Search Results (2,612)

Background/objectives: SARS-CoV-2 antibodies wane after natural infections and vaccinations. COVID-19 booster vaccination enhances the durability and functionality of antibodies against emerging SARS-CoV-2 variants. Data on booster-induced antibody durability in sub-Saharan Africa remain sparse. Comparative analysis of vaccine-induced responses between heterologous and homologous vaccination regimens remains limited. This study evaluated longitudinal RBD-specific IgG responses following homologous and heterologous COVID-19 booster vaccination in previously vaccinated adults. Methods: Adults with prior mRNA or adenoviral-vectored vaccination were boosted with either Pfizer (mRNA) or Janssen (adenoviral-vectored) vaccines. Plasma IgG binding to Wuhan, Delta, and Omicron RBDs was measured pre-booster and at 3, 6, and 9 months. A total of 181 participants were enrolled between November 2022 and October 2023. Results: More than 60% of participants had detectable pre-booster RBD- and N-antigen-specific IgG. Booster vaccination substantially increased Wuhan-specific RBD-IgG at three months, with limited boosting of Delta and Omicron responses. Antibody levels waned to pre-booster concentrations by month nine. Heterologous boosting with a viral-vectored prime followed by Pfizer mRNA significantly enhanced both peak RBD-IgG levels and durability. Conclusions: These longitudinal data provide rare real-world evidence on booster immunogenicity in African adults and demonstrate that heterologous regimens confer a short- to intermediate-term advantage in antibody magnitude compared to a homologous regimen. This benefit was most pronounced within the first six months post-boost. The findings support additional booster dosing to strengthen protection against emerging variants in sub-Saharan Africa. Full article

Background: Sub-Saharan Africa is undergoing a rapid epidemiological transition marked by a growing burden of non-communicable diseases, including breast, cervical, ovarian, and uterine cancers, which constitute major causes of morbidity and mortality among women in the region; however, comprehensive assessments of long-term trends and regional heterogeneity remain limited. This study examines the burden and temporal trends of breast, cervical, ovarian, and uterine cancers across sub-Saharan Africa from 1990 to 2023. Methods: A retrospective ecological analysis was conducted using data from the latest Global Burden of Disease 2023 study. Age-standardised incidence rates, mortality rates, and disability-adjusted life year rates were estimated for breast, cervical, ovarian, and uterine cancers across 48 sub-Saharan African countries and four sub-regions. Temporal trends were assessed from 1990 to 2023, with percentage changes calculated to characterise epidemiological transitions. Geographic variation and age-specific patterns were examined to identify high-burden settings and priority populations. Results: Between 1990 and 2023, the burden of all four cancers increased substantially across sub-Saharan Africa, with significant regional and country-level heterogeneity. Breast cancer exhibited the largest absolute burden, with incidence increasing by over 120 percent and mortality by more than 80 percent, particularly in Central and Western Africa. Cervical cancer remained the leading cause of cancer-related mortality among women in Eastern and Southern Africa, despite evidence of stabilisation or decline in selected countries. Ovarian and uterine cancers demonstrated sustained upward trends, especially in Central Africa, with high mortality-to-incidence ratios indicating late diagnosis and limited treatment access. Across all cancer types, Central and Eastern sub-Saharan Africa consistently experienced the highest disability-adjusted life year burdens. Conclusions: The burden of the selected cancers in sub-Saharan Africa has increased markedly over the past three decades, with persistent regional inequities reflecting gaps in prevention, early detection, and treatment capacity. Strengthening cancer surveillance systems, expanding equitable access to screening and vaccination programmes, and improving diagnostic and treatment infrastructure are critical to reversing current trends. These findings provide region-specific evidence to guide cancer control priorities and resource allocation across sub-Saharan Africa. Full article

In many hospitality workplaces, customer deviant behaviour is no longer an occasional frustration but a routine part of frontline employees’ day, steadily draining their energy, dignity and desire to deliver great service. Yet in sub-Saharan Africa, especially in Ghana, there is still limited evidence showing how this behaviour undermines employees’ motivation and what can realistically be done inside organisations to buffer its impact. This study explored how mistreatment from customers affects the service motivation of frontline employees in Ghanaian hotels and examines whether supportive supervisors can act as a protective buffer. Using a quantitative cross-sectional survey of 508 frontline staff in licensed hotels in the Kumasi Metropolis, the study applies Partial Least Squares Structural Equation Modelling (PLS-SEM) to test these relationships. The findings reveal that when customers display deviant behaviour, employees feel less motivated to offer high-level service. On the other hand, strong supervisor emotional support uplifts service motivation and partially mediates the harm caused by deviant customers. These results show that everyday supervisory support (listening, empathizing, and standing up for staff) can make a tangible difference to how motivated employees feel after difficult customer encounters. The study therefore offers practical guidance for hotel managers who want to safeguard employees and sustain high service standards in demanding customer environments. Full article

Legume crops, such as the common bean (Phaseolus vulgaris L.), are significant in many Sub-Saharan African (SSA) countries, including Eswatini, due to their numerous health benefits, including high protein, fiber, vitamins, and mineral content. Common beans are a staple food in many parts of the world and play a crucial role in nitrogen fixation, thereby improving soil fertility. A field experiment was conducted at Malkerns research station, Eswatini, using 27 common bean genotypes to assess their ability for N-fixation and water relations using the ¹⁵N and ¹³C natural abundance techniques. The data revealed significant differences among the common bean genotypes. Genotypes Cim-Rm-36 and Mwctz20a-Rm19 recorded an increase in plant growth by (6% and 5.74%), N content (5.69% and 5.97%) and greater C content (6.1% and 5.67%) while genotype Mwctz20a-Rm19 also showed an increase in N-fixation (155.73 kg.ha⁻¹). Genotype Mwctz20a-Rm-4 had the highest grain yield (1747.39 kg.ha⁻¹), while genotype Cim-Rm-14-Als61 had the highest N concentration (3.50%), indicating efficient N uptake. The genotypes with the lowest δ¹³C values (−27.38‰ to −28.06‰) suggested similar water use efficiency among the genotypes. The findings of this study revealed that common beans can make a significant contribution to N fertility under drought conditions. Genotypes Cim-Rm-36, Mwctz20a-Rm19, and Mwctz20a-Rm-4 showed desirable characteristics and can be good candidates for possible inclusion in breeding programs. These results have implications for improving common bean production in drought-prone areas and promoting sustainable agriculture practices. Full article

Background: Many countries in sub-Saharan Africa are at risk of inadequate calcium intake, yet no data exist for vulnerable population groups in Madagascar. We aimed to assess daily calcium intake, the major contributing food sources, and the prevalence of inadequate intake in young children, adolescents, and women of reproductive age. Methods: The 2024 National Micronutrient Survey used a two-stage probabilistic design across all 23 regions. The daily calcium intake was estimated using a food frequency questionnaire that focused on calcium-rich foods that are commonly consumed in Madagascar and the calcium concentration measured in drinking water. Results: Calcium intake was low across all population groups, averaging 200–300 mg/d in adolescents and women and below 180 mg/d in young children. The prevalence of inadequate intake exceeded 96% in every population group. While calcium intake increased with increasing household wealth in children, the opposite pattern was observed for adolescents and women, whose intake decreased with increasing wealth. The main contributors to calcium intake were cassava leaves, cassava roots, small fresh and dried fish eaten with bones, drinking water across all population groups, and breastmilk in young children. Conclusions: The calcium intake is low throughout Madagascar and across all demographic groups. Strategies to improve intake are urgently needed and should include promoting continued breastfeeding and the consumption of calcium-rich, locally available, affordable foods such as small fish eaten with bones and leafy green vegetables, alongside a consideration of wheat flour fortified with calcium. Full article

Medical drone delivery (MDD), defined as the use of uncrewed aerial vehicles to transport medical products, is an emerging technological innovation responding to persistent health supply chain challenges in rural and low-resource settings. Within sub-Saharan Africa, MDD systems have demonstrated large-scale success in improving key health outcomes, health supply chain efficiency, and reductions in medical product stockouts and wastage. However, the existing evidence base on the effectiveness of this technology is dominated by quantitative, performance-based evaluations, with limited emphasis on the community-driven mechanisms that shape such outcomes. Drawing on original qualitative research, this article presents a qualitative secondary analysis (QSA) of interview data collected as part of a larger case study on MDD in Madagascar. The QSA, guided by socio-technical systems theory, analyzes a subset of 18 interviews with 23 community-level stakeholders to understand how MDD affects healthcare services in remote regions of the country. Participants reported that MDD led to downstream healthcare improvements in vaccination coverage and malaria-related health outcomes. These improvements were enabled through four interconnected socio-technical mechanisms: (1) improved medical product availability through the mitigation of geographic and transportation barriers, (2) stabilization of vaccine and cold chain transportation, (3) building trust and healthcare-seeking behaviours through predictable service delivery, and (4) reduced physical, mental, and financial burdens experienced by healthcare workers. A final, cross-cutting theme emphasized was the criticality of MDD program continuity, with participants noting that operation disruptions or withdrawals risked reversing benefits and breaking communities’ trust in the health system. By centering lived realities, perceptions, and social processes, this article bridges the gap between predominantly quantitative evidence on MDD systems and the experiences of the communities they are intended to serve. Full article

Background/Objective: Child health serves as a foundational part of human development. Inequities in access to key health services remain high in Sub-Saharan Africa (SSA), most notably among children from disadvantaged, racially, or ethnically marginalized groups. The objective of this structured narrative review is to evaluate and aggregate the available evidence on racial/ethnic disparities in childhood healthcare access in SSA. Methods: A comprehensive search on African Index Medicus (AIM), Web of Science and PubMed for studies published between 2010 and 2025 was executed using relevant MeSH terms and Boolean operators. Studies on healthcare access inequalities among racial or ethnic groups in SSA were included. This study was conducted following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Results: Ten articles were included. Ethnicity was an independent contributor to inequities in childhood healthcare across four domains: vaccination coverage (lower for Hausa/Fulani in Nigeria and Somali/Luhya in Kenya compared to dominant groups), timeliness of vaccination, child mortality (higher in economically and ethnically marginalized groups), and nutritional status (elevated stunting and underweight odds in certain ethnic minorities). Conclusions: Racial and ethnic inequalities in child healthcare access across SSA are driven by multi-factor structural, geographical, and cultural barriers. Although socioeconomic improvement reduces some disparities, it does not eradicate them, highlighting that ethnic identity continues to shape health outcomes independently. Addressing these disparities requires strengthening culturally inclusive healthcare delivery, improving access in underserved regions, and integrating ethnicity-disaggregated monitoring into national health systems. Full article

Amid growing concerns about climate change and its potential impacts on food security and malnutrition, there is a need for climate-smart crops to help mitigate these challenges. African yam bean (Sphenostylis stenocarpa) and Bambara groundnut (Vigna subterranea) are considered climate-smart neglected or underutilised species (NUS) in sub-Saharan Africa (SSA). These legumes are rich in nutrients, comprising fats, carbohydrates, and protein, as well as essential micronutrients. However, their use is constrained by the presence of antinutritive factors (ANFs) such as oxalates, tannins, and phytates, which reduces mineral bioaccessibility and protein digestibility. Fermentation provides a cost-effective means of effectively reducing these antinutrients, thereby making these crops more mainstream due to their enhanced bioavailability and bioactivity. This review summarises the impact of diverse microbes and fermentation techniques on the bioavailability of essential nutrients in Bambara groundnut and African yam bean. The importance of pre-treatment steps such as soaking, germination, dehulling, and thermal treatment will also be discussed. By synthesising recent studies, the review explores the mechanisms by which fermentation degrades the ANFs, enhances nutrient bioavailability and improves protein digestibility from these crops. This review explores the pivotal roles of fermenting microbes, such as species of Lactobacillus and Bacillus, during the process of biotransformation. Full article

Malaria remains a major global health burden, with an estimated 282 million cases and 610,000 deaths reported in 2024, disproportionately affecting children under five years of age and pregnant women in sub-Saharan Africa. Although antimalarial drugs are highly effective at clearing infections, their reliance on timely diagnosis and treatment limits their scalability as a population-wide control strategy. Vaccines therefore represent a critical tool for reducing malaria-associated morbidity and mortality, as well as interrupting parasite transmission, by inducing durable protective immunity. However, the complex lifecycle of Plasmodium parasites poses significant challenges for vaccine development, including the identification of protective antigens and optimal vaccine formulations. In this review, we summarize current vaccine strategies and discuss their key limitations. We also highlight emerging opportunities for possible avenues for future research and development. Full article

Climate change is reshaping global hydrological cycles, intensifying scarcity and heightening health risks in vulnerable regions. This study examines the health impacts of climate-driven water scarcity across the Middle East, South Asia, and Sub-Saharan Africa using data on water availability, climate variability, and health outcomes. The study uses a multi-regional mixed methods approach that brings together climate, hydrology, governance, and health data to explore how climate-driven water scarcity affects public health in South Asia, Sub-Saharan Africa, and the MENA region. It combines quantitative climate and health indicators with qualitative evaluations of water system vulnerability to compare exposure pathways and health outcomes across regions. Findings show that rising temperatures, altered rainfall, declining groundwater, and recurrent droughts undermine water security, leading to increased disease burdens through four pathways: (1) waterborne illnesses from unsafe or insufficient supplies; (2) reduced hygiene due to limited access; (3) food insecurity from crop failures; and (4) mental health stress, conflict, and displacement from water competition. Women, children, and low-income households face disproportionate impacts. Current adaptation measures are fragmented, highlighting the need for integrated water governance to build climate resilience. Recommended strategies include community-based water safety planning, digital water monitoring, and embedding health metrics in climate–water policies. This cross-regional analysis supports equitable, climate-resilient health systems and informs interventions to mitigate water scarcity under accelerating climate change. This study directly supports global policy agendas by providing evidence that advances the objectives of the Sustainable Development Goals and international frameworks on climate resilience, water security, and food and health protection. Full article

Background: Non-cardiac comorbidities (NCCs) are highly prevalent among patients hospitalized for acute heart failure (HF). However, data from sub-Saharan Africa (SSA) on their distribution across HF phenotypes and association with in-hospital outcomes remain limited. Methods: We prospectively enrolled adults hospitalized with acute HF at a tertiary centre in South Africa between February and November 2023. Ten NCCs were assessed and patients were categorized according to comorbidity burden. The primary outcomes were all-cause in-hospital mortality and length of stay. Multivariable regression and sensitivity analyses were performed to identify predictors of outcomes. Results: Of the 406 patients (mean age 54.9 ± 15.8 years; 51% women), HF with reduced ejection fraction (HFrEF) accounted for 63%, HF with mildly reduced ejection fraction (HFmrEF) for 15%, and HF with preserved ejection fraction (HFpEF) for 21%. The most common NCCs were diabetes (47%), chronic kidney disease (CKD) (46%), obesity (45%), and anaemia (33%). Two-thirds had ≥2 NCCs. The median hospital stay was 8 days (IQR: 5–12) and in-hospital mortality was 3.4% (p > 0.05 across NCC groups). Higher heart rate predicted longer hospitalization, while renin angiotensin system inhibitor (RASi) therapy was associated with shorter stay. Lower Kansas City Cardiomyopathy Questionnaire (KCCQ) score (adjusted odds ratio [aOR] 1.009; 95% confidence interval [CI]: 1.003–1.015) and higher log-transformed NT-proBNP were independently associated with increased in-hospital mortality (aOR 1.85; 95% CI: 1.07–3.50; p = 0.026). Total comorbidity burden was not independently associated with length of stay or in-hospital mortality. Conclusions: Non-cardiac comorbidities are common in acute HF in SSA, and functional status and clinical markers were the strongest predictors of length of stay and in-hospital mortality. Full article

Regulatory bodies have observed an increase in environmental issues due to firms’ interactions with the environment. Nonetheless, reconciliation actions are emerging, driven by the pursuit of sustainable development goals. This study investigated the impact of financial development and foreign direct investment on ecological footprints in sub-Saharan African nations, while examining the mediating role of regulatory quality and control for corruption. The research was motivated by the growing environmental degradation in the region amid growing capital inflows and financial market expansion. Using panel data of 18 sub-Saharan African countries between 1996 and 2023, sourced from the World Bank database and World Governance Indicators, we employed an Autoregressive Distributed Lag model to assess the short- and long-run relationships among ecological footprint, financial development, foreign direct investment, and key institutional factors. Results from the baseline model show that financial development significantly increases ecological footprints, while the effect of foreign direct investments is insignificant in the absence of institutional factors. However, when mediating variables are introduced, foreign direct investment significantly worsens ecological footprint, and regulatory quality and control for corruption show strong moderating effects, confirming the pollution haven hypothesis. Also, all control variables (trade openness, gross domestic product per capita, government expenditure, and population density) show significant outcomes with environmental sustainability. The findings underscore the importance of institutional factors in shaping sustainable foreign direct investment flows and financial systems. These research findings offer policy pathways for aligning investment strategies with sustainability goals in sub-Saharan Africa. Recommendations include strengthening the nation’s institutional framework, linking foreign direct investment to environmental compliance and promoting green finance policies across the region. Full article

This study examines how relationship cultivation strategies are interpreted and enacted by strategic communication practitioners in Kenya’s county governments and corporate sector. Drawing on 38 in-depth interviews and guided by relationship management theory, the study employs a theory-informed inductive approach to explore how six key strategies—access, assurances, openness, networking, positivity, and task sharing—manifest in structurally distinct institutional contexts, extending scholarship on relationship cultivation to an underexamined sub-Saharan African setting. Findings reveal that while corporate practitioners operationalize these strategies through deliberate planning, responsiveness, and integrated stakeholder engagement, county government practitioners often face bureaucratic, political, and infrastructural constraints that undermine even basic efforts at relationship building. These sectoral contrasts highlight how the institutional context influences the cultivation of relationships and strategic communication practices. The study contributes to theory by demonstrating the need for a more context-sensitive and adaptive application of relationship management theory, and it offers practical insights for enhancing public engagement in decentralized governance systems. Beyond deepening understanding of strategic communication in Kenya, these findings carry implications for the global study and practice of relationship management across diverse institutional settings. Full article

Background/Objectives: Next to malaria, respiratory viruses, particularly respiratory syncytial virus (RSV), are responsible for the hospitalization and death of thousands of young children each year in sub-Saharan Africa. During peak seasons, conducting separate tests is time-consuming and distressing. This underscores the need for efficient, rapid multiplexed diagnostic tools. This study aimed to evaluate the clinical performance of a lateral flow assay (LFA) based antigen combo rapid diagnostic test (ML Ag Combo RDT, manufactured by MobiLab) that detects RSV, influenza viruses A and B (Flu A/B), and SARS-CoV-2. Methods: The Allplex panel 1 rRT-qPCR assay was used as a reference assay to evaluate the clinical performance of the LFA Ag Combo RDT in pediatric hospital settings. It was performed using 470 nasopharyngeal swab (NPS) specimens from hospitalized children under two years of age with respiratory symptoms. Results: Based on the comparative analysis of the testing results for 470 NPS, the ML Ag Combo RDT demonstrated high sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of 90.06%, 98.38%, 93.67, and 97.39% for RSV, and 30%, 100%, 100%, and 95.43 for Flu A/B, respectively. Agreement with the Allplex panle1 1 rRT-qPCR was strong (κ = 0.90 for RSV) and moderate (κ = 0.45 for Flu A/B), with overall accuracies of 96.63% for RSV and 95.5 for Flu A/B. This was further supported by ROC analysis for aggregated data (RSV and, Flu A/B) with an AUC value of 0.925. As expected, in samples with high viral loads (Ct < 20), the Ag Combo RDT achieved 100% sensitivity for RSV and Flu A/B. Sensitivity declined slightly at lower viral loads (Ct > 35). Conclusions: The ML Ag Combo RDT demonstrates high specificity and diagnostic accuracy for the detection of RSV and Flu A/B in pediatric hospital settings where timely diagnosis is critical. Full article

The overreliance on chemical pesticides in sub-Saharan African (SSA) for agriculture poses major challenges to sustainable agriculture, ecosystem and human health, biodiversity, and environmental sustainability. While genetically modified (GM) crops have demonstrated potential to lower pesticide use and increase crop yield, their widespread adoption remains limited across SSA, with gaps in knowledge on their yield, benefits and policies impacting their uptake. In this study, a literature-based approach was used to synthesize evidence from peer-reviewed articles and government reports published between 2010 and 2025 on pesticide use, farm productivity, and wellbeing of farmers across three focus countries: Nigeria, South Africa, and Burkina Faso. The summary of approved GM crops, events and utilisation across the three focus countries was also retrieved from the International Service for the Acquisition of Agri-biotech Applications (ISAAA) database. Cross-country comparisons were conducted to highlight lessons learned from successful and stalled GM crop programs and to identify regulatory, socio-cultural, and economic factors shaping adoption. It is shown that while GM crops can significantly reduce pesticide usage and production costs, challenges such as public hesitancy, regulatory hurdles, limited farmer awareness, and concerns about ecological consequences continue to hinder wider uptake across the continent. Similarly, weak seed systems and the lack of regionally harmonized biosafety regulations also constrain adoption. In areas where GM crops have been successfully adopted, it was demonstrated that supportive policy frameworks, transparent biosafety regulations, effective seed certification and distribution systems, and sustained community engagement increased farmer confidence and accelerated adoption. Hence, for GM crops to be more widely adopted for sustainable crop protection in sub-Saharan Africa, governments and stakeholders must strengthen biosafety systems, invest in farmer education, promote regional regulatory coordination, and facilitate public–private partnerships. Full article