Search Results (144)

Cancer disparities in low- and middle-income countries (LMICs) arise from multifaceted interactions between environmental exposures, infectious agents, and systemic inequities, such as limited access to care. The exposome, a framework encompassing the totality of non-genetic exposures throughout life, offers a powerful lens for understanding these disparities. In LMICs, populations are disproportionately affected by air and water pollution, occupational hazards, and oncogenic infections, including human papillomavirus (HPV), hepatitis B virus (HBV), Helicobacter pylori (H. pylori), human immunodeficiency virus (HIV), and neglected tropical diseases, such as schistosomiasis. These infectious agents contribute to increased cancer susceptibility and poor outcomes, particularly in immunocompromised individuals. Moreover, climate change, food insecurity, and barriers to healthcare access exacerbate these risks. This review adopts a population-level exposome approach to explore how environmental and infectious exposures intersect with genetic, epigenetic, and immune mechanisms to influence cancer incidence and progression in LMICs. We highlight the critical pathways linking chronic exposure and inflammation to tumor development and evaluate strategies such as HPV and HBV vaccination, antiretroviral therapy, and environmental regulation. Special attention is given to tools such as exposome-wide association studies (ExWASs), which offer promise for exposure surveillance, early detection, and public health policy. By integrating exposomic insights into national health systems, especially in regions such as sub-Saharan Africa (SSA) and South Asia, LMICs can advance equitable cancer prevention and control strategies. A holistic, exposome-informed strategy is essential for reducing global cancer disparities and improving outcomes in vulnerable populations. Full article

Sub-Saharan Africa’s (SSA) corporate environment, like many emerging markets, is marked by institutional voids, weak oversight structures, and patriarchal leadership norms, which heighten the risk of real earnings management (REM). This study examines how CEO characteristics and audit committee gender diversity influence REM among listed manufacturing firms in 12 SSA countries from 2012 to 2023. Anchored in agency theory and Upper Echelon Theory, this study draws on 1189 firm-year observations and employs Pooled OLS, Random Effects, Fixed Effects, Feasible Generalised Least Squares (FGLS), and System GMM estimators. Findings show that female CEOs are consistently associated with lower REM, underscoring the ethical conservatism linked to gender-inclusive leadership. CEO ownership shows a positive and significant association with REM in System GMM, though findings vary across models, indicating potential institutional effects. The firm size is negatively and significantly related to REM in Pooled, RE, and FGLS models, but becomes nonsignificant in FE and System GMM, suggesting the role of external scrutiny may be sensitive to model dynamics. Leverage exhibits a positive and significant relationship with REM in most models, but turns negative and nonsignificant under System GMM, pointing to endogeneity concerns. Interaction effects and country-specific regressions affirm that governance impacts differ across contexts. Policy reforms should prioritise gender-diverse leadership and tailored oversight mechanisms. Full article

Despite having the world’s largest HIV burden, South Africa has yet to attain the 95-95-95 targets. Accurate, complete, and timely data are critical for monitoring a country’s HIV progress. The integration of unique identifier codes (UICs) for key populations (KPs) into routine health information management systems (RHIMS) strengthens data accuracy and completeness, facilitating more targeted HIV interventions and greater accountability. This systematic review assessed how Sub-Saharan African (SSA) countries have integrated KPs’ UICs into RHIMS, highlighting key enablers, challenges, and opportunities. A comprehensive search was conducted across PubMed, Scopus, Google Scholar, MEDLINE, PLOS ONE, and various government and non-government websites to identify the published and grey literature relevant to the study objective from June 2013 to December 2024. References were managed using Zotero version 6.0.36. Two authors independently screened studies using Covidence software. The review was done in accordance with the “Preferred Reporting Items for Systematic Reviews and Meta-Analyses” (PRISMA) guidelines and was registered with the “International Prospective Register of PROSPERO) Systematic Reviews” with the registration number CRD42023440656. Out of 1735 studies screened, 361 duplicates were removed. The review found that only nine of the fifty-three SSA countries have incorporated UICs for KPs into their RHIMS through alphanumeric codes. They include Burundi, Burkina Faso, Ghana, Mali, Kenya, Uganda, Togo, Malawi, and Liberia. Facilitators for KPs’ UIC adoption included strong data security and political will, whereas barriers encompassed compromised privacy, stigma and discrimination. In South Africa, the UIC for KPs can be integrated into the new electronic medical record (EMR) system. Full article

Background/Objectives: The recent Executive Order suspending the United States Agency for International Development (USAID) programmes, including Development Assistance for Health (DAH), has sparked serious debates about the sustainability of ongoing HIV/AIDS control programmes, particularly in Africa. In this study, we examined HIV/AIDS-specific DAH allocation to Africa from 1990 to 2022, and the potential effects of funding cutbacks on disease outcomes. Methods: We nested 54 countries within five sub-regions of Africa and applied linear mixed-effects models to estimate the effects of DAH on HIV/AIDS incidence and mortality rates, accounting for clustering by sub-region and potential variability due to baseline incidence and mortality and other sources of heterogeneity. Results: Total DAH allocated to Africa increased from US$534,343 in 1990 to US$5,273,264 in 2022. The United States (U.S.) public sector contributed nearly two-thirds (US$58,399,088; 63.01%) of the total funding. Most of these funds were disbursed to Southern and Eastern Sub-Saharan Africa (SSA), particularly countries with the highest HIV/AIDS burdens, including South Africa and Kenya. The fixed effects results and predicted margins indicate that, in addition to having a direct effect, U.S. public sector-specific DAH moderates the effectiveness of other international donor funding and domestic general government health spending (GHES) on HIV/AIDS incidence and mortality. Conclusions: Based on the historical trends and funding interactions, the cutback in U.S. DAH could be associated with weakening of the overall effectiveness of other donor funding and GHES. However, any future effects are contingent on African countries’ resilience to evolving challenges and resource allocation. Full article

Background: Nearly half of under-five deaths are linked to undernutrition. Most evidence on undernutrition relies on conventional anthropometric measures. Conventional anthropometric measures fail to capture its overlapping forms and are limited in providing the true burden and distinct disaggregated patterns of undernutrition. Using the Composite Index of Anthropometric Failure (CIAF), this study aims to provide updated regional and country-level pooled prevalence estimates of the overall burden and various single and coexisting patterns of undernutrition among children in Sub-Saharan Africa (SSA). Methods: We systematically searched Medline, CINAHL, Web of Science, Scopus, and Google Scholar for studies published between January 2006 and October 2023. Studies reporting the prevalence of aggregated CIAF or any of the disaggregated forms of CIAF (stunting only, wasting only, underweight only, stunting-underweight, wasting-underweight, and stunting-wasting-underweight) based on the 2006 World Health Organisation (WHO) growth standard were included. Data extraction was performed by two reviewers, and discrepancies were resolved by consensus. Pooled prevalences of various categories of undernutrition were estimated using a random effect model meta-analysis. Subgroup analysis and meta-regression were performed to identify possible sources of heterogeneity among the included studies. Publication bias was checked using the Asymmetry funnel plot and Egger’s test. The protocol was registered on PROSPERO (CRD42023458796). Result: This systematic review and meta-analysis identified 3898 published studies from the database search, of which 26 were included. In SSA, the overall pooled prevalence of undernutrition among children was 37.45% (95% Confidence Interval (CI): 31.97, 42.92). Of these, 10% (95% CI: 8.02, 11.98) of children experienced at least one coexisting form, and 25.5% (95% CI: 16.78, 33.72) experienced at least one single form of undernutrition. Stunting only [22.32% (95% CI: 18.26, 26.39)] was the most prevalent disaggregated pattern of undernutrition, followed by the coexistence of stunting with underweight [10.15% (95% CI: 8.17, 12.13)]. Conclusions: Over one in three children in SSA experienced at least one form of undernutrition. Nearly one-third of these undernourished children were affected by multiple forms of undernutrition. The high prevalence of coexisting undernutrition indicates the need to develop multi-indicator nutrition strategies that could simultaneously address the various dimensions of undernutrition in children. Full article

Background: Post-stroke cognitive impairment (PSCI) remains under-recognized in Sub-Saharan Africa (SSA), in part due to the lack of validated cognitive screening tools adapted to low-literacy populations. We aimed to validate the Identification of Dementia in Elderly Africans (IDEA) cognitive screen in SSA and assess its utility for detecting PSCI in Guinea and Cameroon. Methods: Normative IDEA scores were derived from a control cohort of healthy older adults in Conakry (Guinea) and Bafoussam (Cameroon). The tool was then applied to consecutive stroke patients from the same hospitals within one month of stroke onset. Demographic, clinical, and vascular risk profiles were collected. Between-group comparisons were performed using Welch’s t-tests and chi-square tests. Results: Among 91 healthy controls (median age: 64), the mean IDEA score was 12 ± 2.4. A cut-off of ≤7 (2 standard deviations below the mean) was defined for cognitive impairment. Among 111 stroke patients (median age: 65; mean NIHSS: 9.9 ± 5.8), the mean IDEA score was 9.6 ± 3.2, and 31 patients (28%) had scores ≤ 7. Stroke patients had significantly higher rates of hypertension and diabetes compared to controls. Conclusions: The IDEA screen appears to be a feasible and effective tool for detecting PSCI in SSA clinical settings. The 28% prevalence of cognitive impairment aligns with data from high-income countries, supporting the broader use of the IDEA to strengthen cognitive care pathways in SSA stroke populations. Full article

Globally, financial inclusion is regarded as being crucial for balancing an economy’s financial system. However, despite the significance of financial inclusion, it still needs to be clarified to identify what factors are responsible for the diverse trend of financial inclusion in the forty-five Sub-Saharan Africa (SSA) countries from 1999 to 2024. The main rationale of the study empirically investigated these determinants of financial inclusion in forty-five Sub-Saharan Africa (SSA) countries from 1999 to 2024, which covers three distinct periods: which is the pre-COVID, 2020–2022 is the COVID period, and the post-COVID period from 2023 onward, but examined as a whole from 1999 to 2024 for easy policy formulation for SSA countries. The study was anchored on two main research objectives: firstly, to examine the factors influencing financial inclusion in Sub-Saharan Africa (SSA) in these three distinct periods, and lastly, to present the policy implications of the result of these factors in enhancing financial inclusion in the post-COVID era in SSA. The study used the Panel Least Squares (PLS) technique in the data analysis. The result revealed that economic growth (GRO), Islamic banking (ISMAIC), money supply (MSS), internet users (USERS), and credit availability (CREDIT) positively and significantly enhance financial inclusion with coefficients of 0.001298, 4.926809, 1.08 × 10⁻⁶, 0.459388, and 0.657431, respectively, with significant p-values of 0.0008, 0.0023, 0.0000, 0.0000, and 0.000, respectively. On the flip side, internet servers (SERVER) have a negative coefficient value of 4.63 × 10⁻⁶ with a p-value of 0.000. Though inflation (INFL) and interest rate (INT.) have negative coefficient values of −0.02853 and −0.08317, they have insignificant p-value impacts of 0.2841 and 0.2501, respectively. The result indicates that many of the variables have a significant impact on financial inclusion. This is shown from the probabilities of the t statistics of each of the independent variables in the estimated model, which are significant at the 5% level. The policy implications of these results include the following: firstly, SSA governments should promote economic growth through investment in productive sectors, infrastructure development, and job creation programs to indirectly improve financial inclusion. Secondly, SSA countries’ policymakers should maintain price stability through sound monetary and fiscal policies to ensure inflation does not hinder access to financial services. Thirdly, SSA countries’ governments and central banks should promote lower interest rates and enhance credit accessibility, especially for marginalized groups, through subsidized loans and targeted credit schemes. Fourthly, policymakers should support the expansion of Islamic finance by improving regulatory frameworks and increasing awareness about Sharia-compliant financial products. Full article

Background: Globally, approximately 65% of adolescents undergoing antiretroviral therapy (ART) adhered to their treatment, whereas only 55% achieved viral suppression in 2023. The low rate of viral suppression is concerning, as elevated viral loads are associated with a heightened risk of opportunistic infections, progression to advanced HIV disease, increased mortality, and greater HIV transmission rates. We conducted this scoping review to identify the facilitators and barriers to ART adherence among adolescents and young adults (AYAs) in sub-Saharan Africa (SSA). Methods: We conducted this scoping review following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis extension for Scoping Reviews (PRISMA-ScR) checklist. We searched for peer-reviewed articles published in English from 2014 to 2024 across the SCOPUS, ScienceDirect, PubMed, Africa Journals Online, and Google Scholar databases. Two reviewers independently selected the articles and extracted the data. We used NVivo to develop codes and categories of facilitators and barriers. Results: We used 30 articles reporting on studies conducted in 13 countries in this review. The total number of participants in the studies was 12,250. Sixteen articles reported on qualitative studies, nine on quantitative studies, and five on mixed-methods studies. This scoping review identified various personal (14 articles), interpersonal and social (15 articles), healthcare system-related (9 articles), medication-related (7 articles), and economic (2 articles) factors that facilitate ART adherence among AYAs. Additionally, the scoping review also identified various personal (28 articles), interpersonal and social (13 articles), healthcare system-related (14 articles), medication-related (20 articles), school- or work-related (6 articles), and economic (14 articles) factors that hinder ART adherence among AYAs. Conclusions: Enhancing ART adherence in AYAs requires multiple strategies, including the reduction of internalized stigma, implementation of community awareness campaigns, harm reduction approaches for AYAs who misuse substances, comprehensive education on HIV, and the provision of support from school staff and leadership, alongside the adoption of differentiated service delivery (DSD), which encompasses home-based ART delivery, refills at private pharmacies, community ART distribution centers, and patient-led community ART refill groups, as well as multi-month dispensing practices. Full article

Vaccine preventable diseases remain the leading causes of death among children in Sub-Saharan Africa. Background/Objectives: As vaccines provide the best possible protection only when all required doses are received, it is essential to understand how the published literature is designed and conducted regarding the completion of recommended childhood vaccine series for children aged 12–23 months in SSA. Methods: A comprehensive search was conducted across five databases (PubMed, Embase, CINAHL, Web of Science, and Google Scholar) to identify the relevant literature published between January 2000 through December 2023. Results: A total of 53 studies meeting the inclusion criteria were identified from the five databases. Over half of the studies used a cross-sectional design (n = 32, 60.4%), and less than half of the studies were conducted in Ethiopia (n = 23, 43.4%). The prevalence and associated factors of vaccination series completion were the most commonly explored topics in the literature. The most frequently reported factors associated with vaccine series completion included the caregiver’s education level, household wealth status, number of children under five in the household, knowledge of immunization, maternal education, place of residence, gender of the household head or decision maker, utilization of antenatal or postnatal care visits, place of delivery, distance to a healthy facility or travel time, and possession of a vaccination card. Conclusions: This scoping review identified methodological gaps in the published literature, including a lack of publications from many Sub-Saharan Africa countries and insufficient evidence on trends and inequalities in vaccine series completion. Future research on vaccine series completion is recommended to address these gaps. Full article

This study investigates the relationship between citizens’ perceptions of government socio-economic performance and support for democracy in sub-Saharan Africa (SSA), examining the moderating effect of urbanization rates. A quantitative approach was employed, using Afrobarometer survey data from 32 SSA countries; the research applies a moderation analysis to test these relationships. According to our findings, there is a negative association between perceived socio-economic performance and democratic support in SSA, which is contrary to modernization theory. Furthermore, urbanization rates significantly moderate this relationship, with the negative impact intensifying at higher urbanization levels. These findings suggest growing disillusionment with democracy’s ability to deliver socio-economic benefits in SSA, particularly in rapidly urbanizing areas where expectations may be higher. The study highlights the need to reconsider democratization dynamics in developing regions and underscores the importance of context-specific factors in shaping democratic attitudes. The findings suggest a need for governments and international organizations to focus on improving governance quality and service delivery, especially in urban areas, to maintain democratic support. Full article

Antimicrobial resistance (AMR) poses a significant threat to human, animal, and public health, particularly in Sub-Saharan Africa (SSA), where the beef sector is vital to food security and livelihoods. We conducted a scoping review to explore the determinants and impacts of AMR within the beef value chain in SSA, highlighting the challenges and progress in mitigating AMR risks in livestock production. This review identifies key factors contributing to AMR, including the overuse and misuse of antimicrobials, inadequate veterinary oversight, and weak regulatory frameworks. These practices are prevalent across various stages of the beef value chain, from farm to slaughterhouse, and are exacerbated by informal markets and insufficient infrastructure. Our findings also highlight the role of environmental factors, such as contamination of feed, water, and manure, in the spread of resistant pathogens. Additionally, gaps in AMR surveillance, education, and enforcement limit effective control measures in the region. While efforts to combat AMR have gained momentum in some countries, including the development of national action plans and surveillance systems, substantial challenges remain. These include poor adherence to antimicrobial guidelines, insufficient veterinary training, and the lack of integration between sectors. There is a need for targeted research to better understand antimicrobial misuse, socio-economic drivers, and the environmental pathways of AMR, as well as the need for stronger regulatory frameworks and cross-border cooperation. Addressing these challenges will be essential to safeguarding food safety, public health, and the sustainability of the beef industry in SSA. Full article

As countries worldwide endeavor to fulfill the United Nations Sustainable Development Goal (SDG) 10, which emphasizes reducing inequality, there is a growing imperative to utilize tax policy and institutions to accomplish this objective. Hence, this study is inspired by this rationale. The aim of this study is to assess the relationship between effective VAT (calculated as total VAT revenues divided by final consumption, which reflects the economic incidence of the tax rather than its legal definition), institution index, and income inequality. To achieve this objective, this study uses the system generalized method of moments (SGMM) for 35 Sub Saharan Africa countries from 1995 to 2021. The results show that effective VAT increases income inequality in both the short and long run. However, the effect of the long run is greater than that of the short run. Furthermore, the results reveal that institutional quality reinforced the positive effect of effective value added tax on income inequality in both the short and long run, with the long run being more pronounced than the short run. This suggests that effective VAT policies and institutional quality applied in this study augment income inequality. Additionally, it is also noticed that ethnic fragmentation impedes effective VAT to lower income disparity in the short and long run in SSA. Hence, a relevant policy to strengthen the tax system and improve institutional quality should be given priority in SSA. Full article

The Fourth Industrial Revolution (4IR) has significantly impacted healthcare, including sexually transmitted infection (STI) management in Sub-Saharan Africa (SSA), particularly among key populations (KPs) with limited access to health services. This review investigates 4IR technologies, including artificial intelligence (AI) and machine learning (ML), that assist in diagnosing, treating, and managing STIs across SSA. By leveraging affordable and accessible solutions, 4IR tools support KPs who are disproportionately affected by STIs. Following systematic review guidelines using Covidence, this study examined 20 relevant studies conducted across 20 SSA countries, with Ethiopia, South Africa, and Zimbabwe emerging as the most researched nations. All the studies reviewed used secondary data and favored supervised ML models, with random forest and XGBoost frequently demonstrating high performance. These tools assist in tracking access to services, predicting risks of STI/HIV, and developing models for community HIV clusters. While AI has enhanced the accuracy of diagnostics and the efficiency of management, several challenges persist, including ethical concerns, issues with data quality, and a lack of expertise in implementation. There are few real-world applications or pilot projects in SSA. Notably, most of the studies primarily focus on the development, validation, or technical evaluation of the ML methods rather than their practical application or implementation. As a result, the actual impact of these approaches on the point of care remains unclear. This review highlights the effectiveness of various AI and ML methods in managing HIV and STIs through detection, diagnosis, treatment, and monitoring. The study strengthens knowledge on the practical application of 4IR technologies in diagnosing, treating, and managing STIs across SSA. Understanding this has potential to improve sexual health outcomes, address gaps in STI diagnosis, and surpass the limitations of traditional syndromic management approaches. Full article

Introduction: Undernutrition in low- and middle-income countries (LMICs) remains a leading public health challenge. It accounts for one-third of the under-five mortality rate in sub-Saharan Africa (SSA). This study applied the composite index of anthropometric failure (CIAF) to assess the prevalence of various standalone and coexisting forms of undernutrition and identify associated risk factors. Methods: Nationally representative demographic health survey (DHS) data from 26 SSA countries were used. A multilevel multinomial logistic regression analysis was conducted considering the hierarchical nature of DHS data and more than two categories of outcome variable. Four models were fitted and the model with the highest log-likelihood and lowest deviance was chosen as the best-fitted model. The adjusted relative risk ratio (aRRR) with its corresponding 95% confidence interval (CI) was presented as a measure of the effect. Results: The overall prevalence of undernutrition among under-five children in SSA was 34.59% (95% CI: 34.35–34.82). Additionally, 20.49% (95% CI: 20.30–20.69) and 14.09% (95% CI: 13.92–14.26) of under-five children had standalone and coexisting undernutrition, respectively. The mother’s educational level and household wealth status were the most significant shared drivers for standalone and coexisting undernutrition. On the other hand, child and health service factors were differentiating factors between standalone and coexisting undernutrition. Age of the child, sex of the child, type of birth, birth weight, adherence to age-appropriate feeding, antenatal care visit (ANC), place of delivery, and maternal educational status were the most significant determinants of various undernutrition forms in 0–23-month-old children. For 24–59-month-old children, age of the child, sex of the child, type of birth, household wealth status, and maternal education were identified as the main determinants of different forms of undernutrition. Conclusions: Our analysis revealed that distal factors were shared risk factors among standalone and coexisting forms of undernutrition. However, proximal and intermediate factors varied in the type and strength of the association between standalone and coexisting undernutrition. This implies that holistic and category-specific strategies are needed to significantly reduce undernutrition among under-five children in SSA. Full article

Background: Malaria remains a public health challenge in low- and middle-income countries (LMICs). Despite gains from strategies like Insecticide-Treated Nets (ITNs) and Intermittent Preventive Treatment during pregnancy (IPTp), significant socioeconomic inequalities persist, particularly among pregnant women and children under five. This study analyzed temporal and socioeconomic inequalities in malaria prevention in sub-Saharan Africa (SSA). Methods: Nationally representative Demographic Health Surveys from 10 SSA countries (Mozambique, Burkina Faso, Tanzania, Côte d’Ivoire, Madagascar Kenya, Rwanda, Nigeria, Uganda, and Cameroon) were used, comparing two time periods. Changes in ITN use by pregnant women and children under five, as well as IPTp coverage, were assessed. Inequalities based on socioeconomic status (SES) and residence were analyzed using the Erreygers Normalized Concentration Index and Theil index. Results: The results revealed significant variability in ITN use and IPTp coverage within countries. Eight countries showed improvements in ITN use during pregnancy, with Nigeria seeing a 173.9% increase over five years. Burkina Faso and Tanzania consistently reported high ITN use (~87%) in children under five. IPTp coverage increased in all countries except Kenya. Decomposition using the Theil index indicated that within-group inequalities, particularly based on SES and residence, were the primary drivers of disparities. Conclusions: To ensure progress toward universal health coverage, malaria prevention programs must prioritize vulnerable populations and be continuously evaluated. Full article