Systematic Analysis of Factors Associated with Late Breast Cancer Screening in Women in Sub-Saharan Africa from 2014 to 2020

Research background: Breast cancer remains a major public health problem, with a high number of new cases and deaths each year. However, despite advances in research to improve this disease, there is a high rate of late detection, leading to diagnosis at an advanced stage and a reduced chance of survival. Objective: The aim of this study is to identify the factors associated with late detection of breast cancer in women in Sub-Saharan Africa from 2014 to 2020.Setting: This systematic review focuses on sub-Saharan Africa. Methods: We searched for articles in four databases (PubMed, Embase, Global-Health and CINAHL) between 2014 and 2020 and performed a narrative synthesis to organize and group the different factors associated with late breast cancer detection. Result: After reviewing 583 publications, 6 studies were selected, highlighting factors such as lack of awareness, knowledge gaps, difficulties in accessing health services and financial constraints associated with late breast cancer screening. The participants, who ranged in number from 20 to 1776, were mainly aged between 18 and 25, with a mean age of 25 years and 6 months. Conclusion: The analysis enabled us to identify various factors associated with late breast cancer screening. Collaboration between health professionals, community organizations and policy-makers is essential to foster an environment conducive to the prevention and early detection of breast cancer.

Hepatitis B Vaccination Coverage among University Students in Sub-Saharan Africa: Systematic Review and Meta Analysis

Introduction: Hepatitis B is an infectious disease that remains a real public health problem in Africa. Students represent a group at risk for this disease. The objective of this study was to estimate the hepatitis B vaccination coverage rate among students in sub-Saharan Africa. Methods: A systematic search of databases (PubMed, AJOL) and a manual search of Google Scholar was conducted to retrieve all published studies reporting hepatitis B vaccination coverage among students in sub-Saharan Africa. The pooled coverage rate was estimated with a 95% confidence interval (CI) in a random-effects meta-analysis. Results: A total of 35 studies were included and included 20,520 students. The mean age was 22.1 ± 5.1 years with a predominance of female sex (sex ratio F/M = 1.05). The vaccination coverage rate was 28.8% [95% CI: 22.9% - 34.7%]. Disaggregation allowed to estimate coverage rates of 29.8% [95% CI: 22.9% - 36.7%], 23.4% [95% CI: 9.4% - 37.4%] and 17.0% [95% CI: 14.4% - 19.5%] respectively in West Africa, East Africa and Central Africa. Conclusion: Less than a third of students in sub-Saharan Africa are protected against hepatitis B. However, the majority of this target group is at risk of infection. It would be relevant to screen and, if necessary, vaccinate all new students.

The Effects of Competence and Auditor Training on Fraud Detection Within Multinational Companies in Sub-Saharan Africa

The aim of this study is to examine the qualities that auditors engaged in detecting potential fraud within multinational corporations in Sub-Saharan Africa should possess.To achieve this goal,a quantitative approach was used to develop and test a research model based on three theories:agency theory,attribution theory,and cognitive dissonance theory.Responses from a panel of two hundred and nine(209)auditors who conducted a legal audit mission in a Sub-Saharan multinational were analyzed using SmartPLS 3.3.3 software.The results emphasize the crucial importance of auditors’competence and continuous training in fraud detection.However,professional skepticism and time pressure were found to be non-significant in this context.This conclusion provides essential insights for auditors,highlighting the key qualities needed to effectively address fraud detection within multinational corporations in Sub-Saharan Africa.

Barriers and Facilitators to Evidence-Based Practice among Physiotherapists Practicing in Sub-Saharan Africa

Background: Evidence-based practice (EBP) is vital for high-quality patient care, yet its implementation among physiotherapists in sub-Saharan Africa (SSA) faces significant challenges. This scoping review explores the barriers and facilitators of EBP in this region. Objectives: To identify barriers and facilitators of EBP at individual, organisational, and extra organisational levels among physiotherapists in SSA. Methods: A comprehensive literature search was conducted across PubMed, Sabinet, BioMed Central, and Google Scholar. Seven studies from Ghana, Nigeria, Cameroon, Benin, Kenya, Zimbabwe and South Africa met the inclusion criteria. Results: Key barriers at the practitioner level included lack of time, insufficient knowledge of EBP, limited access to information resources, and inadequate research skills. Facilitators comprised positive attitudes toward EBP and a desire for further knowledge. At the organisational level, resource unavailability emerged as a major barrier. Notably, no studies addressed extra organisational factors. Conclusion: This review highlights critical barriers and facilitators of EBP among SSA physiotherapists and emphasises the need for further research on extra organisational influences. Addressing systemic challenges is essential for enhancing physiotherapist engagement in EBP, ultimately improving patient care and outcomes in sub-Saharan Africa.

History, current status, and prospects of soybean production and research in sub-Saharan Africa

Soybean(Glycine max(L.) Merr.) is a non-native and non-staple crop in sub-Saharan Africa(SSA) with potential to be a commercial crop owing to its wide range of uses as food, feed,and industrial raw material. Soybean was first introduced to SSA by Chinese traders in the19 th century and was cultivated as an economic crop as early as 1903 in South Africa. In the past four decades, soybean cultivation area and production in SSA has increased exponentially, from about 20,000 ha and 13,000 t in the early 1970 s to 1,500,000 ha and2,300,000 t in 2016. Soybean yield has been stagnant in SSA for decades at about 1.1 t ha^(-1),much lower than the world average, representing one of the most challenging issues in the soybean industry in SSA. The low soybean yield in SSA can be attributed to the use of poorperforming varieties and to the limited application of fertilizers and rhizobial inoculants in soils with no history of soybean production. South Africa, Nigeria, Zambia, and Uganda are the leading soybean producers in SSA. Soybean research in SSA is conducted by international and national research institutions, including IITA, national soybean improvement programs, universities, and the private sector. Between 1970 and 2011, 195 soybean varieties were released by IITA, private breeders, and national soybean improvement programs in SSA. This paper reviews the history and current state of soybean production and of the utilization and adoption of tropical varieties in SSA, addresses the major soybean yield-limiting factors across the region, and discusses the potential of the soybean industry in SSA. It also highlights soybean improvement efforts and lessons learned from previous soybean improvement efforts and the current progress of some national soybean improvement programs in SSA. Opportunities for scaling up tropical soybean as a major crop across SSA countries are promising.

What Are the Determinants of Insulin Resistance (IR) and How Effective Is the Sub-Saharan Africa-Specific Threshold of Abdominal Obesity (AO-SSA) Identifying IR in Congolese Black Hypertensive Patients?

Background: Hypertensive patients with insulin resistance (IR) are at greater risk of cardiovascular disease and may represent a particular subset of hypertension (HTN) requiring special medical attention. Quantitative measurements of the IR are not suitable for routine clinical practice. Met-abolic syndrome (MetS) or simply abdominal obesity (AO) is surrogate of IR. The performance of the recently proposed Sub-Saharan Africa cut-off point of abdominal obesity for identifying IR in hypertensive patients has never been evaluated. Aims: The main objective was to compare the performance of the newly proposed Sub-Saharan Africa specific threshold of abdominal obesity (AO-SSA) to that of IDF (AO-IDF) in identifying IR in Congolese Black Hypertensive Patients. Methods: A cross-sectional study was conducted at the Heart of Africa Cardiovascular Center, Lomo Medical Clinic, Kinshasa Limete, DR Congo, between January 2007 and January 2010. Homeostatic model assessment (HOMA) index was calculated to determine IR. Multivariate logistic regression analysis was used to assess the independent determinants of IR. The intrinsic (sensitivity and specificity) and extrinsic (positive predictive value and negative predictive value) characteristics of the AO-SSA, AO-IDF, AO-ATP III, MetS-SSA, MetS-IDF, and MetS-ATP III were calculated. The kappa statistic was determined for agreement between the ATPIII, IDF and SSA defined AO and MetS with HOMA-IR. Results: Men represented the majority of the enrolled patients: 105 (64.4%) and the mean age of all participants were 57 ± 11 years. Insulin resistance was found in 79.1% of the study population with 88.7, 79.3, 84.6, 71.4, 75.5, 91.1, 60.3 and 44.8 respectively among patient with MetS-ATP, MetS-IDF, MetS-SSA, AO-ATP III, AO-IDF, AO-SSA, diabetics and non-obese non-diabetic hypertensive patients. In multivariate analysis, the risk of IR was associated independently and significantly (p < 0.05) with cigarette smoking, low-HDL-C, hyperuricemia, and diastolic HTN, as shown in the following equation: Y = ﹣1.404 + 1.054 Cigarette Smoking + 0.872 low HDL-C + 0.983 hyperuricemia + 0.852 diastolic hypertension. The AO-SSA, with 87.7% sensitivity and 67.6% specificity, was the only surrogate who showed an acceptable agreement with the HOMA-IR index. Abdominal obesity defined according to other thresholds and the metabolic syndrome whatever the used diagnostic criteria have a slight agreement with the HOMA-IR index. Conclusion: IR was found to be prevalent in our study population. Cigarette smoking, low-HDL-C, hyperuricemia, and isolated diastolic HTN magnify IR. The AO-SSA is an easy and cost efficient method to diagnose IR in Congolese Black Hypertensive Patients. Further study in wider group is indicated to validate our findings.

Achieving food and nutritional security through agroforestry: a case of Faidherbia albida in sub-Saharan Africa

Faidherbia albida is an ideal agroforestry tree commonly intercropped with annual crops like millet and groundnuts in the dry and densely populated areas of Africa. With its peculiar reverse phenology, it makes growth demands at a different time from that of crops. In addition, it deposits great amount of organic fertilizer on food crops. Leaves entering soils are comparable to fertilization of almost 50 t·ha^-1year^-1 of manure in dense stands of 50 large trees per ha. These nutrients help maximize agricultural production and reduce the need for a fallow period on poorer soils. Research has shown that millet grown under F. albida yielded 2.5 and 3.4 fold increases in grain and protein, respectively. Animals eat pods which contain mean amounts of crude protein of 20.63% and carbohydrate of 40.1% in seeds. Moreover, the continued existence ofF. albida in agroforestry parklands as in Ethiopia and Mali signifies the success of traditional conservation measures. Modem scientists have also developed much interest in the role of agroforestry in maintaining long-term biological balance between agriculture and livestock production systems. To ensure food security, which still remains a major challenge in sub-Saharan Africa, and concurrently minimize environmental degradation, promotion of agroforestry that specifically involves indigenous trees is crucial. We discuss the prospective role ofF. albida in alleviating poverty while simultaneously protecting the environment from factors associated with, for example, deforestation and loss of biodiversity. The overall aim is to promote wide-scale adoption ofF. albida as a valuable tree crop in farming systems, particularly in those areas where it remains unexploited.

Trade-offs and synergies of climate change adaptation strategies among smallholder farmers in sub-Saharan Africa:A systematic review

Climate change adaptation strategies provide a cushion for smallholder farmers,especially in subSaharan Africa against the risks posed by climate hazards such as droughts and floods.However,the decision-making process in climate adaptation is complex.To better understand the dynamics of the process,we strive to answer this question:what are the potential trade-offs and synergies related to decision-making and implementation of climate adaptation strategies among smallholder farmers in sub-Saharan Africa region?A systematic literature review methodology was used through the Preferred Reporting Items for Systematic Review and Meta-Analysis(PRISMA)statement with the four-stage inclusion/exclusion criteria to identify the literature from selected databases(Scopus and Google Scholar).The climate adaptation strategies are organized into five broad categories(crop management,risk management,soil/land management,water management,and livestock management strategies).Evidence suggests that potential trade-offs may arise concerning added costs,additional labor requirements,and competition among objectives or available resources.The synergies,on the other hand,arise from implementing two or more adaptation strategies concurrently in respect of increased productivity,resilience,yield stability,sustainability,and environmental protection.Trade-offs and synergies may also differ among the various adaptation strategies with minimum/zero tillage,comparatively,presenting more tradeoffs.The development and promotion of low-cost adaptation strategies and complementary climate adaptation options that minimize the trade-offs and maximize the synergies are suggested.Skills and knowledge on proper implementation of climate change adaptation strategies are encouraged,especially at the local farm level.

Microgrids-as-a-Service for Rural Electrification in Sub-Saharan Africa

The majority of the population on the African continent is unable to access basic electricity services,this despite the abundance of renewable energy sources(RESs).The inability to adequately tap into these RESs has led to the continued dependence on non-renewable energy sources such as coal for electricity generation,and kerosene for cooking and lighting,the resulting use of which is poor health conditions.The use of Microgrids(MGs)is being extensively researched as a feasible means of tackling the challenge of electrification,especially in rural and remote areas.Recent times have seen an increasing number of research works focusing on Sub-Saharan Africa(SSA),which is one of the regions with the lowest electrification rates in the world.MGs provide the most suitable means to integrate RESs into the electricity generation process,paving the way towards clean energy for the African continent.This paper presents a review of recent literature on the usage of MG technology for rural electrification,with a specific focus on the applicability of MGs in the SSA context.The paper additionally presents the challenges and opportunities to date.Research findings indicate that SSA has already begun the transition towards clean energy via implementation of RES-based MGs.However,two resonating challenges in the literature are adequate support via policy,and proper planning of project implementation.These two major barriers are needed to be overcome in order to fully utilize MGs for rural electrification in SSA.The key methodology derived from this study is that any effort towards rural electrification requires a sufficient amount of investigation,incorporating both the technological and socio-economic aspects into a suitable design for the target location.

Frequency of Cardiovascular Risk Factors in Systemic Lupus Erythematosus: A Case-Control Study in a Department of Internal Medicine in Sub-Saharan Africa

Background: The morbidity and mortality of systemic lupus erythematosus are largely due to accelerated atherosclerosis. This is partly related to the high prevalence of traditional cardiovascular risk factors. The aim of our study was to determine the frequency of these factors in lupus patients compared to a control population in a department of internal medicine. Methods: We realized a case-control study in patients with systemic lupus erythematosus according to ACR criteria in 1997. Patients were matched by age and gender with controls subjects without autoimmune disease. We studied the frequency of traditional cardiovascular risk factors in both populations. The study was done in the department of internal medicine of Aristide Le Dantec teaching Hospital, in Senegal, during the period from August 2017 to December 2018. The statistical analysis was performed with SPSS 23.0 software and the level of significance was retained for a p-value Results: We recruited 100 subjects including 50 patients and 50 controls. The mean age was 33.5 ± 11.3 years in cases and 33.3 ± 11.3 years in controls. Dyslipidemia was significantly associated with systemic lupus erythematosus (p = 0.009). Levels of triglycerides (p Conclusion: Traditional cardiovascular risk factors including dyslipidemia and hyperuricemia were more common in patients. Similarly, renal failure was associated with lupus.

Spatial spillover effects of official development assistance on environmental pressure in sub-Saharan African(SSA)countries

Impoverished sub-Saharan Africa(SSA)is under increasing environmental pressure from global environmental changes.It is now generally accepted in academic circles that economic development in SSA countries can cause environmental pressure in other countries.However,there is research gap on the impact of economic assistance on environmental pressure in SSA countries and whether economic assistance causes spatial spillovers of environ-mental pressure between SSA countries.To better understand the impact of economic assistance on environmental pressures in SSA,a dynamic spatial Dubin panel model was developed.It helped us explore the spatial spillover effects of economic assistance on environmental pressures in recipient countries based on the panel data from 34 SSA countries.The results show that economic assistance had a positive stimulating effect on environmen-tal pressures of recipient countries,which means that the degree of human disturbance to the environment has deepened.Due to the regional correlation effect,neighboring countries were saddled with environmental pres-sures from the target country.Moreover,environmental pressures have time inertia,which can easily produce a snowball effect.The decomposition of effects shows that the impact of economic assistance on environmental pressures is relatively minor.Environmental pressures have spillover effects,so to deal with diffuse risks,joint regional prevention and control policies should be developed.

Lifestyle Changes for Abdominal Obesity Prevention and Encouraging Fruit Consumption May Be Beneficial in Preventing Left Ventricular Hypertrophy in Sub-Saharan African and Maghreb

There is a growing body of evidence showing a close correlation between left ventricular mass with cardiovascular morbidity and overall mortality. Therefore, identifying the determinants of left ventricular hypertrophy can be of great importance for cardiovascular prevention, for prognosis and therapeutic intervention. Objective: To assess the prevalence and identify the independent determinants of echocardiographic left ventricular hypertrophy in The MA-Ghreb and Sub-Saharan Africa Left-Ventricul ArGEometry Study (MAG-SALVAGES) participants. Methods: The MAG-SALVAGES is a community based study in which 100 asymptomatic Black Sub-Saharan African (BSSA) and 189 white skin Maghreb within the age of 18 to 55 years underwent a resting echocardiography. Multivariate logistic regression analysis was utilized to identify the independent determinants of LVH left ventricular hypertrophy. Results: Men represented the majority of the enrolled participants: 173 (59.9%). Echocardiographic left ventricular hypertrophy was seen in 10 (3.5%) participants. Age ≥40 years, female gender, overall obesity, abdominal obesity, hypertension status and less fruit consumption were significantly associated with echocardiography left ventricular hypertrophy. After adjusting for confounding factors, age ≥40 years, female gender, abdominal obesity and less fruit consumption were independently and significantly associated with echocardiographic left ventricular hypertrophy, as illustrated in the following equation: Y = 0.36 + 0.162 age >40 years + 2.69 female gender + 2.52 abdominal obesity + 1.31 less fruit consumption. Conclusion: Lifestyle changes for the prevention of abdominal obesity and encouraging fruit consumption may be beneficial in preventing left ventricular hypertrophy.

A Cost-Benefit Analysis of China＇s Trade Relations With Sub-Saharan Africa

Trade and economic relations between China and Africa have a protracted history and have developed incrementally over the course of time. Consequently, increasing numbers of Chinese businesses and entrepreneurs have sought partnerships with African companies with the aim of establishing strategic partnerships, collaborations, and joint ventures. In recent years, these Sino-African trading relations have been the subject of consistent debate and scrutiny, attracting positive and negative analyses from scholars and practitioners across disciplines. Some studies questioned China＇s motives in Africa＇s markets, and others viewed with suspicion the structure of Sino-Africa＇s bilateral trading engagements. Conducting an extensive literature survey of related sources and employing content analysis of recent and current data （2000-2009）, the paper examined institutional and academic publications pertaining to Sino-African relationship. It determines imbalance in the structure of Sino-African bilateral trade, negative impact on domestic economic development, and competitive disadvantage in African marketplaces. Policy implications of these findings were provided as well as recommendations for mutual trade benefits and global strategic investments

Towards data-driven models for diverging emerging technologies for maternal,neonatal and child health services in Sub-Saharan Africa:a systematic review

Sub-Saharan Africa(SSA)has the highest maternal and under-five mortality rates in the world.The advent of the coronavirus disease 2019 exacerbated the region's problems by overwhelming the health systems and affecting access to healthcare through travel restrictions and rechanelling of resources towards the containment of the pandemic.The region failed to achieve the Millenium Development Goals on maternal and child mortalities,and is poised to fail to achieve the same goals in the Sustainable Development Goals.To improve on the maternal and child health outcomes,many SSA countries introduced digital technologies for educating pregnant and nurs-ing women,making doctors'appointments and sending reminders to mothers and expectant mothers,as well as capturing information about patients and their illnesses.However,the collected epidemiological data are not being utilised to inform patient care and improve on the quality,efficiency and access to maternal,neonatal and child health(MNCH)care.To the researchers'best knowledge,no review paper has been published that focuses on digital health for MNCH care in SSA and proposes data-driven approaches to the same.Therefore,this study sought to:(1)identify digital systems for MNCH in SSA;(2)identify the applicability and weaknesses of the dig-ital MNCH systems in SSA;and(3)propose a data-driven model for diverging emerging technologies into MNCH services in SSA to make better use of data to improve MNCH care coverage,efficiency and quality.The PRISMA methodology was used in this study.The study revealed that there are no data-driven models for monitoring pregnant women and under-five children in Sub-Saharan Africa,with the available digital health technologies mainly based on SMS and websites.Thus,the current digital health systems in SSA do not support real-time,ubiquitous,pervasive and data-driven healthcare.Their main applicability is in non-real-time pregnancy moni-toring,education and information dissemination.Unless new and more effective approaches are implemented,SSA might remain with the highest and unacceptable maternal and under-five mortality rates globally.The study proposes feasible emerging technologies that can be used to provide data-driven healthcare for MNCH in SSA,and the recommendations on how to make the transition successful as well as the lessons learn from other regions.

Interconnections between governance and socioeconomic conditions:Understanding the challenges in sub-Saharan Africa

Given that challenges on the issue of socioeconomic development faced by countries in sub-Saharan Africa(SSA)have been identified as critical to strengthening the inherent link between governance and socioeconomic conditions,this study examines the interconnections between governance and socioeconomic conditions in SSA.With a focus on 25 countries in SSA between 2005 and 2019,we conduct the analysis based on the Panel-Corrected Standard Error and System Generalized Method of Moments estimations and panel causality tests.The results show that SSA does not seem to have the means of effective governance to spur improved socioeconomic conditions.Moreover,the pervasiveness of institutional problems in many countries of SSA has been responsible for the poor socioeconomic conditions in the region.Likewise,governance quality and socioeconomic conditions are found to influence each other.An improvement in socioeconomic conditions could result in better governance quality.On the other hand,governance quality is viewed as a vital ingredient in achieving needed socioeconomic development outcomes.Thus,it is suggested that there is a need for countries in SSA to streamline governing systems toward engendering improved well-being.The introduction and implementation of transformative policies through effective governance are also necessary for ensuring critical structural changes and increasing social service provision.Overall,there should be a proactive identification of ineffective policies and procedures by policymakers to enhance meaningful impacts in the region.

PV-Hybrid Off-Grid and Mini-Grid Systems for Rural Electrification in Sub-Saharan Africa

Rural electrification remains a great challenge for Sub-Saharan Africa (SSA) as access to electricity is a prerequisite to accelerate its development. The present paper reviews the measures adopted to promote access to electricity in rural and remote areas of SSA. The main barriers to rural electrification in these developing countries are presented before showing technologies used for the aforementioned purpose. Then, adopted methods for enhancing the use of renewable energy in SSA are shown. Moreover, the policy adopted by decision makers and project planners are also highlighted. In addition, the optimal solutions proposed by researchers are given such as the cost-effective off-grid system type that might be a viable alternative to diesel power generation.

Carotid Web as a Cause of Ischemic Stroke in Sub-Saharan Africa: A Preliminary Monocentric Descriptive Study of 6 Cases Collected at the Fann Teaching Hospital (Senegal)

Introduction: Carotid web (CW), a rare and probably unknown arterial cause of ischemic stroke (IS), is commonly reported in young black patients, although most of the published cases resided in a non-African country. We describe the features of the first six Senegalese cases diagnosed at the Neurology Department of the Fann Teaching Hospital in Dakar. Patients and Method: It was a preliminary retrospective and prospective study conducted at the Neurology department of Fann teaching hospital (Dakar-Senegal). The symptomatic CW diagnosis was based on angioCT-scan of the neck arteries. The National Institute of Health Stroke Scale (NIHSS) and the modified-Rankin Scale (mRS) were used to assess the severity of the IS and the functional disability after the event, respectively. Results: CW was causing a left sylvian infarction in 4 patients. The mean age of the patients at the IS diagnosis was 41 ± 6 years with a sex ratio of 1. The mean time to diagnosis of CW was 13 months. Smoking (1/6), hypertension (1/6), and obesity (1/6) were the main vascular risk factors. The mean LDL cholesterol level was 1.52 g/L ± 0.49. The mean initial NIHSS was 15 ± 6 (8-22). Half of the patients had a severe infarction (NIHSS ≥ 15). For secondary prevention, half of the patients were treated with aspirin and the other half with acenocoumarol. After 18 months ± 17 of follow-up, the mean mRS score was 2 ± 1 (1-3). Conclusion: CW is an unknown cause of IS in young black patients. An early and appropriate multidisciplinary management could help to reduce the risk of recurrences.

Scourge of intra-partum foetal death in Sub-Saharan Africa

Intra-partum foetal death has been variously defined.However, a definition adopted at a technical consultation in 2006 is employed in this review. The quality of intrapartum care is a crucial factor for pregnancy outcome for both mothers and new-borns. Intra-partum stillbirth is defined as late foetal death during labour, which clinically presents as fresh stillbirth. The largest proportion of the world's stillbirths occurs in the late preterm, term and intra-partum periods. The Western Pacific region has the greatest reduction in stillbirth with a 3.8% annual decline between 1995 and 2009; however, the annual decline in the African region is less than 1%. Caesarean delivery is still uncommon, especially in rural areas: 1% of births in rural Sub-Saharan Africa and 5% in rural South Asia are by caesarean delivery; 62% of stillbirths occurred during the intra-partum period; 61.4% of stillbirths are attributable to obstetrical complications. Preventive measures aimed at reducing the incidence of intra-partum foetal death entail all measures aimed at improving quality antenatal care and preventing intrapartum asphyxia. This review discusses intra-partum foetal deaths from a Sub-Saharan African perspective. It explores the contribution of research within the region to identifying its impact on new-born health and potential cost-effective policy interventions.

Mass media exposure and its impact on malaria prevention behaviour among adult women in sub-Saharan Africa:results from malaria indicator surveys

Background:Mass media exposure plays a pivotal role in health communication and adoption of a healthy lifestyle.In this study,we aimed to measure the prevalence of malaria prevention behaviour among adult women in eight malariaendemic countries in sub-Saharan Africa(SSA),and assess the influence of mass media exposure in the adoption of those behaviours.Methods:For this study,we collected cross-sectional data on 46,822 women aged between 15 and 49 years from the Malaria Indicator Surveys(MIS)conducted in Burkina Faso,Ghana,Mali,Malawi,Kenya,Nigeria,Sierra Leone and Uganda.As the outcome variable,malaria prevention behaviour was proxied by the use of insecticide treated nets(ITNs)and uptake of antimalarial drugs in last pregnancy.Results:The overall prevalence of sleeping under ITN and that of taking antimalarial drug during the last pregnancy was respectively 67.9%(95%CI=66.6-69.2)and 72.8%(95%CI=71.3-74.2).However,there were disparities in the prevalence of using ITN and antimalarial drug use across the study countries.In the multivariable regression analysis,not receiving malaria related information from radio,poster/billboards,community events,and health workers were found to be significantly associated with reduction in the odds of using ITN the previous night.For the use of antimalarial drugs during last pregnancy,the odds were 23%[OR=0.773,95%CI=0.625-0.956]lower for those who did not receive malaria information on radio compared with those who received.Conclusions:These findings indicate a potentially important role of malaria information received through mass media on utilisation of ITN among women in SSA.More research is needed to explore the factors that limit the accessibility to malaria information through mass media.

Periodontitis and Rheumatoid Arthritis in Sub-Saharan Africa, Gaps and Way Forward: A Systematic Review and Meta-Analysis

Background: This review identified papers that described periodontitis and rheumatoid arthritis in sub-Saharan Africa. Only English language publications from January 2010 to December 2017 describing original research in sub-Saharan Africa on the association between periodontitis and rheumatoid arthritis were considered for this study. Methods: Published databases: Pub-Med, Science direct and Google scholar, were searched using terms “periodontitis”, “rheumatoid arthritis” and “Sub-Saharan Africa” to generate a set of putative studies. Articles with data on both rheumatoid arthritis and periodontitis compared to controls were selected. Studies on the association of periodontitis with cardiovascular disease, arthritis or rheumatoid arthritis alone were excluded. Data were extracted, critically appraised, and analyzed using a random-effect Mantel-Haenszel meta-analysis on plaque index, gingival index, pocket depth and clinical attachment loss. Results: Three publications were selected for the systematic review and 2 for the meta-analysis. Two studies were from Sudan, and one was from Burina Faso. There was a significant increase in pocket depth (mean difference: 0.31;95% CI: 0.21, 0.41;N = 274;(p ≤ 0.001)) and clinical attachment loss (mean difference: 0.47;95% CI: 0.22, 0.75;N = 274;(p ≤ 0.001)) in participants with rheumatoid arthritis compared to normal controls. Conclusion: Findings from these combined studies show a significant relationship between periodontal disease and rheumatoid arthritis with increased periodontal pocket depth and clinical attachment loss. They also highlight the need for additional work especially in the area of associating rheumatoid arthritis with P. gingivalis, the oral microbiome and treating periodontal diseases to help in the management of rheumatoid arthritis.