Systematic Review on the Epidemiology and Management of the Dry Eye Disease in Sub-Saharan Francophone Africa

Introduction: Dry Eye Disease (DED) is a multifactorial affection of the tears and the ocular surface. Its prevalence in the world varies between 7% and 33%. To the best of our knowledge, the prevalence of DED in Subsaharan Francophone African countries is not yet known. The objectives of this systematic review were to determine the prevalence of DED, to identify the main risk factors for DED, and to determine the diagnostic and therapeutic management of DED in Subsaharan Francophone African countries. Methodology: This is a systematic review of articles, dealing with DED, published in English or French language from 2010 to 2020. The following key words (Prevalence OR Incidence OR Proportion OR Rate OR Frequency OR Epidemiology OR Distribution) AND (Risk Factors OR Influences) AND (Symptoms or Questionnaire) AND (Clinical Signs OR Clinical Tests) AND (Dry Eye Disease OR Dry Eye Syndrome) AND (Pharmacological Treatment OR Non-pharmacological Treatment OR Management) AND (Benin OR Burkina Faso OR Burundi OR Cameroon OR Cap-Green OR Central African Republic OR Congo OR Congo (Democratic Republic of) OR Ivory Coast OR Gabon OR Guinea OR Guinea-Bissau OR Equatorial Guinea OR Mali OR Madagascar OR Mauritius (island) OR Niger OR Rwanda OR Sao Tome and Principe OR Senegal OR Seychelles OR Chad OR Togo) in French and English were searched on Pubmed, Chocrane database, Google scholar and ICTRP. Articles in English and French were selected from 2010 to 2020. Results: We selected 05 articles on the epidemiology and management of DED in sub-Saharan francophone Africa. The prevalence of DED in sub-Saharan francophone Africa in the articles ranged from 7.5% to 90.4%. DED affects more women than men. The risk factors found were: age over 50 years, diabetes, meibomian gland dysfunction, prolonged use of computers, and glaucomatous anti-glaucoma drugs. The Test of Breack Up Time (TBUT) was commonly used for the clinical diagnosis of dry eye disease in Sub-Saharan Francophone Africa. The therapeutic strategy for DED was not mentioned in any article. Conclusion: DED, a multifactorial and blinding eye disease, is insufficiently explored by eye health professionals in sub-Saharan Francophone Africa. The implementation of a systematic screening program and strategies for the treatment of dry eye disease in at-risk individuals would be beneficial for sub-Saharan Francophone African countries.

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.

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.

(Re)assessing Climate-Smart Agriculture practices for sustainable food systems outcomes in sub-Saharan Africa:The case of Bono East Region,Ghana

This research paper assesses the reality of Climate-Smart Agriculture(CSA)practices’potential to promote the outcomes of sustainable food systems(SFS)within Ghana’s smallholding agriculture context.The study demon-strates that rural farmers generally perceive CSA’s contribution to‘food and nutrition security’and‘economic performance’as more important than CSA’s contribution to‘social equity’and‘environmental stewardship’.From a narrow perspective,the study demonstrates that farmers perceive CSA’s potential to‘prevent pest and disease outbreaks’and‘increase human capital information’as the most important contribution of CSA to SFS outcomes.In contrast,CSA’s potential to promote environmental stewardship is perceived as the least important among Ghana’s rural farmers.This enormity of displacement of smallholders’perceptions at large is motivated by de-mographic,socioeconomic and ecological factors.Moreso,the CSA for SFS outcomes narratives is driven by farmers’self-apprise,social networks and other local information dissemination agents.Furthermore,research findings suggest farmers’awareness of CSA practices and interventions is deficient owing to unmet training and information needs for approximately 82%of the CSA practices and interventions.This situation elucidates the dichotomy of CSA practices’narratives as tools for attaining food,nutrition security and economic performance to the detriment of critical issues such as increasing awareness and building farmers’capacity to engage with CSA practices while also managing socio-ecological trade-offs that emerge over time due to engagement with CSA.Critical(re)orientation is needed across the scale to drive CSA practices and interventions that confine cli-mate adaptation and food production practices within safe planetary boundaries without undermining social,economic,food and nutrition security needs.

Examination of the poverty-environmental degradation nexus in Sub-Saharan Africa

The relationship between environmental degradation and poverty has increasingly become the focus of national strategic decision-making in recent years.However,despite several theoretical explorations on the nexus,a dearth of empirical literature on the poverty-environmental degradation nexus,specifically on Sub-Saharan Africa(SSA),still exists.In this study,we investigated the poverty-environmental degradation nexus in SSA.We hypothesized that poverty is both a cause and effect of environmental degradation,and this relationship is explained as a vicious cycle.Unlike previous studies,we employed several alternative indicators of environmental degradation to examine the poverty-environmental degradation nexus in this study.We used data from 41 countries of SSA between 1996 and 2019 and employed the generalized method of moments(GMM)approach.The findings suggest a cyclical relationship between poverty and environmental degradation in SSA,which confirms that an increase in poverty leads to an increase in environmental degradation,especially in deforestation and PM2.5 emissions.Similarly,the increase in environmental degradation positively affects poverty in SSA.We also confirmed that exogenous conditioning factors such as population growth rate,education,industrialization,and income inequality,institutional quality indicators such as governance effectiveness,control of corruption,freedom ad civil liberty,and democracy,and endogenous factors including fossil fuel energy use,fuelwood energy use,household health expenditure,infant mortality rate,and agriculture productivity influence the nexus between poverty and environmental degradation.The findings on the relationship between poverty and environmental degradation in SSA are a testimonial evidence that both poverty and environmental degradation are significant issues in SSA.Hence,poverty alleviation policies in SSA should not lead to PM2.5 emissions and deforestation,which may as well force people into a poverty-environmental degradation trap.Instead,poverty reduction policies should simultaneously achieve environmental conservation.

Cardiac Resynchronization Therapy in Heart Failure in Sub-Saharan Africa Environment: Experience of the Principal Hospital of Dakar (Senegal)

Background: Heart failure is a major public health challenge in sub-Saharan Africa. In patients with chronic Heart Failure and cardiac desynchrony, studies have suggested that cardiac resynchronization, can improve cardiac function and the quality of life of patients. However, in Sub-Saharan Africa, very few studies have been done on cardiac resynchronization which is in its infancy. The aim of this study is to report the local data from our hospital. Method: It was a transversal, descriptive and analytical study conducted from November 2019 to September 2022 at the Cardiology Department of the Principal Hospital of Dakar. Results: Twelve patients were implanted for Cardiac Resynchronization Therapy (CRT). The sex ratio was 8 males/4 females. The average age was 67 ± 11 years. Ten patients had non-ischemic heart disease and the two others had ischemic one. All of them had NYHA III or IV scores before CRT. The Quality of Life (QOL) was judged as poor by all of the patients. The average duration of QRS was 156 ± 9 ms. 27.9% ± 5% was the mean Left Ventricular ejection fraction (LVEF). Complications occur in 3/12 patients (25%). It was one CS vein dissection, one micro LV lead dislodgement and one phrenic nerve stimulation. Nine patients, who were considered as responders, had an improvement of QOL and NYHA, the LVEF increased and the end-diastolic dimension, and the duration of the QRS interval all decreased. Two patients do not respond and one (1) who had permanent atrial fibrillation, was a secondary responder after an atrioventricular junction ablation. Conclusion: Cardiac resynchronization is a therapy that improves the QOL of patients, the LVEF and reduces the duration of the QRS interval. However, this procedure is not without risk of complications. In sub-Saharan Africa, the major challenge is to improve the financial accessibility of this therapy for the population.

An Analysis of the COVID-19 Consequences on the Uncertainty Socio-economic Indicators of Sub-Saharan Africa

This study aims to investigate the main sectors of economic development before and the current situation of COVID-19 for Sub-Saharan African countries by demonstrating country experiences,the role of vaccines,and the SSA economy forecast.The study has four main sections,including an introduction,an overview of socioeconomic indicators before the pandemic,methods,results findings,and discussion.The study used mixed methods,including an approach based on secondary data.The quantitative results were analysed using both empirical methods and the researcher’s prior expertise.The analysis of the effects of the COVID-19 pandemic on SSA countries was based on long-term data collected by several international financial institutions.The research findings demonstrated conclusively that COVID-19 is causing the collapse of the SSA economy,the first economic recession in 25 years,$37-79 billion in lost GDP by 2020,and an export decrease of 10.6%.In education,for example,64%of primary and 50%of secondary students lack ICT training,89%(216 million)do not have access to a home computer,and 82%(199 million)do not have an Internet connection missed classes during the COVID-19 period.The agricultural sector in SSA is also impacted by over 239 million hungry people.COVID-19 mass vaccinations and public debt amount to over$154 billion in obligations to get the SSA economy back on its feet with zero tolerance for embezzlement of public funds.These results can be used to make the economies of SSA countries resilient to the current crises and to address some thematic issues,such as the implementation of the African Continental Free Trade Area(AfCFTA)in all SSA countries,which will save time and money by getting rid of border taxes.Therefore,policymakers can use the findings to begin formulating plans to address issues like economic development,education,and food insecurity.

COVID-19 Vaccination Status and Severe Outcomes among Patients Hospitalized for COVID-19 in West Africa, Togo, 2021

Objectives: More than a year after its introduction, COVID-19 vaccination coverage was low in the Togolese population and little data were available on its benefits for hospitalized patients. This study aimed to describe the impact of COVID-19 vaccination on the prognosis of hospitalized patients. Methods: This was a retrospective cohort study of patients admitted to the Centre Hospitalier Régional Lomé Commune (Togo) between June 1, 2021 and May 31, 2022. Primary outcomes (admission to the intensive care unit and death) were presented with frequency and proportion. Mortality rates were presented by sociodemographic and clinical characteristics and compared by appropriate statistical tests. Factors associated with inpatient death were described by performing a Cox proportional hazard regression. Results: A total of 604 patients were hospitalized (50.0% women). The mean age was 54.03 ±17.1 years. Only 55 patients were fully vaccinated (9.1%). ICU admission was significantly more frequent in unvaccinated patients than in vaccinated ones (63.0% vs. 38.2%;p Conclusion: COVID-19 vaccination had a significant benefit for patients with COVID-19 infection in terms of reducing the risk of death. Based on real-world data from sub-Saharan Africa, this information can help optimize the benefit of COVID-19 vaccination by raising community awareness and increasing vaccine coverage while reducing hesitancy.

Interleukin 6 and Bone Erosions in Rheumatoid Arthritis in an African Hospital

Introduction: Rheumatoid arthritis (RA) is a chronic, erosive and deforming inflammatory rheumatic disease. In the era of biotherapies and the arrival of biosimilars in sub-Saharan Africa, the objective of this study was to describe plasma IL-6 variations in RA patients at Cité Verte District Hospital (Cameroon). Material and Methods: Descriptive and analytical cross-sectional study from December 1, 2021 to May 31, 2022. We included patients over 18 years old suffering from RA (ACR/EULAR 2010). Patients with an infection were not included. The data collected were age, sex, smoking status, family history, disease duration, disease activity by DAS28, CRP, rheumatoid factor, and plasma level of IL-6. Bone erosion was sought on radiography and ultrasound. Result: We included 31 patients, 25 of whom were women (80.6%). The mean age was 47.27 ± 17.97 years. Disease activity was predominantly moderate (32.3%) and severe (32.3%). Mean IL-6 level was 15.29 ± 2.36 pg/ml (extremes: 11.26 pg/ml and 20.15 pg/ml). IL-6 levels were higher in patients with a history of smoking. Similarly, IL-6 levels were higher in patients with mildly active RA in remission than in moderately and severely active RA. Mean IL-6 levels were significantly higher in patients with erosive RA (16.3 pg/ml VS 14.6 pg/ml). Conclusion: IL-6 levels were significantly elevated in men, weaned smokers and patients with bone erosions.

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.

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.

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.

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.

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.

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

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.

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.

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.

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.