Systems In sub-Saharan Africa Research Articles

Selenium deficiency risks in sub-Saharan African food systems and their geospatial linkages.

Selenium (Se) is an essential element for human health. However, our knowledge of the prevalence of Se deficiency is less than for other micronutrients of public health concern such as iodine, iron and zinc, especially in sub-Saharan Africa (SSA). Studies of food systems in SSA, in particular in Malawi, have revealed that human Se deficiency risks are widespread and influenced strongly by geography. Direct evidence of Se deficiency risks includes nationally representative data of Se concentrations in blood plasma and urine as population biomarkers of Se status. Long-range geospatial variation in Se deficiency risks has been linked to soil characteristics and their effects on the Se concentration of food crops. Selenium deficiency risks are also linked to socio-economic status including access to animal source foods. This review highlights the need for geospatially-resolved data on the movement of Se and other micronutrients in food systems which span agriculture-nutrition-health disciplinary domains (defined as a GeoNutrition approach). Given that similar drivers of deficiency risks for Se, and other micronutrients, are likely to occur in other countries in SSA and elsewhere, micronutrient surveillance programmes should be designed accordingly.

An infrastructure of light and darkness: in visual conversation with Baudouin Mouanda

ABSTRACTThis article owes its inspiration to a series of photos that poetically documents the street lighting conditions in Brazzaville and which was taken by the Congolese photographer Baudouin Mouanda (born 1981). The first section reviews the provision of electricity and street lighting systems in sub-Saharan Africa as an expression of state power and weakness through infrastructural visibility and invisibility. Its aim is to provide a qualitative background and to enhance the situational understanding of the second, site-related section of the article which focuses on Brazzaville, the capital city of the Republic of Congo. Here Mouanda’s visual series is interpreted in light of conceptions of the ‘shadow’ and the ‘non-complete’, usable in trying to grasp the urban formations and lived realities in the global South.

Farmers’ Preferences for Genetic Resources of Kersting’s Groundnut [Macrotyloma geocarpum (Harms) Maréchal and Baudet] in the Production Systems of Burkina Faso and Ghana

Pulses play important roles in providing proteins and essential amino-acids, and contribute to soils’ nutrients cycling in most smallholder farming systems in Sub-Saharan Africa (SSA). These crops can be promoted to meet food and nutrition security goals in low-income countries. Here, we investigated the status of Kersting’s groundnut (Macrotyloma geocarpum, Fabaceae), a neglected pulse in West Africa. We explored its diversity, the production systems, the production constraints and farmers’ preferences in Burkina Faso and Ghana. Focus groups and semi-structured interviews were conducted in 39 villages with 86 respondents grouped in five sociolinguistic groups. Our results indicated that Macrotyloma geocarpum was produced in three cultivation systems: in the first system, farmers grew Kersting’s groundnut in fields, mostly on mounds or on ridges; in the second system, farmers grew it as field border; and in the third system, no clear tillage practice was identified. The main constraints of those farming systems included: difficulty to harvest, the lack of manpower and the damage due to high soil humidity at the reproductive stage. A total of 62 samples were collected and clustered in six landraces based on seed coat colors including cream, white mottled with black eye, white mottled with greyed orange eye, black, brown mottled, and brown. All six groups were found in the southern-Sudanian zone whereas only white mottled with black eye and black colors were found in the northern-Sudanian zone. The white mottled with black eye landrace was commonly known and widely grown by farmers. Farmers’ preferences were, however, influenced by sociolinguistic membership and the most preferred traits included high yielding, drought tolerance, and resistance against beetles. These findings offer an avenue to develop a relevant breeding research agenda for promoting Kersting’s groundnut in Burkina Faso and Ghana.

Costs of insecticide-treated bed net distribution systems in sub-Saharan Africa

BackgroundInsecticide-treated nets (ITNs) are one of the most cost-effective measures for preventing malaria. The World Health Organization recommends both large-scale mass distribution campaigns and continuous distributions (CD) as part of a multifaceted strategy to achieve and sustain universal access to ITNs. A combination of these strategies has been effective for scaling up ITN access. For policy makers to make informed decisions on how to efficiently implement CD or combined strategies, information on the costs and cost-effectiveness of these delivery systems is necessary, but relatively few published studies of the cost continuous distribution systems exist.MethodsTo address the gap in continuous distribution cost data, four types of delivery systems—CD through antenatal care services (ANC) and the expanded programme on immunization (EPI) (Ghana, Mali, and mainland Tanzania), CD through schools (Ghana and mainland Tanzania), and a combined community/health facility-based distribution (Zanzibar, Tanzania), as well as mass distributions (Mali)—were costed. Data on costs were collected retrospectively from financial and operational records, stakeholder interviews, and resource use surveys.ResultsOverall, from a full provider perspective, mass distributions and continuous systems delivered ITNs at overlapping economic costs per net distributed (mass distributions: 4.37–4.61 USD, CD channels: 3.56–9.90 USD), with two of the school-based systems and the mass distributions at the lower end of this range. From the perspective of international donors, the costs of the CD systems were, for the most part, less costly than the mass distributions (mass distributions: 4.34–4.55 USD, Ghana and Tanzania 2017 school-based: 3.30–3.69 USD, health facility-based: 3.90–4.55 USD, combined community/health facility 4.55 USD). The 2015 school-based distribution (7.30 USD) and 2016 health facility-based distribution (6.52 USD) programmes in Tanzania were an exception. Mass distributions were more heavily financed by donors, while CD relied more extensively on domestic resource contributions.ConclusionsThese results suggest that CD strategies can continue to deliver nets at a comparable cost to mass distributions, especially from the perspective of the donor.

Experimenting with RRI tools to Drive Sustainable Agri-Food Research: The SASS Case Study from Sub-Saharan Africa

The need to develop experimental tools for a responsible research and innovation (RRI) framework is relevant for managing research agendas and policy making that seriously take into account the complex conditions of innovation development (linked to multidisciplinarity and interaction processes) between the researchers and their fieldwork activities. The adoption of an RRI framework is even more important for multidisciplinary and complex issues, such as the agri-food system. In this context, the SASS (Sustainable Agri-food Systems for Sustainable Development (SASS) project represents a good example for verifying the application of the RRI strategy in a varied research group committed to the development of sustainable agri-food systems in Sub-Saharan Africa. The project, which involves more than 50 researchers from different fields of knowledge and theoretical backgrounds, showed the importance of the processes of reflection, re-driving, and convergence in the definition of research objectives and strategies. This process started by experimenting with new dedicated RRI tools in order to allow interactions between the researchers, including exchanging their experience in data collection and theoretical reflection development. With respect to this analysis, it was interesting to analyze how the RRI tools and strategies have been activated between researchers and different stakeholders, generating reflections capable of re-adapting the results towards shared and accessible innovation for the extended society. Following the discussion based on the description of the SASS-RRI agenda tools and following an internal verification given from an RRI-based web survey, this contribution provides new insights, in terms of tools and strategies, to promote and refine RRI approaches. This work underlines how RRI methods have promoted internal and external interactions to connect the research objectives towards a model of open innovation.

Conservation agriculture with drip irrigation: Effects on soil quality and crop yield in sub-Saharan Africa

The traditional agriculture production system in sub-Saharan Africa (SSA) caused significant soil erosion and degradation of soil quality. In addition, dependability of rainfall for irrigation needs limits the crop production. Advanced agricultural practices are thus needed at the local level to sustain the livelihood of smallholder farmers in the region. In this study, conservation agriculture (CA) practice with drip irrigation technology was compared (using field experiments and watershed modeling) with the traditional conventional tillage (CT) practice for its potential in improving soil quality and crop productivity in the region. Biophysical data were collected (2015 to 2017) from a total of 43 paired plots (CA and CT) at four study sites in SSA: Dangishita and Robit in Ethiopia, Yemu in Ghana, and Mkindo in Tanzania. The Agricultural Policy/Environmental eXtender (APEX) model was calibrated and validated with reasonable efficiency in simulating crop yields for both CA and CT practices; average PBIAS ≤±12% and ≤±11%, for CA and CT. The impact of the CA system on soil quality (soil carbon [C] and nitrogen [N]) was analyzed based on the well-tested model prediction results. The total C and N were increased under CA across the study sites on average by 6% and 4.1%, when compared to CT over the study period. Both the experiment and model prediction showed that crop yield was significantly improved by CA—on average 37.4% increases across the sites when compared to CT. Conservation agriculture with drip irrigation was an efficient local strategy to improve crop production in the region while enhancing the ecosystem.

Investing Sustainably in African Livestock Development: Opportunities and Trade-Offs

The production and consumption of animal source foods is central to the ongoing discussion of global food systems. The objectives of this report are first to describe the patterns and changing structures of the Sub-Saharan Africa (SSA) livestock sector and secondly to explore innovations that can help to address the complex trade-offs involved in investing in the development of a sustainable livestock sector. The report reviews trends in consumption, production and trade of major livestock commodities and feed in the four subregions of SSA and presents an overview of key issues facing the sector. A scenario for the SSA livestock sector in 2030 is developed using the IMPACT model. It shows significant growth of production across all major livestock commodities with poultry and pork growing faster than ruminant meat production. A series of technical and institutional innovations show opportunities to address the challenges of sustainably intensifying livestock production in SSA. They include improved forages, improved fodder conservation, artificial insemination combined with estrus synchronization, intensive beekeeping, livestock masterplans, livestock asset transfer programs, indexbased livestock insurance and livestock market information systems. The report concludes that livestock plays multiple key roles in the food systems in SSA and will continue to do so in the coming years. The complexity of the system and the multiple trade-offs imply a need for policy makers to shift from frequent “benign neglect” to actively invest in the analytical capacity to understand the changing roles and issues in SSA livestock development. In spite of important divergences on the future role, opportunities and risks associated with livestock production and consumption, developed economies and SSA nations will benefit from international scientific cooperation to jointly tackle the complex issues facing livestock production as part of the envisaged global food system.

Development and Implementation of Short Courses to Support the Establishment of a Prehospital System in Sub-Saharan Africa: Lessons Learned from Tanzania.

Background Tanzania has no formal prehospital system. The Tanzania Ministry of Health launched a formal prehospital system to address this gap. The Muhimbili University of Health and Allied Sciences (MUHAS) was tasked by the Ministry of Health to develop and implement a multicadre/provider prehospital curriculum so as to produce necessary healthcare providers to support the prehospital system. We aim to describe the process of designing and implementing the multicadre/provider prehospital short courses. The lessons learned can help inform similar initiatives in low- and middle-income countries. Methods MUHAS collaborated with local and international Emergency Medicine and Emergency Medical Services (EMS) specialists to form the Emergency Medical Systems Team (EMST) that developed and implemented four short courses on prehospital care. The EMST used a six-step approach to develop and implement the curriculum: problem identification, general needs assessment, targeted needs assessment, goals and objectives, educational strategies, and implementation. The EMST modified current best EMS practices, protocols, and curricula to be context and resource appropriate in Tanzania. Results We developed four prehospital short courses: Basic Ambulance Provider (BAP), Basic Ambulance Attendant (BAAT), Community First Aid (CFA), and EMS Dispatcher courses. The curriculum was vetted and approved by MUHAS, and courses were launched in November 2018. By the end of July 2019, a total of 63 BAPs, 104 BAATs, 25 EMS Dispatchers, and 287 CFAs had graduated from the programs. The main lessons learned are the importance of a practical approach to EMS development and working with the existing government cadre/provider scheme to ensure sustainability of the project; clearly defining scope of practice of EMS providers before curriculum development; and concurrent development of a multicadre/provider curriculum to better address the logistical barriers of implementation. Conclusion We have provided an overview of the process of designing and implementing four short courses to train multiple cadres/providers of prehospital system providers in Tanzania. We believe this model of curricula development and implementation can be replicated in other countries across Africa.

Comportements alimentaires, accessibilité alimentaire, utilisation et pratiques d’hygiène alimentaire pendant la pandémie de SRAS-CoV-2 au Bénin

Background: The COVID-19 pandemic caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is already affecting all food systems in sub-Saharan Africa including Benin. Aim: The study aimed to determine the dietary behaviors, food accessibility, and handling practices during the SARS-CoV-2 pandemic in Benin and the relationship between these components. Methods: A survey was carried out with 600 respondents in Benin. Data collected were analyzed using SAS and R statistical software. A hierarchical cluster analysis based on the characteristics of the households and their food access, utilization, and handling practices on the most significant components of AFC was then performed. Results: It comes out from the study that hunger and food security levels from 2000 to 2019 in Benin remain unsatisfying and inadequate. This situation had been exacerbated by the new coronavirus pandemic. About food access during COVID-19, 80% of respondents found that their dietary needs had been challenged by the COVID-19 restriction measures. This challenge affects infants as well as children, pregnant women, breastfeeding women, elderly people, and people with a chronic disease. Overall, the price of the food products had increased on the local market, and this change in the price limit the ability of 80% of households to acquire sufficient and safe food. The factorial correspondence analysis of the dietary behaviors and food handling practices during the SARS-CoV-2 pandemic in Benin discriminated three groups of households corresponding to 3 types of dietary behaviors and food handling practices. Conclusion: Preservation of food values chain, improvement of food environment in Benin, and nutritional support of low-resilient populations should be the main way to mitigate impacts of COVID-19 on food security, nutrition, and food safety. Keywords: Benin, dietary behaviors, food access, hygiene, SARS-CoV-2.

Adoption of health information systems: Health professionals perspective

ABSTRACT The healthcare industry has embraced Information and Communication Technology in the performance of its duties to provide quality healthcare services. Though this system provides numerous benefits, research has shown that adoption and use of such systems are limited in the developing world. This study examines factors that will motivate healthcare personnel to adopt and use Health Information Systems using the Unified Theory of Acceptance and Use of Technology (UTAUT2) model. One hundred and ten (110) respondents were selected for the study. The data collected was analysed using Partial Least Square (PLS) with a standard error of 0.10. The findings indicate that Performance Expectancy, Habit and Hedonic Motivation are the main factors users considered to influence their behavioural intention to adopt and use health information system. The results show that when users perceive Health Information systems to improve their performance, they are more likely to adopt and use the system. Stakeholders should consider system quality issues, such as response time and interface design, when developing a new system as these serve as motivational factors towards adoption and use of health information system. This study is among the first few attempts to understand adoption and use of health information systems in Sub-Saharan Africa.

OER Mainstreaming in Cameroon: Perceptions and Barriers

The government of Cameroon has been increasingly pre-occupied with the quality of learning outcomes and the lack of learning resources at all levels of the education system. Research on similar educational systems in Sub-Saharan Africa and beyond indicate that Ministries of Education are exploring the potential of open educational resources (OER) to cut down the high cost of textbooks and enhance the availability of quality learning materials in classrooms. To explore possibilities of mainstreaming OER under the Ministries of Basic and Secondary Education in Cameroon, a quantitative research design approach was used to survey n=393 Regional Pedagogic Supervisors from the 10 Regions of the country. The outcome of this study presents the factors shaping the perspectives of Regional Pedagogic Supervisors in terms of perceptions and barriers to using OER. The novelty of this approach is the application of a proven model for technology acceptance testing in the context of OER. Based on the findings, three major recommendations for mainstreaming OER in Cameroon with potential impact on lowering textbook costs and increasing learning outcomes were formulated.

The rising burden of non-communicable diseases in sub-Saharan Africa

The rising burden of non-communicable diseases in sub-Saharan Africa

Should fertilizer recommendations be adapted to parkland agroforestry systems? Case studies from Ethiopia and Rwanda

AimsThis study aimed to disentangle tree-crop-fertilizer interactions in agroforestry systems, which has been suggested as an entry point for sustainable intensification of smallholder farming systems in sub-Saharan Africa (SSA). Although tree-crop systems generate multiple economic and ecological benefits, tree-crop competition commonly occurs. We hypothesized that mineral fertilizers affect facilitative and competitive interactions differently in tree-crop systems.MethodsTree-crop-fertilizer interactions were explored for wheat growing under Faidherbia albida, and maize growing under Acacia tortilis and Grevillea robusta through omission trials of nitrogen (N) and phosphorus (P) in open fields and fields under tree canopy, using a split plot design. The experiments were conducted in Ethiopia and Rwanda, replicated four times, and over two seasons.ResultsOur results demonstrated that the presence of F. albida significantly improved N and P use efficiencies, leading to significantly higher (P < 0.001) grain yields in wheat. This tree species contributed around 64 kg ha−1 yr.−1 of mineral N. The P use efficiency of wheat under F. albida was double that of open field wheat. By contrast, G. robusta and A. tortilis trees lowered nutrient use efficiencies in maize, leading to significantly less maize grain yields compared with open fields receiving the same fertilization. Probabilities of critically low crop yields and crop failure were significantly greater for maize growing under the canopy of these species.ConclusionsOur results showed that recommended fertilizer rates led to facilitative interaction only with F. albida, highlighting that fertilizer recommendations need to be adapted to agroforestry systems.

Effects of International Financial Integration on Domestic Financial Development in Sub-Saharan African Countries

This paper aims to analyze the effects of international financial integration on the development of domestic financial system in Sub-Saharan Africa, specifically the banking system over the period 2000-2015. The estimation of parameters by system GMM shows that international financial integration is beneficial to the activity and efficiency of the banking system. Moreover, we don’t find a breakdown in the relationship, considering only the post-financial crisis period. In addition, the withdrawal of South Africa and Mauritius due to their levels of international financial integration and domestic financial development cancels out the significant effect on the activity and efficiency of the banking system. Keywords: International financial integration, domestic financial development, financial crisis, sub-Saharan Africa DOI : 10.7176/JESD/10-18-03 Publication date :September 30 th 2019

Biophysical potential of crop residues for biochar carbon sequestration, and co-benefits, in Uganda.

Increasing organic matter/carbon contents of soils is one option proposed to offset climate change inducing greenhouse gas (GHG) emissions, under the auspices of the UNFCC Paris Agreement. One of the complementary practices to sequester carbon in soils on decadal time scales is amending it with biochar, a carbon rich byproduct of biomass gasification. In sub‐Saharan Africa (SSA), there is a widespread and close interplay of agrarian‐based economies and the use of biomass for fuel, which makes the co‐benefits of biochar production for agriculture and energy supply explicitly different from the rest of the world. To date, the quantities of residues available from staple crops for biochar production, and their potential for carbon sequestration in farming systems of SSA have not been comprehensively investigated. We assessed the productivity and usage of biomass waste from maize, sorghum, rice, millet, and groundnut crops; specifically quantifying straw, shanks, chaff, and shells, based on measurements from multiple farmer fields and household surveys in eastern Uganda. Moreover, allometric models were tested, using grain productivity, plant height, and density as predictors. These models enable rapid and low‐cost assessment of the potential availability of feedstocks at various spatial scales: individual cropland, farm enterprise, region, and country. Ultimately, we modeled the carbon balance in soils of major cropping systems when amended with biochar from biomass residues, and up‐scaled this for basic scenario analysis. This interdisciplinary approach showcases that there is significant biophysical potential for soil carbon sequestration in farming systems of Uganda through amendment of biochar derived from unused residues of cereals and legume crops. Furthermore, information about these biomass waste flows is used for estimating the rates of biochar input that could be made to farmlands, as well as the amounts of energy that could be produced with gasifier appliances.

Towards Resilient Health Systems in Sub-Saharan Africa: A Systematic Review of the English Language Literature on Health Workforce, Surveillance, and Health Governance Issues for Health Systems Strengthening.

Background:Meeting health security capacity in sub-Saharan Africa will require strengthening existing health systems to prevent, detect, and respond to any threats to health. The purpose of this review was to examine the literature on health workforce, surveillance, and health governance issues for health systems strengthening.Methods:We searched PubMed, Science Direct, Cochrane library, CINAHL, Web of Science, EMBASE, EBSCO, Google scholar, and the WHO depository library databases for English-language publications between January 2007 and February 2017. Electronic searches for selected articles were supplemented by manual reference screening. The review followed the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines.Results:Out of 1,548 citations retrieved from the electronic searches, 31 articles were included in the review. Any country health system that trains a cadre of health professionals on the job, reduces health workforce attrition levels, and builds local capacity for health care workers to apply innovative mHealth technologies improves health sector performance. Building novel surveillance systems can improve clinical care and improve health system preparedness for health threats. Effective governance processes build strong partnerships for health and create accountability mechanisms for responding to health emergencies.Conclusions:Overall, policy shifts in African countries’ health systems that prioritize training a cadre of willing and able workforce, invest in robust and cost-effective surveillance capacity, and create financial accountability and good governance are vital in health strengthening efforts.

The disequilibrium of double descent: changing inheritance norms among Himba pastoralists.

Matrilineal systems in sub-Saharan Africa tend to co-occur with horticulture and are rare among pastoralists, with the causal arrow pointing from the introduction of cattle to the loss of matriliny. However, most work on this topic stems from either phylogenetic analyses or historical data. To better understand the shift from matrilineal to patrilineal inheritance that occurred among Bantu populations after the adoption of pastoralism, data from societies that are currently in transition are needed. Himba pastoralists, who practice 'double descent', may represent one such society. Using multi-generational ethnography and structured survey data, we describe current norms and preferences about inheritance, as well as associated norms related to female autonomy. We find that preferences for patrilineal inheritance are strong, despite the current practice of matrilineal cattle inheritance. We also find that a preference for patriliny predicts greater acceptance of norm violating behaviour favouring sons over nephews. Finally, we show that there are important generational differences in how men view women's autonomy, which are probably attributable to both changing norms about inheritance and exposure to majority-culture views on women's roles. Our data shed light on how systemic change like the shifts in descent reckoning that occurred during the Bantu expansion can occur. This article is part of the theme issue 'The evolution of female-biased kinship in humans and other mammals'.

Digital Payments: Impact Factors and Mass Adoption in Sub-Saharan Africa

This study explores impact factors that affect the adoption of digital payment systems in sub-Saharan Africa. In this article, we investigate the impact factors that subject-matter experts consider most important to the success of FinTech payment models. The data and their responses are evaluated through the lens of Christensen’s market-creation theory, which contends that the adoption of market-creating innovations by a mass swathe of heretofore non-consumers “pulls” framework conditions into place, including missing infrastructure and enabling regulation. Then, we compare the findings with the literature and three case studies of mobile money adoption in Kenya, South Africa, and Nigeria. This study addresses a gap in the literature regarding the payment and money transfer segment of FinTech innovations in Africa using a multiple case study methodology. We drew together information from multiple sources, including semi-structured interviews, archival data in the form of industry and regulatory reports, and observational field notes. Our findings suggest that enabling environments (Kenya) do jumpstart adoption and difficult frameworks (Nigeria) do evolve. This study will help FinTech innovators, academics, and policymakers to understand how technology and framework conditions impact payment business models in Africa.

HIV-1 self-testing to improve the efficiency of pre-exposure prophylaxis delivery: a randomized trial in Kenya

BackgroundThe introduction of pre-exposure prophylaxis (PrEP) for human immunodeficiency virus-1 (HIV-1) prevention in Africa presents new challenges for health systems that are already overburdened because PrEP delivery requires frequent clinic visits (generally every 3 months) for HIV-1 testing and PrEP refills. HIV-1 self-testing (HIVST) has the potential to improve the efficiency of PrEP delivery by decreasing the number of clinic visits. Here, we describe the rationale and design of a randomized, noninferiority trial designed to test the effectiveness and safety of using HIVST to support PrEP delivery in Kenya.MethodsThe JiPime-JiPrEP (Kiswahili for ‘Test Yourself, PrEP Yourself’) study is a three-arm randomized trial taking place in Thika, Kenya. Participants (n = 495) are eligible for enrollment if they are at least 18 years old, HIV-1 seronegative, and have been taking PrEP for 1 month. Three distinct participant types will be enrolled: men (n = 165) and women (n = 165) who are in mutually disclosed HIV-1 serodiscordant relationships, and women (n = 165) who are at HIV-1 risk and not in a known serodiscordant relationship. Participants in each of these subpopulations will be 1:1:1 randomized to: 1) the standard of care, with quarterly clinic visits; 2) oral HIVST, with biannual clinic visits plus oral HIVSTs to use at the quarters between those visits; or 3) blood-based HIVST, with biannual clinic visits plus blood-based HIVSTs. All participants will complete quantitative surveys and provide blood samples for the objective measurement of PrEP adherence at baseline, 6 months, and 12 months. The primary outcomes are PrEP adherence, PrEP continuation, and HIV-1 testing, measured at 6 months and secondarily at 12 months.DiscussionThe findings from this trial can help to understand how HIVST—a new HIV-1 testing technology—can support health systems in sub-Saharan Africa. Additionally, the findings can inform policy aimed at improving the efficiency of PrEP implementation and scale-up in Kenya.Trial registrationClinicalTrials.gov, NCT03593629. Retrospectively registered on 20 July 2018.

Epidemiological And Health Systems Implications Of Evolving HIV And Hypertension In South Africa And Kenya.

Health systems in sub-Saharan Africa are facing an ongoing HIV epidemic and increasing burden of noncommunicable disease. With the focus shifting to the development of comprehensive primary health care and chronic disease treatment, multidisease modeling is integral to estimating future health care needs. We extended an established agent-based model of HIV transmission to include hypertension in two rural settings: KwaZulu-Natal, South Africa, and western Kenya. We estimated that from 2018 to 2028 hypertension prevalence would increase from 40percent to 46percent in KwaZulu-Natal and from 29percent to 35percent in western Kenya, while HIV prevalence is stabilizing and predicted to decrease. As the health system burden in sub-Saharan Africa is changing, innovative chronic disease treatment and the broadening of successful programs, such as integrated HIV and noncommunicable disease care, are necessary to reach universal health care coverage.