Sub-Saharan Africa has continued leading in prevalence and incidence of major infectious disease killers such as HIV/AIDS, tuberculosis, and malaria. Epidemiological triad of infectious diseases includes susceptible host, pathogen, and environment. It is imperative that all aspects of vertices of the infectious disease triad are analysed to better understand why this is so. Studies done to address this intriguing reality though have mainly addressed pathogen and environmental components of th...
Weaver, J.N.; Brownfield, M.E.; Bergin, M.J.
Coal has been reported in 11 of the 16 sub-Saharan countries discussed in this appraisal: Mauritania, Senegal, Mali, Niger, Benin, Nigeria, Cameroon, Central African Republic, Sudan, Ethiopia, and Somalia. No coal occurrences have been reported in Gambia, Togo, Burkina, Chad, and Djibouti but coal may be present within these countries because neighboring countries do contain coal-bearing rocks. Most of these countries are undergoing desertification or will in the near future. Wood, directly or in the form of charcoal, constitutes two-thirds of the fuel used in Africa. Destruction of forest and shrub lands for fuel is occurring at an increasing rate because of desertification and increasing energy demands. The decline in biological productivity, coupled with concentration of population in areas where water is available and crops may be grown, leads to increasing shortages of wood for fuel. Part of the present and future energy needs of the sub-Saharan region could be met by use of indigenous coal and peat. Nine sedimentary basins, completely or partially within the sub-Saharan region, have the potential of either coal and/or peat deposits of economic value: 1- Senegal Basin, 2- Taoudeni Basin and Gao Trough, 3- Niger Basin, 4- Chad Basin, 5- Chari Basin, 6- Benue Trough (Depression), 7- Sudan Trough, 8- Plateau and Rift Belt, and 9- Somali Basin. Niger and Nigeria are the only countries in sub-Saharan Africa in which coal is presently being mined as a fuel source for powerplants and domestic use. Peat occurs in the deltas, lower river, and interdunal basin areas of Senegal, Mauritania, and Sudan. Peat can be used as an alternate fuel source and is currently being tested as a soil amendment in the agricultural sector. Coal and peat exploration and development studies are urgently required and should be initiated so the coal and peat utilization potential of each country can be determined. The overall objective of these studies is to establish, within the sub-Saharan region, energy independent countries using indigenous coal and peat resources. These resources have the potential to replace wood and wood charcoal as domestic fueld in the urban centers, as well as producing electrical and industrial energy, thus reducing expensive oil imports and decreasing the rate of deforestation. ?? 1991.
Agyemang, Charles; Addo, Juliet; Bhopal, Raj; de Graft Aikins, Ama; Stronks, Karien
Background Most European countries are ethnically and culturally diverse. Globally, cardiovascular disease (CVD) is the leading cause of death. The major risk factors for CVD have been well established. This picture holds true for all regions of the world and in different ethnic groups. However, the prevalence of CVD and related risk factors vary among ethnic groups. Methods This article provides a review of current understanding of the epidemiology of vascular disease, principally coronary heart disease (CHD), stroke and related risk factors among populations of Sub-Sahara African descent (henceforth, African descent) in comparison with the European populations in Europe. Results Compared with European populations, populations of African descent have an increased risk of stroke, whereas CHD is less common. They also have higher rates of hypertension and diabetes than European populations. Obesity is highly prevalent, but smoking rate is lower among African descent women. Older people of African descent have more favourable lipid profile and dietary habits than their European counterparts. Alcohol consumption is less common among populations of African descent. The rate of physical activity differs between European countries. Dutch African-Suriname men and women are less physically active than the White-Dutch whereas British African women are more physically active than women in the general population. Literature on psychosocial stress shows inconsistent results. Conclusion Hypertension and diabetes are highly prevalent among African populations, which may explain their high rate of stroke in Europe. The relatively low rate of CHD may be explained by the low rates of other risk factors including a more favourable lipid profile and the low prevalence of smoking. The risk factors are changing, and on the whole, getting worse especially among African women. Cohort studies and clinical trials are therefore needed among these groups to determine the relative contribution of vascular risk factors, and to help guide the prevention efforts. There is a clear need for intervention studies among these populations in Europe. PMID:19671137
de Graft Aikins Ama
Full Text Available Abstract Background Most European countries are ethnically and culturally diverse. Globally, cardiovascular disease (CVD is the leading cause of death. The major risk factors for CVD have been well established. This picture holds true for all regions of the world and in different ethnic groups. However, the prevalence of CVD and related risk factors vary among ethnic groups. Methods This article provides a review of current understanding of the epidemiology of vascular disease, principally coronary heart disease (CHD, stroke and related risk factors among populations of Sub-Sahara African descent (henceforth, African descent in comparison with the European populations in Europe. Results Compared with European populations, populations of African descent have an increased risk of stroke, whereas CHD is less common. They also have higher rates of hypertension and diabetes than European populations. Obesity is highly prevalent, but smoking rate is lower among African descent women. Older people of African descent have more favourable lipid profile and dietary habits than their European counterparts. Alcohol consumption is less common among populations of African descent. The rate of physical activity differs between European countries. Dutch African-Suriname men and women are less physically active than the White-Dutch whereas British African women are more physically active than women in the general population. Literature on psychosocial stress shows inconsistent results. Conclusion Hypertension and diabetes are highly prevalent among African populations, which may explain their high rate of stroke in Europe. The relatively low rate of CHD may be explained by the low rates of other risk factors including a more favourable lipid profile and the low prevalence of smoking. The risk factors are changing, and on the whole, getting worse especially among African women. Cohort studies and clinical trials are therefore needed among these groups to determine the relative contribution of vascular risk factors, and to help guide the prevention efforts. There is a clear need for intervention studies among these populations in Europe.
Labuda, Damian; Yotova, Vania; Lefebvre, Jean-François; Moreau, Claudia; Utermann, Gerd; Williams, Scott M
The genetic diversity within an 11 kb segment of the MTMR8 gene in a sample of 111 sub-Saharan and 49 non-African X chromosomes was investigated to assess the early evolutionary history of sub-Saharan Africans and the out-of-Africa expansion. The analyses revealed a complex genetic structure of the Africans that contributed to the emergence of modern humans. We observed partitioning of two thirds of old lineages among southern, west/central and east African populations indicating ancient popu...
Makumbi, T.; M. Galukande; Gakwaya, A.
Introduction. Mastalgia is a common breast condition among women referred to breast clinics worldwide. Whereas the prevalence is known in the Western world and Asia, the prevalence of the disease is unknown in many African countries. The aim of this study therefore was to determine the prevalence and describe factors associated with mastalgia among women attending a tertiary hospital in sub-Saharan Africa. Methods. A cross-sectional study was done in Kampala, Uganda. Mastalgia was defined as ...
Full Text Available Abstract Background Sub-Saharan Africa suffers a disproportionate share of the world's burden of disease while having some of the world's greatest health care workforce shortages. Doctors are an important component of any high functioning health care system. However, efforts to strengthen the doctor workforce in the region have been limited by a small number of medical schools with limited enrolments, international migration of graduates, poor geographic distribution of doctors, and insufficient data on medical schools. The goal of the Sub-Saharan African Medical Schools Study (SAMSS is to increase the level of understanding and expand the baseline data on medical schools in the region. Methods The SAMSS survey is a descriptive survey study of Sub-Saharan African medical schools. The survey instrument included quantitative and qualitative questions focused on institutional characteristics, student profiles, curricula, post-graduate medical education, teaching staff, resources, barriers to capacity expansion, educational innovations, and external relationships with government and non-governmental organizations. Surveys were sent via e-mail to medical school deans or officials designated by the dean. Analysis is both descriptive and multivariable. Results Surveys were distributed to 146 medical schools in 40 of 48 Sub-Saharan African countries. One hundred and five responses were received (72% response rate. An additional 23 schools were identified after the close of the survey period. Fifty-eight respondents have been founded since 1990, including 22 private schools. Enrolments for medical schools range from 2 to 1800 and graduates range from 4 to 384. Seventy-three percent of respondents (n = 64 increased first year enrolments in the past five years. On average, 26% of respondents' graduates were reported to migrate out of the country within five years of graduation (n = 68. The most significant reported barriers to increasing the number of graduates, and improving quality, related to infrastructure and faculty limitations, respectively. Significant correlations were seen between schools implementing increased faculty salaries and bonuses, and lower percentage loss of faculty over the previous five years (P = 0.018; strengthened institutional research tools (P = 0.00015 and funded faculty research time (P = 0.045 and greater faculty involvement in research; and country compulsory service requirements (P = 0.039, a moderate number (1-5 of post-graduate medical education programs (P = 0.016 and francophone schools (P = 0.016 and greater rural general practice after graduation. Conclusions The results of the SAMSS survey increases the level of data and understanding of medical schools in Sub-Saharan Africa. This data serves as a baseline for future research, policies and investment in the health care workforce in the region which will be necessary for improving health.
A growing number of countries in sub-Saharan Africa are considering legalizing the growth of genetically modified organisms (GMOs). Furthermore, several projects are underway to develop transgenic crops tailored to the region. Given the contentious nature of GMOs and prevalent anti-GMO sentiments in Africa, a robust ethical analysis examining the concerns arising from the development, adoption, and regulation of GMOs in sub-Saharan Africa is warranted. To date, ethical analyses of GMOs in the global context have drawn predominantly on Western philosophy, dealing with Africa primarily on a material level. Yet, a growing number of scholars are articulating and engaging with ethical theories that draw upon sub-Saharan African value systems. One such theory, Ubuntu, is a well-studied sub-Saharan African communitarian morality. I propose that a robust ethical analysis of Africa's agricultural future necessitates engaging with African moral theory. I articulate how Ubuntu may lead to a novel and constructive understanding of the ethical considerations for introducing GMOs into sub-Saharan Africa. However, rather than reaching a definitive prescription, which would require significant engagement with local communities, I consider some of Ubuntu's broader implications for conceptualizing risk and engaging with local communities when evaluating GMOs. I conclude by reflecting on the implications of using local moral theory in bioethics by considering how one might negotiate between universalism and particularism in the global context. Rather than advocating for a form of ethical relativism, I suggest that local moral theories shed light on salient ethical considerations that are otherwise overlooked. PMID:26481201
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Labuda, Damian; Yotova, Vania; Lefebvre, Jean-François; Moreau, Claudia; Utermann, Gerd; Williams, Scott M
The genetic diversity within an 11 kb segment of the MTMR8 gene in a sample of 111 sub-Saharan and 49 non-African X chromosomes was investigated to assess the early evolutionary history of sub-Saharan Africans and the out-of-Africa expansion. The analyses revealed a complex genetic structure of the Africans that contributed to the emergence of modern humans. We observed partitioning of two thirds of old lineages among southern, west/central and east African populations indicating ancient population stratification predating the out of Africa migration. Age estimates of these lineages, older than coalescence times of uniparentally inherited markers, raise the question whether contemporary humans originated from a single population or as an amalgamation of different populations separated by years of independent evolution, thus suggesting a greater antiquity of our species than generally assumed. While the oldest sub-Saharan lineages, ~500 thousand years, are found among Khoe-San from southern-Africa, a distinct haplotype found among Biaka is likely due to admixture from an even older population. An East African population that gave rise to non-Africans underwent a selective sweep affecting the subcentromeric region where MTMR8 is located. This and similar sweeps in four other regions of the X chromosome, documented in the literature, effectively reduced genetic diversity of non-African chromosomes and therefore may have exacerbated the effect of the demographic bottleneck usually ascribed to the out of Africa migration. Our data is suggestive, however, that a bottleneck, occurred in Africa before range expansion. PMID:24282552
Van Royen, Kathleen; Lachat, Carl; Holdsworth, Michelle; Smit, Karlien; Kinabo, Joyce; Roberfroid, Dominique; Nago, Eunice; Garimoi Orach, Christopher; Kolsteren, Patrick
Optimal nutrition is critical for human development and economic growth. Sub-Saharan Africa is facing high levels of food insecurity and only few sub-Saharan African countries are on track to eradicate extreme poverty and hunger by 2015. Effective research capacity is crucial for addressing emerging challenges and designing appropriate mitigation strategies in sub-Saharan Africa. A clear understanding of the operating environment for nutrition research in sub-Saharan Africa is a much needed p...
Anthony Enisan Akinlo; Tajudeen Egbetunde
The paper examines the long run and causal relationship between financial developmentand economic growth for ten countries in sub-Saharan Africa. Using the vectorerror correction model (VECM), the study finds that financial development is cointegratedwith economic growth in the selected ten countries in sub-Saharan Africa. That is there isa long run relationship between financial development and economic growth in the selectedsub-Saharan African countries. The results show that financial deve...
Munisi, Gibson; Randøy, Trond
This paper examines the extent to which publicly listed companies across Sub-Saharan African countries have adopted good corporate governance practices. We investigate the association of these practices with companies accounting performance and market valuation. The findings indicate that companies across Sub-Saharan Africa have only partly implemented good corporate governance practices. We find a positive association between our constructed index of good corporate governance practices an...
Corsi, Daniel J; Subramanian, S.V
Background: Infant and child mortality rates are among the most important indicators of child health, nutrition, implementation of key survival interventions, and the overall social and economic development of a population. In this paper, we investigate the role of coverage of maternal and child health (MNCH) interventions in contributing to declines in child mortality in sub-Saharan Africa. Design: Data are from 81 Demographic and Health Surveys from 35 sub-Saharan African countries. Using e...
Page, Randy M.; West, Joshua H.
Objectives: To determine if there is an association between psychosocial distress, health-risk behaviors and 12-month suicidal ideation among sub-Saharan African adolescents. Methods: Subjects included a cross-national sample of adolescents (N25,568) representing 7 African countries who completed the Global School-based Student Health Survey
Some scholars argue that the principle of voluntary informed consent is rooted in the Western ethos of liberal individualism; that it would be difficult to implement this requirement in societies where the norms of decision-making emphasize collective rather than individual decision-making (for example, Sub-Saharan Africa); that it would amount to cultural imperialism to seek to implement the principle of voluntary informed consent in non-Western societies. This thesis rejects this skeptici...
Lozano, F; Suárez, B
The lectin pathway of the complement system is activated when mannan-binding lectin (MBL) in complex with MBL-associated serine protease 2 (MASP-2) binds to carbohydrate structures on microorganisms. Structural gene mutations and promoter polymorphisms in the MBL2 gene responsible for low-MBL serum levels are present in all human populations and associate with increased risk of infection. Recently, investigations on Danes revealed the existence of a mutation on the MASP2 gene, which introduces an amino acid substitution in the CUB1 domain (Asp105Gly; numbering refers to the mature protein), and is associated with reduction in the level of MASP-2 in serum. Here, we present the results of a sequence-based typing analysis of the MBL2 and MASP2 gene polymorphisms in a group of 65 Africans (50 North Africans and 15 Sub-Saharan) and of 104 Spaniards. The analysis identified three novel exon 3 MASP2 variants introducing amino acid substitutions at positions 84 (Arg-->Gln), 103 (Arg-->Cys) and 111 (Pro-->Leu) in the CUB1 domain. None of these variants were identified in Spaniards. The Arg84Gln was detected in four of the 15 Sub-Saharans. The Arg103Cys and Pro111Leu variants were detected only among North Africans (two and four individuals, respectively). The Asp105Gly variant was similarly represented among Spaniards and North Africans (three and two individuals, respectively), which appears to be a lower frequency than that reported for Danes (5.5%). As reported for MBL2, the marked geographic distribution of the new MASP2 variants may represent an evolutionary adaptation to different environments.
Lynn, Richard; Meisenberg, Gerhard
Wicherts, Dolan, and van der Maas (2009) contend that the average IQ of sub-Saharan Africans is about 80. A critical evaluation of the studies presented by WDM shows that many of these are based on unrepresentative elite samples. We show that studies of 29 acceptably representative samples on tests other than the Progressive Matrices give a
Oakland, Thomas; Callueng, Carmelo
This cross-national research examined temperament style preferences among children in three sub-Saharan African countries (i.e., Nigeria, South Africa, and Zimbabwe) and possible differences between them on four bipolar temperament styles: extroverted-introverted, practical-imaginative, thinking-feeling, and organized-flexible. Children in these
Pool, John E.; Aquadro, Charles F
Drosophila melanogaster is an important model organism in evolutionary genetics, yet little is known about the population structure and the demographic history of this species within sub-Saharan Africa, which is thought to contain its ancestral range. We surveyed nucleotide variation at four 1-kb fragments in 240 individual lines representing 21 sub-Saharan and 4 Palearctic population samples of D. melanogaster. In agreement with recent studies, we find a small but significant level of geneti...
Sorensen, J P R; Lapworth, D J; Read, D S; Nkhuwa, D C W; Bell, R A; Chibesa, M; Chirwa, M; Kabika, J; Liemisa, M; Pedley, S
Quantitative PCR (qPCR) can rapidly screen for an array of faecally-derived bacteria, which can be employed as tracers to understand groundwater vulnerability to faecal contamination. A microbial DNA qPCR array was used to examine 45 bacterial targets, potentially relating to enteric pathogens, in 22 groundwater supplies beneath the city of Kabwe, Zambia in both the dry and subsequent wet season. Thermotolerant (faecal) coliforms, sanitary risks, and tryptophan-like fluorescence, an emerging real-time reagentless faecal indicator, were also concurrently investigated. There was evidence for the presence of enteric bacterial contamination, through the detection of species and group specific 16S rRNA gene fragments, in 72% of supplies where sufficient DNA was available for qPCR analysis. DNA from the opportunistic pathogen Citrobacter freundii was most prevalent (69% analysed samples), with Vibrio cholerae also perennially persistent in groundwater (41% analysed samples). DNA from other species such as Bifidobacterium longum and Arcobacter butzleri was more seasonally transient. Bacterial DNA markers were most common in shallow hand-dug wells in laterite/saprolite implicating rapid subsurface pathways and vulnerability to pollution at the surface. Boreholes into the underlying dolomites were also contaminated beneath the city highlighting that a laterite/saprolite overburden, as occurs across much of sub-Saharan aquifer, does not adequately protect underlying bedrock groundwater resources. Nevertheless, peri-urban boreholes all tested negative establishing there is limited subsurface lateral transport of enteric bacteria outside the city limits. Thermotolerant coliforms were present in 97% of sites contaminated with enteric bacterial DNA markers. Furthermore, tryptophan-like fluorescence was also demonstrated as an effective indicator and was in excess of 1.4?g/L in all contaminated sites. PMID:26363144
Pandolfelli, Lauren E; Shandra, John M
We conduct a cross-national analysis to test the hypothesis that African Development Bank (AfDB) structural adjustment adversely impacts child mortality in Sub-Saharan Africa. We use generalized least square random effects regression models and two-step Heckman models that correct for selection bias using data on 35 nations with up to four time points (1990, 1995, 2000, and 2005). We find substantial support for our hypothesis, which indicates that Sub-Saharan African nations that receive an AfDB structural adjustment loan tend to have higher levels of child mortality than Sub-Saharan African nations that do not receive such a loan. This finding remains stable even when controlling for selection bias on whether or not a Sub-Saharan African nation receives an AfDB structural adjustment loan. We conclude by discussing the methodological implications of the article, policy suggestions, and possible directions for future research. PMID:23821909
Anthony Enisan Akinlo
Full Text Available The paper examines the long run and causal relationship between financial developmentand economic growth for ten countries in sub-Saharan Africa. Using the vectorerror correction model (VECM, the study finds that financial development is cointegratedwith economic growth in the selected ten countries in sub-Saharan Africa. That is there isa long run relationship between financial development and economic growth in the selectedsub-Saharan African countries. The results show that financial development Granger causeseconomic growth in Central African Republic, Congo Republic, Gabon, and Nigeria whileeconomic growth Granger causes financial development in Zambia. However, bidirectionalrelationship between financial development and economic growth was found in Kenya, Chad,South Africa, Sierra Leone and Swaziland. The results show the need to develop the financialsector through appropriate regulatory and macroeconomic policies. However, in Zambiaemphasis needs to be placed on economic growth to propel financial development.
Songul Kakilli, Acaravci; Ilhan, Ozturk; Ali, Acaravci.
Full Text Available In this paper we review the literature on the finance-growth nexus and investigate the causality between financial development and economic growth in sub-Saharan Africa for the period 1975-2005. Using panel co-integration and panel GMM estimation for causality, the results of the panel co-integratio [...] n analysis provide evidence of no long-run relationship between financial development and economic growth. The empirical findings in the paper show a bi-directional causal relationship between the growth of real GDP per capita and the domestic credit provided by the banking sector for the panels of 24 sub-Saharan African countries. The findings imply that African countries can accelerate their economic growth by improving their financial systems and vice versa.
Ioraver N. Tsegba; Wilson E. Herbert; Emeka E. Ene
This paper investigates the relation between corporate ownership and corporate performance of listed companies in Nigeria, a foremost Sub-Saharan African country during the period 2002-2007. The data is obtained from the firms annual reports and accounts and the Nigerian Stock Exchange daily performance reports. The combination of 70 firms and six-year period studied provides a balanced panel with 420 observations for panel data analysis. The results from the ordinary least square (OLS) regr...
Noah Ndela Ntsama, Jean Frederic
This thesis examines the sources of business cycle fluctuations in a developing Sub-Saharan African economy. We develop an open economy dynamic stochastic general equilibrium model (DSGE), which is log-linearized, calibrated, and estimated with Bayesian techniques using South Africa macroeconomic data. The model incorporates various features such as external habit formation, internal investment adjustment cost, variable capacity utilization, domestically produced goods prices and wages sticki...
This dissertation presents the transit experiences of migrants from Sub-Saharan African countries in the Turkish metropolis of Istanbul. Although the narratives of the individuals met in the course of fieldwork in Istanbul are the primary focus, the thesis also outlines the larger macro-structural conditions faced. The overarching goal of this thesis is thus, through the experiences of the migrants themselves, to critically approach and discuss the concept of transit with the aid of the theor...
Enisan Akinlo, Anthony
This study explores the effects of macroeconomic factors on total factor productivity (TFP) in 34 sub-Saharan African countries for the period 1980-2002. The econometric analysis shows that external debt is negatively and significantly related to TFP. Other factors that have significant negative effect include inflation rate, agricultural valueadded as a percentage of GDP, lending rate, and local price deviation from purchasing power parity. However, our result shows that human capital, expor...
Novignon Jacob; Nonvignon Justice
Abstract Background The burden of fevers remains enormous in sub-Saharan Africa. While several efforts at reducing the burden of fevers have been made at the macro level, the relationship between socioeconomic status and fever prevalence has been inconclusive at the household and individual levels. The purpose of this study was to examine how individual and household socioeconomic status influences the prevalence of fever among children under age five in four sub-Saharan African countries. Me...
Eskemose Andersen, Jørgen
Current definitions of urbanity lead to claims that a large proportion (75% according to UN Habitat) of Sub-Saharan Africas (SSA) urban population is housed in informal settlements with almost all new housing stock provided informally in contradiction to the formal that is defined as planned and regulated by the state. In most cases in SSA cities urban development has no professional assistance in the form of architects or engineers, and what is characterised as disorder, as is the case...
This study examined the schooling experiences and perceptions of resettled sub-Saharan African middle school refugee students in a metropolitan area of the United States Southwest. The research questions underpinning this study included: What are the schooling experiences and perceptions of resettled sub-Saharan African middle school refugee
Kreamer, David K; Usher, Brent
Sub-Saharan Africa faces significant challenges in dealing with ground water pollution. These countries can look to successes and missteps on other continents to help choose their own individual paths to ensuring reliable and clean supplies of ground water. In the large view, sub-Saharan Africa can define specific levels of acceptable risk in water quality that drive cleanup efforts and are amenable to acceptance across national and geographic boundaries. Ground water quality databases must be expanded, and data must be available in an electronic form that is flexible, expandable, and uniform, and that can be used over wide geographic areas. Guidance from other continents is available on well construction, sampling and monitoring, interim remediation, technical impracticability, monitored natural attenuation, and many specific issues such as how to deal with small waste generators and septic contamination of water supply wells. It is important to establish a common African view on the appropriateness of other nations' ground water quality guidance for African issues, economic conditions, and community circumstances. Establishing numerical, concentration-based, water quality action levels for pollutants in ground water, which many neighboring African nations could hold comparable, would set the stage for risk-based remediation of contaminated sites. Efforts to gain public, grass-roots understanding and support for stable and balanced enforcement of standards are also key. Finally, effective capacity building in the region could be an eventual solution to ground water quality problems; with increased numbers of trained environmental professionals, ground water throughout the region can be protected and contaminated sites cleaned up. PMID:19341368
Page, Randy M.; Hall, Cougar P.
Background: This study examines the relationship between sexual behavior, alcohol use, and indicators of psychosocial distress (mental health) of adolescents in 6 sub-Saharan African countries using the Global School-based Student Health Survey (GSHS). Methods: The sample consisted of 22,949 adolescents from Botswana, Kenya, Namibia, Uganda,
Simaga, Bamodi; Vicenzi, Marco; Faoro, Vitalie; Caravita, Sergio; Di Marco, Giovanni; Forton, Kevin; Deboeck, Gael; Lalande, Sophie; Naeije, Robert
Sex and age affect the pulmonary circulation. Whether there may be racial differences in pulmonary vascular function is unknown. Thirty white European Caucasian subjects (15 women) and age and body-size matched 30 black sub-Saharan African subjects (15 women) underwent a cardiopulmonary exercise test and exercise stress echocardiography with measurements of pulmonary artery pressure (PAP) and cardiac output (CO). A pulmonary vascular distensibility coefficient ? was mathematically determined from the natural curvilinearity of multipoint mean PAP (mPAP)-CO plots. Maximum oxygen uptake (V?o2max) and workload were higher in the whites, while maximum respiratory exchange ratio and ventilatory equivalents for CO2 were the same. Pulmonary hemodynamics were not different at rest. Exercise was associated with a higher maximum total pulmonary vascular resistance, steeper mPAP-CO relationships, and lower ?-coefficients in the blacks. These differences were entirely driven by higher slopes of mPAP-CO relationships (2.5 ± 0.7 vs. 1.4 ± 0.7 mmHg·l(-1)·min; P < 0.001) and lower ?-coefficients (0.85 ± 0.33 vs. 1.35 ± 0.51%/mmHg; P < 0.01) in black men compared with white men. There were no differences in any of the hemodynamic variables between black and white women. In men only, the slopes of mPAP-CO relationships were inversely correlated to V?o2max (P < 0.01). Thus the pulmonary circulation is intrinsically less distensible in black sub-Saharan African men compared with white Caucasian Europeans men, and this is associated with a lower exercise capacity. This study did not identify racial differences in pulmonary vascular function in women. PMID:26205542
Olusanya Bolajoko O
Full Text Available Abstract Background Childhood immunisation is recognised worldwide as an essential component of health systems and an indispensable indicator of quality of care for vaccine-preventable diseases. While performance of immunisation programmes is more commonly measured by coverage, ensuring that every child is immunised at the earliest/appropriate age is an important public health goal. This study therefore set out to determine the pattern and predictors of Bacille de Calmette-Guérin (BCG immunisation delays in the first three months of life in a Sub-Saharan African community where BCG is scheduled at birth in order to facilitate necessary changes in current policy and practices for improved services. Methods A cross-sectional study in which immunisation delays among infants aged 0-3 months attending community-based BCG clinics in Lagos, Nigeria over a 2-year period from July 2005 to June 2007 were assessed by survival analysis and associated factors determined by multivariable logistic regression. Population attributable risk (PAR was computed for the predictors of delays. Results BCG was delayed beyond three months in 31.6% of all eligible infants. Of 5171 infants enrolled, 3380 (65.4% were immunised within two weeks and a further 1265 (24.5% by six weeks. A significantly higher proportion of infants born in hospitals were vaccinated in the first six weeks compared to those born outside hospitals. Undernourishment was predictive of delays beyond 2 and 6 weeks while treated hyperbilirubinaemia was associated with decreased odds for any delays. Lack of antenatal care and multiple gestations were also predictive of delays beyond 6 weeks. Undernourishment was associated with the highest PAR for delays beyond 2 weeks (18.7% and 6 weeks (20.8%. Conclusions BCG immunisation is associated with significant delays in this setting and infants at increased risk of delays can be identified and supported early possibly through improved maternal uptake of antenatal care. Combining BCG with subsequent immunisation(s at 6 weeks for infants who missed the BCG may be considered.
Taiwo Akinlo; Olumuyiwa Tolulope Apanisile
This study examined the relationship between insurance and economic growth in sub-Saharan Africa over the period 1986-2011. Pooled OLS, Fixed Effect Model and Generalized Method of Moment Panel Model were employed in the estimation. The estimations of the dynamic panel-data results show that insurance has positive and significance impact on economic growth in sub-Saharan Africa. This shows that premium contributes to economic growth in sub-Saharan Africa which means tha...
Objective To systematically review current smoking prevalence among adults in sub-Saharan Africa from 2007 to May 2014 and to describe the context of tobacco control strategies in these countries. Data Sources Five databases, Medline, Embase, Africa-wide Information, Cinahl Plus, and Global Health were searched using a systematic search strategy. There were no language restrictions. Study Selection 26 included studies measured current smoking prevalence in nationally representative adult populations in sub-Saharan African countries. Data Extraction Study details were independently extracted using a standard datasheet. Data on tobacco control policies, taxation and trends in prices were obtained from the Implementation Database of the WHO FCTC website. Results Studies represented 13 countries. Current smoking prevalence varied widely ranging from 1.8% in Zambia to 25.8% in Sierra Leone. The prevalence of smoking was consistently lower in women compared to men with the widest gender difference observed in Malawi (men 25.9%, women 2.9%). Rwanda had the highest prevalence of women smokers (12.6%) and Ghana had the lowest (0.2%). Rural, urban patterns were inconsistent. Most countries have implemented demand-reduction measures including bans on advertising, and taxation rates but to different extents. Conclusion Smoking prevalence varied widely across sub-Saharan Africa, even between similar country regions, but was always higher in men. High smoking rates were observed among countries in the eastern and southern regions of Africa, mainly among men in Ethiopia, Malawi, Rwanda, and Zambia and women in Rwanda and rural Zambia. Effective action to reduce smoking across sub-Saharan Africa, particularly targeting population groups at increased risk remains a pressing public health priority. PMID:26162085
Balding, Christopher; Feng, Yan; Atashband, Armita
The debate between pro- and anti-international adoption advocates relies heavily on rhetoric and little on data analysis. To better understand the state of orphans and potential adopters in this debate, we utilize the National Survey of Family Growth (NSFG) and the Demographic and Health Surveys (DHS) to study who adopts internationally and the status of orphaned children in sub-Saharan Africa. According to NSFG data adopters are church going, highly educated, stable families aware of the challenges faced by international adoption, with high rates of infertility and rates of child abuse half the population average. According to the DHS data, orphans in sub-Saharan Africa suffer from significantly higher deprivation, reduced schooling and increased levels of stunting and underweight reported than their cohort. Using this data, we estimate conservatively that that 1?50?000 orphans from our sample of sub-Saharan African countries died from their 5-year birth cohort. Given the large number of families seeking to adopt and the high number of orphan deaths, it seems counterproductive to restrict international adoptions given the significantly lower risks faced by children in adopted families compared with remaining orphaned. PMID:25769738
Reinhart Kößler; Arnold-Bergstraesser-Institut
Review of the monograph:Joseph Patrick Ganahl, Corruption, Good Governance, and the African State: A Critical Analysis of the Political-Economic Foundations of Corruption in Sub-Saharan Africa, Potsdam: Potsdam University Press, 2013, ISBN 9783869562483, 300 pp.
Kanayo Ogujiub; Uche Nwogwugw; Enwere Dik
The East Asian catch-up industrialization experience is often presented in the literature as a benchmark for Sub-Saharan African countries seeking to undergo an industrial revolution. A recurrent theme in the East Asian model is the use of the import substitution industrialization (ISI) phase as a basis for technological learning and international business. The East Asian countries used ISI to build up an industrial technological competence. Starting with the low- skill, labour intensive manu...
Watson, H K; Diaz-Chavez, R. A.
This paper synthesizes lessons learnt from research that aimed to identify land in the dryland regions of eight sub-Saharan African study countries where bioenergy feedstocks production has a low risk of detrimental environmental and socio-economic effects. The methodology involved using geographical information systems (GISs) to interrogate a wide range of datasets, aerial photograph and field verification, an extensive literature review, and obtaining information from a wide range of stakeh...
Laan, H.L. van der; Haaren, W.T.M. van
Sum.: The economic policy of structural adjustment, which was initiated in most African countries during the 1980s, posed a serious threat to agricultural marketing boards in sub-Saharan Africa. Two elements of structural adjustment were particularly ominous: 'privatization' threatened the continued existence of marketing boards as public enterprises, and the 'liberalization of trade' worsened the conditions under which they operated. On the basis of an extensive study of the literature, this...
This study carries out an empirical examination of the finance-led, export-led and import-led growth hypothesis for four of the largest Sub-Saharan African economies namely South Africa, Nigeria, Ghana and Kenya. Within a multivariate Vector-Auto Regressive (VAR) framework, the concept of Granger causality is employed to determine the direction of causation between exports and output, duly taking into account the stationarity properties of the time series data. With further substantiation fro...
Degboe Arnold N; Taylor Kelly D; Iwelunmor Juliet; Okoror Titilayo A; BeLue Rhonda; Agyemang Charles; Ogedegbe Gbenga
Abstract Background Sub-Saharan African (SSA) countries are currently experiencing one of the most rapid epidemiological transitions characterized by increasing urbanization and changing lifestyle factors. This has resulted in an increase in the incidence of non-communicable diseases, especially cardiovascular disease (CVD). This double burden of communicable and chronic non-communicable diseases has long-term public health impact as it undermines healthcare systems. Purpose The purpose of th...
Samba Michel Cyrille
This paper analyses the Feldstein-Horioka puzzle in 15 sub-Saharan African countries accounting for the correlation between inward and outward capital flows. Applying cross section, panel data, and even time series analyses, we show that our results are consistent with previous studies related to developing countries. More interesting, we confirm, for sub-Saharan African countries, the recent hypothesis of Georgepoulos and Hejazi (2009) that the Feldstein-Horioka home bias is unrelated to th...
Muideen O. Bakare; Kerim M. Munir; Bello-Mojeed, Mashudat A.
Sub-Saharan African (SSA) population consists of about 45% children, while in Europe and North America children population is 10- 15%. Lately, attention has been directed at mitigating childhood infectious and communicable diseases to reduce under-five mortality. As the under-five mortality index in Sub-Saharan Africa has relatively improved over the last two decades, more Sub-Saharan African children are surviving beyond the age of five and, apparently, a sizeable percentage of this populati...
Capucine de Fouchier
Full Text Available Background: To date no validated instrument in the French language exists to screen for posttraumatic stress disorder (PTSD in survivors of torture and organized violence. Objective: The aim of this study is to adapt and validate the Harvard Trauma Questionnaire (HTQ to this population. Method: The adapted version was administered to 52 French-speaking torture survivors, originally from sub-Saharan African countries, receiving psychological treatment in specialized treatment centers. A structured clinical interview for DSM was also conducted in order to assess if they met criteria for PTSD. Results: Cronbach's alpha coefficient for the HTQ Part 4 was adequate (0.95. Criterion validity was evaluated using receiver operating characteristic curve analysis that generated good classification accuracy for PTSD (0.83. At the original cut-off score of 2.5, the HTQ demonstrated high sensitivity and specificity (0.87 and 0.73, respectively. Conclusion: Results support the reliability and validity of the French version of the HTQ.
Ichoku, Charles; Ellison, Luke
The northern sub-Saharan African (NSSA) region, bounded by the Sahara, Equator, and the West and East African coastlines, is subjected to intense biomass burning every year during the dry season. This is believed to be one of the drivers of the regional carbon and energy cycles, with serious implications for the water cycle anomalies that probably contribute to drought and desertification. In this presentation, we will discuss a new multi-disciplinary research in the NSSA region, review progress, evaluate preliminary results, and interact with the research and user communities to examine how best to coordinate with other research activities in order to address related environmental issues most effectively.
Ashford C. Chea
Full Text Available The paper begins with a brief review of the nature and historical perspective of strategy. This is followed by discussion of industry analysis as in important step in the strategy development process. The paper continues with an analysis of the strategy development process and the role of strategic leadership to sustain strategy. Also presented in the paper is the analysis of how the appropriate management system can be leveraged to support a successful strategy execution and evaluation. The paper ends with an outline of strategic implications and recommendations for sub-Saharan African business leaders and managers.
Full Text Available Abstract Background There exists no consistent explanation for why some countries are successful in combating HIV/AIDS and others are not, and we need such an explanation in order to design effective policies and programmes. Research evaluating HIV interventions from a biomedical or public health perspective does not always take full account of the historical and organizational characteristics of countries likely to influence HIV outcomes. The analysis in this paper addresses this shortcoming by testing the impact of organizational and structural factors, particularly those resulting from population interventions, on HIV outcomes at the country level in sub-Saharan Africa. Methods The primary independent variables are factors that originated from efforts to slow population growth: whether a country has a long-time affiliate of the International Planned Parenthood Federation and whether a country has a population policy. Additional structural factors likely to impact HIV outcomes include the level of wealth, the level of cultural fractionalization, and the former colonial power. The present study uses multivariate regression techniques with countries in sub-Saharan Africa as the unit of analysis, and four measures of success in addressing HIV: the change in prevalence between 2001 and 2009; the change in incidence between 2001 and 2009; the level of overall antiretroviral coverage in 2009; and the level of antiretroviral coverage for prevention of vertical transmission in 2009. Results Countries with the greatest declines in HIV prevalence and incidence had older International Planned Parenthood Federation affiliates and had adopted population policies, even after controlling for age of epidemic, level of antiretroviral coverage, and funding for HIV. Population policies are also important predictors of levels of overall antiretroviral coverage and of coverage of HIV-positive pregnant women to prevent vertical transmission. Structural factors with significant impacts include wealth, cultural fractionalization and former colonial power. Conclusions The organizational and structural context of African countries is strongly predictive of HIV outcomes. This finding implies that policy and programmatic efforts should be put towards strengthening existing organizations and perhaps even creating new ones. The fact that cultural fractionalization also influences HIV outcomes suggests that efforts must be put towards identifying ways to reach political consensus in diverse societies.
BLANGIARDO, Gian Carlo
According to destination country statistics there are nearly ten million emigrants from southern and eastern Mediterranean and Sub-Saharan CARIM countries and about four out of ten of these are women. As to immigration the United Nations estimates eleven million international migrants in CARIM-15 countries, of whom 48% are female. The female emigration rates in CARIM countries vary depending upon destination areas and motivations. In general, Europe and Northern America offer more opportuniti...
Kufuor, Nana Kwabena
The actions of governments are instrumental in economic development, and an important lever of policy is fiscal policy. Taxation and spending cannot only promote economic development but inhibit progress and retard the process, and nowhere is this most evident than in sub-Saharan Africa (SSA), which is the focus of this study. Promoting economic development therefore requires that policies that inhibit the process are identified and addressed. In this light, this thesis investigates two commo...
Norman, Paul J; Hollenbach, Jill A; Nemat-Gorgani, Neda; Guethlein, Lisbeth A; Hilton, Hugo G; Pando, Marcelo J; Koram, Kwadwo A; Riley, Eleanor M; Abi-Rached, Laurent; Parham, Peter
Interactions between HLA class I molecules and killer-cell immunoglobulin-like receptors (KIR) control natural killer cell (NK) functions in immunity and reproduction. Encoded by genes on different chromosomes, these polymorphic ligands and receptors correlate highly with disease resistance and susceptibility. Although studied at low-resolution in many populations, high-resolution analysis of combinatorial diversity of HLA class I and KIR is limited to Asian and Amerindian populations with low genetic diversity. At the other end of the spectrum is the West African population investigated here: we studied 235 individuals, including 104 mother-child pairs, from the Ga-Adangbe of Ghana. This population has a rich diversity of 175 KIR variants forming 208 KIR haplotypes, and 81 HLA-A, -B and -C variants forming 190 HLA class I haplotypes. Each individual we studied has a unique compound genotype of HLA class I and KIR, forming 1-14 functional ligand-receptor interactions. Maintaining this exceptionally high polymorphism is balancing selection. The centromeric region of the KIR locus, encoding HLA-C receptors, is highly diverse whereas the telomeric region encoding Bw4-specific KIR3DL1, lacks diversity in Africans. Present in the Ga-Adangbe are high frequencies of Bw4-bearing HLA-B*53:01 and Bw4-lacking HLA-B*35:01, which otherwise are identical. Balancing selection at key residues maintains numerous HLA-B allotypes having and lacking Bw4, and also those of stronger and weaker interaction with LILRB1, a KIR-related receptor. Correspondingly, there is a balance at key residues of KIR3DL1 that modulate its level of cell-surface expression. Thus, capacity to interact with NK cells synergizes with peptide binding diversity to drive HLA-B allele frequency distribution. These features of KIR and HLA are consistent with ongoing co-evolution and selection imposed by a pathogen endemic to West Africa. Because of the prevalence of malaria in the Ga-Adangbe and previous associations of cerebral malaria with HLA-B*53:01 and KIR, Plasmodium falciparum is a candidate pathogen. PMID:24204327
Full Text Available Review of the monograph:Joseph Patrick Ganahl, Corruption, Good Governance, and the African State: A Critical Analysis of the Political-Economic Foundations of Corruption in Sub-Saharan Africa, Potsdam: Potsdam University Press, 2013, ISBN 9783869562483, 300 pp.
Meyrowitsch, Dan Wolf; Pedersen, Erling Møller; Alifrangis, Michael; Scheike, Thomas; Malecela, Mwelecele N.; Magesa, Stephen M.; Derua, Yahya A.; Rwegoshora, Rwehumbiza T.; Michael, Edwin; Simonsen, Paul Erik
ABSTRACT: BACKGROUND: In sub-Saharan Africa (SSA), malaria caused by Plasmodium falciparum has historically been a major contributor to morbidity and mortality. Recent reports indicate a pronounced decline in infection and disease rates which are commonly ascribed to large-scale bed net programmes and improved case management. However, the decline has also occurred in areas with limited or no intervention. The present study assessed temporal changes in Anopheline populations in two highly malari...
Kawooya, Michael G
The objectives of this review are to outline the needs, challenges, and training interventions for rural radiology (RR) training in Sub-Saharan Africa (SSA). Rural radiology may be defined as imaging requirements of the rural communities. In SSA, over 80% of the population is rural. The literature was reviewed to determine the need for imaging in rural Africa, the challenges, and training interventions. Up to 50% of the patients in the rural health facilities in Uganda may require imaging, la...
Cinyabuguma, Matthias; Putterman, Louis
We use two types of cross-country growth regression models to revisit explanations of slow growth in Africa looking at growth rate variation among African countries only. Both sets of models produce results that are surprising given conclusions based on global sample: within Africa, we .nd greater coastal population negatively and greater ethnic heterogeneity positively associated with growth, while distance from the equator is at .rst negatively and only later positively associated with grow...
Full Text Available Abstract Background The burden of fevers remains enormous in sub-Saharan Africa. While several efforts at reducing the burden of fevers have been made at the macro level, the relationship between socioeconomic status and fever prevalence has been inconclusive at the household and individual levels. The purpose of this study was to examine how individual and household socioeconomic status influences the prevalence of fever among children under age five in four sub-Saharan African countries. Methods The study used data from the 2008 Demographic and Health Survey (DHS from Ghana, Nigeria, Kenya and Sierra Leone with a total of 38,990 children below age five. A multi-level random effects logistic model was fitted to examine the socioeconomic factors that influence the prevalence of fever in the two weeks preceding the survey. Data from the four countries were also combined to estimate this relationship, after country-specific analysis. Results The results show that children from wealthier households reported lower prevalence of fever in Ghana, Nigeria and Kenya. Result from the combined dataset shows that children from wealthier households were less likely to report fever. In general, vaccination against fever-related diseases and the use of improved toilet facility reduces fever prevalence. The use of bed nets by children and mothers did not show consistent relationship across the countries. Conclusion Poverty does not only influence prevalence of fever at the macro level as shown in other studies but also the individual and household levels. Policies directed towards preventing childhood fevers should take a close account of issues of poverty alleviation. There is also the need to ensure that prevention and treatment mechanisms directed towards fever related diseases (such as malaria, pneumonia, measles, diarrhoea, polio, tuberculosis etc. are accessible and effectively used.
Full Text Available Mercy Mvundura, Neeti Nundy, Maggie Kilbourne-Brook, Patricia S Coffey Technology Solutions Global Program, PATH, Seattle, WA, USA Background: Female condoms are the only currently available woman-initiated option that offers dual protection from pregnancy and sexually transmitted infections, including HIV. The Womans Condom is a new female condom designed to provide dual protection and to be highly pleasurable and acceptable. Objective: We sought to estimate the potential dual health impact and cost-effectiveness of a Womans Condom distribution program in 13 sub-Saharan African countries with HIV prevalence rates >4% among adults aged 1549 years. We used two separate, publicly available models for this analysis, the Impact 2 model developed by Marie Stopes International and the Population Services International disability-adjusted life years (DALY calculator program. We estimated the potential numbers of pregnancies and DALYs averted when the Womans Condom is used as a family planning method and the HIV infections and DALYs averted when it is used as an HIV prevention method. Results: Programming 100,000 Womans Condoms in each of 13 countries in sub-Saharan Africa during a 1-year period could potentially prevent 194 pregnancies and an average of 21 HIV infections in each country. When using the World Health Organization CHOosing Interventions that are Cost-Effective (WHO-CHOICE criteria as a threshold to infer the potential cost-effectiveness of the Womans Condom, we found that the Womans Condom would be considered cost-effective. Conclusion: This was a first and successful attempt to estimate the impact of dual protection of female condoms. The health impact is greater for the use of the Womans Condom as an HIV prevention method than for contraception. Dual use of the Womans Condom increases the overall health impact. The Womans Condom was found to be very cost-effective in all 13 countries in our sample. Keywords: female condoms, unintended pregnancy, HIV prevention, contraception, sub-Saharan Africa, cost-effectiveness
Norman, Paul J.; Hollenbach, Jill A.; Nemat-Gorgani, Neda; Guethlein, Lisbeth A; Hilton, Hugo G; Pando, Marcelo J.; Koram, Kwadwo A.; Riley, Eleanor M; Abi-Rached, Laurent; Parham, Peter
Interactions between HLA class I molecules and killer-cell immunoglobulin-like receptors (KIR) control natural killer cell (NK) functions in immunity and reproduction. Encoded by genes on different chromosomes, these polymorphic ligands and receptors correlate highly with disease resistance and susceptibility. Although studied at low-resolution in many populations, high-resolution analysis of combinatorial diversity of HLA class I and KIR is limited to Asian and Amerindian populations with lo...
La construcción del proyecto migratorio y las razones para emigrar en la población de África subsahariana francófona. Un estudio intercontinental Europa - África / Construction of migration project and reasons for emigrating in sub-Saharan African francophone population. An intercontinental study Europe-Africa
Carlos Roberto, Velandia Torres; Marie-Françoise, Lacassagne.
Full Text Available Este estudio da cuenta de las razones de los ciudadanos de África subsahariana francófona para establecerse en Europa, y particularmente en Francia, mediante la creación de un marco comprensivo innovador que vincula tres ejes temáticos: la motivación, las migraciones, y África y sus relaciones con E [...] uropa. 155 participantes en ambos continentes respondieron a un cuestionario sobre su proyecto migratorio real o posible. Los resultados plantean un plano general de acercamiento a los imaginarios y la realidad de los migrantes en el contexto francés, marcado por la reflexión sobre la identidad nacional, los controles migratorios, un clima político reticente a la migración y un tejido social caracterizado por un creciente multiculturalismo. Abstract in english This study describes the motivations of citizens of sub-Saharan Africa francophone to establish in France thanks to the creation of an innovative framework for understanding with three key themes: motivation, migration and Africa and their relations with Europe. 155 participants from both continents [...] responded to a questionnaire about their actual or potential migration project. The results presented raise a general plan of approach to reality and imaginary of sub-Saharan African migrants in the French current context, marked by reflection on national identity, immigration and customs controls, a political climate reticent to migration and a social network characterized by a growing multiculturalism.
Full Text Available Basic provisions for design ground motions in seismic design codes of sub-Saharan African countries are critically reviewed. The seismic codes of Ethiopia, Kenya and Uganda are selected to represent the eastern region, Ghana to represent the west and South Africa to represent the south. The specific [...] provisions considered are those pertaining to site effect and the recurrence period of the design earthquake. The codes are also compared with one another and with selected current international codes from the US and Europe, with respect to selected provisions. The provisions are further viewed from the perspective of the state of the art and the state of the practice. It has been concluded that these basic provisions in most of the sub-Saharan African codes considered are inadequate in guaranteeing safety of human life and limiting damage to property, suggesting a need for immediate updating, an exception being the South African code.
Degboe Arnold N
Full Text Available Abstract Background Sub-Saharan African (SSA countries are currently experiencing one of the most rapid epidemiological transitions characterized by increasing urbanization and changing lifestyle factors. This has resulted in an increase in the incidence of non-communicable diseases, especially cardiovascular disease (CVD. This double burden of communicable and chronic non-communicable diseases has long-term public health impact as it undermines healthcare systems. Purpose The purpose of this paper is to explore the socio-cultural context of CVD risk prevention and treatment in sub-Saharan Africa. We discuss risk factors specific to the SSA context, including poverty, urbanization, developing healthcare systems, traditional healing, lifestyle and socio-cultural factors. Methodology We conducted a search on African Journals On-Line, Medline, PubMed, and PsycINFO databases using combinations of the key country/geographic terms, disease and risk factor specific terms such as "diabetes and Congo" and "hypertension and Nigeria". Research articles on clinical trials were excluded from this overview. Contrarily, articles that reported prevalence and incidence data on CVD risk and/or articles that report on CVD risk-related beliefs and behaviors were included. Both qualitative and quantitative articles were included. Results The epidemic of CVD in SSA is driven by multiple factors working collectively. Lifestyle factors such as diet, exercise and smoking contribute to the increasing rates of CVD in SSA. Some lifestyle factors are considered gendered in that some are salient for women and others for men. For instance, obesity is a predominant risk factor for women compared to men, but smoking still remains mostly a risk factor for men. Additionally, structural and system level issues such as lack of infrastructure for healthcare, urbanization, poverty and lack of government programs also drive this epidemic and hampers proper prevention, surveillance and treatment efforts. Conclusion Using an African-centered cultural framework, the PEN3 model, we explore future directions and efforts to address the epidemic of CVD risk in SSA.
With the advent of modernization traditional African family patterns are slowly but progressively being altered. Family patterns that were the norm in traditional African societies are gradually being substituted by modern values. The progressive transformation of sub Saharan African societies from rural to urban settings has precipitated the advent of changes in family patterns in the region. This paper attempts to examine the changes that are taking place in family structure in sub Saharan ...
Gurney, Karen A.; Mgone, Charles S.
Background The European & Developing Countries Clinical Trials Partnership (EDCTP) is a partnership of European and sub-Saharan African countries that aims to accelerate the development of medical interventions against poverty-related diseases (PRDs). A bibliometric analysis was conducted to 1) measure research output from European and African researchers on PRDs, 2) describe collaboration patterns, and 3) assess the citation impact of clinical research funded by EDCTP. Methodology/Principal Findings Disease-specific research publications were identified in Thomson Reuters Web of Science using search terms in titles, abstracts and keywords. Publication data, including citation counts, were extracted for 20032011. Analyses including output, share of global papers, normalised citation impact (NCI), and geographical distribution are presented. Data are presented as five-year moving averages. European EDCTP member countries accounted for ~33% of global research output in PRDs and sub-Saharan African countries for ~10% (20072011). Both regions contributed more to the global research output in malaria (43.4% and 22.2%, respectively). The overall number of PRD papers from sub-Saharan Africa increased markedly (>47%) since 2003, particularly for HIV/AIDS (102%) and tuberculosis (TB) (81%), and principally involving Southern and East Africa. For 20072011, European and sub-Saharan African research collaboration on PRDs was highly cited compared with the world average (NCI in brackets): HIV/AIDS 1.62 (NCI: 1.16), TB 2.11 (NCI: 1.06), malaria 1.81 (NCI: 1.22), and neglected infectious diseases 1.34 (NCI: 0.97). The NCI of EDCTP-funded papers for 20032011 was exceptionally high for HIV/AIDS (3.24), TB (4.08) and HIV/TB co-infection (5.10) compared with global research benchmarks (1.14, 1.05 and 1.35, respectively). Conclusions The volume and citation impact of papers from sub-Saharan Africa has increased since 2003, as has collaborative research between Europe and sub-Saharan Africa. >90% of publications from EDCTP-funded research were published in high-impact journals and are highly cited. These findings corroborate the benefit of collaborative research on PRDs. PMID:26262756
Following a field survey in neighbourhoods and schools in the poor area of Brussels among adolescents from an African migrant background (Morocco and sub-Saharan Africa), this article examines young peoples attempts to rationalise the discrimination and injustice they experience. As well as their direct effects in terms of social success in particular, institutional discrimination and violence have repercussions on representations of oneself and of the world. The accumulation of experiences ...
Dandume, Muhammad Yusuf; A.C., Dr.Malarvizhi
This paper examines the linkage among financial liberalization, economic growth and poverty reduction in Sub-Saharan African countries (SSA). The study applies the recent panel Co-integration and vector error correction mechanism to address the heterogeneity and cross-border interdependence over the period of 1980 to 2010. The results reveal that economic growth is positively associated with poverty reduction and financial liberalization coefficients are positively related to economic growth....
Yue, Y.; Wang, J.; Ichoku, C. M.; Zhang, F.
This study aims to investigate the radiative effects of smoke and dust aerosols and of the underlying surface in the Northern Sub-Saharan African (NSSA) region using the Weather Research and Forecasting model coupled with Chemistry (WRF-Chem). We performed a yearlong (from September 2009 to September 2010) WRF-Chem simulation using hourly emissions from the Fire Energetics and Emissions Research (FEER) emission dataset derived by multiplying emission coefficients based on aerosol and fire observations from the Moderate Resolution Imaging Spectroradiometer (MODIS) instruments aboard Terra and Aqua with fire radiative energy (FRE) measurements from the geostationary Meteosat Spinning Enhanced Visible and Infrared Imager (SEVIRI). The geographic distribution and vertical profiles of simulated dust and smoke aerosols were evaluated with MODIS true color images and Cloud-Aerosol Lidar data with Orthogonal Polarization (CALIPSO) total attenuated backscatter, aerosol extinction coefficient and depolarization data. We found that simulated aerosol vertical concentration profiles are consistent with the above CALIPSO data. Surface albedo and columnar aerosol optical depth (AOD) sensitivity to smoke and dust simulations are performed with WRF-Chem. The simulated surface albedo and AOD were compared with MODIS albedo product (MODIS43) and AOD measurements from the Aerosol Robotic Network (AERONET). The modeled smoke/dust clear-sky and all-sky radiative impacts were analyzed in this study and reveal interesting results that will be discussed.
Full Text Available Abstract Background Consumption of alcohol is associated with acute and chronic adverse health outcomes. There is a paucity of studies that explore the determinants of alcohol use among adolescents in sub-Saharan Africa and, in particular, that examine the effects of adverse childhood experiences on alcohol use. Methods The paper draws on nationally-representative data from 9,819 adolescents aged 12-19 years from Burkina Faso, Ghana, Malawi, and Uganda. Logistic regression models were employed to identify correlates of self-reported past-year drunkenness. Exposure to four adverse childhood experiences comprised the primary independent variables: living in a food-insecure household, living with a problem drinker, having been physically abused, and having been coerced into having sex. We controlled for age, religiosity, current schooling status, the household head's sex, living arrangements, place of residence, marital status, and country of survey. All analyses were conducted separately for males and females. Results At the bivariate level, all independent variables (except for coerced sex among males were associated with the outcome variable. Overall, 9% of adolescents reported that they had been drunk in the 12 months preceding the survey. In general, respondents who had experienced an adverse event during childhood were more likely to report drunkenness. In the multivariate analysis, only two adverse childhood events emerged as significant predictors of self-reported past-year drunkenness among males: living in a household with a problem drinker before age 10, and being physically abused before age 10. For females, exposure to family-alcoholism, experience of physical abuse, and coerced sex increased the likelihood of reporting drunkenness in the last 12 months. The association between adverse events and reported drunkenness was more pronounced for females. For both males and females there was a graded relationship between the number of adverse events experienced and the proportion reporting drunkenness. Conclusions We find an association between experience of adverse childhood events and drunkenness among adolescents in four sub-Saharan African countries. The complex impacts of adverse childhood experiences on young people's development and behavior may have an important bearing on the effectiveness of interventions geared at reducing alcohol dependence among the youth.
Sacks, Audrey; Levi, Margaret
We introduce a method for measuring effective government and modeling its consequences for social welfare at the individual level. Our focus is on the experiences of citizens living in African countries where famine remains a serious threat. If a government is effective, it will be able to deliver goods that individuals need to improve their
Eskemose Andersen, JØrgen
Current definitions of urbanity lead to claims that a large proportion (75% according to UN Habitat) of Sub-Saharan Africas (SSA) urban population is housed in informal settlements with almost all new housing stock provided informally in contradiction to the formal that is defined as planned and regulated by the state. In most cases in SSA cities urban development has no professional assistance in the form of architects or engineers, and what is characterised as disorder, as is the case with informal urbanisation, is considered as undesirable, inappropriate, dangerous, unhealthy and un-modern (Folkers 2009, Hardoy 1990, Jenkins 2011, Nielsen 2008, Nguluma 2003, Mitlin, D. 2004, Koolhaas 2006). In 2003 the UN adopted a new terminology for what over decades used to be labelled as informal-, squatter-, illegal-, unplanned-, spontaneous settlements, shanty towns with the term slum (UN habitat 2003). However, defining what slum implies is complex and this author consider the term as prejudiced and not covering the diversity most informal settlements represents Further the term stigmatises a remarkable share of any city population in SSA (Huchzermeyer 2011, Davis 2007, Harber 2011, Garau 2005).
Barry, Boubakar; /Assoc. Afr. Univ.; Chukwuma, Victor; /Olabisi Onabanjo U.; Petitdidier, Monique; /CEPT, Velizy; Cottrell, Les; /SLAC; Bartons, Charles; /Australian Natl. U., RSES
The Digital Divide prevents Africa from taking advantages of new information technologies. One of the most urgent priorities is to bring the Internet in African Universities, Research, and Learning Centers to the level of other regions of the world. eGY-Africa, and the Sharing Knowledge Foundation are two bottom-up initiatives by scientists to secure better cyber-infrastructure and Internet facilities in Africa. Recommendations by the present scientific communities are being formulated at national, regional and international levels. The Internet capabilities are well documented at country level overall, but this is not the case at the University level. The snapshot of the Internet status in universities in 17 African countries, obtained by a questionnaire survey, is consistent with measures of Internet penetration in the corresponding country. The monitoring of Internet performance has been proposed to those African universities to provide an information base for arguing the need to improve the coverage for Africa. A pilot program is recommended that will start scientific collaboration with Europe in western Africa using ICT. The program will lay the foundations for the arrival of new technologies like Grids.
Roger J. Chin, MA, MPA
Full Text Available Background: HIV and AIDS continue to have a calamitous effect on individuals living on the continent of Africa. U.S. President George W. Bush implemented the Presidents Emergency Plan for AIDS Relief (PEPFAR with the objective of committing approximately $15 billion from 2004 through 2008 to assist with the reduction of the HIV pandemic worldwide. The majority of the PEPFAR policy and funding focused on 12 countries in sub-Saharan Africa: Botswana, Cote dIvoire, Ethiopia, Kenya, Mozambique, Namibia, Nigeria, Rwanda, South Africa, Tanzania, Uganda, and Zambia. The policy question this research paper seeks to analyze is whether the PEPFAR funding (as a % of Gross Domestic Product (GDP allocated to the 12 countries in Africa had any effect on the decrease of HIV infection rates of males and females between the ages of 15 and 49. Methods: A fixed-effects panel regression analysis was conducted to determine if this association exists. This study examined the 12 African countries that received PEPFAR funding over the years 2002 to 2010; even though PEPFAR was only active from 2004 through 2008, this research included two years prior and two years after this timeframe in order to better estimate the effect of PEPFAR funding on HIV reduction. Results: The results illustrate that on average, ceteris paribus, for every 1 percentage point increase in PEPFAR funding per GDP a country received, the countrys HIV infection rate decreased by 0.355 percentage points. Conclusions and Global Health Implications: While the empirical findings in this study suggested that the correlation between PEPFAR funding and HIV reduction is statistically significant, the practical significance is perhaps less obvious. Arguably, the reduction rate should be higher given the extent of funding targeted to this project. The conclusion of this research provides suggestions on future research and the policy implications of PEPFAR.
Fezeu, Leopold; Balkau, Beverley; Kengne, André-Pascal; Sobngwi, Eugène; Mbanya, Jean-Claude
OBJECTIVES: To determine, in a rural and urban population in Cameroon, the prevalence of the metabolic syndrome (MS) using three definitions and to assess the association between components of the MS, central obesity and HOMA insulin resistance (HOMA-IR) index. METHODS: A representative sample of 1573 adults (638 rural, 935 urban) were interviewed on their personal medical history. Blood pressure and anthropometric measures used standardised methods. After an overnight fast, blood samples wer...
Mullan, Fitzhugh; Frehywot, Seble; Omaswa, Francis; Buch, Eric; Chen, Candice; Greysen, S.R.; Wassermann, Travis; Abu Bakr, Diaa Eldin El Gali; Awases, Magda; Boelen, Charles; Diomande, Mohenou Jean-Marie Isidore; Dovlo, Delanyo; Ferro, Josefo; Haileamlak, Abraham; Iputo, Jehu
Small numbers of graduates from few medical schools, and emigration of graduates to other countries, contribute to low physician presence in sub-Saharan Africa. The Sub-Saharan African Medical School Study examined the challenges, innovations, and emerging trends in medical education in the region. We identified 168 medical schools; of the 146 surveyed, 105 (72%) responded. Findings from the study showed that countries are prioritising medical education scale-up as part of health-system...
Michael G Kawooya
Full Text Available The objectives of this review are to outline the needs, challenges, and training interventions for rural radiology (RR training in Sub-Saharan Africa (SSA. Rural radiology may be defined as imaging requirements of the rural communities. In SSA, over 80% of the population is rural. The literature was reviewed to determine the need for imaging in rural Africa, the challenges, and training interventions. Up to 50% of the patients in the rural health facilities in Uganda may require imaging, largely ultrasound and plain radiography. In Uganda, imaging is performed, on an average, in 50% of the deserving patients in the urban areas, compared to 10-13 % in the rural areas. Imaging has been shown to increase the utilization of facility-based rural health services and to impact management decisions. The challenges in the rural areas are different from those in the urban areas. These are related to disease spectrum, human resource, and socio-economic, socio-cultural, infrastructural, and academic disparities. Countries in Sub-Saharan Africa, for which information on training intervention was available, included: Uganda, Kenya, Tanzania, Rwanda, Zambia, Ghana, Malawi, and Sudan. Favorable national policies had been instrumental in implementing these interventions. The interventions had been made by public, private-for-profit (PFP, private-not-for profit (PNFP, local, and international academic institutions, personal initiatives, and professional societies. Ultrasound and plain radiography were the main focus. Despite these efforts, there were still gross disparities in the RR services for SSA. In conclusion, there have been training interventions targeted toward RR in Africa. However, gross disparities in RR provision persist, requiring an effective policy, plus a more organized, focused, and sustainable approach, by the stakeholders.
This work comprises three parts. The first part aims at presenting the energy situation of sub-Saharan African (SSA) countries grouped in five regions. Because of the demographic pressure and of the petroleum shocks, the commercial energy consumption is growing up rapidly and the energy prices are high for the end-users (because the energy is imported and paid in dollars, and the fiscality share is increased by governments in the case of prices drop in the international market). The important problem of wood fuel is considered, together with the energy-economic growth relations and the determining factors of the energy demand in SSA. Some econometric relations are tested. The second part analyzes the mechanisms generated by petroleum shocks and counter-shocks, and stresses first on the transfers induced by these fluctuations. Then, it presents some macro-economical models which try to integrate the effects of a petroleum shock and makes some calculations based on a decomposition of imports and exports global and partial coefficients. Some important conclusions are inferred from this study: 1 - the second petroleum shock strikes more seriously the oil importing SSA countries because they do not benefit from a favorable international context, like during the first shock (also because the second shock is accompanied by a dollar shock); 2 - the absence of symmetry in oil shocks-counter-shocks; 3 - the crisis of SSA countries is not only of petroleum origin but is also linked with the drop of the export incomes (which itself is partially explained by the impact of petroleum shocks on the industrialized economies), with their bad insertion in the world economy, and with unsuitable domestic economies. The third part proposes some solutions to attenuate the energy and economical difficulties of these countries. It is necessary to implement an energy planning mainly based on the mastery of the demand and on a better management of local resources. The policies of stabilization and of structural adjustment are also presented with their effects on the different sectors. (J.S.)
Behrens, Roger; Diaz Olvera, Lourdes; Plat, Didier; Pochet, Pascal
This paper compares experiences in the application of different approaches to passenger travel data collection in francophone and anglophone cities of West, Central and Southern Africa. Its aim is to identify possible improvements through which common problems might be addressed. The paper draws from the available French and English literature on survey methods applied in Sub-Saharan Africa, as well as from the authors' experiences in designing and administering surveys in this context. Probl...
The characteristics of places where people live and work play an important role in explaining complex social, political, economic and demographic processes. In sub-Saharan Africa rapid urban growth combined with rising poverty is creating diverse urban environments inhabited by people with a wide variety of lifestyles. This research examines how spatial patterns of land cover in a southern portion of the West African country of Ghana are associated with particular characteristics of family organization and reproduction decisions. Satellite imagery and landscape metrics are used to create an urban context definition based on landscape patterns using a gradient approach. Census data are used to estimate fertility levels and household structure, and the association between urban context, household composition and fertility levels is modeled through OLS regression, spatial autoregressive models and geographically weighted regression. Results indicate that there are significant differences in fertility levels between different urban contexts, with below average fertility levels found in the most urbanized end of the urban context definition and above average fertility levels found on the opposite end. The spatial patterns identified in the association between urban context and fertility levels indicate that, within the city areas with lower fertility have significant impacts on the reproductive levels of adjacent neighborhoods. Findings also indicate that there are clear patterns that link urban context to living arrangements and fertility levels. Female- and single-headed households are associated with below average fertility levels, a result that connects dropping fertility levels with the spread of smaller nuclear households in developing countries. At the same time, larger extended family households are linked to below average fertility levels for highly clustered areas, a finding that points to the prevalence of extended family housing in the West African city.
Lindsay, K L
Pregnant women in countries of Sub-Saharan Africa (SSA) are at risk of poor nutritional status and adverse outcomes as a result of poverty, food insecurity, sub-optimal healthcare facilities, frequent infections and frequent pregnancies. Studies from Nigeria, for example, have revealed a high prevalence of both under- and over-nutrition, as well as nutrient deficiencies, including iron, folate, vitamin D and vitamin A. Subsequently, obstetric complications, including hypertension, anaemia, neural tube defects, night-blindness, low birth weight and maternal and perinatal mortality, are common. Migration patterns from SSA to the Western world are on the rise in recent years, with Nigerians now representing the most prevalent immigrant African population in many developed countries. However, the effect of immigration, if any, on the nutritional status and pregnancy outcomes of these women in their host countries has not yet been studied. Consequently, it is unknown to what extent the nutritional deficiencies and pregnancy complications occurring in Nigeria, and other countries of SSA, present in these women post-emigration. This may result in missed opportunities for appropriate antenatal care of a potential high-risk group in pregnancy. The present review discusses the literature regarding nutrition in pregnancy among SSA women, using Nigeria as an example, the common nutrition-related complications that arise and the subsequent obstetric outcomes. The concept of dietary acculturation among immigrant groups is also discussed and deficiencies in the literature regarding studies on the diets of pregnant immigrant women are highlighted.
Access to energy is known as a key issue for poverty reduction. Electrification rate of sub-Saharan countries is one of the lowest among the developing countries. However, this part of the world has natural energy resources that could help raising its access to energy, then its economic development. An original 'flexy-energy' concept of hybrid solar PV/diesel/biofuel power plant, without battery storage, is performed in this paper. This concept is developed in order to not only make access to energy possible for rural and peri-urban populations in Africa (by reducing the electricity generation cost) but also to make the electricity production sustainable in these areas. For landlocked countries like Burkina Faso, this concept could help them reducing their electricity bill (then their fuel consumption) and accelerate their rural and peri-urban electrification coverage. - Research highlights: ? Design and load management Optimization are big concerns for hybrid systems. ? Hybrid solar PV/Diesel is economically viable for remote areas and environmental friendly. ? 'Flexy-energy' concept is a flexible hybrid solar PV/diesel/biomass suitable for remote areas. ? 'Flexy-energy' concept is a flexible hybrid solar PV/diesel/biomass suitable for remote areas.
Madise Nyovani; Ezeh Alex; Fotso Jean-Christophe; Ciera James
Abstract Background Improvements in child survival have been very poor in sub-Saharan Africa (SSA). Since the 1990s, declines in child mortality have reversed in many countries in the region, while in others, they have either slowed or stalled, making it improbable that the target of reducing child mortality by two thirds by 2015 will be reached. This paper highlights the implications of urban population growth and access to health and social services on progress in achieving MDG 4. Specifica...
Rwegoshora Rwehumbiza T
Full Text Available Abstract Background In sub-Saharan Africa (SSA, malaria caused by Plasmodium falciparum has historically been a major contributor to morbidity and mortality. Recent reports indicate a pronounced decline in infection and disease rates which are commonly ascribed to large-scale bed net programmes and improved case management. However, the decline has also occurred in areas with limited or no intervention. The present study assessed temporal changes in Anopheline populations in two highly malaria-endemic communities of NE Tanzania during the period 1998-2009. Methods Between 1998 and 2001 (1st period and between 2003 and 2009 (2nd period, mosquitoes were collected weekly in 50 households using CDC light traps. Data on rainfall were obtained from the nearby climate station and were used to analyze the association between monthly rainfall and malaria mosquito populations. Results The average number of Anopheles gambiae and Anopheles funestus per trap decreased by 76.8% and 55.3%, respectively over the 1st period, and by 99.7% and 99.8% over the 2nd period. During the last year of sampling (2009, the use of 2368 traps produced a total of only 14 Anopheline mosquitoes. With the exception of the decline in An. gambiae during the 1st period, the results did not reveal any statistical association between mean trend in monthly rainfall and declining malaria vector populations. Conclusion A longitudinal decline in the density of malaria mosquito vectors was seen during both study periods despite the absence of organized vector control. Part of the decline could be associated with changes in the pattern of monthly rainfall, but other factors may also contribute to the dramatic downward trend. A similar decline in malaria vector densities could contribute to the decrease in levels of malaria infection reported from many parts of SSA.
Meyrowitsch, Dan Wolf; Pedersen, Erling MØller
ABSTRACT: BACKGROUND: In sub-Saharan Africa (SSA), malaria caused by Plasmodium falciparum has historically been a major contributor to morbidity and mortality. Recent reports indicate a pronounced decline in infection and disease rates which are commonly ascribed to large-scale bed net programmes and improved case management. However, the decline has also occurred in areas with limited or no intervention. The present study assessed temporal changes in Anopheline populations in two highly malaria-endemic communities of NE Tanzania during the period 1998-2009. METHODS: Between 1998 and 2001 (1st period) and between 2003 and 2009 (2nd period), mosquitoes were collected weekly in 50 households using CDC light traps. Data on rainfall were obtained from the nearby climate station and was used to analyze the association between monthly rainfall and malaria mosquito populations. RESULTS: The average number of Anopheles gambiae and Anopheles funestus per trap decreased by 76.8% and 55.3%, respectively over the 1st period, and by 99.7% and 99.8% over the 2nd period. During the last year of sampling (2009), the use of 2368 traps produced a total of only 14 Anopheline mosquitoes. With the exception of the decline in An. gambiae during the 1st period, the results did not reveal any statistical association between mean trend in monthly rainfall and declining malaria vector populations. CONCLUSION: A longitudinal decline in the density of malaria mosquito vectors was seen during both study periods despite the absence of organized vector control. Part of the decline could be associated with changes in the pattern of monthly rainfall, but other factors may also contribute to the dramatic downward trend. A similar decline in malaria vector densities could contribute to the decrease in levels of malaria infection reported from many parts of SSA.
Manco, Licínio; Machado, Patrícia; Lopes, Dinora; Nogueira, Fátima; Rosário, Virgílio E. Do; Alonso, Pedro L.; Varandas, Luís; Trovoada, Maria Jesus; Amorim, António; Arez, Ana Paula
Population samples from Angola, Mozambique, and S. Tomé e Príncipe were screened for the TPI gene promoter variants -5ArarrG, -8GrarrA and -24TrarrG. Three haplotypes were identified in the three populations: the haplotype -5A-8G-24T (average frequency 65.3%) and two less common haplotypes -5G-8G-24T (average frequency 24.7%) and -5G-8A-24T (average frequency 10.0%). A population sample from Central Portugal showed the haplotype -5A-8G-24T in 139 chromosomes and one subject heterozygous for h...
Materu, Peter; Righetti, Petra
This article assesses the status and practice of higher education quality assurance in sub-Saharan Africa, focusing on degree-granting tertiary institutions. A main finding is that structured national-level quality assurance processes in African higher education are a very recent phenomenon and that most countries face major capacity constraints.
Akokpari, J K
Migration and refugee movements could significantly decline in sub-Saharan African countries. However, countries must redistribute meager resources equitably and engage in environmental protection. Refugee and migrant populations have increased in sub-Saharan Africa during 1969-95, from 700,000 to 6.8 million. This study examined the causes of migration and the implications for host countries. Doornbos (1990) identifies the root problem as the partisan nature of African politics and the incapacity to manage ecological degradation. The African state is wholly or partially responsible for the creation of conflicts. Examples abound in Zaire, South Africa, Sudan, Rwanda, Burundi, Somalia, Ethiopia, Liberia, Congo, and Chad. State partisanship is also evident in Angola, Mozambique, Uganda, and Sierra Leone. An estimated 10 million Africans, in 1985, left their homes due to wars, government repression, or the inability of land to support them. In 1994, USAID estimated that 11.6 million Africans in 10 countries were threatened by famine from drought. Environmental degradation has generated conflicts. Africa's marginalized economy results in recession, unemployment, inflation, and distributional conflicts. Democratization has brought conflicts between the state, civil society, and exiles. Refugees face homelessness, poverty, emotional distress, inadequate food, and disease. Host countries face security threats, pressure on limited resources, rebellions from refugees and their involvement with foreign mercenaries, local conflicts between native and refugee populations, and environmental degradation from refugees. PMID:12293796
Domatob, J K
Given the heavy Western metropolitan bias of the media in sub-Saharan Africa, the ideology of neocolonialism continues to exert a dominant influence on economic, social, political, and cultural life. This neocolonial influence is further reinforced by advertising that champions a consumerist culture centered around Western goods. The capital of multinational firms plays a crucial role in the strategy of media imperialism. The dramatic growth of monopolies and the creation of military-industrial-information conglomerates in the 1970s and 1980s have been reflected in the international exchange of information and the interlinkage of mass communication systems in sub-Saharan Africa. Another media strategy that reinforces neocolonialism is the use of satellite communication. If cultural autonomy is defined as sub-Saharan Africa's capacity to decide on the allocation of its environmental resources, then cultural synchronization is a massive threat to that autonomy. Few African nations have the resources or expertise necessary to design, establish, or maintain communication systems that could accurately reflect their own culture. Nonetheless, there are some policy options. Personnel can be trained to respect African values and to recognize the dangers of neocolonial domination. The production of indigenous programs could reduce the media's foreign content. The incorporation of traditional drama and dance in the media could enhance this process. Above all, a high degree of planning is necessary if sub-Saharan African states intend to tackle the media and its domination by neocolonialist ideology. PMID:12281808
Wicherts, Dolan, Carlson & van der Maas (WDCM) (2010) contend that the average IQ in sub-Saharan Africa is about 76 in relation to a British mean of 100 and sd of 15. This result is achieved by including many studies of unrepresentative elite samples. Studies of acceptably representative samples indicate a sub-Saharan Africa IQ of approximately
Van Hooft, W.F.
The African buffalo ( Syncerus caffer ) is one of the most numerous mammals of sub-Saharan Africa. Since the end of the 19th it has been affected by rinderpest epidemics and by habitat fragmentation due to increasing urbanisation and cultivation. In this thesis the genetic diversity of the African buffalo is investigated. A better knowledge of the population genetics of the African buffalo is necessary for an effective management and protection of this species. The goals of this thesis were t...
Karen H Keddy
Full Text Available OBJECTIVE: To evaluate three commercial typhoid rapid antibody tests for Salmonella Typhi antibodies in patients suspected of having typhoid fever in Mpumalanga, South Africa, and Moshi, United Republic of Tanzania. METHODS: The diagnostic accuracy of Cromotest® (semiquantitative slide agglutination and single tube Widal test,TUBEX®and Typhidot® was assessed against that of blood culture. Performance was modelled for scenarios with pretest probabilities of 5% and 50%. FINDINGS: In total 92 patients enrolled: 53 (57.6% from South Africa and 39 (42.4% from the United Republic of Tanzania. Salmonella Typhi was isolated from the blood of 28 (30.4% patients. The semiquantitative slide agglutination and single-tube Widal tests had positive predictive values (PPVs of 25.0% (95% confidence interval, CI: 0.6-80.6 and 20.0% (95% CI: 2.5-55.6, respectively. The newer typhoid rapid antibody tests had comparable PPVs: TUBEX®, 54.1% (95% CI: 36.9-70.5; Typhidot® IgM, 56.7% (95% CI: 37.4-74.5; and Typhidot® IgG, 54.3% (95% CI: 36.6-71.2. For a pretest probability of 5%, PPVs were: TUBEX®, 11.0% (95% CI: 6.6-17.9; Typhidot® IgM, 9.1% (95% CI: 5.8-14.0; and Typhidot® IgG, 11.0% (6.3-18.4. For a pretest probability of 50%, PPVs were: TUBEX®, 70.2% (95% CI: 57.3-80.5; Typhidot® IgM, 65.6% (95% CI: 54.0-75.6; and Typhidot® IgG, 70.0% (95% CI: 56.0-81.1. CONCLUSION: Semiquantitative slide agglutination and single-tube Widal tests performed poorly. TUBEX® and Typhidot® may be suitable when pretest probability is high and blood cultures are unavailable, but their performance does not justify deployment in routine care settings in sub-Saharan Africa.
The need to decompose CO2 emission intensity is predicated upon the need for effective climate change mitigation and adaptation policies. Such analysis enables key variables that instigate CO2 emission intensity to be identified while at the same time providing opportunities to verify the mitigation and adaptation capacities of countries. However, most CO2 decomposition analysis has been conducted for the developed economies and little attention has been paid to sub-Saharan Africa. The need for such an analysis for SSA is overwhelming for several reasons. Firstly, the region is amongst the most vulnerable to climate change. Secondly, there are disparities in the amount and composition of energy consumption and the levels of economic growth and development in the region. Thus, a decomposition analysis of CO2 emission intensity for SSA affords the opportunity to identify key influencing variables and to see how they compare among countries in the region. Also, attempts have been made to distinguish between oil and non-oil-producing SSA countries. To this effect a comparative static analysis of CO2 emission intensity for oil-producing and non oil-producing SSA countries for the periods 1971-1998 has been undertaken, using the refined Laspeyres decomposition model. Our analysis confirms the findings for other regions that CO2 emission intensity is attributable to energy consumption intensity, CO2 emission coefficient of energy types and economic structure. Particularly, CO2 emission coefficient of energy use was found to exercise the most influence on CO2 emission intensity for both oil and non-oil-producing sub-Saharan African countries in the first sub-interval period of our investigation from 1971-1981. In the second subinterval of 1981-1991, energy intensity and structural effect were the two major influencing factors on emission intensity for the two groups of countries. However, energy intensity effect had the most pronounced impact on CO2 emission intensity in non-oil-producing sub-Saharan African countries, while the structural effect explained most of the increase in CO2 emission intensity among the oil-producing countries. Finally, for the period 1991-1998, structural effect accounted for much of the decrease in intensity among non-oil-producers, while CO2 emission coefficient of energy use was the major force driving the decrease among oil-producing countries. The dynamic changes in the CO2 emission intensity and energy intensity effects for the two groups of countries suggest that fuel switching had been predominantly towards more carbon-intensive production in oil-producing countries and less carbon-intensive production in non-oil-producing SSA countries. In addition to the decomposition analysis, the article discusses policy implications of the results. We hope that the information and analyses provided here would help inform national energy and climate policy makers in SSA of the relative weaknesses and possible areas of strategic emphasis in their planning processes for mitigating the effects of climate change
Tully, K. L.; Russo, T.; Hickman, J. E.; Palm, C.
Nearly 80% of countries in sub-Saharan Africa (SSA) face problems of nitrogen (N) scarcity, which together with poverty causes food insecurity and malnutrition. The Alliance for a Green Revolution in Africa has set a goal of increasing fertilizer use in the region six-fold by 2015. While there is substantial evidence that greater N fertilizer use will improve crop yields, it could lead to increased N leaching and elevated nitrate (NO3-) concentrations in surface water and groundwater reservoirs. However, it is unclear what the magnitude of impacts will be in SSA given historically low nutrient additions (of less than 5 kg N/ha/yr), highly degraded soils (due to years of nutrient and soil organic matter depletion), and a wide range of soil types on which increased fertilizer use is occurring. Current estimates of N dynamics and balances in SSA agriculture now rely on data from other regions with different soil types, soil fertility, and land management practices. To understand the influence of increased fertilizer use on water quality requires data from representative areas in SSA. Experimental maize plots were established in a randomized complete block design in both western Kenya (clayey soil) and mid-western Tanzania (sandy soil). Plots were amended with 0, 50, 75, and 200 kg N/ha/yr as mineral fertilizer. Tension lysimeters were installed at three depths in each treatment, and water was collected throughout the maize growing season. Soil water solutions were analyzed for NO3--N. Flow through the soil column at each soil depth, was modeled using VS2DT, a variably saturated flow and solute transport model, and water flux values were multiplied by measured NO3--N concentrations to estimate seasonal N leaching flux. Soil texture was a major driver of N losses, altering both the pathways and magnitude of losses. Clayey soils in western Kenya show an enormous potential for loss of NO3--N immediately following the onset of rains as they trigger high rates of N mineralization and nitrification in the topsoil (known as the 'birch effect'). We did not observe this pulse in the sandy soils of central Tanzania. However, NO3- N concentrations in leachate were three times lower at 200 cm in clayey soils compared to sandy soils as a result of higher anion exchange capacity in clays. We show that while clayey soils lose NO3--N in a large pulse at the onset of rains, sandy soils lose large quantities of NO3--N over the course of the maize growing season. Results from this study can help inform recommended N application rates in similar soils (tropical Ultisols and Oxisols), to optimize yields while minimizing N leaching losses.
This study investigated the impact of energy consumption and CO2 emission on GDP (gross domestic product) growth and the financial development in thirty Sub Saharan African Countries. The panel model was used in this study from the period 1980 to 2008. The results showed that energy consumption had played an important role to increase both economic growth and the financial development in the investigated economies but with the consequence of high po llution. This study recommended that these countries should increase energy productivity by increasing energy efficiency, implementation of energy savings projects, energy conservation, and energy infrastructure outsourcing to achieve its financial development and GDP growth and to increase their investment on energy projects to achieve the full energy potential. -- Highlights: ? The impact of energy consumption, CO2 emission on GDP and the financial development in the SSA countries was investigated. ? The panel model was implied in this study from the period 1980 to 2008. ? The results show energy consumption increased economic growth and the financial development but with higher pollution.
Naomi M., Seboni; Mabel K.M., Magowe; Leana R., Uys; Mary B, Suh; Komba N., Djeko; Haouaou, Moumouni.
Full Text Available To explore the role expectations of different stakeholders in the health care system on the roles and tasks that nurses and midwives perform, in order to clarify and strengthen these roles and shape the future of nursing education and practice in sub-Saharan Africa. Qualitative focus group discussio [...] ns were held with different stakeholders (nurses, health service managers, patients and their caregivers, community members and leaders and other health professionals) in eight African countries in order to establish their role expectations of nurses and midwives. Three questions about their role expectations and the interviews were taped, transcribed, and translated into English and analysed. There was consensus amongst the stakeholders regarding eight role functions: taking care of patients; giving health information; managing the care environment; advocating for patients; services and policies; providing emergency care; collaborating with other stakeholders; and providing midwifery care to women, infants and their families. There was disagreement amongst the stakeholders about the role of diagnosis and prescribing treatment. Nursing derives its mandate from communities it serves, and the roles expected must therefore form part of nursing regulation, education and practice standards. Health planners must use these as a basis for job descriptions and rewards. Once these are accepted in the training and regulation of nursing, they must be marketed so that recipients are aware thereof.
Naomi M. Seboni
Full Text Available To explore the role expectations of different stakeholders in the health care system on the roles and tasks that nurses and midwives perform, in order to clarify and strengthen these roles and shape the future of nursing education and practice in sub-Saharan Africa. Qualitative focus group discussions were held with different stakeholders (nurses, health service managers, patients and their caregivers, community members and leaders and other health professionals in eight African countries in order to establish their role expectations of nurses and midwives. Three questions about their role expectations and the interviews were taped, transcribed, and translated into English and analysed. There was consensus amongst the stakeholders regarding eight role functions: taking care of patients; giving health information; managing the care environment; advocating for patients; services and policies; providing emergency care; collaborating with other stakeholders; and providing midwifery care to women, infants and their families. There was disagreement amongst the stakeholders about the role of diagnosis and prescribing treatment. Nursing derives its mandate from communities it serves, and the roles expected must therefore form part of nursing regulation, education and practice standards. Health planners must use these as a basis for job descriptions and rewards. Once these are accepted in the training and regulation of nursing, they must be marketed so that recipients are aware thereof.
Imoisili, Omoye E.; Sumner, Anne E
Obesity, hypertension, atherosclerosis, and type 2 diabetes mellitus are increasing in all regions of sub-Saharan Africa. The metabolic syndrome is a valuable tool in predicting atherosclerosis and type 2 diabetes in populations in Europe and North America. However, the applicability of the metabolic syndrome to African populations has not been studied. Prior to investing scarce funds into diagnosing and treating the metabolic syndrome, primary research needs to be designed to determine the p...
Gnonlonfin, Gbemenou Joselin Benoit; Hell, K.
Mycotoxins contamination in some agricultural food commodities seriously impact human and animal health and reduce the commercial value of crops. Mycotoxins are toxic secondary metabolites produced by fungi that contaminate agricultural commodities pre- or postharvest. Africa is one of the continents where environmental, agricultural and storage conditions of food commodities are conducive of Aspergillus fungi infection and aflatoxin biosynthesis. This paper reviews the commodity-wise aetiology and contamination process of aflatoxins and evaluates the potential risk of exposure from common African foods. Possible ways of reducing risk for fungal infection and aflatoxin development that are relevant to the African context. The presented database would be useful as benchmark information for development and prioritization of future research. There is need for more investigations on food quality and safety by making available advanced advanced equipments and analytical methods as well as surveillance and awareness creation in the region.
Brown, Nicholas I.
Antivenom is the only specific treatment for systemic envenoming from snakebite, but remains unavailable to thousands of snakebite victims around the world. A cycle of inconsistent and low market demand, sub-optimal utilisation, rising costs and reduced output of antivenoms have resulted from long term under-investment in procurement and quality regulatory programs. This study provides a contemporary overview of the African antivenom market within the context of the global market. Globally, 3...
Full Text Available Published by Palgrave MacmillanOver the last decade the topic of energy security has reappeared on global policy agendas. Most analyses of international energy geopolitics examine the interests and behaviour of powerful energy-importing countries like the US and China. This chapter begins by examining foreign powers expanded exploitation of oil and uranium resources in Sub-Saharan Africa. It goes on to examine how energy importers efforts to enhance their energy security through Africa are impacting energy security within Africa. It assesses Sub-Saharan states attempts to increase consumption of local oil and uranium reserves. Observing the constraints on these efforts, it then outlines some alternative strategies that have been employed to enhance African energy security. It concludes that, while local community-based development projects have improved the well-being of many households, they are not a sufficient guarantor of energy security. Inadequate petroleum access, in particular, remains a development challenge. Foreign powers efforts to increase their oil security are undermining the energy security of Sub-Saharan African citizens.
Perez, S; Junod, A
We now have a better knowledge of the specific features of depression in sub-Saharan Africa. Anthropologically speaking, the Western model is irrelevant. Depression in sub-Saharan Africa involves the relationship of the subject to himself or others in a mode specific to African cultures. Ignoring this fact can lead to simplistic ethnocentrism. From a clinical standpoint, depressive illness characterized by somatic manifestations, delusions of persecution, and anxiety are increasingly uncommon. As African societies modernize, these traditional forms are being gradually supplanted by states with symptoms and prognoses more like those observed in industrialized countries. Hybrid depressive syndromes are now the most widespread. Epidemiologically the notion widely held only a few decades ago that depression is a rare occurrence in Africa has now been dispelled. Many studies have been conducted to determine the exact incidence, age distribution, and sex ratio but more precise data is still needed. This investigation will require improvement in screening and diagnostic methods which must be not only suitable for clinical use but also adaptable to local conditions. This is also true with regard to management which has the same goals as anywhere else in the world. Treatment facilities are different in urban and rural areas but care is often dispensed in unconventional settings and may be combined with traditional methods. Drug availability is limited by problems involving supply and cost. This explains why electro-convulsive therapy which was introduced into sub-Saharan Africa long ago still plays a major role in the treatment of depression. PMID:9791599
Brian Kevin Reilly; Paul Andre DeGeorges
This is an historic overview of conservation in Sub-Saharan Africa from pre-colonial times through the present. It demonstrates that Africans practiced conservation that was ignored by the colonial powers. The colonial market economy combined with the human and livestock population explosion of the 21st century are the major factors contributing to the demise of wildlife and critical habitat. Unique insight is provided into the economics of a representative safari company, something that has ...
Katja Vintar Mally
Full Text Available Sub-Saharan Africa is a very diverse region with extensive natural wealth, great human potential, and a rich history. However, the majority of its countries are among the poorest in the world and about half of its 800 million inhabitants live in extreme poverty. Sub-Saharan Africa produces only 1.5% of the worlds GDP and its share in world trade has fallen from 6% in 1980 to 2% today. The regions exports remain dominated by primary goods (fuels, ores, and agricultural products. The roots of the regions economic weakness lie variously in the past colonial relationships with European countries and in unjust global trade patterns as well as in misuse of power by ruling political elites in the post-independence era. Numerous civil wars and other conflicts have fragmented the sub-Saharan countries into many factions and parties fighting for domination. The region is lagging behind developed countries because of corruption, lack of infrastructure, weakness of its institutions, heavy indebtedness, lack of education and health services, and unfavorable natural conditions, among other factors. Subsistence agriculture is the source of livelihood for most Africans. Nevertheless, average yields per hectare are low and heavily dependent on climatic conditions. Compared to urban areas (except for slums, people living in rural areas have worse infrastructure and are further from achieving the UNs Millennium Development Goals. The recent increase in food prices is threatening the limited progress in reducing hunger and malnutrition (28% of children under age five are underweight and particularly vulnerable to infectious diseases. Little progress has been made in reducing child and maternal mortality; mortality rates remain the highest in the world. In the previous decade, life expectancy in sub-Saharan countries has fallen due to the spread of HIV/AIDS and it still remains below fifty. In addition, many negative socioeconomic effects are the result of malaria, which kills approximately one million people every year, 91% of whom live in sub-Saharan Africa. In order to promote gender equality and empower women, education is of vital importance. Compared to other (especially developed regions, school enrollment rates are considerably lower and dropout rates considerably higher, particularly for girls. The majority of countries in subSaharan Africa will not be able to achieve their educational goals by 2015. Despite the fact that the region is not exceeding the carrying capacities of its environment (as measured by its ecological footprint, environmental problems in some areas are severe. Deforestation, desertification, coral bleaching, negative effects of climate changes (sea level rise, reduced freshwater availability, extreme weather events, etc., loss of biodiversity, and soil degradation are the most worrying. Population growth is exacerbating these environmental problems and is making it more difficult to achieve a higher standard of living for all. Owing to the complexity of developmental problems, sub-Saharan Africa will have to use its own resources very wisely and make the most of development aid from developed countries.
Jennifer A Veltman
Full Text Available Introduction: Meningitis is one of the leading causes of death among patients living with HIV in sub-Saharan Africa. There is no widespread tracking of the incidence rates of causative agents among patients living with HIV, yet the aetiologies of meningitis are different than those of the general population. Methods: We reviewed the scientific literature published in PubMed to determine the incidence rates of meningitis among hospitalized people living with HIV in sub-Saharan Africa and report our findings from seven studies across sub-Saharan Africa. Results: We found high rates of cryptococcal meningitis (1968%. Tuberculous meningitis was lower (136%, although some centres included possible cases as other meningitis; therefore, this may not be a true representation of the total cases. Pyogenic meningitis ranged from 6 to 30% and other meningitis ranged from 7 to 28% of all reported cases of meningitis. Mortality rates ranged from 25 to 68%. This review describes the most common aetiologies and provides practical diagnostic, treatment and prevention considerations as they apply to the individual living with HIV in sub-Saharan Africa. Conclusions: Diagnosis is often limited, and wider availability of accurate and low-cost laboratory diagnostics is desperately needed for prompt diagnosis and initiation of appropriate treatment. Wider acceptance and adoption of available preventative modalities can decrease the incidence of potentially fatal central nervous system infections in African patients living with HIV.
Tankwanchi, Akhenaten Benjamin Siankam; Vermund, Sten H; Perkins, Douglas D
Data monitoring is a key recommendation of the WHO Global Code of Practice on the International Recruitment of Health Personnel, a global framework adopted in May 2010 to address health workforce retention in resource-limited countries and the ethics of international migration. Using data on African-born and African-educated physicians in the 2013 American Medical Association Physician Masterfile (AMA Masterfile), we monitored Sub-Saharan African (SSA) physician recruitment into the physician workforce of the United States (US) post-adoption of the WHO Code of Practice. From the observed data, we projected to 2015 with linear regression, and we mapped migrant physicians' locations using GPS Visualizer and ArcGIS. The 2013 AMA Masterfile identified 11,787 active SSA-origin physicians, representing barely 1.3% (11,787/940,456) of the 2013 US physician workforce, but exceeding the total number of physicians reported by WHO in 34 SSA countries (N = 11,519). We estimated that 15.7% (1,849/11,787) entered the US physician workforce after the Code of Practice was adopted. Compared to pre-Code estimates from 2002 (N = 7,830) and 2010 (N = 9,938), the annual admission rate of SSA émigrés into the US physician workforce is increasing. This increase is due in large part to the growing number of SSA-born physicians attending medical schools outside SSA, representing a trend towards younger migrants. Projection estimates suggest that there will be 12,846 SSA migrant physicians in the US physician workforce in 2015, and over 2,900 of them will be post-Code recruits. Most SSA migrant physicians are locating to large urban US areas where physician densities are already the highest. The Code of Practice has not slowed the SSA-to-US physician migration. To stem the physician "brain drain", it is essential to incentivize professional practice in SSA and diminish the appeal of US migration with bolder interventions targeting primarily early-career (age ? 35) SSA physicians. PMID:25875010
Telles, José Luiz; Borges, Ana Paula Abreu
The Sub-Saharan part of the African continent is the area that has the highest disease burden in the world and is the only region of the planet where it is expected that the number of poor people will increase in the coming decades. The countries of this region, to different degrees, experience slow process of population aging but at the same time, it is the are where the elderly population grows fastest in absolute numbers. Based on a review of the literature, an attempt was made to highlight the social and demographic situation in which the elderly live in the Sub-Saharan region and the main challenges faced by local governments to overcome the complex problems affecting society as a whole. It was found that public policies geared to this segment of the population in the region do not represent a priority and, consequently, are unlikely to be included in the current agenda of international cooperation. PMID:24263872
Khan, Zeyaur R; Midega, Charles A.O.; Pittchar, Jimmy O.; Murage, Alice W.; Birkett, Michael A.; Bruce, Toby J.A.; Pickett, John A.
Food insecurity is a chronic problem in Africa and is likely to worsen with climate change and population growth. It is largely due to poor yields of the cereal crops caused by factors including stemborer pests, striga weeds and degraded soils. A platform technology, pushpull, based on locally available companion plants, effectively addresses these constraints resulting in substantial grain yield increases. It involves intercropping cereal crops with a forage legume, desmodium, and plantin...
Access to safe water is currently a privilege for the citizens of many developing countries in Asia and Africa. In the last few decades changes in climate have increased concentrations of greenhouse gasses. The results of global warming have had a significant impact upon the hydrological cycle from freshwater resources to rising sea levels, flooding and precipitation changes. Population concentration and growth have also placed additional pressures on water resources resulting in changes to e...
Comas, Iñaki; Hailu, Elena; Kiros, Teklu; Bekele, Shiferaw; Mekonnen, Wondale; Gumi, Balako; Tschopp, Rea; Ameni, Gobena; Hewinson, R Glyn; Robertson, Brian D; Goig, Galo A; Stucki, David; Gagneux, Sebastien; Aseffa, Abraham; Young, Douglas; Berg, Stefan
Colonial medical reports claimed that tuberculosis (TB) was largely unknown in Africa prior to European contact, providing a "virgin soil" for spread of TB in highly susceptible populations previously unexposed to the disease [1, 2]. This is in direct contrast to recent phylogenetic models which support an African origin for TB [3-6]. To address this apparent contradiction, we performed a broad genomic sampling of Mycobacterium tuberculosis in Ethiopia. All members of the M. tuberculosis complex (MTBC) arose from clonal expansion of a single common ancestor  with a proposed origin in East Africa [3, 4, 8]. Consistent with this proposal, MTBC lineage 7 is almost exclusively found in that region [9-11]. Although a detailed medical history of Ethiopia supports the view that TB was rare until the 20(th) century , over the last century Ethiopia has become a high-burden TB country . Our results provide further support for an African origin for TB, with some genotypes already present on the continent well before European contact. Phylogenetic analyses reveal a pattern of serial introductions of multiple genotypes into Ethiopia in association with human migration and trade. In place of a "virgin soil" fostering the spread of TB in a previously naive population, we propose that increased TB mortality in Africa was driven by the introduction of European strains of M. tuberculosis alongside expansion of selected indigenous strains having biological characteristics that carry a fitness benefit in the urbanized settings of post-colonial Africa. PMID:26687624
Muideen O. Bakare
Full Text Available Sub-Saharan African (SSA population consists of about 45% children, while in Europe and North America children population is 10- 15%. Lately, attention has been directed at mitigating childhood infectious and communicable diseases to reduce under-five mortality. As the under-five mortality index in Sub-Saharan Africa has relatively improved over the last two decades, more Sub-Saharan African children are surviving beyond the age of five and, apparently, a sizeable percentage of this population would be living with one or more childhood neurodevelopmental disorders (NDD. The distribution of child mental health service resources across the world is unequal. This manifests in the treatment gap of major childhood onset mental health problems in SSA, with the gap being more pronounced for childhood NDD. It is important to balance the public health focus and research funding priorities in Sub-Saharan Africa. We urgently need to define the burden of childhood NDD in the region for healthcare planning and policy formulation.
Khan, Zeyaur R; Midega, Charles A O; Pittchar, Jimmy O; Murage, Alice W; Birkett, Michael A; Bruce, Toby J A; Pickett, John A
Food insecurity is a chronic problem in Africa and is likely to worsen with climate change and population growth. It is largely due to poor yields of the cereal crops caused by factors including stemborer pests, striga weeds and degraded soils. A platform technology, 'push-pull', based on locally available companion plants, effectively addresses these constraints resulting in substantial grain yield increases. It involves intercropping cereal crops with a forage legume, desmodium, and planting Napier grass as a border crop. Desmodium repels stemborer moths (push), and attracts their natural enemies, while Napier grass attracts them (pull). Desmodium is very effective in suppressing striga weed while improving soil fertility through nitrogen fixation and improved organic matter content. Both companion plants provide high-value animal fodder, facilitating milk production and diversifying farmers' income sources. To extend these benefits to drier areas and ensure long-term sustainability of the technology in view of climate change, drought-tolerant trap and intercrop plants are being identified. Studies show that the locally commercial brachiaria cv mulato (trap crop) and greenleaf desmodium (intercrop) can tolerate long droughts. New on-farm field trials show that using these two companion crops in adapted push-pull technology provides effective control of stemborers and striga weeds, resulting in significant grain yield increases. Effective multi-level partnerships have been established with national agricultural research and extension systems, non-governmental organizations and other stakeholders to enhance dissemination of the technology with a goal of reaching one million farm households in the region by 2020. These will be supported by an efficient desmodium seed production and distribution system in eastern Africa, relevant policies and stakeholder training and capacity development. PMID:24535391
Khan, Zeyaur R.; Midega, Charles A. O.; Pittchar, Jimmy O.; Murage, Alice W.; Birkett, Michael A.; Bruce, Toby J. A.; Pickett, John A.
Food insecurity is a chronic problem in Africa and is likely to worsen with climate change and population growth. It is largely due to poor yields of the cereal crops caused by factors including stemborer pests, striga weeds and degraded soils. A platform technology, pushpull, based on locally available companion plants, effectively addresses these constraints resulting in substantial grain yield increases. It involves intercropping cereal crops with a forage legume, desmodium, and planting Napier grass as a border crop. Desmodium repels stemborer moths (push), and attracts their natural enemies, while Napier grass attracts them (pull). Desmodium is very effective in suppressing striga weed while improving soil fertility through nitrogen fixation and improved organic matter content. Both companion plants provide high-value animal fodder, facilitating milk production and diversifying farmers income sources. To extend these benefits to drier areas and ensure long-term sustainability of the technology in view of climate change, drought-tolerant trap and intercrop plants are being identified. Studies show that the locally commercial brachiaria cv mulato (trap crop) and greenleaf desmodium (intercrop) can tolerate long droughts. New on-farm field trials show that using these two companion crops in adapted pushpull technology provides effective control of stemborers and striga weeds, resulting in significant grain yield increases. Effective multi-level partnerships have been established with national agricultural research and extension systems, non-governmental organizations and other stakeholders to enhance dissemination of the technology with a goal of reaching one million farm households in the region by 2020. These will be supported by an efficient desmodium seed production and distribution system in eastern Africa, relevant policies and stakeholder training and capacity development. PMID:24535391
Codjoe, Samuel N.A.; Owusu, George; Burkett, Virginia
Several recent international assessments have concluded that climate change has the potential to reverse the modest economic gains achieved in many developing countries over the past decade. The phenomenon of climate change threatens to worsen poverty or burden populations with additional hardships, especially in poor societies with weak infrastructure and economic well-being. The importance of the perceptions, experiences, and knowledge of indigenous peoples has gained prominence in discussions of climate change and adaptation in developing countries and among international development organizations. Efforts to evaluate the role of indigenous knowledge in adaptation planning, however, have largely focused on rural people and their agricultural livelihoods. This paper presents the results of a study that examines perceptions, experiences, and indigenous knowledge relating to climate change and variability in three communities of metropolitan Accra, which is the capital of Ghana. The study design is based on a three-part conceptual framework and interview process involving risk mapping, mental models, and individual stressor cognition. Most of the residents interviewed in the three communities of urban Accra attributed climate change to the combination of deforestation and the burning of firewood and rubbish. None of the residents associated climate change with fossil fuel emissions from developed countries. Numerous potential adaptation strategies were suggested by the residents, many of which have been used effectively during past drought and flood events. Results suggest that ethnic residential clustering as well as strong community bonds in metropolitan Accra have allowed various groups and long-settled communities to engage in the sharing and transmission of knowledge of weather patterns and trends. Understanding and building upon indigenous knowledge may enhance the design, acceptance, and implementation of climate change adaptation strategies in Accra and urban regions of other developing nations.
Gilioli, Gianni; Caroli, Anna Maria; Tikubet, Getachew; Herren, Hans R; Baumgärtner, Johann
This paper presents a framework for the development of socio-ecological systems towards enhanced sustainability. Emphasis is given to the dynamic properties of complex, adaptive social-ecological systems, their structure and to the fundamental role of agriculture. The tangible components that meet the needs of specific projects executed in Kenya and Ethiopia encompass project objectives, innovation, facilitation, continuous recording and analyses of monitoring data, that allow adaptive management and system navigation. Two case studies deal with system navigation through the mitigation of key constraints; they aim to improve human health thanks to anopheline malaria vectors control in Nyabondo (Kenya), and to improve cattle health through tsetse control and antitrypanosomal drug administration to cattle in Luke (Ethiopia). The second case deals with a socio-ecological navigation system to enhance sustainability, establishing a periurban diversified enterprise in Addis Ababa (Ethiopia) and developing a rural sustainable social-ecological system in Luke (Ethiopia). The project procedures are briefly described here and their outcomes are analysed in relation to the stated objectives. The methodology for human and cattle disease vector control were easier to implement than the navigation of social-ecological systems towards sustainability enhancement. The achievements considerably differed between key constraints removal and sustainability enhancement projects. Some recommendations are made to rationalise human and cattle health improvement efforts and to smoothen the road towards enhanced sustainability: i) technology system implementation should be carried out through an innovation system; ii) transparent monitoring information should be continuously acquired and evaluated for assessing the state of the system in relation to stated objectives for (a) improving the insight into the systems behaviour and (b) rationalizing decision support; iii) the different views of all stakeholders should be reconciled in a pragmatic approach to social-ecological system management. Significance for public healthRecently, there is a growing interest in studying the link between human, animal and environmental health. The connection between these different dimensions is particularly important for developing countries in which people face the challenge of escaping vicious cycle of high diseases prevalence, food insecurity driven by absolute poverty and population growth, and natural capital as a poverty trap. The design and implementation of such efforts, aiming at human health improvement and poverty alleviation, should be framed into adaptive social-ecological system management perspectives. In this paper, we present few case studies dealing with human health improvement through anopheline malaria vectors control in Kenya, cattle health improvement through tsetse vectored nagana control, antitrypanosomal drug administration to cattle in Ethiopia and with the development of rural sustainable communities in Ethiopia. Some recommendations are given to rationalise human and cattle health improvement efforts and to smoothen the road towards enhanced sustainability. PMID:25170511
Full Text Available PROBLEM: Little is known about the burden of influenza in sub-Saharan Africa. Routine influenza surveillance is key to getting a better understanding of the impact of acute respiratory infections on sub-Saharan African populations. APPROACH: A project known as Strengthening Influenza Sentinel Surveillance in Africa (SISA was launched in Angola, Cameroon, Ghana, Nigeria, Rwanda, Senegal, Sierra Leone and Zambia to help improve influenza sentinel surveillance, including both epidemiological and virological data collection, and to develop routine national, regional and international reporting mechanisms. These countries received technical support through remote supervision and onsite visits. Consultants worked closely with health ministries, the World Health Organization, national influenza laboratories and other stakeholders involved in influenza surveillance LOCAL SETTING: Influenza surveillance systems in the target countries were in different stages of development when SISA was launched. Senegal, for instance, had conducted virological surveillance for years, whereas Sierra Leone had no surveillance activity at all. RELEVANT CHANGES: Working documents such as national surveillance protocols and procedures were developed or updated and training for sentinel site staff and data managers was organized. LESSONS LEARNT: Targeted support to countries can help them strengthen national influenza surveillance, but long-term sustainability can only be achieved with external funding and strong national government leadership.
Sulzbach, Sara; De, Susna; Wang, Wenjuan
Global financing for the HIV response has reached unprecedented levels in recent years. Over US$10 billion were mobilized in 2007, an effort credited with saving the lives of millions of people living with HIV (PLHIV). A relatively unexamined aspect of the global HIV response is the role of the private sector in financing HIV/AIDS services. As the nature of the response evolves from emergency relief to long-term sustainability, understanding current and potential contributions from the private sector is critical. This paper examines trends in private sector financing, management and resource consumption related to HIV/AIDS in five sub-Saharan African countries, with a particular emphasis on the effects of recently scaled-up donor funding on private sector contributions. We analysed National Health Accounts HIV/AIDS subaccount data for Kenya, Malawi, Rwanda, Tanzania and Zambia between 2002 and 2006. HIV subaccounts provide comparable data on the flow of HIV/AIDS funding from source to use. Findings indicate that private sector contributions decreased in all countries except Tanzania. With regards to managing HIV/AIDS funds, non-governmental organizations are increasingly controlling the largest share of resources relative to other stakeholders, whereas private for-profit entities are managing fewer HIV/AIDS resources since the donor influx. The majority of HIV/AIDS funds were spent in the public sector, although a considerable amount was spent at private facilities, largely fuelled by out-of-pocket (OOP) payments. On the whole, OOP spending by PLHIV decreased over the 4-year period, with the exception of Malawi, demonstrating that PLHIV have increased access to free or subsidized HIV/AIDS services. Our findings suggest that the influx of donor funding has led to decreased private contributions for HIV/AIDS. The reduction in private sector investment and engagement raises concerns about the sustainability of HIV/AIDS programmes over the long term, particularly in light of current global economic crisis and emerging competing priorities. PMID:21729920
Steyn, Nelia P; McHiza, Zandile J
This review illustrates the outcomes of the nutrition transition in Sub-Saharan Africa (SSA) and its association with overweight and obesity; the relationship with the double burden of malnutrition is also explored. We describe the increase in overweight in nearly all Sub-Saharan African countries and present data on associated increased gross domestic product, and availability of energy, protein, fat, and sugar at country national levels. Predictors of overweight are described by means of various studies undertaken in SSA, and dietary intakes of numerous countries are presented. Overall, we show that socioeconomic status, gender, age, parity, physical inactivity, and increased energy, fat, and sugar intake are powerful predictors of overweight and/or obesity. The urgency for health interventions in countries in the early stages of the nutrition transition is emphasized, particularly in view of the fact that fat intake is still less than 30% of energy intake in nearly all Sub-Saharan African countries. PMID:24725148
Gordon C McCord
Full Text Available OBJECTIVE: To provide cost guidance for developing a locally adaptable and nationally scalable community health worker (CHW system within primary-health-care systems in sub-Saharan Africa. METHODS: The yearly costs of training, equipping and deploying CHWs throughout rural sub-Saharan Africa were calculated using data from the literature and from the Millennium Villages Project. Model assumptions were such as to allow national governments to adapt the CHW subsystem to national needs and to deploy an average of 1 CHW per 650 rural inhabitants by 2015. The CHW subsystem described was costed by employing geographic information system (GIS data on population, urban extents, national and subnational disease prevalence, and unit costs (from the field for wages and commodities. The model is easily replicable and configurable. Countries can adapt it to local prices, wages, population density and disease burdens in different geographic areas. FINDINGS: The average annual cost of deploying CHWs to service the entire sub-Saharan African rural population by 2015 would be approximately 2.6 billion (i.e. 2600 million United States dollars (US$. This sum, to be covered both by national governments and by donor partners, translates into US$ 6.86 per year per inhabitant covered by the CHW subsystem and into US$ 2.72 per year per inhabitant. Alternatively, it would take an annual average of US$ 3750 to train, equip and support each CHW. CONCLUSION: Comprehensive CHW subsystems can be deployed across sub-Saharan Africa at cost that is modest compared with the projected costs of the primary-health-care system. Given their documented successes, they offer a strong complement to facility-based care in rural African settings.
Robberstad, Bjarne; Hemed, Yusuf; Norheim, Ole Frithjof
Background: There is a high and rising prevalence of cardiovascular risk in sub-Saharan Africa, a development typical for countries in epidemiological transition. Contrary to recommendations in treatment guidelines, medical interventions to prevent cardiovascular disease are implemented only on a limited scale in these settings. There is a widespread concern that such treatment is not cost-effective compared to alternative health interventions. The main objectives of this article are ther...
Eucebious Lekalakala- Mokgele
The status of older adults in Africa occupies a small but rapidly expanding share of the global literature on ageing. The human immunodeficiency virus (HIV) and acquired immune deficiency syndrome (AIDS) pandemic has generated a new focus on the changing role of the elderly in communities that have been affected. In sub-Saharan Africa, where millions are projected to be infected with HIV and about two million deaths are recorded annually amongst the traditionally productive adults, such loss ...
The bulk of rural populations in sub-Saharan Africa have no access to electricity and are under-served by any other form of modern infrastructure. The cost of infrastructure to mainly scattered communities has been perennially cited as largely to blame. Quite often rural networks are overdesigned, resulting in under utilization and, therefore, costly overheads. One reason often cited for the overspecification is anticipation of load growth. In most sub-Sahara African rural areas, however, economic growth rates are low, and a designer has no justification in specifying an infrastructure capacity exceeding more than a few percent of existing consumer requirements. This paper proposes methods that critically look at the geometry of small grid network designs to address the construction challenges in rural sub-Saharan Africa
Excoffier, Laurent Georges Louis; Pellegrini, Béatrice; Sanchez-Mazas, Alicia; Simon, Christian; Langaney, André
This paper aims to review the contribution of genetic data to the prehistory and history of sub·Saharan African peoples. The authors review briefly paleontologic data, which give limited information about modern Homo sapiens sapiens origins and isolation of present African gene pools. Most linguistic and archaeological theories about African peoples'prehistory are then confronted with the most informative genetic data available. Rhesus, Gm, HLA, and DNA data are analyzed. Their frequent haplo...
Pauly, M.; Hoppe, E.; Mugisha, L.; Petrelková, Klára Judita; Akoua-Koffi, C.; Couacy-Hymann, E.; Anoh, A. E.; Mossoun, A.; Schubert, G.; Wiersma, L.; Pascale, S.; Muyembe, J.-J.; Karhemere, S.; Weiss, S.; Leendertz, S. A.; Calvignac-Spencer, S.; Leendertz, F. H.; Ehlers, B.
Ro?. 11, ?. 25 (2014), s. 25. ISSN 1743-422X R&D Projects: GA ?R GA206/09/0927 Institutional support: RVO:68081766 Keywords : Adenoviridae * Human adenovirus D * Genotype * Sub-Saharan Africa * PCR Subject RIV: GJ - Animal Vermins ; Diseases, Veterinary Medicine Impact factor: 2.181, year: 2014
Abiola Fatimah, Adenowo; Babatunji Emmanuel, Oyinloye; Bolajoko Idiat, Ogunyinka; Abidemi Paul, Kappo.
Full Text Available Schistosomiasis, a neglected tropical disease of poverty ranks second among the most widespread parasitic disease in various nations in sub-Saharan Africa. Neglected tropical diseases are causes of about 534,000 deaths annually in sub-Saharan Africa and an estimated 57 million disability-adjusted li [...] fe-years are lost annually due to the neglected tropical diseases. The neglected tropical diseases exert great health, social and ?nancial burden on economies of households and governments. Schistosomiasis has profound negative effects on child development, outcome of pregnancy, and agricultural productivity, thus a key reason why the "bottom 500 million" inhabitants of sub-Saharan Africa continue to live in poverty. In 2008, 17.5 million people were treated globally for schistosomiasis, 11.7 million of those treated were from sub-Saharan Africa. This enervating disease has been successfully eradicated in Japan, as well as in Tunisia. Morocco and some Caribbean Island countries have made signi?cant progress on control and management of this disease. Brazil, China and Egypt are taking steps towards elimination of the disease, while most sub-Saharan countries are still groaning under the burden of the disease. Various factors are responsible for the continuous and persistent transmission of schistosomiasis in sub-Saharan Africa. These include climatic changes and global warming, proximity to water bodies, irrigation and dam construction as well as socio-economic factors such as occupational activities and poverty. The morbidity and mortality caused by this disease cannot be overemphasized. This review is an exposition of human schistosomiasis as it affects the inhabitants of various communities in sub-Sahara African countries. It is hoped this will bring a re-awakening towards efforts to combat this impoverishing disease in terms of vaccines development, alternative drug design, as well as new point-of-care diagnostics.
Adenowo, Abiola Fatimah; Oyinloye, Babatunji Emmanuel; Ogunyinka, Bolajoko Idiat; Kappo, Abidemi Paul
Schistosomiasis, a neglected tropical disease of poverty ranks second among the most widespread parasitic disease in various nations in sub-Saharan Africa. Neglected tropical diseases are causes of about 534,000 deaths annually in sub-Saharan Africa and an estimated 57 million disability-adjusted life-years are lost annually due to the neglected tropical diseases. The neglected tropical diseases exert great health, social and financial burden on economies of households and governments. Schistosomiasis has profound negative effects on child development, outcome of pregnancy, and agricultural productivity, thus a key reason why the "bottom 500 million" inhabitants of sub-Saharan Africa continue to live in poverty. In 2008, 17.5 million people were treated globally for schistosomiasis, 11.7 million of those treated were from sub-Saharan Africa. This enervating disease has been successfully eradicated in Japan, as well as in Tunisia. Morocco and some Caribbean Island countries have made significant progress on control and management of this disease. Brazil, China and Egypt are taking steps towards elimination of the disease, while most sub-Saharan countries are still groaning under the burden of the disease. Various factors are responsible for the continuous and persistent transmission of schistosomiasis in sub-Saharan Africa. These include climatic changes and global warming, proximity to water bodies, irrigation and dam construction as well as socio-economic factors such as occupational activities and poverty. The morbidity and mortality caused by this disease cannot be overemphasized. This review is an exposition of human schistosomiasis as it affects the inhabitants of various communities in sub-Sahara African countries. It is hoped this will bring a re-awakening towards efforts to combat this impoverishing disease in terms of vaccines development, alternative drug design, as well as new point-of-care diagnostics. PMID:25636189
Chinsembu, Kazhila C
Although the burden of malaria is decreasing, parasite resistance to current antimalarial drugs and resistance to insecticides by vector mosquitoes threaten the prospects of malaria elimination in endemic areas. Corollary, there is a scientific departure to discover new antimalarial agents from nature. Because the two antimalarial drugs quinine and artemisinin were discovered through improved understanding of the indigenous knowledge of plants, bioprospecting Sub-Saharan Africa's enormous plant biodiversity may be a source of new and better drugs to treat malaria. This review analyses the medicinal plants used to manage malaria in Sub-Saharan Africa. Chemical compounds with antiplasmodial activity are described. In the Sub-Saharan African countries cited in this review, hundreds of plants are used as antimalarial remedies. While the number of plant species is not exhaustive, plants used in more than one country probably indicate better antimalarial efficacy and safety. The antiplasmodial data suggest an opportunity for inventing new antimalarial drugs from Sub-Saharan-African flora. PMID:26297798
Bennett, Brady W.; Marshall, Brandon D. L.; Gjelsvik, Annie; McGarvey, Stephen T.; Lurie, Mark N.
Objectives The aim of this study was to determine the association between violent conflict and HIV incidence within and across 36 sub-Saharan Africa countries between 1990 and 2012. Methods We used generalized linear mixed effect modeling to estimate the effect of conflict periods on country-level HIV incidence. We specified random intercepts and slopes to account for across and within country variation over time. We also conducted a sub-analysis of countries who experienced conflict to assess the effect of conflict intensity on country-level HIV incidence. All models controlled for level of economic development, number of refugees present in the country, and year. Results We found that, compared to times of peace, the HIV incidence rate increased by 2.1 per 1000 infections per year (95%CI: 0.39, 3.87) in the 5 years prior to conflict. Additionally, we found a decrease of 0.7 new infections per 1000 people per year (95%CI: -1.44, -0.01) in conflicts with 25 to 1000 battle-related deaths and a decrease of 1.5 new infections per 1000 people per year (95%CI:-2.50, -0.52) for conflict with more than 1000 battle-related deaths, compared to conflicts with less than 25 battle-related deaths Conclusions Our results demonstrate that HIV infection rates increase in the years immediately prior to times of conflict; however, we did not identify a significant increase during and immediately following periods of violent conflict. Further investigation, including more rigorous data collection, is needed, as is increased aid to nations at risk of violent conflict to help in the fight against HIV/AIDS in sub-Saharan Africa. PMID:26562434
The introduction to this description of emigration dynamics in sub-Saharan Africa notes that the region is characterized by intensive migration caused by such factors as population growth, negative economic growth, ethnic conflict, and human rights abuses. The second section of the report discusses the fragmentary and incomplete nature of data on international migration in the region, especially data on conventional migration. Section 3 looks at demographic factors such as high population growth, illiteracy levels, HIV seroprevalence, and urbanization which lead to high unemployment and emigration. The fourth section considers the effects of the rapid expansion of education which is outstripping the absorptive capacity of the economies of many countries. Unemployment is a serious problem which is projected to become worse as increases in employment opportunities continue to lag behind increases in output. Sections five, six, and seven of the report describe relevant economic factors such as per capita income, income distribution, the economic resource base, and economic development; poverty; and the effects of economic adjustment programs, especially on employment opportunities and wages in the public and private sectors. The next section is devoted to sociocultural factors influencing migration both on the micro- and the macro-levels, including the influence of ethnicity and ethnic conflicts as well as the domination of leadership positions by members of minority groups. The political factors discussed in section 9 include women's status, repressive regimes, political instability which leads to underdevelopment, and the policies of the Organization of African Unity which broadened the definition of refugees and set inviolable borders of member states identical to those inherited upon independence. Section 10 outlines ecological factors contributing to migration, including the decline in acreage of arable land, soil deterioration, poor land management, and the effects of draught. The interaction of all of these factors has contributed to refugee flows of acute magnitude and complexity. The next major section of the report describes the migration situation in each subregion (Western Africa, Nigeria and Ghana, the Sahel, Mail, Eastern Africa, Southern Africa, and Lesotho). The report concludes that migration in response to socioeconomic conditions will continue until conditions improve in the countries of origin. PMID:12347006
Pitman, John P; Wilkinson, Robert; Liu, Yang; von Finckenstein, Bjorn; Smit Sibinga, Cees Th; Lowrance, David W; Marfin, Anthony A; Postma, Maarten J; Mataranyika, Mary; Basavaraju, Sridhar V
National blood use patterns in sub-Saharan Africa are poorly described. Although malaria and maternal hemorrhage remain important drivers of blood demand across Africa, economic growth and changes in malaria, HIV/AIDS, and noncommunicable disease epidemiology may contribute to changes in blood demand. We evaluated indications for blood use in Namibia, a country in southern Africa, using a nationally representative sample and discuss implications for the region. Clinical and demographic data related to the issuance of blood component units in Namibia were reviewed for a 4-year period (August 1, 2007-July 31, 2011). Variables included blood component type, recipient age and sex, and diagnosis. Diagnoses reported by clinicians were reclassified into International Statistical Classification of Diseases, 10th Revision categories. Multiple imputation methods were used to complete a data set missing age, sex or diagnosis data. Descriptive analyses were conducted to describe indications for transfusions and use of red blood cells (RBCs), platelets, and plasma. A total of 39,313 records accounting for 91,207 blood component units were analyzed. The median age of Namibian transfusion recipients was 45 years (SD, ±19). A total of 78,660 RBC units were issued in Namibia during the study period. Red blood cells transfused for "unspecified anemia" accounted for the single largest category of blood issued (24,798 units). Of the overall total, 38.9% were for diseases of the blood and blood-forming organs (D50-D89). Infectious disease (A00-B99), pregnancy (O00-O99), and gastrointestinal (K20-K93) accounted for 14.8%, 11.1%, and 6.1% of RBC units issued, respectively. Although a specific diagnosis of malaria accounted for only 2.7% of pediatric transfusions, an unknown number of additional transfusions for malaria may have been categorized by requesting physicians as unspecified anemia and counted under diseases of blood forming organs. During the study period, 9751 units of fresh-frozen plasma were issued. Nearly one-quarter of these units (23.1%) were issued for gastrointestinal (K20-K93) diagnoses. Malignant neoplasms (C00-C97) accounted for 38.1% of 2978 platelet units issued. Blood use in Namibia reflects changes in the health care system due to economic development, improvement in HIV/AIDS and malaria epidemiology, high rates of health care facility-based childbirth, and access to noncommunicable disease treatment. However, better documentation of the indications for transfusion is needed to confirm these observations. Changing patterns of health care will result in changing demands for blood components. Improved methods to evaluate blood use patterns in sub-Saharan Africa may help set realistic national blood collection goals. PMID:25573416
Naoussi, Claude Francis; Tripier, Fabien
This article explores the role of trend shocks in explaining the specificities of business cycles in Sub-Saharan African (SSA) countries using the methodology introduced by Aguiar and Gopinath (2007) [Emerging Market Business Cycles: The Cycle Is the Trend Journal of Political Economy 115(1)]. We specify a small open economy model with transitory and trend shocks on productivity to replicate the differences in the business cycle behavior of output and consumption across countries, especially ...
Kluth, Michael Friederich
This article argues that aspirations of maintaining a dominant influence over sub-Saharan security issues has spurred the French and British leadership of European Union (EU) foreign and security policy integration, just as it has informed military capability expansions by the armed forces of the main EU powers. While Europe's initial African focus was on stabilising a continent marred by state failure, civil wars and genocides, changes in the global security context, especially the shift toward...
Rudel, Thomas K.
For decades, the dynamics of tropical deforestation in sub-Saharan Africa (SSA) have defied easy explanation. The rates of deforestation have been lower than elsewhere in the tropics, and the driving forces evident in other places, government new land settlement schemes and industrialized agriculture, have largely been absent in SSA. The context and causes for African deforestation become clearer through an analysis of new, national-level data on forest cover change for SSA countries for the ...
The international community is devoting increasing attention to social security issues in developing countries as part of its preoccupation with poverty reduction. This paper discusses social security arrangements in place in sub-Saharan African countries to mitigate the contingencies of their citizens, with emphasis on the masses of poor people, including the ways in which the poor themselves try to tackle unexpected adversity. The basic argument is that for a social security system to be fe...
Kofi B. Afful; Kofi F. Asiedu
This study examines the effectiveness of the state in stimulating stock market activity in sub-Saharan Africa (SSA) using fiscal policy, governance quality and stock market as the main determinant variables. Using annual data from six selected sub-Saharan African economies and employing a dynamic panel data estimating technique, we find that government effectiveness stimulates capitalization while business regulations decrease it in SSA. In addition, we find that final consumption expenditure...
Laleman, G.; Kegels, G.; Marchal, B.; Van Roost, D; Bogaert, I.; Van Damme, W
ABSTRACT: BACKGROUND: In this paper, we aim to quantify the contribution of international health volunteers to the health workforce in sub-Saharan Africa and to explore the perceptions of health service managers regarding these volunteers. METHODS: Rapid survey among organizations sending international health volunteers and group discussions with experienced medical officers from sub-Saharan African countries. RESULTS: We contacted 13 volunteer organizations having more than 10 full-time equi...
Bogaert Isa; Van der Roost Dirk; Marchal Bruno; Kegels Guy; Laleman Geert; van Damme Wim
Abstract Background In this paper, we aim to quantify the contribution of international health volunteers to the health workforce in sub-Saharan Africa and to explore the perceptions of health service managers regarding these volunteers. Methods Rapid survey among organizations sending international health volunteers and group discussions with experienced medical officers from sub-Saharan African countries. Results We contacted 13 volunteer organizations having more than 10 full-time equivale...
Full Text Available As universal service in terms of ICTs provision cannot be achieved in the times agreed for several international bilateral and multilateral aid organizations. It is important to create mechanisms to reduce the lack of use of ICTs in sub-Saharan African countries. This paper specifically analyses the different ICT underdeveloped areas in the sub-Saharan African countries and the factors explain such status. At the same time, the paper proposes a set of policy guidelines that might help improving the current situation in several areas such as investment, employment, infrastructure and technology in order that some countries may overcome unfavourable ICT development. The main research question is: is there any chance that sub-Saharan African countries can overcome the critical situation in which they currently are? And if so, what are the key components and processes to develop and to do changes. In this way, a proposed framework is provided for the examination of policy makers, investors, and other stakeholders in the ICT field in these countries.
Zulu Eliya; Undie Chi-Chi; Oronje Rose; Crichton Joanna
Abstract Background The mass media have excellent potential to promote good sexual and reproductive health outcomes, but around the world, media often fail to prioritize sexual and reproductive health and rights issues or report them in an accurate manner. In sub-Saharan Africa media coverage of reproductive health issues is poor due to the weak capacity and motivation for reporting these issues by media practitioners. This paper describes the experiences of the African Population and Health ...
Luis Távora-Tavira, Rosa Teodósio, Jorge Seixas, Emília Prieto, Rita Castro, Filomena Exposto, Jorge Atouguia
Background: For geographical and recent historic reasons, Portugal is a gateway and home for immigration from sub-Saharan countries. Misconceptions related to these populations often lead to consider them as high-frequency clusters for dissemination of sexually transmitted infections (STIs). Epidemiological evidence-based data is needed to elucidate these issues and baseline prevalence studies are the starting point for this.Methodology: A prospective study was conducted in 220 African migran...
Dillon, David G; Gurdasani, Deepti; Riha, Johanna; Ekoru, Kenneth; Asiki, Gershim; Mayanja, Billy N; Levitt, Naomi S; Crowther, Nigel J; Nyirenda, Moffat; Njelekela, Marina; Ramaiya, Kaushik; Nyan, Ousman; Adewole, Olanisun O; Anastos, Kathryn; Azzoni, Livio; Boom, W Henry; Compostella, Caterina; Dave, Joel A; Dawood, Halima; Erikstrup, Christian; Fourie, Carla M; Friis, Henrik; Kruger, Annamarie; Idoko, John A; Longenecker, Chris T; Mbondi, Suzanne; Mukaya, Japheth E; Mutimura, Eugene; Ndhlovu, Chiratidzo E; Praygod, George Amani; Pefura Yone, Eric W; Pujades-Rodriguez, Mar; Range, Nyagosya; Sani, Mahmoud U; Schutte, Aletta E; Sliwa, Karen; Tien, Phyllis C; Vorster, Este H; Walsh, Corinna; Zinyama, Rutendo; Mashili, Fredirick; Sobngwi, Eugene; Adebamowo, Clement; Kamali, Anatoli; Seeley, Janet; Young, Elizabeth H; Smeeth, Liam; Motala, Ayesha A; Kaleebu, Pontiano; Sandhu, Manjinder S
Sub-Saharan Africa (SSA) has the highest burden of HIV in the world and a rising prevalence of cardiometabolic disease; however, the interrelationship between HIV, antiretroviral therapy (ART) and cardiometabolic traits is not well described in SSA populations.
Matsobane J, Manala.
Full Text Available The aim of this article is to describe the impact of Christianity on sub-Saharan Africa. I shall start by first examining the key words in the title of this article, and by briefly discussing the phenomenal growth of Christianity in sub-Saharan Africa. The article further describes the impact of Chr [...] istianity on sub-Saharan Africa in terms of education, socio-politics, and health; here I shall base my remarks on the history of Christian missions in the region since the late nineteen century. As far as education is concerned, this article recognises that education that focuses on holistic human development is a positive force, and a force that was introduced by Christianity. I shall also point out that Christianity initiated medical advances that improved the health of those who live in the region. Regeneration as espoused by Christianity constitutes something of great value. On the downside, Christianity led to the demise of the African customs, which it viewed as pagan and evil; the religion also led to the implementation of apartheid (to which it gave its theological support), and undermined the leadership role of women. Finally, Christianity has bedevilled race relations in Africa generally.
Mónica, Carvalho; Pedro, Brito; Virgínia, Lopes; Lisa, Andrade; Mª João, Anjos; Francisco Corte, Real; Leonor, Gusmão.
Full Text Available The present-day Brazilian population is a consequence of the admixture of various peoples of very different origins, namely, Amerindians, Europeans and Africans. The proportion of each genetic contribution is known to be very heterogeneous throughout the country. The aim of the present study was to [...] compare the male lineages present in two distinct Brazilian populations, as well as to evaluate the African contribution to their male genetic substrate. Thus, two Brazilian population samples from Manaus (State of Amazon) and Ribeirão Preto (State of São Paulo) and three African samples from Guinea Bissau, Angola and Mozambique were typed for a set of nine Y chromosome specific STRs. The data were compared with those from African, Amerindian and European populations. By using Y-STR haplotype information, low genetic distances were found between the Manaus and Ribeirão Preto populations, as well as between these and others from Iberia. Likewise, no significant distances were observed between any of the African samples from Angola, Mozambique and Guinea Bissau. Highly significant Rst values were found between both Brazilian samples and all the African and Amerindian populations. The absence of a significant Sub-Saharan African male component resulting from the slave trade, and the low frequency in Amerindian ancestry Y-lineages in the Manaus and Ribeirão Preto population samples are in accordance with the accentuated gender asymmetry in admixture processes that has been systematically reported in colonial South American populations.
Adewoyin, Ademola Samson
Sickle cell disease (SCD) predominates in sub-Saharan Africa, East Mediterranean areas, Middle East, and India. Nigeria, being the most populous black nation in the world, bears its greatest burden in sub-Saharan Africa. The last few decades have witnessed remarkable scientific progress in the understanding of the complex pathophysiology of the disease. Improved clinical insights have heralded development and establishment of disease modifying interventions such as chronic blood transfusions,...
Spearman, C Wendy; Sonderup, Mark W
Disparities in health reflect the differences in the incidence, prevalence, burden of disease and access to care determined by socio-economic and environmental factors. With liver disease, these disparities are exacerbated by a combination of limited awareness and preventable causes of morbidity and mortality in addition to the diagnostic and management costs. Sub-Saharan Africa, comprising 11% of the world's population, disproportionately has 24% of the global disease burden, yet allocates Malaria (goal 6), many successes have been achieved. A 2010 Global Burden of Disease study demonstrated that cirrhosis mortality in sub-Saharan Africa doubled between 1980 and 2010. Aetiologies included hepatitis B (34%), hepatitis C (17%), alcohol (18%) and unknown in 31%. Hepatitis B, C and alcohol accounted for 47, 23 and 20% of hepatocellular carcinoma respectively. In 10%, the underlying aetiology was not known. Liver disease reflects the broader disparities in healthcare in sub-Saharan Africa. However, many of these challenges are not insurmountable as vaccines and new therapies could comprehensively deal with the burden of viral hepatitis. Access to and affordability of therapeutics remains the major barrier. PMID:26053588
Olurotimi A Adejumo
Full Text Available Introduction: Adolescents are a unique and sometimes neglected group in the planning of healthcare services. This is the case in many parts of sub-Saharan Africa, where more than eight out of ten of the world's HIV-infected adolescents live. Although the last decade has seen a reduction in AIDS-related mortality worldwide, largely due to improved access to effective antiretroviral therapy (ART, AIDS remains a significant contributor to adolescent mortality in sub-Saharan Africa. Although inadequate access to ART in parts of the subcontinent may be implicated, research among youth with HIV elsewhere in the world suggests that suboptimal adherence to ART may play a significant role. In this article, we summarize the epidemiology of HIV among sub-Saharan African adolescents and review their adherence to ART, emphasizing the unique challenges and factors associated with adherence behaviour. Methods: We conducted a comprehensive search of online databases for articles, relevant abstracts, and conference reports from meetings held between 2010 and 2014. Our search terms included adherence, compliance, antiretroviral use and antiretroviral adherence, in combination with adolescents, youth, HIV, Africa, interventions and the MeSH term Africa South of the Sahara. Of 19,537 articles and abstracts identified, 215 met inclusion criteria, and 148 were reviewed. Discussion: Adolescents comprise a substantial portion of the population in many sub-Saharan African countries. They are at particular risk of HIV and may experience worse outcomes. Although demonstrated to have unique challenges, there is a dearth of comprehensive health services for adolescents, especially for those with HIV in sub-Saharan Africa. ART adherence is poorer among older adolescents than other age groups, and psychosocial, socio-economic, individual, and treatment-related factors influence adherence behaviour among adolescents in this region. With the exception of a few examples based on affective, cognitive, and behavioural strategies, most adherence interventions have been targeted at adults with HIV. Conclusions: Although higher levels of ART adherence have been reported in sub-Saharan Africa than in other well-resourced settings, adolescents in the region may have poorer adherence patterns. There is substantial need for interventions to improve adherence in this unique population.
Adejumo, Olurotimi A; Malee, Kathleen M; Ryscavage, Patrick; Hunter, Scott J; Taiwo, Babafemi O
Introduction Adolescents are a unique and sometimes neglected group in the planning of healthcare services. This is the case in many parts of sub-Saharan Africa, where more than eight out of ten of the world's HIV-infected adolescents live. Although the last decade has seen a reduction in AIDS-related mortality worldwide, largely due to improved access to effective antiretroviral therapy (ART), AIDS remains a significant contributor to adolescent mortality in sub-Saharan Africa. Although inadequate access to ART in parts of the subcontinent may be implicated, research among youth with HIV elsewhere in the world suggests that suboptimal adherence to ART may play a significant role. In this article, we summarize the epidemiology of HIV among sub-Saharan African adolescents and review their adherence to ART, emphasizing the unique challenges and factors associated with adherence behaviour. Methods We conducted a comprehensive search of online databases for articles, relevant abstracts, and conference reports from meetings held between 2010 and 2014. Our search terms included adherence, compliance, antiretroviral use and antiretroviral adherence, in combination with adolescents, youth, HIV, Africa, interventions and the MeSH term Africa South of the Sahara. Of 19,537 articles and abstracts identified, 215 met inclusion criteria, and 148 were reviewed. Discussion Adolescents comprise a substantial portion of the population in many sub-Saharan African countries. They are at particular risk of HIV and may experience worse outcomes. Although demonstrated to have unique challenges, there is a dearth of comprehensive health services for adolescents, especially for those with HIV in sub-Saharan Africa. ART adherence is poorer among older adolescents than other age groups, and psychosocial, socio-economic, individual, and treatment-related factors influence adherence behaviour among adolescents in this region. With the exception of a few examples based on affective, cognitive, and behavioural strategies, most adherence interventions have been targeted at adults with HIV. Conclusions Although higher levels of ART adherence have been reported in sub-Saharan Africa than in other well-resourced settings, adolescents in the region may have poorer adherence patterns. There is substantial need for interventions to improve adherence in this unique population. PMID:26385853
Adair-Rohani, Heather; Zukor, Karen; Bonjour, Sophie; Wilburn, Susan; Kuesel, Annette C.; Hebert, Ryan; Fletcher, Elaine R
Only 34% of hospitals have reliable electricity access in surveyed sub-Saharan African countries. However, analysis in 2 countries indicates modest improvements in electricity access over time. Ambitious plans to improve health service delivery in sub-Saharan Africa need to address this critical issue.
Herslund, Lise Byskov; Jalyer, Fatameh; Jean-Baptiste, Nathalie; Jørgensen, Gertrud; Kabisch, Sigrun; Kombe, Wilbard; Lindley, Sarah J.; Karlsson Nyed, Patrik; Pauleit, Stephan; Printz, Andreas; Vedeld, Trond
In this paper, we develop and apply a multi-dimensional vulnerability assessment framework for understanding the impacts of climate change-induced hazards in Sub- Saharan African cities. The research was carried out within the European/African FP7 project CLimate change and Urban Vulnerability in Africa, which investigated climate change-induced risks, assessed vulnerability and proposed policy initiatives in five African cities. Dar es Salaam (Tanzania) was used as a main case with a particular...
Musoke, Maria G. N.
The paper presents a Sub-Saharan African academic Librarian's experience in trying to address the changing needs and practices of university library users. Special reference is made to Makerere University Library. Most of the changes have been brought about by the various paradigm shifts in teaching, learning and research, as well as advances in
Batana, Yele Maweki
Since the seminal work of Sen, poverty has been recognized as a multidimensional phenomenon. The recent availability of relevant databases renewed the interest in this approach. This paper estimates multidimensional poverty among women in fourteen Sub-Saharan African countries using the Alkire and Foster multidimensional poverty measures, whose
Rates of primary enrollment, female primary enrollment, private school enrollment, and literacy during 1960-92 were analyzed for 39 sub-Saharan African countries. Throughout the period, strongly Christian countries had higher enrollment and literacy rates than strongly Islamic countries, regardless of economic level, type of state, or colonial
Abstract Background Sub-Saharan Africa faces a human resources crisis in the health sector. Over the past two decades its population has increased substantially, with a significant rise in the disease burden due to HIV/AIDS and recurrent communicable diseases and an increased incidence of noncommunicable diseases. This increased demand for health services is met with a rather low supply of health workers, but this notwithstanding, sub-Saharan African countries also experience significant wast...
Full Text Available Introduction: Antiretrovirals are available at low prices in sub-Saharan Africa, but these prices may not be consistently available for middle-income countries in other regions with large HIV epidemics. Over 30% of HIV infected people live in countries outside sub-Saharan Africa. Several key antiretrovirals are still on patent, with generic production restricted. We assessed price variations for key antiretroviral drugs inside versus outside sub-Saharan Africa. Methods: HIV drug prices used in national programmes (20102014 were extracted from the WHO Global Price Reporting Mechanism database for all reporting middle-income countries as classified by the World Bank. Treatment costs (branded and generic were compared for countries inside sub-Saharan Africa versus those outside. Five key second-line antiretrovirals were analysed: abacavir, atazanavir, darunavir, lopinavir/ritonavir, raltegravir. Results: Prices of branded antiretrovirals were significantly higher outside sub-Saharan Africa (p<0.001, adjusted for year of purchase (see Table 1. For example, the median (interquartile range price of darunavir from Janssen was $732 (IQR $732-806 per person-year in sub-Saharan Africa versus $4689 (IQR $4075-5717 in non-African middle-income countries, an increase of 541%. However, when supplied by generic companies, most antiretrovirals were similarly priced between countries in sub-Saharan Africa and other regions. Conclusions: Pharmaceutical companies are selling antiretrovirals to non-African middle-income countries at prices 74541% higher than African countries with similar gross national incomes. However, generic companies are selling most of these drugs at similar prices across regions. Mechanisms to ensure fair pricing for patented antiretrovirals across both African and non-African middle-income countries need to be improved, to ensure sustainable treatment access.
Monjok, Emmanuel; Smesny, Andrea; Mgbere, Osaro; Essien, E James
The sub-Saharan region of Africa is the most severely affected HIV/AIDS region in the world. The population of this region accounts for 67% of all people living with HIV/AIDS and 72% of all AIDS-related deaths. As international collaboration makes access to HIV treatment more widely available in this region the need to increase the population's awareness of its serostatus becomes greater. The incorporation of provider-initiated HIV testing and counseling (routine HIV testing model) as part of a routine medical care would not only increase the population's serostatus awareness but also lead to a better understanding of HIV prevention and treatment and ultimately, increased utilization of available HIV/AIDS prevention programs on a much larger scale. This mini-review summarizes some important regional, sociocultural, economic, legal, and ethical issues that may be deterrent factors to maximal implementation and integration of provider initiated HIV testing and counseling as part of routine medical care in the sub-Saharan African region. PMID:20071594
Dillon, David G; Gurdasani, Deepti; Riha, Johanna; Ekoru, Kenneth; Asiki, Gershim; Billy N. Mayanja; Naomi S. Levitt; Crowther, Nigel J.; Nyirenda, Moffat; Njelekela, Marina; Ramaiya, Kaushik; Nyan, Ousman; Adewole, Olanisun O; ANASTOS, Kathryn; Azzoni, Livio
Background Sub-Saharan Africa (SSA) has the highest burden of HIV in the world and a rising prevalence of cardiometabolic disease; however, the interrelationship between HIV, antiretroviral therapy (ART) and cardiometabolic traits is not well described in SSA populations.
Dillon, David G; Gurdasani, Deepti
Sub-Saharan Africa (SSA) has the highest burden of HIV in the world and a rising prevalence of cardiometabolic disease; however, the interrelationship between HIV, antiretroviral therapy (ART) and cardiometabolic traits is not well described in SSA populations.
Full Text Available Abstract Our knowledge of pharmacogenetic variability in diverse populations is scarce, especially in sub-Saharan Africa. To bridge this gap in knowledge, we characterised population frequencies of clinically relevant pharmacogenetic traits in two distinct South African population groups. We genotyped 211 tagging single nucleotide polymorphisms (tagSNPs in 12 genes that influence antiretroviral drug disposition, in 176 South African individuals belonging to two distinct population groups residing in the Western Cape: the Xhosa (n = 109 and Cape Mixed Ancestry (CMA (n = 67 groups. The minor allele frequencies (MAFs of eight tagSNPs in six genes (those encoding the ATP binding cassette sub-family B, member 1 [ABCB1], four members of the cytochrome P450 family [CYP2A7P1, CYP2C18, CYP3A4, CYP3A5] and UDP-glucuronosyltransferase 1 [UGT1A1] were significantly different between the Xhosa and CMA populations (Bonferroni p CYP2C18, CYP3A4, the gene encoding solute carrier family 22 member 6 [SLC22A6] and UGT1A1 between the two South African populations. Characterising the Xhosa and CMA population frequencies of variant alleles important for drug transport and metabolism can help to establish the clinical relevance of pharmacogenetic testing in these populations.
Konstantin A. Pantserev
Full Text Available The paper devotes to the problem of overcoming of the digital divide in the Sub Saharan African States. On the example of Kenya the author speaks about the comparative success of the development of the information technologies in Africa and in turn underlines the most significant obstacles on the way of African states to the global information society and suggests the means how to overcome them.
Anyangwe, Stella C E; Mtonga, Chipayeni
Health systems played a key role in the dramatic rise in global life expectancy that occurred during the 20th century, and have continued to contribute enormously to the improvement of the health of most of the world's population. The health workforce is the backbone of each health system, the lubricant that facilitates the smooth implementation of health action for sustainable socio-economic development. It has been proved beyond reasonable doubt that the density of the health workforce is directly correlated with positive health outcomes. In other words, health workers save lives and improve health. About 59 million people make up the health workforce of paid full-time health workers world-wide. However, enormous gaps remain between the potential of health systems and their actual performance, and there are far too many inequities in the distribution of health workers between countries and within countries. The Americas (mainly USA and Canada) are home to 14% of the world's population, bear only 10% of the world's disease burden, have 37% of the global health workforce and spend about 50% of the world's financial resources for health. Conversely, sub-Saharan Africa, with about 11% of the world's population bears over 24% of the global disease burden, is home to only 3% of the global health workforce, and spends less than 1% of the world's financial resources on health. In most developing countries, the health workforce is concentrated in the major towns and cities, while rural areas can only boast of about 23% and 38% of the country's doctors and nurses respectively. The imbalances exist not only in the total numbers and geographical distribution of health workers, but also in the skills mix of available health workers. WHO estimates that 57 countries world wide have a critical shortage of health workers, equivalent to a global deficit of about 2.4 million doctors, nurses and midwives. Thirty six of these countries are in sub- Saharan Africa. They would need to increase their health workforce by about 140% to achieve enough coverage for essential health interventions to make a positive difference in the health and life expectancy of their populations. The extent causes and consequences of the health workforce crisis in Sub-Saharan Africa, and the various factors that influence and are related to it are well known and described. Although there is no "magic bullet" solution to the problem, there are several documented, tested and tried best practices from various countries. The global health workforce crisis can be tackled if there is global responsibility, political will, financial commitment and public-private partnership for country-led and country-specific interventions that seek solutions beyond the health sector. Only when enough health workers can be trained, sustained and retained in sub-Saharan African countries will there be meaningful socio-economic development and the faintest hope of attaining the Millennium Development Goals in the sub-continent. PMID:17617671
Full Text Available Health systems played a key role in the dramatic rise in global life expectancy that occurred during the 20th century, and have continued to contribute enormously to the improvement of the health of most of the worldÃ¢ÂÂs population. The health workforce is the backbone of each health system, the lubricant that facilitates the smooth implementation of health action for sustainable socio-economic development. It has been proved beyond reasonable doubt that the density of the health workforce is directly correlated with positive health outcomes. In other words, health workers save lives and improve health. About 59 million people make up the health workforce of paid full-time health workers world-wide. However, enormous gaps remain between the potential of health systems and their actual performance, and there are far too many inequities in the distribution of health workers between countries and within countries. The Americas (mainly USA and Canada are home to 14% of the worldÃ¢ÂÂs population, bear only 10% of the worldÃ¢ÂÂs disease burden, have 37% of the global health workforce and spend about 50% of the worldÃ¢ÂÂs financial resources for health. Conversely, sub-Saharan Africa, with about 11% of the worldÃ¢ÂÂs population bears over 24% of the global disease burden, is home to only 3% of the global health workforce, and spends less than 1% of the worldÃ¢ÂÂs financial resources on health. In most developing countries, the health workforce is concentrated in the major towns and cities, while rural areas can only boast of about 23% and 38% of the countryÃ¢ÂÂs doctors and nurses respectively. The imbalances exist not only in the total numbers and geographical distribution of health workers, but also in the skills mix of available health workers. WHO estimates that 57 countries world wide have a critical shortage of health workers, equivalent to a global deficit of about 2.4 million doctors, nurses and midwives. Thirty six of these countries are in sub-Saharan Africa. They would need to increase their health workforce by about 140% to achieve enough coverage for essential health interventions to make a positive difference in the health and life expectancy of their populations. The extent causes and consequences of the health workforce crisis in Sub-Saharan Africa, and the various factors that influence and are related to it are well known and described. Although there is no Ã¢ÂÂmagic bulletÃ¢ÂÂ solution to the problem, there are several documented, tested and tried best practices from various countries. The global health workforce crisis can be tackled if there is global responsibility, political will, financial commitment and public-private partnership for country-led and country-specific interventions that seek solutions beyond the health sector. Only when enough health workers can be trained, sustained and retained in sub-Saharan African countries will there be meaningful socio-economic development and the faintest hope of attaining the Millennium Development Goals in the sub-continent.
Fourie, D.J. (David Johannes); Schoeman, R.E. (Ria Elizabeth)
The primary means of HIV transmission sexual intercourse has been known for over two decades, but that information does not prevent thousands of men and women from contracting the virus every day. The AIDS epidemic creates a high and ongoing mortality in the economic and social active sector of populations in sub-Saharan Africa. The epidemic is being driven by inequities and uneven development, exacerbating existing poverty and human misery. In hard-hit countries in sub-Saharan Africa, th...
Adedokun, Babatunde O; Yusuf, Bidemi O; Lasisi, J Taye; Jinadu, A A; Sunmonu, M T; Ashanke, A F; Lasisi, O Akeem
Understanding the perceptions of genetic testing by members of the deaf community may help in planning deafness genetics research, especially so in the context of strong adherence to cultural values as found among native Africans. Among Yorubas in Nigeria, deafness is perceived to be caused by some offensive actions of the mother during pregnancy, spiritual attack, and childhood infections. We studied attitudes towards, and acceptance of genetic testing by the deaf community in Nigeria. Structured questionnaires were administered to individuals sampled from the Vocational Training Centre for the Deaf, the religious Community, and government schools, among others. The main survey items elicited information about the community in which the deaf people participate, their awareness of genetic testing, whether or not they view genetic testing as acceptable, and their understanding of the purpose of genetic testing. There were 150 deaf participants (61.3 % males, 38.7 % females) with mean age of 26.7 years ±9.8. A majority of survey respondents indicated they relate only with other members of the deaf community (78 %) and reported believing genetic testing does more good than harm (79.3 %); 57 % expressed interest in genetic testing. Interest in genetic testing for deafness or in genetic testing in pregnancy was not related to whether respondents relate primarily to the deaf or to the hearing community. However, a significantly higher number of male respondents and respondents with low education reported interest in genetic testing. PMID:25983050
Monekosso, G L
Developments in medical education in Sub-Saharan Africa over the past 100 years have been characterized by the continent's unique history. During the first half of the 20th century, the Europeans effectively installed medical education in their African colonies. The years 1950 to 1960 were distinguished by successful movements for independence, with new governments giving priority to medical education. By 1980, there were 51 medical schools in Sub-Saharan Africa. The period from 1975 to 1990 was problematic both politically and economically for Sub-Saharan Africa, and medical schools did not escape the general difficulties. War, corruption, mounting national debts, and political instability were characteristics of this period. In many countries, maintaining medical school assets--faculty members, buildings, laboratories, libraries--became difficult, and emigration became the goal of many health professionals. In contrast, the past 20 years have seen rapid growth in the number of medical schools in Sub-Saharan Africa. Economic growth and political stability in most Sub-Saharan African countries augur well for investment in health systems strengthening and in medical education. There are, nonetheless, major problem areas, including inadequate funding, challenges of sustainability, and the continuing brain drain. The 20th century was a time of colonialism and the struggle for independence during which medical education did not advance as quickly or broadly as it did in other regions of the world. The 21st century promises a different history, one of rapid growth in medical education, leading to better care and better health for the people of Africa. PMID:25072563
Petroleum products are the lifeblood of the economies of all Sub-Saharan African countries. They are key fuels used in road transport and power generation. Households use kerosene and liquefied petroleum gas (LPG) for lighting and cooking. In this era of high oil prices, if the product is state-subsidized, the government budget bears the brunt of price increases. If the price changes are passed through to consumers, the household budgets are impacted directly. The countries most vulnerable to oil price shocks are the low-income oil importers which are disproportionately concentrated in Sub-Saharan Africa. End user prices are affected by several factors: market size and economies of scale, mode of product transport, controlled pricing, protection of inefficient domestic suppliers, degree of competition, clear and stable legal framework, effective monitoring and disclosure of industry statistics. This paper is based on two recent studies of the oil sectors of several countries in Sub-Saharan Africa which posed the following questions: Is each stage in the supply chain, from import of crude oil or refined products to retail, efficiently run and are the efficiency gains passed on to end-users? If not, what are the potential causes and possible means of remedying the problems? - Highlights: Examines comparative efficiencies of oil product supply chains in twelve sub-Saharan countries. Identifies areas for improvement towards best practice. Objective is to reduce differential between international reference prices and consumer prices
Fredriksen, Birger; Fossberg, Camilla Helgø
Over the next two decades, sub-Saharan Africa will face substantial pressure to expand its secondary education system. This is driven by the current low development of secondary education compared to other world regions, continued rapid population growth, the increase in the enrollment and completion rates at the primary education level, and the
Sharp, Colin P.; Vermeulen, Marion; Nébié, Yacouba; Djoko, Cyrille F; Lebreton, Matthew; Tamoufe, Ubald; Rimoin, Anne W.; Kayembe, Patrick K; Carr, Jean K.; Servant-Delmas, Annabelle; Laperche, Syria; Harrison, G. L. Abby; Pybus, Oliver G.; Delwart, Eric; Nathan D. Wolfe
Human parvovirus 4 infections are primarily associated with parenteral exposure in western countries. By ELISA, we demonstrate frequent seropositivity for antibody to parvovirus 4 viral protein 2 among adult populations throughout sub-Saharan Africa (Burkina Faso, 37%; Cameroon, 25%; Democratic Republic of the Congo, 35%; South Africa, 20%), which implies existence of alternative transmission routes.
Ángel Pérez González
Full Text Available The contributions made by theory on democratic consolidation in Eastern Europe are also pertinent to analysis of processes of democratization and democratic consolidation in other areas, such as sub-Saharan Africa. The parameters of analysis highlight the importance of a strong state (organized, with legitimated institutions and a structured society (whether multiethnic or not as necessary conditions for democratization. On the assumption that the colonizing powers basically used two models the French assimilationist model and the British indirect government model the study of how these conditions were fulfilled in various sub-Saharan states leads to two conclusions: the first, the possibility of a process of democratization in those states where European (French colonization produced a total assimilation of the colonized society, including above all the colonizers political values; and the second, the possibility of processes of democratization in states produced by British colonization where the indigenous structures and those of the metropolis were superimposed, a phenomenon which allowed the application of democratic values by legitimated local institutions.
Cabral, Manuel Herédia Caldeira; Veiga, Paula
This paper studies the political and economic factors that determine successful export diversification (ED) and export sophistication (ES) strategies in the Sub-Saharan African (SSA) countries and also the way in which successful ED and sophistication strategies contribute to explain the improving in some of the millennium development goals (MDG). We run separate regressions for the determinants of ES and ED, using disaggregated data of the 48 SSA countries, from 1960 to 2005. ...
Docquier, Frédéric; Vasilakis, Chrysovalantis; Tamfutu Munsi, Dieudonné
In this paper, we identify and quantify the role of international migration in the propagation of HIV across sub-Saharan African countries. We use a panel database on bilateral migration flows and HIV prevalence rates covering 44 countries over the nineties. Controlling for unobserved heterogeneity, spatial autocorrelation, reverse causality and reflection issues, and incorrect treatment of country fixed effects, we regress the log-change of HIV prevalence rates on the average levels of preva...
Bedi, A. S.; Shiferaw, A.
The Dynamics of Job Creation and Job Destruction: Is Sub-Saharan Africa Different? This paper analyzes the creation, destruction and reallocation of jobs in order to understand the micro-dynamics of aggregate employment change in African manufacturing. The nature and magnitude of gross job flows are examined using a unique panel data of Ethiopian manufacturing establishments over the period 1996-2007. We also assess the relative importance of firm demographics, industry effects and business c...
A Markov-switching model with time-varying transition probabilities is applied to sub- Saharan African data to examine the link between output collapses and growth. In the model, the growth rate moves discretely between two regimes; one characterised by a stable positive average growth rate, and a collapse regime characterised by negative and volatile growth rate. The aim is to derive plausible estimates of the transition probabilities for the Markov chain component. These estimates are th...
Ebeke, Christian; Ehrhart, Hélène
This paper focuses on the sources and consequences of the instability of tax revenue in Sub-Saharan African countries. We take advantage of a unique and extraordinarily rich dataset on the composition of tax revenues for a large number of countries. Using panel data for 39 countries observed over the period 1980-2005, our results are threefold. Firstly, the instability of government tax revenue leads to an instability of both the public investment and government consumption, and finally, redu...
Djurfeldt, Göran; Larsson, Rolf
This paper discusses food security and the African food crisis. By means of data from a survey of over 3000 farm households in eight sub-Saharan countries, the authors conclude that food security requires a broad integration of smallholders in the market. Subsistence orientation does not promote food security, while seed fertilizer technology does. Market integration of maize producers seems to be driven by the State, not by the market on its own. The diffusion of technology is stimulated by ...
Amavilah, Voxi Heinrich
I estimate and compare the effects of globalization, governance, and conventional factors and forces on the economic performance of Sub-Saharan African countries. The analysis finds that both physical and human capita as well as unexplained technical residuals affect economic performance, although human capital and technical change do not always have statistically significant impacts. The policy implication of these results calls for improvement of all three variables. Economic ...
Hansen, Henrik; Rand, John
Based on firm level data from 16 Sub-Saharan African countries we show how three different measures of credit constraints lead to three different estimates of gender differences in manufacturing firms credit situation. Using a perception based credit constraint measure female owned firms appear relatively more constrained than male owned firms. Using formal financial access data we find no gender effect. Finally, using direct information on credit constraints, male owned small firms appear disa...
Mayosi, Bongani M.
Heart failure in sub?Saharan Africans is mainly due to non?ischaemic causes, such as hypertension, rheumatic heart disease, cardiomyopathy and pericarditis. The two endemic diseases that are major contributors to the clinical syndrome of heart failure in Africa are cardiomyopathy and pericarditis. The major forms of endemic cardiomyopathy are idiopathic dilated cardiomyopathy, peripartum cardiomyopathy and endomyocardial fibrosis. Endomyocardial fibrosis, which affects children, has the worst...
Ogunleye, Eric Kehinde
Purposeful, well-targeted and successful transformation policies will be elusive for a country or region that does not understand the relative importance of its sectoral sources of growth. This study aims at eliciting our understanding in this respect by providing an assessment of the relative importance of the major sectors as sources of growth in sub-Saharan African (SSA) countries. Our findings reveal that, contrary to the general belief that agriculture is the most important contributor t...
Milner, Chris; Tandrayen, Verena
Since the late 1980's many Sub-Saharan African governments, under the auspices of the World Bank and IMF, have embarked on substantial reform programmes aimed at liberalising trade and expanding exports. There has been a large literature exploring aggregate export and growth response to trade liberalisation, but relatively little empirical work on the labour market effects of these programmes. This paper seeks to provide insights into the individual wage effects of the trade-status of firms. ...
O' Sullivan, Kevin
Using a wide variety of sources, from archival and printed works to the interviews with those involved in policy-making, this project uses the example of sub-Saharan African policy to explore the internationalisation of Irish foreign policy and its interaction with global politics. The narrative of Ireland's involvement in the decolonisation of Africa, policy on apartheid and minority rule, the importance of missionaries, and the evolution of an Irish development aid programme is inter-woven ...
Smith-Greenaway, Emily; Trinitapoli, Jenny
Contextual characteristics influence infant mortality above and beyond family-level factors. The widespread practice of polygyny is one feature of many sub-Saharan African contexts that may be relevant to understanding patterns of infant mortality. Building on evidence that the prevalence of polygyny reflects broader economic, social, and cultural features, and has implications for how families engage in the practice, we investigate whether and how the prevalence of polygyny (1) spills over t...
Van Lith, Lynn M; Yahner, Melanie; Bakamjian, Lynn
Contrary to conventional wisdom, many sub-Saharan African womenoften at young ageshave an unmet need for family planning to limit future births, and many current limiters do not use the most effective contraceptive methods. Family planning programs must improve access to a wide range of modern contraceptive methods and address attitudinal and knowledge barriers if they are to meet women's needs.
E. Jane Morris
Modern biotechnology, including the application of transgenic techniques to produce Genetically Modified Organisms (GMOs), can play a significant role in increasing agricultural production in a sustainable way, but its products need to be tailored for the developing world. In sub-Saharan Africa, the capacity to develop GMOs and ensure they meet stringent regulatory requirements is somewhat limited. Most African governments contribute little to science and technology either financially or thro...
Lovina, Obewu Onwuka
The most populous country in Africa, Nigeria accounts for approximately one sixth of the African population (or one fifth of Sub-Saharan African population). Approximately 50 % of Nigerians are urban dwellers. At least 24 cities have populations of more than 100,000. The variety of customs, languages, and traditions among Nigeria's 389 ethnic groups gives the country a cultural diversity. Nigeria suffers from a population explosion, with a current population in excess of 170 million (2012) an...
Chad, like many other sub-Saharan African countries, depends for most of its energy demand on woodfuels; 90% or more of the country's energy balance comes from biomass energy. Obvious environmental problems appear around cities because of their highly concentrated demand, and this threatens the sustainability of supply. But, this does not need to be a problem, and woodfuel can also be an engine of economic growth, particularly in rural areas. A few policy conditions will need to be satisfied and in Chad this appears to be the case. As a result, the woodfuel supply of the capital N'Djamena could become sustainable, thereby continuing to provide low-cost energy to the urban population for the foreseeable future while giving income generation opportunities in rural areas. A win-win situation?!
Lahlou-Kassi, A; Rey, B; Faye, B
Dairy production to supply African urban centers is one of the dynamic livestock sectors in sub-Saharan Africa (periurban dairy farms). There is a modification in the relative impact of economically important diseases: these farms have an increased capacity to control the major traditional African diseases through genetic or health interventions, hence favouring the emergence of diseases of intensification, which affect dairy production. In this framework, the International Livestock Centre for Africa is starting a research programme which aims, by an ecopathological approach, to judge the true existence of this pathology as opposed to the major African diseases, and to compare its economic importance in various agroecological zones. PMID:8038810
Klassen Nathan; Packer Corinne; Labonté Ronald
Abstract Background Canada is a major recipient of foreign-trained health professionals, notably physicians from South Africa and other sub-Saharan African countries. Nurse migration from these countries, while comparatively small, is rising. African countries, meanwhile, have a critical shortage of professionals and a disproportionate burden of disease. What policy options could Canada pursue that balanced the right to health of Africans losing their health workers with the right of these wo...
Ojo-Igbinoba, M. E.
This document is concerned with the practice of conservation of library materials in African university libraries south of the Sahara and north of the Limpopo. Data were collected using a questionnaire mailed to 42 university libraries in Sub-Saharan Africa. Responses were received from 27 libraries for a 64% response rate. Data analysis was
This article provides an overview of the current state of the liquefied petroleum gases (LPG) market in sub Saharan Africa (SSA) and analyses the supply and demand patterns, the constraints on supply imposed by the insufficient output from refineries unable to meet the increasing demand, and institutional and regulatory issues. Details are given of the pricing policies, the economic benefits that could be obtained by increasing the scale of operations, the use of subsidies, private sector participation, and LPG activities in Angola, Cameroon, the Congo, and the Ivory Coast. The role of the World Bank in the Africa Gas Initiative to promote the use of natural gas reserves in SSA, and requirements for developing the LPG market are discussed
The focus of this report is to identify and portray current barriers to the scaling up of private investment and finance for electricity generation from renewable energy sources in the sub-Saharan region. Best practice in tackling these barriers is identified, partly from a literature review but especially from the results of a survey conducted among 36 financial institutions that are UNEP Finance Initiative members and two non-member banks (all survey respondents have experience in the field of energy infrastructure finance). Promising avenues in the areas of local policy reform, incentive mechanisms and international de-risking instruments are highlighted. In particular, this report addresses the following questions: (a) Why are sub-Saharan Africa and developing countries elsewhere failing to expand electricity generation from renewable sources? What are the barriers to such expansion? What is keeping the risk-return profile of renewable energy investments in sub-Saharan Africa unattractive and projects commercially unviable?; (b) What have been the experiences of private sector lenders and investors in the area of renewable energy projects in developing countries? What barriers and drivers have they encountered, and how can these experiences be of use in sub-Saharan Africa?; (c) What can be learned from the modest but encouraging successes of a few sub-Saharan African countries? Can these results be replicated? What was done in these countries to improve the risk-return profile of renewable energy and unlock private finance?.
Francesca L Cavallaro
Full Text Available Objective To examine temporal trends in caesarean delivery rates in southern Asia and sub-Saharan Africa, by country and wealth quintile. Methods Cross-sectional data were extracted from the results of 80 Demographic and Health Surveys conducted in 26 countries in southern Asia or sub-Saharan Africa. Caesarean delivery rates were evaluated as percentages of the deliveries that ended in live births for each wealth quintile in each survey. The annual rates recorded for each country were then compared to see if they had increased over time. Findings Caesarean delivery rates had risen over time in all but 6 study countries but were consistently found to be lower than?5% in 18 of the countries and 10% or less in the other eight countries. Among the poorest 20% of the population, caesarean sections accounted for less than?1% and less than?2% of deliveries in 12 and 21 of the study countries, respectively. In each of 11 countries, the caesarean delivery rate in the poorest 40% of the population remained under?1%. In Chad, Ethiopia, Guinea, Madagascar, Mali, Mozambique, Niger and Nigeria, the rate remained under?1% in the poorest 80%. Compared with the 22 African study countries, the four study countries in southern Asia experienced a much greater rise in their caesarean delivery rates over time. However, the rates recorded among the poorest quintile in each of these countries consistently fell below?2%. Conclusion Caesarean delivery rates among large sections of the population in sub-Saharan Africa are very low, probably because of poor access to such surgery.
Rudel, Thomas K
For decades, the dynamics of tropical deforestation in sub-Saharan Africa (SSA) have defied easy explanation. The rates of deforestation have been lower than elsewhere in the tropics, and the driving forces evident in other places, government new land settlement schemes and industrialized agriculture, have largely been absent in SSA. The context and causes for African deforestation become clearer through an analysis of new, national-level data on forest cover change for SSA countries for the 2000-2005 period. The recent dynamic in SSA varies from dry to wet biomes. Deforestation occurred at faster rates in nations with predominantly dry forests. The wetter Congo basin countries had lower rates of deforestation, in part because tax receipts from oil and mineral industries in this region spurred rural to urban migration, declines in agriculture and increased imports of cereals from abroad. In this respect, the Congo basin countries may be experiencing an oil and mineral fuelled forest transition. Small farmers play a more important role in African deforestation than they do in southeast Asia and Latin America, in part because small-scale agriculture remains one of the few livelihoods open to rural peoples. PMID:23878341
Full Text Available OBJECTIVE: To provide internationally comparable data on the frequencies of different causes of death. METHODS: We analysed verbal autopsies obtained during 1999 -2002 from 12 demographic surveillance sites in sub-Saharan Africa and Bangladesh to find cause-specific and age-specific mortality rates. The cause-of-death codes used by the sites were harmonized to conform to the ICD-10 system, and summarized with the classification system of the Global Burden of Disease 2000 (Version 2. FINDINGS: Causes of death in the African sites differ strongly from those in Bangladesh, where there is some evidence of a health transition from communicable to noncommunicable diseases, and little malaria. HIV dominates in causes of mortality in the South African sites, which contrast with those in highly malaria endemic sites elsewhere in sub-Saharan Africa (even in neighbouring Mozambique. The contributions of measles and diarrhoeal diseases to mortality in sub-Saharan Africa are lower than has been previously suggested, while malaria is of relatively greater importance. CONCLUSION: The different patterns of mortality we identified may be a result of recent changes in the availability and effectiveness of health interventions against childhood cluster diseases.
How did nutritional status develop in sub-Saharan Africa during the second half of the 20th century, and what role did economic development play in nutrition and health? Aggregating data from more than 200,000 women in 28 sub-Saharan African countries, we use mean height as an indicator of net nutritional status and find that the nutritional status of 1960 birth cohorts was relatively high. This situation, however, was not sustained. In almost all countries examined, mean heights were stagnating or decreasing after the 1970 cohorts. Using regression analysis we model human growth from birth to maturity, and find that economic growth had a significant and robust influence on final adult height at two distinct periods of the life cycle: (1) in the first years of life and (2) at puberty. We conclude that the economic difficulties of the late 1970s and 1980s contributed to the decline or stagnation in heights. PMID:20071250
Kluth, Michael Friederich
This article argues that aspirations of maintaining a dominant influence over sub-Saharan security issues has spurred the French and British leadership of European Union (EU) foreign and security policy integration, just as it has informed military capability expansions by the armed forces of the main EU powers. While Europe's initial African focus was on stabilising a continent marred by state failure, civil wars and genocides, changes in the global security context, especially the shift towards multipolarity manifest in China's growing engagement, has prompted a complementary focus on deterring other powers from making military inroads into the subcontinent. Hence Europe's sub-Saharan security focus is shifting from stabilisation towards deterrence. This helps explain recent military procurements which, in spite of the extremely challenging fiscal position of most EU member states, feature large-scale investments in long-range deterrence capabilities.
Full Text Available Over the last few decades, many states in sub-Saharan Africa have adopted draconian anti-migrant policies, leaving refugees and migrants vulnerable to violence, harassment, and economic exploitation. These policies represent a shift from the relatively hospitable attitude shown by many African nations in the immediate post-colonial period. Explanations at the local level do not adequately explain the pervasiveness of these changes or why many developing states are now replicating the migration discourse and practices of the global north. Drawing on scholarship and data from a number of states in the region, including Tanzania, Kenya, Ghana, and South Africa, this paper argues that owing to the widespread implementation of neoliberal economic policies, these states are now subject to many of the same incentives and constraints that operate in the developed north. As a result, political parties and business elites have used national migration policy as an instrument for enhancing their political and economic positions. Insofar as neoliberal globalization continues to exacerbate inequality within the developing world, the harsh measures taken by governments of developing countries against their refugee and migrant populations are likely to increase. It is therefore important that scholars of migration and human rights begin to reassess the prevailing, nearly exclusive emphasis in many globalization studies on the dehumanizing policies and exploitation of southern migrants by states in the global north, as such an emphasis risks obscuring the emergence of more complex patterns of migration and anti-migrant practices in the developing world.
Salomon Joshua A.
Full Text Available OBJECTIVE: To improve the methodological basis for modelling the HIV/AIDS epidemics in adults in sub-Saharan Africa, with examples from Botswana, Central African Republic, Ethiopia, and Zimbabwe. Understanding the magnitude and trajectory of the HIV/AIDS epidemic is essential for planning and evaluating control strategies. METHODS: Previous mathematical models were developed to estimate epidemic trends based on sentinel surveillance data from pregnant women. In this project, we have extended these models in order to take full advantage of the available data. We developed a maximum likelihood approach for the estimation of model parameters and used numerical simulation methods to compute uncertainty intervals around the estimates. FINDINGS: In the four countries analysed, there were an estimated half a million new adult HIV infections in 1999 (range: 260 to 960 thousand, 4.7 million prevalent infections (range: 3.0 to 6.6 million, and 370 thousand adult deaths from AIDS (range: 266 to 492 thousand. CONCLUSION: While this project addresses some of the limitations of previous modelling efforts, an important research agenda remains, including the need to clarify the relationship between sentinel data from pregnant women and the epidemiology of HIV and AIDS in the general population.
Luis Távora-Tavira, Rosa Teodósio, Jorge Seixas, Emília Prieto, Rita Castro, Filomena Exposto, Jorge Atouguia
Full Text Available Background: For geographical and recent historic reasons, Portugal is a gateway and home for immigration from sub-Saharan countries. Misconceptions related to these populations often lead to consider them as high-frequency clusters for dissemination of sexually transmitted infections (STIs. Epidemiological evidence-based data is needed to elucidate these issues and baseline prevalence studies are the starting point for this.Methodology: A prospective study was conducted in 220 African migrants (171 men and 49 women, recently arrived in Portugal, at the time of their first consultation. The presence of STIs was evaluated using a clinical syndromic approach and biological confirmation for gonorrhoea, Chlamydia trachomatis genital infection, syphilis, Hepatitis B and Human Immunodeficiency Virus (HIV infection.Results: Global prevalence of the targeted infections were 1.8% for gonorrhoea, 0 % for Chlamydia infection, 4.1% for Syphilis, 5.9% for HBsAg presence and 7.3% for HIV infection. Globally, 16.4% of the studied persons had at least one sexually transmitted infection.Conclusions: We concluded that prevalence rates encountered in this population is similar to that of non-migrant Portuguese populations with a high risk for sexually transmitted diseases. Therefore migration from sub-Saharan Africa doesnt seem to constitute a particularly critical isolated factor for public health risk of STIs in the community.
This study investigates the causality relationship between crude oil consumption and economic growth in twenty three Sub-Saharan African countries. We applied a multivariate panel Granger causality framework during 19852011 and we included crude oil price as the control variable of the model. The results indicate that in the short-run, there is a bi-directional causality relationship between crude oil consumption and economic growth in oil importing region and there is a uni-directional causality relationship from crude oil consumption to GDP in oil exporting region. However, in the long-run there is a bi-directional causality relationship between them in both regions. Therefore, reducing crude oil consumption without employing appropriate policies adversely impacts on economic growth of Sub-Saharan Africa. Hence, in order to reduce crude oil dependency of the region policymakers should pay more attention to the issue of energy efficiency programs. - Highlights: ? We examined Granger causality among oil consumption and GDP in Sub-Saharan Africa. ? Crude oil price is the control variable of the model. ? There is short run bi-directional causality among oil and GDP (oil importing). ? There is short run uni-directional causality from oil to GDP (oil exporting). ? There is a long run bi-directional causality among oil and GDP in both regions
Stadlmayr, Barbara; Charrondière, U Ruth; Eisenwagen, Sandra; Jamnadass, Ramni; Kehlenbeck, Katja
Indigenous fruits constitute an important part of human diets in many sub-Saharan African countries, particularly in rural areas and during droughts. In order to promote and expand the utilisation of these fruits, knowledge on their nutritional composition is essential. This review presents the results of a literature research of the nutritional composition of ten selected indigenous fruits from sub-Saharan Africa. Species were selected based on their current importance as well as their future potential for nutrition, processing and cash income generation. Compositional data were compiled and mean values of components per species were calculated. Most papers were compiled for Adansonia digitata (26) and Dacryodes edulis (16), followed by Tamarindus indica (ten), Balanites aegyptiaca (nine), Sclerocarya birrea (nine), Ziziphus mauritiana (nine), Vitex doniana (seven) and Irvingia gabonensis (five), and least for Uapaca kirkiana (three) and Syzygium guineense (three). Fruits were found to be mainly analysed for macronutrients and minerals. Vitamins, apart from vitamin C, were rarely reported. Substantial compositional differences were found among as well as within the different fruit species. The results of this study emphasise the need to generate more high-quality data on a wider spectrum of components of the selected indigenous fruits in sub-Saharan Africa. PMID:23633245
Stefanos, Xenarios; Paul, Pavelic.
Full Text Available Greater use of groundwater in Sub-Saharan Africa is a pre-requisite for improved human welfare; however, the costs associated with groundwater development are prohibitively high and poorly defined. This study identifies and disaggregates the costs of groundwater development in 11 Sub-Saharan African [...] countries, while the cost factors that most strongly affect drilling expenditures are traced. Further, the institutional and technical constraints impeding groundwater development are also explored while a time-series analysis forecasts future drilling expenditures. The results indicate that mobilisation and demobilisation costs, together with well development costs, factors that are difficult to change, are most significantly affecting the total costs of drilling. Further, the nature of the hydrogeological formation (which is largely a site characteristic), along with the often-aged machinery (which can be controlled), are also major impediments to lowering the cost of drilling. All countries are forecasted to have a slight to considerable drilling cost decrease for the next decade which offers encouragement for future groundwater development. Greater attention to the individual cost factors and to forecasting analysis could help to design more coherent and consistent groundwater development policies in Sub-Saharan Africa.
Deaton, Angus S; Tortora, Robert
The health of people in sub-Saharan Africa is a major global concern. However, data are weak, and little is known about how people in the region perceive their health or their health care. We used data from the Gallup World Poll in 2012 to document sub-Saharan Africans' perceived health status, their satisfaction with health care, their contact with medical professionals, and the priority they attach to health care. In comparison to other regions of the world, sub-Saharan Africa has the lowest ratings for well-being and the lowest satisfaction with health care. It also has the second-lowest perception of personal health, after only the former Soviet Union and its Eastern European satellites. HIV prevalence is positively correlated with perceived improvements in health care in countries with high prevalence. This is consistent with an improvement in at least some health care services as a result of the largely aid-funded rollout of antiretroviral treatment. Even so, sub-Saharan Africans do not prioritize health care as a matter of policy, although donors are increasingly shifting their aid efforts in the region toward health. PMID:25715657
Bloom, David E.; Humair, Salal; Rosenberg, Larry; Sevilla, J.P.; TRUSSELL, JAMES
Managing rapid population growth and spurring economic growth are among the most pressing policy challenges for Sub-Saharan Africa. We discuss the links between them and investigate the potential of family planning programs to address these challenges. Specifically, we estimate the impact of family planning programs on income per capita that can arise via the demographic dividend (DD), a boost to per capita income that operates through a chain of causality related to declining fertility. We d...
Heather E. Thompson; Ford, James D; Lea Berrang-Ford
In recent years it has become clear that climate change is an inevitable process. In Sub-Saharan Africa, the expectation is that climate change will have an especially negative impact, not only a result of projected warming and rainfall deficits, but also because of the vulnerability of the population. The impact upon food security will be of great significance, and may be defined as being composed of three components: availability, access, and utilization. To further investigate the link, a ...
Wesolowski, Amy; O'Meara, Wendy Prudhomme; Eagle, Nathan; Tatem, Andrew J; Buckee, Caroline O
Simple spatial interaction models of human mobility based on physical laws have been used extensively in the social, biological, and physical sciences, and in the study of the human dynamics underlying the spread of disease. Recent analyses of commuting patterns and travel behavior in high-income countries have led to the suggestion that these models are highly generalizable, and as a result, gravity and radiation models have become standard tools for describing population mobility dynamics for infectious disease epidemiology. Communities in Sub-Saharan Africa may not conform to these models, however; physical accessibility, availability of transport, and cost of travel between locations may be variable and severely constrained compared to high-income settings, informal labor movements rather than regular commuting patterns are often the norm, and the rise of mega-cities across the continent has important implications for travel between rural and urban areas. Here, we first review how infectious disease frameworks incorporate human mobility on different spatial scales and use anonymous mobile phone data from nearly 15 million individuals to analyze the spatiotemporal dynamics of the Kenyan population. We find that gravity and radiation models fail in systematic ways to capture human mobility measured by mobile phones; both severely overestimate the spatial spread of travel and perform poorly in rural areas, but each exhibits different characteristic patterns of failure with respect to routes and volumes of travel. Thus, infectious disease frameworks that rely on spatial interaction models are likely to misrepresent population dynamics important for the spread of disease in many African populations. PMID:26158274
Wang, Shuoguo; Lachance, Joseph; Tishkoff, Sarah A; Hey, Jody; Xing, Jinchuan
Recent studies have found evidence of introgression from Neanderthals into modern humans outside of sub-Saharan Africa. Given the geographic range of Neanderthals, the findings have been interpreted as evidence of gene exchange between Neanderthals and modern humans descended from the Out-of-Africa (OOA) migration. Here, we examine an alternative interpretation in which the introgression occurred earlier within Africa, between ancestors or relatives of Neanderthals and a subset of African mod...
Full Text Available Introduction: In 2011, a French national survey of people living with HIV (PLHIV has shown that 40% of persons diagnosed since 2003 are originated from sub-Saharan Africa, two thirds of them being women. For them, in the short term, access to social rights is a priority. Today, over 90% of PLHIV are treated effectively and with the aging of this population, questions about their future perspectives arise. Our service provides a multidisciplinary (medical, psychological, social approach to PLHIV. The aim of our study is to describe the future perspectives of sub-Saharan women living with HIV residing in France for more than 7 years, because it is the time required for the implementation of fundamental rights and social insertion. Do they plan to return to their country of origin after their retirement? Does the HIV infection force them to stay in France? Materials and Methods: Prospective pilot mono-centric study. Between January and April 2014, every HIV-infected woman born in a sub-Saharan country, resident in France for at least 7 years, attending for their routine outpatient visit was consecutively included. Data were collected through a structured, semi-directed interview made by their usual hospital physician or social worker. Results: Consecutively, 76 women agreed to participate to the interview, none refused. Mean age: 42 years , time since HIV diagnosis: 12 years . HIV diagnosis was made before arriving in France for 3% of them; in 33% diagnosis was made in the year of arrival; diagnosis made several years after arrival in 63%. Even if 69% of these women had been irregularly residing in France for a period, all of them had obtained a regular situation for residence and 50% acquired the French nationality. Mean duration of residence was 15 years . Two thirds of them are employed. In the future, although 50% plan to have a shared residence between France and Africa, only 20% of them plan to settle back definitely in Africa and no woman declared that she would look for a medical follow up in Africa for their HIV infection. Conclusions: This study shows a good integration in France of HIV-infected sub-Saharan woman. Their links with Africa remain strong but very few plan to return in their country of origin due to lack of confidence in the African health infrastructures.
Full Text Available There is no doubt that communicable diseases will remain the predominant health problem for the populations in sub-Saharan Africa, including adults, for the next 10--20 years. Concern has been expressed that the available resources to deal with this problem would be reduced by increasing the emphasis on noncommunicable diseases. The latter, however, already present a substantial burden because their overall age-specific rates are currently higher in adults in sub-Saharan Africa than in populations in Established Market Economies. There is also evidence that the prevalence of certain noncommunicable diseases, such as diabetes and hypertension, is increasing rapidly, particularly in the urban areas, and that significant demands are being made on the health services by patients with these diseases. To ignore the noncommunicable diseases would inevitably lead to an increase in their burden; the provision of health services for them would be largely undirected by issues of clinical and cost effectiveness, and their treatment and prevention would be left to the mercy of local and global commercial interests. Improved surveillance of all diseases within sub-Saharan Africa is needed in order to place noncommunicable diseases properly within the context of the overall burden of disease. Research is needed to guide improvements in the clinical and cost effectiveness of resources currently committed to the care of patients with noncommunicable diseases, and to direct and evaluate preventive measures.
Jensen Jeffrey D
Full Text Available Abstract Background Levels of molecular diversity in Drosophila have repeatedly been shown to be higher in ancestral, African populations than in derived, non-African populations. This pattern holds for both coding and noncoding regions for a variety of molecular markers including single nucleotide polymorphisms and microsatellites. Comparisons of X-linked and autosomal diversity have yielded results largely dependent on population of origin. Results In an attempt to further elucidate patterns of sequence diversity in Drosophila melanogaster, we studied nucleotide variation at putatively nonfunctional X-linked and autosomal loci in sub-Saharan African and North American strains of D. melanogaster. We combine our experimental results with data from previous studies of molecular polymorphism in this species. We confirm that levels of diversity are consistently higher in African versus North American strains. The relative reduction of diversity for X-linked and autosomal loci in the derived, North American strains depends heavily on the studied loci. While the compiled dataset, comprised primarily of regions within or in close proximity to genes, shows a much more severe reduction of diversity on the X chromosome compared to autosomes in derived strains, the dataset consisting of intergenic loci located far from genes shows very similar reductions of diversities for X-linked and autosomal loci in derived strains. In addition, levels of diversity at X-linked and autosomal loci in the presumably ancestral African population are more similar than expected under an assumption of neutrality and equal numbers of breeding males and females. Conclusion We show that simple demographic scenarios under assumptions of neutral theory cannot explain all of the observed patterns of molecular diversity. We suggest that the simplest model is a population bottleneck that retains an ancestral female-biased sex ratio, coupled with higher rates of positive selection at X-linked loci in close proximity to genes specifically in derived, non-African populations.
Smith, AD; Tapsoba, P; Peshu, N.; Sanders, EJ; Jaffe, HW
Globally, men who have sex with men (MSM) continue to bear a high burden of HIV infection. In sub-Saharan Africa, same-sex behaviours have been largely neglected by HIV research up to now. The results from recent studies, however, indicate the widespread existence of MSM groups across Africa, and high rates of HIV infection, HIV risk behaviour, and evidence of behavioural links between MSM and heterosexual networks have been reported. Yet most African MSM have no safe access to relevant HIV/A...
Dietz & Kolokouris, Heine & Kyriakos
The recent Chinese engagement in Africa has been on the focal point of a heated debate not only within the academia but also in the public dialogue as it has paid generous attention by the international media outlets sometimes in the wrong direction, though. This paper is aiming at shed a light on the factors which led to the contemporary Sino-African approach. More specifically, this will take place by analyzing the today´s Chinese foreign policy towards Sub-Saharan Africa by taking into acc...
Hansen, Henrik; Rand, John
Based on firm level data from 16 Sub-Saharan African countries we show how three different measures of credit constraints lead to three different estimates of gender differences in manufacturing firms credit situation. Using a perception based credit constraint measure female owned firms appear relatively more constrained than male owned firms. Using formal financial access data we find no gender effect. Finally, using direct information on credit constraints, male owned small firms appear disadvantaged. Furthermore we show a strong size gradient in the gender gap for the two measures for which we find significant gender differences.
Sub-Saharan African (SSA) countries rely heavily on donor assistance and international borrowing. The Official Development Assistance (ODA)/GNP ratio in SSA is expected to rise well into the next century. Increases or decreases of ODA, which is known to be the main source of SSA's investment, may depend on the type of global settlement expected to emerge in the post-cold war world. SSA has therefore a stake on the type of globalisation which may frame world economic policy and financial aid to i...
Full Text Available Abstract Background In this paper, we aim to quantify the contribution of international health volunteers to the health workforce in sub-Saharan Africa and to explore the perceptions of health service managers regarding these volunteers. Methods Rapid survey among organizations sending international health volunteers and group discussions with experienced medical officers from sub-Saharan African countries. Results We contacted 13 volunteer organizations having more than 10 full-time equivalent international health volunteers in sub-Saharan Africa and estimated that they employed together 2072 full-time equivalent international health volunteers in 2005. The numbers sent by secular non-governmental organizations (NGOs is growing, while the number sent by development NGOs, including faith-based organizations, is mostly decreasing. The cost is estimated at between US$36 000 and US$50 000 per expatriate volunteer per year. There are trends towards more employment of international health volunteers from low-income countries and of national medical staff. Country experts express more negative views about international health volunteers than positive ones. They see them as increasingly paradoxical in view of the existence of urban unemployed doctors and nurses in most countries. Creating conditions for employment and training of national staff is strongly favoured as an alternative. Only in exceptional circumstances is sending international health volunteers viewed as a defendable temporary measure. Conclusion We estimate that not more than 5000 full-time equivalent international health volunteers were working in sub-Saharan Africa in 2005, of which not more than 1500 were doctors. A distinction should be made between (1 secular medical humanitarian NGOs, (2development NGOs, and (3 volunteer organizations, as Voluntary Service Overseas (VSO and United Nations volunteers (UNV. They have different views, undergo different trends and are differently appreciated by government officials. International health volunteers contribute relatively small numbers to the health workforce in sub-Saharan Africa, and it seems unlikely that they will do more in the future. In areas where they play a role, their contribution to service delivery is sometimes very significant.
E. Jane Morris
Full Text Available Modern biotechnology, including the application of transgenic techniques to produce Genetically Modified Organisms (GMOs, can play a significant role in increasing agricultural production in a sustainable way, but its products need to be tailored for the developing world. In sub-Saharan Africa, the capacity to develop GMOs and ensure they meet stringent regulatory requirements is somewhat limited. Most African governments contribute little to science and technology either financially or through strong policies. This leaves the determination of research and development priorities in the hands of international funding agencies. Whereas funding from the United States is generally supportive of GM technology, the opposite is true of funding from European sources. African countries are thus pulled in two different directions. One alternative to this dilemma might be for countries in the sub-Saharan Africa region to develop stronger South-South collaborations, but these need to be supported with adequate funding. African governments as well as external funding agencies are urged to consider the important role that biotechnology, including GM technology, can play in contributing to sustainable development in Africa, and to provide adequate support to the development of capacity to research, develop and commercialize GMOs in the region.
Full Text Available Abstract Background Because of previously reported ethnic differences in determinants and markers of obesity and related metabolic disorders, we sought to investigate circulating levels of adiponectin and their correlates in a sub-Saharan African (sSA population. Subjects and Methods We studied 70 non-diabetic volunteers (33M/37F living in Yaoundé, Cameroon, aged 2469 yr, with BMI 2042 kg/m2. In all participants we measured waist circumference and total body fat by bioimpedance, and obtained a fasting venous blood sample for measurement of plasma glucose, serum insulin and adiponectin concentrations. We performed a euglycaemic hyperinsulinaemic clamp in 1/4 subjects, and HOMAIR was used as surrogate of fasting insulin sensitivity index since it best correlates to clamp measurements. Results Males had lower adiponectin levels than females (8.8 ± 4.3 vs. 11.8 ± 5.5 ?g/L. There was no significant correlation between adiponectin and total body fat (rs = -0.03; NS, whereas adiponectin was inversely correlated with waist circumference (rs = -0.39; p = 0.001. Adiponectin correlated negatively with insulin resistance (rs = -0.35; p = 0.01. In a regression analysis using fasting adiponectin concentration as the dependent variable, and age, HOMAIR, waist circumference, and fat mass as predictors, waist circumference (? = -3.30; p = 0.002, fat mass (? = -2.68; p = 0.01, and insulin resistance (? = -2.38; p = 0.02 but not age (? = 1.11; p = 0.27 were independent predictors of adiponectin. When considering gender, these relations persisted with the exception of waist circumference in females. Conclusion Adiponectin correlates in this study population are comparable to those observed in Caucasians with the exception of waist circumference in women. The metabolic significance of waist circumference is therefore questioned in sSA women.
There is increasing agreement among the nutrition community about the use of length/height-for-age as the indicator to monitor the long-term impact of chronic nutritional deficiencies. Stunting, an indicator of linear growth failure, has both long- and short-term consequences affecting growth and development and adult work potential. The number of stunted children in sub-Saharan Africa is expected to increase by 2025 if the current trends remain. Stunting among African children peaks during the complementary feeding period, which coincides with the period when children are no longer on exclusive breastfeeding and infections are frequent. Addressing stunting has become the focus of global efforts. The World Health Assembly in 2012 set a 40 % reduction in the number of stunted children by 2025. To effectively address the issues of stunting in sub-Saharan Africa is it appropriate to examine the issue of what it takes. The WHO Multicentre Growth Reference Study (MGRS) conducted in several regions of the world, including Africa has lessons on what it would take to prevent in African children. The children in the MGRS had good socioeconomic background characteristics reflected by years of maternal education and availability of basic amenities, such as potable water and sanitary conditions. The prescription of exclusive breastfeeding, high-quality diversified diets and attention to care were critical factors contributing to healthy growth for the African children. Preventing stunting in sub-Saharan Africa is possible. It requires governments to put in place policies that would create the conducive environment needed. The complex and multiple causes of stunting offer the opportunity to address stunting in a multisectoral and within a food systems approach. The global resolve to make food systems deliver on healthy diet requires all stakeholders to work together to achieve the global goal of reducing stunting. This review highlights the key elements contributing to adequate growth in the Africa cohort of the WHO-MGRS and how these provide lessons for addressing stunting in children in sub-Saharan Africa. PMID:25908310
Chersich, Matthew F.; Stanley Luchters; Innocent Ntaganira; Antonio Gerbase; Ying-Ru Lo; Fiona Scorgie; Richard Steen
Introduction: Virtually no African country provides HIV prevention services in sex work settings with an adequate scale and intensity. Uncertainty remains about the optimal set of interventions and mode of delivery. Methods: We systematically reviewed studies reporting interventions for reducing HIV transmission among female sex workers in sub-Saharan Africa between January 2000 and July 2011. Medline (PubMed) and non-indexed journals were searched for studies with quantitative study outcomes...
Financing of agriculture by commercial and non-commercial institutions in rural Sub-Saharan African in recent years has being relatively constant despite remarkable increase in the number of institutions operating within this area. This development may be attributed to how these institutions rate the business of agriculture and the risks involved. However the slow pace of financing sustainable agriculture such as bio-based economy in the presence of internationaliza...
Divine Odame Appiah; Juliet Nana Buaben
Mining is one of the controversial industries, all over the world, particularly in sub-Saharan African countries. This is because the industry is fraught with lots of institutional and socio-economic contradictions, which is characterized by large multi-national companies. Mining in Ghanas western region, where gold is mainly exploited, presents different situations with greater expectations for community development. In all, a total of 102 household questionnaires and key informant intervie...
This paper draws on rich ethnographic data and complementary survey research from a three-country study (Ghana, Malawi, South Africa) of young peoples mobility to explore the gendered nature of childrens journeys to school in sub-Saharan Africa. In most African countries, girls participation in formal education is substantially lower than boys, especially at secondary school level. Transport and mobility issues often form an important component of this story, though the precise patterning...
O'Hare, Bernadette A M; Southall, David P
Objectives To compare the rates of under-5 mortality, malnutrition, maternal mortality and other factors which influence health in countries with and without recent conflict. To compare central government expenditure on defence, education and health in countries with and without recent conflict. To summarize the amount spent on SALW and the main legal suppliers to countries in Sub-Saharan African countries (SSA), and to summarize licensed production of Small Arms and Light Weapons (SALW) in t...
Despite great improvements over the past several years, the quality of demographic data in Africa is still a problem, and Africa remains the least well known continent. Population growth is extremely rapid, with all countries growing at annual rates of over 3%. The natural increase rate even shows some signs of increasing slightly in the next decade or so. Africa's population was estimated at 220 million in 1950, 650 million at present, and is projected at 1.5 billion by 2025. Africans represented 9% of the world population in 1960, but will increase to 19% around 2025. The rapid population growth is the result of declining mortality since the 1950s unmatched by changes in fertility. There are significant socioeconomic and rural-urban mortality differentials in Africa, but as yet only highly educated urbanites have measurably reduced their family size. 2 consequences of this rapid growth are the youth of the population, with almost 50% under 20 years, and its high density in some areas. By 2025, 18 countries will have densities of over 100 persons per sq km. Almost everywhere in Africa, family sizes are at least 6 children/woman. 3 factors explaining this high level of fertility are the earliness and universality of marriage, rates of contraceptive usage of only 4-10% in most countries, and declining durations of breast feeding and sexual abstinence, which traditionally served as brakes on fertility. As a rule, women marry young and remain married until the end of their reproductive years. Divorce and widowhood are common, but remarriage is usually rapid if the woman is still of reproductive age. Life expectancy at birth in sub-Saharan Africa has increased from some 36 years around 1950 to 50 years at present. Progress in control of mortality, and especially infant mortality, has been slower than expected, and Africa still has by far the lowest life expectancy of any major region. Regional, rural-urban, and socioeconomic mortality differentials are considerable and sometimes increasing. In some countries the gaps in life expectancy between rural and urban residents or between social classes are as high as 15 or 20 years. The major causes of death have scarcely changed in 2 or 3 decades: diarrhea, measles, acute respiratory infections, tetanus, malaria, all aggravated by malnutrition and the new scourge of AIDS. Migration and urbanization remain major components of family survival strategies. The increasing pace of urbanization has brought a decline in urban living standards. About half of the world's refugees and displaced persons are in Africa. It was not its demography that brought Africa to its current position of underdevelopment, but population will exercise enormous pressure on available resources. Already for the continents as a whole, food production is increasing less rapidly than population. The challenges are immense: from now until 2000, the working age population will increase by 49% and the school age population (6-11 years) by 58%. PMID:12283847
Andre M. N. Renzaho
Full Text Available Background: Diabetes is one of the non-communicable diseases (NCDs which is rising significantly across sub-Saharan African (SSA countries and posing a threat to the social, economic, and cultural fabric of the SSA population. The inclusion of NCDs into the post-2015 development agenda along with the global monitoring framework provides an opportunity to monitor progress of development programmes in developing countries. This paper examines challenges associated with dealing with diabetes within the development agenda in SSA and explores some policy options. Design: This conceptual review draws from a range of works published in Medline and the grey literature to advance the understanding of the post-2015 development agenda and how it relates to NCDs. The paper begins with the burden of diabetes in sub-Sahara Africa and then moves on to examine challenges associated with diabetes prevention, treatment, and management in Africa. It finishes by exploring policy implications. Results: With regards to development programmes on NCDs in the SSA sub-continent, several challenges exist: 1 poor documentation of risk factors, 2 demographic transitions (rapid urbanisation and ageing, 3 the complementary role of traditional healers, 4 tuberculosis and the treatment of the acquired immunodeficiency syndrome as risk factors for diabetes, 5 diabetes in complex emergencies, 6 diabetes as an international development priority and not a policy agenda for many SSA countries, and 7 poorly regulated food and beverage industry. Conclusion: For the post-2015 development agenda for NCDs to have an impact, sufficient investments will be needed to address legislative, technical, human, and fiscal resource constraints through advocacy, accountability, political leadership, and effective publicprivate partnership. Striking the right balance between competing demands and priorities, policies, and implementation strategies hold the key to an effective response to diabetes in SSA countries.
Renzaho, Andre M. N.
Background Diabetes is one of the non-communicable diseases (NCDs) which is rising significantly across sub-Saharan African (SSA) countries and posing a threat to the social, economic, and cultural fabric of the SSA population. The inclusion of NCDs into the post-2015 development agenda along with the global monitoring framework provides an opportunity to monitor progress of development programmes in developing countries. This paper examines challenges associated with dealing with diabetes within the development agenda in SSA and explores some policy options. Design This conceptual review draws from a range of works published in Medline and the grey literature to advance the understanding of the post-2015 development agenda and how it relates to NCDs. The paper begins with the burden of diabetes in sub-Sahara Africa and then moves on to examine challenges associated with diabetes prevention, treatment, and management in Africa. It finishes by exploring policy implications. Results With regards to development programmes on NCDs in the SSA sub-continent, several challenges exist: 1) poor documentation of risk factors, 2) demographic transitions (rapid urbanisation and ageing), 3) the complementary role of traditional healers, 4) tuberculosis and the treatment of the acquired immunodeficiency syndrome as risk factors for diabetes, 5) diabetes in complex emergencies, 6) diabetes as an international development priority and not a policy agenda for many SSA countries, and 7) poorly regulated food and beverage industry. Conclusion For the post-2015 development agenda for NCDs to have an impact, sufficient investments will be needed to address legislative, technical, human, and fiscal resource constraints through advocacy, accountability, political leadership, and effective publicprivate partnership. Striking the right balance between competing demands and priorities, policies, and implementation strategies hold the key to an effective response to diabetes in SSA countries. PMID:25994288
Hall, Victoria; Thomsen, Reimar W
ABSTRACT: BACKGROUND: Diabetes prevalence is increasing globally, and Sub-Saharan Africa is no exception. With diverse health challenges, health authorities in Sub-Saharan Africa and international donors need robust data on the epidemiology and impact of diabetes in order to plan and prioritise their health programmes. This paper aims to provide a comprehensive and up-to-date review of the epidemiological trends and public health implications of diabetes in Sub-Saharan Africa. METHODS: We conducted a systematic literature review of papers published on diabetes in Sub-Saharan Africa 1999-March 2011, providing data on diabetes prevalence, outcomes (chronic complications, infections, and mortality), access to diagnosis and care and economic impact. RESULTS: Type 2 diabetes accounts for well over 90% of diabetes in Sub-Saharan Africa, and population prevalence proportions ranged from 1% in rural Uganda to 12% in urban Kenya. Reported type 1 diabetes prevalence was low and ranged from 4 per 100,000 in Mozambique to 12 per 100,000 in Zambia. Gestational diabetes prevalence varied from 0% in Tanzania to 9% in Ethiopia. Proportions of patients with diabetic complications ranged from 7-63% for retinopathy, 27-66% for neuropathy, and 10-83% for microalbuminuria. Diabetes is likely to increase the risk of several important infections in the region, including tuberculosis, pneumonia and sepsis. Meanwhile, antiviral treatment for HIV increases the risk of obesity and insulin resistance. Five-year mortality proportions of patients with diabetes varied from 4-57%. Screening studies identified high proportions (>40%) with previously undiagnosed diabetes, and low levels of adequate glucose control among previously diagnosed diabetics. Barriers to accessing diagnosis and treatment included a lack of diagnostic tools and glucose monitoring equipment and high cost of diabetes treatment. The total annual cost of diabetes in the region was estimated at US$67.03 billion, or US$8836 per diabetic patient. CONCLUSION: Diabetes exerts a significant burden in the region, and this is expected to increase. Many diabetic patients face significant challenges accessing diagnosis and treatment, which contributes to the high mortality and prevalence of complications observed. The significant interactions between diabetes and important infectious diseases highlight the need and opportunity for health planners to develop integrated responses to communicable and non-communicable diseases.
Full Text Available Abstract Background Diabetes prevalence is increasing globally, and Sub-Saharan Africa is no exception. With diverse health challenges, health authorities in Sub-Saharan Africa and international donors need robust data on the epidemiology and impact of diabetes in order to plan and prioritise their health programmes. This paper aims to provide a comprehensive and up-to-date review of the epidemiological trends and public health implications of diabetes in Sub-Saharan Africa. Methods We conducted a systematic literature review of papers published on diabetes in Sub-Saharan Africa 1999-March 2011, providing data on diabetes prevalence, outcomes (chronic complications, infections, and mortality, access to diagnosis and care and economic impact. Results Type 2 diabetes accounts for well over 90% of diabetes in Sub-Saharan Africa, and population prevalence proportions ranged from 1% in rural Uganda to 12% in urban Kenya. Reported type 1 diabetes prevalence was low and ranged from 4 per 100,000 in Mozambique to 12 per 100,000 in Zambia. Gestational diabetes prevalence varied from 0% in Tanzania to 9% in Ethiopia. Proportions of patients with diabetic complications ranged from 7-63% for retinopathy, 27-66% for neuropathy, and 10-83% for microalbuminuria. Diabetes is likely to increase the risk of several important infections in the region, including tuberculosis, pneumonia and sepsis. Meanwhile, antiviral treatment for HIV increases the risk of obesity and insulin resistance. Five-year mortality proportions of patients with diabetes varied from 4-57%. Screening studies identified high proportions (> 40% with previously undiagnosed diabetes, and low levels of adequate glucose control among previously diagnosed diabetics. Barriers to accessing diagnosis and treatment included a lack of diagnostic tools and glucose monitoring equipment and high cost of diabetes treatment. The total annual cost of diabetes in the region was estimated at US$67.03 billion, or US$8836 per diabetic patient. Conclusion Diabetes exerts a significant burden in the region, and this is expected to increase. Many diabetic patients face significant challenges accessing diagnosis and treatment, which contributes to the high mortality and prevalence of complications observed. The significant interactions between diabetes and important infectious diseases highlight the need and opportunity for health planners to develop integrated responses to communicable and non-communicable diseases.
Full Text Available Community case management (CCM involves training, supporting, and supplying community health workers (CHWs to assess, classify and manage sick children with limited access to care at health facilities, in their communities. This paper aims to provide an overview of the status in 2013 of CCM policy and implementation in subSaharan African countries.
Gurdasani, Deepti; Carstensen, Tommy; Tekola-Ayele, Fasil; Pagani, Luca; Tachmazidou, Ioanna; Hatzikotoulas, Konstantinos; Karthikeyan, Savita; Iles, Louise; Pollard, Martin O.; Choudhury, Ananyo; Ritchie, Graham R. S.; Xue, Yali; Asimit, Jennifer; Nsubuga, Rebecca N.; Young, Elizabeth H.; Pomilla, Cristina; Kivinen, Katja; Rockett, Kirk; Kamali, Anatoli; Doumatey, Ayo P.; Asiki, Gershim; Seeley, Janet; Sisay-Joof, Fatoumatta; Jallow, Muminatou; Tollman, Stephen; Mekonnen, Ephrem; Ekong, Rosemary; Oljira, Tamiru; Bradman, Neil; Bojang, Kalifa; Ramsay, Michele; Adeyemo, Adebowale; Bekele, Endashaw; Motala, Ayesha; Norris, Shane A.; Pirie, Fraser; Kaleebu, Pontiano; Kwiatkowski, Dominic; Tyler-Smith, Chris; Rotimi, Charles; Zeggini, Eleftheria; Sandhu, Manjinder S.
Given the importance of Africa to studies of human origins and disease susceptibility, detailed characterization of African genetic diversity is needed. The African Genome Variation Project provides a resource with which to design, implement and interpret genomic studies in sub-Saharan Africa and worldwide. The African Genome Variation Project represents dense genotypes from 1,481 individuals and whole-genome sequences from 320 individuals across sub-Saharan Africa. Using this resource, we find novel evidence of complex, regionally distinct hunter-gatherer and Eurasian admixture across sub-Saharan Africa. We identify new loci under selection, including loci related to malaria susceptibility and hypertension. We show that modern imputation panels (sets of reference genotypes from which unobserved or missing genotypes in study sets can be inferred) can identify association signals at highly differentiated loci across populations in sub-Saharan Africa. Using whole-genome sequencing, we demonstrate further improvements in imputation accuracy, strengthening the case for large-scale sequencing efforts of diverse African haplotypes. Finally, we present an efficient genotype array design capturing common genetic variation in Africa.
Chukwuemeka Afigbo; Steven Muegge
SW Global is an African-based application service provider of information technology infrastructure and software. This article describes how SW Global, a for-profit private sector company, creates high-impact value at universities and governments in developing countries through an innovative business model anchored around service subscriptions, open source software, and open content.
This thesis examines whether urbanization affects GDP per capita positively in Sub-Saharan Africa. Further investigations are done to study how the size of the prime city affects GDP per capita, as well as how the prime city as a percentage of urban population interacts with GDP per capita. The results show that urbaization and GDP per capita interact positively - that is, increase in urbaization increases GDP per capita. We also find that size of the prime city as a percentage of total popul...
ALLEN, Franklin; Carletti, Elena; CULL, Robert; QIAN, Jun 'QJ'; SENBET, Lemma
Economic growth in Africa has long been disappointing. We document that the financial sectors of most sub-Saharan African countries remain significantly underdeveloped by the standards of other developing countries. We examine the factors that are associated with financial development in Africa and compare them with those in other developing countries. Population density appears to be considerably more important for banking sector development in Africa than elsewhere. Given the high costs ...
Full Text Available Abstract Background The rapid urban malaria appraisal (RUMA methodology aims to provide a cost-effective tool to conduct rapid assessments of the malaria situation in urban sub-Saharan Africa and to improve the understanding of urban malaria epidemiology. Methods This work was done in Yopougon municipality (Abidjan, Cotonou, Dar es Salaam and Ouagadougou. The study design consists of six components: 1 a literature review, 2 the collection of available health statistics, 3 a risk mapping, 4 school parasitaemia surveys, 5 health facility-based surveys and 6 a brief description of the health care system. These formed the basis of a multi-country evaluation of RUMA's feasibility, consistency and usefulness. Results A substantial amount of literature (including unpublished theses and statistics was found at each site, providing a good overview of the malaria situation. School and health facility-based surveys provided an overview of local endemicity and the overall malaria burden in different city areas. This helped to identify important problems for in-depth assessment, especially the extent to which malaria is over-diagnosed in health facilities. Mapping health facilities and breeding sites allowed the visualization of the complex interplay between population characteristics, health services and malaria risk. However, the latter task was very time-consuming and required special expertise. RUMA is inexpensive, costing around 8,50013,000 USD for a six to ten-week period. Conclusion RUMA was successfully implemented in four urban areas with different endemicity and proved to be a cost-effective first approach to study the features of urban malaria and provide an evidence basis for planning control measures.
Full Text Available Although schools are generally regarded as a 'safe haven' for children, the reality for many girls is that schools can be a place of sexual discrimination, harassment and violence, perpetrated by fellow male students and teachers alike. The widespread problem of sexual and gender-based violence, par [...] ticularly sexual violence, in schools has been well-documented in a range of studies and reports in sub-Saharan Africa. Sexual and gender-based violence in schools not only violates girls' fundamental rights to dignity and equality, and their rights to be free from violence, but it also undermines their rights to education, particularly when, as is often the case, states fail to take measures to protect girls. Although there is a growing body of empirical research documenting the nature and extent of this problem, particularly in various sub-Saharan African countries, how regional and international human rights law applies to protect girls in this situation appears to have received limited consideration. This article attempts to fill this gap in the literature, by providing an analysis of the problem of sexual and gender-based violence in schools within the framework of regional and international human rights law. The article's objective is to identify and discuss rights-based legal strategies to combat this pervasive human rights violation, specifically within the sub-Saharan African context, with an emphasis on regional developments and regional responses.
Muwanika, Vincent B.; Nyakaana, Silvester; Siegismund, Hans Redlef
The spectacular diversity of sub-Saharan Africa's large mammals was hit by constant social strife and civil war over three decades (1970s-1990s) leading to localized extinctions and drastic reductions in population sizes for many species. These localized extinctions and reduction in population sizes undermine the ability of species to evolve and adapt to changing environments as a result of genetic erosion. The genetic consequences of the widespread reduction of population sizes as a result of s...
Dray, James Daniel; Tilley, James; Wiliams, Gavin
This thesis addresses the question of who votes in Africa and why. It uses three sets of quantitative data at three different levels to test its claims: an original compilation of national level institutional and socioeconomic indicators for over 700 elections from independence until 2006 compiled by the author; the Afrobarometer survey of almost 50 000 voters in 17 multiparty African regimes; and the first ever purpose-built survey aimed at testing rational choice turnout models in an Africa...
Full Text Available This study presents a summary overview of the carbon balance of Sub-Saharan Africa (SSA by synthesizing the available data from national communications to UNFCCC and first results from the project CarboAfrica (net ecosystem productivity and emissions from fires, deforestation and forest degradation, by field and model estimates. According to these preliminary estimates the overall carbon balance of SSA varies from 0.43 Pg C y?1 (using in situ measurements for savanna NEP to a much higher sink of 2.53 Pg C y?1 (using model estimates for savanna NEP. UNFCCC estimates lead to a moderate carbon sink of 0.58 Pg C y?1. Excluding anthropogenic disturbance and intrinsic episodic events, the carbon uptake by forests (0.98 Pg C y?1 and savannas (from 1.38 to 3.48 Pg C y?1, depending on the used methodology are the main components of the SSA sink effect. Fires (0.72 Pg C y?1, deforestation (0.25 Pg C y?1 and forest degradation (0.77 Pg C y?1 are the main contributors to the SSA carbon emissions, while the agricultural sector contributes only with 0.12 Pg C y?1. Notably, the impact of forest degradation is higher than that caused by deforestation, and the SSA forest net carbon balance is close to equilibrium. Savannas play a major role in shaping the SSA carbon balance, due to their large areal extent, their fire regime, and their strong interannual NEP variability, but they are also a major uncertainty in the overall budget. This paper shows that Africa plays a key role in the global carbon cycle system and probably could have a potential for carbon sequestration higher than expected, even if still highly uncertain. Further investigations are needed, particularly to better address the role of savannas and tropical forests. The current CarboAfrica network of carbon measurements could provide future unique data sets for better estimating the African carbon balance.
Full Text Available This study gives an outlook on the carbon balance of Sub-Saharan Africa (SSA by presenting a summary of currently available results from the project CarboAfrica (namely net ecosystem productivity and emissions from fires, deforestation and forest degradation, by field and model estimates supplemented by bibliographic data and compared with a new synthesis of the data from national communications to UNFCCC. According to these preliminary estimates the biogenic carbon balance of SSA varies from 0.16 Pg C y?1 to a much higher sink of 1.00 Pg C y?1 (depending on the source data. Models estimates would give an unrealistic sink of 3.23 Pg C y?1, confirming their current inadequacy when applied to Africa. The carbon uptake by forests and savannas (0.34 and 1.89 Pg C y?1, respectively, are the main contributors to the resulting sink. Fires (0.72 Pg C y?1 and deforestation (0.25 Pg C y?1 are the main contributors to the SSA carbon emissions, while the agricultural sector and forest degradation contributes only with 0.12 and 0.08 Pg C y?1, respectively. Savannas play a major role in shaping the SSA carbon balance, due to their large extension, their fire regime, and their strong interannual NEP variability, but they are also a major uncertainty in the overall budget. Even if fossil fuel emissions from SSA are relative low, they can be crucial in defining the sign of the overall SSA carbon balance by reducing the natural sink potential, especially in the future. This paper shows that Africa plays a key role in the global carbon cycle system and probably could have a potential for carbon sequestration higher than expected, even if still highly uncertain. Further investigations are needed, particularly to better address the role of savannas and tropical forests and to improve biogeochemical models. The CarboAfrica network of carbon measurements could provide future unique data sets for better estimating the African carbon balance.
Scheibe, Andrew; Kanyemba, Brian; Syvertsen, Jennifer; Adebajo, Sylvia; Baral, Stefan
Despite consistent evidence, effective interventions and political declarations to reduce HIV infections among men who have sex with men (MSM), coverage of MSM programmes in sub-Saharan Africa (SSA) remains low. Punitive legal frameworks and hostile social circumstances and inadequate health systems further contribute to the high HIV burden among MSM in SSA. The authors use the Modified Social Ecological Model to discuss economic influences in relation to HIV and MSM in SSA. Nigerian, South African and Ugandan case studies are used to highlight economic factors and considerations related to HIV among MSM. The authors argue that criminalisation of consensual sexual practices among adults increases the frequency of human rights violations contributing to the incidence of HIV infections. Furthermore, marginalisation and disempowerment of MSM limits their livelihood opportunities, increases the prevalence of sex work and drug use and limits financial access to HIV services. Sexual and social networks are complex and ignoring the needs of MSM results in increased risks for HIV acquisition and transmission to all sexual partners with cumulative economic and health implications. The authors recommend a public health and human rights approach that employs effective interventions at multiple levels to reduce the HIV burden among MSM and the general population in SSA. PMID:26050380
April, Michael D.
Opt-out testing for the human immunodeficiency virus (HIV) incorporates testing as a routine part of health care for all patients unless they refuse. The ethics of this approach to testing in sub-Saharan Africa is a source of controversy. Opt-out HIV testing is expected to improve survival by increasing case detection and thus linking more HIV-infected people to earlier treatment, provided there is effective patient follow-up and programme sustainability. At the population level, these benefi...
Full Text Available Background: This study described the current conditions of work of paediatric surgeons in Francophone sub-Saharan Africa (FSSA and set the debate at the level of the humanist thinking in medicine. Patients and Methods: This was a multicentre study from 1 st May to 30 th October 2008. The African Society of paediatric surgeons? directory was used to identify paediatric surgeons in the Francophone?s countries in Sub Saharan Africa. The parameters studied were number of surgeons per country, means of training, working conditions, remunerations, needs for continuous training and the research. Results: A total of 41 paediatric surgeons (68.33% responded. The average number of paediatric surgeons per country was 5. The means of training included government scholarships among 7 paediatric surgeons (17.07%, scholarship from a non-governmental organisations in 14 (34.15% and self-sponsorships in 20 (48.78%. The average salary was 450 Euros ( (range: 120-1 400 Euros. Most of the paediatric surgeons (68.29% had internet services for continuous update courses and research. Thirty six paediatric surgeons (87.80% had no subscription to specialised scientific journals. Conclusion: The paediatric surgeon in FSSA faces many problems related to his working and living conditions that may have a negative impact on their competences.
Muuka, Geoffrey; Songolo, Nadi; Kabilika, Swithine; Hang'ombe, Bernard M; Nalubamba, King S; Muma, John B
Contagious bovine pleuropneumonia (CBPP) is a disease of economic importance that is widely distributed in sub-Saharan African and contributes significantly to cattle morbidity and mortality. Control of CBPP offers a number of challenges as a result many developing countries in Africa are still struggling with this disease. In this study, we look at the challenges encountered in CBPP control in sub-Saharan Africa from the Zambian perspective. In conducting this study, we reviewed scientific literature and reports from the Ministry of Agriculture and Livestock and related animal institutions, and also made interviews with experts and key government officials involved in CBPP control in Zambia. Among the challenges identified for the successful control of CBPP were as follows: failure in the delivery of veterinary services, lack of a cattle identification system, natural phenomenon, livestock husbandry systems in the traditional sector, human movements, traditional practices among cattle farmers and cattle marketing systems. It was seen that the epidemiology of CBPP in Zambia is influenced by both ecological and anthological factors. Therefore, design and implementation of any control or eradication programme should be area/regional-dependent taking into account the different factors influencing disease transmission and maintenance. PMID:22843213
Georgios K. Bountagkidis
Full Text Available The EU and most aid donors invoke a strong normative power face by explicitly connecting foreign aid with human and social development. However, how well the EUs rhetoric is consistent with its practices as a multilateral development actor has not been explored extensively. In this study, we challenge the normative dimension of the EUs development policy and explore whether the EUs Official Development Assistance to Sub-Saharan Africa is based on objective deprivation on the part of recipient countries or whether it is interest driven. We use a least squares dummy variable model regression to examine aid flows from the EU to all 48 Sub-Saharan African states for the period 2000 to 2010. The evidence found indicates that in certain instances, aid allocation contradicts the normative rhetoric that the EU uses to describe its development policy, as the donors own interests in the region seem to supersede priority given to the needs of the aid recipient states. A limitation to the findings is the fact that normative values and strategic interests are not mutually exclusive. Nevertheless, the present study suggests that the EUs portrayal as a force for good in international relations requires cautious critique.
Zachariah, R; Ford, N; Philips, M; Lynch, S; Massaquoi, M; Janssens, V; Harries, A D
Sub-Saharan Africa is facing a crisis in human health resources due to a critical shortage of health workers. The shortage is compounded by a high burden of infectious diseases; emigration of trained professionals; difficult working conditions and low motivation. In particular, the burden of HIV/AIDS has led to the concept of task shifting being increasingly promoted as a way of rapidly expanding human resource capacity. This refers to the delegation of medical and health service responsibilities from higher to lower cadres of health staff, in some cases non-professionals. This paper, drawing on Médecins Sans Frontières' experience of scaling-up antiretroviral treatment in three sub-Saharan African countries (Malawi, South Africa and Lesotho) and supplemented by a review of the literature, highlights the main opportunities and challenges posed by task shifting and proposes specific actions to tackle the challenges. The opportunities include: increasing access to life-saving treatment; improving the workforce skills mix and health-system efficiency; enhancing the role of the community; cost advantages and reducing attrition and international 'brain drain'. The challenges include: maintaining quality and safety; addressing professional and institutional resistance; sustaining motivation and performance and preventing deaths of health workers from HIV/AIDS. Task shifting should not undermine the primary objective of improving patient benefits and public health outcomes. PMID:18992905
Murunga, A N; Owira, P M O
The true incidence of diabetic ketoacidosis (DKA) in sub-Saharan Africa is unknown but unlike in the Western countries, DKA is also uniquely frequent among type 2 diabetes patients of African origin. Increased hyperglycaemia and hepatic ketogenesis lead to osmotic diuresis, dehydration and tissue hypoxia. Acute complications of DKA include cerebral oedema, which may be compounded by malnutrition, parasitic and microbial infections with rampant tuberculosis and HIV. Overlapping symptoms of these conditions and misdiagnosis of DKA contribute to increased morbidity and mortality. Inability of the patients to afford insulin treatment leads to poor glycemic control as some patients seek alternative treatment from traditional healers or use herbal remedies further complicating the disease process. Standard treatment guidelines for DKA currently used may not be ideal as they are adapted from those of the developed world. Children presenting with suspected DKA should be screened for comorbidities which may complicate fluid and electrolyte replacement therapy protocol. Patient rehabilitation should take into account concurrent treatment for infectious conditions to avoid possible life-threatening drug interactions. We recommend that health systems in sub-Saharan Africa leverage the Expanded Immunization Programme or TB/HIV/AIDS programmes, which are fairly well entrenched to support diabetes services. PMID:24112393
Debats, S. R.; Luo, D.; Estes, L. D.; Fuchs, T.; Caylor, K. K.
Sub-Saharan Africa is an important focus for food security research, because it is experiencing unprecedented population growth, agricultural activities are largely dominated by smallholder production, and the region is already home to 25% of the world's undernourished. One of the greatest challenges to monitoring and improving food security in this region is obtaining an accurate accounting of the spatial distribution of agriculture. Households are the primary units of agricultural production in smallholder communities and typically rely on small fields of less than 2 hectares. Field sizes are directly related to household crop productivity, management choices, and adoption of new technologies. As population and agriculture expand, it becomes increasingly important to understand both the distribution of field sizes as well as how agricultural communities are spatially embedded in the landscape. In addition, household surveys, a common tool for tracking agricultural productivity in Sub-Saharan Africa, would greatly benefit from spatially explicit accounting of fields. Current gridded land cover data sets do not provide information on individual agricultural fields or the distribution of field sizes. Therefore, we employ cutting edge approaches from the field of computer vision to map fields across Sub-Saharan Africa, including semantic segmentation, discriminative classifiers, and automatic feature selection. Our approach aims to not only improve the binary classification accuracy of cropland, but also to isolate distinct fields, thereby capturing crucial information on size and geometry. Our research focuses on the development of descriptive features across scales to increase the accuracy and geographic range of our computer vision algorithm. Relevant data sets include high-resolution remote sensing imagery and Landsat (30-m) multi-spectral imagery. Training data for field boundaries is derived from hand-digitized data sets as well as crowdsourcing.
Mereu, V.; Spano, D.; Gallo, A.; Carboni, G.
Agriculture in Sub-Saharan Africa (SSA) drives the economy of many African countries and it is mainly rain-fed agriculture used for subsistence. Increasing temperatures, changed precipitation patterns and more frequent droughts may lead to a substantial decrease of crop yields. The projected impacts of future climate change on agriculture are expected to be significant and extensive in the SSA due to the shortening of the growing seasons and the increasing of water-stress risk. Differences in Agro-Ecological Zones and geographical characteristics of SSA influence the diverse impacts of climate change, which can greatly differ across the continent and within countries. The vulnerability of African Countries to climate change is aggravated by the low adaptive capacity of the continent, due to the increasing of its population, the widespread poverty, and other social factors. In this contest, the assessment of climate change impact on agricultural sector has a particular interest to stakeholder and policy makers, in order to identify specific agricultural sectors and Agro-Ecological Zones that could be more vulnerable to changes in climatic conditions and to develop the most appropriate policies to cope with these threats. For these reasons, the evaluation of climate change impacts for key crops in SSA was made exploring climate uncertainty and focusing on short period monitoring, which is particularly useful for food security and risk management analysis. The DSSAT-CSM (Decision Support System for Agrotechnology Transfer - Cropping System Model) software, version 4.5 was used for the analysis. Crop simulation models included in DSSAT-CSM are tools that allow to simulate physiological process of crop growth, development and production, by combining genetic crop characteristics and environmental (soil and weather) conditions. For each selected crop, the models were used, after a parameterization phase, to evaluate climate change impacts on crop phenology and production. Multiple combinations of soils and climate conditions, crop management and varieties were considered for the different Agro-Ecological Zones. The climate impact was assessed using future climate prediction, statistically and/or dynamically downscaled, for specific areas. Direct and indirect effects of different CO2 concentrations projected for the future periods were separately explored to estimate their effects on crops. Several adaptation strategies (e.g., introduction of full irrigation, shift of the ordinary sowing/planting date, changes in the ordinary fertilization management) were also evaluated with the aim to reduce the negative impact of climate change on crop production. The results of the study, analyzed at local, AEZ and country level, will be discussed.
Ahmad Reza Hosseinpoor
Full Text Available OBJECTIVE: To measure within-country wealth-related inequality in the health service coverage gap of maternal and child health indicators in sub-Saharan Africa and quantify its contribution to the national health service coverage gap. METHODS: Coverage data for child and maternal health services in 28 sub-Saharan African countries were obtained from the 2000-2008 Demographic Health Survey. For each country, the national coverage gap was determined for an overall health service coverage index and select individual health service indicators. The data were then additively broken down into the coverage gap in the wealthiest quintile (i.e. the proportion of the quintile lacking a required health service and the population attributable risk (an absolute measure of within-country wealth-related inequality. FINDINGS: In 26 countries, within-country wealth-related inequality accounted for more than one quarter of the national overall coverage gap. Reducing such inequality could lower this gap by 16% to 56%, depending on the country. Regarding select individual health service indicators, wealth-related inequality was more common in services such as skilled birth attendance and antenatal care, and less so in family planning, measles immunization, receipt of a third dose of vaccine against diphtheria, pertussis and tetanus and treatment of acute respiratory infections in children under 5 years of age. CONCLUSION: The contribution of wealth-related inequality to the child and maternal health service coverage gap differs by country and type of health service, warranting case-specific interventions. Targeted policies are most appropriate where high within-country wealth-related inequality exists, and whole-population approaches, where the health-service coverage gap is high in all quintiles.
This study analyses the outcomes of independent power projects (IPPs) across Sub-Saharan Africa. Approximately 20 such projects have taken root to date, concentrated mainly in 8 countries. A suite of country level and project level factors play a critical role in determining project success, chief among them: the manner in which planning, procurement and contracting are coherently linked, the role of development finance institutions along with the development origins of firms and credit enhancements. - Highlights: ? We analyse the outcomes of independent power projects (IPPs) across Sub-Saharan Africa. ? Approximately 20 IPPs have taken root to date, concentrated mainly in 8 countries. ? A suite of country level and project level factors play a critical role in determining project success. ? Key success factors are the coherence of planning, procurement and contracting. ? Also important is the role of DFIs, the development origins of firms, and credit enhancements.
Results of research and intervention programs have convinced a majority of African decision makers of the desirability of reducing the number of births to very young mothers. But many families, especially in rural areas, continue to value early marriage and childbearing. In Niger, for example, the 1992 Demographic and Health Survey indicated that 47% of women currently aged 20-24 years had entered a union before the age of 15 and 87% by the age of 18. 53% had children before they reached 18. Early pregnancy within marriage is seldom regarded as a problem, and is often welcomed by the girl as a proof of fecundity. Attitudes toward premarital pregnancy, on the other hand, depend greatly on the social context. In Islamic areas, where all premarital sexual relations are frowned upon, families favor very early marriage as a means of preventing extramarital pregnancy. In groups undergoing transition to modern norms, pregnancy is viewed as a problem when it interrupts the mother's school attendance, and mothers are subjected to stigmatizing and moralistic sanctions. A more objective approach is to consider the social and health implications of early pregnancy rather than viewing it as the transgression of a norm. Health studies have clearly demonstrated the dangers of pregnancy for adolescents who have not achieved their full growth and the risks of illegal abortion. Motherhood is a great handicap to training and employment of young girls. Family planning programs have made avoidance of early pregnancy a priority. The Demographic and Health Surveys and other studies over the past fifteen years have greatly increased knowledge of adolescent fertility and of entry into adult life including marriage, but some confusion persists regarding the concept of adolescent fertility. Statistical data should distinguish between very young mothers and those over about 18 years, when most have reached physiological maturity. The marital status of the young mother should also be taken into account. Most African countries with data available from more than one survey appear to have experienced a trend toward decline in the number of very early marriages and pregnancies. Such declines as have occurred are probably the result of urbanization and school attendance rather than any specific policy measure. Programs targeted to adolescents should distinguish between the risks of early pregnancy and of premarital fertility. Increased attention should be directed to rural women who marry and have children at very young ages. PMID:12178204
Ramjee, Gita; Daniels, Brodie
Thirty years since the discovery of HIV, the HIV pandemic in sub-Saharan Africa accounts for more than two thirds of the worlds HIV infections. Southern Africa remains the region most severely affected by the epidemic. Women continue to bear the brunt of the epidemic with young women infected almost ten years earlier compared to their male counterparts. Epidemiological evidence suggests unacceptably high HIV prevalence and incidence rates among women. A multitude of factors increase womens ...
Bombelli, A.; Henry, M; Castaldi, S.; S. Adu-Bredu; Arneth, A; A. De Grandcourt; E. Grieco; Kutsch, W. L.; Lehsten, V.; A. Rasile; Reichstein, M.; Tansey, K.; Weber, U.; Valentini, R.
This study presents a summary overview of the carbon balance of Sub-Saharan Africa (SSA) by synthesizing the available data from national communications to UNFCCC and first results from the project CarboAfrica (net ecosystem productivity and emissions from fires, deforestation and forest degradation, by field and model estimates). According to these preliminary estimates the overall carbon balance of SSA varies from 0.43 Pg C y?1 (using in situ measurements fo...
Recent years have seen a considerable shift in economic conditions in sub-Saharan Africa. Economic growth has been robust, international reserves are on the rise and levels of external debt are falling. Combined with the global boom in commodity prices, as well as expansion of Chinese interests in the region, international investors are increasingly viewing Africa as a serious investment option. As a result of these trends, the landscape in which foreign donors have operated is changing rapid...
Graham, R.L.; Perlack, R.D.; Prasad, A.M.G.; Ranney, J.W.; Waddle, D.B.
Current and future carbon emissions from land-use change and energy consumption were analyzed for Sub-Saharan Africa. The energy sector analysis was based on UN energy data tapes while the land-use analysis was based on a spatially-explicit land-use model developed specifically for this project. The impacts of different energy and land-use strategies on future carbon emissions were considered. (A review of anthropogenic emissions of methane, nitrous oxides, and chlorofluorocarbons in Sub-Saharan Africa indicated that they were probably minor in both a global and a regional context. The study therefore was focused on emissions of carbon dioxide.) The land-use model predicts carbon emissions from land use change and the amount of carbon stored in vegetation (carbon inventory) on a yearly basis between 1985 and 2001. Emissions and inventory are modeled at 9000 regularly-spaced point locations in Sub-Saharan Africa using location-specific information on vegetation type, soils, climate and deforestation. Vegetation, soils, and climate information were derived from continental-scale maps while relative deforestation rates(% of forest land lost each year) were developed from country-specific forest and deforestation statistics (FAO Tropical Forest Resources Assessment for Africa, 1980). The carbon emissions under different land use strategies in Sub-Saharan Africa were analyzed by modifying deforestation rates and altering the amount of carbon stored under different land uses. The considered strategies were: preservation of existing forests, implementation of agroforestry, and establishment of industrial tree plantations. 82 refs., 16 figs., 25 tabs.
Ogundipe, Adeyemi; Ogundipe, Oluwatomisin
This study examined the relationship between foreign aid and economic development in Sub Saharan Africa. The study seeks to examine the role of institutions in aid effectiveness in SSA countries by adopting a theoretical framework similar to the Endogenous/New Growth model and the System Generalized Method of Moments (GMM) technique of estimation in order to overcome the challenge of endogeneity perceived in the institution variables and Aid-Growth argument. It was observed that foreign aid d...
Bhorat, Haroon; Kanbur, Ravi; Stanwix, Benjamin
Although the sectors and fraction of workers covered are small given the low rates of formality and urbanization in Sub-Saharan Africa (SSA), as the number of covered workers grows wage regulation will become increasingly significant. We find that higher minimum wage values are associated with higher GDP per capita. Importantly, however, we find that the minimum wage relative to the mean wage is higher in low income countries than in lower- and upper-middle income countries. Indeed, SSA as a ...
Jones, Edward Samuel; Tarp, Finn
Should policy-makers, including foreign donors, focus employment strategies in sub-Saharan Africa on strengthening access to formal wage employment or on raising productivity in the informal sector? We examine the evidence in Mozambique and show that crude distinctions between formality and informality are not illuminating. The observed welfare advantage of formal sector workers essentially derives from differences in endowments and local conditions. Non-agricultural informal work can yield high...
Gouvras, Anouk N
Schistosomiasis is a chronic infection by a digean trematode of the genus Schistosoma. More than 207 million people are infected with this parasite, of which 120 million are symptomatic. There are two main species infecting humans in sub-Saharan Africa: Schistosoma haematobium and S. mansoni, both occur in areas with similar socio-economic and environmental conditions and often have matching distribution patterns. The principle aims of the research presented in this thesis were ...
Munyambonera Ezra Francis
The central theme of this study was to investigate the determinants of commercial bank profitability in Sub-Saharan Africa. The analysis used an unbalanced panel of 216 commercial banks drawn from 42 countries in SSA for the period 1999 to 2006. Using the cost efficiency model, bank profitability was estimated using panel random effects method in static framework. The explanatory variables are growth in bank assets, growth in bank deposits, capital adequacy, operational efficiency (inefficie...
Bush, Ruth; Boehmer, Elleke; Garfitt, J.S.T.
This thesis is an investigation of literary institutions and print culture in France during the two decades following the Second World War. It demonstrates how the changing metropolitan literary marketplace, driven by new methods of book production and bookselling; the rise of internationalism and tiers-mondisme; and a nascent notion of francophonie, accommodated writing of and on sub-Saharan Africa. The first half of the thesis focuses on three institutions of particular significance: the pu...
Thomas J. Betjeman; Samara E. Soghoian; Foran, Mark P.
Mobile phone penetration rates have reached 63% in sub-Saharan Africa (SSA) and are projected to pass 70% by 2013. In SSA, millions of people who never used traditional landlines now use mobile phones on a regular basis. Mobile health, or mHealth, is the utilization of short messaging service (SMS), wireless data transmission, voice calling, and smartphone applications to transmit health-related information or direct care. This systematic review analyzes and summarizes key articles from the c...
Stewart Sarah L
Full Text Available Abstract Background The cause of the high HIV prevalence in sub-Saharan Africa is incompletely understood, with heterosexual penile-vaginal transmission proposed as the main mechanism. Heterosexual HIV transmission has been estimated to have a very low probability; but effects of cofactors that vary in space and time may substantially alter this pattern. Methods To test the effect of individual variation in the HIV infectiousness generated by co-infection, we developed and analyzed a mathematical sexual network model that simulates the behavioral components of a population from Malawi, as well as the dynamics of HIV and the co-infection effect caused by other infectious diseases, including herpes simplex virus type-2, gonorrhea, syphilis and malaria. Results The analysis shows that without the amplification effect caused by co-infection, no epidemic is generated, and HIV prevalence decreases to extinction. But the model indicates that an epidemic can be generated by the amplification effect on HIV transmission caused by co-infection. Conclusion The simulated sexual network demonstrated that a single value for HIV infectivity fails to describe the dynamics of the epidemic. Regardless of the low probability of heterosexual transmission per sexual contact, the inclusion of individual variation generated by transient but repeated increases in HIV viral load associated with co-infections may provide a biological basis for the accelerated spread of HIV in sub-Saharan Africa. Moreover, our work raises the possibility that the natural history of HIV in sub-Saharan Africa cannot be fully understood if individual variation in infectiousness is neglected.
Andre Pascal Kengne
Full Text Available Andre Pascal Kengne1, Anastase Dzudie2, Eugene Sobngwi31The George Institute for International Health, University of Sydney, Australia; 2Heart failure and transplantation Unit, Louis Pradels Cardiovascular Hospital, Lyon, France; 3National Obesity Centre, Yaounde Central Hospital, CameroonPurpose: Heart failure is the ultimate complication of cardiac involvements in diabetes. The purpose of this review was to summarize current literature on heart failure among people with diabetes mellitus in sub-Saharan Africa (SSA.Method: Bibliographic search of published data on heart failure and diabetes in sub-Saharan Africa over the past 26 years.Results: Heart failure remains largely unexplored in general population and among people with diabetes in Africa. Heart failure accounts for over 30% of hospital admission in specialized cardiovascular units and 3%7% in general internal medicine. Over 11% of adults with heart failure have diabetes. Risk factors for heart failure among those with diabetes include classical cardiovascular risk factors, without evidence of diabetes distinctiveness for other predictors common in Africa. Prevention, management, and outcomes of heart failure are less well known; recent data suggest improvement in the management of risk factors in clinical settings.Conclusions: Diabetes mellitus is growing in SSA. Related cardiovascular diseases are emerging as potential health problem. Heart failure as cardiovascular complication remains largely unexplored. Efforts are needed through research to improve our knowledge of heart failure at large in Africa. Multilevel preventive measures, building on evidences from other parts of the world must go along side.Keywords: diabetes mellitus, cardiovascular diseases, heart failure, sub-Saharan Africa
Uchudi, Joseph; Magadi, Monica; Mostazir, Mohammod
A number of authors have identified multiple concurrent sexual partnerships by both men and women to lie at the root of the HIV/AIDS epidemic in sub-Saharan Africa. This study applies multilevel models to Demographic and Health Survey data collected during 2003-2008 in 20 sub-Saharan African countries to examine the influence of social and cultural context on involvement with multiple sexual partnerships in the region, above and beyond the effects of individual characteristics. The findings provide support for the ecological argument that health behaviours are shaped and determined by societal conditions, in addition to the effects of individual and household characteristics. Involvement with multiple sex partners is most prevalent in societies in which sexual norms are widely permissive and where polygyny is common. Individual autonomy is substantial and attitudes towards sexuality are more liberal among men and women who live in communities in which sexual norms are widely permissive. Men and women who are most likely to have multiple sex partners in the sub-Saharan region are those who initiated sexual activity earlier and those who have the individual attributes (e.g. young age, urban residence, education, media exposure and working for cash and away from home) that bring to them more rights and/or decision-making autonomy, but not necessarily more financial resources and economic security (mostly among women). On the other hand, involvement with multiple partners is determined by cultural norms (i.e. permissive sexual norms) and social change (i.e. mass education, expansion of cash employment). The findings suggest a number of opportunities for more effective policy and programmatic responses to curb the prevalence of multiple partnerships in sub-Saharan Africa. PMID:22067066
Investment by organizations and agencies has led to a growing body of evidence and information to assist ophthalmologists and others to meet the needs of children with cataract in Africa. The geographic distribution of research, training, and programme development across Africa has been uneven; investment has been greatest in eastern and southern Africa. Population based surveys (using key informants) suggest that 1535% of childhood blindness is due to congenital or developmental cataract. T...
Hogan, Daniel R; Salomon, Joshua A; Canning, David; Hammitt, James K.; Zaslavsky, Alan M; Bärnighausen, Till
Objectives: Population-based HIV testing surveys have become central to deriving estimates of national HIV prevalence in sub-Saharan Africa. However, limited participation in these surveys can lead to selection bias. We control for selection bias in national HIV prevalence estimates using a novel approach, which unlike conventional imputation can account for selection on unobserved factors. Methods: For 12 Demographic and Health Surveys conducted from 2001 to 2009 (N=138 300), we predict HIV ...
This thesis explores the determinants of household cooking fuel use within the context of the energy ladder hypothesis. Rooted in economic theory, the hypothesis constructs a linear model of household energy use in developing countries. I draw on existing survey data assembled by the United States Agency for International Development (USAID) to construct a dataset of 26 sub-Saharan African countries. Using this, I assess the validity of the energy ladder in this geographical context. My analysis examines the relationship between wealth and cooking fuel use, as measured by the shares of households reporting the use of traditional, transitional or modern cooking fuels at the enumeration level, an administrative definition created for census sampling. I additionally test for the effects of other characteristics, such as asset ownership and demographic characteristics. Furthermore, I explore the differences in effects between rural and urban areas. I conclude that wealth is not the sole influencer of cooking fuel choice.
Deodat Emilson Adenutsi
Full Text Available This study examines the macroeconomic impact of inward international remittances on human-centered development in 15 Sub-Saharan African countries. Following the fixed-effects balanced panel data estimation procedure for the period, 1987 to 2007, the empirical results reveal that, indeed, international remittance inflows impact positively on human development in the long run. As per the empirical findings, the study concludes that, given the irreversible high propensity to travel abroad among the productively active citizens of the sub-region in a bid to earn a decent wage, the relevant institutions and policymakers within the sub-region should devise appropriate strategies and policy framework to attract higher remittances from abroad. The empirical model and methodology used in this study are relevant and, hence, can be applied in related fields of study.
Full Text Available The present international approach to management of transboundary animal diseases (TADs is based on the assumption that most can be eradicated ; consequently, that is the usual objective adopted by international organizations concerned with animal health. However, for sub-Saharan Africa and southern Africa more particularly, eradication of most TADs is impossible for the foreseeable future for a variety of technical, financial and logistical reasons. Compounding this, the present basis for access to international markets for products derived from animals requires that the area of origin (country or zone is free from trade-influencing TADs. The ongoing development of transfrontier conservation areas (TFCAs, extending across huge areas of southern Africa, therefore presents a development conundrum because it makes creation of geographic areas free from TADs more difficult and brings development based on wildlife conservation on the one hand and that based on livestock production on the other into sharp conflict. Sub-Saharan Africa is consequently confronted by a complex problem that contributes significantly to retarded rural development which, in turn, impedes poverty alleviation. In southern Africa specifically, foot-and-mouth disease (FMD presents the greatest problem in relation to access to international markets for animal products. However, it is argued that this problem could be overcome by a combination between (1 implementation of a commodity-based approach to trade in products derived from animals and (2 amendment of the international standards for FMD specifically (i.e. the FMD chapter in the Terrestrial Animal Health Code of the World Organisation for Animal Health [OIE] so that occurrence of SAT serotype viruses in free-living African buffalo need not necessarily mean exclusion of areas where buffalo occur from international markets for animal products. This would overcome a presently intractable constraint to market access for southern African countries and enable conservation and livestock production to be more effectively integrated, to the benefit of both.
This paper addresses current and emerging HIV prevention strategies for women in Sub-Saharan Africa, in light of recent trial results and ongoing research. What are the major opportunities and challenges for widespread implementation of new and emerging HIV prevention strategies? The paper discusses the major individual, social and structural factors that underpin women's disproportionate risk for HIV infection, with attention to gender, adolescents as a vulnerable population, and the need to engage men. Also, the influence of these factors on the ultimate success of both behavioral and biomedical HIV prevention technologies for women in sub-Saharan Africa is discussed. Finally, the paper examined how the new and emerging biobehavioral prevention strategies served as tools to empower women to adopt healthy HIV preventive and reproductive health behaviors. PMID:26050373
Seims, Sara; Khadduri, Rolla
Recent studies on development aid from European donors revealed that their funding of the health sector in sub-Saharan Africa rarely includes performance measures suitable for tracking operational progress in improving sexual and reproductive health and rights. Analysis of health sector agreements verifies this. Particularly lacking are metrics related to four critically important areas: (1) reducing mortality and morbidity from unsafe abortion, (2) preventing and treating gender-based violence, (3) reducing unwanted pregnancies among the poorest women, and (4) reducing unwanted pregnancies among adolescents. During 2011 and the first half of 2012, the authors interviewed 85 experts in health service delivery, ministries of health, human rights, development economics and social science from sub-Saharan Africa, Europe and the United States. We asked them to identify measures to assess progress in these areas, and built on their responses to propose up to four practical performance measures for each of the areas, for inclusion in health sector support agreements. These measures are meant to supplement, not replace, current population-based measures such as changes in maternal mortality ratios. The feasibility of using these performance measures requires political commitment from donors and governments, investment in baseline data, and expanding the role of sexual and reproductive health and rights civil society in determining priorities. PMID:23245424
Full Text Available Here, we present 12 loci paternal haplotypes (Y-STR profiles against the backdrop of the Y-SNP marker system of Bantu males from the Maputo Province of Southeast Africa, a region believed to represent the southeastern fringe of the Bantu expansion. Our Maputo Bantu group was analyzed within the context of 27 geographically relevant reference populations in order to ascertain its genetic relationship to other Bantu and non Bantu (Pygmy, Khoisan and Nilotic sub-equatorial tribes from West and East Africa. This study entails statistical pair wise comparisons and multidimensional scaling based on YSTR Rst distances, network analyses of Bantu (B2a-M150 and Pygmy (B2b-M112 lineages as well as an assessment of Y-SNP distribution patterns. Several notable findings include the following: 1 the Maputo Province Bantu exhibits a relatively close paternal affinity with both east and west Bantu tribes due to high proportion of Bantu Y chromosomal markers, 2 only traces of Khoisan (1.3% and Pygmy (1.3% markers persist in the Maputo Province Bantu gene pool, 3 the occurrence of R1a1a-M17/M198, a member of the Eurasian R1a-M420 branch in the population of the Maputo Province, may represent back migration events and/or recent admixture events, 4 the shared presence of E1b1b1-M35 in all Tanzanian tribes examined, including Bantu and non-Bantu groups, in conjunction with its nearly complete absence in the West African populations indicate that, in addition to a shared linguistic, cultural and genetic heritage, geography (e.g., east vs. west may have impacted the paternal landscape of sub-Saharan Africa, 5 the admixture and assimilation processes of Bantu elements were both highly complex and region-specific.
Gruca, Marta; van Andel, Tinde
Palms (Arecaceae) are prominent elements in African traditional medicines. It is, however, a challenge to find detailed information on the ritual use of palms, which are an inextricable part of African medicinal and spiritual systems. This work reviews ritual uses of palms within African ethnomedicine. We studied over 200 publications on uses of African palms and found information about ritual uses in 26 of them. At least 12 palm species in sub-Saharan Africa are involved in various ritual practices: Borassus aethiopum, Cocos nucifera, Dypsis canaliculata, D. fibrosa, D. pinnatifrons, Elaeis guineensis, Hyphaene coriacea, H. petersiana, Phoenix reclinata, Raphia farinifera, R. hookeri, and R. vinifera. In some rituals, palms play a central role as sacred objects, for example the seeds accompany oracles and palm leaves are used in offerings. In other cases, palms are added as a support to other powerful ingredients, for example palm oil used as a medium to blend and make coherent the healing mixture. A better understanding of the cultural context of medicinal use of palms is needed in order to obtain a more accurate and complete insight into palm-based traditional medicines.
Isabel, Gentil García.
Full Text Available Justificación: La población inmigrante subsahariana es la más desconocida para los profesionales de la salud. Objetivo: Conocer, a través de sus voces, su cosmovisión que enmarca valores, creencias y prácticas sobre salud y enfermedad, centrándonos en el ser humano con enfoque holístico. Metodología [...] : Cualitativa, fenomenología. Resultados: Su concepción de la vida y del universo está impregnada de la religión más antigua del mundo: el animismo. Los antepasados que murieron siguen estando para protegerles. Aprecian la atención sanitaria española pero hay padecimientos que resuelve mejor la medicina tradicional africana. Aunque la atención es correcta puede despertarse susceptibilidad al no conocer los códigos culturales de la nueva sociedad. La solidaridad familiar es el valor fundamental. Conclusión: La solidaridad, valor ancestral en los humanos, debe seguir guiando a los profesionales de la salud comprometidos con la salud de la población, defendiendo el Estado de Bienestar frente a las voces que pretenden desmantelarlo. Abstract in english The population of sub-Saharan immigrants is unknown by health care professionals. Objective: know, across his voices, his cosmovision that frames values, beliefs and practices on health and disease, centring on the human being with holistic approach. Methodology qualitative, phenomenology. Results: [...] His conception of the life and of the universe is impregnated with the most ancient religion of the world: the animism. The forbears who died continue being to protect them. They estimate the sanitary Spanish attention though there are sufferings that there solves better the traditional African medicine. Though the attention is correct one can wake susceptibility up on not having known all the cultural codes of the new company. The familiar solidarity is a fundamental value. Conclusions: the ancient solidarity in the human beings must continue guiding the professionals of the health compromised with the health of the population, defending the Welfare state opposite to the voices they it tries to dismantle.
Nulu, Shanti; Aronow, Wilbert S; Frishman, William H
Sub-Saharan Africa (SSA) bears the highest burden of both communicable and noncommunicable disease and has the weakest health systems. Much attention is directed toward a rising burden of chronic disease in the setting of epidemiologic transition and urbanization. Indeed, the highest prevalence of hypertension globally is in the World Health Organization's African region at 46% of adults aged 25 and above. And while hypertension in SSA is common, its prevalence varies significantly between urban and rural settings. Although there is evidence for epidemiologic transition in urban areas, there is also evidence of static levels of hypertension within rural areas, which comprise more than 70% of the population of SSA. Furthermore, overall cardiovascular (CV) risk in rural areas remains low. The mean age of hypertensives in SSA is approximately 30s to 40s, burdening those at peak productivity. Complications of hypertension are frequent, given the poor levels of awareness and treatment (heart disease, as ischemic heart disease is uncommon. Mortality associated with these complications is high, with in-hospital mortality from 2 different sites reported as around 20%. The overall burden of hypertension is likely to be more related to poor access and availability of health systems and is representative of a looming crisis in health care delivery. The best approaches to population-wide treatment are those that utilize CV risk prediction for those with stage 1 hypertension, whereas treatment is generally indicated for all those with stage 2 or greater hypertension, especially in light of the high burden of stroke in SSA. Current guidelines recommend first-line drug therapy with a diuretic or calcium channel blocker. Despite these recommendations, the major obstacles to hypertension treatment are systemic and include the availability and cost of medications, the adequacy of health facilities and systems, and the lack of health insurance to address affordability. New and innovative systems-oriented approaches are needed to address the burden of hypertension on a platform of global equity. PMID:26284525
Ekouevi, K; Adepoju, A
This discussion concludes that the economic crises of the 1980s resulted in a halt to the social and economic development of sub-Saharan Africa. Employment, health, and education sectors all deteriorated under structural adjustment programs (SAPs) and poor economic performance. SAPs are considered inadequate solutions to long-term problems. Economic crises were found to affect countries differently in their demographic impact. Delayed demographic transition occurred both through economic development as a prerequisite and as a result of poor economic development. Case studies of each country are considered the appropriate geographic unit of analysis of demographic change rather than regional or comparative studies. The economic crises in sub-Saharan Africa occurred due to both external (commodity prices, high real interest rates, and decreasing net capital flows) and internal distortions (strategies of development such as import substitution, neglect of the agricultural sector, and government control of prices and trade). The unfavorable external context reduced export prices and earnings while increasing the costs of imports. Internal controls were detrimental to farmers. During the 1970s and 1980s African countries experienced declines in both the volume and value of exports, increases in import volume, and imbalances in the balance of payments. Large domestic borrowing and foreign borrowing was done by governments, which was at the expense of the private sector. Economic management and corruption were rampant. SAPs restrained demand, reduced public expenditures, adjusted exchange rates, contracted the size of the public sector, liberalized trade, deregulated the interest rate, stimulated domestic production, and used market forces for balancing optimum allocation of resources. SAPs were the fix for trade imbalances and government debt. Development was slowed or stopped. During 1980-87 spending on health care, education, and infrastructure was drastically reduced. These already weak sectors were further weakened. Inflation rose. Public sector employment was reduced. Wages declined, which resulted in a massive demoralization, unemployment, and poverty. Manpower development was threatened by declines in education. PMID:12319912
Full Text Available OBJECTIVE: To determine whether the Mexico City Policy, a United States government policy that prohibits funding to nongovernmental organizations performing or promoting abortion, was associated with the induced abortion rate in sub-Saharan Africa. METHODS: Women in 20 African countries who had induced abortions between 1994 and 2008 were identified in Demographic and Health Surveys. A country's exposure to the Mexico City Policy was considered high (or low if its per capita assistance from the United States for family planning and reproductive health was above (or below the median among study countries before the policy's reinstatement in 2001. Using logistic regression and a difference-in-difference design, the authors estimated the differential change in the odds of having an induced abortion among women in high exposure countries relative to low exposure countries when the policy was reinstated. FINDINGS: The study included 261 116 women aged 15 to 44 years. A comparison of 1994-2000 with 2001-2008 revealed an adjusted odds ratio for induced abortion of 2.55 for high-exposure countries versus low-exposure countries under the policy (95% confidence interval, CI: 1.76-3.71. There was a relative decline in the use of modern contraceptives in the high-exposure countries over the same time period. CONCLUSION: The induced abortion rate in sub-Saharan Africa rose in high-exposure countries relative to low-exposure countries when the Mexico City Policy was reintroduced. Reduced financial support for family planning may have led women to substitute abortion for contraception. Regardless of one's views about abortion, the findings may have important implications for public policies governing abortion.
Van Wijk, M. T.; Tittonell, P.A.; Rufino, M.C.; Herrero, M.; Pacini, C.; Ridder, N., de; Giller, K.E.
African smallholder farming systems are complex, dynamic systems with many interacting biophysical subcomponents. In these systems the major inputs and outputs are managed by human agency ¿ the farmers. To analyse potential developmental pathways of smallholder farming systems in sub-Saharan Africa (SSA), we recognised the need for a tool that can capture the effects and consequences of decision-making on the use of resources. Here we describe and apply such a new modelling tool, developed wi...
Tsafack Temah, Chrystelle
Throughout African continent, HIV/AIDS epidemic has became a major cause of death and poverty. Nonetheless, the relation between poverty and HIV/AIDS epidemic is not as straightforward as it might first appear. Indeed, if at the international level the most affected regions are the poorest, in Sub-Saharan Africa however, the most affected countries also happen to be the richest. Meanwhile, these countries are also those with the least egalitarian income distributions in the world. Moreover, t...
Azarnert, Leonid V.
This article investigates the relationship between foreign aid and population growth in sub-Saharan Africa. The work considers population growth rate and a directly related to fertility demographic indicator - total fertility rate. Using a panel of 43 African countries over the last four decades of the 20th century, it demonstrates the positive association between foreign aid and population growth and suggests that foreign aid affects population growth primarily through its effect on fertilit...
Azandjeme, Colette Sylvie; Bouchard, Michèle; Fayomi, Benjamin; Djrolo, Francois; Houinato, Dismand; Delisle, Hélène
The diabetes burden is growing in Sub-Saharan Africa (SSA). The low overall access to health care has been documented to contribute to the high diabetes-related mortality. Due to economic, demographic, epidemiological and nutrition transitions in SSA, the growing prevalence of diabetes appears to be related to obesogenic lifestyles and the intergenerational impact of malnutrition in women of childbearing age. Both overnutrition and undernutrition have been associated with the development of diabetes and other chronic diseases. Africans are also suspected of being genetically predisposed to diabetes. According to existing data in developed countries, exposure to pesticides, particularly organochlorines and metabolites, is associated with a higher risk of developing type 2 diabetes and its comorbidities. In African countries, pesticide exposure levels often appear much higher than in developed countries. Furthermore, undernutrition, which is still highly prevalent in SSA, could increase susceptibility to the adverse effects of organic pollutants. Therefore, the growing and inadequate use of pesticides may well represent an additional risk factor for diabetes in SSA. Additionally, high exposure to pesticides in African infants in utero and during the perinatal period may increase the intergenerational risk of developing diabetes in SSA. PMID:24160309
...EXPORT-IMPORT BANK Sub-Saharan Africa Advisory Committee of the Export-Import...Special Meeting SUMMARY: The Sub-Saharan Africa Advisory Committee was established by...financial commitments in Sub- Saharan Africa under the loan, guarantee, and...
Boukandou Mounanga, Marlaine; Mewono, Ludovic; Aboughe Angone, Sophie
In sub-Saharan Africa, traditional medicine is widely used in rural and urban areas also. This is essentially due to the prohibitive cost of pharmaceutical-based medicine and the low incomes of a major part of the population. In addition, the efficacies of many of these traditional and plant-based medicines are proven, but the fact remains that certain plants used in traditional medicine have toxic effects. It is in this perspective that we investigated by bibliographic literature on the toxicity of plants used in traditional medicine. It is crucial to gain knowledge on these plant-based medicines prepared and prescribed by practitioners, particularly in terms of toxicity, composition, specific efficacy of disease and to advise practitioners of this alternative medicine on the protection and security of patients. PMID:26087230
Grietens, Koen Peeters; Ribera, Joan Muela; Erhart, Annette; Hoibak, Sarah; Ravinetto, Raffaella M; Gryseels, Charlotte; Dierickx, Susan; O'Neill, Sarah; Muela, Susanna Hausmann; D'Alessandro, Umberto
Collecting blood samples from individuals recruited into clinical research projects in sub-Saharan Africa can be challenging. Strikingly, one of the reasons for participant reticence is the occurrence of local rumors surrounding "blood stealing" or "blood selling." Such fears can potentially have dire effects on the success of research projects--for example, high dropout rates that would invalidate the trial's results--and have ethical implications related to cultural sensitivity and informed consent. Though commonly considered as a manifestation of the local population's ignorance, these rumors represent a social diagnosis and a logical attempt to make sense of sickness and health. Born from historical antecedents, they reflect implicit contemporary structural inequalities and the social distance between communities and public health institutions. We aim at illustrating the underlying logic governing patients' fear and argue that the management of these beliefs should become an intrinsic component of clinical research. PMID:24821846
Mveyange, Anthony Francis; Skovsgaard, Christian
Estimating the impact of HIV/AIDS epidemic on economic growth is challenging because of endogeneity concerns. In this paper, we use novel data on male circumcision and distance from the first HIV outbreak as instrumental variables for the HIV/AIDS epidemic in 241 regions across 25 countries in sub-Saharan Africa during 200312. Our main finding shows that the impact of HIV/AIDS epidemic on economic growth is negative but statistically insignificant. Further investigation on the main channels through which HIV/AIDS may affect economic growthnamely human capital, population growth, and productivityfinds no impacts of the HIV/AIDS epidemic on these channels.
Barter Devra M
Full Text Available Abstract Background Tuberculosis (TB is known to disproportionately affect the most economically disadvantaged strata of society. Many studies have assessed the association between poverty and TB, but only a few have assessed the direct financial burden TB treatment and care can place on households. Patient costs can be particularly burdensome for TB-affected households in sub-Saharan Africa where poverty levels are high; these costs include the direct costs of medical and non-medical expenditures and the indirect costs of time utilizing healthcare or lost wages. In order to comprehensively assess the existing evidence on the costs that TB patients incur, we undertook a systematic review of the literature. Methods PubMed, EMBASE, Science Citation Index, Social Science Citation Index, EconLit, Dissertation Abstracts, CINAHL, and Sociological Abstracts databases were searched, and 5,114 articles were identified. Articles were included in the final review if they contained a quantitative measure of direct or indirect patient costs for treatment or care for pulmonary TB in sub-Saharan Africa and were published from January 1, 1994 to Dec 31, 2010. Cost data were extracted from each study and converted to 2010 international dollars (I$. Results Thirty articles met all of the inclusion criteria. Twenty-one studies reported both direct and indirect costs; eight studies reported only direct costs; and one study reported only indirect costs. Depending on type of costs, costs varied from less than I$1 to almost I$600 or from a small fraction of mean monthly income for average annual income earners to over 10 times average annual income for income earners in the income-poorest 20% of the population. Out of the eleven types of TB patient costs identified in this review, the costs for hospitalization, medication, transportation, and care in the private sector were largest. Conclusion TB patients and households in sub-Saharan Africa often incurred high costs when utilizing TB treatment and care, both within and outside of Directly Observed Therapy Short-course (DOTS programs. For many households, TB treatment and care-related costs were considered to be catastrophic because the patient costs incurred commonly amounted to 10% or more of per capita incomes in the countries where the primary studies included in this review were conducted. Our results suggest that policies to decrease direct and indirect TB patient costs are urgently needed to prevent poverty due to TB treatment and care for those affected by the disease.
...Open Special Meeting of the Sub-Saharan Africa Advisory Committee of the Export-Import...Ex-Im Bank) SUMMARY: The Sub-Saharan Africa Advisory Committee was established by...financial commitments in Sub- Saharan Africa under the loan, guarantee, and...
Full Text Available Abstract Background Canada is a major recipient of foreign-trained health professionals, notably physicians from South Africa and other sub-Saharan African countries. Nurse migration from these countries, while comparatively small, is rising. African countries, meanwhile, have a critical shortage of professionals and a disproportionate burden of disease. What policy options could Canada pursue that balanced the right to health of Africans losing their health workers with the right of these workers to seek migration to countries such as Canada? Methods We interviewed a small sample of émigré South African physicians (n = 7 and a larger purposive sample of representatives of Canadian federal, provincial, regional and health professional departments/organizations (n = 25; conducted a policy colloquium with stakeholder organizations (n = 21; and undertook new analyses of secondary data to determine recent trends in health human resource flows between sub-Saharan Africa and Canada. Results Flows from sub-Saharan Africa to Canada have increased since the early 1990s, although they may now have peaked for physicians from South Africa. Reasons given for this flow are consistent with other studies of push/pull factors. Of 8 different policy options presented to study participants, only one received unanimous strong support (increasing domestic self-sufficiency, one other received strong support (increased health system strengthening in source country, two others mixed support (voluntary codes on ethical recruitment, bilateral or multilateral agreements to manage flows and four others little support or complete rejection (increased training of auxiliary health workers in Africa ineligible for licensing in Canada, bonding, reparation payments for training-cost losses and restrictions on immigration of health professionals from critically underserved countries. Conclusion Reducing pull factors by improving domestic supply and reducing push factors by strengthening source country health systems have the greatest policy traction in Canada. The latter, however, is not perceived as presently high on Canadian stakeholder organizations' policy agendas, although support for it could grow if it is promoted. Canada is not seen as "actively' recruiting" ("poaching" health workers from developing countries. Recent changes in immigration policy, ongoing advertising in southern African journals and promotion of migration by private agencies, however, blurs the distinction between active and passive recruitment.
Osafo, Charlotte; Raji, Yemi Raheem; Burke, David; Tayo, Bamidele O; Tiffin, Nicki; Moxey-Mims, Marva M; Rasooly, Rebekah S; Kimmel, Paul L; Ojo, Akinlolu; Adu, Dwomoa; Parekh, Rulan S
CKD affects an estimated 14% of adults in sub-Saharan Africa, but very little research has been done on the cause, progression, and prevention of CKD there. As part of the Human Heredity and Health in Africa (H3Africa) Consortium, the H3Africa Kidney Disease Research Network was established to study prevalent forms of kidney disease in sub-Saharan Africa and increase the capacity for genetics and genomics research. The study is performing comprehensive phenotypic characterization and analyzing environmental and genetic factors from nine clinical centers in four African countries (Ghana, Nigeria, Ethiopia, and Kenya) over a 5-year period. Approximately 4000 participants with specified kidney disease diagnoses and 4000 control participants will be enrolled in the four African countries. In addition, approximately 50 families with hereditary glomerular disease will be enrolled. The study includes both pediatric and adult participants age research infrastructure can be successfully established in Africa. This study will provide clinical, biochemical, and genotypic data that will greatly increase the understanding of CKD in sub-Saharan Africa. PMID:26138261
Amissah-Arthur, Abigail; Balstad Miller, Roberta
Given current population trends and projections in sub-Saharan Africa, it is anticipated that substantial intensification of agricultural cropland is certain within the next decades. In the absence of adoption of improved technologies poor rural populations in this region will continue to degrade and mine the natural resources to ensure their survival. All these actions will have far-reaching implications for environmental quality and human health. However, only through the integration of environment and development concerns with greater attention to these link can we achieve the goal of fulfilling the basic needs, improved living standards for all, better protected and managed eco-systems and a safer, more prosperous future. The paper reviews case studies and provides examples of the integration, analysis, and visualization of information from remotely sensed, biophysical and socioeconomic information to assess the present situation hindering agricultural development in sub-Saharan Africa. These studies show the interactions between socio-economic and environmental factors that can help governments and policy-makers assess the scope of the problems, examine alternatives and decide on a course of action. Sound decisions depend on accurate information, yet most African countries face severe competing demands for the financial and human commitments necessary to staff an information system equal to its policy-making requirements. The role of international data centers is reviewed in terms of their abilities to develop and maintain information systems that bring together available accumulated knowledge and data. This permits comparative studies, which make it possible to develop a better understanding of the relationships among demographic dynamics, technology, cultural behavioral norms, and land resources and hence better decision making for sustainable development.
Bosley Thomas M
Full Text Available Abstract Background Genetic studies of the Arabian Peninsula are scarce even though the region was the center of ancient trade routes and empires and may have been the southern corridor for the earliest human migration from Africa to Asia. A total of 120 mtDNA Saudi Arab lineages were analyzed for HVSI/II sequences and for haplogroup confirmatory coding diagnostic positions. A phylogeny of the most abundant haplogroup (preHV1 (R0a was constructed based on 13 whole mtDNA genomes. Results The Saudi Arabian group showed greatest similarity to other Arabian Peninsula populations (Bedouin from the Negev desert and Yemeni and to Levantine populations. Nearly all the main western Asia haplogroups were detected in the Saudi sample, including the rare U9 clade. Saudi Arabs had only a minority sub-Saharan Africa component (7%, similar to the specific North-African contribution (5%. In addition, a small Indian influence (3% was also detected. Conclusion The majority of the Saudi-Arab mitochondrial DNA lineages (85% have a western Asia provenance. Although the still large confidence intervals, the coalescence and phylogeography of (preHV1 haplogroup (accounting for 18 % of Saudi Arabian lineages matches a Neolithic expansion in Saudi Arabia.
José Luiz, Telles; Ana Paula Abreu, Borges.
Full Text Available A região Subsaariana do continente africano é onde se concentra a maior carga de doença do mundo e é a única região do planeta onde se espera que o número de pessoas pobres irá aumentar nas próximas décadas. Os países desta região, em diferentes graus, experimentam processo lento de envelhecimento p [...] opulacional, mas, ao mesmo tempo, é onde a população idosa mais cresce em números absolutos. A partir de revisão da bibliografia, buscou-se destacar a situação demográfica e social em que vivem as pessoas idosas na região subsaariana e os principais desafios que se impõem aos governos locais para a superação dos complexos problemas postos a toda a sociedade. Constatou-se que as políticas públicas voltadas para este segmento populacional na região não representam prioridade e, por conseguinte, dificilmente entram na agenda atual da cooperação internacional. Abstract in english The Sub-Saharan part of the African continent is the area that has the highest disease burden in the world and is the only region of the planet where it is expected that the number of poor people will increase in the coming decades. The countries of this region, to different degrees, experience slow [...] process of population aging but at the same time, it is the are where the elderly population grows fastest in absolute numbers. Based on a review of the literature, an attempt was made to highlight the social and demographic situation in which the elderly live in the Sub-Saharan region and the main challenges faced by local governments to overcome the complex problems affecting society as a whole. It was found that public policies geared to this segment of the population in the region do not represent a priority and, consequently, are unlikely to be included in the current agenda of international cooperation.
Gulinck Hubert; Peterson Andrew T; Neerinckx Simon B; Deckers Jozef; Leirs Herwig
Abstract Background Plague is a rapidly progressing, serious illness in humans that is likely to be fatal if not treated. It remains a public health threat, especially in sub-Saharan Africa. In spite of plague's highly focal nature, a thorough ecological understanding of the general distribution pattern of plague across sub-Saharan Africa has not been established to date. In this study, we used human plague data from sub-Saharan Africa for 19702007 in an ecological niche modeling framework t...
Full Text Available OBJECTIVE: To determine participation in polio supplementary immunization activities (SIAs in sub-Saharan Africa among users and non-users of routine immunization services and among users who were compliant or non-compliant with the routine oral poliovirus vaccine (OPV immunization schedule. METHODS: Data were obtained from household-based surveys in non-polio-endemic sub-Saharan African countries. Routine immunization service users were children (aged 85% in 12 SIAs but non-user participation was > 85% in only 5 SIAs. In 18 SIAs, participation was greater among users (P < 0.01 in 16, 0.05 in 1 and < 0.10 in 1 than non-users. In 14 SIAs, adjusted analyses revealed lower participation among non-compliant users than among compliant users (P < 0.01 in 10, < 0.05 in 2 and < 0.10 in 2. CONCLUSION: Large percentages of children participated in SIAs. Prior use of routine immunization services and compliance with the routine OPV schedule showed a strong positive association with SIA participation.
Beaudoin, Christopher E
In light of the great threat that HIV/AIDS poses in sub-Saharan Africa, the current study assesses HIV/AIDS posters from this region with specific reference to health message frames, including HIV sources, consequences, self-efficacy, preventive means, and barriers and benefits to employing such means of prevention. There is a two-step methodology. First, the content of HIV/AIDS posters from 15 sub-Saharan African countries was coded for the six health message frames. Second, relationships between the health message frames and four social determinants (HIV rate, HIV awareness, condom use and uncertainty avoidance (UAI)) were assessed with hierarchical linear modeling (HLM). Analysis indicates that self-efficacy is the most common frame, but that almost one-quarter of the posters has none of the six health message frames. HLM indicates some favorable findings, including that health message frames are used most often in countries with the most troubling levels of HIV awareness and condom use. Less favorably, health message frames are used least common in countries that have high levels of UAI and high HIV rates. Improvements for related media practices and policy are articulated. PMID:17596544
Herslund, Lise Byskov; Jalyer, Fatameh
In this paper, we develop and apply a multi-dimensional vulnerability assessment framework for understanding the impacts of climate change-induced hazards in Sub- Saharan African cities. The research was carried out within the European/African FP7 project CLimate change and Urban Vulnerability in Africa, which investigated climate change-induced risks, assessed vulnerability and proposed policy initiatives in five African cities. Dar es Salaam (Tanzania) was used as a main case with a particular focus on urban flooding. The multi-dimensional assessment covered the physical, institutional, attitudinal and asset factors influencing urban vulnerability. Multiple methods were applied to cover the full range of vulnerabilities and to identify potential response strategies, including: model-based forecasts, spatial analyses, document studies, interviews and stakeholder workshops. We demonstrate the potential of the approach to assessing several dimensions of vulnerability and illustrate the complexity of urban vulnerability at different scales: households (e.g., lacking assets); communities (e.g., situated in low-lying areas, lacking urban services and green areas); and entire cities (e.g., facing encroachment on green and flood-prone land). Scenario modeling suggests that vulnerability will continue to increase strongly due to the expected loss of agricultural land at the urban fringes and loss of green space within the city. However, weak institutional commitment and capacity limit the potential for strategic coordination and action. To better adapt to urban flooding andthereby reduce vulnerability and build resilience, we suggest working across dimensions and scales, integrating climate change issues in city-level plans and strategies and enabling local actions to initiate a learning-by-doing process of adaptation.
Downing Raymond V
Full Text Available Abstract Background The principles and practice of Family Medicine that arose in developed Western countries have been imported and adopted in African countries without adequate consideration of their relevance and appropriateness to the African context. In this study we attempted to elicit a priori principles of generalist medical practice from the experience of long-serving medical officers in a variety of African counties, through which we explored emergent principles of Family Medicine in our own context. Methods A descriptive study design was utilized, using qualitative methods. 16 respondents who were clinically active medical practitioners, working as generalists in the public services or non-profit sector for at least 5 years, and who had had no previous formal training or involvement in academic Family Medicine, were purposively selected in 8 different countries in southern, western and east Africa, and interviewed. Results The respondents highlighted a number of key issues with respect to the external environment within which they work, their collective roles, activities and behaviours, as well as the personal values and beliefs that motivate their behaviour. The context is characterized by resource constraints, high workload, traditional health beliefs, and the difficulty of referring patients to the next level of care. Generalist clinicians in sub-Saharan Africa need to be competent across a wide range of clinical disciplines and procedural skills at the level of the district hospital and clinic, in both chronic and emergency care. They need to understand the patient's perspective and context, empowering the patient and building an effective doctor-patient relationship. They are also managers, focused on coordinating and improving the quality of clinical care through teamwork, training and mentoring other health workers in the generalist setting, while being life-long learners themselves. However, their role in the community, was found to be more aspirational than real. Conclusions The study derived a set of principles for the practice of generalist doctors in sub-Saharan Africa based on the reported activities and approaches of the respondents. Patient-centred care using a biopsychosocial approach remains as a common core principle despite wide variations in context. Procedural and hospital care demands a higher level of skills particularly in rural areas, and a community orientation is desirable, but not widely practiced. The results have implications for the postgraduate training of family physicians in sub-Saharan Africa, and highlight questions regarding the realization of community-orientated primary care.
Desgrées-du-Loû, Annabel; Orne-Gliemann, Joanna
In Africa, a large proportion of HIV infections occur within stable relationships, either because of prior infection of one of the partners or because of infidelity. In five African countries at least two-thirds of couples with at least one HIV-positive partner were HIV serodiscordant; in half of them, the woman was the HIV-positive partner. Hence, there is an urgent need to define strategies to prevent HIV transmission within couple relationships. HIV counselling and testing have largely been organised on an individual and sex-specific basis, for pregnant women in programmes for prevention of mother-to-child transmission of HIV and in STI consultations and recently male circumcision for men. A couple-centred approach to HIV counselling and testing would facilitate communication about HIV status and adoption of preventive behaviours within couples. This paper reviews what is known about HIV serodiscordance in heterosexual couples in sub-Saharan Africa and what has been published about couple-centred initiatives for HIV counselling and testing since the early 1990s. Despite positive outcomes, couple-oriented programmes have not been implemented on a large scale. In order to stimulate and strengthen HIV prevention efforts, increased attention is required to promote prevention and testing and counselling for couples in stable relationships. PMID:19027631
Felix Kayode OLAKULEHIN
Full Text Available Educational provision in developing sub-Saharan Africa states has been severely hindered by the hydra-headed problems of access, cost and quality. Amidst these challenges is the pledge of regional and national education policymakers and development planners to ensure that there is maximum access equitable and qualitative education for all (EFA in Africa. There is also a burning need for improved literacy levels and functional education, in order to overcome the development deficits that are currently facing the region. The pledge of education for all resonates the agreement which representatives of several nations of the world signed at the Jomtien summit on Education for All and the subsequent evaluation meetings. Following this pledge, several developing, sub-Sahara African nations have evolved initiatives for instituting sustainable Open Flexible Learning (ODL systems in order to meet up with the seemingly intractable EFA objectives. This paper examined the potential impact of these OFL initiatives on the achievement of the EFA objectives which is seen as the basis of development planning, administration and implementation in Africa. It identified the various challenges confronting effective implementation of ODL on the continent, amidst the need to expand access to educational opportunities. An attempt was made to situate the OFL system at the centre of the strategies for achieving these EFA objectives in the region and finally, a proposal for sustainable policy initiatives for implementing OFL systems for the attainment of education for all in Africa is made.
Full Text Available This report presents the proceedings of the field research conducted in the framework of a doctoralresearch on the European Union (EU as an emerging coordinator in development cooperation.This research aims to seek in-depth and interpreted understanding of the paradox betweenthe EUs ambitions on the one hand and practice on the ground on the other by investigating theEUs role in four sub-Saharan African countries (Tanzania, Zambia, Burkina Faso and Senegal.As such, it aims to add empirical evidence to the debate on the role of the EU as a developmentactor. More specifically, it investigates how the ambitions of the EU are translated at country leveland in which situations the EU is more/less likely to act as a coordinator, making use of a pragmatistresearch approach. This approach is especially suited to problem-driven research that aims tounderstand a complex phenomenon. The article introduces the research question and the rationale,gives an overview of the research approach and the methodological considerations and endswith a summary of the research process and the preliminary findings of the field research.
Sub-Saharan African (SSA) countries rely heavily on donor assistance and international borrowing. The Official Development Assistance (ODA)/GNP ratio in SSA is expected to rise well into the next century. Increases or decreases of ODA, which is known to be the main source of SSA's investment, may depend on the type of global settlement expected to emerge in the post-cold war world. SSA has therefore a stake on the type of globalisation which may frame world economic policy and financial aid to it. Neo-liberal globalisation has no enthusiasm for massive financial transfers. The incipient globalising ideas which emerged from the Rio Summit in 1992 have suggested to increase ODAs in real terms and debt relief to control crushing debt service payments. Agenda 21 has created new and additional facilities formally for increasing donor assistance in the form of financial and investment transfers. The question is whether this new mechanism will make any difference to stem the SSA decline and can "incentivise" the region's renewal or renaissance. This article will focus on how globalisation may be related to increase or decrease of financial transfer to SSA. (C) 2000 Elsevier Science Ltd. All rights reserved.
Full Text Available There is a critical need for governments in the region to realize the magnitude of the challenge in order to proactively respond to it. This means that for the region to meet its sanitation goals, these governments must prioritize sanitation in their national budgets. While the scale of sanitation challenges differs from one country to another, common bottlenecks arise from the pace of demographic growth, rapid urbanization and growth of informal settlements. All these factors are further aggravated by poverty, a critical developmental challenge that has continued to undermine the efforts of most governments. The irony however, is the fact that sanitation can considerably alleviate poverty, but due to other competing priorities such as education, health, environment, gender equality and economic growth, sanitation is least prioritized at all levels of governance. This phenomenon explains why majority of African people cannot access basic sanitation. This paper examines the challenges of financing sanitation in sub-Saharan countries, focusing on (i what is to be financed (ii how much will it cost (iii policy shifts to remedy the situation. The paper concludes by suggesting pertinent recommendations.
Yabiku, Scott T.
We use uniquely detailed data from a predominantly Christian high-fertility area in Mozambique to examine denominational differentials in fertility from two complementary perspectivesdynamic and cumulative. First, we use event-history analysis to predict yearly risks of birth from denominational affiliation. Then, we employ Poisson regression to model the association between the number of children ever born and share of reproductive life spent in particular denominations or outside organized religion. Both approaches detect a significant increase in fertility associated with membership in a particular type of African-initiated churches which is characterized by strong organizational identity, rigid hierarchy, and insular corporate culture. Membership in the Catholic Church is also associated with elevated completed fertility. We relate these results to extant theoretical perspectives on the relationship between religion and fertility by stressing the interplay between ideological, social, and organizational characteristics of different types of churches and situate our findings within the context of fertility transition and religious demographics in Mozambique and elsewhere in sub-Saharan Africa.
Ala, Fereydoun; Allain, Jean-Pierre; Bates, Imelda; Boukef, Kamel; Boulton, Frank; Brandful, James; Dax, Elizabeth M; El Ekiaby, Magdy; Farrugia, Albert; Gorlin, Jed; Hassall, Oliver; Lee, Helen; Loua, André; Maitland, Kathryn; Mbanya, Dora; Mukhtar, Zainab; Murphy, William; Opare-Sem, Ohene; Owusu-Ofori, Shirley; Reesink, Henk; Roberts, David; Torres, Oscar; Totoe, Grace; Ullum, Henrik; Wendel, Silvano
Jean-Pierre Allain and colleagues argue that, while unintended, the foreign aid provided for blood transfusion services in sub-Saharan Africa has resulted in serious negative outcomes, which requires reflection and rethinking.
Kuzvinetsa Peter, Dzvimbo; Kholeka Constance, Moloi.
Full Text Available In a shrinking world, in which a neo-liberal discourse has permeated sub-Saharan African higher education, critical reflection is required to assess the merits and demerits of globalisation. Research, intensive discussion and hearings conducted over a two-year period by the Task Force on Higher Educ [...] ation and Society, convened by the World Bank and United Nations Educational, Scientific, and Cultural Organization (UNESCO) for the purpose of exploring the future of higher education in the developing world, led to the conclusion that without more and better higher education, developing countries would find it increasingly difficult to benefit from the global knowledge economy. A decade later, we argue for a radical change in the traditional discourse on globalisation because of the emergence of countries such as China, South Africa, India, and Brazil as global players in the world economy. These emerging global powers, reframe the political and imperial philosophy at the epicentre of globalisation discourse - an economic creed, through their mutual consultation and coordination on significant political issues. Their economic and military capabilities enable them to influence the trade regime and thereby strengthen the voice of the developing world as a whole. In relation to this paper's inquiry, the cooperation of these emerging powers gives the free enfranchised people of the world an opportunity to choose a different path of international relations (internationalisation) formed on more liberal lines, as opposed to the neo-liberal economic rationality of globalisation. This paper therefore examines globalisation and internationalisation of higher education in sub-Saharan Africa, a field in which increased knowledge production and distribution open up opportunities for users, institutions and societies. Against a background of chronic economic uncertainty we examine the influence of major international institutions on the direction of higher education, in particular teacher education. Drawing on relevant literature and our own experience, reflexively, we argue that the tendency, towards free market regulation ideologies, privileges neo-liberal global knowledge discourses, such that they impose on higher education a need to respond across a range of fields.
Kuzvinetsa Peter Dzvimbo
Full Text Available In a shrinking world, in which a neo-liberal discourse has permeated sub-Saharan African higher education, critical reflection is required to assess the merits and demerits of globalisation. Research, intensive discussion and hearings conducted over a two-year period by the Task Force on Higher Education and Society, convened by the World Bank and United Nations Educational, Scientific, and Cultural Organization (UNESCO for the purpose of exploring the future of higher education in the developing world, led to the conclusion that without more and better higher education, developing countries would find it increasingly difficult to benefit from the global knowledge economy. A decade later, we argue for a radical change in the traditional discourse on globalisation because of the emergence of countries such as China, South Africa, India, and Brazil as global players in the world economy. These emerging global powers, reframe the political and imperial philosophy at the epicentre of globalisation discourse - an economic creed, through their mutual consultation and coordination on significant political issues. Their economic and military capabilities enable them to influence the trade regime and thereby strengthen the voice of the developing world as a whole. In relation to this paper's inquiry, the cooperation of these emerging powers gives the free enfranchised people of the world an opportunity to choose a different path of international relations (internationalisation formed on more liberal lines, as opposed to the neo-liberal economic rationality of globalisation. This paper therefore examines globalisation and internationalisation of higher education in sub-Saharan Africa, a field in which increased knowledge production and distribution open up opportunities for users, institutions and societies. Against a background of chronic economic uncertainty we examine the influence of major international institutions on the direction of higher education, in particular teacher education. Drawing on relevant literature and our own experience, reflexively, we argue that the tendency, towards free market regulation ideologies, privileges neo-liberal global knowledge discourses, such that they impose on higher education a need to respond across a range of fields.
Whether development is defined by the long-standing economic parameter of per capita gross national product (GNP) or by the newly introduced Human Development Index (HDI), which is not based exclusively on per capita GNP, the countries of sub-Saharan Africa rank at or near the bottom of the developing world. Agriculture and agro-based processing are the mainstays of the economies of the majority of these countries. Because of this, and also because many of the diseases endemic in these countries are communicable, the application of modern biotechnology (including genetic engineering, tissue culture and monoclonal antibody technology) and related biotechnologies could play an important part in creating sustainable development in the region. There is, therefore, an urgent need to train more of the region's indigenous citizens, and to equip more laboratories, in modern biotechnology. It is suggested that, in order to accelerate the harnessing of the fruits of biotechnology, more countries in the region should affiliate with the International Centre for Genetic Engineering and Biotechnology (ICGEB). It is further suggested that a regional equivalent of the ICGEB be built and the services of non-governmental biotechnology organizations used. PMID:24421003
Bove, Riley; Valeggia, Claudia
In this paper we review the literature on the association between polygyny and women's health in sub-Saharan Africa. We argue that polygyny is an example of "co-operative conflict" within households, with likely implications for the vulnerability of polygynous women to illness, and for their access to treatment. We begin with a review of polygyny and then examine vulnerability to sexually transmitted infections (STIs, including HIV) and differential reproductive outcomes. Polygyny is associated with an accelerated transmission of STIs, both because it permits a multiplication of sexual partners and because it correlates with low rates of condom use, poor communication between spouses, and age and power imbalances among other factors. Female fertility is affected by the interplay between marital rank, household status, and cultural norms in polygynous marriages. Finally, we present areas which have received only cursory attention: mental health and a premature, "social" menopause. Although data are scarce, polygyny seems to be associated with higher levels of anxiety and depression, particularly around stressful life events. It is our hope that the examples reviewed here will help build a framework for mixed method quality research, which in turn can inform decision makers on more appropriate, context-dependent health policies. PMID:18952335
van der Sande Marianne A.B.; Inskip Hazel M; Jaiteh Kebba O.; Maine Nicholas P.; Walraven Gijs E.L.; Hall Andrew J; McAdam Keith P.W.J.
OBJECTIVE: To determine trends in the causes of death in a West African town. Mortality caused by infectious diseases is reported to be declining while degenerative and man-made mortality factors are increasingly significant. Most mortality analyses for sub-Saharan Africa have involved extrapolation and have not been derived from community-based data. METHODS: Historical data on causes of death coded by physicians were analysed for the urban population of Banjul for the period 1942-97. As the...
Njuguna, J.; Qader, SS
Malaria is the leading cause of morbidity and mortality in Sub-Saharan Africa. One key strategic intervention is provision of early diagnosis and prompt effective treatment. A major setback has been the development of drug resistance to commonly used antimalarials. To overcome this, most countries in Sub-Saharan Africa have adopted Artemisinin Combination Therapy (ACT) as a first line treatment for uncomplicated malaria. Artemether Lumefantrine (AL) and Artesunate Amodiaquine (ASAQ) are the m...
Akachi, Yoko; CANNING, David
In most developing countries, rising levels of nutrition and improvements in public health have led to declines in infant mortality and rising adult height. In Sub-Saharan Africa, however, we see a different pattern. Sub-Saharan Africa has seen large reductions in infant mortality over the last fifty years, but without any increase in protein or energy intake, and against a background of stagnant, or even declining, adult height. Adult height is a sensitive indicator of the nutrition and morb...
INOUE, TAKESHI; Hamori, Shigeyuki
This article empirically analyzes the role of finance in economic growth in Sub-Saharan Africa from the perspective of what is termed herein financial permeation. By estimating panel data on 37 countries in Sub-Saharan Africa between 2004 and 2010, we examine whether financial permeation through improved convenience and access to financial services has contributed to economic growth in this region. Empirical results clearly indicate that financial permeation has a statistically significant ...
Alagidede, Paul; Adu, George; Frimpong, Prince Boakye
This paper is a contribution to the empirics of climate change and its effect on sustainable economic growth in Sub-Saharan Africa. Using data on two climate variables, temperature and precipitation, and employing panel cointegration techniques, we estimate the short- and long-run effects of climate change on growth. We establish that an increase in temperature significantly reduces economic performance in Sub-Saharan Africa. Furthermore, we show that the relationship between real gross domes...
This article provides a comparative summary of the findings of the survey of Business Ethics as field of Teaching, Training and Reserach across the four sub-regions in Sub-Saharan Africa ( Western Africa, Southern Africa, Eastern Africa and Francophone Africa). The article commences with a discussion on the terminology that is used to refer to Business and Economic Ethics in Sub-Saharan Africa. It Then provides an overview of the prevalence and distribution of Business Ethics as field of Teac...
Natural resources in sub-Saharan Africa suffer from a bad reputation. Oil and diamonds, particularly, have been blamed for a number of Africas illnesses such as poverty, corruption, dictatorship and war. This paper outlines the different areas and transmission channels of how this so-called resource curse is said to materialize. By assessing empirical evidence on sub-Saharan Africa it concludes that the resource curse theory fails to sufficiently explain why and how several countries have ...
... and TB African Americans / Blacks Viral Hepatitis STD Rates by Race or Ethnicity Community Approaches to Reducing STDs Tuberculosis (TB), African-American Community Division of HIV/AIDS Prevention (DHAP) HIV Among Youth in the US Vital Signs National Black HIV/AIDS Awareness Day ...
Cilia, Roberto; Akpalu, Albert; Sarfo, Fred Stephen; Cham, Momodou; Amboni, Marianna; Cereda, Emanuele; Fabbri, Margherita; Adjei, Patrick; Akassi, John; Bonetti, Alba; Pezzoli, Gianni
During the past decade, a number of large drug trials suggested that the initiation of levodopa therapy should be delayed to reduce the risk of motor complications in patients with Parkinson's disease. However, the relative contribution of the cumulative exposure to levodopa and of disease progression to the pathophysiology of motor fluctuations and dyskinesias is still poorly understood. In this 4-year multicentre study, we investigated a large cohort of patients with Parkinson's disease in a sub-Saharan African country (Ghana), where access to medication is limited and the initiation of levodopa therapy often occurs many years after onset. The primary objective was to investigate whether the occurrence of motor complications is primarily related to the duration of levodopa therapy or to disease-related factors. Study design included a cross-sectional case-control analysis of data collected between December 2008 and November 2012, and a prospective study of patients followed-up for at least 6 months after the initiation of levodopa therapy. Ninety-one patients fulfilled criteria for clinical diagnosis of idiopathic Parkinson's disease (58 males, mean age at onset 60.6 ± 11.3 years). Demographic data were compared to those of 2282 consecutive Italian patients recruited during the same period, whereas nested matched subgroups were used to compare clinical variables. Demographic features, frequency and severity of motor and non-motor symptoms were comparable between the two populations, with the only exception of more frequent tremor-dominant presentation in Ghana. At baseline, the proportion of Ghanaian patients with motor fluctuations and dyskinesias was 56% and 14%, respectively. Although levodopa therapy was introduced later in Ghana (mean disease duration 4.2 ± 2.8 versus 2.4 ± 2.1 years, P < 0.001), disease duration at the occurrence of motor fluctuations and dyskinesias was similar in the two populations. In multivariate analysis, disease duration and levodopa daily dose (mg/kg of body weight) were associated with motor complications, while the disease duration at the initiation of levodopa was not. Prospective follow-up for a mean of 2.6 ± 1.3 years of a subgroup of 21 patients who were drug-naïve at baseline [median disease duration 4.5 (interquartile range, 2.3-5) years] revealed that the median time to development of motor fluctuations and dyskinesias after initiation of levodopa therapy was 6 months. We conclude that motor fluctuations and dyskinesias are not associated with the duration of levodopa therapy, but rather with longer disease duration and higher levodopa daily dose. Hence, the practice to withhold levodopa therapy with the objective of delaying the occurrence of motor complications is not justified. PMID:25034897
Chisholm, Daniel; Naci, Huseyin; Hyder, Adnan Ali; Tran, Nhan T; Peden, Margie
Objective To identify and estimate the population costs and effects of a selected set of enforcement strategies for reducing the burden of road traffic injuries in developing countries. Design Cost effectiveness analysis based on an epidemiological model. Setting Two epidemiologically defined World Health Organization sub-regions of the world: countries in sub-Saharan Africa with very high adult and high child mortality (AfrE); and countries in South East Asia with high adult and high c...
Lapworth, D. J.; Macdonald, A. M.; Bonsor, H. C.; Tijani, M.N; Calow, R.C.
In stark contrast to food scarcity, very little systematic data collection has been done to investigate the role water scarcity has on livelihoods within rural communities in sub-Saharan Africa, particularly during droughts or periods of water stress (Calow et al. 2009). The sustainable development and management of water resources in Africa, particularly perennial groundwater resources, remains a major priority, especially within the context of climate variability, population growth and pres...
Chivenge, Pauline; Mabhaudhi, Tafadzwanashe; Modi, Albert T.; Mafongoya, Paramu
Modern agricultural systems that promote cultivation of a very limited number of crop species have relegated indigenous crops to the status of neglected and underutilised crop species (NUCS). The complex interactions of water scarcity associated with climate change and variability in sub-Saharan Africa (SSA), and population pressure require innovative strategies to address food insecurity and undernourishment. Current research efforts have identified NUCS as having potential to reduce food an...
Flinkenflögel, Maaike; Kallestrup, Per
International studies have demonstrated that well-functioning primary health care organized around family and community health teams is adamant in establishing a cost-effective health system that provides equitable and accessible health services to the entire population. The World Health Report 2008 (PHC Now more than ever) urged health systems worldwide to make a shift to more comprehensive health care. Family and community medicine training is developing in Sub-Saharan Africa but in many count...
Ngugi, AK; Bottomley, C; Kleinschmidt, I.; Wagner, RG; Kakooza-Mwesige, A; Ae-Ngibise, K; Owusu-Agyei, S; Masanja, H; Kamuyu, G; Odhiambo, R.; Chengo, E; Sander, JW; Newton, CR
Background: The prevalence of epilepsy in sub-Saharan Africa seems to be higher than in other parts of the world, but estimates vary substantially for unknown reasons. We assessed the prevalence and risk factors of active convulsive epilepsy across five centres in this region. Methods: We did large population-based cross-sectional and case-control studies in five Health and Demographic Surveillance System centres: Kilifi, Kenya (Dec 3, 2007-July 31, 2008); Agincourt, South Africa (Aug 4, 2008...
Heller, R; Okello, J B A; Siegismund, H
The Cape buffalo (Syncerus caffer caffer) is one of the dominant and most widespread herbivores in sub-Saharan Africa. High levels of genetic diversity and exceptionally low levels of population differentiation have been found in the Cape buffalo compared to other African savannah ungulates. Patterns of genetic variation reveal large effective population sizes and indicate that Cape buffalos have historically been interbreeding across considerable distances. Throughout much of its range, the Cap...
Hauffe, T.; Schultheiß, R.; Van Bocxlaer, B.; Prömmel, K.; Albrecht, C.
Species diversity and how it is structured on a continental scale is influenced by stochastic, ecological, and evolutionary driving forces, but hypotheses on determining factors have been mainly examined for terrestrial and marine organisms. The extant diversity of African freshwater mollusks is in general well assessed to facilitate conservation strategies and because of the medical importance of several taxa as intermediate hosts for tropical parasites. This historical accumulation of knowledge has, however, not resulted in substantial macroecological studies on the spatial distribution of freshwater mollusks. Here, we use continental distribution data and a recently developed method of random and cohesive allocation of species distribution ranges to test the relative importance of various factors in shaping species richness of Bivalvia and Gastropoda. We show that the mid-domain effect, that is, a hump-shaped richness gradient in a geographically bounded system despite the absence of environmental gradients, plays a minor role in determining species richness of freshwater mollusks in sub-Saharan Africa. The western branch of the East African Rift System was included as dispersal barrier in richness models, but these simulation results did not fit observed diversity patterns significantly better than models where this effect was not included, which suggests that the rift has played a more complex role in generating diversity patterns. Present-day precipitation and temperature explain richness patterns better than Eemian climatic condition. Therefore, the availability of water and energy for primary productivity during the past does not influence current species richness patterns much, and observed diversity patterns appear to be in equilibrium with contemporary climate. The availability of surface waters was the best predictor of bivalve and gastropod richness. Our data indicate that habitat diversity causes the observed species-area relationship, and hence, that environmental heterogeneity is a principal driver of freshwater mollusk richness on a continental scale.
Temu, Florence; Leonhardt, Marcus; Carter, Jane; Thiam, Sylla
Sub-Saharan African countries now face the double burden of Non Communicable and Communicable Diseases. This situation represents a major threat to fragile health systems and emphasises the need for innovative integrative approaches to health care delivery. Health services need to be reorganised to address populations needs holistically and effectively leverage resources in already resource-limited settings. Access and delivery of quality health care should be reinforced and implemented at p...
Lopez Enrique; Goodkin Karl; Joska John A; Singh Dinesh; Myer Landon; Paul Robert H; John Sally; Sunpath Henry
Abstract Background There is an urgent need to more accurately diagnose HIV-associated neurocognitive disorder (HAND) in Africa. Rapid screening tests for HIV-associated dementia are of limited utility due to variable sensitivity and specificity. The use of selected neuropsychological tests is more appropriate, but norms for HIV seronegative people are not readily available for sub-Saharan African populations. We sought to derive normative scores for two commonly used neuropsychological tests...
Matthew F Chersich
Full Text Available Introduction: Virtually no African country provides HIV prevention services in sex work settings with an adequate scale and intensity. Uncertainty remains about the optimal set of interventions and mode of delivery. Methods: We systematically reviewed studies reporting interventions for reducing HIV transmission among female sex workers in sub-Saharan Africa between January 2000 and July 2011. Medline (PubMed and non-indexed journals were searched for studies with quantitative study outcomes. Results: We located 26 studies, including seven randomized trials. Evidence supports implementation of the following interventions to reduce unprotected sex among female sex workers: peer-mediated condom promotion, risk-reduction counselling and skills-building for safer sex. One study found that interventions to counter hazardous alcohol-use lowered unprotected sex. Data also show effectiveness of screening for sexually transmitted infections (STIs and syndromic STI treatment, but experience with periodic presumptive treatment is limited. HIV testing and counselling is essential for facilitating sex workers access to care and antiretroviral treatment (ART, but testing models for sex workers and indeed for ART access are little studied, as are structural interventions, which create conditions conducive for risk reduction. With the exception of Senegal, persistent criminalization of sex work across Africa reduces sex workers control over working conditions and impedes their access to health services. It also obstructs health-service provision and legal protection. Conclusions: There is sufficient evidence of effectiveness of targeted interventions with female sex workers in Africa to inform delivery of services for this population. With improved planning and political will, services including peer interventions, condom promotion and STI screening would act at multiple levels to reduce HIV exposure and transmission efficiency among sex workers. Initiatives are required to enhance access to HIV testing and ART for sex workers, using current CD4 thresholds, or possibly earlier for prevention. Services implemented at sufficient scale and intensity also serve as a platform for subsequent community mobilization and sex worker empowerment, and alleviate a major source of incident infection sustaining even generalized HIV epidemics. Ultimately, structural and legal changes that align public health and human rights are needed to ensure that sex workers on the continent are adequately protected from HIV.
Heather E. Thompson
Full Text Available In recent years it has become clear that climate change is an inevitable process. In Sub-Saharan Africa, the expectation is that climate change will have an especially negative impact, not only a result of projected warming and rainfall deficits, but also because of the vulnerability of the population. The impact upon food security will be of great significance, and may be defined as being composed of three components: availability, access, and utilization. To further investigate the link, a systematic literature review was done of the peer-reviewed literature related to climate change and food security, employing the realist review method. Analysis of the literature found consistent predictions of decreased crop productivity, land degradation, high market prices, negative impacts on livelihoods, and increased malnutrition. Adaptation strategies were heavily discussed as a means of mitigating a situation of severe food insecurity across the entire region. This is linked to issues of development, whereby adaptation is essential to counteract the negative impacts and improve the potential of the population to undergo development processes. Findings additionally revealed a gap in the literature about how nutrition will be affected, which is of importance given the links between poor nutrition and lack of productivity.
Leon, Natalie; Sanders, David; Van Damme, Wim; Besada, Donela; Daviaud, Emmanuelle; Oliphant, Nicholas P; Berzal, Rocio; Mason, John; Doherty, Tanya
Community-based research on child survival in sub-Saharan Africa has focussed on the increased provision of curative health services by a formalised cadre of lay community health workers (CHWs), but we have identified a particular configuration, that deserves closer scrutiny. We identified a two-tiered CHW system, with the first tier being the lessor known or 'hidden' community/village level volunteers and the second tier being formal, paid CHWs, in Ethiopia, Mali, and Niger. Whilst the disease-focussed tasks of the formal CHW tier may be more amenable to classic epidemiological surveillance, we postulate that understanding the relationship between formalised CHWs and volunteer cadres, in terms of scope, location of practice and ratio to population, would be important for a comprehensive evaluation of child survival in these countries. We report on the findings from our joint qualitative and quantitative investigations, highlighting the need to recognise the 'hidden' contribution of volunteers. We need to better characterize the volunteers' interaction with community-based and primary care services and to better understand ways to improve the volunteer systems with the right type of investments. This is particularly important for considering the models for scale-up of CHWs in sub-Saharan Africa. PMID:25770090
Donald P., King; Miki, Madi; Valerie, Mioulet; Jemma, Wadsworth; Caroline F., Wright; Bego& #241; a, Valdazo-González; Nigel P., Ferris; Nick J., Knowles; Jef, Hammond.
Full Text Available Using foot-and-mouth disease (FMD) as an example, this review describes new tools that can be used to detect and characterise livestock diseases. In recent years, molecular tests that can detect and characterise pathogens in a diverse range of sample types have revolutionised laboratory diagnostics. [...] In addition to use in centralised laboratories, there are opportunities to locate diagnostic technologies close to the animals with suspected clinical signs. Work in this area has developed simple-to-use lateral-flow devices for the detection of FMD virus (FMDV), as well as new hardware platforms to allow molecular testing to be deployed into the field for use by non-specialists. Once FMDV has been detected, nucleotide sequencing is used to compare field strains with reference viruses. Transboundary movements of FMDV are routinely monitored using VP1 sequence data, while higher resolution transmission trees (at the farm-to-farm level) can be reconstructed using full-genome sequencing approaches. New technologies such as next-generation sequencing technologies are now being applied to dissect the viral sequence populations that exist within single samples. The driving force for the use of these technologies has largely been influenced by the priorities of developed countries with FMD-free (without vaccination) status. However, it is important to recognise that these approaches also show considerable promise for use in countries where FMD is endemic, although further modifications (such as sample archiving and strain and serotype characterisation) may be required to tailor these tests for use in these regions. Access to these new diagnostic and sequencing technologies in sub-Saharan Africa have the potential to provide novel insights into FMD epidemiology and will impact upon improved strategies for disease control. Effective control of infectious diseases is reliant upon accurate diagnosis of clinical cases using laboratory tests, together with an understanding of factors that impact upon the epidemiology of the infectious agent. A wide range of new diagnostic tools and nucleotide sequencing methods are used by international reference laboratories to detect and characterise the agents causing outbreaks of infectious diseases. In the past, high costs (initial capital expenses, as well as day-to-day maintenance and running costs) and complexity of the protocols used to perform some of these tests have limited the use of these methods in smaller laboratories. However, simpler and more cost-effective formats are now being developed that offer the prospect that these technologies will be even more widely deployed into laboratories particularly those in developing regions of the world such as sub-Saharan Africa.
Canossi, A; Piancatelli, D; Aureli, A; Oumhani, K; Ozzella, G; Del Beato, T; Liberatore, G; El Aouad, R; Adorno, D
The aim of this study was to provide genetic and anthropological information on the Chaouya (CH), an Arabic-speaking population living in West Morocco, Atlantic coast (Settat). In 98 unrelated healthy CH volunteers, we first investigated the human leukocyte antigen (HLA) class I and II allele polymorphisms using a sequence-based typing method and examined haplotypes and relatedness of this group to other African and Mediterranean populations. The study showed the close relatedness with Tunisian population and other North Africans, together with a strong influence of various immigrations, mainly Spaniards, French, and Portuguese, as expected. Nevertheless, analysis of class II allele frequencies (afs) showed that Oromo and Amhara Ethiopian groups cluster together with the Berbers and other North Africans, confirming the relationship between these populations (Afro-Asiatic linguistic group, Hamites). South and sub-Saharan Africans cluster separately at a great distance from CH, except the sub-Saharan Bantu population from Congo Kinshasa, which shows a relatively close genetic relationship ascribable to the effect of a diversifying selection. On the other hand, considering HLA class I afs analyses, it was noteworthy that CH grouped together with sub-Saharans, showing a close genetic distance mainly with Ugandas and Kenians Luo. PMID:20492599
Peroni Marco; Giglio Pietro; Masi Fabio; Bartolo Michelangelo; Bernava Giuseppe M; Nucita Andrea; Pizzimenti Giovanni; Palombi Leonardo
Abstract Background The DREAM Project operates within the framework of the national health systems of several sub-Saharan African countries and aims to introduce the essential components of an integrated strategy for the prevention and treatment of HIV/AIDS. The project is intended to serve as a model for a wide-ranging scale-up in the response to the epidemic. This paper aims to show DREAM's challenges and the solutions adopted. One of the solutions is the efficient management of the clinica...
Full Text Available Abstract Background The continued poor sexual and reproductive health (SRH outcomes in sub-Saharan Africa highlight the difficulties in reforming policies and laws, and implementing effective programmes. This paper uses one international and two national case studies to reflect on the challenges, dilemmas and strategies used in operationalising sexual and reproductive health and rights (SRHR in different African contexts. Methods The international case study focuses on the progress made by African countries in implementing the African Unions Maputo Plan of Action (for the Operationalisation of the Continental Policy Framework for Sexual and Reproductive Health and Rights and the experiences of state and non-state stakeholders in this process. The case was developed from an evaluation report of the progress made by nine African countries in implementing the Plan of Action, qualitative interviews exploring stakeholders experiences and perceptions of the operationalisation of the plan (carried out as part of the evaluation in Botswana and Nigeria, and authors reflections. The first national case study explores the processes involved in influencing Ghanas Domestic Violence Act passed in 2007; developed from a review of scientific papers and organisational publications on the processes involved in influencing the Act, qualitative interview data and authors reflections. The second national case study examines the experiences with introducing the 2006 Sexual Offences Act in Kenya, and it is developed from organisational publications on the processes of enacting the Act and a review of media reports on the debates and passing of the Act. Results Based on the three cases, we argue that prohibitive laws and governments reluctance to institute and implement comprehensive rights approaches to SRH, lack of political leadership and commitment to funding SRHR policies and programmes, and dominant negative cultural framing of womens issues present the major obstacles to operationalising SRH rights. Analysis of successes points to the strategies for tackling these challenges, which include forming and working through strategic coalitions, employing strategic framing of SRHR issues to counter opposition and gain support, collaborating with government, and employing strategic opportunism. Conclusion The strategies identified show future pathways through which challenges to the realisation of SRHR in Africa can be tackled.
Neerinckx, Simon B; Peterson, Andrew T
Background Plague is a rapidly progressing, serious illness in humans that is likely to be fatal if not treated. It remains a public health threat, especially in sub-Saharan Africa. In spite of plague's highly focal nature, a thorough ecological understanding of the general distribution pattern of plague across sub-Saharan Africa has not been established to date. In this study, we used human plague data from sub-Saharan Africa for 1970-2007 in an ecological niche modeling framework to explore the potential geographic distribution of plague and its ecological requirements across Africa. Results We predict a broad potential distributional area of plague occurrences across sub-Saharan Africa. General tests of model's transferability suggest that our model can anticipate the potential distribution of plague occurrences in Madagascar and northern Africa. However, generality and predictive ability tests using regional subsets of occurrence points demonstrate the models to be unable to predict independent occurrence points outside the training region accurately. Visualizations show plague to occur in diverse landscapes under wide ranges of environmental conditions. Conclusion We conclude that the typical focality of plague, observed in sub-Saharan Africa, is not related to fragmented and insular environmental conditions manifested at a coarse continental scale. However, our approach provides a foundation for testing hypotheses concerning focal distribution areas of plague and their links with historical and environmental factors.
The bulk of rural populations in sub-Saharan Africa have no access to electricity and are under-served by any other form of modern infrastructure. The cost of infrastructure to mainly scattered communities has been perennially cited as largely to blame. This is an undeniable truth, but only part of it. There are in addition, myriads of social, economic and political obstacles that play an unquantified and frequently unrecognized negative role. At the route of the problem lies a subdued role of the would-be recipients who in fact, unlike anybody else, are conversant with their problems. Consequently, a number of products may come as impositions or misplaced priorities. Consumer participation for sustainable development has been articulated at international forums and in publications as being advantageous. In practice however, the concept appears to be generally shunned and even when, occasionally, tried the needs of the consumers are presumed and their roles prescribed. This paper discusses a range of social, economic and political issues that constitute major obstacles to the realisation of sustainable rural development
Full Text Available In recent times, disasters and risk management have gained significant attention, especially with increasing awareness of the risks and increasing impact of natural and other hazards especially in the developing world. Vulnerability, the potential for loss of life or property from disaster, has biophysical or social dimensions. Social vulnerability relates to societal attributes which has negative impacts on disaster outcomes. This study sought to develop a spatially explicit index of social vulnerability, thus addressing the dearth of research in this area in sub-Saharan Africa. Nineteen variables were identified covering various aspects. Descriptive analysis of these variables revealed high heterogeneity across the South West region of Nigeria for both the state and the local government areas (LGAs. Feature identification using correlation analysis identified six important variables. Factor analysis identified two dimensions, namely accessibility and socioeconomic conditions, from this subset. A social vulnerability index (SoVI showed that Ondo and Ekiti have more vulnerable LGAs than other states in the region. About 50% of the LGAs in Osun and Ogun have a relatively low social vulnerability. Distribution of the SoVI shows that there are great differences within states as well as across regions. Scores of population density, disability and poverty have a high margin of error in relation to mean state scores. The study showed that with a geographical information system there are opportunities to model social vulnerability and monitor its evolution and dynamics across the continent.
Full Text Available In developing countries, the drinking water supply is still an open issue. In sub-Saharan Africa, only 68% of the population has access to improved sources of drinking water. Moreover, some regions are affected by geogenic contaminants (e.g., fluoride and arsenic and the lack of access to sanitation facilities and hygiene practices causes high microbiological contamination of drinking water in the supply chain. The Water Safety Plan (WSP approach introduced by the World Health Organisation (WHO in 2004 is now under development in several developing countries in order to face up to these issues. The WSP approach was elaborated within two cooperation projects implemented in rural areas of Burkina Faso and Senegal by two Italian NGOs (Non-Governmental Organisations. In order to evaluate its sustainability, a questionnaire based on five different sustainability elements and a cost and time consumption evaluation were carried out and applied in both the case studies. Results demonstrated that the questionnaire can provide a useful and interesting overview regarding the sustainability of the WSP; however, further surveys in the field are recommended for gathering more information. Time and costs related to the WSP elaboration, implementation, and management were demonstrated not to be negligible and above all strongly dependent on water quality and the water supply system complexity.
Full Text Available The declining efficacy of acaricide treatment as a means of reducing the prevalence of Theileria parva infections in sub-Saharan Africa has intensified efforts to achieve control through immunization of susceptible cattle. The infection and treatment method of immunization has enjoyed a resurgence with the availability of more effective cold chain facilities, although concerns remain regarding the possibility of vaccine strains spreading in local tick populations. In addition, an in-depth understanding of protective mechanisms deployed by immune cattle and the antigens targeted by them has led to substantial progress in the development of candidate subunit vaccines against both sporozoite and schizont stages of the parasite. The likely success of these vaccines, as well as infection and treatment immunization, will ultimately depend on the extent to which they disturb the endemic status of the parasite. These issues are discussed in the light of recent information on the genotypic diversity of T. parva in the field and the extent to which this is compromised by the immune response.
Enattah, Nabil Sabri; Jensen, Tine G K; Boyd, Mette; Lewinski, Rikke; Kuokkanen, Mikko; Rasinpera, Heli; El-Shanti, Hatem; Seo, Jeong Kee; Alifrangis, Michael; Khalil, Insaf F; Natah, Abdrazak; Ali, Ahmed; Natah, Sirajedin; Comas, David; Mehdi, S Qasim; Groop, Leif; Vestergaard, Else Marie; Imtiaz, Faiqa; Rashed, Mohamed S; Meyer, Brian; Troelsen, Jesper; Peltonen, Leena
The T(-13910) variant located in the enhancer element of the lactase (LCT) gene correlates perfectly with lactase persistence (LP) in Eurasian populations whereas the variant is almost nonexistent among Sub-Saharan African populations, showing high prevalence of LP. Here, we report identification of two new mutations among Saudis, also known for the high prevalence of LP. We confirmed the absence of the European T(-13910) and established two new mutations found as a compound allele: T/G(-13915) ...
BREGUET, Georges; Bütler, R.; Bütler-Brunner, E.; Sanchez-Mazas, Alicia
The aim of this investigation is to examine the distribution of the Ag immunological polymorphism in human populations on a worldwide scale and to look for possible explanations of this distribution in the field of modern human peopling history and Ag-system evolution. Extensive Ag-antigene typings were carried out on 13 human population samples, including sub-Saharan African, European, west and east Asiatic, Melanesian, Australian aborigine, and Amerindian groups. Complete Ag-haplotype frequ...
Short, Susan E.; Goldberg, Rachel E.
Background In sub-Saharan Africa many children live in extreme poverty and experience a burden of illness and disease that is disproportionately high. The emergence of HIV and AIDS has only exacerbated long-standing challenges to improving childrens health in the region, with recent cohorts experiencing pediatric AIDS and high levels of orphan status, situations which are monitored globally and receive much policy and research attention. Childrens health, however, can be affected also by living with HIV-infected adults, through associated exposure to infectious diseases and the diversion of household resources away from them. While long recognized, far less research has focused on characterizing this distinct and vulnerable population of HIV-affected children. Methods Using Demographic and Health Survey data from 23 countries collected between 2003 and 2011, we estimate the percentage of children living in a household with at least one HIV-infected adult. We assess overlaps with orphan status and investigate the relationship between children and the adults who are infected in their households. Results The population of children living in a household with at least one HIV-infected adult is substantial where HIV prevalence is high; in Southern Africa, the percentage exceeded 10% in all countries and reached as high as 36%. This population is largely distinct from the orphan population. Among children living in households with tested, HIV-infected adults, most live with parents, often mothers, who are infected; nonetheless, in most countries over 20% live in households with at least one infected adult who is not a parent. Conclusion Until new infections contract significantly, improvements in HIV/AIDS treatment suggest that the population of children living with HIV-infected adults will remain substantial. It is vital to on-going efforts to reduce childhood morbidity and mortality to consider whether current care and outreach sufficiently address the distinct vulnerabilities of these children. PMID:26575484
Full Text Available Abstract Background Despite growing HIV and cancer prevalence in Sub-Saharan Africa, and WHO advocacy for a public health approach to palliative care provision, opioid availability is severely limited. Uganda has achieved a morphine roll-out programme in partnership with the Ministry of Health. This study aimed to evaluate that programme by identifying challenges to implementation that may inform replication. Methods A multi-methods protocol appraised morphine regulation, storage, prescribing, and consumption in three phases: key informant interviews throughout the opioid supply chain, and direct observation and audit of clinical practice. Results Regulation had achieved its goal of preventing misuse and leakage from the supply chain. However, the Government felt that relaxation of regulation was now appropriate. Confusion and complexity in storage and authorisation rules led to discontinuation of opioid pain management at the patient level and also wasted service time in trying to obtain supplies to which they were entitled. Continued neglect to prescribe among clinicians and public fear of opioids led to under prescribing, and clinical skills showed some evidence of need for improvement with respect to physical assessment and follow-up. Conclusion The Ugandan programme offers a successful model for both advocacy and Governmental support in achieving opioid roll-out across health districts. Despite initial concerns, abuse of opioids has not been evident. Further work is required to ensure that available supplies of opioids are prescribed to those in need, and that clinical standards are met. However, the programme for roll-out has proved a useful model to expand opioid availability as the first step in improving patient care, and may prove a useful template for other Sub-Saharan African countries.
Coburn, Carolyn; Restivo, Michael; Shandra, John M
We conduct a cross-national analysis to test the hypothesis that African Development Bank (AfDB) structural adjustment lending adversely impacts maternal mortality in Sub-Saharan Africa. We analyze data for thirty-five Sub-Saharan African nations with up to four time points (1990, 1995, 2000, and 2005) with generalized least squares random effects regression models and modified two-step Heckman models that correct for potential endogeneity regarding whether or not a Sub-Saharan African nations receives an AfDB structural adjustment loan. We find support for our hypothesis that indicates that Sub-Saharan African nations that receive an AfDB structural adjustment loan tend to have higher levels of maternal mortality than Sub-Saharan African nations that do not receive such a loan. This finding remains stable even when controlling for endogeneity. We conclude by talking about the theoretical and methodological implications along with possible directions for future research. PMID:25769869
Reed, Cecile C
Scattered records of parasitic species infecting commercially important marine fishes in sub-Saharan Africa are known from just a few countries where concerted efforts have been made by local parasitologists (e.g. Senegal, Nigeria, South Africa). Most of these consist of taxonomic records or general surveys of parasite faunas associated with marine hosts, which may or may not have been of commercial value. Little to no multi-disciplinary research is conducted in most parts of sub-Saharan Africa and hence parasitological data are not commonly used to advise fisheries management procedures. This review summarizes current knowledge on all parasitological research associated with commercially important marine fish species in sub-Saharan Africa. PMID:24785716
Molecular genetic techniques were used to gain insights into the evolutionary forces that have shaped the present day diversity of African savannah ungu-lates, which constitute the most species-rich mega faunal assemblage on earth. The studies included in this thesis represent individual species-specific data sets, which are used to elucidate evolutionary processes of importance to the savannah ungulate community. Patterns of DNA variation were analyzed to assess the genetic signatures of Pleist...
Sánchez-Quinto, Federico; Botigué, Laura R; Civit, Sergi; Arenas, Conxita; Avila Arcos, Maria del Carmen; Bustamante, Carlos D; Comas, David; Lalueza-Fox, Carles
One of the main findings derived from the analysis of the Neandertal genome was the evidence for admixture between Neandertals and non-African modern humans. An alternative scenario is that the ancestral population of non-Africans was closer to Neandertals than to Africans because of ancient population substructure. Thus, the study of North African populations is crucial for testing both hypotheses. We analyzed a total of 780,000 SNPs in 125 individuals representing seven different North African...
Comparing changes in haematologic parameters occurring in patients included in randomized controlled trials of artesunate-amodiaquine vs single and combination treatments of uncomplicated falciparum in sub-Saharan Africa
Zwang Julien; Ndiaye Jean-Louis; Djimdé Abdoulaye; Dorsey Grant; Mårtensson Andreas; Karema Corine; Olliaro Piero
Abstract Background Artesunate-amodiaquine (AS&AQ) is a widely used artemisinin combination therapy (ACT) for falciparum malaria. A comprehensive appreciation of its effects on haematology vs other anti-malarials is needed in view of potential safety liabilities. Methods Individual-patient data analysis conducted on a database from seven randomized controlled trials conducted in sub-Saharan African comparing AS&AQ to reference treatments in uncomplicated falciparum malaria patients of all age...
John G Cleland
Full Text Available OBJECTIVE: To review progress towards adoption of contraception among married or cohabiting women in western and eastern Africa between 1991 and 2004 by examining subjective need, approval, access and use. METHODS: Indicators of attitudes towards and use of contraception were derived from Demographic and Health Surveys, which are nationally representative and yield internationally comparable data. Trends were examined for 24 countries that had conducted at least two surveys between 1986 and 2007. FINDINGS: In western Africa, the subjective need for contraception remained unchanged; about 46% of married or cohabiting women reported a desire to stop and/or postpone childbearing for at least two years. The percentage of women who approved of contraception rose from 32 to 39 and the percentage with access to contraceptive methods rose from 8 to 29. The proportion of women who were using a modern method when interviewed increased from 7 to 15% (equivalent to an average annual increase of 0.6 percentage points. In eastern African countries, trends were much more favourable, with contraceptive use showing an average annual increase of 1.4 percentage points (from 16% in 1986 to 33% in 2007. CONCLUSION: In western Africa, progress towards adoption of contraception has been dismally slow. Attitudinal resistance remains a barrier and access to contraceptives, though improving, is still shockingly limited. If this situation does not change radically in the short run, the United Nations population projections for this subregion are likely to be exceeded. In eastern Africa, the prospects for a future decline in fertility are much more positive.
Molecular genetic techniques were used to gain insights into the evolutionary forces that have shaped the present day diversity of African savannah ungu-lates, which constitute the most species-rich mega faunal assemblage on earth. The studies included in this thesis represent individual species-specific data sets, which are used to elucidate evolutionary processes of importance to the savannah ungulate community. Patterns of DNA variation were analyzed to assess the genetic signatures of Pleistocene refugia and investigate aspects of speciation, intraspecific structuring, hybridization, and historic migration pat-terns.
Naylor, R.; Burney, J. A.; Postel, S.
The poorest populations in sub-Saharan Africa live in rural areas and depend on smallholder agricultural production for their livelihoods. Over 90% of all farmed area in Sub-Saharan Africa is rainfed, with crop production centering on 3-5 months of rainfall. Rapid population growth is reducing land per capita ratios, and low yields for staple crops make food security an increasingly challenging goal. Malnutrition, most noticeable among children, peaks during the dry season. Recent data on aggregate economic growth and investment in Africa hide these patterns of seasonal hunger and income disparity. Perhaps most perversely, smallholder farmers in the dry tropical regions of sub-Saharan Africa are (and will continue to be) some of the earliest and hardest hit by climate change. Our research focuses on the role distributed, small-scale irrigation can play in food security and climate change adaptation in sub-Saharan Africa. As Asia's agricultural success has demonstrated, irrigation, when combined with the availability of inputs (fertilizer) and improved crop varieties, can enable year-round production, growth in rural incomes, and a dramatic reduction in hunger. The situation in Africa is markedly different: agroecological conditions are far more heterogeneous than in Asia and evaporation rates are relatively high; most smallholders lack access to fertilizers; and market integration is constrained by infrastructure, information, and private sector incentives. Yet from a resource perspective, national- and regional-level estimates suggest that Internal Renewable Water Resources (IRWR) are nowhere near fully exploited in Sub-Saharan Africa -- even in the Sudano-Sahel, which is considered to be one of the driest regions of the continent. Irrigation can thus be implemented on a much larger scale sustainably. We will present (a) results from controlled, experimental field studies of solar-powered drip irrigation systems in the rural Sudano-Sahel region of West Africa. We have shown that such systems can be implemented in a cost-competitive and environmentally responsible manner, with significant and sustained impact on livelihoods. These findings will be coupled with (b) case studies of successful and failed irrigation projects across the continent that reveal technical and institutional requirements for success; and (c) regional and continental data that quantify the larger-scale food security, development, adaptation, and mitigation potentials of these types of smallholder systems.
J, Edge; I, Buccimazza; H, Cubasch; E, Panieri.
Full Text Available Communicable diseases are the major cause of mortality in lower-income countries. Consequently, local and international resources are channelled mainly into addressing the impact of these conditions. HIV, however, is being successfully treated, people are living longer, and disease patterns are chan [...] ging. As populations age, the incidence of cancer inevitably increases. The World Health Organization has predicted a dramatic increase in global cancer cases during the next 15 years, the majority of which will occur in low- and middle-income countries. Cancer treatment is expensive and complex and in the developing world 5% of global cancer funds are spent on 70% of cancer cases. This paper reviews the challenges of managing breast cancer in the developing world, using sub-Saharan Africa as a model.
Nygaard, Ivan; Bindner, Henrik W.
Solar PV is one among other low carbon technologies for rural electrification in Sub Saharan Africa (SSA). Solar PV systems have for almost 30 years been disseminated in SSA, resulting in more than half a million installations concentrated in a few countries. While PV systems have technically matured and markets have gradually developed, PV for rural electrification has often been perceived with scepticism from potential users, donors, government officials and researchers, and solar PV has in many camps been labelled as donor driven, expensive and fragile technology mainly serving the richest parts of the populations and with little or no value for productive uses. However, feasibility for solar PV has improved in the last few years. Retail prices for solar photovoltaic modules are reduced by 20-30% since 2001, and although far from the peak in 2008, oil prices in the next two years to come are expected to settle at a level, which is about three times the world market average in the years from 1985-2003. Therefore, rather than being limited to a niche for populations living in dispersed settlements outside the reach of grid electrification, solar PV is expected to play an important role in mini grid rural electrification schemes based on hybrid solar PVdiesel generators. This may bring PV systems in line with fossil fuel based systems in terms of consumer cost and options for productive use and it changes the market for PV from mainly donor supported schemes into mainstream rural electrification schemes governed and financed by electric utilities and rural electrification agencies. Based on a literature review and the experience with a full scale hybrid wind/PV diesel system at RISØ DTU, this paper provides cost estimates for hybrid PV-diesel systems and policy recommendations to change the application of PV technologies for development in SSA.
Koosimile, Anthony T.; Suping, Shanah M.
This paper takes the view that the emergence of some trends and practices in science education mirrors the influence of the process of globalisation in Anglophone Sub-Saharan Africa. Through a literature review, an attempt is made to link science education and globalisation by answering the question: "What influence does globalisation have on
Mortlock, Marinda; Kuzmin, Ivan V.; Weyer, Jacqueline; Gilbert, Amy T.; Agwanda, Bernard; Rupprecht, Charles E.; Nel, Louis H.; Kearney, Teresa; Malekani, Jean M.
As part of a larger survey for detection of pathogens among wildlife in sub-Saharan Africa conducted during 20072012, multiple diverse paramyxovirus sequences were detected in renal tissues of bats. Phylogenetic analysis supports the presence of at least 2 major viral lineages and suggests that paramyxoviruses are strongly associated with several bat genera. PMID:26402433
Mutula, Stephen Mudogo
Purpose: This article aims to present experiences and the lessons learned from the University of Botswana (UB) library automation project. The implications of the project for similar libraries planning automation in sub Saharan Africa and beyond are adduced. Design/methodology/approach: The article is a case study of library automation at the
Caradee Y., Wright; Mary, Norval; Beverley, Summers; Lester, Davids; Gerrie, Coetzee; Matthew O., Oriowo.
Full Text Available Photoprotection messages and 'SunSmart' programmes exist mainly to prevent skin cancers and, more recently, to encourage adequate personal sun exposure to elicit a vitamin D response for healthy bone and immune systems. Several developed countries maintain intensive research networks and monitor sol [...] ar UV radiation to support awareness campaigns and intervention development. The situation is different in sub-Saharan Africa. Adequate empirical evidence of the impact of solar UV radiation on human health, even for melanomas and cataracts, is lacking, and is overshadowed by other factors such as communicable diseases, especially HIV, AIDS and tuberculosis. In addition, the established photoprotection messages used in developed countries have been adopted and implemented in a limited number of sub-Saharan countries but with minimal understanding of local conditions and behaviours. In this review, we consider the current evidence for sun-related effects on human health in sub-Saharan Africa, summarise published research and identify key issues. Data on the prevalence of human diseases affected by solar UV radiation in all subpopulations are not generally available, financial support is insufficient and the infrastructure to address these and other related topics is inadequate. Despite these limitations, considerable progress may be made regarding the management of solar UV radiation related health outcomes in sub-Saharan Africa, provided researchers collaborate and resources are allocated appropriately.
Caradee Y. Wright
Full Text Available Photoprotection messages and SunSmart programmes exist mainly to prevent skin cancers and, more recently, to encourage adequate personal sun exposure to elicit a vitamin D response for healthy bone and immune systems. Several developed countries maintain intensive research networks and monitor solar UV radiation to support awareness campaigns and intervention development. The situation is different in sub-Saharan Africa. Adequate empirical evidence of the impact of solar UV radiation on human health, even for melanomas and cataracts, is lacking, and is overshadowed by other factors such as communicable diseases, especially HIV, AIDS and tuberculosis. In addition, the established photoprotection messages used in developed countries have been adopted and implemented in a limited number of sub-Saharan countries but with minimal understanding of local conditions and behaviours. In this review, we consider the current evidence for sun-related effects on human health in sub-Saharan Africa, summarise published research and identify key issues. Data on the prevalence of human diseases affected by solar UV radiation in all subpopulations are not generally available, financial support is insufficient and the infrastructure to address these and other related topics is inadequate. Despite these limitations, considerable progress may be made regarding the management of solar UV radiation related health outcomes in sub-Saharan Africa, provided researchers collaborate and resources are allocated appropriately.
Siegismund, H R; Arctander, P
The structure of elephant populations from east and south Africa has been analyzed by Georgiadis et al. (1994) on the basis of restriction site variation of mitochondrial DNA. They used F statistics based on identity by descent in tests for subdivision and reached the conclusion that there was a significant differentiation at the continental level, but that "populations were not significantly subdivided at the regional levels." The data were reanalyzed by Monte-Carlo permutation tests where popu...
Masse, Dominique; Ndour Badiane, Yacine; Hien, Edmond; Akpo, Léonard-Élie; Assigbetsé, Komi; Bilgo, Ablassé; Diédhiou, Ibrahima; Hien, Victor; Lardy, Lydie
In the context of environmental and socio-economic changes, the agriculture of Sub-Saharan African countries will have to ensure food security of the population, while reducing its environmental footprint. The biophysical and social systems of agricultural production are complex. Innovative agricultural practices will be based on an intensification of ecological processes that determine the functioning of the soil-plant system, farmers' fields and agro-ecosystems. This ecological engineering approach is useful to take up the challenge of Sub-Saharan agricultures in the future, as shown in researches conducted by IESOL International Joint Lab "Intensification of agricultural soils in West Africa" (ISRA, UCAD, TU, OU, INERA, IRD). PMID:23916205
Esayas Haregot Hilawe
Full Text Available Objective To assess differences between men and women in the prevalence of diabetes mellitus, impaired fasting glycaemia and impaired glucose tolerance in sub-Saharan Africa. Methods In September 2011, the PubMed and Web of Science databases were searched for community-based, cross-sectional studies providing sex-specific prevalences of any of the three study conditions among adults living in parts of sub-Saharan Africa (i.e. in Eastern, Middle and Southern Africa according to the United Nations subregional classification for African countries. A random-effects model was then used to calculate and compare the odds of men and women having each condition. Findings In a meta-analysis of the 36 relevant, cross-sectional data sets that were identified, impaired fasting glycaemia was found to be more common in men than in women (OR: 1.56; 95% confidence interval, CI: 1.202.03, whereas impaired glucose tolerance was found to be less common in men than in women (OR: 0.84; 95% CI: 0.720.98. The prevalence of diabetes mellitus which was generally similar in both sexes (OR: 1.01; 95% CI: 0.911.11 was higher among the women in Southern Africa than among the men from the same subregion and lower among the women from Eastern and Middle Africa and from low-income countries of sub-Saharan Africa than among the corresponding men. Conclusion Compared with women in the same subregions, men in Eastern, Middle and Southern Africa were found to have a similar overall prevalence of diabetes mellitus but were more likely to have impaired fasting glycaemia and less likely to have impaired glucose tolerance.
Full Text Available Whereas mobile phone-based surveillance has the potential to provide real-time validated data for disease clustering and prompt respond and investigation, little evidence is available on current practice in sub-Sahara Africa. The objective of this review was to examine mobile phone-based mHealth interventions for Public Health surveillance in the region. We conducted electronic search in MEDLINE, EMBASE, IEE Xplore, African Index Medicus (AIM, BioMed Central, PubMed Central (PMC, the Public Library of Science (PLoS and IRIS for publications used in the review. In all, a total of nine studies were included which focused on infectious disease surveillance of malaria (n = 3, tuberculosis (n = 1 and influenza-like illnesses (n = 1 as well as on non-infectious disease surveillance of child malnutrition (n = 2, maternal health (n = 1 and routine surveillance of various diseases and symptoms (n = 1. Our review revealed that mobile phone-based surveillance projects in the sub-Saharan African countries are on small scale, fragmented and not well documented. We conclude by advocating for a strong drive for more research in the applied field as well as a better reporting of lessons learned in order to create an epistemic community to help build a more evidence-based field of practice in mHealth surveillance in the region.
Brinkel, Johanna; Krämer, Alexander; Krumkamp, Ralf; May, Jürgen; Fobil, Julius
Whereas mobile phone-based surveillance has the potential to provide real-time validated data for disease clustering and prompt respond and investigation, little evidence is available on current practice in sub-Sahara Africa. The objective of this review was to examine mobile phone-based mHealth interventions for Public Health surveillance in the region. We conducted electronic search in MEDLINE, EMBASE, IEE Xplore, African Index Medicus (AIM), BioMed Central, PubMed Central (PMC), the Public Library of Science (PLoS) and IRIS for publications used in the review. In all, a total of nine studies were included which focused on infectious disease surveillance of malaria (n = 3), tuberculosis (n = 1) and influenza-like illnesses (n = 1) as well as on non-infectious disease surveillance of child malnutrition (n = 2), maternal health (n = 1) and routine surveillance of various diseases and symptoms (n = 1). Our review revealed that mobile phone-based surveillance projects in the sub-Saharan African countries are on small scale, fragmented and not well documented. We conclude by advocating for a strong drive for more research in the applied field as well as a better reporting of lessons learned in order to create an epistemic community to help build a more evidence-based field of practice in mHealth surveillance in the region. PMID:25396767
Shandera, Wayne Xavier
To investigate why Southern sub-Saharan Africa is more severely impacted by HIV and AIDS than other parts of sub-Saharan Africa, I conducted a review of the literature that assessed viral, host and transmission (societal) factors. This narrative review evaluates: 1) viral factors, in particular the aggregation of subtype-C HIV infections in Southern sub-Saharan Africa; 2) host factors, including unique behaviour patterns, concomitant high prevalence of sexually transmitted diseases, circumcision patterns, average age at first marriage and immunogenetic determinants; and, 3) transmission and societal factors, including levels of poverty, degrees of literacy, migrations of people, extent of political corruption, and the usage of contaminated injecting needles in community settings. HIV prevalence data and published indices on wealth, fertility, and governmental corruption were correlated using statistical software. The high prevalence of HIV in Southern sub-Saharan Africa is not explained by the unusual prevalence of subtype-C HIV infection. Many host factors contribute to HIV prevalence, including frequency of genital ulcerating sexually transmitted infections, absence of circumcision (compiled odds ratios suggest a protective effect of between 40% and 60% from circumcision), and immunogenetic loci, but no factor alone explains the high prevalence of HIV in the region. Among transmission and societal factors, the wealthiest, most literate and most educated, but also the most income-disparate, nations of sub-Saharan Africa show the highest HIV prevalence. HIV prevalence is also highest within societies experiencing significant migration and conflict as well as in those with government systems experiencing a high degree of corruption. The interactions between poverty and HIV transmission are complex. Epidemiologic studies currently do not suggest a strong role for the community usage of contaminated injecting needles. Areas meriting additional study include clade type, host immunogenetic determinants, the complex interrelationship of HIV with poverty, and the community usage of contaminated injecting needles. PMID:25866173
April, Michael D
Opt-out testing for the human immunodeficiency virus (HIV) incorporates testing as a routine part of health care for all patients unless they refuse. The ethics of this approach to testing in sub-Saharan Africa is a source of controversy. Opt-out HIV testing is expected to improve survival by increasing case detection and thus linking more HIV-infected people to earlier treatment, provided there is effective patient follow-up and programme sustainability. At the population level, these benefits will likely outweigh the potential negative consequences of individuals experiencing HIV-related stigma. These justifications appeal to consequentialist moral theories that the acceptability of an action depends upon its outcomes. On the other hand, liberal moral theories state that the autonomy of individuals should always be protected unless restricting autonomy is necessary to protect the welfare of others. Opt-out consent may restrict autonomy and it is unclear whether it would benefit people other than those being tested. Yet, the doctrine of libertarian paternalism proposes that it is justifiable and desirable to use unobtrusive mechanisms to help individuals make choices to maximize their own welfare. Central to this idea are the premises featured by supporters of opt-out consent that individuals will not always make the best choices for their own welfare but they may be influenced to do so in ways that will not compromise their freedom of choice. Also important is the premise that all policies inevitably exert some such influence: opt-in consent encourages test refusal just as opt-out consent encourages acceptance. Based on these premises, opt-out testing may be an effective and ethically acceptable policy response to Africa's HIV epidemic. PMID:20865076
Jones, Edward Samuel; Gibbon, Peter
This article investigates the process of development in a traditional African export market, focusing on a contract farming scheme for organic cocoa in rural Uganda. Based on a repeated household survey, we measure the impact of the scheme on the income of participants and the economic mechanisms behind these effects. We find substantial benefits from the scheme, driven primarily by the establishment of credible incentives for farmers to adopt technologies which improve cocoa quality. There is a...
Daar Abdallah S
Full Text Available Abstract In recent years emerging markets such as India, China, and Brazil have developed appropriate business models and lower-cost technological innovations to address health challenges locally and internationally. But it is not well understood what capabilities African countries, with their high disease burden, have in science-based health innovation. This gap in knowledge is addressed by this series in BMC International Health and Human Rights. The series presents the results of extensive on-the-ground research in the form of four country case studies of health and biotechnology innovation, six studies of institutions within Africa involved in health product development, and one study of health venture funds in Africa. To the best of our knowledge it is the first extensive collection of empirical work on African science-based health innovation. The four country cases are Ghana, Rwanda, Tanzania and Uganda. The six case studies of institutions are A to Z Textiles (Tanzania, Acorn Technologies (South Africa, Bioventures venture capital fund (South Africa, the Malagasy Institute of Applied Research (IMRA; Madagascar, the Kenyan Medical Research Institute (KEMRI; Kenya, and Niprisans development by Nigerias National Institute for Pharmaceutical Research and Development and Xechem (Nigeria. All of the examples highlight pioneering attempts to build technological capacity, create economic opportunities, and retain talent on a continent significantly affected by brain drain. They point to the practical challenges for innovators on the ground, and suggest potentially helpful policies, funding streams, and other support systems. For African nations, health innovation represents an opportunity to increase domestic capacity to solve health challenges; for international funders, it is an opportunity to move beyond foreign aid and dependency. The shared goal is creating self-sustaining innovation that has both health and development impacts. While this is a long-term strategy, this series shows the potential of African-led innovation, and indicates how it might balance realism against opportunity. There is ample scope to learn lessons more systematically from cases like those we discuss; to link entrepreneurs, scientists, funders, and policy-makers into a network to share opportunities and challenges; and ultimately to better support and stimulate African-led health innovation.
Lund, C; Alem, A; Schneider, M; Hanlon, C; Ahrens, J; Bandawe, C; Bass, J; Bhana, A; Burns, J; Chibanda, D; Cowan, F; Davies, T; Dewey, M; Fekadu, A; Freeman, M; Honikman, S; Joska, J; Kagee, A; Mayston, R; Medhin, G; Musisi, S; Myer, L; Ntulo, T; Nyatsanza, M; Ofori-Atta, A; Petersen, I; Phakathi, S; Prince, M; Shibre, T; Stein, D J; Swartz, L; Thornicroft, G; Tomlinson, M; Wissow, L; Susser, E
There is limited evidence on the acceptability, feasibility and cost-effectiveness of task-sharing interventions to narrow the treatment gap for mental disorders in sub-Saharan Africa. The purpose of this article is to describe the rationale, aims and methods of the Africa Focus on Intervention Research for Mental health (AFFIRM) collaborative research hub. AFFIRM is investigating strategies for narrowing the treatment gap for mental disorders in sub-Saharan Africa in four areas. First, it is assessing the feasibility, acceptability and cost-effectiveness of task-sharing interventions by conducting randomised controlled trials in Ethiopia and South Africa. The AFFIRM Task-sharing for the Care of Severe mental disorders (TaSCS) trial in Ethiopia aims to determine the acceptability, affordability, effectiveness and sustainability of mental health care for people with severe mental disorder delivered by trained and supervised non-specialist, primary health care workers compared with an existing psychiatric nurse-led service. The AFFIRM trial in South Africa aims to determine the cost-effectiveness of a task-sharing counselling intervention for maternal depression, delivered by non-specialist community health workers, and to examine factors influencing the implementation of the intervention and future scale up. Second, AFFIRM is building individual and institutional capacity for intervention research in sub-Saharan Africa by providing fellowship and mentorship programmes for candidates in Ethiopia, Ghana, Malawi, Uganda and Zimbabwe. Each year five Fellowships are awarded (one to each country) to attend the MPhil in Public Mental Health, a joint postgraduate programme at the University of Cape Town and Stellenbosch University. AFFIRM also offers short courses in intervention research, and supports PhD students attached to the trials in Ethiopia and South Africa. Third, AFFIRM is collaborating with other regional National Institute of Mental Health funded hubs in Latin America, sub-Saharan Africa and south Asia, by designing and executing shared research projects related to task-sharing and narrowing the treatment gap. Finally, it is establishing a network of collaboration between researchers, non-governmental organisations and government agencies that facilitates the translation of research knowledge into policy and practice. This article describes the developmental process of this multi-site approach, and provides a narrative of challenges and opportunities that have arisen during the early phases. Crucial to the long-term sustainability of this work is the nurturing and sustaining of partnerships between African mental health researchers, policy makers, practitioners and international collaborators. PMID:25833714
Rasanathan, Kumanan; Muñiz, Maria; Bakshi, Salina; Kumar, Meghan; Solano, Agnes; Kariuki, Wanjiku; George, Asha; Sylla, Mariame; Nefdt, Rory; Young, Mark; Diaz, Theresa
Background Community case management (CCM) involves training, supporting, and supplying community health workers (CHWs) to assess, classify and manage sick children with limited access to care at health facilities, in their communities. This paper aims to provide an overview of the status in 2013 of CCM policy and implementation in subSaharan African countries. Methods We undertook a crosssectional, descriptive, quantitative survey amongst technical officers in Ministries of Health and UNICEF offices in 2013. The survey aim was to describe CCM policy and implementation in 45 countries in subSaharan Africa, focusing on: CHW profile, CHW activities, and financing. Results 42 countries responded. 35 countries in subSaharan Africa reported implementing CCM for diarrhoea, 33 for malaria, 28 for pneumonia, 6 for neonatal sepsis, 31 for malnutrition and 28 for integrated CCM (treatment of 3 conditions: diarrhoea, malaria and pneumonia) an increase since 2010. In 27 countries, volunteers were providing CCM, compared to 14 countries with paid CHWs. User fees persisted for CCM in 6 countries and markups on commodities in 10 countries. Most countries had a national policy, memo or written guidelines for CCM implementation for diarrhoea, malaria and pneumonia, with 20 countries having this for neonatal sepsis. Most countries plan gradual expansion of CCM but many countries plans were dependent on development partners. A large group of countries had no plans for CCM for neonatal sepsis. Conclusion 28 countries in subSaharan Africa now report implementing CCM for pneumonia, diarrhoea and malaria, or iCCM. Most countries have developed some sort of written basis for CCM activities, yet the scale of implementation varies widely, so a focus on implementation is now required, including monitoring and evaluation of performance, quality and impact. There is also scope for expansion for newborn care. Key issues include financing and sustainability (with development partners still providing most funding), gaps in data on CCM activities, and the persistence of user fees and markups in several countries. National health management information systems should also incorporate CCM activities. PMID:25520791
Full Text Available Abstract Background The identification of safe and effective alternatives to blood transfusion is a public health priority. In sub-Saharan Africa, blood shortage is a cause of mortality and morbidity. Blood transfusion can also transmit viral infections. Giving tranexamic acid (TXA to bleeding surgical patients has been shown to reduce both the number of blood transfusions and the volume of blood transfused. The objective of this study is to investigate whether routinely administering TXA to bleeding elective surgical patients is cost effective by both averting deaths occurring from the shortage of blood, and by preventing infections from blood transfusions. Methods A decision tree was constructed to evaluate the cost-effectiveness of providing TXA compared with no TXA in patients with surgical bleeding in four African countries with different human immunodeficiency virus (HIV prevalence and blood donation rates (Kenya, South Africa, Tanzania and Botswana. The principal outcome measures were cost per life saved and cost per infection averted (HIV, Hepatitis B, Hepatitis C averted in 2007 International dollars ($. The probability of receiving a blood transfusion with and without TXA and the risk of blood borne viral infection were estimated. The impact of uncertainty in model parameters was explored using one-way deterministic sensitivity analyses. Probabilistic sensitivity analysis was performed using Monte Carlo simulation. Results The incremental cost per life saved is $87 for Kenya and $93 for Tanzania. In Botswana and South Africa, TXA administration is not life saving but is highly cost saving since fewer units of blood are transfused. Further, in Botswana the administration of TXA averts one case of HIV and four cases of Hepatitis B (HBV per 1,000 surgical patients. In South Africa, one case of HBV is averted per 1,000 surgical patients. Probabilistic sensitivity analyses confirmed the robustness of the model. Conclusion An economic argument can be made for giving TXA to bleeding elective surgical patients. In countries where there is a blood shortage, TXA would be a cost effective way to reduce mortality. In countries where there is no blood shortage, TXA would reduce healthcare costs and avert blood borne infections.
Ben Chirwa; Chipayeni Mtonga; Anyangwe, Stella C. E.
The United Nations Millennium Development Goals (MDGs) are a series of 8 goals and 18 targets aimed at ending extreme poverty by 2015, and there are 48 quantifiable indicators for monitoring the process. Most of the MDGs are health or health-related goals. Though the MDGs might sound ambitious, it is imperative that the world, and sub-Saharan Africa in particular, wake up to the persistent and unacceptably high rates of extreme poverty that populations live in, and find lasting solutions to a...
Agyemang, C.; Bhopal, R.; Bruijnzeels, M.
Broad terms such as Black, African, or Black African are entrenched in scientific writings although there is considerable diversity within African descent populations and such terms may be both offensive and inaccurate. This paper outlines the heterogeneity within African populations, and discusses the strengths and limitations of the term Black and related labels from epidemiological and public health perspectives in Europe and the USA. This paper calls for debate on appropriate terminologies for African descent populations and concludes with the proposals that (1) describing the population under consideration is of paramount importance (2) the word African origin or simply African is an appropriate and necessary prefix for an ethnic label, for example, African Caribbean or African Kenyan or African Surinamese (3) documents should define the ethnic labels (4) the label Black should be phased out except when used in political contexts. PMID:16286485
Full Text Available Abstract Background Although sub-Saharan Africa (SSA is rapidly urbanizing, the terms used to classify urban ecotypes are poorly defined in the context of malaria epidemiology. Lack of clear definitions may cause misclassification error, which likely decreases the accuracy of continent-wide estimates of malaria burden, limits the generalizability of urban malaria studies, and makes identification of high-risk areas for targeted interventions within cities more difficult. Accordingly, clustering techniques were applied to a set of urbanization- and malaria-related variables in Kisumu, Kenya, to produce a quantitative classification of the urban environment for malaria research. Methods Seven variables with a known or expected relationship with malaria in the context of urbanization were identified and measured at the census enumeration area (EA level, using three sources: a the results of a citywide knowledge, attitudes and practices (KAP survey; b a high-resolution multispectral satellite image; and c national census data. Principal components analysis (PCA was used to identify three factors explaining higher proportions of the combined variance than the original variables. A k-means clustering algorithm was applied to the EA-level factor scores to assign EAs to one of three categories: "urban," "peri-urban," or "semi-rural." The results were compared with classifications derived from two other approaches: a administrative designation of urban/rural by the census or b population density thresholds. Results Urban zones resulting from the clustering algorithm were more geographically coherent than those delineated by population density. Clustering distributed population more evenly among zones than either of the other methods and more accurately predicted variation in other variables related to urbanization, but not used for classification. Conclusion Effective urban malaria epidemiology and control would benefit from quantitative methods to identify and characterize urban areas. Cluster analysis techniques were used to classify Kisumu, Kenya, into levels of urbanization in a repeatable and unbiased manner, an approach that should permit more relevant comparisons among and within urban areas. To the extent that these divisions predict meaningful intra-urban differences in malaria epidemiology, they should inform targeted urban malaria interventions in cities across SSA.
Agreement between clinicians' and care givers' assessment of intelligence in Nigerian children with intellectual disability: 'ratio IQ' as a viable option in the absence of standardized 'deviance IQ' tests in sub-Saharan Africa
Aguocha Chinyere M
Full Text Available Abstract Background There may be need to assess intelligent quotient (IQ scores in sub-Saharan African children with intellectual disability, either for the purpose of educational needs assessment or research. However, modern intelligence scales developed in the western parts of the world suffer limitation of widespread use because of the influence of socio-cultural variations across the world. This study examined the agreement between IQ scores estimation among Nigerian children with intellectual disability using clinicians' judgment based on International Classification of Diseases, tenth Edition (ICD - 10 criteria for mental retardation and caregivers judgment based on 'ratio IQ' scores calculated from estimated mental age in the context of socio-cultural milieu of the children. It proposed a viable option of IQ score assessment among sub-Saharan African children with intellectual disability, using a ratio of culture-specific estimated mental age and chronological age of the child in the absence of standardized alternatives, borne out of great diversity in socio-cultural context of sub-Saharan Africa. Methods Clinicians and care-givers independently assessed the children in relation to their socio-cultural background. Clinicians assessed the IQ scores of the children based on the ICD - 10 diagnostic criteria for mental retardation. 'Ratio IQ' scores were calculated from the ratio of estimated mental age and chronological age of each child. The IQ scores as assessed by the clinicians were then compared with the 'ratio IQ' scores using correlation statistics. Results A total of forty-four (44 children with intellectual disability were assessed. There was a significant correlation between clinicians' assessed IQ scores and the 'ratio IQ' scores employing zero order correlation without controlling for the chronological age of the children (r = 0.47, df = 42, p = 0.001. First order correlation controlling for the chronological age of the children showed higher correlation score between clinicians' assessed IQ scores and 'ratio IQ' scores (r = 0.75, df = 41, p = 0.000. Conclusion Agreement between clinicians' assessed IQ scores and 'ratio IQ' scores was good. 'Ratio IQ' test would provide a viable option of assessing IQ scores in sub-Saharan African children with intellectual disability in the absence of culture-appropriate standardized intelligence scales, which is often the case because of great diversity in socio-cultural structures of sub-Saharan Africa.
Adisa, Femi; Isabalija, Stephen R.
This paper discusses the need for IS research with a focus on SME adoption of enterprise systems in the context of Sub-Saharan Africa. Previous IS research into general adoption in several developing countries have shown that local context play a significant role in the successful implementation of any information system. SMEs constitute a majority of all organizations in most Sub Saharan economies, thus their importance to the socioeconomic development and empowerment of the region cannot be overemphasized. However, the absence of literature and focused research into factors that influence enterprise systems adoption and use that are particular to this region represents a huge gap for both researchers and practitioners. This call to action paper will attempt to present the implications of this deficiency and outline areas where future research can be most beneficial to stakeholders.
Full Text Available This paper investigates the effect of remittance inflows on real exchange rates in sub-Saharan Africa (SSA using annual data from 1980 to 2008 for 34 countries, the method of moments estimator developed by Arellano and Bover (1995 and the feasible generalized least squares estimator developed by Parks (1967 and Kmenta (1986. We find that when cross-sectional dependence and individual effects are controlled for, remittances to sub-Saharan Africa as a whole increase the underlying real exchange rates of recipient countries. However, this real exchange rate appreciation is mitigated by monetary policy interventions and the direction of fiscal expenditures towards tradable goods. Thus, the real exchange rate appreciation does not lead to the loss of export competitiveness or a worsening of the trade deficit in the countries in the panel.
Stulac, Sara; Binagwaho, Agnes; Tapela, Neo M; Wagner, Claire M; Muhimpundu, Marie Aimee; Ngabo, Fidele; Nsanzimana, Sabin; Kayonde, Leonard; Bigirimana, Jean Bosco; Lessard, Adam J; Lehmann, Leslie; Shulman, Lawrence N; Nutt, Cameron T; Drobac, Peter; Mpunga, Tharcisse; Farmer, Paul E
Despite an estimated 456,000 deaths caused by cancer in sub-Saharan Africa in 2012 and a cancer burden that is predicted to double by 2030, the region accounts for only 0·3% of worldwide medical expenditure for cancer. Challenges to cancer care in sub-Saharan Africa include a shortage of clinicians and training programmes, weak healthcare infrastructure, and inadequate supplies. Since 2011, Rwanda has developed a national cancer programme by designing comprehensive, integrated frameworks of care, building local human resource capacity through partnerships, and delivering equitable, rights-based care. In the 2 years since the inauguration of Rwanda's first cancer centre, more than 2500 patients have been enrolled, including patients from every district in Rwanda. Based on Rwanda's national cancer programme development, we suggest principles that could guide other nations in the development of similar cancer programmes. PMID:26248848
Kamau, Edwin; Campino, Susana; Amenga-Etego, Lucas; Drury, Eleanor; Ishengoma, Deus; Johnson, Kimberly; Mumba, Dieudonne; Kekre, Mihir; Yavo, William; Mead, Daniel; Bouyou-Akotet, Marielle; Apinjoh, Tobias; Golassa, Lemu; Randrianarivelojosia, Milijaona; Andagalu, Ben; Maiga-Ascofare, Oumou; Amambua-Ngwa, Alfred; Tindana, Paulina; Ghansah, Anita; MacInnis, Bronwyn; Kwiatkowski, Dominic; Djimde, Abdoulaye A
Mutations in the Plasmodium falciparum K13-propeller domain have recently been shown to be important determinants of artemisinin resistance in Southeast Asia. This study investigated the prevalence of K13-propeller polymorphisms across sub-Saharan Africa. A total of 1212 P. falciparum samples collected from 12 countries were sequenced. None of the K13-propeller mutations previously reported in Southeast Asia were found, but 22 unique mutations were detected, of which 7 were nonsynonymous. Allele frequencies ranged between 1% and 3%. Three mutations were observed in >1 country, and the A578S was present in parasites from 5 countries. This study provides the baseline prevalence of K13-propeller mutations in sub-Saharan Africa. PMID:25367300
Lund, Henrik Hautop
This concept paper explores a technological building block approach to the development of a flexible rehabilitation tool that may address some of the needs in sub-Saharan Africa. We briefly outline some of the health challenges that lead us to suggest a concept for physical rehabilitation solutions to address many diverse patient groups (e.g. disabled children, cardiac, and stroke patients), to be used in both urban and rural areas, to be easily used in community based rehabilitation (e.g. by community rehabilitation workers), to motivate the users, and to be robust to failure (e.g. power failure) in remote areas. The concept leads to the implementation of modular interactive tiles for rehabilitation, and suggestions for future use in sub-Saharan Africa.
Full Text Available There is a growing interest in using Information and Communication Technologies (ICTs to support poverty reduction efforts and strategies in the framework of the Millennium Development Goals (MDGs. These interest ended up revealing how much the Poverty Reduction Strategy Papers (PRSPs of many african nations have underestimated the importance of ICTs as a development tool. The fact that so little was mentionned about the use of ICTs for poverty alleviation and creation of employment highlighted the confusion, and uncertainty of decision makers. At the country level, ICT is still to be effectively integrated into national poverty alleviation and development strategies. The question then is how ICTs can help achieve those objectives. How can ICTs be used as tools to fight against poverty? Poverty is widely recognized as multidimensional, encompassing food security, health, education, rights, security and dignity, amongst others as stressed by Bachelor and al in a model showing the intricate linkages between ICTs and most PRSP goals. The link between ICTs and poverty reduction strategy is therefore not that obvious. Although, researchers and development partners involved in poverty alleviation recognize more easily the linkage between ICT and poverty reduction strategies. In any case, it is a prerequisite to have a conducive environment and country readiness for ICTs implementation. Unfortunately, in many Sub-Saharan Africa countries, there is not yet a clear and effective policy and strategy for the use of ICT.
Lees, Shelley; Kielmann, Karina; Cataldo, Fabian; Gitau-Mburu, D
In response to the human resource challenges facing African health systems, there is increasing involvement of informal care providers in HIV care. Through social and institutional interactions that occur in the delivery of HIV care, linkages between formal and informal systems of care often emerge. Based on a review of studies documenting the relationships between formal and informal HIV care in sub-Saharan Africa, we suggest that linkages can be conceptualised as either 'actor-oriented' or 'systems-oriented'. Studies adopting an actor-oriented focus examine hierarchical working relationships and communication practices among health systems actors, while studies focusing on systems-oriented linkages document the presence, absence or impact of formal inter-institutional partnership agreements. For linkages to be effective, the institutional frameworks within which linkages are formalised, as well as the ground-level interactions of those engaged in care, ought to be considered. However, to date, both actor- and system-oriented linkages appear to be poorly utilised by policy makers to improve HIV care. We suggest that linkages between formal and informal systems of care be considered across health systems, including governance, human resources, health information and service delivery in order to improve access to HIV services, enable knowledge transfer and strengthen health systems. PMID:23116123
T. P., Masere; K. J., Duffy.
Full Text Available Achieving food security is a challenge for the developed and developing world. These challenges are greater for developing nations such as in Africa because of the severity of the problems. An important aspect of this is poor agricultural productivity. Worldwide, technology is being developed to inc [...] rease agricultural production. One aspect of this is the development of predictive computer models that enable farmers to optimise crops using management decision based on simulation scenarios. Most African farmers do not have the computer resources or expertise to implement these types of technology. Even extension offices in Africa, who provide much needed advice, can be under resourced in this way. We suggest here that simpler computer models that are cheaper and easier to use need to be developed. As a first step in this process we investigate here which factors are most cost effectively managed using computer simulations in semi-arid conditions pertinent to much of sub-Saharan Africa. Factors known to be important in crop farming are planting date, sowing density, variety, weeding, soils and fertiliser. We use qualitative arguments with simulations and conclude that interactions between rainfall, soil condition and fertiliser can benefitfrom simulations and thus should help in their management.
Rispel, Laetitia C; de Sousa, César A D Palha; Molomo, Boitumelo G
The global resurgence of interest in the social determinants of health provides an opportunity for determined action on unacceptable and unjust health inequalities that exist within and between countries. This paper reviews three categories of social inclusion policies: cash-transfers; free social services; and specific institutional arrangements for programme integration in six selected countries--Botswana, Mozambique, South Africa, Ethiopia, Nigeria, and Zimbabwe. The policies were appraised as part of the Social Exclusion Knowledge Network (SEKN) set up under the auspices of the World Health Organization's Commission on Social Determinants of Health. The paper highlights the development landscape in sub-Saharan Africa and presents available indicators of the scale of inequity in the six countries. A summary of the policies appraised is presented, including whether or what the impact of these policies has been on health inequalities. Cross-cutting benefits include poverty alleviation, notably among vulnerable children and youths, improved economic opportunities for disadvantaged households, reduction in access barriers to social services, and improved nutrition intake. The impact of these benefits, and hence the policies, on health status can only be inferred. Among the policies reviewed, weaknesses or constraints were in design and implementation. The policy design weaknesses include targeting criteria, their enforcement and latent costs, inadequate participation of the community and failure to take the cultural context into account. A major weakness of most policies was the lack of a monitoring and evaluation system, with clear indicators that incorporate system responsiveness. The policy implementation weaknesses include uneven regional implementation with rural areas worst affected; inadequate or poor administrative and implementation capacity; insufficient resources; problems of fraud and corruption; and lack of involvement of civil servants, exacerbating implementation capacity problems. The key messages to sub-Saharan African governments include: health inequalities must be measured; social policies must be carefully designed and effectively implemented addressing the constraints identified; monitoring and evaluation systems need improvement; and participation of the community needs to be encouraged through conducive and enabling environments. There is a need for a strong movement by civil society to address health inequalities and to hold governments accountable for improved health and reduced health inequalities. PMID:19761083
Slutsker Laurence; Vulule John; Onyango Bernard; Rosen Daniel H; Lindblade Kim A; Siri Jose G; Wilson Mark L
Abstract Background Although sub-Saharan Africa (SSA) is rapidly urbanizing, the terms used to classify urban ecotypes are poorly defined in the context of malaria epidemiology. Lack of clear definitions may cause misclassification error, which likely decreases the accuracy of continent-wide estimates of malaria burden, limits the generalizability of urban malaria studies, and makes identification of high-risk areas for targeted interventions within cities more difficult. Accordingly, cluster...
Birner, Regina; Palaniswamy, Nethra
Acknowledging that the agricultural sector can play an important role as an engine of pro-poor growth in Sub-Saharan Africa, the purpose of this paper is to identify the factors that influence the ?political will? of governments to support this sector. The concept of ?political resources? from the political science literature is used to guide the analysis, as it combines the insights from state-centered and society-centered approaches to explain agricultural policies. Drawing on panel data co...
Macdonald, A. M.; Davies, J
Groundwater has proved the most reliable resource for meeting rural water demand in sub-Saharan Africa. There are four main hydrogeological environments in SSA. Each of these broad categories requires different methods for finding and abstracting groundwater. 1. Crystalline basement occupies 40% of the land area of SSA; 220 million people live in rural areas underlain by crystalline basement rocks. Groundwater is found where the rocks have been significantly weathered or in und...
Draper, Peter; Freytag, Andreas; Al Doyaili, Sarah
In recent years sub-Saharan Africa, notwithstanding the global financial crisis, has increased its share in global trade and investment flows. This has led to an appreciable improvement in development levels, albeit off a small base. However, these patterns are still dominated by commodity flows and investment, and remain marginal on the global stage. Increased trade and investment flows, particularly related to network services, would be of great benefit to the sub-continent. Yet many domest...
Soil fertility management in sub-Saharan Africa is complex, diverse and dynamic. Farmers' investments are determined by a wide variety of factors, including bio-physical characteristics of the environment, access to resources and the institutional, and socio-economic context of farming and livelihood making. Within this context, defining soil fertility problems in general terms is not meaningful and proposing a limited number of standard interventions, aimed at the 'average' farmer is of limi...
Caradee Y. Wright; Mary Norval; Beverley Summers; Lester Davids; Gerrie Coetzee; Matthew O. Oriowo
Photoprotection messages and SunSmart programmes exist mainly to prevent skin cancers and, more recently, to encourage adequate personal sun exposure to elicit a vitamin D response for healthy bone and immune systems. Several developed countries maintain intensive research networks and monitor solar UV radiation to support awareness campaigns and intervention development. The situation is different in sub-Saharan Africa. Adequate empirical evidence of the impact of solar UV radiation on hum...
Ungauged catchments can be found in many parts of the world, but particularly in sub-Saharan Africa. Information collected in a gauged catchment and its regionalisation to ungauged areas is crucial for water resources assessment. Especially farmers in semi-arid areas are in need of such information. Inter and intra-seasonal rainfall variability is large in these areas, and farmers depend more and more on additional surface and groundwater resources for their crop production. As a result, unde...
In the past decades, most of the countries in Sub-Saharan Africa have been affected by armed conflicts. By means of a time-series cross-sectional (TSCS) database, we attempt to measure the impact of war on a sample of 43 countries in Africa from 1950 to 2010. These conflicts, and especially civil wars, are shown to have a strong negative effect on
Eugene Sobngwi; Andre Pascal Kengne; Leopold Fezeu; Paschal Awah; Alain Lekoubou
Chronic diseases are becoming increasingly important in sub-Saharan Africa (SSA). The current density and distribution of health workforce suggest that SSA cannot respond to the growing demand for chronic disease care, together with the frequent infectious diseases. Innovative approaches are therefore needed to rapidly expand the health workforce. In this article, we discuss the evidences in support of nurse-led strategies for chronic disease management in SSA, with a focus on hypertension an...
The signatory countries of the Convention on Biological Diversity set the objective of halting the decline of biodiversity by 2010, but as the target date arrived and passed, the status of biodiversity on the planet remained dismal. With the dawn of the UN Decade for Biodiversity at the Rio+20 Earth Summit in June 2012 and as the UN Biodiversity Strategic Plan moves forward, this article contextualizes biodiversity prospects in sub-Saharan Africa by examining the history of interactions betwe...
Curry Leslie; Taylor Lauren; Chen Peggy; Bradley Elizabeth
Abstract Background Leadership is widely regarded as central to effective health-care systems, and resources are increasingly devoted to the cultivation of strong health-care leadership. Nevertheless, the literature regarding leadership capacity building has been developed primarily in the context of high-income settings. Less research has been done on leadership in low-income settings, including sub-Saharan Africa, particularly in health care, with attention to historical, political and soci...
As a result of persistent development crisis, there is anexplosive growth in the presence of multi-lateral Western NonGovernmental Organizations (NGOS) and other privately fundedcharitable organizations in the developing world, particularly in sub-Saharan Africa. Although the objective of the various developmentagencies is to reduce poverty and foster development for marginalpopulations, the effectiveness of their mission is ultimately dependent on thenderlying framework of neoliberalism. Es...
Kluth, Michael Friederich; Pilegaard, Jess
Sub-Saharan Africa constitutes a distinct security region and hosts a high proportion of fragile and failed states presiding over territories with abundant resources but no indigenous great powers! Following offensive neorealist logic, the absence of local great powers explains the continued benign neglect of the US. External influence from European powers is nonetheless significant, albeit several BRIC countries are challenging the position of the former colonial masters. In response France a...
Kodila-Tedika, Oasis; Agbor, Julius
This paper investigates the effects of religion on a broad set of development outcomes in sub-Saharan Africa. We regroup these outcomes into three broad categories, namely, development process outcomes (growth, investment, conflict, and government quality), institutional outcomes (property rights and the rule of law) and social development outcomes (social and gender protection). Using two new measures of religion religious fractionalization (RELFRAC) and religious polarization (RELPOL), al...
The study uses power relations theory to investigate existence of perceived retaliation against internal whistleblowers in Sub-Saharan Africa using evidence from employees in public institutions of Kenya. Focus was on the way perceived retaliation is related to seriousness of wrongdoing, whistleblower psychological power and management support to whistleblowers. The research design was quantitative, exploratory and analytical using cross-sectional data. Respondents were selected using simple ...
Awel, Ahmed Mohammed
This paper investigated the effect of terms of trade growth and its volatility on economic growth in Sub-Saharan Africa. I employed dynamic panel data models of difference and system GMM that could account biases associated with endogeneity of explanatory variables and problems induced by unobserved country specific characteristics. I used both net barter terms of trade and income terms of trade as a measure of terms of trade for the entire analysis of this paper. Using data from 1985 to 2010...
Barter Devra M; Agboola Stephen O; Murray Megan B; Bärnighausen Till
Abstract Background Tuberculosis (TB) is known to disproportionately affect the most economically disadvantaged strata of society. Many studies have assessed the association between poverty and TB, but only a few have assessed the direct financial burden TB treatment and care can place on households. Patient costs can be particularly burdensome for TB-affected households in sub-Saharan Africa where poverty levels are high; these costs include the direct costs of medical and non-medical expend...
Vuyst, Hugo De; Alemany, Laia; Lacey, Charles; Carla J. Chibwesha; Sahasrabuddhe, Vikrant; Banura, Cecily; Denny, Lynette; Parham, Groesbeck P.
Despite the scarcity of high quality cancer registries and lack of reliable mortality data, it is clear that human papillomavirus (HPV)-associated diseases, particularly cervical cancer, are major causes of morbidity and mortality in sub-Saharan Africa (SSA). Cervical cancer incidence rates in SSA are the highest in the world and the disease is the most common cause of cancer death among women in the region. The high incidence of cervical cancer is a consequence of the inability of most count...
Seguino, Stephanie; Were, Maureen
Researchers have linked sub-Saharan Africa's (SSA) poor growth performance in recent decades to several factors, including geography, institutions, and low returns to investment. This literature has not yet integrated the research that identifies linkages between gender, economic development, and growth, however. This paper explores the macro effects of gender, transmitted via the productive sector and in the household, in part due to the tendency for work - paid and unpaid - to be gender-seg...
Caracciolo, Francesco; Santeramo, Fabio Gaetano
During the past decade, commodities prices have risen substantially and the trend is likely to persist as attested by recent OECD-FAO projections. The recent debate has not reached a clear consensus on the effects of this trend on poverty and income inequality in LDCs, thus complicating the policy planning process. Our paper aims at analyzing the likely welfare and income inequality impacts of food price trends in three Sub-Saharan countries, namely Tanzania, Ghana and Ethiopia. Moreover, we ...
Kleemann, Linda; Lay, Jann; Nolte, Kerstin; Ott, Konrad; Thiele, Rainer; Voget-Kleschin, Lieske
For local people in sub-Saharan Africa, large land investment projects currently imply many risks and few benefits. Drawing on own ethical and economic research and using evidence from the authors' case studies in Kenya, Mali and Zambia and a new database of large-scale land acquisitions worldwide, this brief offers policy recommendations for host governments, investors and the international community so as to achieve a more favourable balance of risks and benefits in land investment projects...
Little investigation has been made to explain why women are less likely than are men to support democracy in sub-Saharan Africa. This gender difference in politics has been found in numerous studies and may hinder the much needed legitimation of democracy in this region. This paper addresses the question of whether this observed gender gap is due to the omission of social institutions related to gender inequality, something that affects women's daily life and deprives them of autonomy at home...
Migrant remittances reached $21 billion in sub-Saharan Africa (SSA) in 2008 according to the World Bank estimates. Despite these important flows, few macroeconomic studies have been conducted on this topic in SSA compared to other developing regions. The existing studies on the impact of remittances in SSA have been mostly in the form of case studies at the microeconomic level or reports. The objective of this study is to fill in this gap by investigating the impact of remittances on savings ...
Technical, vocational education, and training has remained an explosive topic because it can create a divided society in terms of education and the benefits associated with it. Internationally, it has always been a complex and controversial topic compared to the general education strand. It has presented inconsistent arguments over the years, particularly in Sub-Saharan Africa were policies have too often prescribed it as the panacea to addressing youth unemployment. On the one hand, it seems...
Kifle Gelan, Mengistu
The Sub-Saharan Africa (SSA) region is faced with limited medical personnel and healthcare services to address the many healthcare problems of the region. Poor health indicators reflect the overall decline in socio-economic development. Shortages of access to health services in the region is further complicated by the concentration of health services in urban areas, the regions multiple medical problems (over 70% of HIV/AIDS cases in the world); and the brain drain phenomenon it is estimat...
Aidt, Toke; Leon, Gabriel
We show that drought-induced changes in the intensity of riots lead to moves towards democracy in sub-Saharan Africa, and that these changes are often a result of concessions made as a result of the riots. This provides evidence that low-intensity conflict can have a substantial short-run impact on democratic change, and supports the .window of opportunity. hypothesis: droughts lead to an increase in the threat of conflict, and incumbents often respond by making democratic concessions.
The present international approach to management of transboundary animal diseases (TADs) is based on the assumption that most can be eradicated ; consequently, that is the usual objective adopted by international organizations concerned with animal health. However, for sub-Saharan Africa and southern Africa more particularly, eradication of most TADs is impossible for the foreseeable future for a variety of technical, financial and logistical ...
De Garine-Wichatitsky, Michel; Caron, Alexandre; Kock, Richard A.; Tschopp, R.; Munyeme, M.; Hofmeyr, Markus; Michel, Anita Luise
Infection of wild animals by bovine tuberculosis (bTB) is raising concern worldwide. This article reviews the current epidemiological situation, risk of emergence and control options at the wildlife-livestock-human interface in sub-Saharan Africa. In livestock, bTB has been confirmed in the majority of countries from all parts of the continent. Wildlife infection is confirmed in 7 countries from southern and eastern Africa, apparently spreading in the southern Africa region. My...
Abstract Background In a restricted sense, the resource curse is a theory that explains the inverse relationship classically seen between dependence on natural resources and economic growth. It defines a peculiar economic and political environment, epitomised by oil extraction in sub-Saharan Africa. Methods Based on secondary research and illustrations from four oil-rich geographical areas (the Niger Delta region of Nigeria, Angola, southern Chad, Southern Sudan), I propose a framework for an...
Boyd, Anders; Maylin, Sarah; Moh, Raoul; Gabillard, Delphine; Menan, Hervé; Mahjoub, Nadia; Danel, Christine; Anglaret, Xavier; Eholié, Serge Paul; Girard, Pierre-Marie; Zoulim, Fabien; Delaugerre, Constance; Lacombe, Karine
Most research in sub-Saharan Africa establishes hepatitis B infection via one-time hepatitis B surface antigen (HBsAg) testing. Of 237 HIV-infected patients from two clinical trials testing HBsAg positive (MiniVidas®), 206 (86.9%) had validated serological tests using another assay (Architect). Discrepancies could be due to inactive infection, highlighting the importance of assessing hepatitis B virus infection phase. PMID:26283522
This paper uses the data set from the fourth survey by UNIDO of manufacturing firms in Sub-Saharan Africa to identify whether foreign direct investment affects the behaviour of local firms with respect to investment, product innovation and process innovation. We look at the perception and response of 1,140 manufacturing firms in 9 sectors in 19 countries. Using Probit models the results suggest that, once controlling for firm's characteristics, there is a marked difference between perception ...
Gelb, Alan; Meyer, Christian J.; Ramachandran, Vijaya
We consider economic development of sub-Saharan Africa from the perspective of slow convergence of productivity, both across sectors and firms within sectors. Why have 'productivity enclaves', islands of high productivity in a sea of smaller low-productivity firms, not diffused more rapidly? We summarize and analyse three sets of factors: First, the poor business climate, which constraints the allocation of production factors between sectors and firms. Second, the complex political economy of...
Imam, B.M.; Koch, Steven F.
In Sub-Saharan Africa, infant, child and maternal mortalities are very high compared to other regions. We estimate a cross-country empirical model of the determinants of those mortalities. We find, similar to other studies, that in addition to per capita GDP, health and education interventions can affect mortalities, however, the effect depends on the mortality rate being modelled. Importantly, the prevalence of the adult HIV / AIDS infection rate is detrimentally impacting mortality in the S...
Sevcsik Ann-Marie; Boakye Isaac; Amuasi John; Diap Graciela; Pecoul Bernard
Abstract At a recent meeting (Sept 18, 2009) in which reasons for the limited access to artemisinin-based combination therapy (ACT) in sub-Saharan Africa were discussed, policy and market surveys on anti-malarial drug availability and accessibility in Burundi and Sierra Leone were presented in a highly interactive brainstorming session among key stakeholders across private, public, and not-for-profit sectors. The surveys, the conduct of which directly involved the national malaria control pro...
Peeters Grietens, Koen; Ribera, Joan Muela; Erhart, Annette; Hoibak, Sarah; Ravinetto, Raffaella M; Gryseels, Charlotte; Dierickx, Susan; O'Neill, Sarah; Muela, Susanna Hausmann; D'Alessandro, Umberto
Collecting blood samples from individuals recruited into clinical research projects in sub-Saharan Africa can be challenging. Strikingly, one of the reasons for participant reticence is the occurrence of local rumors surrounding blood stealing or blood selling. Such fears can potentially have dire effects on the success of research projectsfor example, high dropout rates that would invalidate the trial's resultsand have ethical implications related to cultural sensitivity and informed c...
Obstetric fistula (OF) continues to devastate the lives of women in sub-Saharan Africa. Many women with the condition are suffering in silence. They are unaware of the available treatment options or unaware of where to get treatment. Yet, the condition is treatable and preventable. Recently, many countries and nongovernmental organizations (NGOs) in the region embarked on interventions to address the impact of the condition, however, much emphasis is put to identifying and treating the exist...
Blackden, Mark; Canagarajah, Sudharshan; Klasen, Stephan; Lawson, David
The study suggests that gender inequality acts as a significant constraint to growth in sub-Saharan Africa, and that removing gender-based barriers to growth will make a substantial contribution to realizing Africas economic potential. In particular we highlight gender gaps in education, related high fertility levels, gender gaps in formal sector employment, and gender gaps in access to assets and inputs in agricultural production as particular barriers reducing the ability of women to contr...
Frank Chirowa; Stephen Atwood; Marc Van der Putten
Background: This article provided an analysis of gender inequality, health expenditure and itsrelationship to maternal mortality. Objective: The objective of this article was to explore gender inequality and its relationship with health expenditure and maternal mortality in sub-Saharan Africa (SSA). A unique analysis was used to correlate the Gender Inequality Index (GII), Health Expenditure and Maternal Mortality Ratio (MMR). The GII captured inequalities across three dimensions Reproducti...
Koethe, John R.; Douglas C. Heimburger
The twin global epidemics of HIV infection and food scarcity disproportionately affect sub-Saharan Africa, and a significant proportion of patients who require antiretroviral therapy (ART) are malnourished because of a combination of HIV-associated wasting and inadequate nutrient intake. Protein-calorie malnutrition, the most common form of adult malnutrition in the region, is associated with significant morbidity and compounds the immunosuppressive effects of HIV. A low body mass index (BMI)...
Ossa, Gonzalo; Kramer-Schadt, Stephanie; Peel, Alison J; Scharf, Anne K; Voigt, Christian C
Flying foxes (Pteropodidae) are key seed dispersers on the African continent, yet their migratory behavior is largely unknown. Here, we studied the movement ecology of the straw-colored fruit bat, Eidolon helvum, and other fruit bats by analyzing stable isotope ratios in fur collected from museum specimens. In a triple-isotope approach based on samples of two ecologically similar non-migratory pteropodids, we first confirmed that a stable isotope approach is capable of delineating between geographically distinct locations in Sub-Saharan Africa. A discriminant function analysis assigned 84% of individuals correctly to their capture site. Further, we assessed how well hydrogen stable isotope ratios (?(2)H) of fur keratin collected from non-migratory species (n = 191 individuals) records variation in ?(2)H of precipitation water in sub-Saharan Africa. Overall, we found positive, negative and no correlations within the six studied species. We then developed a reduced major axis regression equation based on individual data of non-migratory species to predict where potentially migratory E. helvum (n = 88) would come from based on their keratin ?(2)H. Across non-migratory species, ?(2)H of keratin and local water correlated positively. Based on the isoscape origin model, 22% of E. helvum were migratory, i.e. individuals had migrated over at least 250 km prior to their capture. Migratory individuals came from locations at a median distance of about 860 km from the collection site, four even from distances of at least 2,000 km. Ground-truthing of our isoscape origin model based on keratin ?(2)H of extant E. helvum (n = 76) supported a high predictive power of assigning the provenance of African flying foxes. Our study highlights that stable isotope ratios can be used to explain the migratory behavior of flying foxes, even on the isotopically relatively homogenous African continent, and with material collected by museums many decades or more than a century ago. PMID:23029206
Steyn Nelia P
Full Text Available Abstract Background During the last century we have seen wide-reaching changes in diet, nutritional status and life expectancy. The change in diet and physical activity patterns has become known as the nutrition transition. At any given time, a country or region within a country may be at different stages within this transition. This paper examines a range of nutrition-related indicators for countries in Sub-Saharan Africa (SSA and attempts to develop a typical model of a country in transition. Methods Based on the availability of data, 40 countries in SSA were selected for analysis. Data were obtained from the World Health Organisation, Demographic and Health Surveys and the Food and Agriculture Organisation of the United Nations. Multiple linear regression analysis (MLRA was used to explore the determinants of infant mortality. A six point score was developed to identify each country's stage in the nutrition transition. Results MLRA showed that underweight-for-age, protein and the percentage of exclusively breastfed infants were associated with the infant mortality rate (IMR. The majority of countries (n = 26 used in the analysis had nutrition transition scores of zero and one. Most of them had a high prevalence of infant mortality, children that were stunted or underweight-for-age, small percentages of women that were overweight and obese, and low intakes of energy, protein, and fat. Countries with the highest scores include South Africa, Ghana, Gabon, Cape Verde and Senegal which had relatively low IMRs, high levels of obesity/overweight, and low levels of underweight in women, as well as high intakes of energy and fat. These countries display classic signs of a population well established in the nutrition-related non-communicable disease phase of the nutrition transition. Conclusions Countries in SSA are clearly undergoing a nutrition transition. More than half of them are still in the early stage, while a few have reached a point where changes in dietary patterns are affecting health outcomes in a large portion of the population. Those in the early stage of the transition are especially important, since primordial prevention can still be introduced.
Adjiwanou, Vissého; N'Bouke, Afiwa
We question the positive effect of intimate partner violence on women's modern contraceptive use in sub-Saharan Africa found in previous studies. The explanations offered for this counter-intuitive result are either that women make greater efforts to avoid childbearing in conflictual relationships, or that endogeneity bias exists. Endogeneity bias stems from the inability of researchers to attribute a specific cause to one variable when they are unable to control for related missing covariates. Demographic and Health Survey data from 13 countries in sub-Saharan Africa provide evidence for the latter but not the former. Indeed, using simple probit regression models, we observe a positive relationship between intimate partner violence and modern contraceptive use in Burkina Faso, Mali, Nigeria, Tanzania, and Zimbabwe. This effect remains unchanged when controlling for various measures of women's autonomy in the household, showing that these two variables interact with contraceptive use independently. However, the use of recursive bivariate probit and Rosenbaum bounds sensitivity analysis to control for endogeneity biases erodes the initial positive effect in the five countries, although only partially in Burkina Faso. Our research shows that the previously reported findings arise from poor model specification and highlights the need for more appropriate data to assess the effect of intimate partner violence on modern contraceptive use in sub-Saharan Africa. PMID:26059986
Full Text Available Abstract Background The HIV/AIDS pandemic in sub-Saharan Africa is widely recognised as a development disaster threatening poverty reduction, economic growth and not merely a health issue. Its mitigation includes the societal-wide adoption and implementation of specific health technologies, many of which depend on functional institutions and State. Discussion Donor and International Institutions' strategies to mitigate HIV/AIDS in sub-Saharan Africa are premised on a single optimal model of the State, one which focuses on the decentralised delivery of public goods alone (such as healthcare the service delivery state. The empirical evidence, though sparse, of "successful" and "unsuccessful" sub-Saharan Africa states' performance in mitigating HIV/AIDS does not support this model. Rather, the evidence suggests an alternative model that takes a country context specific approach encompassing political power, institutional structures and the level of health technology needed. This model draws on the historical experience of East Asian countries' rapid development. Summary For international public health policies to be effective, they must consider a country tailored approach, one that advocates a coordinated strategy designed and led by the State with involvement of wider society specific to each country's particular history, culture, and level of development.
Ismaila Adamu Saidu
Full Text Available Ensuring an efficient and equitable delivery of quality assured diagnosis and treatment of tuberculosis (TB is the major drive of the TB control programme and the alternatives for incorporating preventative efforts have not yet been fully considered. The aim of the study was to examine the social determinants of TB transmission in sub-Saharan Africa. Four electronic databases (Medline, CINAHL, PubMed, and Web of Science were systematically searched to obtained relevant articles and critical appraisal skill programme tools were used to analyze data. Out 515 articles obtained from the electronic database search only 18 met the inclusion and exclusion criteria of the systematic review. The study shows that male sex, young age (25-34 years, low education, unemployment, low income, poverty, tobacco smoking, and alcohol abuse are the identified social determinants of tuberculosis in sub-Saharan Africa. Therefore, focus on social determinates of TB, adjunct to early diagnosis and successful treatment completion, can play a pivotal role in reducing the soaring levels to TB transmission in sub-Saharan Africa.
Langevang, Thilde; Gough, Katherine
Shrinking public sectors and limited opportunities for gaining formal wage employment in the private sector have resulted in entrepreneurship being promoted as a means of generating youth employment. This discourse is being widely promoted within sub-Saharan Africa despite little being known about how best to support youth employment and entrepreneurship. This paper focuses on two of the main trades which young women in sub-Saharan Africa have typically entered: hairdressing and dressmaking. Through drawing on a qualitative case study of hairdressers and seamstresses in Ghana, it is shown how the two professions have fared quite differently in recent years: whereas hairdressing has boomed, dressmaking has been stagnating. The paper shows how these diverging trajectories can be attributed to three related factors. First, globalisation has affected the two trades differently; second, their respective trade associations have reacted differently to the new constraints and opportunities generated by globalisation and their training systems have undergone different degrees of professionalisation; and third, the prestige associated with the two professions has changed affecting the aspirations of young women to enter the professions and the experiences of those that do. As the paper shows, geographers potentially have much to contribute to employment and entrepreneurship debates by providing more contextualised studies which recognise the complex interplay between globalisation, institutions and individuals in particular places and acknowledge the ensuing diverse employment experiences. Such studies are highly relevant for policymakers who are facing the difficult challenge of how to create employment and stimulate entrepreneurship in sub-Saharan Africa.
AgMIP conducted the first set of comprehensive regional integrated assessments of climate change impacts on smallholder farmers in Sub-Saharan Africa and South Asia led by researchers from the regions themselves. The project developed new methods integrating climate, crop, livestock and economic models to conduct climate change impact assessments that characterize impacts on smallholder groups. AgMIP projections of climate change impacts on agriculture are more realistic than previous assessments because they take agricultural development into account. Using the best available data and models, the assessments directly evaluated yield, income, and poverty outcomes including the effects of adaptation packages and development pathways. Results show that even with agricultural development, climate change generally will exert negative pressure on yields of smallholder farmers in Sub-Saharan Africa and South Asia. Without adaptation, climate change leads to increased poverty in some locations in Sub-Saharan Africa and South Asia compared to a future in which climate change does not occur. Adaptation can significantly improve smallholder farmer responses to climate change. AgMIP expert teams identified improved varieties, sowing practices, fertilizer application, and irrigation applications as prioritized adaptation strategies. These targeted adaptation packages were able to overcome a portion of detrimental impacts but could not compensate completely in many locations. Even in cases where average impact is near zero, vulnerability (i.e., those at risk of loss) can be substantial even when mean impacts are positive.
Clark, Shelley; Hamplová, Dana
Single motherhood in sub-Saharan Africa has received surprisingly little attention, although it is widespread and has critical implications for children's well-being. Using survival analysis techniques, we estimate the probability of becoming a single mother over women's life course and investigate the relationship between single motherhood and child mortality in 11 countries in sub-Saharan Africa. Although a mere 5 % of women in Ethiopia have a premarital birth, one in three women in Liberia will become mothers before first marriage. Compared with children whose parents were married, children born to never-married single mothers were significantly more likely to die before age 5 in six countries (odds ratios range from 1.36 in Nigeria to 2.61 in Zimbabwe). In addition, up to 50 % of women will become single mothers as a consequence of divorce or widowhood. In nine countries, having a formerly married mother was associated with a significantly higher risk of dying (odds ratios range from 1.29 in Zambia to 1.75 in Kenya) relative to having married parents. Children of divorced women typically had the poorest outcomes. These results highlight the vulnerability of children with single mothers and suggest that policies aimed at supporting single mothers could help to further reduce child mortality in sub-Saharan Africa. PMID:23839100
Vouking, Marius Zambou; Tamo, Violette Claire; Mbuagbaw, Lawrence
Buruli ulcer (BU) is a cutaneous neglected tropical disease caused by Mycobacterium ulcerans. Participation of Community Health Workers (CHWs) is an integral part of the management of BU, yet their impact has not been systematically evaluated in sub-Saharan Africa. METHODS: Our objectives were to summarize the evidence on the impact of CHWs on the control of BU in sub-Saharan Africa by looking at their recruitment, training, non-governmental support and performance. We searched the following ...
Bruno, Lars C.
This thesis looks at the differences in economic growth between Sub-Saharan Africa and East Asia in the time period from 1960 until today. Three major causes are assessed which all are attempted linked to the governments role; i) Structural causes; ii) Economic policy; and iii) Institutional causes. The main results indicate that Sub-Saharan Africa suffered from worse structural effects than East Asia; and that East Asia had a more favourable institutional environment. The role of economic p...
HELSINKI SCHOOL OF ECONOMICS (HSE) ABSTRACT International Business, Masters Thesis 24.4.2009 Elias KahlaAbstract: EFFECTS OF INSTITUTIONAL CONSTRAINTS TO FOREIGN MARKET ENTRY STRATEGIES OF FINNISH ICT-COMPANIES IN SUB-SAHARAN AFRICA Abstract: Objectives of the research The aim of this study was to examine the effects of institutional constraints to Finnish ICT companies in sub-Saharan Africa. To be more specific, the aim was to investigate using institutional theor...
Andersen, Louise Buhl
Aim: To establish an overview of school-based interventions carried out to support the health and well-being of vulnerable children in Zimbabwe and similar socio-economic contexts in sub-Saharan Africa. Methods: A literature search was carried out in Web of Knowledge using combinations of the following search terms: support, intervention, school, child, Zimbabwe, sub-Saharan Africa, health, well-being, inclusion and enrolment. A total of 12 articles were identified as relevant to the resea...
Mwai, Grace W; Gitau Mburu; Kwasi Torpey; Peter Frost; Nathan Ford; Janet Seeley
Introduction: The provision of HIV treatment and care in sub-Saharan Africa faces multiple challenges, including weak health systems and attrition of trained health workers. One potential response to overcome these challenges has been to engage community health workers (CHWs). Methodology: A systematic literature search for quantitative and qualitative studies describing the role and outcomes of CHWs in HIV care between inception and December 2012 in sub-Saharan Africa was performed in the fo...
Akachi, Yoko; Canning, David
We investigate trends in cohort infant mortality rates and adult heights in 39 developing countries since 1960. In most regions of the world improved nutrition, and reduced childhood exposure to disease, have lead to improvements in both infant mortality and adult stature. In Sub-Saharan Africa, however, despite declining infant mortality rates, adult heights have not increased. We argue that in Sub-Saharan Africa the decline in infant mortality may have been due to interventions that prevent...
Villholth, Karen G.; Ganeshamoorthy, Jegan; Rundblad, Christian M.; Knudsen, Theis S.
A simple but comprehensive framework for analysing the potential for and constraints to groundwater development for irrigated agriculture in sub-Saharan Africa is proposed. The framework, based on food value chain principles, is applied to the sub-Saharan context and a specific catchment in Tanzania, the Usangu plains, where groundwater has been proposed as a strategic resource for augmenting food production and smallholder livelihoods and to alleviate seasonal water scarcity. The novel contribu...
Yawson, Robert M.; Yawson, Ivy
This paper reviews the status of Agricultural Biotechnology in Sub-Saharan Africa. It addresses the potential economic benefits to Sub-Saharan Africa and the effect biotechnology policies may have on growth, production and poverty reduction. The extent to which agricultural biotechnology will compound or mitigate the constraints faced by smallholders/subsistence farmers is also discussed. The status of crop biotechnology research worldwide is reviewed and the influence of intellectual propert...
Paz-Zulueta, María; Llorca, Javier; Santibáñez, Miguel
This retrospective cohort study compares the utilization of prenatal care between African immigrant and native Spanish women. For 2007-2010, we identified 231 pregnant African immigrant women. The native-born population sample was obtained by simple random sampling in a 1:3 ratio. The Kessner Index (KI) and our Own Index (OI) were applied to rate prenatal care adequacy in three categories (adequate, intermediate, and inadequate). Odds ratios (ORs) were estimated using non-conditional logistic regression. Prenatal care was adequate according to the indexes (KI or OI) in 21.3 and 25.8% of North Africans and in 22.5 and 30.4% of sub-Saharan Africans. The ORs of inadequacy when adjusted for maternal age, social risk factors, and previous reproductive outcomes were 30.32 and 35.47 (KI or OI) in North and 64.43 and 67.93 in sub- Saharan Africans. These results suggest significant differences in obtaining adequate prenatal care between immigrant and native Spanish women. PMID:25138137
Agyemang, C; Bhopal, R; Bruijnzeels, M
Broad terms such as Black, African, or Black African are entrenched in scientific writings although there is considerable diversity within African descent populations and such terms may be both offensive and inaccurate. This paper outlines the heterogeneity within African populations, and discusses the strengths and limitations of the term Black and related labels from epidemiological and public health perspectives in Europe and the USA. This paper calls for debate on appropriate terminologie...
Crewe, Robin M
The threat to honeybee populations in the USA, Europe and Latin America over the past few years has received extensive media attention.Yet, very little is said about African honeybee populations, even though honeybees come from Africa.
It is broadly accepted that agricultural growth is essential for Sub-Saharan Africas development, in support of economic growth and a structural transformation of the economy towards industrialization, food security and poverty reduction. Many believe that genetically modified crops have the potential to produce higher yields in many of Sub-Saharan Africas unfavourable climatic conditions and can therefore help in providing food security to the region. While some countries in Sub-Saharan Af...
Ricardo J Soares Magalhães
Full Text Available OBJECTIVE: To determine whether blood haemoglobin concentration in preschool-age children (< 5 years of age is geographically heterogeneous in sub-Saharan Africa and describe its association with environmental variables that drive anaemia of different etiologies. METHODS: Data were obtained on 24 277 preschool-age children in western Africa (2862 cluster sites and 25 343 in eastern Africa (2999 cluster sites from the 2001-2007 Demographic and Health Surveys (DHS for sub-Saharan Africa. Cluster sites were linked to environmental information on distance to perennial water body, elevation, land surface temperature and normalized difference vegetation index (NDVI; a proxy for rainfall in a geographical information system. Statistical associations with environmental variables were determined using multivariate regression models, and the spatial dependence of haemoglobin concentration unexplained by these factors was quantified using semivariograms. FINDINGS: In eastern Africa, the lowest haemoglobin concentrations (< 70 g/l occurred in small clusters throughout the region; in western Africa, they occurred in a large cluster straddling the border between Burkina Faso and Mali. Our results show significant continent-wide associations between haemoglobin concentration and environmental variables, particularly in western Africa for land surface temperature and NDVI, and in eastern Africa for elevation. Residual spatial dependence was significant, and the magnitude was greater in western than in eastern Africa. CONCLUSION: The distribution of anaemia is driven by large-scale environmental factors, and the epidemiological drivers differ in western and eastern Africa. Strategies for anaemia control in preschool-age children in sub-Saharan Africa should be tailored to local conditions, taking into account the specific etiology and prevalence of anaemia.
Addison, Tony; Ghoshray, Atanu
Commodity price shocks are an important type of external shock and are often cited as a problem for economic growth in sub-Saharan Africa. This paper quantifies the impact of agricultural commodity price shocks using a near vector autoregressive model. The novel aspect of this model is that we define an auxiliary variable that can potentially capture the definition of a price shock that allows us to determine whether the response of per capita Gross domestic product (GDP) growth in sub-Sahara...
In the past decades, most of the countries in sub-Saharan Africa have been affected by armed conflicts. By means of a time-series cross-sectional (TSCS) database, we attempt to measure the impact of war on a sample of 43 countries in Africa from 1950 to 2010. These conflicts, and especially civil wars, are shown to have a strong negative effect on the educational performances of the countries studied. The rate of children not attending school, as well as secondary school enrollment rates, see...
Fosu, Augustin Kwasi
This study explores the extent to which inequality affects the impact of income growth on the rates of poverty changes in sub-Saharan Africa (SSA) comparatively with non-SSA, based on a global sample of 1977-2004 unbalanced panel data. For both regions and all three measures of poverty - headcount, gap, and squared gap - the paper finds the impact of GDP growth on poverty reduction as a decreasing function of initial inequality. The impacts are similar in direction for SSA and non-SSA, so tha...
Jones, Edward Samuel; Tarp, Finn
Should policy-makers, including foreign donors, focus employment strategies in sub-Saharan Africa on strengthening access to formal wage employment or on raising productivity in the informal sector? We examine the evidence in Mozambique and show that crude distinctions between formality and informality are not illuminating. The observed welfare advantage of formal sector workers essentially derives from differences in endowments and local conditions. Non-agricultural informal work can yield higher returns than formal work. The implication is that the informal sector must not be marginalized; and raising productivity in agriculture must be accorded a central place in boosting employment.
Steyn Nelia P; Mchiza Zandile; Abrahams Zulfa
Abstract Background During the last century we have seen wide-reaching changes in diet, nutritional status and life expectancy. The change in diet and physical activity patterns has become known as the nutrition transition. At any given time, a country or region within a country may be at different stages within this transition. This paper examines a range of nutrition-related indicators for countries in Sub-Saharan Africa (SSA) and attempts to develop a typical model of a country in transiti...
Corker, Jamaica; Coast, Ernestina
1. Significance/background Polygyny is rarely, if ever, included in family planning (FP) messaging in Sub-Saharan Africa, even though the region has the worlds highest rates of polygyny. In West Africa a majority of women will spend some portion of their married life in a polygynous union as a co-wife. Research on polygyny has tended to focus on the influence of polygyny on outcomes such as fertility preferences and rates and contraceptive use, and there is little consensus as to the...
Bryant, Malcolm; Beard, Jennifer
In Sub-Saharan Africa, 15.1 million children have been orphaned because of human immunodeficiency virus (HIV). They face significant vulnerabilities, including stigma and discrimination, trauma and stress, illness, food insecurity, poverty, and difficulty accessing education. Millions of additional children who have living parents are vulnerable because their parents or other relatives are infected. This article reviews the current situation of orphans and vulnerable children, explores the underlying determinants of vulnerability and resilience, describes the response by the global community, and highlights the challenges as the HIV pandemic progresses through its fourth decade. PMID:26613693
Weaver, J.N.; Landis, E.R.
Coal and peat are essentially unused and in some cases unknown in sub-Saharan Africa. However, they might comprise valuable alternative energy sources in some or all of the developing nations of the region. The 11 countries considered in this appraisal reportedly contain coal and peat. On the basis of regional geology, another five countries might also contain coal-bearing rocks. If the resource potential is adequate, coal and peat might be utilized in a variety of ways including substituting for fuelwood, generating electricity, supplying process heat for local industry and increasing agricultural productivity. -from Author
Full Text Available Abstract Background The DREAM Project operates within the framework of the national health systems of several sub-Saharan African countries and aims to introduce the essential components of an integrated strategy for the prevention and treatment of HIV/AIDS. The project is intended to serve as a model for a wide-ranging scale-up in the response to the epidemic. This paper aims to show DREAM's challenges and the solutions adopted. One of the solutions is the efficient management of the clinical data regarding the treatment of the patients and epidemiological analyses. Methods Specific software for the management of the patients' EMR has been created within the DREAM programme in order to deal with the challenges deriving from the context in which DREAM operates. Setting up a computer infrastructure in health centres, providing a power supply, as well as managing the data and the project resources efficiently and reliably, are some of the questions that have been analysed in this study. Results Over the years this software has proved that it is able to respond to the need for efficient management of the clinical data and organization of the health centres. Today it is used in 10 countries in sub-Saharan Africa by thousands of professionals and by now it has reached its fourth version. The medical files of over 73,000 assisted patients are managed by this software and the data collected with it have become essential for the epidemiological research that is carried out to improve the effectiveness of the therapy. Conclusion Sub-Saharan Africa is the region hardest hit by HIV and AIDS in the world. However, the resources and responses adopted so far, to confront the epidemic, have at times been rather minimalist. The DREAM project has faced the battle against the epidemic by equipping itself with qualitative standards comparable to Western ones. The experience of DREAM has revealed that it is indeed possible to guarantee levels of excellence in developing countries, also in the sphere of ICT (Information and Communication Technology, thus making the intervention even more effective and contributing to bridging the digital divide.
Ngo, Nicole S.; Gatari, Michael; Yan, Beizhan; Chillrud, Steven N.; Bouhamam, Kheira; Kinney, Patrick L.
Few studies examine urban air pollution in sub-Saharan Africa (SSA), yet urbanization rates there are among the highest in the world. In this study, we measured 8-hr average occupational exposure levels of fine particulate matter (PM2.5), black carbon (BC), ultra violet active-particulate matter (UV-PM), and trace elements for individuals who worked along roadways in Nairobi, specifically bus drivers, garage workers, street vendors, and women who worked inside informal settlements. We found BC and re-suspended dust were important contributors to PM2.5 levels for all study populations, particularly among bus drivers, while PM2.5 exposure levels for garage workers, street vendors, and informal settlement residents were not statistically different from each other. We also found a strong signal for biomass emissions and trash burning, which is common in Nairobi's low-income areas and open-air garages. These results suggest that the large portion of urban residents in SSA who walk along roadways would benefit from air quality regulations targeting roadway emissions from diesel vehicles, dust, and trash burning. This is the first study to measure occupational exposure to urban air pollution in SSA and results imply that roadway emissions are a serious public health concern.
Bodin, P.; Olin, S.; Pugh, T. A. M.; Arneth, A.
Food security can be defined as stable access to food of good nutritional quality. In Sub Saharan Africa access to food is strongly linked to local food production and the capacity to generate enough calories to sustain the local population. Therefore it is important in these regions to generate not only sufficiently high yields but also to reduce interannual variability in food production. Traditionally, climate impact simulation studies have focused on factors that underlie maximum productivity ignoring the variability in yield. By using Modern Portfolio Theory, a method stemming from economics, we here calculate optimum current and future crop selection that maintain current yield while minimizing variance, vs. maintaining variance while maximizing yield. Based on simulated yield using the LPJ-GUESS dynamic vegetation model, the results show that current cropland distribution for many crops is close to these optimum distributions. Even so, the optimizations displayed substantial potential to either increase food production and/or to decrease its variance regionally. Our approach can also be seen as a method to create future scenarios for the sown areas of crops in regions where local food production is important for food security.
Ngo, Nicole S.; Gatari, Michael; Yan, Beizhan; Chillrud, Steven N.; Bouhamam, Kheira; Kinneym, Patrick L.
Few studies examine urban air pollution in sub-Saharan Africa (SSA), yet urbanization rates there are among the highest in the world. In this study, we measured 8-hr average occupational exposure levels of fine particulate matter (PM2.5), black carbon (BC), ultra violet active-particulate matter (UV-PM), and trace elements for individuals who worked along roadways in Nairobi, specifically bus drivers, garage workers, street vendors, and women who worked inside informal settlements. We found BC and re-suspended dust were important contributors to PM2.5 levels for all study populations, particularly among bus drivers, while PM2.5 exposure levels for garage workers, street vendors, and informal settlement residents were not statistically different from each other. We also found a strong signal for biomass emissions and trash burning, which is common in Nairobis low-income areas and open-air garages. These results suggest that the large portion of urban residents in SSA who walk along roadways would benefit from air quality regulations targeting roadway emissions from diesel vehicles, dust, and trash burning. This is the first study to measure occupational exposure to urban air pollution in SSA and results imply that roadway emissions are a serious public health concern. PMID:26034383
Pantelic, Marija; Shenderovich, Yulia; Cluver, Lucie; Boyes, Mark
This systematic review aims to synthesise evidence on predictors of internalised HIV stigma amongst people living with HIV in sub-Saharan Africa. Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were used. Studies were identified through electronic databases, grey literature, reference harvesting and contacts with key researchers. Quality of findings was assessed through an adapted version of the Cambridge Quality Checklists. A total of 590 potentially relevant titles were identified. Seventeen peer-reviewed articles and one draft book chapter were included. Studies investigated socio-demographic, HIV-related, intra-personal and interpersonal correlates of internalised stigma. Eleven articles used cross-sectional data, six articles used prospective cohort data and one used both prospective cohort and cross-sectional data to assess correlates of internalised stigma. Poor HIV-related health weakly predicted increases in internalised HIV stigma in three longitudinal studies. Lower depression scores and improvements in overall mental health predicted reductions in internalised HIV stigma in two longitudinal studies, with moderate and weak effects, respectively. No other consistent predictors were found. Studies utilising analysis of change and accounting for confounding factors are necessary to guide policy and programming but are scarce. High-risk populations, other stigma markers that might layer upon internalised stigma, and structural drivers of internalised stigma need to be examined. PMID:25559431
Studies were performed to improve iodine deficiency control programs. Goitre rates and cassava processing practices were compared in three Central African Republic (CAR) populations. Short-cuts in cassava processing were associated with elevated urinary thiocyanate and increased goitre rates, suggesting a goitrogenic effect in one population. While improved cassava processing may be beneficial, the priority is to correct the iodine deficiency. The use of the urinary iodine/tiocyanate ratio a...
Kenfack, Joseph; Bignom, Blaise
Sub-Saharan Africa owns important renewable energy potential and is still heavily using carbon energy. This is having a negative impact on the climate and on the environment. Given the local cost of carbon energy, the purchase power of people, the availability and the reserve of carbon energy in the area, this resource is being heavily used. This practice is harmful to the climate and is also resulting on poor effort to promote renewable energy in remote areas. The important renewable energy potential is still suffering from poor development. The purpose of this paper is among other things aiming at showing the rate of carbon energy use and its potential impact on climate and environment. We will also ensure that the renewable energy resources of Central Sub-Saharan Africa are known and are subject to be used optimally to help mitigate climate change. After showing some negative impacts of carbon energy used in the area, the work also suggests actions to promote and sustain the development of renewable energy. Based on the knowledge of the Central African energy sector, this paper will identify actions for reduce access to carbon energy and improved access to sustainable, friendly, affordable energy services to users as well as a significant improvement of energy infrastructure and the promotion of energy efficiency. We will show all type of carbon energy used, the potential for solar, biomass and hydro while showing where available the level of development. After a swot analysis of the situation, identified obstacles for the promotion of clean energy will be targeted. Finally, suggestions will be made to help the region develop a vision aiming at developing good clean energy policy to increase the status of renewable energy and better contribute to fight against climate change. Cameroon case study will be examined as illustration. Analysis will be made from data collected in the field. |End Text|
Ladner, Joël; Besson, Marie-Hélène; Rodrigues, Mariana; Saba, Joseph; Audureau, Etienne
Background To evaluate the performance and to identify predictive factors of performance in prevention of mother-to-child HIV transmission programs (PMTCT) in sub-Saharan African countries. Methods From 2000 to 2011, PMTCT programs included in the Viramune Donation Programme (VDP) were prospectively followed. Each institution included in the VDP provided data on program implementation, type of management institution, number of PMTCT sites, key programs outputs (HIV counseling and testing, NVP regimens received by mothers and newborns). Nevirapine Coverage Ratio (NCR), defined as the number of women who should have received nevirapine (observed HIV prevalence x number of women in antenatal care), was used to measure performance. Included programs were followed every six months through progress reports. Results A total of 64 programs in 25 sub-Saharan African countries were included. The mean program follow-up was 48.0 months (SD = 24.5); 20,084,490 women attended in antenatal clinics were included. The overall mean NCR was 0.52 (SD = 0.25), with an increase from 0.37 to 0.57 between the first and last progress reports (p<.0001); NCR increased by 3.26% per year-program. Between the first and the last report, the number of women counseled and tested increased from 64.3% to 86.0% (p<.0001), the number of women post-counseled from 87.5% to 91.3% (p = 0.08). After mixed linear regression analysis, type of responsible institution, number of women attended in ANC, and program initiation in 2005-2006 were significant predictive factors associated with the NCR. The effect of the time period increased from earlier to later periods. Conclusion A longitudinal assessment of large PMTCT programs shows that scaling-up of programs was increased in sub-Saharan African countries. The PMTCT coverage increased throughout the study period, especially after 2006. Performance may be better for programs with a small or medium number of women attended in ANC. Identification of factors that predict PMTCT program performance may help in the development and expansion of additional large PMTCT services in sub-Saharan Africa. PMID:26098311
Rees Helen V
Full Text Available Abstract Sub-Saharan Africa carries a massive dual burden of HIV and alcohol disease, and these pandemics are inextricably linked. Physiological and behavioural research indicates that alcohol independently affects decision-making concerning sex, and skills for negotiating condoms and their correct use. More than 20 studies in Africa have reported higher occurrence of HIV among people with problem drinking; a finding strongly consistent across studies and similar among women and men. Conflation of HIV and alcohol disease in these setting is not surprising given patterns of heavy-episodic drinking and that drinking contexts are often coterminous with opportunities for sexual encounters. HIV and alcohol also share common ground with sexual violence. Both perpetrators and victims of sexual violence have a high likelihood of having drunk alcohol prior to the incident, as with most forms of violence and injury in sub-Saharan Africa. Reducing alcohol harms necessitates multi-level interventions and should be considered a key component of structural interventions to alleviate the burden of HIV and sexual violence. Brief interventions for people with problem drinking (an important component of primary health care, must incorporate specific discussion of links between alcohol and unsafe sex, and consequences thereof. Interventions to reduce alcohol harm among HIV-infected persons are also an important element in positive-prevention initiatives. Most importantly, implementation of known effective interventions could alleviate a large portion of the alcohol-attributable burden of disease, including its effects on unsafe sex, unintended pregnancy and HIV transmission.
Mohammed Ershad HUSSAIN
Full Text Available In this study, we examine the connection between economic growth and debt, with the question in mind -Is debt a burden and bad for economic growth? Employing several sophisticated statistical approaches to investigate the problem and to assess the impact of debt on economic growth in 48 countries of Sub-Saharan Africa from 1995 to 2012, we find evidence of Granger causality between debt and economic growth in 8 out of the 48 sub-Saharan countries during the period of study and validate for the existence of Debt Laffer Curve. We also study the relationship between debt and economic growth rate in Granger causality and Dynamic Arellano-Bond panel data estimation frameworks, and find evidence of a negative correlation between the two variables (Debt and GDP and confirm the findings by testing several versions of the models. Political decision and economic policy are intertwined and need to be examined carefully when implemented for economic growth and our findings lend credence to the politically unpopular austerity measures (constraints on government spending financed by borrowing. There is a limit to the economic growth rate that the government financed expenditure can bring. If the burden of debt is too high then there is a negative impact of debt on the economic growth.Keywords. Economic Growth, Debt, Laffer curve and Investments.JEL. E20, E60, E24.
Deenanath, Evanie Devi; Iyuke, Sunny; Rumbold, Karl
Recently, interest in using bioethanol as an alternative to petroleum fuel has been escalating due to decrease in the availability of crude oil. The application of bioethanol in the motor-fuel industry can contribute to reduction in the use of fossil fuels and in turn to decreased carbon emissions and stress of the rapid decline in crude oil availability. Bioethanol production methods are numerous and vary with the types of feedstock used. Feedstocks can be cereal grains (first generation feedstock), lignocellulose (second generation feedstock), or algae (third generation feedstock) feedstocks. To date, USA and Brazil are the leading contributors to global bioethanol production. In sub-Saharan Africa, bioethanol production is stagnant. During the 1980s, bioethanol production has been successful in several countries including Zimbabwe, Malawi, and Kenya. However, because of numerous challenges such as food security, land availability, and government policies, achieving sustainability was a major hurdle. This paper examines the history and challenges of bioethanol production in sub-Saharan Africa (SSA) and demonstrates the bioethanol production potential in SSA with a focus on using bitter sorghum and cashew apple juice as unconventional feedstocks for bioethanol production. PMID:22536020
Jumbe, Charles B.L. [University of Malawi, Centre for Agricultural Research and Development, Bunda College, P.O. Box 219, Lilongwe (Malawi); Msiska, Frederick B.M. [Ministry of Agriculture and Food Security, P.O. Box 30134, Lilongwe 3 (Malawi); Madjera, Michael [Evangelical Church in Middle Germany, P.O. Box 1424, 39004 Magdeburg (Germany)
This paper analyses national, regional and international biofuels policies and strategies to assess whether these policies promote or undermine the development of biofuels sector in Africa. Despite having a huge comparative advantage in land, labour and good climatic conditions favourable for the growing of energy crops, few countries in Sub-Saharan Africa have included biofuels strategies in their energy or national development policies. Further results show that while developed countries commit huge financial resources for research, technology development and the provision of tax-incentives to both producers and consumers, there is little government support for promoting biofuels in Africa. Although the consequences of biofuels on food supply remain uncertain, the mandatory blending of biofuels with fossil fuels by industrialized countries will create demand for land in Africa for the growing of energy crops for biofuels. This paper urgently calls upon national governments in Sub-Saharan Africa to develop appropriate strategies and regulatory frameworks to harness the potential economic opportunities from biofuels sector development, while protecting the environment and rural communities from the adverse effects of land alienation from the mainstream agriculture towards the growing of energy crops for biofuels at the expense of traditional food crops. (author)
Jumbe, Charles B.L., E-mail: email@example.com [University of Malawi, Centre for Agricultural Research and Development, Bunda College, P.O. Box 219, Lilongwe (Malawi); Msiska, Frederick B.M., E-mail: firstname.lastname@example.org [Ministry of Agriculture and Food Security, P.O. Box 30134, Lilongwe 3 (Malawi); Madjera, Michael, E-mail: email@example.com [Evangelical Church in Middle Germany, P.O. Box 1424, 39004 Magdeburg (Germany)
This paper analyses national, regional and international biofuels policies and strategies to assess whether these policies promote or undermine the development of biofuels sector in Africa. Despite having a huge comparative advantage in land, labour and good climatic conditions favourable for the growing of energy crops, few countries in Sub-Saharan Africa have included biofuels strategies in their energy or national development policies. Further results show that while developed countries commit huge financial resources for research, technology development and the provision of tax-incentives to both producers and consumers, there is little government support for promoting biofuels in Africa. Although the consequences of biofuels on food supply remain uncertain, the mandatory blending of biofuels with fossil fuels by industrialized countries will create demand for land in Africa for the growing of energy crops for biofuels. This paper urgently calls upon national governments in Sub-Saharan Africa to develop appropriate strategies and regulatory frameworks to harness the potential economic opportunities from biofuels sector development, while protecting the environment and rural communities from the adverse effects of land alienation from the mainstream agriculture towards the growing of energy crops for biofuels at the expense of traditional food crops.
Environmental change and sustainable development present a challenge for all nations. Developed countries have to dismantle and change historic practice before progressing, whereas developing countries can move directly to new technology and new institutional frameworks. This chapter seeks to identify trends in energy supply and use that both improve sustainability and provide opportunities for commerce and industry. Worldwide experience is studied for application in sub-Saharan Africa (abbreviated as 'Africa' henceforward). Such application is central to UNIDO's programmes in energy and environment. These programmes consider both the supply and the demand sides, by the provision of energy for industry, use of renewable energy resources and improved industrial energy end-use efficiency. Key factors are de-linking intensity of energy use from economic growth and reducing environmental damage from energy supply and use The background for this chapter is 'Sustainable Energy Regulation and Policy-making for Africa', a set of 20 training-modules produced for UNIDO and REEEP (the Renewable Energy and Energy Efficiency Partnership). The modules will be used by governments, regulatory offices and industry in Africa for stimulating policy and commercial development in renewable energy and energy efficiency. Of particular relevance is the general trend to more liberalized electricity supplies, as regulated within new legislation. Within each country, institutional frameworks can be changed and improved for the benefit of both citizens and commerce alike. There is a common trend worldwide to include institutional mechanisms for the increase of renewable energy generation and the efficient use of energy within regulatory legislation, e.g. (Harrington et al., 2007). Government involvement and ministerial regulation is most common for electricity. In all countries, the introductory stages of electricity supply have been strongly influenced by national and local government action and ownership. However, once initiated, an established market economy, involving many competitive private companies, should produce electricity at less cost to the consumer and the nation, than if wholly owned and operated by government. Such improvement requires a carefully constructed legal framework, especially because there are many monopoly aspects of electricity supply. The administration and control of the legal objectives requires jurisdiction, usually by the appointment of a Regulator with a specialist and independent staff. Thus, hand-in-hand with the liberalization of energy supplies is the requirement for regulation. Since 1990, liberalization of energy supply, especially of electricity, has been introduced throughout Europe. The main actions have been at national level; consequently, individual national policies and methods dominate. Nevertheless, having an integrated European electricity grid encourages commonality throughout Europe. Associated with liberalization is the growth of private company participation and hence the need for legally enforceable regulation by a Regulator. The pattern of development in Europe is similar to many other world regions including North America. However, European electricity supply is older and the population more concentrated than in most other regions, therefore the opportunity for structured liberalization came first in Europe. Consequently, the European experience is important for formulating policy elsewhere, including Africa. However, without competition from several private companies for each contract, liberalization may well fail to deliver the improved services and reduced energy tariffs expected; chapter three considers such experience. Coincidentally with the trend to energy supply liberalization, has come the need for renewable energy supplies and increased energy efficiency. This change is promoted by several factors, including: sustainable development, new technology, reduced emissions and climate change. New technology enables improvements in the efficient generation and use of energy, thus bri ngin
Hanson, Stefan; Hanson, Claudia
HIV control efforts in sub-Saharan Africa meet with difficulties. Incidence and prevalence remains high, and little behaviour change seems to have taken place. The focus on HIV control has shifted to anti-retroviral therapy (ART), although this is unlikely either to be cost-effective or the reduce the incidence of HIV. There is reason to change the current approach. Three questions arise: Is there a need to adjust the view on the determinants of the HIV epidemic in sub-Saharan Africa? Are the...
Byass, Peter; Calvert, Clara; Miiro-Nakiyingi, Jessica; Lutalo, Tom; Michael, Denna; Crampin, Amelia; Gregson, Simon; Takaruza, Albert; Robertson, Laura; Herbst, Kobus; Todd, Jim; Zaba, Basia
BACKGROUND: Reliable population-based data on HIV infection and AIDS mortality in sub-Saharan Africa are scanty, even though that is the region where most of the world's AIDS deaths occur. There is therefore a great need for reliable and valid public health tools for assessing AIDS mortality. OBJECTIVE: The aim of this article is to validate the InterVA-4 verbal autopsy (VA) interpretative model within African populations where HIV sero-status is recorded on a prospective basis, and examine t...
According to a growing body of literature, some orphans are at heightened risk of early sexual debut and early marriage. This study examines a rarely explored aspect of orphanhood: the timing and type of parental death and their relationship to these outcomes. The study also explores whether education mediates orphans risk of early sexual initiation and early marriage. The data are drawn from the 2004 National Survey of Adolescents, which includes interviews with 1219-year-old adolescents i...
Gerald Gabler; Steven Kaddu; Jennifer Weinberg; Carrie Kovarik
BACKGROUND: Telemedicine allows health providers in remote areas to transfer information for medical consultation anywhere in the world and serves to support local health workers through discussion and access to pertinent educational materials. Many developing nations have a dire shortage of doctors and other health resources. Therefore, affordable, easy-to-use technologies are imperative for providing care and much needed educational opportunities as well as reducing the limitations imposed ...
Moore, Ann M; Madise, Nyovani; Awusabo-Asare, Kofi
Unwanted sexual experiences are most frequently examined from the woman's perspective, yet these experiences happen to men as well. Part of the reason for the paucity of studies on coerced sexual experiences among men is the difficulty in gathering information about such experiences. This study examines the prevalence of unwanted sexual experiences at sexual debut as well as ever among young men aged 12-19 years old in Burkina Faso, Ghana, Malawi and Uganda. The data come from nationally-representative surveys and in-depth interviews with approximately 50 young men in each country gathered around 2004. Between 4 and 12% of young men stated that they were 'not willing at all' at sexual debut and between 3 and 6% said that they had ever experienced unwanted sex. Narratives from in-depth interviews give insights into the context surrounding men's unwanted sexual experiences. The sometimes conflicting information provided by the respondents serve to confound rather than illuminate the contexts within which these unwanted sexual experiences occurred, demonstrating that coercion for young men looks extremely different than coercion for young women, spurring us to improve our measures of sexual coercion among men. PMID:22943657
Claudia L. McCalman
Full Text Available Understanding patients? cultural expectations could contribute to better health outcomes and decrease cultural health disparities. This qualitative pilot study objective was to explore experiences, perceptions, and expectations of males and females Angolan students as patients in America. Eighteen face-to-face interviews were conducted at a Midwestern university. Burgoon?s expectancy violation theory (1991 was the theoretical background. Results revealed as positive expectation violations an advanced technology, quality of services, medicine availability, and emphasis on preventive care. Negative expectation violations included high service costs, complicated insurance system, short medical encounters, and difficulty in building relational history with providers. The study also revealed that culturally related communication barriers as well as negative violations of expectations hinder the quality of intercultural clinical encounters and can affect health outcomes. Participants emphasized the importance of these interpersonal relations and their connection with perceptions of caregivers? professional competence. International patients/students revealed that they believe friendliness on the part of the caregiver is a signal that they are dealing with a good doctor or nurse. Intercultural competence is an important asset of caregivers who work in multicultural clinics and in college health. Practical implications emerged in international advising and clinician?s education.
Physical infrastructures are a set of interconnected structural elements whose function is to participate in attracting capital flows in order for the economy to function efficiently. They transfer capital flows that are able to ensure growth and stability. They also constitute a major challenge for growth and development. We have attempted in this paper to study the influence of physical infrastructures and financial development on foreign direct investments (FDIs) in the context of Sub-Saha...
Full Text Available Holly Taggart,1 Sheila Greatrex-White,2 1Mental Health Commission, CentreForum, Westminster, UK; 2School of Health Sciences, Queen's Medical Centre, University of Nottingham, Nottingham, UK Aim: To identify relevant and pertinent themes and interventions within the literature relating to childhood traumatic grief, in order to provide a sound background of evidence for further research and service development. Background: Childhood traumatic grief is caused when a significant person in a child's life dies under circumstances that they perceive to be traumatic. This can leave a child unable to return to the same level of physical and emotional functioning that he or she had prior to the death occurring. In Sub-Saharan Africa, there is an increased risk for childhood traumatic grief due to a high prevalence of orphanhood, environmental stressors, stigma, and abuse. This can have detrimental effects upon mental health. Methods: The review followed the York methodology: identifying the purpose and agreeing on the strategy beforehand; identifying relevant sources/studies; selecting the studies; charting the data; and collating, summarizing, and reporting results. Results and discussion: Interventions identified to prevent and/or manage traumatic grief included narrative exposure therapy, psychotherapy, mentoring, peer-group support, psychosocial support, a grief and loss therapy session, and memory boxes. Mental health remains neglected within service and policy development as well as in global health spending. The average amount expended on mental health services per person per year in low-income countries is less than $0.25. Only 36% of people in low income countries are covered by a mental health policy, compared with 92% in high income countries. Limitations: The sixth stage of the York methodology was omitted. Only papers written in English were included in the review. Conclusion: Childhood traumatic grief in young people is an important issue within Sub-Saharan Africa and has relevance to the global mental health agenda. Implications for nursing and health policy: With the HIV/AIDS pandemic continuing to threaten and the number of orphans estimated to rise, a number of recommendations developed from the literature are suggested. Keywords: childhood traumatic grief, HIV/AIDS, interventions, mental health, orphans, scoping review, Sub-Saharan Africa, young people
Padoa, C.; Goldman, A.; Jenkins, T.; RAMSAY, M.
Cystic fibrosis (CF) is a common autosomal recessive disorder in populations of European descent. However, very little is known about CF in populations of African origin among whom it has been believed to be extremely rare. The aim of this study was to determine if this is the case or whether it is under-reported. A CFTR mutation, 3120+1G?A, which was first reported in three African-American CF patients, has been shown to account for 9-14% of African-American CF chromosomes. It has also been ...
Prevalences of dementia and cognitive impairment among older people in sub-Saharan Africa: a systematic review / : / Prevalence de la demence et des troubles cognitifs chez les personnes agees en Afrique sub-saharienne : une etude systematique / : / : / La prevalencia de la demencia y el deterioro cognitivo en las personas mayores en el Africa subsahariana: una revision sistematica
Angelique, Mavrodaris; John, Powell; Margaret, Thorogood.
Full Text Available Resumen Objetivo Realizar una revisión sistemática de la literatura sobre la prevalencia del deterioro cognitivo y la demencia en el África subsahariana. Métodos Se hicieron búsquedas en cinco bases de datos electrónicas a fin de hallar resúmenes pertinentes e identificar los documentos que cumpl [...] ieran con los requisitos para una revisión del texto completo. Los estudios se incluyeron cuando dos autores coincidían en que el diseño era de cohorte, de casos y controles o transversal y si presentaban los datos a nivel de población, si se limitaban a los adultos africanos negros mayores de 50 años o descritos como "personas mayores" o "ancianas", si incluían datos correspondientes a las personas que residen en el África subsahariana y si presentaban, al menos, un grado de deterioro cognitivo o resultados clínicos relevantes sobre el deterioro cognitivo. Se realizaron búsquedas de las referencias de los artículos incluidos en nuestro estudio a fin de identificar más publicaciones que cumplieran los requisitos, se arbitraron los desacuerdos sobre la inclusión en las discusiones que involucraban a todos los autores y se recogieron los datos de forma independiente por dos autores mediante un formulario desarrollado por los autores y probado en una muestra de trabajos. Resultados Se halló un total de 2320 documentos únicos y se revisó el texto completo de 87 de ellos. Se seleccionaron diecinueve documentos que incluían 11 estudios transversales, todos ellos publicados entre 1995 y 2011. Los estudios tuvieron lugar en Benin, Botswana, la República Centroafricana, el Congo y Nigeria, en los que se registraron aproximadamente 10 500 participantes. La prevalencia de la demencia varió del 0 % en Nigeria, al 10,1 % (intervalo de confianza del 95 %, IC: 8,06-11,08), también en Nigeria. La prevalencia del deterioro cognitivo varió del 6,3 % en Nigeria, al 25 % (IC del 95 %: 21,2 a 29,0) en la República Centroafricana. Conclusión La prevalencia de la demencia y el deterioro cognitivo en el África subsahariana variaron mucho, y fueron pocos los estudios publicados que se revelaron mediante la búsqueda bibliográfica. Abstract in english Objective To perform a systematic review of the literature on the prevalence of cognitive impairment and dementia in sub-Saharan Africa. Methods Five electronic databases were searched for relevant abstracts and to identify papers eligible for full-text review. A study was included if two authors [...] agreed that it had a cohort, casecontrol or cross-sectional design and reported population-level data; was limited to black African adults older than 50 years or described as elderly or old; reported data for individuals residing in sub-Saharan Africa; and reported at least one measure of cognitive impairment or clinical outcomes relevant to cognitive decline. References of papers included in our study were searched to identify additional candidate publications. Disagreements about inclusion were adjudicated during discussions involving all authors. Data were extracted independently by two authors, using a form developed by the authors and tested on a sample of papers. Findings A total of 2320 unique papers was found; the full text of 87 was reviewed. Nineteen papers featuring 11 cross-sectional studies were included; all were published during 19952011. Studies occurred in Benin, Botswana, the Central African Republic, the Congo and Nigeria and enrolled approximately 10?500 participants. The prevalence of dementia ranged from 0%, in Nigeria, to 10.1% (95% confidence interval, CI: 8.611.8), also in Nigeria. The prevalence of cognitive impairment ranged from 6.3%, in Nigeria, to 25% (95% CI: 21.229.0), in the Central African Republic. Conclusion Prevalences of dementia and cognitive impairment in sub-Saharan Africa varied widely, with few published studies revealed by the literature search.
Raji Abdulghafar Bello
Full Text Available Human immunodeficiency syndrome (HIV whose full-blown period is called acquired immunity deficiency syndrome (AIDS is today a terminal disease. While one weakens the body hormones, the other comes to claim the life with its accompanying opportunistic diseases. Several factors have been reviewed to be causing the infection and its prevalence as well as its socio-economic, scientific and cultural dimensions. The cost implication of this ailment is enormous when considered from individual, national or global perspective, especially when the cost of treatment and the cost of the disability adjusted life years (DALYs lost to incapacitation from HIV/AIDS is considered. This study has investigated the financial implications of treatment and the DALYs lost to HIV/AIDS from the perspective of sub-Saharan Africa covering thirty-five countries. Infected population of age 15-49 years were considered, being the active life year age group. Applying Morrows DALYs measurement, and Ainsworths per capita general rule method of costing HIV/AIDS, it was found that the cost of treatment of HIV/AIDS in any country depends on her economic strength on the one hand and the size of the infected population on the other, to the extent that no country spends or loses less than 3 percent of her national income on treatment and to DALYs. To any country, the financial cost of the DALYs lost to HIV/AIDS is much more than the cost of treatment per episode, mostly huge enough to develop a sector of the countrys economy. However, a single recommendation could be difficult as individual countries experience different effect, but different countries must pursue long-run anti-prevalence policies individually and as economic region or bloc.
Full Text Available The United Nations Millennium Development Goals (MDGs are a series of 8 goals and 18 targets aimed at ending extreme poverty by 2015, and there are 48 quantifiable indicators for monitoring the process. Most of the MDGs are health or health-related goals. Though the MDGs might sound ambitious, it is imperative that the world, and sub-Saharan Africa in particular, wake up to the persistent and unacceptably high rates of extreme poverty that populations live in, and find lasting solutions to age-old problems. Extreme poverty is a cause and consequence of low income, food insecurity and hunger, education and gender inequities, high disease burden, environmental degradation, insecure shelter, and lack of access to safe drinking water and basic sanitation. It is also directly linked to unsound governance and inequitable distribution of public wealth. While many regions in the world will strive to attain the MDGs by 2015, most of the countries in sub-Saharan Africa, with major human development challenges associated with socio-economic disparities, will not. ZambiaÃ¢ÂÂs MDG progress reports of 2003 and 2005 show that despite laudable political commitment and some advances made towards achieving universal primary education, gender equality, improvement of child health and management of the HIV/AIDS epidemic, it is not likely that Zambia will achieve even half of the goals. ZambiaÃ¢ÂÂs systems have been weakened by high disease burden and excess mortality, natural and man-made environmental threats and some negative effects of globalization such as huge external debt, low world prices for commodities and the human resource Ã¢ÂÂbrain drainÃ¢ÂÂ, among others. Urgent action must follow political will, and some tried and tested strategies or Ã¢ÂÂquick winsÃ¢ÂÂ that have been proven to produce high positive impact in the short term, need to be rapidly embarked upon by Zambia and other countries in sub-Saharan Africa if they are to achieve the Millennium Development Goals.
Although considerable achievements in the global reduction of hunger and poverty have been made, progress in Africa so far has been very limited. At present, a third of the African population faces widespread hunger and chronic malnutrition and is exposed to a constant threat of acute food crisis and famine. The most affected are rural households whose livelihood is heavily dependent on traditional rainfed agriculture. Rainfall plays a major role in determining agricultural production and hen...
Muller, Bernadette; Haller, Max
It is widely recognised that higher education is crucial for socio-economic growth in developing countries. Sub-Saharan Africa (SSA) is lagging behind in this regard in spite of a strong expansion of universities in the last decades. However, this growth may have led to a deterioration of the quality of higher education. There is no dearth of
Isabalija, Stephen Robert
Although e-medicine, just as with all information technology (IT), was developed and piloted in developed countries, it has not been successfully applied to address pressing medical problems in SSA (Mbarika & Okoli, 2003; Maher, et al., 2010). There is a lot of research that has been conducted in the last decade on telemedicine in sub-Saharan
Tadesse, T.; Haile, M.; Senay, G.; Wardlow, B.D.; Knutson, C.L.
Reducing the impact of drought and famine remains a challenge in sub-Saharan Africa despite ongoing drought relief assistance in recent decades. This is because drought and famine are primarily addressed through a crisis management approach when a disaster occurs, rather than stressing preparedness and risk management. Moreover, drought planning and food security efforts have been hampered by a lack of integrated drought monitoring tools, inadequate early warning systems (EWS), and insufficient information flow within and between levels of government in many sub-Saharan countries. The integration of existing drought monitoring tools for sub-Saharan Africa is essential for improving food security systems to reduce the impacts of drought and famine on society in this region. A proactive approach emphasizing integration requires the collective use of multiple tools, which can be used to detect trends in food availability and provide early indicators at local, national, and regional scales on the likely occurrence of food crises. In addition, improving the ability to monitor and disseminate critical drought-related information using available modern technologies (e.g., satellites, computers, and modern communication techniques) may help trigger timely and appropriate preventive responses and, ultimately, contribute to food security and sustainable development in sub-Saharan Africa. ?? 2008 United Nations.
Mtebe, Joel S.
Learning Management Systems (LMS) have been widely adopted by higher education institutions globally for over a decade. Institutions in sub-Saharan Africa now spend a significant proportion of their limited resources on installing and maintaining these systems. This expenditure continues to increase, raising questions as to whether LMS in these
Assessment of a participatory rural appraisal project in Ethiopia indicated that decentralization of extension in sub-Saharan Africa is an opportunity for farmers and extension agents to collaborate. The congruence of experiential learning and participatory approaches can contribute to the transformation of "top-down" extension approaches. (SK)
P, Pavelic; V, Smakhtin; G, Favreau; KG, Villholth.
Full Text Available Strategies for increasing the development and use of groundwater for agriculture over much of Sub-Saharan Africa (SSA) are urgently needed. Expansion of small-scale groundwater irrigation offers an attractive option to smallholder farmers to overcome unreliable wet-season rainfall and enhance dry-se [...] ason production. This paper presents a simple, generic groundwater-balance-based methodology that uses a set of type-curves to assist with decision making on the scope for developing sustainable groundwater irrigation supplies, and to help understand how cropping choices influence the potential areal extent of irrigation. Guidance to avoid over-exploitation of the resource is also provided. The methodology is applied to 2 sites in West Africa with contrasting climatic and subsurface conditions. At both sites the analysis reveals that there is significant potential for further groundwater development for irrigation whilst allowing provisions for other sectoral uses, including basic human needs and the environment.
Kluth, Michael Friederich; Pilegaard, Jess
Sub-Saharan Africa constitutes a distinct security region and hosts a high proportion of fragile and failed states presiding over territories with abundant resources but no indigenous great powers! Following offensive neorealist logic, the absence of local great powers explains the continued benign neglect of the US. External influence from European powers is nonetheless significant, albeit several BRIC countries are challenging the position of the former colonial masters. In response France and the United Kingdom (UK) have turned to European foreign and security policy integration to pool resources and promote burden sharing with other EU partners, in order to maintain power in the region. This European mobilization has kept rivals at bay but has also instigated balancing behaviour as revisionist suitors boost their conventional power projection capabilities.
This paper provides a test of the generalizability of the barriers approach (Rahat and Hazan, 2011) to the study of electoral system reform attempts. It does so by examining a set of recent attempts of electoral system change in four Sub-Saharan countries (South Africa, Lesotho, Kenya, and Zimbabwe), some of which were successful, while other were abortive. The conclusion reached is that the barriers approach is useful as a helpful framework for evaluating such reform attempts, even though it is also less convincing in some cases. Two of the barriers (actors vested interest and the superiority of the institutional status quo) appear to be more important than the other five barriers, i.e., what one would also expect from the outset.
Israëls, Trijn; Kambugu, Joyce; Kouya, Francine; El-Mallawany, Nader Kim; Hesseling, Peter B; Kaspers, Gertjan J L; Eden, Tim; Renner, Lorna; Molyneux, Elizabeth M
Over 80% of children with cancer live in low and middle-income countries where survival rates are much lower than high-income countries. Challenges to successful treatment of paediatric cancers in these countries include late presentation, malnutrition, failure to complete treatment and less-intense supportive care leading to increased treatment-related mortality and the need to reduce the intensity of treatment. Clinical trials can contribute to improved care and survival by providing objective information on the number of patients treated, accuracy of diagnosis, causes of treatment failure and the efficacy of specific interventions. Clinical trials can also help to build capacity (salary support and training), improve facilities (equipment) and fund treatment or essential associated costs (social support, nutritional support and follow-up care). In this article, we discuss our experience with clinical trials in Malawi and sub-Saharan Africa with emphasis on the treatment of children with Wilms tumour. PMID:23897077
Alberta L Wang
Full Text Available OBJECTIVE: To review the types, content and accuracy of print media reports on male circumcision for preventing HIV infection among men in sub-Saharan Africa. METHODS: We conducted a trilingual search (English, French, Portuguese of LexisNexis® with the phrase "male circumcision" for the period from 28 March 2007 to 30 June 2008. The articles identified were screened for the central theme of male circumcision for preventing HIV infection in men in sub-Saharan Africa and for publication types targeting lay audiences - newspapers, magazines, newswires or newsletters. We judged the accuracy of the reports and determined the context, public perceptions, misconceptions and areas of missing information in the print media. We also explored whether the media could be better used to maximize the impact of male circumcision. FINDINGS: We identified 412 articles, of which 219 were unique and 193 were repeats. "Peaks and valleys" occurred in the volume of articles over time. Most articles (56.0% presented male circumcision for the prevention of HIV infection in a positive light. Those that portrayed it negatively had an overall repeat rate 2.9 times higher than positive articles. Public health messages formulated by international health agencies were few but generally accurate. CONCLUSION: The accuracy of the reports was good, although the articles were few and frequently omitted important messages. This suggests that public health authorities must help the media understand important issues. A communication strategy to sequence important themes as male circumcision programmes are scaled up would allow strategic coverage of accurate messages over time.
Full Text Available Malaria is the leading cause of morbidity and mortality in Sub-Saharan Africa. One key strategic intervention is provision of early diagnosis and prompt effective treatment. A major setback has been the development of drug resistance to commonly used antimalarials. To overcome this, most countries in Sub-Saharan Africa have adopted Artemisinin Combination Therapy (ACT as a first line treatment for uncomplicated malaria. Artemether Lumefantrine (AL and Artesunate Amodiaquine (ASAQ are the main drugs of choice. There are key implementation issues, which may have a bearing on the scaling up of this new treatment. This article reviewed the published papers on ACT with focus on sustainability, compliance, and diagnosis. ACTs are costly, but highly effective. Their scaling up is the most cost effective malaria intervention currently available. Most countries rely heavily on the Global Fund for their scaling up. AL has a short shelf life, a complicated six-dose regimen that requires intake with fat to ensure sufficient bioavailability. High rates of adherence have been reported. Use of parasitic diagnosis is advocated to ensure rational use. Parasitic diagnostics like rapid test and microscopy are currently inadequate. The majority of malaria cases may continue to be diagnosed clinically leading to over prescription of drugs. ACTs are currently not available at the community level for home based management of malaria. Issues related to safety and rational use need to be addressed before their use in the informal health sector like community drug sellers and community health workers. The majority of malaria cases at the community level could go untreated or continue to be treated using less effective drugs.We conclude that ACTs are highly effective. A major challenge is ensuring rational use and access at the household level. It is hoped that addressing these issues will increase the likelihood that ACT achieves its intended goals of reducing morbidity and mortality due to malaria, and delaying the onset of drug resistance.
Schlag, Nicolai; Zuzarte, Fiona
In the developing nations of sub-Saharan Africa, providing households with modern energy services is a critical step towards development. A large majority of households in the region rely on traditional biomass fuels for cooking, which represent a significant proportion of energy used in the domestic setting. The disadvantages of these fuels are many: they are inefficient energy carriers and their heat is difficult to control; they produce dangerous emissions; and their current rate of extraction is not sustainable for forests. Transition to clean cooking fuels such as liquefied petroleum gas (LPG) or ethanol would resolve many of these issues as they do not produce dangerous particulate emissions, and are commercially viable, offering a number of socio-economic advantages over traditional options. Despite the benefits of fuel switching, clean cooking fuels are rarely used in households in sub-Saharan Africa. Their failure to attain widespread use can be attributed to a number of market barriers. One of the major issues is cost: clean cooking fuels are prohibitively expensive for many households, and the high price of compatible stoves further discourages their use. Besides the expense, many consumers are hesitant to adopt the new technology, reflecting the lack of public awareness of the relevant issues. At the same time, Africa's underdeveloped infrastructure prevents these fuels from being made available in many local marketplaces. To date, this combination of factors has largely stifled the transition to clean cooking fuels. National governments can adopt a number of strategies to address these issues. The creation of clean cooking-fuel initiatives at the national level would be an important first step, after which governments can begin to address the issues more effectively. The introduction of relevant financial instruments would help to tackle the economic barriers to clean cooking fuels, and public outreach and education could overcome socio-cultural obstacles. Through such a policy framework, national governments can play a significant role in encouraging the transition to clean cooking fuels
Full Text Available Background: This article provided an analysis of gender inequality, health expenditure and itsrelationship to maternal mortality. Objective: The objective of this article was to explore gender inequality and its relationship with health expenditure and maternal mortality in sub-Saharan Africa (SSA. A unique analysis was used to correlate the Gender Inequality Index (GII, Health Expenditure and Maternal Mortality Ratio (MMR. The GII captured inequalities across three dimensions Reproductive health, Women empowerment and Labour force participation between men and women. The GII is a composite index introduced by the UNDP in 2010 and corrects for the disadavanatges of the other gender indices. Although the GII incorporates MMR in its calculation, it should not be taken as a substitute for, but rather as complementary to, the MMR.Method: An exploratory and descriptive design to a secondary documentary review using quantitative data and qualitative information was used. The article referred to sub-Saharan Africa, but seven countries were purposively selected for an in-depth analysis based on the availability of data. The countries selected were Angola, Botswana, Malawi, Mozambique,South Africa, Zambia and Zimbabwe.Results: Countries with high gender inequality captured by the gender inequality index were associated with high maternal mortality ratios as compared with countries with lower gender inequality, whilst countries that spend less on health were associated with higher maternal deaths than countries that spend more.Conclusion: A potential relationship exists between gender inequality, health expenditure, and maternal mortality. Gender inequalities are systematic and occur at the macro, societal and household levels.
Himmelgreen, David A; Romero-Daza, Nancy; Turkon, David; Watson, Sharon; Okello-Uma, Ipolto; Sellen, Daniel
Recently a few vocal health experts have suggested that some of the billions of dollars currently used to prevent and treat HIV and AIDS be reallocated to address more basic problems such as malnutrition, tuberculosis, malaria, and enteric and diarrheal disease caused by lack of access to clean water. While not universally agreed upon, this reassessment of policy priorities acknowledges that there are multiple other health problems that deserve renewed attention from the international community. It also highlights the fact that the impacts of the HIV pandemic are exacerbated by widespread poverty, food insecurity and malnutrition, and gender inequality. Nowhere is this more evident than in sub-Saharan Africa, where multiple epidemics conflate and seriously compromise the survival of individuals and communities. Given the widespread occurrence of famine in sub-Saharan Africa, issues of food and economic security become of paramount importance in efforts to address the region's HIV epidemics. This paper examines the historical, political-economic, and cultural dimensions of the HIV epidemic in the context of the growing problem of food and economic insecurity. Furthermore, using theoretical frameworks that emphasize the dynamic interrelation between HIV/AIDS and food insecurity, we present suggestions for combining traditional HIV-prevention strategies with food production and nutritioneducation programming. In light of the complex interactions between HIV/AIDS and food insecurity and the lack of accessible treatment modalities, such programming could potentially reduce the risk for transmission of HIV through behavioural changes and improved nutritional and immune status, and increase the life expectancy of people living with HIV or AIDS. PMID:25875704
The purpose of this paper is to identify and develop potential solutions on how to facilitate the financing of bioenergy projects in Sub-Saharan Africa. We focus on four main areas that have been identified from empirical research in achieving this objective; these are: (i) financing, (ii) markets; (iii) trade and (iv) policy. The sources utilised consist of primary and secondary data compilation and analysis. Of particular relevance are the results of a market survey undertaken on funding opportunities, where the perspectives of both, project developers as well as project financiers are taken into account. Results indicate that the four areas cannot be treated autonomously, as they not only overlap but impact each other. There are a number of difficulties for biofuel ventures, not least the nature of the projects themselves, but also around the financing and political landscape of these enterprises. Common solutions which cross cut the four areas are the need to raise awareness and the skillsets, in areas including, financing opportunities, markets, policy, technical aspects among a range of stakeholders involved in biofuel ventures. There is also a necessity to create a supporting framework for the emerging carbon trading-related activities in Africa. - Highlights: ? We identify and develop potential solutions towards facilitating the financing of bioenergy projects in sub-Saharan Africa. ? We focus on four areas to achieve this objective; these are: (i) financing, (ii) markets; (iii) trade and (iv) policy. ? Common solutions which cross cut the four areas are the need to raise awareness and develop skillsets of stakeholders involved.
Zumla, Alimuddin; Petersen, Eskild; Nyirenda, Thomas; Chakaya, Jeremiah
Tuberculosis (TB) today remains a global emergency affecting 9.0 million people globally. The African Region bears the highest global TB/HIV burden and over 50% of TB cases in SSA are co-infected with HIV. An estimated 1.5 million died from the TB globally in 2013. A large majority of the 360,000 HIV-positive TB cases who died were from sub-Saharan Africa. Research and development is an important pillar of the WHO post-2015 global TB strategy. Advances in development of diagnostics, drugs, host-directed therapies, and vaccines will require evaluation under field conditions through multi-centre clinical trials at different geographical locations. Thus it is critically important that these evaluations are fully supported by all African governments and the capacity, trained staff and infrastructure required to perform the research and evaluations is built and made available. This viewpoint article reviews the opportunities provided by recently launched second programme (2015-2024) of the European & Developing Countries Clinical Trials Partnership (EDCTP2) for tackling the TB epidemic in Africa through its magnanimous portfolio. The unique opportunities provided by EDCTP2 for leadership of scientific research in TB and other diseases fully devolving to Africa are also covered. PMID:25809755
Coudray, C; Olivieri, A; Achilli, A; Pala, M; Melhaoui, M; Cherkaoui, M; El-Chennawi, F; Kossmann, M; Torroni, A; Dugoujon, J M
The mitochondrial DNA variation of 295 Berber-speakers from Morocco (Asni, Bouhria and Figuig) and the Egyptian oasis of Siwa was evaluated by sequencing a portion of the control region (including HVS-I and part of HVS-II) and surveying haplogroup-specific coding region markers. Our findings show that the Berber mitochondrial pool is characterized by an overall high frequency of Western Eurasian haplogroups, a somehow lower frequency of sub-Saharan L lineages, and a significant (but differential) presence of North African haplogroups U6 and M1, thus occupying an intermediate position between European and sub-Saharan populations in PCA analysis. A clear and significant genetic differentiation between the Berbers from Maghreb and Egyptian Berbers was also observed. The first are related to European populations as shown by haplogroup H1 and V frequencies, whereas the latter share more affinities with East African and Nile Valley populations as indicated by the high frequency of M1 and the presence of L0a1, L3i, L4*, and L4b2 lineages. Moreover, haplogroup U6 was not observed in Siwa. We conclude that the origins and maternal diversity of Berber populations are old and complex, and these communities bear genetic characteristics resulting from various events of gene flow with surrounding and migrating populations. PMID:19053990
Migrations in Africa have occurred since ancient times, but the 20th century migratory flows to Europe are a new phenomenon. After decolonization, the European economies needed cheap labor and African workers were attracted by the prospect of paying jobs. The 4 million foreigners in France comprise 7-8% of the population. Nearly 1/2 are of European origin, 1/3 are from Algeria, Tunisia, and Morocco, and about 3.5%, or 150,000 persons, are from Africa south of the Sahara. The main African countries of origin are Mali, Senegal, and Mauritania. Burkina Faso, the Ivory Coast, Togo, and Cameroon are less well represented. The migration to Europe began after World War II with small groups of Malians and Senegalese who had learned to speak French through their contact with French colonists and were readily assimilated into the labor force, mainly as skilled workers. Beginning in the late 1950s, their numbers increased rapidly. Accords signed by France, Mali, Senegal, and Mauritania in 1960 and 1963 to regularize their influx were ignored by employers needing labor and by Africans entering on tourist visas to seek work. By the early 1970s there were about 50,000 Africans in France, over 80% of them male. At about the same time immigration came to be regarded as a serious social and political problem, where before it had been little noticed. The number of immigrants had increased, especially in some neighborhoods of large cities, but not as much as generally believed. A larger proportion of families made the immigrants more visible on the streets and in the schools. The world economic recession caused the migrants to be regarded as competitors for the few jobs available. Cultural differences between the French and the immigrants increased. On the whole, North Africans are more numerous and visible, but Malians and Senegalese have become numerous enough in some Parisian neighborhoods to be perceived as a threat. Some journalists and politicians have fanned existing tensions for ideologic and electoral reasons. After 1973, France adopted an increasingly restrictive immigration policy. In 1981, 130,000 illegal immigrants were given legal status, and family regrouping was facilitated, but otherwise there has been a progressive hardening of immigration policy. An essential element of the situation is that most immigrants currently in France are there to stay. Temporary immigration has, for many of them, become permanent. Family groups are increasingly seen even among the Africans, whose situation is about as marginal as that of Portuguese or Spanish immigrants in the 1950s. A process of adaption to French society by the immigrants and to the immigrants by French society is already underway for Africans. PMID:12341902
Wittemyer, George; Daballen, David; Douglas-Hamilton, Iain
Knowledge of population processes across various ecological and management settings offers important insights for species conservation and life history. In regard to its ecological role, charisma and threats from human impacts, African elephants are of high conservation concern and, as a result, are the focus of numerous studies across various contexts. Here, demographic data from an individually based study of 934 African elephants in Samburu, Kenya were summarized, providing detailed inspec...
Deployment of community health workers across rural sub-Saharan Africa: financial considerations and operational assumptions / Déploiement des agents de santé communautaires en Afrique rurale subsaharienne: considérations financières et hypothèses opérationnelles / Despliegue de trabajadores comunitarios de la salud en zonas rurales del África subsahariana: consideraciones financieras y supuestos operativos
Gordon C, McCord; Anne, Liu; Prabhjot, Singh.
Full Text Available OBJETIVO: Facilitar asesoramiento sobre los costes necesarios para desarrollar un sistema de trabajadores comunitarios de la salud (TCS) con capacidad para adaptarse a ámbitos locales y con flexibilidad a nivel nacional, en el marco de los sistemas sanitarios de atención primaria en el África subsah [...] ariana. MÉTODOS: Se estimaron los gastos anuales para la capacitación, el equipamiento y el despliegue de los trabajadores comunitarios de la salud en las zonas rurales del África subsahariana mediante el análisis de datos procedentes de la literatura, así como del Proyecto Aldeas del Milenio. Los supuestos del modelo son adecuados para permitir a los gobiernos nacionales adaptar el subsistema de los trabajadores comunitarios de la salud a las necesidades nacionales, así como para realizar un despliegue medio de un trabajador comunitario de la salud por cada 650 habitantes en las zonas rurales antes de 2015. El subsistema de trabajadores comunitarios de la salud descrito se calculó mediante el análisis de datos del sistema de información geográfica (GIS, por sus siglas en inglés) sobre la población, los territorios urbanos, la incidencia de enfermedades a nivel nacional y subnacional, así como los costes unitarios (en el campo de salarios y necesidades básicas). El modelo puede configurarse y reproducirse con facilidad. Los países pueden adaptarlo a los precios, los salarios, la densidad demográfica, así como a la carga de enfermedades locales en distintas áreas geográficas. RESULTADOS: Se estima que el coste medio anual por el despliegue de trabajadores comunitarios de la salud para prestar atención a toda la población de las zonas rurales del África subsahariana antes de 2015 sería de unos 2,6 billones (es decir, 2 600 millones) de dólares estadounidenses (US$). Dicha suma, que será cubierta tanto por los gobiernos nacionales como por los socios donantes, se traduce en US$ 6,86 anuales por habitante, cubierta por el subsistema de trabajadores comunitarios de la salud, y en US$ 2,72 anuales por habitante. Asimismo, la capacitación, el equipamiento y el apoyo a cada TCS supondría una media anual de US$ 3750. CONCLUSIÓN: Se pueden desplegar subsistemas integrales de trabajadores comunitarios de la salud en todo el África subsahariana por un coste modesto, si se compara con los costes previstos para un sistema de atención sanitaria primaria. A juzgar por los éxitos documentados, estos ofrecen un sólido complemento para la atención en servicios sanitarios en entornos rurales de África. Abstract in english OBJECTIVE: To provide cost guidance for developing a locally adaptable and nationally scalable community health worker (CHW) system within primary-health-care systems in sub-Saharan Africa. METHODS: The yearly costs of training, equipping and deploying CHWs throughout rural sub-Saharan Africa were c [...] alculated using data from the literature and from the Millennium Villages Project. Model assumptions were such as to allow national governments to adapt the CHW subsystem to national needs and to deploy an average of 1 CHW per 650 rural inhabitants by 2015. The CHW subsystem described was costed by employing geographic information system (GIS) data on population, urban extents, national and subnational disease prevalence, and unit costs (from the field for wages and commodities). The model is easily replicable and configurable. Countries can adapt it to local prices, wages, population density and disease burdens in different geographic areas. FINDINGS: The average annual cost of deploying CHWs to service the entire sub-Saharan African rural population by 2015 would be approximately 2.6 billion (i.e. 2600 million) United States dollars (US$). This sum, to be covered both by national governments and by donor partners, translates into US$ 6.86 per year per inhabitant covered by the CHW subsystem and into US$ 2.72 per year per inhabitant. Alternatively, it would take an annual average of US$ 3750 to train, equip and support each CHW. CONCLUSION: Comprehensive CHW subsy
Comparing changes in haematologic parameters occurring in patients included in randomized controlled trials of artesunate-amodiaquine vs single and combination treatments of uncomplicated falciparum in sub-Saharan Africa
Full Text Available Abstract Background Artesunate-amodiaquine (AS&AQ is a widely used artemisinin combination therapy (ACT for falciparum malaria. A comprehensive appreciation of its effects on haematology vs other anti-malarials is needed in view of potential safety liabilities. Methods Individual-patient data analysis conducted on a database from seven randomized controlled trials conducted in sub-Saharan African comparing AS&AQ to reference treatments in uncomplicated falciparum malaria patients of all ages. Haematologic values (white cells total and neutrophil counts, haemoglobin/haematocrit, platelets were analysed as both continuous and categorical variables for their occurrence, (severity grade 1-4 and changes during follow-up. Risks and trends were calculated using multivariate logistic random effect models. Results 4,502 patients (72% p = 0.001. Multivariate analysis showed that the risk of anaemia, thrombocytopaenia, and leucopaenia decreased with follow-up time, while neutropaenia increased; the risk of anaemia and thrombocytopaenia increased with higher baseline parasitaemia and parasitological reappearance. White cells total count was not a good surrogate for neutropaenia. No systematic significant difference between treatments was detected. Older patients were at lower risks. Conclusion The effects of AS&AQ on haematologic parameters were not different from those of other anti-malarial treatments used in sub-Saharan Africa. This analysis provides the basis for a broader evaluation of haematology following anti-malarial treatment. Continuing monitoring of haematologic safety on larger databases is required.
C, Steffen; F, Debellut; BD, Gessner; FC, Kasolo; AA, Yahaya; N, Ayebazibwe; O, Bassong; Y, Cardoso; S, Kebede; S, Manoncourt; KA, Vandemaele; AW, Mounts.
Full Text Available SITUACIÓN: Existe poca información sobre la carga de morbilidad de la gripe en el África subsahariana. La vigilancia rutinaria de la gripe es clave para poder entender mejor el impacto de las infecciones respiratorias agudas en las poblaciones del África subsahariana. ENFOQUE: Se inició un proyecto [...] conocido como SISA, Strengtheninginfluenza sentinel surveillance in Africa, (Refuerzo de la vigilancia centinela de la gripe en África) en Angola, Camerún, Ghana, Nigeria, Ruanda, Senegal, Sierra Leona y Zambia para ayudar a mejorar la vigilancia centinela de la gripe, incluida la recopilación de datos epidemiológicos y virológicos, y para desarrollar mecanismos de información rutinarios a nivel nacional, regional e internacional. Estos países recibieron asistencia técnica por medio de supervisión remota y visitas directas. Los consultores trabajaron estrechamente con los ministerios de sanidad, la Organización Mundial de la Salud, los laboratorios nacionales de gripe y otros interesados relacionados con la vigilancia de la gripe. MARCO REGIONAL: Los sistemas de vigilancia de la gripe en los países objetivo se encontraban en diferentes fases de desarrollo cuando se implementó el proyecto SISA. Por ejemplo, en Senegal se había llevado a cabo la vigilancia virológica durante años, mientras que en Sierra Leona no se había realizado ninguna actividad de vigilancia. CAMBIOS IMPORTANTES: Se desarrollaron o actualizaron los documentos de trabajo, como protocolos y procedimientos de vigilancia nacional, y se organizaron cursos para el personal centinela in situ y para los administradores de datos. LECCIONES APRENDIDAS: La asistencia específica para los países puede ayudar a los mismos a reforzar la vigilancia de la gripe a nivel nacional, pero solo se puede conseguir una sostenibilidad a largo plazo con financiación externa y con un fuerte liderazgo gubernamental nacional. Abstract in english PROBLEM: Little is known about the burden of influenza in sub-Saharan Africa. Routine influenza surveillance is key to getting a better understanding of the impact of acute respiratory infections on sub-Saharan African populations. APPROACH: A project known as Strengthening Influenza Sentinel Survei [...] llance in Africa (SISA) was launched in Angola, Cameroon, Ghana, Nigeria, Rwanda, Senegal, Sierra Leone and Zambia to help improve influenza sentinel surveillance, including both epidemiological and virological data collection, and to develop routine national, regional and international reporting mechanisms. These countries received technical support through remote supervision and onsite visits. Consultants worked closely with health ministries, the World Health Organization, national influenza laboratories and other stakeholders involved in influenza surveillance LOCAL SETTING: Influenza surveillance systems in the target countries were in different stages of development when SISA was launched. Senegal, for instance, had conducted virological surveillance for years, whereas Sierra Leone had no surveillance activity at all. RELEVANT CHANGES: Working documents such as national surveillance protocols and procedures were developed or updated and training for sentinel site staff and data managers was organized. LESSONS LEARNT: Targeted support to countries can help them strengthen national influenza surveillance, but long-term sustainability can only be achieved with external funding and strong national government leadership.
Edwards, Viv; Ngwaru, Jacob Marriote
Growing interest in bilingual education in sub-Saharan Africa has highlighted an urgent need for reading material in African languages. In this paper, we focus on authors, one of several groups of stakeholders with responsibility for meeting this demand. We address three main issues: the nature and extent of African language publishing for
Mountford, Andrew; Rapoport, Hillel
According to recent UN projections more than 50 percent of the growth in world population over the next half century will be due to population growth in Africa. Given this, any policy that influences African demography will have a significant impact on the world distribution of income. In this paper we discuss the potential for migration policies to affect fertility and education decisions, and hence, population growth in Africa. We present the results from different scenarios for more or les...