Search Results (2,371)

Malaria remains a leading cause of morbidity and mortality among children in sub-Saharan Africa. Acute kidney injury (AKI) is increasingly recognized as a frequent and severe complication of pediatric severe malaria, yet it remains largely underdiagnosed. This under-recognition is driven by important limitations in current diagnostic approaches. The World Health Organization (WHO) criteria rely on fixed serum creatinine (SCr) thresholds that are poorly adapted to children, whereas Kidney Disease Improving Global Outcomes (KDIGO) criteria require baseline SCr (bSCr) values that are rarely available in low-resource settings. The estimation of bSCr using back-calculation methods is further complicated by population-specific factors, particularly malnutrition, which reduces creatinine generation and may mask kidney injury. In addition, urine output (UO) monitoring is often underutilized despite its diagnostic value, and access to laboratory testing remains limited. Emerging biomarkers such as neutrophil gelatinase-associated lipocalin (NGAL), cystatin C, and kidney injury molecule-1 (KIM-1) show promise for early detection and risk stratification but remain insufficiently validated in African pediatric populations. In this narrative review, we highlight key challenges in diagnosing malaria-associated AKI (MAKI) in children and discuss potential strategies to improve early detection in resource-limited settings, with the aim of reducing morbidity and mortality. Full article

Advances in antiretroviral therapy have transformed infection with HIV into a manageable chronic disease, increasing the survival of people living with HIV, who are also undergoing a demographic aging process marked by the emergence of non-communicable chronic diseases. This study aims to map and analyze how the scientific literature addresses the organization and integration of care in the HIV-NCD syndemic, identifying implications for nursing and for health systems. This is a Rapid Scoping Review, using the databases PubMed, Scopus, CINAHL, and LILACS. Data synthesis was conducted using Microsoft Excel. The research was structured using the PCC framework: Population—people living with HIV (≥18 years); Concept—organization and integration of care in the HIV-NCD syndemic, including care models, care coordination, service integration, and the role of nursing; and Context—health services and systems. Twenty-three studies were included, most of which used qualitative methodology, were conducted in sub-Saharan Africa, and had predominantly female samples. This study demonstrated that the organization of care in the HIV-NCD syndemic remains predominantly characterized by fragmented models, which are insufficient to address the complexity of multimorbidity. Integrated care models emerge as a promising strategy; however, their effects remain limited in settings marked by health inequalities. Full article

Informal settlements are disproportionately exposed to climate risks due to inadequate infrastructure, insecure tenure, environmental exposure, and exclusion from formal planning. Climate-resilient infrastructure (CRI) is essential for urban adaptation, but evidence about its enablement, implementation, and sustainability in informal settlements remains fragmented. This study conducts a PRISMA-guided systematic integrative review of English-language, peer-reviewed literature published between 2010 and 19 March 2026. Database searches in Scopus and Web of Science identified 1962 records. Of these, 40 studies met the final inclusion criteria. These studies were synthesised across five strategic domains: governance and institutional; community and social; financial and economic; technical and design; and knowledge, data, and digital. A rapid MMAT-based appraisal found the evidence base to be moderate to strong, though the included study designs were diverse. Technical and design responses predominate; however, their long-term effectiveness depends on governance coordination and community participation. In contrast, financial and economic strategies, as well as knowledge, data, and digital strategies, remain underdeveloped, revealing weaknesses in the enabling systems required for long-term sustainability. The evidence base is geographically uneven, with strong concentration in Sub-Saharan Africa. Overall, the review shows that CRI in informal settlements is best understood as a comprehensive process shaped by institutions, participation, and local conditions rather than as a purely technical intervention. The findings are limited by the focus on English-language, peer-reviewed studies and uneven regional coverage. However, they indicate that advancing CRI requires integrated strategies combining infrastructure design, institutional capacity, community agency, and long-term enabling systems. Full article

As a major source of investment in Africa, the rapid growth of China’s Foreign Direct Investment (FDI) in Africa has exerted a profound influence on regional development and food security. Based on multinational panel data of African countries from 2006 to 2024, this paper systematically investigates the impact, transmission mechanisms, and heterogeneous characteristics of China’s FDI on food security in Africa. The empirical results show that China’s FDI in Africa has a significant positive effect on food security. Mechanism analysis indicates that China’s FDI improves food security indirectly, mainly through upgrading infrastructure and promoting agricultural technology spillovers. Moderating effect analysis reveals that a sound governance environment and strong absorptive capacity amplify its positive impact, whereas a less diversified industrial structure (a low share of secondary industry) weakens its effectiveness. This paper provides policy implications for optimizing the layout of China’s investment in Africa and promoting the sustainable development of Africa’s food system. Full article

This study investigates the relationship between the Quasi-Biennial Oscillation (QBO) and precipitation anomalies over sub-Saharan Africa (SSA) during the December–February season (DJF season) using ERA5 reanalysis and CHIRPS observations. The ERA5 accurately reproduces CHIRPS precipitation patterns, but their QBO relationships differ: ERA5 shows QBO correlates with the second and third precipitation mode, while CHIRPS exhibits stronger correlation with the first mode. Based on CHIRPS, the net QBO effect identifies southern, central SSA, and southern Madagascar as regions sensitive to precipitation reduction, with significant phase dependence and regional heterogeneity. During the westerly QBO phase, precipitation increases over southern SSA and northern Madagascar but decreases over central SSA. During the easterly phase, drying dominates most of SSA. Southern SSA drying is primarily linked to the easterly phase, while central SSA and southern Madagascar drying is associated with the westerly phase. Diagnostic analysis reveals the westerly phase enhances ascent and moisture convergence over southern SSA, while the easterly phase induces subsidence and moisture divergence. This study reveals the differential impacts and mechanisms of various QBO phases on precipitation over SSA, clarifies the phase dependence of regional responses and their physical processes, and provides a new stratospheric predictor for understanding the driving mechanisms of precipitation variability over extratropical Africa and improving regional precipitation prediction. Full article

Background: The role of religion and faith-based organisations in public health is increasingly examined through the framework of religious health assets (RHAs), defined as resources located in or held by religious entities that may be mobilised for health and development. Within this framework, church health assets (CHAs) are conceptualised as congregationally specific expressions of RHAs, namely, the tangible and intangible resources recognised within local church settings and interpreted by church leaders as relevant to adolescent and youth sexual and reproductive health (AYSRH). Despite growing interest, there remains limited empirical work examining how such assets are perceived in relation to young people’s sexual and reproductive health, particularly from an emic perspective in sub-Saharan Africa. Aim: This study explored how pastors in South Africa’s Vaal Triangle perceive church assets relevant to AYSRH. Methods: The article presents findings from a qualitative study based on in-depth semi-structured interviews with eleven purposively selected pastors from Vanderbijlpark, Vereeniging, and Sasolburg. Data were collected between August 2019 and February 2020, prior to the COVID-19 restrictions that later altered face-to-face engagement in South Africa. Data were analysed using thematic content analysis informed by interpretive description, employing iterative coding, constant comparison, memoing, and a clearly defined audit trail. Results: The findings identified ten perceived CHAs, comprising five tangible assets, interaction spaces, community resources, normative teaching materials, networks and partnerships, and financial resources—and five intangible assets—reputation, voice on sexuality, mission and vision, a ready audience, and embodied messages. Across these themes, pastors predominantly framed AYSRH in moral and pedagogical terms, emphasising abstinence, guidance, and restoration, rather than a broader continuum encompassing information, prevention, care, rights, and service access. Conclusions: The study concludes that pastors perceive churches to possess substantial AYSRH-related assets; however, the analysis reflects perceptions rather than demonstrated implementation or measurable impact. The findings highlight both potential and limitation, indicating that the same assets may function as facilitators or barriers depending on their interpretation and application. The study contributes a pastor-centred, emic account of CHAs within a South African context and underscores the need for future multi-stakeholder research to assess how faith-sensitive AYSRH interventions operate in practice. Full article

Background: Childhood tuberculosis (TB) is a major but underappreciated threat to human health. Because diagnosis of tuberculosis in children is difficult, there are a lack of accurate global statistics. This study aimed to comprehensively assess the long-term global, regional, and age-specific burden of childhood TB from 1990 to 2021, to examine its temporal trends and socioeconomic inequalities, and to project future patterns through 2045. Methods: We used incidence and mortality data from the GBD 2021 database for TB in children ages 0–14 years from 1990 to 2021. Children were stratified into three age groups—<5, 5–9 and 10–14 years—and classified by region and Socio-Demographic Index (SDI). Multiple statistical approaches were employed, including average annual percentage change and Bayesian age-period-cohort models, to analyze spatiotemporal trends in disease burden and generate projections for the next 20 years. We used decomposition analysis to separate demographic from epidemiological drivers and concentration indices to quantify socioeconomic inequalities. Results: In 2021 there were, globally, an estimated 759,300 incident cases of childhood TB and 70,659 deaths. Since 1990, childhood TB incidence and mortality rates have declined at average annual rates of 2.61% and 4.48%, respectively. The SDI showed a significant negative correlation with both incidence and mortality of childhood TB (p < 0.05). In 2021, 78.01% of childhood TB deaths were in children under 5 years of age, and over 80% of global childhood TB deaths occurred in Sub-Saharan Africa. Epidemiological interventions were partly offset by rapid population growth in low-SDI regions. The trends show that the incidence and mortality will continue to decline through 2045, but not enough to meet the goal of eliminating childhood TB by 2035. Conclusions: Global efforts should adopt an age-specific framework that prioritizes universal preventive treatment to eliminate mortality in children under 5 years, and implements active case finding to reduce transmission chains among children 5–14 years. Sustaining the decrease in the TB burdens of low-SDI regions requires international financing strategies attuned to expanding populations to ensure epidemiological success is not erased by demographic growth. Full article

Snakebite envenoming is a major yet neglected tropical disease in sub-Saharan Africa, where antivenom efficacy is critically limited by intraspecific venom variation shaped by local ecological pressures. Nigeria’s sharply contrasting Sudan Savanna (North) and Lowland Rainforest (South) provide an ideal natural system to investigate this variation, yet a comparative analysis of its medically important snakes has been lacking. We conducted an integrated proteomic and functional characterization of venoms from the puff adder (Bitis arietans) and black-necked spitting cobra (Naja nigricollis) collected in Kaduna (North) and Ibadan (South). Using high-resolution LC-MS/MS, SDS-PAGE, and biochemical assays (phospholipase A₂, protease, fibrinogenolytic, hemolytic, and coagulation activities), we mapped region-specific venom compositions and characterized their functional activities. Bitis arietans displayed region-associated divergence: southern venom was enriched in serine proteases, whereas northern venom was dominated by lectins and distinct snake venom metalloproteinase isoforms. Naja nigricollis showed a conserved phospholipase A₂/three-finger toxins backbone, yet southern venoms exhibited elevated snake venom metalloproteinase III and L-amino acid oxidase. These molecular differences manifested functionally, with southern B. arietans venom showing higher protease activity than northern B. arietans, whereas southern and northern N. nigricollis venom exhibited similar protease activity but enhanced phospholipase A₂ activity in southern N. nigricollis. This work provides the first integrated proteomic and functional comparison of venoms from northern and southern Nigerian venom sample of B. arietans and N. nigricollis. While based on a limited number of individuals, the observed differences should be considered preliminary and indicative of potential regional trends rather than population-level characteristics. Full article

Background: Children, adolescents and young adults living with HIV represent a vulnerable population. Achieving viral suppression in this population remains a major challenge in sub-Saharan Africa. Methods: We conducted a cross-sectional study among HIV-positive individuals aged 0–24 years in Gabon. Data were collected, including viral load (VL), CD4 counts, and immunosuppression levels. Viral suppression was defined as VL < 1000 copies/mL. Statistical comparisons across age groups and immunosuppression categories were performed. Results: Of the 130 (100%) participants included, 59 (45.4%) were males and 71 (54.6%) females. Overall, 72 (55.4%) achieved viral suppression, while 58 (44.6%) remained uncontrolled. Viral suppression increased with age (23.8% (5/21) in 0–7 years; 29.2% (14/48) in 8–15 year and 42.6% (26/61) in 16–24 years), yet uncontrolled VL were predominant across all groups. Median VL values were low but showed wide interquartile ranges, indicating heterogeneity in viral control. Mean CD4 counts declined significantly with age (780 in 0–8 years vs. 470 in 16–24 years; p = 0.001). Immunosuppression levels correlated inversely with virological control (p < 0.001). Conclusions: Despite moderate overall viral suppression, nearly half of adolescents and young adults failed to achieve virological control. The decline in CD4 counts with age highlights increased vulnerability in this population. Full article

Background: Streptococcus pneumoniae, also referred to as pneumococcus, is of immense public health significance. In particular, it causes severe invasive diseases among children. This has led to the recommendation of anti-pneumococcal prophylaxis, including the administration of penicillin and pneumococcal conjugate vaccines (PCVs), which have become available in about 90% of the countries in sub-Saharan Africa. Nonetheless, breakthrough disease still occurs. Also, PCVs can cause a shift in the distribution of pneumococcal serotypes, usually towards non-vaccine types. However, in many sub-Saharan African countries where PCVs have been introduced, there are hardly any comprehensive post-vaccination surveillance data on pneumococcus. Aim: To describe the post-vaccination epidemiology of invasive pneumococcal disease (IPD) in Ghana, including the prevalence, serotype distribution and antibiotic resistance. Methods: The study was cross-sectional and involved 14,597 patients recruited at the Korle Bu Teaching Hospital, Greater Accra Regional Hospital, Princess Marie Louise Children’s Hospital, Ho Regional Hospital, Eastern Regional Hospital, and Zonal Public Health and Reference Laboratory, Tamale. Specimens of cerebrospinal fluid (obtained by lumbar puncture) and blood were collected routinely from meningitis patients, while blood specimens were taken from pneumonia patients. These were cultured for S. pneumoniae following standard microbiological methods and subjected to antimicrobial susceptibility testing. The isolates were serotyped by the pneumotest latex agglutination kit, and the results confirmed by Quellung reaction, using serotype-specific antisera. Results: The overall prevalence of IPD was 0.66% (n = 97), varying across syndromes: bloodstream infections (0.53%, n = 38), meningitis (2.45%, n = 43), and pneumonia (0.28%, n = 16). The majority of the cases (56.70%, n = 55) occurred in the 11–20-year-old group. Ten pneumococcal serotypes were identified, with Serotype 1 being predominant (58.76%), followed by Serotypes 23B (11.34%), 33F (9.28%), and 12F (8.24%). Vaccine serotypes accounted for 81.44% of the isolates, while 18.56% were non-vaccine serotypes (23A, 23B, and 38). Antimicrobial resistance was highest against sulphamethoxazole-trimethoprim (52%), ampicillin (51%), and penicillin (46%). No resistance was observed against ciprofloxacin, levofloxacin, and vancomycin. The multidrug resistance proportion was 42.3% (n = 41). Conclusions: Even in the post-vaccination era, vaccine-type IPD remains a significant public health issue in Ghana. The observed serotype distribution and antimicrobial resistance patterns warrant sustained surveillance, more adaptive vaccination policies, and rigorous antibiotic stewardship to effectively mitigate IPD burden. Full article

Background: Basic emergency care is an important component of health system strengthening in resource-limited settings in sub-Saharan Africa. Objectives: This scoping review mapped and synthesised evidence on the implementation, capacity-building approaches, and policy implications of the WHO/ICRC Basic Emergency Care (BEC) course in the region. Methods: Twenty studies from 13 countries were included. Reported facilitators of BEC implementation included perceived relevance to frontline practice, practical and structured course content, contextual adaptation, mentorship, and training-of-trainers or cascade approaches. Reported barriers included time constraints, staffing shortages, limited infrastructure and emergency care resources, and technological challenges affecting digital reinforcement strategies. Across studies, BEC was generally associated with short-term improvements in provider knowledge, confidence, and perceived competence. However, implementation outcomes were reported inconsistently and were largely limited to acceptability, feasibility, and appropriateness, with less evidence on adoption, cost, penetration, and sustainability. Evidence on longer-term retention, practice change, patient outcomes, and broader system-level impact remained limited. Conclusions: Overall, BEC appears to be a potentially useful and context-appropriate approach to strengthening frontline emergency care training, but stronger longitudinal and implementation-focused evaluations are needed. Full article

Background: In sub-Saharan Africa, missed opportunities for vaccination are a major obstacle to reaching the global target of vaccination coverage. The study’s aim was to identify the factors driving missed opportunities for vaccination indicators, including crude missed opportunities for vaccination, all corrected, uncorrected, and some corrected missed opportunities for vaccination in children aged 12–23 months in sub-Saharan Africa. Methods: This was a multilevel mixed-effects population-based cross-sectional analysis using Demographic Health Surveys and Multiple Indicators Cluster Surveys data collected from 1 January 2019 to 31 December 2023 from twenty-one countries in sub-Saharan Africa. Both multilevel mixed-effects logistic regression and multilevel multinomial logistic regression were undertaken to assess the strengths of association between missed opportunities for vaccination indicators and covariates. Results: We included a total of 23,490 children aged 12–23 months. In multilevel fixed-effects logistic regression, our findings revealed that mothers’ education levels, listening to radio, sales ‘occupation, bicycle as mode of transportation to the nearest health facility, and health insurance were all associated with lower crude missed opportunities for vaccination. In contrast, father’s primary education and watching television were associated with increased risk of missed opportunities for vaccination. In multilevel fixed-effects multinomial logistic regression, mothers’ education levels, watching television, Muslim, and health-insured children were all associated with all corrected missed opportunities for vaccination. In the same line, mothers with primary education, watching television, private health facilities as delivery place, and health-insured children were associated with some corrected missed opportunities for vaccination. In the random-effects, the intraclass correlation coefficient showed missed opportunities for vaccination variances of 18% for crude missed opportunities for vaccination and 27% for all corrected, some corrected, and uncorrected missed opportunities for vaccination between communities in SSA. Conclusions: A variety of driving factors influence MOVs indicators in children aged 12–23 months, mainly caregivers’ education, media exposure, health insurance, occupation, religion, and mode of transportation to the nearest health facility. Effective evidence-based strategies are needed to minimize the influence of barriers on missed opportunities for vaccination in children aged 12–23 months in sub-Saharan Africa. Full article

Integrated watershed management relies on distributed hydrological models to simulate water transport processes and support decision-making. However, model reliability is often constrained by the resolution and quality of input data, particularly soil information. High-resolution soil datasets remain scarce in many regions of Sub-Saharan Africa, limiting the representation of spatial soil heterogeneity in hydrological simulations. This study evaluates the effect of detailed soil information derived using the Soil–Land Inference Model (SoLIM) on the performance of the Soil and Water Assessment Tool (SWAT) in the Sigi River watershed, a topographically complex watershed in northeastern Tanzania. Two model setups were compared: (i) a high-resolution SoLIM-based soil dataset and (ii) the coarser global ISRIC SoilGrids database. The SoLIM-informed model better reproduced hydrographs and flow duration curves and showed stronger parameter sensitivities, achieving superior calibration performance (NSE = 0.87, PBIAS = 8.7%) compared to SoilGrids (NSE = 0.86, PBIAS = 11.1%). Hydrological component analysis further revealed that SoLIM enhanced baseflow (181 vs. 60 mm/year) and percolation (349 vs. 135 mm/year) while reducing surface runoff (263 vs. 474 mm/year). These findings demonstrate that high-resolution soil data measurably improve the representation of subsurface processes and moderately improve streamflow performance, especially for baseflow and low-flow regimes; reduce model uncertainty; and improve the robustness of SWAT simulations, thereby supporting more effective watershed management in data-scarce and heterogeneous landscapes. Full article

This paper investigates the role of financial institution development in promoting renewable energy generation in African economies. The paper is motivated by the increasing global emphasis on clean energy transition and the need to achieve the Sustainable Development Goals, particularly those related to affordable and clean energy and climate action. It focuses on identifying the mechanisms through which financial development influences renewable energy outcomes. Grounded in the Schumpeterian theory of finance, the paper argues that financial institutions facilitate innovation and structural transformation by allocating resources toward productive investments, including renewable energy projects. The analysis examines whether credit to the private sector serves as a mediating channel in this relationship. It also evaluates the moderating roles of institutional quality and natural resource rents. Using a Panel Autoregressive Distributed Lag (PARDL) model within a dynamic fixed-effects error correction framework, the findings reveal a nonlinear relationship. Financial institution development initially promotes renewable energy generation, but its positive effect weakens beyond a threshold of resource dependence. Institutional quality strengthens the effectiveness of financial development, while credit to the private sector fully transmits its impact on renewable energy generation. The results highlight the importance of strengthening financial systems, improving governance, and enhancing private sector credit allocation to support sustainable energy development in Africa. Full article

In sub-Saharan Africa, intensive pesticide use in irrigated agriculture is threatening the quality of soil, water bodies and ecosystem services, yet integrated risk assessments remain limited. This study evaluated the environmental implications and risks of pesticide residues in soils (0–20 cm; n = 15) and irrigation water (n = 15) from off-season irrigation area of the Goulbi Maradi Valley, Niger. Twelve commonly used pesticides in Djiratawa, Maradi 3 and Tibiri, were quantified by High-Performance Liquid Chromatography with Variable Wavelength Detector (HPLC-VWD), revealing Tibiri as a contamination hotspot, where the total pesticide residues in soil and irrigation water reached 6.4 and 19.7 times the respective European Union soil and drinking water benchmarks, dominated by Cypermethrin, Emamectin benzoate and Chlorpyrifos ethyl in soils, and Emamectin benzoate and Dichlorvos in water. Multivariate analysis showed that soil particle size, particularly higher clay content, controlled the retention of strongly sorbing compounds, while pH and salinity governed the occurrence of more soluble residues in irrigation water. While non-carcinogenic risks for Adults and Children via soil and water exposure were acceptable (Hazard Quotient and Hazard Index < 1), ecological risks were unacceptable, with Folsomia candida and Daphnia magna the most affected organisms, driven by Emamectin benzoate (Toxicity Exposure Ratio < 2). Priority actions include phasing out Dichlorvos and Paraquat dichloride, tightening controls on Emamectin benzoate and expanding food-chain monitoring, particularly in vegetables and fish, to support multi-trophic risk assessment and safer irrigation management. Full article