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.

A Generic and Reliable Land Acquisition Protocol Implementation for Sub-Saharan Africa Countries

Land acquisition is subject of many frauds worldwide. In Africa countries, land acquisition frauds are a real curse. Main reasons of the high land acquisition frauds in Africa are a lack of a reliable land acquisition protocol implementation, no centralized information system that records land transactions and integrates all actors, lack of education about the acquisition protocol and lack of applied sanctions in case of frauds. As of sanctions, the issue is bound to the corruption plague in Africa. Authorities that are supposed to rule the laws are not well paid and are part of the corruption scheme. Most frequent frauds are multiple sales of the same land, falsified land title, false owner identification. In Africa, a land belongs generally to the first residents of the area. To claim ownership of a land, an owner should be recognized by the rural or city authorities. To achieve this recognition, he must obtain from those authorities an attribution letter. The author proposed a complete and reliable land acquisition protocol named ACLAP (Africa Countries Land Acquisition Protocol). The purpose of this paper is to explain the main components of the protocol implementation and show its efficiency when confronting fraud threats. In this paper, a Generic and Reliable Land Acquisition Protocol Implementation in Sub-Saharan Africa countries context is proposed. The platform keeps relevant land transaction information for administrators, managers, buyers, sellers, or for people consultation purpose. The application may be used in village, city, department, region, or country for land management decision making.

(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.

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.

Evaluation of the Local Epinephrine Anesthesia without Tourniquet in the Surgical Treatment of Hand Injuries in Adults: About 27 Cases in Sub-Saharan Africa

Background: In sub-Saharan Africa, surgery for hand injuries is usually performed under axillary or general anesthesia. This is often not without consequences. The Wide Awake Local Anesthesia No Tourniquet (WALANT) is, therefore, an anesthetic asset in the surgical treatment of hand injuries. This study aims to share an experience on this technique’s effectiveness and to spark interest among African authors and practitioners. Method: This prospective study focuses on 27 surgeries of hand injuries carried out with WALANT. The study spanned over nine months (November 2021-August 2022) and included 19 men and eight women with a mean age of 35.4 years (extremes: 19 and 54). There were five (18%) flexor tendon ruptures, three of which were in zone 2, eleven (41%) metacarpal fractures, four of which were open, seven (26%) phalangeal fractures, two of which were open, and four (15%) finger springs. The operated lesions were assessed at a minimum of three months. The pain was assessed using the Visual Analog Scale. The QuickDASH score was evaluated for each patient at the end of the follow-up period. Results: Intra-operatively, the mean value of the Visual Analog Scale was 1/10, with extreme values of 1/10 and 3/10. Of the five cases of flexor tendon ruptures, three were located in zone 2 and two in zone 3. The metacarpal fractures were divided into seven closed diaphyseal fractures and four extra-articular metaphyseal fractures. Four of the seven phalangeal fractures were oblique diaphyseal, and three were transverse diaphyseal. The treatment of the protruding fingers followed the conventional technique. The assessment of the QuickDASH score in the months following surgery showed a score of 11.8 in the first month, 10.3 in the second month, and 5.0 in the third month. Conclusion: WALANT is an easy-to-use, unexpensive anesthetic technique that enables shorter operating times. It rarely presents complications. It is recommended for hand surgeries performed with limited technical resources.

Challenges of Rheumatoid Arthritis Management in Sub-Saharan Africa in the 21st Century

In recent decades, several advances have been made in the management of rheumatoid arthritis (RA) both in the diagnostic field and in the therapeutic field. Unfortunately, RA remains poorly studied in black Africa. Epidemiological data are rare and controversial. The estimated prevalence of RA in Africa is about 0% - 2.54%. Risk factors associated with RA must be studied by taking into account special features of black Africa such as the low tobacco consumption in certain regions, the tropical climate and the high frequency of endemic parasitic and viral infections. The initially supposed mildness of RA in black Africa is increasingly challenged. The diagnosis is often made too late because of the scarcity of rheumatologists and ignorance. Diagnostic tools are limited to the clinical data, the erythrocyte sedimentation rate and radiographs as the other tools are poorly available. In addition, there are misconceptions in African communities, responsible for loss of sight during follow-up and treatment discontinuations. This is exacerbated by the shortage of disease-modifying anti-rheumatic drugs (DMARDs) and the inability to afford them. Furthermore, biological agents are very difficult to access. Further studies are essential to better understand the characteristics of RA in black Africa. Thus, collaborations between African and Western research teams seem very important. In order to make available the DMARDs especially biological agents, pharmaceutical companies can contribute through research partnerships. Moreover, governments should provide a better place for chronic inflammatory diseases in the programs against non-communicable diseases. Finally, training must also be promoted to increase the number of specialists and the level of knowledge of other health workers.

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.

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.

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.

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.

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.

Degree of financialization and energy efficiency in Sub-Saharan Africa: do institutions matter?

The United Nations Sustainable Development Goal 7 emphasizes the need for economies around the world to double their efforts in energy efficiency improvements.This is because improvements in energy efficiency can trigger economic growth and considered as one of the‘green’growth strategies due to its carbon free content.To this end,some empirical studies have investigated the nexus between economic growth and energy efficiency,but the effects of the latter on financial indicators have not been sufficiently studied in the literature,at least in developing economies like Africa.This study examines the effect of energy efficiency improvements on commercial bank profitability under different political regimes(i.e.,autocratic and democratic political regimes);something previous literature had neglected.The study uses panel data,consisting of 43 African countries and the simultaneous System Generalized Method of Moments.We found that energy efficiency improvement is more likely to induce higher bank profitability in political institutions with the characteristics of centralization of power compared with those with decentralization of power.Furthermore,for the banking sector,the findings suggest that energy utilization behavior of clients should be included in the loan or credit valuation process.For the government,the agenda of energy efficiency should be aggressively pursued while taking cognizance of creating a political environment that weans itself from a‘grandfathering’behavior.

Front-of-pack labeling:a health literacy intervention to improve cardiovascular health in Sub-Saharan Africa

There is a surge in the burden of cardiovascular disease(CVD)in Sub-Saharan African(SSA)countries.Over the last 50 years there has been a rapid growth in the consumption of ultra-processed food products high in salt,fat,and glycemic load in SSA.There is overwhelming evidence linking UPFP consumption to an increased risk of coronary artery disease,cerebrovascular disease,overall CVD,and all-cause mortality.Front-of-pack labeling(FOPL)represents an important intervention to guide consumers towards healthier diets and ultimately contribute to the prevention of diet-related adverse health outcomes including CVD.This paper discusses the challenges in the development and implementation of FOPL systems in SSA,and proposes some key elements that would be critical for developing an effective FOPL system in SSA countries.

Linkages between Agricultural Diversification, Dietary Diversity, and Nutrition Outcomes in Sub-Saharan Africa: A Systematic Review

An enabling policy environment and good governance are fundamental drivers for agriculture and food systems, framing how they work and for whom in the global efforts to achieve Sustainable Development Goal 2 and food justice for all. The review examined the policy environment in sub-Saharan Africa in relation to linkages between agricultural diversification, dietary diversity, and nutrition. The systematic review of literature entailed searching Ovid MEDLINE, PubMed, Embase, African Journals Online and PsychINFO databases from Jan 1, 2010, to Feb 30, 2021, for eligible studies and technical reports. Publications reporting on agricultural diversification, dietary diversity, and nutrition outcomes in relation to policy environment were included. Qualitative synthesis of the abstracted evidence was conducted. SSA countries recognise the crucial role of agricultural diversification as a pathway to achieving food security with increasing emphasis on smallholder farmers. There is a rich base of policies that are complemented by lived experiences and best practices which can strengthen linkages between agricultural diversification, agribusiness and dietary diversity. For instance, the application of precision farming, agro-ecological zones targeted agricultural intensification and gender sensitive land administration, access and tenure in countries experiencing declining farm size could potentially ensure the youth, men and women have equitable and innovative opportunities of access to elements of improved agricultural systems. Smallholder farmers with the majority in rural settings, maintain de facto agricultural diversity. It is essential for any policy design or intervention to take into account the specific country’s context;pay particular attention to socioeconomic capabilities of the rural population along with fiscal capacity and trade-offs. Empirical evidence on the nexus between agricultural diversification and nutrition is mixed and limited.

Ulcerative Colitis in Sub-Saharan Africa: Analysis of 24 Cases in Dakar (Senegal)

Introduction: The aim of our study was to determine the socio-demographic, diagnostic and therapeutic aspects of ulcerative colitis (UC) in one of the largest gastroenterology departments in Senegal. Patients and Method: This was a retrospective and descriptive study based on the analysis of the records of patients hospitalized in the Hepato-Gastroenterology Department of the Grand Yoff General Hospital (Dakar, Senegal) between January 2013 and December 2019. All cases of UC were collected. Clinical, biological, endoscopic and histological data were collected, as well as treatment options. Results: We observed 24 cases, representing a prevalence of 0.87% of inpatients. The mean age of patients was 36 (ranged 18 to 73) and sex ratio 0.9 (13 females). The mean diagnostic delay was 1.6 years (ranged 4 months to 5 years). The clinical symptomatology was dominated by diarrhea with blood and mucus (18 cases). The Litchiger score on admission averaged 8 and 5 patients (20.8%) had severe acute colitis. Colonoscopy showed pancolonic involvement (Montreal E3) in 11 cases (45.8%) and severe endoscopic lesions (stage 3 of the Mayo endoscopic subscore) in 10 cases (41.6%). Therapeutically, 17 patients (70.8%) were initially treated with corticosteroids. Background therapy was 5-ASA in 17 patients (70.8%) and azathioprine in 7 patients (29.2%). Two cases of death (8.3%) were observed following colectasia with colonic perforations before emergency surgery could be performed. Conclusion: UC in our study was primarily among young adults with a slight female predominance. Diagnosis is often late. The lack of biotherapy requires close collaboration with surgeons for the management of severe forms.