Search results for: Sumiti Saharan

Authors: Fouzia Brihmat

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Economic planning models, which are used to build microgrids and distributed energy resources, are the current norm for expressing such confidence (DER). These models often decide both short-term DER dispatch and long-term DER investments. This research investigates the most cost-effective hybrid (photovoltaic-diesel) renewable energy system (HRES) based on Total Net Present Cost (TNPC) in an Algerian Saharan area, which has a high potential for solar irradiation and has a production capacity of 1GW/h. Lead-acid batteries have been around much longer and are easier to understand, but have limited storage capacity. Lithium-ion batteries last longer, are lighter, but generally more expensive. By combining the advantages of each chemistry, we produce cost-effective high-capacity battery banks that operate solely on AC coupling. The financial implications of this research describe the corrosion process that occurs at the interface between the active material and grid material of the positive plate of a lead-acid battery. The best cost study for the HRES is completed with the assistance of the HOMER Pro MATLAB Link. Additionally, during the course of the project's 20 years, the system is simulated for each time step. In this model, which takes into consideration decline in solar efficiency, changes in battery storage levels over time, and rises in fuel prices above the rate of inflation. The trade-off is that the model is more accurate, but it took longer to compute. As a consequence, the model is more precise, but the computation takes longer. We initially utilized the Optimizer to run the model without MultiYear in order to discover the best system architecture. The optimal system for the single-year scenario is the Danvest generator, which has 760 kW, 200 kWh of the necessary quantity of lead-acid storage, and a somewhat lower COE of $0.309/kWh. Different scenarios that account for fluctuations in the gasified biomass generator's production of electricity have been simulated, and various strategies to guarantee the balance between generation and consumption have been investigated. The technological optimization of the same system has been finished and is being reviewed in a recent paper study.

Keywords: battery, corrosion, diesel, economic planning optimization, hybrid energy system, lead-acid battery, multi-year planning, microgrid, price forecast, PV, total net present cost

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Authors: Temitayo Tosin Alawiye

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Plant disease control is important in maintaining plant vigour, grain quantity, abundance of food, feed, and fibre produced by farmers all over the world. Farmers make use of different methods in controlling these diseases but one of the commonly used method is the use of chemicals. However, the continuous and excessive usages of these agrochemicals pose a danger to the environment, man and wildlife. The more the population growth the more the food security challenge which leads to more pressure on agronomic growth. Agricultural waste also known as green waste are the residues from the growing and processing of raw agricultural products such as fruits, vegetables, rice husk, corn cob, mushroom growth medium waste, coconut husk. They are widely used in land bioremediation, crop production and protection which include disease control. These agricultural wastes help the crop by improving the soil fertility, increase soil organic matter and reduce in many cases incidence and severity of disease. The objective was to review the agricultural waste that has worked effectively against certain soil-borne diseases such as Fusarium oxysporum, Pythiumspp, Rhizoctonia spp so as to help minimize the use of chemicals. Climate change is a major problem of agriculture and vice versa. Climate change and agriculture are interrelated. Change in climatic conditions is already affecting agriculture with effects unevenly distributed across the world. It will increase the risk of food insecurity for some vulnerable groups such as the poor in Sub Saharan Africa. The food security challenge will become more difficult as the world will need to produce more food estimated to feed billions of people in the near future with Africa likely to be the biggest hit. In order to surmount this hurdle, smallholder farmers in Africa must embrace climate-smart agricultural techniques and innovations which includes the use of green waste in agriculture, conservative agriculture, pasture and manure management, mulching, intercropping, etc. Training and retraining of smallholder farmers on the use of green energy to mitigate the effect of climate change should be encouraged. Policy makers, academia, researchers, donors, and farmers should pay more attention to the use of green energy as a way of reducing incidence and severity of soilborne plant diseases to solve looming food security challenges.

Keywords: agricultural waste, climate change, green energy, soil borne plant disease

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Authors: Mengistu G. Woldu, Hani Y. Zaki, Areeg Faggad, Badreldin E. Abdalla

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Background: Type 2 diabetes mellitus (T2DM) is a complex, degenerative, and multi-factorial disease, which is culpable for huge mortality and morbidity worldwide. Even though relatively significant numbers of studies are conducted on the genetics domain of this disease in the developed world, there is huge information gap in the sub-Saharan Africa region in general and in Eritrea in particular. Objective: The principal aim of this study was to investigate the association of common variants of the Insulin Receptor Substrate 1 (IRS1) and Transcription Factor 7-Like 2 (TCF7L2) genes with T2DM in the Eritrean population. Method: In this cross-sectional case control study 200 T2DM patients and 112 non-diabetes subjects were participated and genotyping of the IRS1 (rs13431179, rs16822615, 16822644rs, rs1801123) and TCF7L2 (rs7092484) tag SNPs were carries out using PCR-RFLP method of analysis. Haplotype analyses were carried out using Plink version 1.07, and Haploview 4.2 software. Linkage disequilibrium (LD), and Hardy-Weinberg equilibrium (HWE) analyses were performed using the Plink software. All descriptive statistical data analyses were carried out using SPSS (Version-20) software. Throughout the analysis p-value ≤0.05 was considered statistically significant. Result: Significant association was found between rs13431179 SNP of the IRS1 gene and T2DM under the recessive model of inheritance (OR=9.00, 95%CI=1.17-69.07, p=0.035), and marginally significant association found in the genotypic model (OR=7.50, 95%CI=0.94-60.06, p=0.058). The rs7092484 SNP of the TCF7L2 gene also showed markedly significant association with T2DM in the recessive (OR=3.61, 95%CI=1.70-7.67, p=0.001); and allelic (OR=1.80, 95%CI=1.23-2.62, p=0.002) models. Moreover, eight haplotypes of the IRS1 gene found to have significant association withT2DM (p=0.013 to 0.049). Assessments made on the interactions of genotypes of the rs13431179 and rs7092484 SNPs with various parameters demonstrated that high density lipoprotein (HDL), low density lipoprotein (LDL), waist circumference (WC), and systolic blood pressure (SBP) are the best T2DM onset predicting models. Furthermore, genotypes of the rs7092484 SNP showed significant association with various atherogenic indexes (Atherogenic index of plasma, LDL/HDL, and CHLO/HDL); and Eritreans carrying the GG or GA genotypes were predicted to be more susceptible to cardiovascular diseases onset. Conclusions: Results of this study suggest that IRS1 (rs13431179) and TCF7L2 (rs7092484) gene polymorphisms are associated with increased risk of T2DM in Eritreans.

Keywords: IRS1, SNP, TCF7L2, type 2 diabetes

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Authors: E. Isaac, I. Jalo, Y. Alkali, A. Ajani, A. Rasaki, Y. Jibrin, K. Mustapha, S. Charanchi, A. Kudi, H. Danlami

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Introduction: Hepatitis B infection is endemic in sub-Saharan Africa, where transmission predominantly occurs in infants and children by perinatal and horizontal routes. The risk of chronic infection peaks when infection is acquired early. Materials and Methods: Records of Hepatitis B surface and envelope antigen results in Federal Teaching Hospital, Gombe between May 2000 and May 2015 were retrieved and analyzed. Results: Paediatric outpatient visits and in-patient admissions were 64,193 accounting for 13% of total. Individuals tested for Hepatitis B surface antigenaemia were 23,866. Children aged 0-18 years constituted 11% (2,626). Among children tested, males accounted for 52.8% (1386/2626) and females 47.2% (1240/2626). Infants contributed 65 (2.3%); 1-4 year old children 309 (11.7%); 5-9 year old children 564 (21.4%) and adolescents 1717 (65.1%). HbSAg sero-positivity was 18% (496/2626) among children tested. The highest number of children tested per year was in 2009 (518) and 2014 (569) and the lowest, in the first study year (62). The highest sero-positivity rate was in 2010; 21.7% (54/255). Children aged 0-18years accounted for 10.5% (496/4720) of individuals with Hepatitis B surface antigenaemia. Sero-positivity was 3.1% (2/65); 12.9% (40/309); 18.1% (102/564); and 20.5% (352/1717) in infants, children ages 1-4years, 5-9years and adolescents respectively. 2.5% (1/40) and 4% (1/25) of male and female infants respectively had HbSAg. Among children aged 1-4years, 15.1% (30/198) of males and 9.0% (10/111) of females were seropositive; 14.8% (52/350) and 22% (50/224) of male and female 5-9year old children respectively has HbSAg. 14.3% (138/943) of adolescent females had Hepatitis B surface antigenaemia. Adolescent males demonstrated the highest sero-positivity rate 27.6% (214/774). 97.3% (483/496) of children who demonstrated Hepatitis B surface antigenaemia were tested for dual carriage with the e antigen. Males accounted for 296/483 (63.1%) and females 187/483 (36.9%). Infants constituted 0.97% (4/482); children aged 1-4years, 5-9years and adolescents were 6.8% (33/483); 20.9% (100/483) and 71.3% (342/483) respectively. 17.6% (85/483) of children tested had HBe antigenaemia. Of these, males accounted for 69.4% (59/85). 1.2% (1/85) were infants; 9.4% (8/85%) 1-4years; 22.3% (19/85) 5-9years and 68.2% (58/85) adolescents. 25% (1/4) infants; 24% (8/33) children aged 1-4 years; 19% (19/100) 5-9 year old children and 16.9% (58/342) adolescents had dual carriage. Infants and young children demonstrated the highest rate of dual carriage but were less likely to be tested for dual carriage 37/42 (88%) than their 5-9 year old 98% (100/102) and adolescent 342/352 (97%) counterparts. HB e antigen positivity rate was 45.4% (59/130) males and 36.0% (27/75) in females. Conclusion: Hepatitis B surface antigenaemia is high among adolescent males. Infants and young children who had HBSAg had the highest rate of envelope antigen carriage. Testing in pregnancy, vaccination programmes and prophylaxis need to be strengthened.

Keywords: children, dual carriage, Gombe, hepatitis B

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Authors: Temitayo Abayomi Ewemoje, Isaac Olugbemiga Afolayan, Badmus Alao Tayo

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Researchers in developing countries have worked on improving cassava resistance to diseases and pests, high yielding and early maturity However, water management has received little or no attention as cassava cultivation in Sub-Saharan Africa depended on available precipitation (rain-fed condition). Therefore the need for water management in Agricultural crop production cannot be overemphasized. As other sectors compete with agricultural sector for fresh water (which is not readily available), there is need to increase water productivity in agricultural production. Experimentation was conducted to examine water use, growth and yield of improved cassava varieties under rain fed condition using Latin- square design with four replications. Four improved disease free stem cassava varieties TMS (30572, 980505, 920326 and 090581) were planted and growth parameters of the varieties were monitored for 90 and 120 days after planting (DAP). Effective rainfall useful for the plant growth was calculated using CROPWAT8 for Windows. Results indicated TMS090581 was having the highest tuber yield and plant height while TMS30572 had highest number of nodes. Tuber stem and leaf water productivities at 90 and 120 DAP of TMS (30572, 980505, 920326 and 090581) are (1.27 and 3.58, 1.44 and 2.35, 0.89 and 1.86, 1.64 and 3.77) kg/m3 (1.56 and 2.59, 1.95 and 2.02, 1.98 and 2.05, 1.95 and 2.18) kg/m3, and (1.34 and 2.32, 1.94 and 2.16, 1.57 and 1.40, 1.27 and 1.80) kg/m3 respectively. Based on tuber water productivity TMS090581 are recommended while TMS30572 are recommended based on leaf and stem productivity in water scarce regions.Experimentation was conducted to examine water use, growth and yield of improved cassava varieties under rain fed condition using Latin- square design with four replications. Four improved disease free stem cassava varieties TMS (30572, 980505, 920326 and 090581) were planted and growth parameters of the varieties were monitored for 90 and 120 days after planting (DAP). Effective rainfall useful for the plant growth was calculated using CROPWAT8 for Windows. Results indicated TMS090581 was having the highest tuber yield and plant height while TMS30572 had the highest number of nodes. Tuber, stem and leaf water productivities at 90 and 120 DAP of TMS (30572, 980505, 920326 and 090581) are (1.27 and 3.58, 1.44 and 2.35, 0.89 and 1.86, 1.64 and 3.77) kg/m3 (1.56 and 2.59, 1.95 and 2.02, 1.98 and 2.05, 1.95 and 2.18) kg/m3, and (1.34 and 2.32, 1.94 and 2.16, 1.57 and 1.40, 1.27 and 1.80) kg/m3 respectively. Based on tuber water productivity TMS090581 are recommended while TMS30572 are recommended based on leaf and stem productivity in water scarce regions

Keywords: improved TMS varieties, leaf productivity, rain-fed cassava production, stem productivity, tuber productivity

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Authors: E. Isaac, I. Jalo, Y. Alkali, A. Ajani, A. Rasaki, Y. Jibrin, K. Mustapha, A. Ayuba, S. Charanchi, H. Danlami

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Introduction: Hepatitis B infection continues to be a serious global health problem with about 2 billion people infected worldwide, many of these in sub-Saharan Africa. Nigeria is one of the countries with the highest incidence, with a prevalence of 10-15%. Methods: Records of Hepatitis B surface and envelope antigen test results in adults in Federal Teaching Hospital, Gombe between May 2000 and May 2015 were retrieved and analyzed. Findings: Adult out-patient consultations and in-patient admissions were 343,083 and 67,761 respectively, accounting for 87% of total. Hepatitis B surface antigenaemia was tested for in 23,888 adults and children. 88.9% (21240) were adults. Males constituted 56% (11902/21240) and females 44% (9211/21240). 5104 (24.0%) of tested individuals were 19-25years; 12,039 (56.7%) 26-45years; 21119 (9.0%) 46-55years; 2.8% (590/21240) and 766 (3.6%) >65years. Among adult males, 17% (2133/11902) was contributed by ages 19-25. 58% (7017/11902), 11.9% (1421/11902), 6.4% (765/11902) and 4.7% (563/11902) of males were 26-45 years old, 46-55 years old and 56-65 years and >65year old respectively. Adults aged 19-25years, 26-45 years, 46-55years, 56-65 and > 65years each constituted 32% (2966/9211); 54.4% (5009/9211); 7.4% (684/9211), 3.8% (350/9211) and 2.2% (201/9211) of females respectively. 16.2% (3431/21,240) demonstrated Hepatitis B surface antigenaemia. The sero-positivity rate was 16.9% (865//5104) between 19-25years, 21.2% (2559/12,039) among 26-45year old individuals. 17.9% (377/2111); 14.1% (83/590) and 7.3% (56/766) of 46-55year old, 56-65year old and >65year old individuals screened were seropositive. The highest sero-positivity rate was found in male young adults aged 19-25years 27.9% (398/1426) and lowest in elderly males 7.4% (28/377). HBe antigen testing rate among HbSAg seropositive individuals was 97.3% (3338/3431). Males constituted 59.7% (1992/3338) and females 40.3% (1345/3338). 25.3% (844/3338) were aged 19-25years; 61.1% (2039/3338) 26-45years; 10.2% (340/3338) 46-55years; 2.7% (90/3338) 56-65years and 0.7% >65years old. HB e antigenaemia was positive in 8.2% (275/3338) of those tested. 41% (113/275); 50.2% (138/275); 5.4% (15/275); 1.8% (5/275) and 1.1 (3/275) of HB e sero-positivity was among age groups 19-25, 26-45, 46-55, 56-65 and > 65year old individuals. Dual sero-positivity rate was highest 13% (113/844) in young adults 19-25years and lowest between 46-55years; 15/340 (4.4%). 4.2% (15/360); 13.5% (69/512); 6.7% (90/1348); 4.6% (10/214); 5% (2/40) and 6.7% (1/15) of males aged 19-25; 26-45; 46-55; 56-65; and >65years had HB e antigenaemia respectively. Among females - 27/293 (9.2%) aged 19-25; 26/500 (5.2%) 26-45; 2/84 (2.4%) 46-55; 1/12 (8.3%) 56-65 and 1/9(11.1%) >65years had dual antigenaemia. In women of childbearing age, 6.9% (53/793) had a dual carriage. Conclusion: Dual hepatitis B surface and envelope antigenaemia are highest in young adult males. This will have significant implications for the development of chronic liver disease and hepatocellular carcinoma.

Keywords: adult, Hepatitis B, Nigeria, dual carriage

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Authors: Mwehe Mathenge, Ben G. J. S. Sonneveld, Jacqueline E. W. Broerse

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Smallholder farmers are important drivers of agriculture productivity, food security, and poverty reduction in Sub-Saharan Africa. However, they are faced with myriad challenges in their efforts at participating in agribusiness markets. How the geographic explicit factors existing at the local level interact to impede smallholder farmers' decision to participates (or not) in agribusiness markets is not well understood. Deconstructing the spatial complexity of the local environment could provide a deeper insight into how geographically explicit determinants promote or impede resource-poor smallholder farmers from participating in agribusiness. This paper’s objective was to identify, map, and analyze local spatial autocorrelation in factors that impede poor smallholders from participating in agribusiness markets. Data were collected using geocoded researcher-administered survey questionnaires from 392 households in Western Kenya. Three spatial statistics methods in geographic information system (GIS) were used to analyze data -Global Moran’s I, Cluster and Outliers Analysis (Anselin Local Moran’s I), and geographically weighted regression. The results of Global Moran’s I reveal the presence of spatial patterns in the dataset that was not caused by spatial randomness of data. Subsequently, Anselin Local Moran’s I result identified spatially and statistically significant local spatial clustering (hot spots and cold spots) in factors hindering smallholder participation. Finally, the geographically weighted regression results unearthed those specific geographic explicit factors impeding market participation in the study area. The results confirm that geographically explicit factors are indispensable in influencing the smallholder farming decisions, and policymakers should take cognizance of them. Additionally, this research demonstrated how geospatial explicit analysis conducted at the local level, using geographically disaggregated data, could help in identifying households and localities where the most impoverished and resource-poor smallholder households reside. In designing spatially targeted interventions, policymakers could benefit from geospatial analysis methods in understanding complex geographic factors and processes that interact to influence smallholder farmers' decision-making processes and choices.

Keywords: agribusiness markets, GIS, smallholder farmers, spatial statistics, disaggregated spatial data

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Authors: Linneth Nkateko Mabila, Patrick Hulisani Demana, Tebogo Maria Mothiba

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Background: Sustaining adherence to antiretroviral therapy (ART) over the long term by people, especially children living with Human-Immunodeficiency Virus (HIV), requires accurate and consistent monitoring, and this is a particular challenge for countries in sub-Saharan Africa. However, the regularity and punctuality in monthly antiretroviral treatment collections indicate medication adherence to a certain extent since it has been revealed to be a significant determinant of the outcome of ART. Aim: This study assessed and described the pattern of monthly antiretroviral treatment collections among a cohort of virally unsuppressed HIV-positive children initiated and managed on ART in the rural public clinics of Mopani District, Limpopo, and explored the nurses' perceptions and views of the findings. Methods: A facility-based mixed-methods study was conducted to assess the honoring of scheduled monthly treatment collection practices by a cohort of HIV-positive children under 15 years initiated and managed on ART by Nurse Initiated Management of Antiretroviral Treatment (NIMART)-trained professional nurses (PNs) from 01 January 2015 to 31 December 2015 in public PHC clinics of Mopani District Municipality. This was followed by the exploration of the nurses' perceptions and views regarding this issue to share their experiences and knowledge acquired through managing these children on ART. Results: From a total of 7105 analysable visits, only 44% (3134) were honored as scheduled, with 40% (2828) of children presenting to the clinics after the scheduled appointment date – they missed their appointments, and 11% (768) of treatment collections that took place before the scheduled appointment date. This finding was further confirmed by 90% (97) of the nurses, who reported that they have children who miss scheduled appointments in their public clinics. The primary reasons for children missing appointments were related to caregivers' forgetfulness and conflict between the school schedule and the dates of clinic visits. Conclusion: We confirmed a high prevalence of non-adherence to scheduled monthly ART collections and the existence of health system, social, and caregiver-related factors that threaten treatment adherence and proper clinical outcomes. These findings suggest an urgent need for intervention since non-adherence to ARV therapy can be life-threatening to the child and poses the danger of reduced life expectancy.

Keywords: antiretroviral therapy (art), nimart, virally unsuppressed children, missed appointments

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Authors: Chinyama Lukama, Million Phiri, Namuunda Mutombo

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Background: Improving access and utilization to high-quality sexual and reproductive health (SRH) information and services, including family planning (FP) commodities, is central to the global developmental agenda of sub-Saharan Africa (SSA). Despite the importance of family planning use in enhancing maternal health outcomes and fertility reduction, the prevalence of adolescents and young women using modern contraception is generally low in SSA. Zambia is one of the countries in Southern Africa with a high prevalence of teenage pregnancies and fertility rates. Despite many initiatives that have been implemented to improve access and demand for family planning commodities, utilization of FP, especially among adolescents and young women, has generally been low. The objective of this research agenda was to better understand the determinants of modern contraceptive use in adolescents and young women in Zambia. This analysis produced findings that will be critical for informing the strengthening of sexual and reproductive health policy strategies aimed at bolstering the provision and use of maternal health services in order to further improve maternal health outcomes in the country. Method: The study used the recent data from the Demographic and Health Survey of 2018. A sample of 3,513 adolescents and young women (ADYW) were included in the analysis. Multilevel logistic regression models were employed to examine the association of individual and contextual factors with modern contraceptive use among adolescents and young women. Results: The prevalence of modern contraception among sexually active ADYW in Zambia was 38.1% [95% CI, 35.9, 40.4]. ADYW who had secondary or higher level education [aOR = 2.16, 95% CI=1.35–3.47], those with exposure to listening to the radio or watching television [aOR = 1.26, 95% CI=1.01–1.57], and those who had decision-making power at household level [aOR = 2.18, 95% CI=1.71–2.77] were more likely to use modern contraceptives. Conversely, strong neighborhood desire for large family size among ADYW [aOR = 0.65 95% CI = 0.47–0.88] was associated with less likelihood to use modern contraceptives. Community access to family planning information through community health worker visits increased the likelihood [aOR = 1.48, 95% CI=1.16–1.91] of using modern contraception among ADYW. Conclusion: The study found that both individual and community factors were key in influencing modern contraceptive use among adolescents and young women in Zambia. Therefore, when designing family planning interventions, the Government of Zambia, through its policymakers and sexual reproductive health program implementers at the Ministry of Health, in collaboration with stakeholders, should consider the community context. There should also be deliberate actions to encourage family planning education through the media.

Keywords: adolescents, young women, modern contraception use, fertility, family planning

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Authors: Eyob Seife, Molla Alemayaehu, Tesfalem Teshome, Bereket Seyoum, Behailu Getachew

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Globally, immunization averts between 2 and 3 million deaths yearly, but Vaccine-Preventable Diseases still account for more in Sub-Saharan African countries and takes the majority of under-five deaths yearly, which indicates the need for consistent and on-time information to have evidence-based decision so as to save lives of these vulnerable groups. However, ensuring data of sufficient quality and promoting an information-use culture at the point of collection remains critical and challenging, especially in remote areas where the Ararso district is selected based on a hypothesis of there is a difference in reported and recounted immunization data consistency. Data quality is dependent on different factors where organizational, behavioral, technical and contextual factors are the mentioned ones. A cross-sectional quantitative study was conducted on September 2022 in the Ararso district. The study used the world health organization (WHO) recommended data quality self-assessment (DQS) tools. Immunization tally sheets, registers and reporting documents were reviewed at 4 health facilities (1 health center and 3 health posts) of primary health care units for one fiscal year (12 months) to determine the accuracy ratio, availability and timeliness of reports. The data was collected by trained DQS assessors to explore the quality of monitoring systems at health posts, health centers, and at the district health office. A quality index (QI), availability and timeliness of reports were assessed. Accuracy ratios formulated were: the first and third doses of pentavalent vaccines, fully immunized (FI), TT2+ and the first dose of measles-containing vaccines (MCV). In this study, facility-level results showed poor timeliness at all levels and both over-reporting and under-reporting were observed at all levels when computing the accuracy ratio of registration to health post reports found at health centers for almost all antigens verified. A quality index (QI) of all facilities also showed poor results. Most of the verified immunization data accuracy ratios were found to be relatively better than that of quality index and timeliness of reports. So attention should be given to improving the capacity of staff, timeliness of reports and quality of monitoring system components, namely recording, reporting, archiving, data analysis and using information for decisions at all levels, especially in remote and areas.

Keywords: accuracy ratio, ararso district, quality of monitoring system, regular immunization program, timeliness of reports, Somali region-Ethiopia

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Authors: Ebenezer Kwesi Armah-Ansah, Kenneth Fosu Oteng, Esther Selasi Avinu, Eugene Budu, Edward Kwabena Ameyaw

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Background: Maternal mortality, particularly in Benin, is a major public health concern in Sub-Saharan Africa. To provide a positive pregnancy experience and reduce maternal morbidities, all pregnant women must get appropriate and timely prenatal support. However, many pregnant women in developing countries, including Benin, begin antenatal care late. There is a paucity of empirical literature on the prevalence and predictors of early antenatal care visits in Benin. As a result, the purpose of this study is to investigate the prevalence and predictors of early antenatal care visits among women of productive age in Benin. Methods: This is a secondary analysis of the 2017/2018 Benin Demographic and Health Survey (BDHS) data. The study involved 6,919 eligible women. Data analysis was conducted using Stata version 14.2 for Mac OS. We adopted a multilevel logistic regression to examine the predictors of early ANC visits in Benin. The results were presented as odds ratios (ORs) associated with 95% confidence intervals (CIs) and p-value <0.05 to determine the significant associations. Results: The prevalence of early ANC visits among pregnant women in Benin was 57.03% [95% CI: 55.41-58.64]. In the final multilevel logistic regression, early ANC visit was higher among women aged 30-34 [aOR=1.60, 95% CI=1.17-2.18] compared to those aged 15-19, women with primary education [aOR=1.22, 95% CI=1.06-142] compared to the non-educated women, women who were covered by health insurance [aOR=3.03, 95% CI=1.35-6.76], women without a big problem in getting the money needed for treatment [aOR=1.31, 95% CI=1.16-1.49], distance to the health facility, not a big problem [aOR=1.23, 95% CI=1.08-1.41], and women whose partners had secondary/higher education [aOR=1.35, 95% CI=1.15-1.57] compared with those who were not covered by health insurance, had big problem in getting money needed for treatment, distance to health facility is a big problem and whose partners had no education respectively. However, women who had four or more births [aOR=0.60, 95% CI=0.48-0.74] and those in Atacora Region [aOR=0.50, 95% CI=0.37-0.68] had lower odds of early ANC visit. Conclusion: This study revealed a relatively high prevalence of early ANC visits among women of reproductive age in Benin. Women's age, educational status of women and their partners, parity, health insurance coverage, distance to health facilities, and region were all associated with early ANC visits among women of reproductive in Benin. These factors ought to be taken into account when developing ANC policies and strategies in order to boost early ANC visits among women in Benin. This will significantly reduce maternal and newborn mortality and help achieve the World Health Organization’s recommendation that all pregnant women should initiate early ANC visits within the first three months of pregnancy.

Keywords: antenatal care, Benin, maternal health, pregnancy, DHS, public health

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Authors: Silas Webb, Joseph Hartland

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Background: Long-term retention of patients on ART has become a major health challenge in Sub-Saharan Africa (SSA). In 2010 a systematic review of 39 papers found that 30% of patients were no longer taking their ARTs two years after starting treatment. In the same review, it was noted that there was a paucity of data as to why patients become lost to follow-up (LTFU) in SSA. This project was performed in Mulanje Mission Hospital in Malawi as part of Swindon Academy’s Global Health eSSC. The HIV prevalence for Malawi is 10.3%, one of the highest rates in the world, however prevalence soars to 18% in the Mulanje. Therefore it is essential that patients at risk of being LTFU are identified early and managed appropriately to help them continue to participate in the service. Methodology: All patients on adult antiretroviral formulations at MMH, who were classified as ‘defaulters’ (patients missing a scheduled follow up visit by more than two months) over the last 12 months were included in the study. Demographic varibales were collected from Mastercards for data analysis. A comparison group of patients currently not lost to follow up was created by using all of the patients who attended the HIV clinic between 18th-22nd July 2016 who had never defaulted from ART. Data was analysed using the chi squared (χ²) test, as data collected was categorical, with alpha levels set at 0.05. Results: Overall, 136 patients had defaulted from ART over the past 12 months at MMH. Of these, 43 patients had missing Mastercards, so 93 defaulter datasets were analysed. In the comparison group 93 datasets were also analysed and statistical analysis done using Chi-Squared testing. A higher proportion of men in the defaulting group was noted (χ²=0.034) and defaulters tended to be younger (χ²=0.052). 94.6% of patients who defaulted were taking Tenofovir, Lamivudine and Efavirenz, the standard first line ART therapy in Malawi. The mean length of time on ART was 39.0 months (RR: -22.4-100.4) in the defaulters group and 47.3 months (RR: -19.71-114.23) in the control group, with a mean difference of 8.3 less months in the defaulters group (χ ²=0.056). Discussion: The findings in this study echo the literature, however this review expands on that and shows the demographic for the patient at most risk of defaulting and being LTFU would be: a young male who has missed more than 4 doses of ART and is within his first year of treatment. For the hospital, this data is important at it identifies significant areas for public health focus. For instance, fear of disclosure and stigma may be disproportionately affecting younger men, so interventions can be aimed specifically at them to improve their health outcomes. The mean length of time on medication was 8.3 months less in the defaulters group, with a p-value of 0.056, emphasising the need for more intensive follow-up in the early stages of treatment, when patients are at the highest risk of defaulting.

Keywords: anti-retroviral therapy, ART, HIV, lost to follow up, Malawi

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Authors: Charles Mazhazhate

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This study interrogates and analyses the intricate kin- and- kith network patterns of corruption and mismanagement of resources prevalent in public sector supply chains bedeviling the developing economies of Sub-Saharan Africa with particular reference to Zimbabwe. This is forcing governments to resort to harsh fiscal policies that see their citizens paying high taxes against a backdrop of incomes below the poverty datum line, and this negatively affects their quality of life. The corporate world is also affected by the various tax-regime instituted. Mismanagement of resources and corrupt practices are rampant in state-owned enterprises to the extent that institutional policies, procedures, and practices are often flouted for the benefit of a clique of individuals. This interwoven in kith and kin blood human relations in organizations where appointments to critical positions are based on ascribed status. People no longer place value in their systems to make them work thereby violating corporate governance principles. Greediness and ‘unholy friendship connections’ are instrumental in fueling the employment of people who know each other from their discrete backgrounds. Such employments or socio-metric unions are meant to protect those at the top by giving them intelligent information through spying on what other subordinates are doing inside and outside the organization. This practice has led to the underperforming of organizations as those employees with connections and their upper echelons favorites connive to abuse resources for their own benefit. Even if culprits are known, no draconian measures are employed as a deterrence measure. Public value along public sector supply chains is lost. The study used a descriptive case study research design on fifty organizations in Zimbabwe mainly state-owned enterprises. Both qualitative and quantitative instrumentations were used. Both Snowball and random sampling techniques were used. The study found out that in all the fifty SOEs, there were employees in key positions related to top management, with tentacles feeding into the law enforcement agents, judiciary, security systems, and the executive. Such employees in public seem not to know each other with but would be involved in dirty scams and then share the proceeds with top people behind the scenes. The study also established that the same employees do not have the necessary competencies, qualifications, abilities, and capabilities to be in those positions. This culture is now strong that it is difficult to bust. The study recommends recruitment of all employees through an independent employment bureau to ensure strategic fit.

Keywords: corruption, state owned enterprises, strategic fit, public sector supply chains, efficiency

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Authors: Desta Kebede Ayana, Lies Sercu, Demelash Mengistu

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The study is set in Ethiopia, a sub-Saharan multilingual, multiethnic African country, which has seen a significant increase in the number of universities in recent years. The aim of this growth is to provide access to education for all cultural and linguistic groups across the country. However, there are challenges in promoting intercultural competence among students in this diverse context. The aim of the study is to investigate the interculturalization of Ethiopian Higher Education Institutions as perceived by university lecturers and administrators. In particular, the study aims to determine the level of support for this educational innovation and gather suggestions for its implementation and institutionalization. The researchers employed semi-structured interviews with administrators and lecturers from two large Ethiopian universities to gather data. Thematic analysis was utilized for coding and analyzing the interview data, with the assistance of the NVIVO software. The findings obtained from the grounded analysis of the interview data reveal that while there are opportunities for interculturalization in the curriculum and campus life, support for educational innovation remains low. Administrators and lecturers also emphasize the government's responsibility to prioritize interculturalization over other educational innovation goals. The study contributes to the existing literature by examining an under-researched population in an under-researched context. Additionally, the study explores whether Western perspectives of intercultural competence align with the African context, adding to the theoretical understanding of intercultural education. The data for this study was collected through semi-structured interviews conducted with administrators and lecturers from two large Ethiopian universities. The interviews allowed for an in-depth exploration of the participants' views on interculturalization in higher education. Thematic analysis was applied to the interview data, allowing for the identification and organization of recurring themes and patterns. The analysis was conducted using the NVIVO software, which aided in coding and analyzing the data. The study addresses the extent to which administrators and lecturers support the interculturalization of Ethiopian Higher Education Institutions. It also explores their suggestions for implementing and institutionalizing intercultural education, as well as their perspectives on the current level of institutionalization. The study highlights the challenges in interculturalizing Ethiopian universities and emphasizes the need for greater support and prioritization of intercultural education. It also underscores the importance of considering the African context when conceptualizing intercultural competence. This research contributes to the understanding of intercultural education in diverse contexts and provides valuable insights for policymakers and educational institutions aiming to promote intercultural competence in higher education settings.

Keywords: administrators, educational change, Ethiopia, intercultural competence, lecturers

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Authors: Zenebu Adere Tola

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Informal settlements behave dynamically over space and time and the number of people living in such housing areas is growing worldwide. In the cities of developing countries especially in sub-Saharan Africa, poverty, unemployment rate, poor living condition, lack transparency and accountability, lack of good governance are the major factors to contribute for the people to hold land informally and built houses for residential or other purposes. In most of Ethiopian cities informal settlement is highly seen in peripheral areas this is because people can easily to hold land for housing from local farmers, brokers, speculators without permission from concerning bodies. In Adama informal settlement has created risky living conditions and led to environmental problems in natural areas the main reason for this was the lack of sufficient knowledge about informal settlement development. On the other side there is a strong need to transform informal into formal settlements and to gain more control about the actual spatial development of informal settlements. In another hand to tackle the issue it is at least very important to understand the scale of the problem. To understand the scale of the problem it is important to use up-to-date technology. For this specific problem, it is good to use high-resolution imagery to detect informal settlement in Adama city. The main objective of this study is to assess the spatiotemporal dynamics and environmental impacts of informal settlement using OBIA. Specifically, the objective of this study is to; identify informal settlement in the study area, determine the change in the extent and pattern of informal settlement and to assess the environmental and social impacts of informal settlement in the study area. The methods to be used to detect the informal settlement is object-oriented image analysis. Consequently, reliable procedures for detecting the spatial behavior of informal settlements are required in order to react at an early stage to changing housing situations. Thus, obtaining spatial information about informal settlement areas which is up to date is vital for any actions of enhancement in terms of urban or regional planning. Using data for this study aerial photography for growth and change of informal settlements in Adama city. Software ECognition software for classy to built-up and non-built areas. Thus, obtaining spatial information about informal settlement areas which is up to date is vital for any actions of enhancement in terms of urban or regional planning.

Keywords: informal settlement, change detection, environmental impact, object based analysis

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Authors: Danielle A. Walker, Kyle L. Johnson, Patrick J. Fox, Jacen S. Moore

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The HIV Continuum of Care has become a universal model to provide context for the process of HIV testing, linkage to care, treatment, and viral suppression. HIV testing is the first step in moving toward community viral suppression. Countries with a lower socioeconomic status experience the lowest rates of testing and access to care. The Democratic Republic of the Congo is located in the heart of sub-Saharan Africa, where testing and access to care are low and women experience higher HIV prevalence compared to men. In the Democratic Republic of the Congo there is only a 21.6% HIV testing rate among women. Because a critical gap exists between a woman’s risk of contracting HIV and the decision to be tested, this study was conducted to obtain a better understanding of the relationship between factors that could influence HIV testing among women. The datasets analyzed were from the 2013-14 Democratic Republic of the Congo Demographic and Health Survey Program. The data was subset for women with an age range of 18-49 years. All missing cases were removed and one variable was recoded. The total sample size analyzed was 14,982 women. The results showed that there did not seem to be a difference in HIV testing by mean age. Out of 11 religious categories (Catholic, Protestant, Armee de salut, Kimbanguiste, Other Christians, Muslim, Bundu dia kongo, Vuvamu, Animist, no religion, and other), those who identified as Other Christians had the highest testing rate of 25.9% and those identified as Vuvamu had a 0% testing rate (p<0.001). There was a significant difference in testing by religion. Only 0.7% of women surveyed identified as having no religious affiliation. This suggests partnerships with key community and religious leaders could be a tool to increase testing. Over 60% of women who had never been tested for HIV did not know where to be tested. This highlights the need to educate communities on where testing facilities can be located. Almost 80% of women who believed HIV could be transmitted by supernatural means and/or witchcraft had never been tested before (p=0.08). Cultural beliefs could influence risk perception and testing decisions. Consequently, misconceptions need to be considered when implementing HIV testing and prevention programs. Location by province, years of education, and wealth index were also analyzed to control for socioeconomic status. Kinshasa had the highest testing rate of 54.2% of women living there, and both Equateur and Kasai-Occidental had less than a 10% testing rate (p<0.001). As the education level increased up to 12 years, testing increased (p<0.001). Women within the highest quintile of the wealth index had a 56.1% testing rate, and women within the lowest quintile had a 6.5% testing rate (p<0.001). This study concludes that further research is needed to identify culturally competent methods to increase HIV education programs, build partnerships with key community leaders, and improve knowledge on access to care.

Keywords: Democratic Republic of the Congo, cultural beliefs, education, HIV testing

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Authors: Arsalan Jabbar, Wajiha Javed, Nelofer Mehboob, Zahid Memon

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Introduction: There are multiple social, individual and cultural factors that influence an individual’s decision to adopt family planning methods especially among non-users in patriarchal societies like Pakistan.Non-users, if targeted efficiently, can contribute significantly to country’s CPR. A research study showed that non-users if convinced to adopt lactational amenorrhea method can shift to long-term methods in future. Research shows that if non-users are targeted efficiently a 59% reduction in unintended pregnancies in Saharan Africa and South-Central and South-East Asia is anticipated. Methods: We did secondary data analysis on Pakistan Demographic Heath Survey (2012-13) dataset. Use of contraception (never-use/ever-use) was the outcome variable. At univariate level Chi-square/Fisher Exact test was used to assess relationship of baseline covariates with contraception use. Then variables to be incorporated in the model were checked for multi-collinearity, confounding, and interaction. Then binary logistic regression (with an urban-rural stratification) was done to find the relationship between contraception use and baseline demographic and social variables. Results: The multivariate analyses of the study showed that younger women (≤ 29 years) were more prone to be never users as compared to those who were > 30 years and this trend was seen in urban areas (AOR 1.92, CI 1.453-2.536) as well as rural areas (AOR 1.809, CI 1.421-2.303). While looking at regional variation, women from urban Sindh (AOR 1.548, CI 1.142-2.099) and urban Balochistan (AOR 2.403, CI 1.504-3.839) had more never users as compared to other urban regions. Women in the rich wealth quintile were more never users and this was seen both in urban and rural localities (urban (AOR 1.106 CI .753-1.624); rural areas (AOR 1.162, CI .887-1.524)) even though these were not statistically significant. Women idealizing more children(> 4) are more never users as compared to those idealizing less children in both urban (AOR 1.854, CI 1.275-2.697) and rural areas (AOR 2.101, CI 1.514-2.916). Women who never lost a pregnancy were more inclined to be non-users in rural areas (AOR 1.394, CI 1.127-1.723) .Women familiar with only traditional or no method had more never users in rural areas (AOR 1.717, CI 1.127-1.723) but in urban areas it wasn’t significant. Women unaware of Lady Health Worker’s presence in their area were more never users especially in rural areas (AOR 1.276, CI 1.014-1.607). Women who did not visit any care provider were more never users (urban (AOR 11.738, CI 9.112-15.121) rural areas (AOR 7.832, CI 6.243-9.826)). Discussion/Conclusion: This study concluded that government, policy makers and private sector family planning programs should focus on the untapped pool of never users (younger women from underserved provinces, in higher wealth quintiles, who desire more children.). We need to make sure to cover catchment areas where there are less LHWs and less providers as ignorance to modern methods and never been visited by an LHW are important determinants of never use. This all is in sync with previous literate from similar developing countries.

Keywords: contraception, demographic and health survey, family planning, never users

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Authors: Adelaide Rethabile Motshabi Pitso-Mbili

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The disparity between universities in rural and urban areas of South Africa is still an ongoing issue. There are a lot of variations in these universities, such as the performance of the students and the lecturers, which is viewed as a worrying discrepancy related to knowledge gaps or educational inequality. According to research, rural students routinely perform worse than urban students in sub-Saharan Africa, and the disparity is wide when compared to the global average. This may be a result of the various challenges that universities in rural and urban areas face. Hence, the aim of this study was to compare the challenges faced by rural and urban universities, especially in hospitality and tourism programs, and recommend possible solutions. This study used a qualitative methodology and included focus groups and in-depth interviews. Eight focus groups of final-year students in hospitality and tourism programs from four institutions and four department heads of those programs participated in in-depth interviews. Additionally, the study was motivated by the teacher collaboration theory, which proposes that colleagues can help one another for the benefit of students and the institution. It was revealed that rural universities face more challenges than urban universities when it comes to hospitality and tourism education. The results of the interviews showed that universities in rural areas have a high staff turnover rate and offer fewer courses due to a lack of resources, such as the infrastructure, staff, equipment, and materials needed to give students hands-on training on the campus and in various hospitality and tourism programs. Urban universities, on the other hand, provide a variety of courses in the hospitality and tourism areas, and while resources are seldom an issue, they must deal with classes that have large enrolments and insufficient funding to support them all. Additionally, students in remote locations noted that having a lack of water and electricity makes it difficult for them to perform practical lessons. It is recommended that universities work together to collaborate or develop partnerships to help one another overcome obstacles and that universities in rural areas visit those in urban areas to observe how things are done there and to determine where they can improve themselves. The significance of the study is that it will truly bring rural and urban educational processes and practices into greater alignment of standards, benefits, and achievements; this will also help retain staff members within the rural area universities. The present study contributes to the literature by increasing the accumulation of knowledge on research topics, challenges, trends and innovation in hospitality and tourism education and setting forth an agenda for future research. The current study adds to the body of literature by expanding the accumulation of knowledge on research topics that contribute to trends and innovations in hospitality and tourism education and by laying out a plan for future research.

Keywords: hospitality and tourism education, rural and urban universities, collaboration, teacher and student performance, educational inequality

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Authors: Dejene Ermias Mekango, Mussie Alemayehu, Gebremedhin Berhe Gebregergs, Araya Abrha Medhanye, Gelila Goba

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Background: Maternal near miss (MNM) can be used as a proxy indicator of maternal mortality ratio. There is a huge gap in life time risk between Sub-Saharan Africa and developed countries. In Ethiopia, a significant number of women die each year from complications during pregnancy, childbirth and the post-partum period. Besides, a few studies have been performed on MNM, and little is known regarding determinant factors. This study aims to identify determinants of MNM among women in Tigray region, Northern Ethiopia. Methods: a case-control study in hospital found in Tigray region, Ethiopia was conducted from January 30 - March 30, 2016. The sample included 103 cases and 205 controls recruited from women seeking obstetric care at six public hospitals. Clients having a life-threatening obstetric complication including haemorrhage, hypertensive diseases of pregnancy, dystocia, infections, and anemia or clinical signs of severe anemia in women without haemorrhage were taken as cases and those with normal obstetric outcomes were considered as controls. Cases were selected based on proportional to size allocation while systematic sampling was employed for controls. Data were analyzed using SPSS version 20.0. Binary and multiple variable logistic regression (odds ratio) analyses were calculated with 95% CI. Results: The largest proportion of cases and controls was among the ages of20–29 years, accounting for37.9 %( 39) of cases and 31.7 %( 65) of controls. Roughly 90% of cases and controls were married. About two-thirds of controls and 45.6 %( 47) of cases had gestational age between 37-41 weeks. History of chronic medical conditions was reported in 55.3 %(57) of cases and 33.2%(68) of controls. Women with no formal education [AOR=3.2;95%CI:1.24, 8.12],being less than 16 years old at first pregnancy [AOR=2.5; 95%CI:1.12,5.63],induced labor[AOR=3; 95%CI:1.44, 6.17], history of Cesarean section (C-section) [AOR=4.6; 95%CI: 1.98, 7.61] or chronic medical disorder[AOR=3.5;95%CI:1.78, 6.93], and women who traveled more than 60 minutes before reaching their final place of care[AOR=2.8;95% CI: 1.19,6.35] all had higher odds of experiencing MNM. Conclusions: The Government of Ethiopia should continue its effort to address the lack of road and health facility access as well as education, which will help reduce MNM. Work should also be continued to educate women and providers about common predictors of MNM like the history of C-section, chronic illness, and teenage pregnancy. These efforts should be carried out at the facility, community, and individual levels. The targeted follow-up to women with a history of chronic disease and C-section could also be a practical way to reduce MNM.

Keywords: maternal near miss, severe obstetric hemorrhage, hypertensive disorder, c-section, Tigray, Ethiopia

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Authors: Ngabirano Levis

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One of Africa’s major environmental challenges remains air pollution. In 2017, UNICEF estimated over 400,000 children in Africa died as a result of indoor pollution, while 350 million children remain exposed to the risks of indoor pollution due to the use of biomass and burning of wood for cooking. Over time, indeed, the major causes of mortality across Africa are shifting from the unsafe water, poor sanitation, and malnutrition to the ambient and household indoor pollution, and greenhouse gas (GHG) emissions remain a key factor in this. In addition, studies by the OECD estimated that the economic cost of premature deaths due to Ambient Particulate Matter Pollution (APMP) and Household Air Pollution across Africa in 2013 was about 215 Billion US Dollars and US 232 Billion US Dollars, respectively. This is not only a huge cost for a continent where over 41% of the Sub-Saharan population lives on less than 1.9 US Dollars a day but also makes the people extremely vulnerable to the negative climate change and environmental degradation effects. Such impacts have led to extended droughts, flooding, health complications, and reduced crop yields hence food insecurity. Climate change, therefore, poses a threat to global targets like poverty reduction, health, and famine. Despite efforts towards mitigation, air contributors like carbon dioxide emissions are on a generally upward trajectory across Africa. In Egypt, for instance, emission levels had increased by over 141% in 2010 from the 1990 baseline. Efforts like the climate change adaptation and mitigation financing have also hit obstacles on the continent. The International Community and developed nations stress that Africa still faces challenges of limited human, institutional and financial systems capable of attracting climate funding from these developed economies. By using the qualitative multi-case study method supplemented by interviews of key actors and comprehensive textual analysis of relevant literature, this paper dissects the key emissions and air pollutant sources, their impact on the well-being of the African people, and puts forward suggestions as well as a remedial mechanism to these challenges. The findings reveal that whereas climate change mitigation plans appear comprehensive and good on paper for many African countries like Uganda; the lingering political interference, limited research guided planning, lack of population engagement, irrational resource allocation, and limited system and personnel capacity has largely impeded the realization of the set targets. Recommendations have been put forward to address the above climate change impacts that threaten the food security, health, and livelihoods of the people on the continent.

Keywords: Africa, air pollution, climate change, mitigation, emissions, effective planning, institutional strengthening

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Authors: Saheed Shittu, Lolwa Alansari, Fahed Nattouf, Tawa Olukade, Naji Abdallah, Tamara Alshdafat, Sarra Amdouni

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Cesarean sections (CS), a highly regarded surgical intervention for improving fetal-maternal outcomes and serving as an integral part of emergency obstetric services, are not without complications. Although CS has many advantages, it poses significant risks to both mother and child and increases healthcare expenditures in the long run. The escalating global prevalence of CS, coupled with variations in rates among immigrant populations, has prompted an inquiry into the correlation between CS rates and the nationalities of women undergoing deliveries at Al-Wakra Hospital (AWH), Qatar's second-largest public maternity hospital. This inquiry is motivated by the notable CS rate of 36%, deemed high in comparison to the 34% recorded across other Hamad Medical Corporation (HMC) maternity divisions This is Qatar's first comprehensive investigation of Caesarean section rates and nationalities. A retrospective cross-sectional study was conducted, and data for all births delivered in 2019 were retrieved from the hospital's electronic medical records. The CS rate, the crude rate, and adjusted risks of Caesarean delivery for mothers from each nationality were determined. The common indications for CS were analysed based on nationality. The association between nationality and Caesarean rates was examined using binomial logistic regression analysis considering Qatari women as a standard reference group. The correlation between the CS rate in the country of nationality and the observed CS rate in Qatar was also examined using Pearson's correlation. This study included 4,816 births from 69 different nationalities. CS was performed in 1767 women, equating to 36.5%. The nationalities with the highest CS rates were Egyptian (49.6%), Lebanese (45.5%), Filipino and Indian (both 42.2%). Qatari women recorded a CS rate of 33.4%. The major indication for elective CS was previous multiple CS (39.9%) and one prior CS, where the patient declined vaginal birth after the cesarean (VBAC) option (26.8%). A distinct pattern was noticed: elective CS was predominantly performed on Arab women, whereas emergency CS was common among women of Asian and Sub-Saharan African nationalities. Moreover, a significant correlation was found between the CS rates in Qatar and the women's countries of origin. Also, a high CS rate was linked to instances of previous CS. As a result of these insights, strategic interventions were successfully implemented at the facility to mitigate unwarranted CS, resulting in a notable reduction in CS rate from 36.5% in 2019 to 34% in 2022. This proves the efficacy of the meticulously researched approach. The focus has now shifted to reducing primary CS rates and facilitating well-informed decisions regarding childbirth methods.

Keywords: maternal nationality, caesarean section rate variation, migrants, high-income country

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Authors: Getahun Lemma

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Introduction Guinea Worm Disease (GWD), also known as dracunculiasisis, is one of the oldest diseases in the history of mankind. Dracunculiasis is caused by a parasitic nematode, Dracunculus medinensis. Infection is acquired by drinking contaminated water with copepods containing infective Guinea Worm (GW) larvae). Almost one year after the infection, the worm usually emerges out through the skin on a lower, causing severe pain and disabilities. Although there is no effective drug or vaccine against the disease, the chain of transmission can be effectively prevented with simple and cost effective public health measures. Death due to dracunculiasis is very rare. However, it results in a wide range of physical, social and economic sequels. The disease is usually common in the rural, remote places of Sub-Saharan African countries among the marginalized societies. Currently, GWD is one of the neglected tropical diseases, which is on the verge of eradication. The global Guinea Worm Eradication Program (GWEP) was started in 1980. Since then, the program has achieved a tremendous success in reducing the global burden and number of GW case from 3.5 million to only 28 human cases at the end of 2018. However, it has recently been shown that not only humans can become infected, with a total of 1,105 animal infections have been reported at the end of 2018. Therefore, the objective of this study was to identify the existing challenges in the last mile of the GWEP in order To inform Policy makers and stakeholders on potential measures to finally achieve eradication. Method Systematic literature review on articles published from January 1, 2000 until May 30, 2019. Papers listed in Cochrane Library, Google Scholar, ProQuest PubMed and Web of Science databases were searched and reviewed. Results Twenty-five articles met inclusion criteria of the study and were selected for analysis. Hence, relevant data were extracted, grouped and descriptively analyzed. Results showed the main challenges complicating the last mile of global GWEP: 1. Unusual mode of transmission; 2. Rising animal Guinea Worm infection; 3. Suboptimal surveillance; 4. Insecurity; 5. Inaccessibility; 6. Inadequate safe water points; 7. Migration; 8. Poor case containment measures, 9. Ecological changes; and 10. New geographic foci of the disease. Conclusion This systematic review identified that most of the current challenges in the GWEP have been present since the start of the campaign. However, the recent change in epidemiological patterns and nature of GWD in the last remaining endemic countries illustrates a new twist in the global GWEP. Considering the complex nature of the current challenges, there seems to be a need for a more coordinated and multidisciplinary approach of GWD prevention and control measures in the last mile of the campaign. These new strategies would help to make history by eradicating dracunculiasis as the first ever parasitic disease.

Keywords: dracunculiasis, eradication program, guinea worm, last mile

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Authors: Aliyu Bello Mohammed

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Vital registration or registration of vital events is one of the three major sources of demographic data in Nigeria. The other two are the population census and sample survey. The former is judged to be an indispensable source of demographic data because, it provide information on vital statistics and population trends between two census periods. Various literacy works however depict the vital registration in Nigeria as incapable of providing accurate data for the country. The study has both theoretical and practical significances. The trends and pattern of vital registration has not received adequate research interest in Sub-Saharan Africa in general and Nigeria in particular. This has created a gap in understanding the extent and consequence of the scourge in Africa sub-region. Practically, the study also captures the policy interventions of government and Non-Governmental Organizations (NGOs) that would help enlighten the public on the importance of vital registration in Nigeria. Furthermore, feasible policy strategies that will enhance trends and pattern vital registration in the society would emanate from the study. The study adopted a cross sectional survey design and applied multi stage sampling techniques to sample 230 respondents from the general public in the study area. The first stage involved the splitting of the local government into wards. The second stage involves selecting streets, while the third stage was the households. In all, 6 wards were sampled for the study. The study utilized both primary and secondary sources of data. The primary sources of data used were the questionnaire, focus group discussion (FGD) and in-depth interview (IDI) guides while the secondary sources of data were journals and books, newspapers and magazines. Twelve FGD sessions with 96 study participants and five IDI sessions with the heads of vital registration facilities were conducted. The quantitative data were analyzed using Statistical Package for Social Sciences (SPSS). Descriptive statistics like tables, frequencies and percentages were employed in presenting and interpreting the data. Information from the qualitative data was transcribed and ordered in themes to ensure that outstanding points of the responses are noted. The following conclusions were drawn from the study: the available vital registration facilities are not adequate and were not evenly distributed in the study area; lack of awareness and knowledge of the existence and the importance of vital registration by majority of the people in the local government; distance to vital registration centres from their residents; most births in the area were not registered, and even among the few births that were registered, majority of them were registered after the limited period for registration. And the study reveals that socio-economic index, educational level and distance of facilities to residents are determinants of access to vital registration facility. The study concludes by discussing the need for a reliable and accurate vital registration system if Nigeria’s vision of becoming one of the top 20 economies in the world in 2020 would be realized.

Keywords: trends, patterns, vital, registration and assessment

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Authors: Luphumlo Ncanywa, Paul Watts

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Malaria is a disease that kills approximately one million people annually. Children and pregnant women in sub-Saharan Africa lost their lives due to malaria. Malaria continues to be one of the major causes of death, especially in poor countries in Africa. Decrease the burden of malaria and save lives is very essential. There is a major concern about malaria parasites being able to develop resistance towards antimalarial drugs. People are still dying due to lack of medicine affordability in less well-off countries in the world. If more people could receive treatment by reducing the cost of drugs, the number of deaths in Africa could be massively reduced. There is a shortage of pharmaceutical manufacturing capability within many of the countries in Africa. However one has to question how Africa would actually manufacture drugs, active pharmaceutical ingredients or medicines developed within these research programs. It is quite likely that such manufacturing would be outsourced overseas, hence increasing the cost of production and potentially limiting the full benefit of the original research. As a result the last few years has seen major interest in developing more effective and cheaper technology for manufacturing generic pharmaceutical products. Micro-reactor technology (MRT) is an emerging technique that enables those working in research and development to rapidly screen reactions utilizing continuous flow, leading to the identification of reaction conditions that are suitable for usage at a production level. This emerging technique will be used to develop antimalarial drugs. It is this system flexibility that has the potential to reduce both the time was taken and risk associated with transferring reaction methodology from research to production. Using an approach referred to as scale-out or numbering up, a reaction is first optimized within the laboratory using a single micro-reactor, and in order to increase production volume, the number of reactors employed is simply increased. The overall aim of this research project is to develop and optimize synthetic process of antimalarial drugs in the continuous processing. This will provide a step change in pharmaceutical manufacturing technology that will increase the availability and affordability of antimalarial drugs on a worldwide scale, with a particular emphasis on Africa in the first instance. The research will determine the best chemistry and technology to define the lowest cost manufacturing route to pharmaceutical products. We are currently developing a method to synthesize Lumefantrine in continuous flow using batch process as bench mark. Lumefantrine is a dichlorobenzylidine derivative effective for the treatment of various types of malaria. Lumefantrine is an antimalarial drug used with artemether for the treatment of uncomplicated malaria. The results obtained when synthesizing Lumefantrine in a batch process are transferred into a continuous flow process in order to develop an even better and reproducible process. Therefore, development of an appropriate synthetic route for Lumefantrine is significant in pharmaceutical industry. Consequently, if better (and cheaper) manufacturing routes to antimalarial drugs could be developed and implemented where needed, it is far more likely to enable antimalarial drugs to be available to those in need.

Keywords: antimalarial, flow, lumefantrine, synthesis

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Authors: Savas Yildiz

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The article assesses the performance of international aid donors to determine the sub-national distribution of their aid projects dependent on recipient countries’ governance. The present paper extends the scope from a cross-country perspective to a more detailed analysis by looking at the effects of institutional qualities on the sub-national distribution of foreign aid. The analysis examines geo-referenced aid project in 37 countries and 404 regions at the first administrative division level in Sub-Saharan Africa from the World Bank (WB) and the African Development Bank (ADB) that were approved between the years 2000 and 2011. To measure the influence of institutional qualities on the distribution of aid the following measures are used: control of corruption, government effectiveness, regulatory quality and rule of law from the World Governance Indicators (WGI) and the corruption perception index from Transparency International. Furthermore, to assess the importance of ethnic heterogeneity on the sub-national distribution of aid projects, the study also includes interaction terms measuring ethnic fragmentation. The regression results indicate a general skew of aid projects towards regions which hold capital cities, however, being incumbent presidents’ birth region does not increase the allocation of aid projects significantly. Nevertheless, with increasing quality of institutions aid projects are less skewed towards capital regions and the previously estimated coefficients loose significance in most cases. Higher ethnic fragmentation also seems to impede the possibility to allocate aid projects mainly in capital city regions and presidents’ birth places. Additionally, to assess the performance of the WB based on its own proclaimed goal to aim the poor in a country, the study also includes sub-national wealth data from the Demographic and Health Surveys (DSH), and finds that, even with better institutional qualities, regions with a larger share from the richest quintile receive significantly more aid than regions with a larger share of poor people. With increasing ethnic diversity, the allocation of aid projects towards regions where the richest citizens reside diminishes, but still remains high and significant. However, regions with a larger share of poor people still do not receive significantly more aid. This might imply that the sub-national distribution of aid projects increases in general with higher ethnic fragmentation, independent of the diverse regional needs. The results provide evidence that institutional qualities matter to undermine the influence of incumbent presidents on the allocation of aid projects towards their birth regions and capital regions. Moreover, even for countries with better institutional qualities the WB and the ADB do not seem to be able to aim the poor in a country with their aid projects. Even, if one considers need-based variables, such as infant mortality and child mortality rates, aid projects do not seem to be allocated in districts with a larger share of people in need. Therefore, the study provides further evidence using more detailed information on the sub-national distribution of aid projects that aid is not being allocated effectively towards regions with a larger share of poor people to alleviate poverty in recipient countries directly. Institutions do not have any significant influence on the sub-national distribution of aid towards the poor.

Keywords: aid allocation, georeferenced data, institutions, spatial analysis

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Authors: Gideon Abagna Azunre

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Informal urbanism is perhaps the most ubiquitous urban phenomenon in sub-Saharan Africa (SSA) and Ghana specifically. Estimates suggest that about two-fifths of urban dwellers (37.9%) in Ghana live in informal settlements, while two-thirds of the working labour force are within the informal economy. This makes Ghana invariably an ‘informal country.’ Informal urbanism involves economic and housing activities that are – in law or in practice – not covered (or insufficiently covered) by formal regulations. Many urban folks rely on informal urbanism as a survival strategy due to limited formal waged employment opportunities or rising home prices in the open market. In an era of globalizing neoliberalism, this struggle to survive in cities resonates with several people globally. For years now, there have been intense debates on the utility of informal urbanism – both its economic and housing dimensions – in developing sustainable cities. While some scholars believe that informal urbanism is beneficial to the sustainable city development agenda, others argue that it generates unbearable negative consequences and it symbolizes lawlessness and squalor. Consequently, the main aim of this research was to dig below the surface of the narratives to locate the role of informal urbanism in the quest for sustainable cities. The research geographically focused on Ghana and its burgeoning informal sector. Also, both primary and secondary data were utilized for the analysis; Secondary data entailed a synthesis of the fragmented literature on informal urbanism in Ghana, while primary data entailed interviews with informal stakeholders (such as informal settlement dwellers), city authorities, and planners. These two data sets were weaved together to discover the nexus between informal urbanism and the tripartite dimensions of sustainable cities – economic, social, and environmental. The results from the research showed a two-pronged relationship between informal urbanism and the three dimensions of sustainable city development. In other words, informal urbanism was identified to both positively and negatively affect the drive for sustainable cities. On the one hand, it provides employment (particularly to women), supplies households’ basic needs (shelter, health, water, and waste management), and enhances civic engagement. However, on the other hand, it perpetuates social and gender inequalities, insecurity, congestion, and pollution. The research revealed that a ‘black and white’ interpretation and policy approach is incapable of capturing the complexities of informal urbanism. Therefore, trying to eradicate or remove it from the urbanscape because it exhibits some negative consequences means cities will lose their positive contributions. The inverse also holds true. A careful balancing act is necessary to maximize the benefits and minimize the costs. Overall, the research presented a de-colonial theorization of informal urbanism and thus followed post-colonial scholars’ clarion call to African cities to embrace the paradox of informality and find ways to integrate it into the city-building process.

Keywords: informal urbanism, sustainable city development, economic sustainability, social sustainability, environmental sustainability, Ghana

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Authors: William Gallagher, Harriet Bothwell, Lowri Evans, Kevin Jones

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Background: Worldwide, a third of adult deaths are caused by cardiovascular disease, a high proportion occurring in the developing world. Contributing to these poor outcomes are suboptimal assessments, treatments and monitoring of the acutely unwell patient. Successful training in trauma and neonates is recognised in the developing world but there is little literature supporting adult resuscitation. As far as the authors are aware no literature has been published on resuscitation training in Uganda since 2000 when a resuscitation training officer ran sessions in neonatal and paediatric resuscitation. The aim of this project was to offer training in Basic Life Support ( BLS) to staff and healthcare students based at Villa Maria Hospital in the Kalungu District, Central Uganda. This project was undertaken as a student selected component (SSC) offered by Swindon Academy, based at the Great Western Hospital, to medical students in their fourth year of the undergraduate programme. Methods: Semi-structured, informal interviews and focus groups were conducted with different clinicians in the hospital. These interviews were designed to focus on the level of training and understanding of BLS. A training session was devised which focused on BLS (excluding the use of an automatic external defribrillator) involving pre and post-training questionnaires and clinical assessments. Three training sessions were run for different cohorts: a pilot session for 5 Ugandan medical students, a second session for a group of 8 nursing and midwifery students and finally, a third was devised for physicians. The data collected was analysed in excel. Paired T-Tests determined statistical significance between pre and post-test scores and confidence before and after the sessions. Average clinical skill assessment scores were converted to percentages based on the area of BLS being assessed. Results: 27 participants were included in the analysis. 14 received ‘small group training’ whilst 13 received’ large group training’ 88% of all participants had received some form of resuscitation training. Of these, 46% had received theory training, 27% practical training and only 15% received both. 12% had received no training. On average, all participants demonstrated a significant increase of 5.3 in self-assessed confidence (p <0.05). On average, all participants thought the session was very useful. Analysis of qualitative date from clinician interviews in ongoing but identified themes identified include rescue breaths being considered the most important aspect resuscitation and doubts of a ‘good’ outcome from resuscitation. Conclusions: The results of this small study reflect the need for regular formal training in BLS in low resource settings. The active engagement and positive opinions concerning the utility of the training are promising as well as the evidence of improvement in knowledge.

Keywords: basic life support, education, resuscitation, sub-Saharan Africa, training, Uganda

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Authors: Emmanuel A. David, Rebecca O. Soremekun, Roseline I. Aderemi-Williams

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Background: The complexities involved in the management of diabetes mellitus require a multi-dimensional, multi-professional collaborative and continuous care by health care providers and a substantial self-care by the patients in order to achieve desired treatment outcomes. The effect of pharmacists’ care in the management of diabetes in resource-endowed nations is well documented in literature, but randomised-controlled assessment of the impact of pharmacist-led care among patients with diabetes in resource-limited settings like Nigeria and sub-Saharan Africa countries is scarce. Objective: To evaluate the impact of Pharmacist-led care on glycaemic control in patients with uncontrolled type 2 diabetes, using a randomised-controlled study design Methods: This study employed a prospective randomised controlled design, to assess the impact of pharmacist-led care on glycaemic control of 108 poorly controlled type 2 diabetic patients. A total of 200 clinically diagnosed type 2 diabetes patients were purposively selected using fasting blood glucose ≥ 7mmol/L and tested for long term glucose control using Glycated haemoglobin measure. One hundred and eight (108) patients with ≥ 7% Glycated haemoglobin were recruited for the study and assigned unique identification numbers. They were further randomly allocated to intervention and usual care groups using computer generated random numbers, with each group containing 54 subjects. Patients in the intervention group received pharmacist-structured intervention, including education, periodic phone calls, adherence counselling, referral and 6 months follow-up, while patients in usual care group only kept clinic appointments with their physicians. Data collected at baseline and six months included socio-demographic characteristics, fasting blood glucose, Glycated haemoglobin, blood pressure, lipid profile. With an intention to treat analysis, Mann-Whitney U test was used to compared median change from baseline in the primary outcome (Glycated haemoglobin) and secondary outcomes measure, effect size was computed and proportion of patients that reached target laboratory parameter were compared in both arms. Results: All enrolled participants (108) completed the study, 54 in each study. Mean age was 51±11.75 and majority were female (68.5%). Intervention patients had significant reduction in Glycated haemoglobin (-0.75%; P<0.001; η2 = 0.144), with greater proportion attaining target laboratory parameter after 6 months of care compared to usual care group (Glycated haemoglobin: 42.6% vs 20.8%; P=0.02). Furthermore, patients who received pharmacist-led care were about 3 times more likely to have better glucose control (AOR 2.718, 95%CI: 1.143-6.461) compared to usual care group. Conclusion: Pharmacist-led care significantly improved glucose control in patients with uncontrolled type 2 diabetes mellitus and should be integrated in the routine management of diabetes patients, especially in resource-limited settings.

Keywords: glycaemic control , pharmacist-led care, randomised-controlled trial , type 2 diabetes mellitus

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Authors: Johnson Opoku-Asante, Emmanuel Bobobee, Joseph Akowuah, Eric Amoah Asante

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In recent years, the issue of postharvest losses has become a serious concern in Sub-Saharan Africa. Postharvest technology development and adaptation need urgent attention, particularly for small and medium-scale rice farmers in Africa. However, to better develop any postharvest technology, knowledge of the mechanical properties of different varieties of paddy rice is vital. There is also the issue of the development of new rice cultivars. The objectives of this research are to (1) determine the mechanical properties of the selected paddy rice varieties at varying moisture content. (2) conduct a comparative analysis of the mechanical properties of selected rice paddy for different variety-moisture content interactions. (3) determine the significant statistical differences between the mean values of the various variety-moisture content interactions The mechanical properties of AGRA rice, CRI-Amankwatia, CRI-Enapa and CRI-Dartey, four local varieties developed by Crop Research Institute of Ghana are compared at 11.5%, 13.0% and 16.5% dry basis moisture content. The mechanical properties measured are Sphericity, Aspect ratio, Grain mass, 1000 Grain mass, Bulk Density, True Density, Porosity and Angle of Repose. Samples were collected from the Kwadaso Agric College of the CRI in Kumasi. The samples were threshed manually and winnowed before conducting the experiment. The moisture content was determined on a dry basis using the Moistex Screw-Type Digital Grain Moisture Meter. Other equipment used for data collection were venire calipers and Citizen electronic scale. A 4×3 factorial arrangement was used in a completely randomized design in three replications. Tukey's HSD comparisons test was conducted during data analysis to compare all possible pairwise combinations of the various varieties’ moisture content interaction. From the results, it was concluded that Sphericity recorded 0.391 mm³ to 0.377 mm³ for CRI-Dartey at 16.5% and CRI-Enapa at 13.5%, respectively, whereas Aspect Ratio recorded 0.298 mm³ to 0.269 mm³ for CRI-Dartey at 16.5% and CRI-Enapa at 13.5% respectively. For grain mass, AGRA rice at 13.0% also recorded 0.0312 g as the highest score and CRI-Enapa at 13.0% obtained 0.0237 as the lowest score. For the GM1000, it was observed that it ranges from 29.33 g for CRI-Amankwatia at 16.5% moisture content to 22.54 g for CRI-Enapa at 16.5% interactions. Bulk Density ranged from 654.0 kg/m³ to 422.9 kg/m³ for CRI-Amankwatia at 16.5% and CRI-Enapa at 11.5% as the highest and lowest recordings, respectively. It was also observed that the true Density ranges from 1685.8 kg/m3 for AGRA rice at 13.0% moisture content to 1352.5 kg/m³ for CRI-Enapa at 16.5% interactions. In the case of porosity, CRI-Enapa at 11.5% received the highest score of 70.83% and CRI-Amankwatia at 16.5 received the lowest score of 55.88%. Finally, in the case of Angle of Repose, CRI-Amankwatia at 16.5% recorded the highest score of 47.3o and CRI-Enapa at 11.5% recorded the least score of 34.27o. In all cases, the difference in mean value was less than the LSD. This indicates that there were no significant statistical differences between their mean values, indicating that technologies developed and adapted for one variety can equally be used for all the other varieties.

Keywords: angle of repose, aspect ratio, bulk density, porosity, sphericity, mechanical properties

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Authors: Olasunkanmi Olapeju

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A large chunk of global population are not yet connected to water borne faecal management systems that rely on flush mechanisms and sewers networks that are linked with a central treatment plant. Only about 10% of sub-Saharan African countries are connected to central sewage systems. In Nigeria, majority of the population do not only depend on on-plot sanitation systems, a huge chunk do not also have access to safe and improved toilets. Apart from the organizational challenges and technical capacity, the other major factors that account for why faecal waste management is yet unimproved in developing countries are faulty planning frameworks that fail to maintain balance between urbanization dynamics and infrastructures, and misconceptions about what modern sanitation is all about. In most cases, the quest to implement developmental patterns that integrate modern sewers based sanitation systems have huge financial and political costs. Faecal waste management in poor countries largely lacks the needed political attention and budgetary prioritization. Yet, the on-plot sanitation systems being mainly relied upon the need to be managed in a manner that is sustainable and healthy, pending when development would embrace a more sustainable off-site central sewage system. This study is aimed at investigating existing strategies for managing on-plot sanitation systems’ faecal waste in Ogun state, Nigeria, with the aim of recommending sustainable sanitation management systems. The study adopted the convergent parallel variant of the mixed-mode technique, which involves the adoption of both quantitative and qualitative method of data collection. Adopting a four-level multi-stage approach, which is inclusive of all political divisions in the study area, a total of 330 questionnaires were respectively administered in the study area. Moreover, the qualitative data adopted the purposive approach in scoping down to 33 key informants. SPSS software (Version 22.0) was employed for descriptively analysis. The study shows that about 52% of households adopt the non-recovery management (NRM) means of burying their latrines with sand sludge shrinkage with chemicals such as carbides. The dominance of the non-recovery management means seriously constrains the quest for faecal resource recovery. Essentially, the management techniques adopted by households depend largely on the technology of their sanitary containments, emptying means available, the ability of households to pay for the cost of emptying, and the social acceptability of the reusability of faecal waste, which determines faecal resource recoverability. The study suggests that there is a need for municipal authorities in the study area to urgently intervene in the sanitation sector and consider it a key element of the planning process. There is a need for a comprehensive plan that would ensure a seamless transition to the adoption of a modern sanitation management system.

Keywords: faecal, management, planning, waste, sanitation, sustainability

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