搜索结果：The Journal of communicable diseases

Advances in antiretroviral therapy have enabled people living with HIV (PLHIV) to live longer and healthier lives. However, aging with HIV infection is accompanied by an increased risk of non-communicable diseases (NCDs), highlighting the need to integrate care services. The Academic Model Providing Access to Healthcare (AMPATH) in Eldoret, Kenyahas, which has been providing care for PLHIV for over 30 years, is seeing an increase in NCDs, particularly hypertension and diabetes, especially among older patients. It is unclear how healthcare providers manage the complex healthcare needs of older adults living with HIV (OALWH) and comorbid NCDs, or how they perceive the integration of hypertension and diabetes care within the HIV care platform. We conducted in-depth interviews at an AMPATH facility in Eldoret, Kenya. Ten healthcare providers (three nurses and seven clinical officers) were interviewed to explore the facilitators and barriers to integrating HIV and NCD care services for OALWH. Audio records were transcribed verbatim, content analysis was performed, and the capabilities (C), opportunities (O), and motivation (M) models for behavior change (COM-B model) were used to comprehensively map the drivers and barriers that shape healthcare providers' acceptance, adoption, and implementation of integrated HIV and NCD care services. The majority of participants had worked for more than five years, offering care for people living with HIV. All participants had experience managing older adults living with HIV and expressed challenges with the lack of coordinated care delivery for HIV and NCDs. The participants highlighted the potential challenges of optimal adherence to antiretroviral therapy (ART) among OALWH in the presence of multiple chronic conditions. Based on these challenges, participants perceived the integration of hypertension and diabetes care into the HIV care platform as beneficial to clients and the overall healthcare system. Factors such as the availability of physical resources and infrastructure (C), availability of training opportunities for NCD care (O), leadership support (M), and motivation to provide person-centered care (M) were perceived as facilitators of HIV/NCD integrated care delivery. Impeding factors such as lack of guidelines for integration (O), siloed healthcare service delivery (O), inadequate resource allocation for NCDs (O), and perceived increased workload (M) were also highlighted by healthcare providers. The findings of this study highlight healthcare providers' perceived facilitators and barriers to the integration of NCD care into HIV care platforms. The insights gained from this study hold the potential to inform tailored interventions, policy decisions, and capacity-building initiatives aimed at fostering successful integration and improving overall health care delivery to meet the needs of OALWH in resource-constrained settings.

In view of the global burden of non-communicable diseases (NCDs), the focus is shifting increasingly towards structural prevention measures. Effective implementation of these measures is crucial. Using the Context and Implementation of Complex Interventions (CICI) Framework, this article reflects on the implementation of two ratio prevention measures and discusses challenges in the application of implementation science approaches. Case 1 (Collaboration for Evidence-Based Healthcare and Public Health in Africa-CEBHA+) examined measures for the prevention of NCDs and road traffic accidents in sub-Saharan Africa. Case 2 ("Präventionskette Freiham") evaluated a community network in Germany that aims to enable children and adolescents from socially disadvantaged families to grow up well and healthy. Data published in project-related publications served as the basis for the analysis, supplemented by a questionnaire-based reflection by the researchers involved. For both data sources, the data collected were coded inductively and assigned to the deductive categories of the CICI Framework. In both cases, contextual and structural conditions, implementation agents, and strategies were assessed on multiple levels, with an emphasis on implementation agents. While Präventionskette Freiham pursued a systematic process evaluation with explicit use of implementation science approaches, this was only implicitly considered in CEBHA+, which makes comparability, classification in the literature, and overarching consideration more difficult. Implementation science approaches should be given a stronger focus in the field of relationship prevention in order to fully exploit their potential. HINTERGRUND: Angesichts der globalen Krankheitslast durch nichtübertragbare Erkrankungen (Non-Communicable Diseases – NCDs) rücken verhältnispräventive Maßnahmen verstärkt in den Fokus. Entscheidend ist dabei die wirksame Umsetzung solcher Maßnahmen. Dieser Beitrag reflektiert anhand des Frameworks „Context and Implementation of Complex Interventions“ (CICI) beispielhaft die Umsetzung zweier verhältnispräventiver Maßnahmen und diskutiert Herausforderungen bei der Anwendung implementierungswissenschaftlicher Ansätze. In Fall 1 („Collaboration for Evidence-based Healthcare and Public Health in Africa“ – CEBHA+) wurden Maßnahmen zur Prävention von NCDs und Verkehrsunfällen in Subsahara-Afrika untersucht. Im Fall 2 („Präventionskette Freiham“) wurde ein kommunales Netzwerk, das Kindern und Jugendlichen ein gutes, gesundes Aufwachsen und Teilhabe unabhängig vom sozialen Status der Familie ermöglichen soll, in Deutschland evaluiert. Als Datengrundlage dienen projektbezogene Veröffentlichungen, ergänzt durch eine fragebogenbasierte Reflexion der beteiligten Wissenschaftler*innen. Für beide Datenquellen wurden die erhobenen Daten induktiv kodiert und den deduktiven Kategorien des CICI-Frameworks zugeordnet. In beiden Fällen wurden Aspekte des Kontexts und der Implementierung auf multiplen Ebenen erfasst, mit Fokus auf Implementierungsakteur*innen. Während die Präventionskette Freiham eine systematische Prozessevaluation unter explizitem Einsatz implementierungswissenschaftlicher Ansätze verfolgte, wurde dies in CEBHA+ nur implizit berücksichtigt, was die Vergleichbarkeit, Einordnung in die Literatur und umfassende Betrachtung erschwerte. Implementierungswissenschaftliche Ansätze sollten verstärkt auf Verhältnisprävention ausgerichtet werden, um deren Potenzial vollständig auszuschöpfen.

The use of social media platforms for social and educational interactions has transformed the way information sharing takes place. However, this has also exposed the public to health-related misinformation, posing significant challenges for global health. This is particularly challenging in sub-Saharan Africa (SSA), where the burden of noncommunicable diseases (NCDs) now compounds existing challenges from communicable diseases. This review aimed to examine the growing challenge of health-related social media misinformation and the potential implications for NCD burden in SSA, and explore possible strategies for combating social media misinformation in the context of NCDs. Useful data for this review were obtained by consultation of online sources of information using search engines and online databases. Social media platforms serve various health-related purposes, including health interventions, health campaigns, medical education, disease outbreak surveillance, and behavior change. WhatsApp, Facebook, X (formerly Twitter), and YouTube are the leading platforms associated with health-related misinformation in SSA. Potential implications of health-related social media misinformation are misconceived clinical diagnosis, inappropriate self-medication and failure to adhere to evidence-based treatment modalities. Social media misinformation in the area of NCDs can potentially influence people's health-related attitudes, behaviour and undermine appropriate implementation of evidence-based interventions. Collaboration among stake holders such as healthcare professionals, religious organizations and social media influencers, as well as public awareness campaigns and regulatory policies are plausible strategies for combating the issue. There is limited research on the implications of health-related social media misinformation on NCDs in SSA highlighting the need for further studies. L'utilisation des plateformes de médias sociaux pour les interactions sociales et éducatives a transformé la manière dont l'information est partagée. Cependant, cela a également exposé le public à des informations erronées liées à la santé, ce qui pose des défis majeurs pour la santé mondiale. Cette situation est particulièrement préoccupante en Afrique subsaharienne (ASS), où la charge des maladies non transmissibles (MNT) s'ajoute aux défis existants liés aux maladies transmissibles. Cette revue vise à examiner le défi croissant de la désinformation liée à la santé sur les médias sociaux et ses implications potentielles sur la charge des MNT en ASS, ainsi qu'à explorer des stratégies possibles pour lutter contre la désinformation dans ce contexte. Les données utiles pour cette revue ont été obtenues par consultation de sources en ligne via des moteurs de recherche et des bases de données. Les plateformes de médias sociaux remplissent divers rôles liés à la santé, notamment les interventions sanitaires, les campagnes de santé publique, l'éducation médicale, la surveillance des épidémies et le changement de comportement. WhatsApp, Facebook, X (anciennement Twitter) et YouTube sont les principales plateformes associées à la désinformation en matière de santé en ASS. Les implications potentielles incluent des diagnostics erronés, l'automédication inappropriée et le non-respect des traitements fondés sur des données probantes. La désinformation sur les MNT diffusée via les médias sociaux peut influencer les attitudes et comportements liés à la santé, et compromettre la mise en œuvre adéquate des interventions fondées sur des preuves. La collaboration entre les professionnels de santé, les organisations religieuses et les influenceurs des médias sociaux, ainsi que les campagnes de sensibilisation et les politiques réglementaires, sont des stratégies plausibles pour combattre ce phénomène. Les recherches sur les effets de la désinformation sanitaire sur les MNT en ASS restent limitées, soulignant le besoin d'études approfondies. Médias sociaux, Désinformation, Maladies non transmissibles, Afrique subsaharienne.

In low-income countries such as the Democratic Republic of the Congo (DRC), the strategies implemented to combat tuberculosis (TB) are threatened by the emergence of non-communicable diseases (NCDs), such as diabetes mellitus (DM). Very little data on the implementation of services to manage TB-DM are generally available in these low-income countries. The aim of this study was therefore to assess the level of implementation of DM screening and treatment activities in TB unit clinics (TUCs) in Lubumbashi, DRC. A cross-sectional study was conducted using the Service Availability and Readiness Assessment (SARA) questionnaire from June to July 2023. Fourteen tracer items, divided into 4 domains-i) guidelines and staff, ii) basic equipment, iii) diagnostic capacity, and iv) drugs and products-were assessed. The readiness indices were compared according to the managerial instance and the activity package organized in each of the selected TUCs. A Chi2 test with a significance level set at p = 0.05 was used for this comparison, and Cronbach's α coefficient was calculated to estimate the reliability or consistency of the questionnaire. Of the 35 TUCs visited, 19 (54.3%) were public health facilities, and 20 (57.1%) had a supplementary package of activities (SPA). The readiness of TUCs for providing DM diagnostic and treatment services was around 50%. A statistically significant difference was observed based on the managerial instance overseeing the TUC (p = 0.00) and the package of activities offered within these institutions (p = 0.00). The current study has underscored the limited capability of TUCs in Lubumbashi to provide services for managing TB-DM comorbidity in DRC. It is imperative to implement strategies aimed at enhancing this capacity and taking into account the local context and influencing factors.

Malaria, a preventable parasitic disease, causes most child deaths in sub-Saharan Africa (SSA). Reliable cause-of-death data are essential to evaluate progress toward the national and global malaria control goals. However, civil registration and vital statistics are often weak and incomplete in many low- and middle-income countries. In such circumstances, verbal autopsy (VA) provides an alternative means of mortality surveillance. In some settings, VA has been paired with Minimally Invasive Tissue Sampling (MITS) to obtain detailed biological confirmation of the causes of death. Here, we compare malaria-attributed and all-cause mortality among children younger than five years in six SSA countries, using three computer models (GPT-4o, InSilicoVA, and InterVA-5) to assign causes of death, against MITS as the reference standard. We examined 3129 under-five deaths enrolled in six Child Health and Mortality Prevention Surveillance (CHAMPS) country sites in SSA between December 2016 and December 2022. Contrived free-text narrative summaries were generated for each record and coded into International Classification of Diseases (ICD-10) codes by GPT-4o. InSilicoVA and InterVA-5 outputs, provided in the World Health Organization 2016 VA codes, were harmonized to ICD-10 for comparison. The primary comparison was the underlying cause of death in VA models and MITS. Sierra Leone had the highest proportion of post-neonatal deaths attributed to malaria at 30.3% (67/221), followed by Kenya at 17.3% (42/243), then Mozambique at 13% (18/138) and Mali at 5.5% (3/55) as defined by MITS. No malaria-attributable deaths were observed in neonates and stillbirths. GPT-4o correctly classified 60 (46.2%) of 130 malaria deaths, compared with 39 (30.0%) for InSilicoVA and 30 (23.1%) for InterVA-5. At the population level, the GPT-4o model achieved a higher cause-specific mortality fraction accuracy (0.36) compared to InSilicoVA (0.07) and InterVA-5 (0.08). GPT-4o performed comparatively better in attributing malaria, HIV/AIDS, and diarrhoeal diseases compared to other communicable diseases. GPT-4o demonstrated superior performance over probabilistic VA models in identifying malaria-attributed deaths. National vital registration authorities and health ministries should consider integrating large language model-driven tools into their VA systems to enhance diagnostic precision. While less practicable at scale, focal and periodic MITS comparisons are useful for improving verbal autopsy systems. National mortality data are essential to track progress in reducing childhood deaths from malaria and other conditions.

The syndemic framework provides a critical lens for understanding the complex interplay between HIV/AIDS, mental health (MH) conditions, and non-communicable diseases (NCDs) in Africa. This scoping review explores how these conditions converge to form a syndemic that disproportionately affects vulnerable populations - particularly people living with HIV/AIDS (PLWH). Contextual factors such as stigma, lower socioeconomic resulting in poverty, gender, resource limitations, and fragmented healthcare systems exacerbate these interrelated conditions, posing significant challenges to individuals and their health. A scoping review was conducted to examine the syndemic interactions between HIV/AIDS, MH, and NCDs across Africa. Utilizing the PRISMA-ScR framework and a predefined inclusion criterion, literature searches were conducted in the following databases: PubMed/Medline (OVID), Web of Science (all databases), Web of Science (core collection), Global Health, Cumulative Index of Allied Health Literature (CINAHL), MEDLINE OVID, Psychinfo (OVID), Psychinfo (proquest); and Psychinfo (psychnet) in March 2024. Articles were screened independently by two peer reviewers and conflicts were resolved by a third reviewer. Data were extracted to summarize study characteristics, prevalence rates, and the contextual factors that underpin syndemic interactions among HIV/AIDS, MH and NCDs. An initial search retrieved 5937 articles, with 2913 articles remaining after removal of duplicates. Title and abstract screening further excluded 2706 articles. In total, 207 full-text articles were assessed, of which 17 publications were extracted and included in the review. The scoping review identified a significant prevalence of multi-morbidities amongst PLWH, particularly within hypertension, diabetes, and depression. Women and older adults were disproportionately affected, with gender and age disparities shaping health outcomes. Contextual factors such as stigma, socioeconomic barriers, and fragmented healthcare systems were consistently reported as key contributors to worsening such multi-morbidities. In many publications, NCDs and MH conditions were undiagnosed or poorly managed, complicating HIV treatment and reducing the quality of life. Individual and structural resource limitations, along with poor healthcare integration, further hindered effective care. This scoping review underscores the urgent need for integrated healthcare models to address the syndemic of HIV/AIDS, NCDs, and MH in Africa. Interventions should prioritize stigma reduction, capacity building, and comprehensive care to address the underlying socioeconomic determinants of health among PLWH. Strengthening healthcare systems and promoting holistic, patient-centered care is essential for reducing disparities, improving health outcomes, and achieving the Sustainable Development Goals. Future research should expand geographic and demographic coverage to capture the full scope of these syndemic relationships in diverse African contexts.

The burden of non-communicable diseases (NCDs) in adolescent and young adult females in sub-Saharan Africa (SSA) has not been comprehensively studied. To address this gap, we analysed data from the Global Burden of Diseases (GBD) 2021, focusing on death due to NCDs in females aged 10-24&#x2009;years in SSA. We extracted data from GBD 2021 on NCD deaths in females aged 10-24&#x2009;years in SSA from 2000 to 2021. We presented the numbers and death rates of NCDs, and the proportion of NCDs in all-cause deaths was calculated. Pearson's correlation was applied to explore the NCD burden on the socioeconomic development and health system. Additionally, we projected the NCD burden until 2050 by applying mixed-effects models. In 2021, 52&#x200a;083.13 (42&#x200a;018.18&#x223c;61&#x200a;630.88) NCD deaths, at a mortality rate of 27.59 (22.26&#x223c;32.64) per 100&#x200a;000 population, emerged, accounting for 21.13% (17.57%&#x223c;24.22%) of the total deaths. Neoplasms, cardiovascular diseases, digestive diseases, neurological disorders, and diabetes and kidney diseases were the top five leading causes of deaths. Inverse associations were observed between the NCD death rates and indicators of the socioeconomic and health system (P&#x2009;<&#x2009;.001). An increasing trend was observed of the NCD death numbers and the contributing proportions since 2000, and it was predicted to continue increasing through to 2050, with the highest increasing trend in neoplasms. The rising disease burden of NCDs for adolescent and young adult females in SSA has attracted attention. Targeted interventions and strengthened health systems should be prioritized to address the concerning NCD burden in adolescent girls in SSA.

Schistosomiasis is a neglected tropical disease that mostly affects inhabitants of sub-Saharan Africa. With rising global migration, imported cases of schistosomiasis are increasingly being reported in non-endemic countries, where diagnosis is hindered by low parasite burdens and multiple Schistosoma species. Microscopy remains the gold standard, despite its limitations, whereas molecular techniques offer greater sensitivity. The aim of this study was to assess the performance of real-time polymerase chain reaction (PCR) protocols for the detection, at an international health centre in Barcelona, of imported cases of urogenital and intestinal schistosomiasis. This cross-sectional study included 75 adults from sub-Saharan Africa attending the Drassanes-Vall d'Hebron International Health Unit, Barcelona, between May 2023 and February 2024. Paired urine and stool samples were collected. Microscopy was performed on all samples. Urine was analysed by real-time PCR using the Dra1 target sequence. Stool was tested by three protocols targeting, respectively, Dra1, Sm1-7, and 28S rRNA. Schistosoma infection was confirmed by microscopic identification of eggs and/or parasite DNA detection by real-time PCR. Schistosomiasis was confirmed in 12/75 patients (16%). Urogenital schistosomiasis was diagnosed in 3/75 cases; the performance values of real-time PCR in urine samples were not assessed. In stool, the pan-Schistosoma real-time PCR showed 55.6% sensitivity and 98.5% specificity, with a moderate agreement (&#x3ba;&#x2009;=&#x2009;0.631) with microscopy. The Sm1-7 assay fully matched microscopy for Schistosoma mansoni detection, and reached 100% sensitivity and specificity. A novel contribution of this study is the application of a real-time PCR assay targeting the Dra1 repetitive sequence in stool samples for the detection of Schistosoma intercalatum/Schistosoma guineensis. All of the microscopy-positive cases were real-time PCR positive, and one additional infection was detected by real-time PCR, which meant that 100% sensitivity and 98.6% specificity were achieved with this technique. Our findings underscore the need for accurate diagnostic tools for cases of imported schistosomiasis in non-endemic settings. Microscopy remains the reference standard, while the pan-Schistosoma real-time PCR showed limited sensitivity for stool samples. In contrast, the Sm1-7 and Dra1 assays demonstrated higher sensitivity and strong concordance with microscopy, with Dra1 also proving useful for the detection of S. intercalatum/S. guineensis in stool.

Tuberculosis (TB) is a major health burden in Africa. Although TB is treatable, anti-TB drugs are associated with adverse drug reactions (ADRs), which are partly attributed to pharmacogenetic variation. The distribution of star alleles (haplotypes) influencing anti-TB drug metabolism is unknown in many African populations. This presents challenges in implementing genotype-guided therapy in Africa to decrease the occurrence of ADRs and enhance the efficacy of anti-TB drugs. In this study, we used StellarPGx to call variants and star alleles in NAT1, NAT2, GSTM1, GSTT1, GSTP1, and CYP2E1, from 1079 high-depth African whole genomes. We present the distribution of common, rare, and potential novel star alleles across various Sub-Saharan African (SSA) populations, in comparison with other global populations. NAT1*10 (53.6%), GSTT1*0 (65%), GSTM1*0 (48%), and NAT2*5 (17.5%) were among the predominant functionally relevant star alleles. Additionally, we predicted varying phenotype distributions for NAT1 and NAT2 (acetylation) and the glutathione-S-transferase (GST) enzymes (detoxification activity) between SSA and other global populations. Forty-seven potentially novel haplotypes were identified computationally across the genes. This study provides insight into the distribution of key variants and star alleles potentially relevant to anti-TB drug metabolism and other drugs prescribed across various African populations. The high number of potentially novel star alleles exemplifies the need for pharmacogenomics studies in the African context. Overall, our study provides a foundation for functional pharmacogenetic studies and potential implementation of pharmacogenetic testing in Africa to reduce the risk of ADRs related to treatment of TB and other diseases.

Increased taxation on alcohol and tobacco is among the cost-effective measures used to deal with the burden of noncommunicable diseases (NCDs) globally. Despite adopting such efforts, the impacts of taxation on alcohol and tobacco are yet to be fully understood. The study's objective is to find empirical evidence regarding changes in the NCD mortality rate associated with changes in the tax rates of tobacco and alcohol. The study adopted the System Generalized Method of Moments (SGMM) to explore the relationship between levels of taxes and NCD mortality rates. The SGMM allowed the inclusion of the dependent variable as an explanatory variable, assuming reverse causality was assumed. There appears to be a negative relationship between increased taxes and the rates of NCDs. Specifically, we provide empirical evidence supporting the negative association between taxes on alcohol and tobacco cigarettes and the mortality rates from NCDs, which aligns with the propositions advocated by the World Health Organization (WHO). Additionally, the interaction between alcohol taxes on spirits and beer indicates a possibility of complementarity, consistent with taxation principles. Notably, we also observed that higher tobacco cigarette prices are negatively associated with NCD mortality rates. The results indicate that increasing taxes on major health risk factors is necessary to reduce non-communicable diseases (NCDs). Implementing these tax increases will likely help achieve Sustainable Development Goal 3.4, which aims to reduce NCD mortality by one-third by the year 2030.

The World Health Organization certified China malaria-free in 2021. Consequently, preventing the risk of malaria re-introduction caused by imported malaria has now become a major challenge. This study aims to characterize the dynamics and predict the risk of malaria importation in Jiangsu Province, where the number of imported malaria cases ranks among the highest in China. The annual number of cases with imported malaria in Jiangsu Province, the annual number of travelers from sub-Saharan Africa (SSA) to Jiangsu Province (both Chinese and international travelers), and the annual number of Chinese migrant workers from Jiangsu Province who stayed abroad between 2013 and 2020 were assessed. The spatio-temporal dynamics of malaria importation was characterized with ArcGIS 10.8. A negative binomial model was applied to model malaria importation to Jiangsu Province, China. A total of 2,221 of imported malaria cases were reported from January 1, 2013, until December 31, 2020. Imported malaria cases into China were mainly from SSA (98%) and P. falciparum (78%), the most common species. A seasonal pattern was observed, with the most cases occurring from December to February. The negative binomial model, which incorporates the number of Chinese migrant workers from Jiangsu Province who stayed abroad as an independent variable, demonstrated better performance (AIC: 96.495, BIC: 94.230) compared to the model based solely on travelers from SSA to Jiangsu Province. The model indicated an estimated 139% increase in imported cases for a 10% increase in Chinese migrant workers from Jiangsu Province who stayed abroad. In conclusion, our study underscores the importance of incorporating data on Chinese migrant workers who have stayed abroad when predicting malaria importation risks. By integrating both international travel patterns and migrant worker data, our findings offer a more robust framework for assessing and managing malaria risk in Jiangsu Province. This approach provides valuable insights for public health officials, enabling more effective resource allocation and targeted interventions to prevent the re-introduction of malaria and improve overall disease management.

Stand-alone HIV clinics in sub-Saharan Africa (SSA) have effectively expanded antiretroviral therapy since the 2000s, transforming HIV from a deadly infection into a chronic condition. However, over the past decade, there has been a significant rise in the prevalence of non-communicable diseases (NCDs) globally and in SSA. People living with HIV are at higher risk for some NCDs, including hypertension, diabetes and different cancers. The region's current healthcare infrastructure is not equipped to address this growing burden. Integrating health services for HIV and NCDs (ie, combining services for HIV with services for hypertension, diabetes, depression and mental health, substance use disorder or cancer) could be one strategy for responding to these challenges. In this scoping review, we aim to identify randomised controlled trials on HIV-NCD integration, assess implemented integration models and measured outcomes and highlight evidence gaps. This scoping review will follow the Arksey and O'Malley (2005) methodological framework. Reporting will be guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR) checklist. We will conduct a systematic search of the databases OVID Medline, Embase, Web of Science, Global, Africa Index Medicus, including terms related to HIV, NCDs and healthcare integration. Included trials must have been conducted within SSA and have been published in English or French after 1 January 2010. We will not select based on sample size or number of clusters. Both the title and abstract screening and full-text screening will be done in Covidence by at least two reviewers working independently. Data extraction will focus on key variables, including study design, geographical location, integration intervention, measured outcomes and reported findings. This scoping review aims to generate new insights from publicly available research. Therefore, ethical approval is not required. Study findings will be shared through discussion with policymakers, implementation science researchers and healthcare providers. The results of this study are intended to be published in a peer-reviewed journal. This protocol has been registered with Center for Open Science OSF Registry (DOI: 10.17605/OSF.IO/RGQSN). The search was conducted on 25 March 2024 and updated on 21 October 2024. The review is expected to be completed by March 2025.

Studies of type 1 diabetes in sub-Saharan Africa have suggested that the clinical phenotype might differ from phenotypes reported elsewhere. We aimed to establish whether type 1 diabetes diagnosed in children and young adults in three countries across sub-Saharan Africa is of autoimmune origin. In this observational, cross-sectional study, we identified participants without obesity from outpatient clinics in government and private hospitals in Cameroon, Uganda, and South Africa who were of self-reported Black African ethnicity with young-onset (age <30 years), insulin-treated, clinically diagnosed type 1 diabetes. We measured islet autoantibodies to GADA, IA-2A, and ZnT8A, and calculated a genetic risk score (GRS) for type 1 diabetes, which we compared with control populations without diabetes derived from the Uganda Genome Resource databank and other studies. Endogenous insulin secretion was assessed using plasma C-peptide. We compared findings with those for participants with self-reported Black (n=429) and White (n=2602) ancestry with type 1 diabetes from the SEARCH for Diabetes in Youth (SEARCH) study in the USA. Of 1072 participants identified between Aug 28, 2019, and March 31, 2022 (Cameroon and Uganda), and Oct 3, 2007, to Sept 14, 2015 (South Africa), 894 were included in our analysis (454 [50&#xb7;8%] were male and 440 [49&#xb7;2%] were female): 248 participants were from Cameroon, 370 from Uganda, and 276 from South Africa. Participants from sub-Saharan Africa were diagnosed with diabetes at a median age of 15 years (IQR 11-19), with a median diabetes duration of 5 years (2-10), and a BMI of 21&#xb7;7 kg/m2 (19&#xb7;5-24&#xb7;1). Only 312 (34&#xb7;9%) of 894 participants were positive for islet autoantibodies; these participants had classic features of type 1 diabetes, including 225 (82&#xb7;7%) of 272 with plasma C-peptide <200 pmol/L, and high type 1 diabetes GRS. Those without islet autoantibodies (582 [65&#xb7;1%] of 894) had significantly lower median type 1 diabetes GRS than those with autoantibodies (9&#xb7;66 [IQR 7&#xb7;77-11&#xb7;33] vs 11&#xb7;76 [10&#xb7;49-12&#xb7;91]; p<0&#xb7;0001), suggesting a subgroup with a non-autoimmune diabetes subtype, with clinical features and C-peptide concentrations not consistent with type 2 diabetes. Among participants diagnosed younger than 20 years, autoantibody-negative diabetes was also observed in 65 (15&#xb7;1%) of 429 participants with Black ancestry in SEARCH (although less frequently than in sub-Saharan Africa [59 (55&#xb7;1%) of 107]), and these participants also had a low type 1 diabetes GRS (median 10&#xb7;41 [IQR 8&#xb7;65-12&#xb7;22] in autoantibody-negative subgroup). No such pattern was observed in White participants in SEARCH: 241 (9&#xb7;3%) of 2602 were autoantibody negative and median GRS for type 1 diabetes was similar in autoantibody-negative and autoantibody-positive participants (median 13&#xb7;42 [IQR 11&#xb7;80-14&#xb7;61] vs 13&#xb7;49 [12&#xb7;29-14&#xb7;58]). In sub-Saharan Africa, clinically diagnosed type 1 diabetes is heterogeneous, comprising classic autoimmune type 1 diabetes and a novel, non-autoimmune, insulin-deficient diabetes subtype. There is evidence of this subtype in Black but not White individuals in the USA. Therefore, alternative causes must be considered in this group of individuals, and understanding the drivers of this subtype might offer new insights into prevention and treatment. UK National Institute of Health and Care Research. For the French translation of the abstract see Supplementary Materials section.

Most countries experienced disruptions in essential health services since the beginning of the COVID-19 pandemic, with the risk and prioritization of COVID-19 leading to diversions of resources and health staff. Disruptions were particularly concerning in humanitarian and fragile settings due to pre-existing vulnerabilities. We investigated how healthcare workers (HCW) perceived changes in health service provision, and whether and how programmatic adaptations were introduced in three humanitarian settings. Key informant interviews were conducted with 29, 39 and 54 frontline HCWs in the Central African Republic, the Democratic Republic of Congo, and Bangladesh, respectively. The interviews were coded by two authors using deductive and inductive coding. Data were organized in a framework, and thematic analysis was conducted to identify similarities and discrepancies across respondents and study sites. Data were collected between March and July 2021 in each country. HCWs' perceptions varied across services and countries. Most HCWs reported decreased consultations for maternal and newborn health, sexual reproductive health, communicable diseases, and community-based activities, with mixed perceptions across countries for vaccinations, nutrition, non-communicable diseases, and referrals. Reasons for reduced healthcare utilization included fear of contracting COVID-19 and receiving the COVID-19 vaccine, compliance with movement restrictions, financial barriers, and medication stockouts. Factors specific to humanitarian settings included insecurity, population displacement, presence of a technical partner, lack of medical equipment, and staff shortages. Infection prevention and control measures (i.e., patient triage, mask-wearing, physical distance, hand washing) were introduced in all countries. Other service adaptations included spaced out consultations, reduced group size, extended drug prescriptions, changes in nutrition protocols, telemedicine, and shift to COVID-19 focus during awareness activities. During the first year of the COVID-19 pandemic, HCWs reported varying healthcare utilization according to different services and contexts in three humanitarian settings. Program adaptations to address COVID-19 risks were introduced. Although guidance existed at the global level, contextual factors such as insecurity, displacement, and pre-existing capacity affected healthcare utilization and health service delivery more than the COVID-19 pandemic, especially in DRC and CAR, where the number of reported COVID-19 cases remained low for several months.

&#xa0;Worldwide, the proportion of hypertensive patients with controlled blood pressure is poor. Knowledge on hypertension has been recognised as a major determinant of uncontrolled hypertension. &#xa0;This study aimed to determine factors associated with knowledge and control of hypertension among hypertensive patients in Kimpese Health Zone, in the Democratic Republic of the Congo (DRC). &#xa0;Six health facilities of the Kimpese Health Zone were selected. &#xa0;This study was an analytical cross-sectional study from May 2021 to December 2021. Information on socio-demographic characteristics, clinical data and knowledge on hypertension was collected. Factors associated with knowledge and control of hypertension were determined using logistic regression analysis. &#xa0;A total of 301 participants with a sex ratio of 1:3 (F M) and a mean age of 60.5 &#xb1; 12.1 years were included in the study. Poor knowledge on hypertension (79.1%) and a treatment failure (84.3%) were common. Low educational level (p&#xa0;= 0.024; adjusted odds ratio [aOR] = 2.64 [1.72-3.73]), rural residence (p&#xa0;= 0.02; aOR = 3.34 [1.24-8.52]) and a lack of information by a health professional (physician or nurse) (p&#xa0;&#x2264; 0.001; aOR = 3.34 [1.24-8.52]) were significantly associated with poor knowledge. In addition, high cardiovascular risk (p&#xa0;= 0.009; aOR = 2.75 [1.29-5.84]), subclinical atherosclerosis (p&#xa0;= 0.000, AOR = 9.26 [3.54-24.23]) and absence of knowledge on hypertension (p&#xa0;= 0.042, AOR = 1.96 [1.49-2.23]) were significantly associated with uncontrolled hypertension. &#xa0;There was propensity of uncontrolled hypertension and poor knowledge among the study participants. Poor socio-demographic conditions and a lack of accurate information on hypertension increased odds of poor knowledge of the disease. In addition, insufficient knowledge on hypertension and comorbidities were associated with uncontrolled hypertension.Contribution:&#xa0;Education on hypertension and screening; managing comorbidities in integrating approach to non-communicable diseases are key components of managing hypertension in our setting to improve health outcomes.

Emerging and re-emerging infectious diseases continue to pose a severe threat to public health in Sub-Saharan Africa (SSA) and globally. Community-related interventions, such as community e-Health literacy, can contribute to the preparedness to respond effectively to emerging and re-emerging infectious diseases. This study investigated the relationship between e-Health literacy and SSA countries' perceptions of the importance of readiness for potential pandemics. This cross-sectional study was conducted in sub-Saharan African countries (Nigeria, Rwanda, Burundi, and South Africa) among adults aged 18 years and above between July 2020 and August 2021, respondents were recruited through a non-probability sampling technique. Participants were asked to self-report the perceived importance of 13 items on future pandemic preparedness scored on a 5 Likert-point scale. The four key dimensions of pandemic preparedness were online medical consultation, online courses, messaging for healthcare, and shopping. E-Health literacy was the key exposure. The questionnaire was adapted from a previously validated e-Health literacy scale. Data was collected through a self-administered questionnaire online. Data analysis was done using Stata and descriptive statistics including frequency, proportions, means, and standard deviation were used to summarize variables. Inferential statistics including chi-square and logistic regressions were used to test the significance of association between e-health literacy and pandemic preparedness setting the level of significance at 5%. A total of 1295 people participated in this study. Roughly half of all participants, 685 (52.90%), were aged between 18 and 29 and 685 (52.90%) were females. The standardised average (SE) e-Health literacy score was 29.55 (0.19). Shopping was perceived as the most important dimension of pandemic preparedness across participating countries (mean (SE) of 3.32 (0.06) and above across all countries for online shopping), while online medical consultation was the least perceived as important (mean (SE) of 2.88 (0.08) or less in two countries for instant health advice from chatbot). In the fully adjusted model, e-Health literacy was associated with 8 out of 13 items of the perceived importance of the pandemic preparedness questionnaire. Those include online consultation with doctors (OR&#x2009;=&#x2009;1.11, 95% CI 1.02-1.21), telephone health advice (OR&#x2009;=&#x2009;1.07, 95%CI 1.00-1.15), medicine delivery (OR&#x2009;=&#x2009;1.04, 95% CI 1.03-1.06), getting medicine prescribed in a hospital visit/follow-up in a community pharmacy (OR&#x2009;=&#x2009;1.07, 95% CI 1.05-1.10), receiving health information via email (OR&#x2009;=&#x2009;1.08, 95% CI 1.01-1.17) and via social media (OR&#x2009;=&#x2009;1.08, 95% CI 1.03-1.14), online shopping (OR&#x2009;=&#x2009;1.07, 95% CI 1.03-1.11) and instant streaming courses (OR&#x2009;=&#x2009;1.09, 95% CI 1.02-1.16). The higher e-Health literacy scores were associated with a higher perception of most elements as important in future pandemic readiness. Strengthening e-Health literacy can be a key element of the preparation for pandemics in SSA countries.

Evolving human-wildlife interactions have contributed to emerging zoonoses outbreaks, and pandemic prevention policy for wildlife management and conservation requires enhanced consideration from this perspective. However, the risk of unintended consequences is high. In this study, we aimed to assess how unrecognised complexity and system adaptation can lead to policy failure, and how these dynamics may impact zoonotic spillover risk and food system outcomes. This study focused on three countries: China, the Democratic Republic of the Congo (DRC) and the Philippines. We combined evidence from a rapid literature review with key informant interviews to develop causal loop diagrams (CLDs), a form of systems map representing causal theory about system factors and interconnections. We analysed these CLDs using the 'fixes that fail' (FTF) systems archetype, a conceptual tool used to understand and communicate how system adaptation can lead to policy failure. In each country, we situated the FTF in the wider system of disease ecology and food system factors to highlight how zoonotic risk and food system outcomes may be impacted. We interviewed 104 participants and reviewed 303 documents. In each country, we identified a case of a policy with the potential to become an FTF: wildlife farming in China, the establishment of a new national park in the DRC, and international conservation agenda-setting in the Philippines. In each country, we highlighted context-specific impacts of the FTF on zoonotic spillover risk and key food system outcomes. Our use of systems thinking highlights how system adaptation may undermine prevention policy aims, with a range of unintended consequences for food systems and human, animal and environmental health. A broader application of systems-informed policy design and evaluation could help identify instruments approporiate for the disruption of system traps and improve policy success. A One Health approach may also increase success by supporting collaboration, communication and trust among actors to imporove collective policy action.

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

Integrated knowledge translation (IKT) is an approach facilitating collaboration between researchers and decision-makers towards evidence-informed decision-making. Increasingly evaluated in various contexts, less is known about the implementation process of IKT, including in low- and middle-income countries. The Collaboration for Evidence-based Healthcare and Public Health in Africa (CEBHA+) developed, implemented and evaluated an IKT approach across five countries. Here, we examined how the IKT approach was implemented in the African-German multi-country research consortium, investigating project-level context; implementation process, strategy, and outcomes; and exploring intervention core components. This process evaluation used a mixed-methods comparative case study design. Following a previously published protocol, the main authors of this paper surveyed and interviewed African&#xa0;CEBHA+ researchers and their partners from policy and practice in 2020/2021 and 2022/2023 and identified relevant IKT-related documents. We drew on our programme theory and implementation science frameworks to undertake qualitative content analysis of interview data and documents. Data was analysed within sites, integrated with descriptively analysed quantitative survey data, and subsequently compared across sites. We enrolled 36 researchers and 19 decision-makers and analysed 92 IKT-related documents. IKT was implemented at the five sites in Ethiopia, Malawi, Rwanda, South Africa, and Uganda. In our cross-site analysis of fidelity and adaptability of IKT, we identified three core components of the IKT approach: (i) continuous tailored engagement between researchers and decision-makers, (ii) researchers' commitment to research impact, and (iii) linking to existing KT routines. The context analysis revealed that IKT implementation was facilitated by local KT structures, pre-existing knowledge translation routines and relationships with decision-makers, senior leadership motivation, and funder support including a dedicated budget for IKT activities. Feasibility of IKT implementation was reduced by administrative challenges, overall project complexity, and conflicting priorities. This research leveraged a unique opportunity to study a systematic IKT approach implemented across sites in five African countries in the context of a large international research consortium. The findings can inform IKT design and implementation in other multi-site and multi-country projects. Particularly, the identified core components can guide adaptation and refinement of IKT in contextually diverse settings, including low- and middle- income countries.