BACKGROUND: Climate change increasingly impacts health, particularly of rural populations in sub-Saharan Africa due to their limited resources for adaptation. Understanding these impacts remains a challenge, as continuous monitoring of vital signs in such populations is limited. Wearable devices (wearables) present a viable approach to studying these impacts on human health in real time.
OBJECTIVE: The aim of this study was to assess the feasibility and effectiveness of consumer-grade wearables in measuring the health impacts of weather exposure on physiological responses (including activity, heart rate, body shell temperature, and sleep) of rural populations in western Kenya and to identify the health impacts associated with the weather exposures.
METHODS: We conducted an observational case study in western Kenya by utilizing wearables over a 3-week period to continuously monitor various health metrics such as step count, sleep patterns, heart rate, and body shell temperature. Additionally, a local weather station provided detailed data on environmental conditions such as rainfall and heat, with measurements taken every 15 minutes.
RESULTS: Our cohort comprised 83 participants (42 women and 41 men), with an average age of 33 years. We observed a positive correlation between step count and maximum wet bulb globe temperature (estimate 0.06, SE 0.02; P=.008). Although there was a negative correlation between minimum nighttime temperatures and heat index with sleep duration, these were not statistically significant. No significant correlations were found in other applied models. A cautionary heat index level was recorded on 194 (95.1%) of 204 days. Heavy rainfall (>20 mm/day) occurred on 16 (7.8%) out of 204 days. Despite 10 (21%) out of 47 devices failing, data completeness was high for sleep and step count (mean 82.6%, SD 21.3% and mean 86.1%, SD 18.9%, respectively), but low for heart rate (mean 7%, SD 14%), with adult women showing significantly higher data completeness for heart rate than men (2-sided t test: P=.003; Mann-Whitney U test: P=.001). Body shell temperature data achieved 36.2% (SD 24.5%) completeness.
CONCLUSIONS: Our study provides a nuanced understanding of the health impacts of weather exposures in rural Kenya. Our study\'s application of wearables reveals a significant correlation between physical activity levels and high temperature stress, contrasting with other studies suggesting decreased activity in hotter conditions. This discrepancy invites further investigation into the unique socioenvironmental dynamics at play, particularly in sub-Saharan African contexts. Moreover, the nonsignificant trends observed in sleep disruption due to heat expose the need for localized climate change mitigation strategies, considering the vital role of sleep in health. These findings emphasize the need for context-specific research to inform policy and practice in regions susceptible to the adverse health effects of climate change.

UNASSIGNED: Acute respiratory infections (ARIs) are the leading cause of death in children under the age of 5 globally. Maternal healthcare-seeking behavior may help minimize mortality associated with ARIs since they make decisions about the kind and frequency of healthcare services for their children. Therefore, this study aimed to predict the absence of maternal healthcare-seeking behavior and identify its associated factors among children under the age 5 in sub-Saharan Africa (SSA) using machine learning models.
UNASSIGNED: The sub-Saharan African countries\' demographic health survey was the source of the dataset. We used a weighted sample of 16,832 under-five children in this study. The data were processed using Python (version 3.9), and machine learning models such as extreme gradient boosting (XGB), random forest, decision tree, logistic regression, and Naïve Bayes were applied. In this study, we used evaluation metrics, including the AUC ROC curve, accuracy, precision, recall, and F-measure, to assess the performance of the predictive models.
UNASSIGNED: In this study, a weighted sample of 16,832 under-five children was used in the final analysis. Among the proposed machine learning models, the random forest (RF) was the best-predicted model with an accuracy of 88.89%, a precision of 89.5%, an F-measure of 83%, an AUC ROC curve of 95.8%, and a recall of 77.6% in predicting the absence of mothers\' healthcare-seeking behavior for ARIs. The accuracy for Naïve Bayes was the lowest (66.41%) when compared to other proposed models. No media exposure, living in rural areas, not breastfeeding, poor wealth status, home delivery, no ANC visit, no maternal education, mothers\' age group of 35-49 years, and distance to health facilities were significant predictors for the absence of mothers\' healthcare-seeking behaviors for ARIs. On the other hand, undernourished children with stunting, underweight, and wasting status, diarrhea, birth size, married women, being a male or female sex child, and having a maternal occupation were significantly associated with good maternal healthcare-seeking behaviors for ARIs among under-five children.
UNASSIGNED: The RF model provides greater predictive power for estimating mothers\' healthcare-seeking behaviors based on ARI risk factors. Machine learning could help achieve early prediction and intervention in children with high-risk ARIs. This leads to a recommendation for policy direction to reduce child mortality due to ARIs in sub-Saharan countries.

UNASSIGNED: Approximately 20 to 120 million women of reproductive age worldwide are thought to be affected by female genital schistosomiasis (FGS). It is a preventable manifestation of schistosomiasis in adolescent girls and women, which remains underreported, underdiagnosed, or misdiagnosed, and largely untreated.
UNASSIGNED: This study aimed to map evidence on the knowledge and management of FGS from 1950 to 2022 in sub-Saharan Africa.
UNASSIGNED: The Arksey and O\'Malley and Levac et al. framework suggestions and a guideline from Joanna Briggs Institute will be employed. Search for literature will be in PubMed, Scopus, Cochrane, Web of Science, MEDLINE via PubMed, and Google Scholar from 1950 to 2022 for useful published research articles using key phrases or search terms and grey literature with limitations for studies conducted in sub-Saharan Africa. Two reviewers will screen the articles. Kappa coefficients by Cohen statistics will be computed for inter-screener agreement, and the selected articles will be evaluated using Mixed Method Appraisal Tool (MMAT).
UNASSIGNED: The researchers will map and explore the evidence of the knowledge and management of FGS in the subregion. The years of publications, countries of study, and settings will be reported, and the identified research gaps will be reported.
UNASSIGNED: The researchers anticipate that this study will determine and map the evidence on the knowledge and management of FGS in sub-Saharan Africa; identify knowledge and management gaps, and direct future research.
UNASSIGNED: This study will add to the literature on FGS and direct future research regarding the knowledge and management of FGS.

Armed conflicts exacerbate public health challenges in Sub-Saharan Africa. Inequality across groups and poverty in rural areas can be an important factor in triggering local wars. This study investigates whether equitable distribution of public services by governments across urban and rural geographical regions reduces the risk of local wars initiated by armed groups in Sub-Saharan African countries. Does an equitable distribution of public services such as healthcare and clean water public services across regions decrease the risk of armed conflicts? Uneven distribution of public services can increase the risk of conflict by contributing to group grievances, rural poverty, and rent-seeking competition over government resources. Analyses of 39 Sub-Saharan African countries from 1947 to 2021 show that a one-standard deviation increase in equal access to public services by urban-rural location lowers the risk of armed conflict, a substantial 37 to 53 percent with consideration of a battery of control variables.

BACKGROUND: Across sub-Saharan Africa, mid-level healthcare managers oversee implementation of national guidelines. It remains unclear whether leadership and management training can improve population health outcomes.
METHODS: We sought to evaluate leadership/management skills among district-level health managers in Uganda participating in the SEARCH-IPT randomised trial to promote isoniazid preventive therapy (IPT) for persons with HIV (PWH). The intervention, which led to higher IPT rates, included annual leadership/management training of managers. We conducted a cross-sectional survey assessing leadership/management skills among managers at trial completion. The survey evaluated self-reported use of leadership/management tools and general leadership/management. We conducted a survey among a sample of providers to understand the intervention\'s impact. Targeted minimum loss-based estimation (TMLE) was used to compare responses between trial arms.
RESULTS: Of 163 managers participating in the SEARCH-IPT trial, 119 (73%) completed the survey. Intervention managers reported more frequent use of leadership/management tools taught in the intervention curriculum than control managers (+3.64, 95% CI 1.98-5.30, P < 0.001). There were no significant differences in self-reported leadership skills in the intervention as compared to the control group. Among providers, the average reported quality of guidance and supervision was significantly higher in intervention vs control districts (+1.08, 95% CI 0.63-1.53, P = 0.001).
CONCLUSIONS: A leadership and management training intervention increased the use of leadership/management tools among mid-level managers and resulted in higher perceived quality of supervision among providers in intervention vs control districts in Uganda. These findings suggest improved leadership/management among managers contributed to increased IPT use among PWH in the intervention districts of the SEARCH-IPT trial.
BACKGROUND: Dans toute l\'Afrique subsaharienne, les gestionnaires de soins de santé de niveau intermédiaire supervisent la mise en œuvre des directives nationales. Il n\'est toujours pas clair si la formation en leadership et en gestion peut améliorer les résultats en matière de santé de la population.
UNASSIGNED: Nous avons cherché à évaluer les compétences en leadership et en gestion des responsables de la santé au niveau des districts en Ouganda participant à l\'essai randomisé SEARCH-IPT visant à promouvoir le traitement préventif à l\'isoniazide (TPI) pour les personnes vivant avec le VIH (PWH, pour l’anglais « people living with HIV »). L\'intervention, qui a permis d\'augmenter les taux de TPI, comprenait une formation annuelle en leadership et en gestion des gestionnaires. Nous avons mené une enquête transversale pour évaluer les compétences en leadership et en gestion des gestionnaires à la fin de l\'essai. L\'enquête a évalué l\'utilisation autodéclarée d\'outils de leadership et de gestion et de leadership et de gestion en général. Nous avons mené une enquête auprès d\'un échantillon de prestataires pour comprendre l\'impact de l\'intervention. L\'estimation ciblée basée sur les pertes minimales (TMLE, « Targeted minimum loss-based estimation ») a été utilisée pour comparer les réponses entre les groupes de l\'essai.
UNASSIGNED: Sur les 163 gestionnaires qui ont participé à l\'essai SEARCH-IPT, 119 (73%) ont répondu au sondage. Les gestionnaires d\'intervention ont déclaré utiliser plus fréquemment les outils de leadership/gestion enseignés dans le programme d\'intervention que les gestionnaires de contrôle (+3,64 ; IC à 95% 1,98–5,30 ; P < 0,001). Il n\'y avait pas de différences significatives dans les compétences de leadership autodéclarées dans l\'intervention par rapport au groupe témoin. Parmi les prestataires, la qualité moyenne déclarée de l\'orientation et de la supervision était significativement plus élevée dans les districts d\'intervention que dans les districts témoins (+1,08 ; IC à 95% 0,63–1,53 ; P = 0,001).
CONCLUSIONS: Une intervention de formation au leadership et à la gestion a permis d\'accroître l\'utilisation d\'outils de leadership et de gestion parmi les cadres intermédiaires et d\'améliorer la perception de la qualité de la supervision parmi les prestataires dans les districts d\'intervention par rapport aux districts de contrôle en Ouganda. Ces résultats suggèrent que l\'amélioration du leadership et de la gestion chez les gestionnaires a contribué à l\'augmentation de l\'utilisation du TPI chez les personnes handicapées dans les districts d\'intervention de l\'essai SEARCH-IPT.

BACKGROUND: Pregnant women are a vulnerable population to COVID-19 given an increased susceptibility to severe SARS-CoV-2 infection and pregnancy complications. However, few SARS-CoV-2 serological surveys have been performed among this population to assess the extent of the infection in sub-Saharan countries. The objectives of this study were to determine SARS-CoV-2 seroprevalence among Beninese pregnant women, to identify spatial seropositivity clusters and to analyse factors associated with the infection.
METHODS: A cross-sectional study including women in their third trimester of pregnancy attending the antenatal care (ANC) clinics at Allada (south Benin) and Natitingou (north Benin) was conducted. Rapid diagnostic tests (RDT) for detection of IgG/IgM against the SARS-CoV-2 spike protein were performed using capillary blood. Seroprevalence of SARS-CoV-2 antibodies and associations between SARS-CoV-2 serostatus and maternal characteristics were analyzed by multivariate logistic regression. Spatial analyses were performed using the spatial scan statistics to identify spatial clusters of SARS-CoV-2 infection.
RESULTS: A total of 861 pregnant women were enrolled between May 4 and June 29, 2022. 58/861 (6.7%) participants reported having received COVID-19 vaccine. None of the participants had been diagnosed with COVID-19 during their pregnancy. SARS-CoV-2 antibodies were detected in 607/802 (75.7%; 95% CI 72.56%-78.62%) of unvaccinated participants. Several urban and rural spatial clusters of SARS-CoV-2 cases were identified in Allada and one urban spatial cluster was identified in Natitingou. Unvaccinated participants from Allada with at least one previous morbidity were at a three-times higher risk of presenting SARS-CoV-2 antibodies (OR = 2.89; 95%CI 1.19%-7.00%).
CONCLUSIONS: Three out of four pregnant women had SARS-CoV-2 antibodies, suggesting a high virus circulation among pregnant women in Benin, while COVID-19 vaccination coverage was low. Pregnant women with comorbidities may be at increased risk of SARS-CoV-2 infection. This population should be prioritized for COVID-19 diagnosis and vaccination in order to prevent its deleterious effects.
BACKGROUND: NCT06170320 (retrospectively registered on December 21, 2023).

UNASSIGNED: Due to hazardous working conditions, welders are more likely to be exposed to mild to severe eye issues during the welding process. Globally, this issue is a major contributor to vision loss and blindness. One of the most frequent causes of unilateral blindness in the globe is ocular injury.
UNASSIGNED: This review aimed to assess the pooled prevalence of ocular protection practice and associated factors among welders in sub-Saharan Africa.
UNASSIGNED: Databases including PubMed, Scopus, web of Science, Google Scholar, and the African Journals Online were systematically searched for relevant literature. The statistical analysis was performed using STATA data analysis software version 14, while Microsoft Excel was used for data abstraction. We checked publication bias using a funnel plot and Egger and Begg regression tests. A p-value < 0.05 was considered significant, suggesting the presence of presence publication bias. The I2 statistics were used to assess heterogeneity between studies. The study\'s overall effect was evaluated using the random effects model.
UNASSIGNED: From retrieved 2,326 original studies, 17 studies were included in the final pooled prevalence analysis. The overall prevalence of ocular protection practice among small-scale welders in sub-Saharan Africa was 53.71% (95% CI: 42.54, 64.88). Having pre and in-service training [AOR: 4.97, 95% CI: (2.64, 9.36)], having work experience as a welder [AOR: 4.94, 95% CI: (3.24, 7.54)], and having a history of ocular injury [AOR: 2.99, 95% CI: (1.58, 5.66)] were significantly associated with the ocular protection practices.
UNASSIGNED: In sub-Saharan African countries, the ocular protection practices among small-scale welders were low. Furthermore, the current meta-analysis found ocular protection practice to be significantly associated with on-the-job training, work experience of welders, and a history of ocular injury in the past year of small-scale welders in sub-Saharan Africa. This review will serve as baseline data for further studies to generate inputs for eye care providers and policymakers to improve good practice levels about ocular protection. Policies should be put in place to ensure all welders use proper personal-protective equipment, and receive regular health training.

UNASSIGNED: Liquefied petroleum gas (LPG) is a clean cooking fuel that emits less household air pollution (HAP) than polluting cooking fuels (e.g. charcoal, wood). While switching from polluting fuels to LPG can reduce HAP and improve health, the impact of \'stacking\' (concurrent use of polluting fuels and LPG) on adverse health symptoms (e.g. headaches, eye irritation, cough) among female cooks is uncertain.
UNASSIGNED: Survey data from the CLEAN-Air(Africa) study was collected on cooking patterns and health symptoms over the last 12 months (cough, wheezing, chest tightness, shortness of breath, eye irritation, headaches) from approximately 400 female primary cooks in each of three peri‑urban communities in sub-Saharan Africa: Mbalmayo, Cameroon; Obuasi, Ghana; and Eldoret, Kenya. Random effects Poisson regression, adjusted for socioeconomic and health-related covariates, assessed the relationship between primary and secondary cooking fuel type and self-reported health symptoms.
UNASSIGNED: Among 1,147 participants, 10 % (n = 118) exclusively cooked with LPG, 45 % (n = 509) stacked LPG and polluting fuels and 45 % (n = 520) exclusively cooked with polluting fuels. Female cooks stacking LPG and polluting fuels had significantly higher odds of shortness of breath (OR 2.16, 95 %CI:1.04-4.48) compared with those exclusively using LPG. In two communities, headache prevalence was 30 % higher among women stacking LPG with polluting fuels (Mbalmayo:82 %; Eldoret:65 %) compared with those exclusively using LPG (Mbalmayo:53 %; Eldoret:33 %). Women stacking LPG and polluting fuels (OR 2.45, 95 %CI:1.29-4.67) had significantly higher odds of eye irritation than women cooking exclusively with LPG. Second-hand smoke exposure was significantly associated with higher odds of chest tightness (OR 1.92, 95 % CI:1.19-3.11), wheezing (OR 1.76, 95 % CI:1.06-2.91) and cough (OR 1.78, 95 %CI:1.13-2.80).
UNASSIGNED: In peri‑urban sub-Saharan Africa, women exclusively cooking with LPG had lower odds of several health symptoms than those stacking LPG and polluting fuels. Promoting a complete transition to LPG in these communities may likely generate short-term health benefits for primary cooks.

There is a notable lack of continuous monitoring of air pollutants in the Global South, especially for measuring chemical composition, due to the high cost of regulatory monitors. Using our previously developed low-cost method to quantify black carbon (BC) in fine particulate matter (PM2.5) by analyzing reflected red light from ambient particle deposits on glass fiber filters, we estimated hourly ambient BC concentrations with filter tapes from beta attenuation monitors (BAMs). BC measurements obtained through this method were validated against a reference aethalometer between August 2 and 23, 2023 in Addis Ababa, Ethiopia, demonstrating a very strong agreement (R2 = 0.95 and slope = 0.97). We present hourly BC for three cities in sub-Saharan Africa (SSA) and one in North America: Abidjan (Côte d\'Ivoire), Accra (Ghana), Addis Ababa (Ethiopia), and Pittsburgh (USA). The average BC concentrations for the measurement period at the Abidjan, Accra, Addis Ababa Central summer, Addis Ababa Central winter, Addis Ababa Jacros winter, and Pittsburgh sites were 3.85 μg/m3, 5.33 μg/m3, 5.63 μg/m3, 3.89 μg/m3, 9.14 μg/m3, and 0.52 μg/m3, respectively. BC made up 14-20% of PM2.5 mass in the SSA cities compared to only 5.6% in Pittsburgh. The hourly BC data at all sites (SSA and North America) show a pronounced diurnal pattern with prominent peaks during the morning and evening rush hours on workdays. A comparison between our measurements and the Goddard Earth Observing System Composition Forecast (GEOS-CF) estimates shows that the model performs well in predicting PM2.5 for most sites but struggles to predict BC at an hourly resolution. Adding more ground measurements could help evaluate and improve the performance of chemical transport models. Our method can potentially use existing BAM networks, such as BAMs at U.S. Embassies around the globe, to measure hourly BC concentrations. The PM2.5 composition data, thus acquired, can be crucial in identifying emission sources and help in effective policymaking in SSA.

Dolutegravir resistance is emerging in routine clinical contexts in southern Africa, primarily in patients with prior treatment experience failing dolutegravir-based antiretroviral therapy (ART). This potential issue was raised by The Nucleosides and Darunavir/Dolutegravir in Africa trial that compared dolutegravir and boosted protease inhibitor-based therapy as second-line ART, in which new dolutegravir resistance was observed at failure. However, recent data suggest that also at risk are patients who were transitioned to dolutegravir from non-nucleoside reverse transcriptase inhibitor-based ART while viremic. Identifying patients experiencing failure of dolutegravir with resistance will be difficult given current gaps in viral load monitoring and limited capacity for genotypic resistance testing. As a result, in the short term, most patients affected will go unrecognized, with particularly important implications for patients affected who have advanced HIV or who are pregnant/breastfeeding. Prospective research is needed to understand the scope of the problem, identify additional risk factors, and determine best management. In the short term, for most patients with dolutegravir resistance and prior non-nucleoside reverse transcriptase inhibitor exposure, the best option will be a timely switch to a regimen anchored by a boosted protease inhibitor, with a high genetic barrier to resistance.