data as a tool for improving productivity and managing health institutions, and promote a data culture among health professionals to support a change in mindset and the acquisition of information management skills. Moreover, in countries with a highly centralized political system like ours, a high-level strategic and political anchor for such projects is often necessary to guarantee their success.

Toward smallholder bamboo-integrated agro-silvopastoral systems in sub-Saharan Africa: assessing the impact of bamboo leaves on consumption pattern, growth performance and manure characteristics of West African dwarf goats

IntroductionThe selection of appropriate plant species, particularly those tailored to supplement ruminants raised under agrosilvopastoral systems, remains a persistent challenge.ObjectiveIn a 30-day study, the feed intake, growth performance, and manure characteristics of West African dwarf (WAD) goats fed bamboo leaf supplement were evaluated. Materials and methodsA total of 30 animals with an average weight of 9.9 ± 0.21 kg were divided into a control group, and four bamboo-supplemented groups, following a 2 x 2 factorial arrangement within a completely randomized design. Each group had six animal replicates and received the following dietary treatments: T1 (control) – 400g of basal diet composed of 60% Megathyrsus maximus and 40% Bridelia ferruginea leaves per day; T2—basal diet composed of the T1 diet supplemented with 400 g of Oxytenanthera abyssinica (A. Rich.) Munro leaves per day; T3—basal diet composed of the T1 diet supplemented with 400 g of Bambusa balcooa (Beema) leaves per day; T4—basal diet composed of the T1 diet supplemented with 600 g of O. abyssinica (A. Rich.) leaves per day; and T5—basal diet composed of the T1 diet supplemented with 600 g of B. balcooa leaves per day. The data were analyzed using generalized linear model procedures in Minitab Statistical Software at a 5% significance level. ResultsThe results showed varied (p < 0.05) dry matter compositions spanning from 894.3 to 910 g/kg with the highest contents of crude protein (194 g/kg), nitrogen (31 g/kg), crude fibre (302 g/kg), ash (156 g/kg), acid detergent fibre (429 g/kg), and acid detergent lignin (3.6 g/kg) recorded for B. ferruginea. The leaves of Bambusa balcooa contained the highest neutral detergent fibre (481 g/kg) while M. maximus had the highest organic matter content (911 g/kg). Significant interaction effect (p < 0.05) was observed between the supplement type and the supplementation level, impacting various parameters including feed intake ranging from 398 g (T1) to 469 g (T3) per day, weight gain from 27 g (T1) to 72 g (T2) per day, feed conversion efficiency from 6% (T1) to 15% (T2), manure output from 241 g (T2) to 260 g (T5) per day, carbon- nitrogen (C: N) ratio from 9 (T2) to 20 (T5), faecal acidity levels from 4 (T1) to 5 (T4). Comparatively, higher daily dry matter intake was recorded for the animal groups fed the B. balcooa supplement than their counterparts fed the O. abyssinica supplement. However, the O. abyssinica supplemented groups were more efficient in converting feed to body weight, with feed conversion efficiency approximately 9% higher than the B. balcooa-supplemented groups. Furthermore, in general, the animal groups that received a daily supplement of 400 g gave higher feed efficiency, with performance approximately 3.2% higher compared to the groups receiving 600 g. Likewise, these groups displayed higher faecal N output while concurrently achieving a reduced C: N ratio, indicative of enhanced nutrient utilization and potential environmental benefits. ConclusionTo conclude, integrating 400 grams of bamboo leaves into animal diet can enhance basal diet consumption, accelerate animal growth, and yield manure akin to chemical fertilizers, making it a valuable strategy for bamboo-integrated agro-silvopastoral systems practitioners.

One Hundred Priority Questions for the Development of Sustainable Food Systems in Sub-Saharan Africa

Sub-Saharan Africa is facing an expected doubling of human population and tripling of food demand over the next quarter century, posing a range of severe environmental, political, and socio-economic challenges. In some cases, key Sustainable Development Goals (SDGs) are in direct conflict, raising difficult policy and funding decisions, particularly in relation to trade-offs between food production, social inequality, and ecosystem health. In this study, we used a horizon-scanning approach to identify 100 practical or research-focused questions that, if answered, would have the greatest positive impact on addressing these trade-offs and ensuring future productivity and resilience of food-production systems across sub-Saharan Africa. Through direct canvassing of opinions, we obtained 1339 questions from 331 experts based in 55 countries. We then used online voting and participatory workshops to produce a final list of 100 questions divided into 12 thematic sections spanning topics from gender inequality to technological adoption and climate change. Using data on the background of respondents, we show that perspectives and priorities can vary, but they are largely consistent across different professional and geographical contexts. We hope these questions provide a template for establishing new research directions and prioritising funding decisions in sub-Saharan Africa.

The HIV/AIDS responses pre and during the COVID-19 pandemic in sub-Saharan Africa: A basis for sustainable health system strengthening post–COVID-19

In May 2023, the World Health Organization announced that COVID-19 was no longer a global emergency. The impact of COVID-19 on the provision of HIV/AIDS services was not that severe due to the reprogramming of key resources. For health systems in sub-Saharan Africa to become resilient to future pandemics, lessons should be learned from the successful HIV/AIDS response in the region, and how the HIV/AIDS services were successfully adapted to the COVID-19 pandemic. In this article, we reviewed the 6 World Health Organization health system building blocks on how the best practices from the provision of HIV/AIDS services and the services’ response to the COVID-19 pandemic can be used as a basis for restoring and strengthening health systems to offer universal access to quality essential health services. The success of the leadership and governance for universal access to anti-retroviral therapy can be a blueprint for the realization of universal health coverage. Significant efficiencies that resulted in the reduction in anti-retroviral therapy costs can be leveraged to ensure cheaper essential drugs while differentiated service delivery models can be used to improve health service accessibility. New technologies that have proven to be successful in HIV/AIDS care can also be used in the care of other diseases, including disease outbreaks. The strong health information systems developed for HIV programs can be used as a foundation for developing health information systems for the whole health sector while the healthcare professionals trained for the provision of HIV/AIDS services can be trained to provide services for a variety of other conditions.

Value-Ethical System in Sub-Saharan Africa. From the Past to the Future

The article is devoted to the analysis of the value-ethical system in Sub-Saharan Africa in historical retrospect with the transition to modernity. The concept of “value-ethical system” reflects the specifics of the African worldview, in which all values have a moral meaning. The article analyzes the value foundation on which Africans want to build “the Africa they dream of” (as stated in the program document of the African Union “Agenda 2063”). The author examines African traditional values based on the research of modern African scientists, on her own African archives, on memories and personal impressions collected by the author during her stay in the countries of the African continent. In traditional Africa, there exist value-ethical complexes in which ancient folk wisdom is concentrated. This is, for example, Ubuntu of the Bantu peoples – humanity, equality of people, regardless of race, nationality, religion. It is also a community solidarity associated with the importance of family ties. The author proves that the culture of Sub-Saharan Africa belongs to the collectivist type. Collectivism in combination with Ubuntu serves as a barrier to the adoption by Africans of a Protestant work ethic that welcomes individual success, competition, and profit orientation (outside of the principle of fairness). “Western” values are the opposite of traditional African ethics and values. Currently, the countries of sub-Saharan Africa are looking for their own way of development within the framework of capitalism. African scientists want to develop a system of economic philosophy that includes traditional African values in order to make capitalism relevant to African countries and acceptable to the African mentality. Special attention is paid to the issues of dialogue, traditional democracy and African organizational and managerial principles.

Low-cost agroforestry technologies for climate change mitigation and adaptation in Sub-Saharan Africa: A review

Agroforestry encompasses a large set of techniques and practices that have the potential to improve farm productivity with minimum environmental impacts in the context of climate change mitigation and adaptation (CCMA). In this paper, we discuss the relevance of agroforestry technologies and practices for CCMA in Sub-Saharan Africa (SSA). We recorded 173 scholarly works and and reviewed 62. Our findings indicate that comprehensive and well-developed technologies are used in agroforestry systems in SSA. They can be classified into four main groups (intercropping, improved fallows, mulching and parkland) and seven sub-groups (relay cropping, hedgerow intercropping, rotational woodlots, coppicing fallows, farmer-managed regeneration, on-farm tree domestication through poly-propagation and mulching) based on factors including the origins and uses of the trees and the types of tree-crop association. Our review showed that the maximum positive effect of parkland agroforestry is obtained when tree density ranges from 20 to 40 tree/ha, indicating an increase in crop production of 915.9 kg/ha. Furthermore, overall, the returns to labour of techniques involving fertilizer trees outperform those for natural fallows by 17%. Agroforestry techniques contribute substantially to the REDD+ program, but the best techniques with the highest cost-benefit- ratio and a substantial CCMA effect appear to be the intercropping and improved fallow systems. However, we observed a lack of detailed context-specific economic, social and environmental costs for the different techniques. For effective and rational decision-making by farmers in their adoption of agroforestry, further research should focus on filling in the detailed economic, social and environmental costs of each technology in each specific context.

Applying circular economy principles to intensification of livestock production in Sub-Saharan Africa

In the context of sustainable agricultural development, much has been made of the need to apply agroecology or regenerative principles to improve rural livelihoods and to align the sector with critical planetary health boundaries. This movement is a reaction to the perceived private and social costs arising from both production and consumption associated with industrialised agriculture, mostly in upper-income countries, with several default assumptions being apparent about applicability elsewhere. The notion of circularity, or the circular economy, is frequently conflated with agro ecological rhetoric, often overlooking a longer tradition of circular resource use efficiency in traditional mixed crop–livestock farming in low-income settings. This paper examines the concept and origins of circularity and reviews some examples of historic circular economy research within the international agricultural research system as applied to smallholder agriculture. These include (i) studies focusing on the impact of crop residue retention, (ii) work on residue incorporation and/or mulching and their effects on crop yields and soil fertility, (iii) research on the effects of manure use on crop yields and soil fertility and (iv) work on the feeding of crop residues to livestock. We consider some promising innovations or practices adhering to circular economy principles. Candidate innovations focus on the improvement of livestock feeding practices including the breeding of dual-purpose crops to enhance livestock nutrition, conversion of cereal straw residues to high-quality feed, use of cassava waste as livestock feed and use of insects as livestock feed. We conclude by considering how circular bio-economy principles might be maintained in the future evolution of food systems in Sub-Saharan Africa.

Incidental radiological findings during clinical tuberculosis screening in Lesotho and South Africa: a case series

BackgroundChest X-ray offers high sensitivity and acceptable specificity as a tuberculosis screening tool, but in areas with a high burden of tuberculosis, there is often a lack of radiological expertise to interpret chest X-ray. Computer-aided detection systems based on artificial intelligence are therefore increasingly used to screen for tuberculosis-related abnormalities on digital chest radiographies. The CAD4TB software has previously been shown to demonstrate high sensitivity for chest X-ray tuberculosis-related abnormalities, but it is not yet calibrated for the detection of non-tuberculosis abnormalities. When screening for tuberculosis, users of computer-aided detection need to be aware that other chest pathologies are likely to be as prevalent as, or more prevalent than, active tuberculosis. However, non­-tuberculosis chest X-ray abnormalities detected during chest X-ray screening for tuberculosis remain poorly characterized in the sub-Saharan African setting, with only minimal literature.Case presentationIn this case series, we report on four cases with non-tuberculosis abnormalities detected on CXR in TB TRIAGE + ACCURACY (ClinicalTrials.gov Identifier: NCT04666311), a study in adult presumptive tuberculosis cases at health facilities in Lesotho and South Africa to determine the diagnostic accuracy of two potential tuberculosis triage tests: computer-aided detection (CAD4TB v7, Delft, the Netherlands) and C-reactive protein (Alere Afinion, USA). The four Black African participants presented with the following chest X-ray abnormalities: a 59-year-old woman with pulmonary arteriovenous malformation, a 28-year-old man with pneumothorax, a 20-year-old man with massive bronchiectasis, and a 47-year-old woman with aspergilloma.ConclusionsSolely using chest X-ray computer-aided detection systems based on artificial intelligence as a tuberculosis screening strategy in sub-Saharan Africa comes with benefits, but also risks. Due to the limitation of CAD4TB for non-tuberculosis-abnormality identification, the computer-aided detection software may miss significant chest X-ray abnormalities that require treatment, as exemplified in our four cases. Increased data collection, characterization of non-tuberculosis anomalies and research on the implications of these diseases for individuals and health systems in sub-Saharan Africa is needed to help improve existing artificial intelligence software programs and their use in countries with high tuberculosis burden.

Consistency, variability, and predictability of on-farm nutrient responses in four grain legumes across East and West Africa.

Grain legumes are key components of sustainable production systems in sub-Saharan Africa, but wide-spread nutrient deficiencies severely restrict yields. Whereas legumes can meet a large part of their nitrogen (N) requirement through symbiosis with N2-fixing bacteria, elements such as phosphorus (P), potassium (K) and secondary and micronutrients may still be limiting and require supplementation. Responses to P are generally strong but variable, while evidence for other nutrients tends to show weak or highly localised effects. Here we present the results of a joint statistical analysis of a series of on-farm nutrient addition trials, implemented across four legumes in four countries over two years. Linear mixed models were used to quantify both mean nutrient responses and their variability, followed by a random forest analysis to determine the extent to which such variability can be explained or predicted by geographic, environmental or farm survey data. Legume response to P was indeed variable, but consistently positive and we predicted application to be profitable for 67% of farms in any given year, based on prevailing input costs and grain prices. Other nutrients did not show significant mean effects, but considerable response variation was found. This response heterogeneity was mostly associated with local or temporary factors and could not be explained or predicted by spatial, biophysical or management factors. An exception was K response, which displayed appreciable spatial variation that could be partly accounted for by spatial and environmental covariables. While of apparent relevance for targeted recommendations, the minor amplitude of expected response, the large proportion of unexplained variation and the unreliability of the predicted spatial patterns suggests that such data-driven targeting is unlikely to be effective with current data.

For a shift of paradigm in healthcare systems in sub-Saharan Africa: Moving from current unequal access to modern care to sustainable health systems encompassing African traditional medicine

Background: Health is one of the major challenges for the development of Africa, whether it is to improve the current state of health of Africans or to allow the emergence of a healthy workforce able to contribute to the economic growth of Africa. Objectives: This paper aims to highlighting gaps in access to modern care, to identify attraction factors for traditional African medicine helping with the current health crisis due to Covid-19, to propose ways of uilding synergies and to encourage more efficient and consistent health systems. Methods: We conducted a systematic review using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. We evaluated sources of heterogeneity by keywords (health system, health care providers, Africa, diseases), and pooled heterogeneity analysis addressed by authors, using meta-analysis methods. Results: With Covid-19, African health systems have been less overwhelmed and health consequences less dramatic than those of European and American countries, but the pandemic has exposed the flaws of health systems that have reached their limits. Conclusion: Because health is one of the relatively neglected challenges in development policies in Africa and because health will become a strategic development issue in the coming years, it is therefore becoming increasingly important to re-think the organization and functioning of health systems in Africa.

Techno-economic feasibility of hybrid hydro-FPV systems in Sub-Saharan Africa under different market conditions

Floating photovoltaic (FPV) systems are an emerging and increasingly competitive application of solar PV, especially in land area-constrained countries. This study focuses on the optimal dimensioning and scheduling of a grid-connected hybrid hydro-FPV system. The case study is based on a cascade hydropower system located in Sub-Saharan Africa. The techno-economic feasibility of the hybrid system is analysed under different types of revenue streams and load commitments. Moreover, the resource complementarity between solar irradiation and reservoir water inflow in different weather years is analysed. A linear programming model for optimal dimensioning/scheduling of a hybrid hydro-FPV system is proposed. The results indicate that hybridisation with FPV can under the proposed PPA and spot market structure increase the annual producer profits by 18–21% and 0–4%, respectively compared to a hydro-only system. Furthermore, it is estimated that the CAPEX of FPV should be around 42–57% lower than that of ground-mounted PV (GPV) with single-axis tracking for the hydro-FPV system to reach the same annual producer profit as the hydro-GPV system. Considering improved efficiency by cooling the FPV modules, the revenues increase by 0–3% depending on the selected weather year and market scheme.