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Multiple estimates exist of global monetary and multidimensional poverty, but populations at risk of social exclusion still lack a worldwide estimate. This paper fills this gap by providing the first estimates of the share and number of populations at risk of social exclusion worldwide. The paper contributes to the literature in three important respects. First, it develops a conceptual framework of social exclusion that emphasizes the relative, multidimensional, and dynamic features of exclusion. Second, it proposes a macro-counting methodology that allows measuring populations at risk of exclusion based on identity, circumstances, and socioeconomic conditions, while advancing a protocol to avoid double counting of individuals at risk of social exclusion. Third, the empirical strategy provides to the best of our knowledge, the first estimates of populations at risk of social exclusion by dimensions of exclusion on a global and regional scale. Overall, we estimate that between 2.33 and 2.43 billion people—roughly 32 per cent of the global population—are at risk of social exclusion. The South Asia and East Asia and Pacific regions contain 1.3 billion such people, with India and China alone home to 840 million of them. Meanwhile, 52 per cent of sub-Saharan Africa's population is vulnerable to exclusion, the greatest share of any region. Our findings have important policy implications. While antipoverty policies can support household consumption and smooth its volatility among the poor, they are unlikely to address social exclusion stemming from ethnic, racial, or gender discrimination. Therefore, addressing exclusion necessitates a suite of multiple interventions tailored to distinct groups and sustained over time. [ABSTRACT FROM AUTHOR]

The sustainable availability and resilient supply of safe drinking water remains a challenge that is far from fulfilled. As of 2024, around 2 billion people worldwide do not have access to safe drinking water. The regions of Sub-Saharan Africa and South Asia are the most vulnerable regions in this regard. This is despite the fact that these regions are home to some of the world's fastest-growing economies. However, economic growth and rapid urbanization may also be connected to the increasing water stress in the suburban and rural areas. We propose addressing the two main challenges in this regard, which are the selection of the suitable treatment and distribution systems for different contexts using a decision support system following a Whole-of-Resource Approach (WORA). This approach considers the different water sources and sinks as contributing to a positive or negative change in the single resource, irrespective of whether the resource, in this case water, is used for domestic, industrial, or agricultural purposes. In this regard, this paper presents an illustrative proof of concept for such a decision support tool based on a multiple-criteria decision analysis. The decision support tool is aimed at facilitating water management within a WORA by providing recommendations regarding rainwater harvesting and savings in agricultural water consumption, in addition to suggesting water treatment and distribution systems, enabling systemic water resource management adapted to local context-specific conditions and needs. [ABSTRACT FROM AUTHOR]

According to common measures of private capital mobilization, such as the shares of foreign direct and portfolio investment in GDP, many low-income countries perform poorly in attracting private capital flows. However, these indicators do not account for differences in economic characteristics across countries, and thus cannot provide insights on countries' performance relative to their potential levels of private capital flows as determined by their domestic economic structure and constraints. This paper addresses this gap by using nonparametric data envelopment analysis (DEA) to empirically calculate the efficient frontier for private capital mobilization as a function of countries' domestic enabling environment, and then assess each country's performance relative to that of other countries featuring similar domestic conditions. Our results reveal that many low-income countries, particularly in Africa and South Asia, which do not rank high according to achieved levels of private capital flows, are in fact performing on or very close to the efficient frontier. This indicates that these countries are good performers given the limited resources available to them. Tracking the performance of countries and regions over time, we furthermore find that sub-Saharan Africa experienced the strongest increases in DEA efficiency scores between 2007 and 2018, indicating that various countries in this region were catching up with the frontier. [ABSTRACT FROM AUTHOR]

Food security is a crucial issue for developing countries, with many populations suffering from undernourishment. While numerous factors contribute to this issue, the role of natural resources has been neglected. This paper, therefore, examines for the first time how natural resource dependence affects the prevalence of undernourishment in developing countries. Accounting for the effects of total rents and point resources, the results show that natural resource dependence explains the prevalence of undernourishment (including stunting and low birth weight) ceteris paribus. Appraising the natural resources-undernourishment nexus by geographical location suggests that the effect is more pronounced in sub-Saharan Africa, South Asia, and low- and lower-middle-income countries. Among the mechanisms to explain this result, we identify control of corruption, democracy, internal conflicts, income inequality, and agricultural investments as potential transmission channels through which natural resources influence undernourishment. [ABSTRACT FROM AUTHOR]

Development interventions increasingly include women's empowerment and gender equality among their objectives, but evaluating their impact has been stymied by the lack of measures that are comparable across interventions. This paper synthesizes the findings of 11 mixed-methods impact evaluations of agricultural development projects from South Asia and sub-Saharan Africa that were part of the Gender, Agriculture, and Assets Project, Phase 2 (GAAP2). As part of GAAP2, qualitative and quantitative data were used to develop and validate the multidimensional project-level Women's Empowerment in Agriculture Index (pro-WEAI), which was used to assess the impact of GAAP2 projects on women's empowerment. This paper assesses the extent to which: (1) a two- to three-year agricultural development project can contribute to women's empowerment; and (2) a suite of methods comprising a standardized quantitative measure of women's empowerment and a set of qualitative protocols, can evaluate such impacts. Our synthesis finds that the most common positive significant impacts were on the instrumental and collective agency indicators that comprise pro-WEAI, owing to the group-based approaches used. We found few projects significantly improved intrinsic agency, even among those with explicitly stated objectives to change gender norms. Unsurprisingly, we find mixed, and mostly null impacts on aggregate pro-WEAI, with positive impacts more likely in the South Asian, rather than African, cases. Our results highlight the need for projects to design their strategies specifically for empowerment, rather than assume that projects aiming to reach and benefit women automatically empower them. Our study also shows the value of a suite of methods containing a common metric to compare empowerment impacts and qualitative protocols to understand and contextualize these impacts. • We use pro-WEAI to assess 11 projects' impacts on women's agency and empowerment. • Pro-WEAI comprises quantitative and qualitative protocols co-developed by projects. • Significant positive impacts observed on instrumental and collective agency. • More limited or null impacts detected on intrinsic agency. • Intentionality is important in projects' strategies to empower women. [ABSTRACT FROM AUTHOR]

Background: Surgical site infection (SSI) surveillance programs are recommended to be included in national infection prevention and control (IPC) programs, yet few exist in low- or middle-income countries (LMICs). Our goal was to identify components of surveillance in existing programs that could be replicated elsewhere and note opportunities for improvement to build awareness for other countries in the process of developing their own national surgical site infection surveillance (nSSIS) programs. Methods: We administered a survey built upon the U.S. Centers for Disease Control and Prevention's framework for surveillance system evaluation to systematically deconstruct logistical infrastructure of existing nSSIS programs in LMICs. Qualitative analyses of survey responses by thematic elements were used to identify successful surveillance system components and recognize opportunities for improvement. Results: Three respondents representing countries in Europe and Central Asia, sub-Saharan Africa, and South Asia designated as upper middle-income, lower middle-income, and low-income responded. Notable strengths described by respondents included use of local paper documentation, staggered data entry, and limited data entry fields. Opportunities for improvement included outpatient data capture, broader coverage of healthcare centers within a nation, improved audit processes, defining the denominator of number of surgical procedures, and presence of an easily accessible, free SSI surveillance training program for healthcare workers. Conclusions: Outpatient post-surgery surveillance, national coverage of healthcare facilities, and training on how to take local SSI surveillance data and integrate it within a broader nSSIS program at the national level remain areas of opportunities for countries looking to implement a nSSIS program. [ABSTRACT FROM AUTHOR]

Hepatitis E virus (HEV) is one of the emerging zoonotic diseases in Sub-Saharan Africa. Domestic pigs are considered to be the main reservoir for this infectious disease. A third of the world's population is thought to have been exposed to the virus. The zoonotic transmission of the HEV raises serious zoonotic and food safety concerns for the general public. This is a major public health issue in both developed and developing countries. The World Health Organization (WHO) estimated that 44,000 people died in 2015 as a result of HEV infection. East and South Asia have the highest prevalence of this disease overall. In this study, we proposed, developed, and analyzed the transmission routes of the infection using a fractional-order derivative approach. The existence, stability, and uniqueness of solutions were established using the approach and concept in Banach space. Local and global stability was determined using the Hyers–Ulam (HU) stability approach. Numerical simulation was conducted using existing parameter values, and it was established that, as the susceptible human population declines, the number of infected human populations rises with a change in fractional order θ ^. When the susceptible pig population increases, the number of infected pig populations rises with a change in θ ^. It was observed that a few variations in the fractional derivative order did not alter the function's overall behavior with the results of numerical simulations. Moreover, as the number of recovered human populations increases, there is a corresponding increase in the population of recovered pigs with a change in θ ^. The exponential increase in the infected pig population can be controlled by treatment of the infected pigs and prevention of the susceptible pigs. The authors recommend policymakers, and stakeholders prioritize the fight against the virus by enforcing the prevention of humans and treatment of infected pigs. The model can be extended to optimal control and cost-effectiveness analysis to determine the most effective control strategy that comes with less cost in the combat of the disease. [ABSTRACT FROM AUTHOR]

Background: Hyperglycemia during pregnancy leads to adverse maternal and fetal outcomes. Thus, strict monitoring of blood glucose levels is warranted. This study aims to determine the association of early to mid-pregnancy HbA1c levels with the development of pregnancy complications in women from three countries in South Asia and Sub-Saharan Africa. Methods: We performed a secondary analysis of the AMANHI (Alliance for Maternal and Newborn Health Improvement) cohort, which enrolled 10,001 pregnant women between May 2014 and June 2018 across Sylhet-Bangladesh, Karachi-Pakistan, and Pemba Island-Tanzania. HbA1c assays were performed at enrollment (8 to < 20 gestational weeks), and epidemiological data were collected during 2–3 monthly household visits. The women were followed-up till the postpartum period to determine the pregnancy outcomes. Multivariable logistic regression models assessed the association between elevated HbA1c levels and adverse events while controlling for potential confounders. Results: A total of 9,510 pregnant women were included in the analysis. The mean HbA1c level at enrollment was found to be the highest in Bangladesh (5.31 ± 0.37), followed by Tanzania (5.22 ± 0.49) and then Pakistan (5.07 ± 0.58). We report 339 stillbirths and 9,039 live births. Among the live births were 892 preterm births, 892 deliveries via cesarean section, and 532 LGA babies. In the multivariate pooled analysis, maternal HbA1c levels of ≥ 6.5 were associated with increased risks of stillbirths (aRR = 6.3, 95% CI = 3.4,11.6); preterm births (aRR = 3.5, 95% CI = 1.8–6.7); and Large for Gestational Age (aRR = 5.5, 95% CI = 2.9–10.6). Conclusion: Maternal HbA1c level is an independent risk factor for predicting adverse pregnancy outcomes such as stillbirth, preterm birth, and LGA among women in South Asia and Sub-Saharan Africa. These groups may benefit from early interventional strategies. [ABSTRACT FROM AUTHOR]

This review aims to map the burden of pulmonary TB among immigrants in the UK and investigate associated factors. It also reviews the TB management approaches among immigrants in the UK.Design: The study utilized PRISMA guidelines to search electronic databases (PubMed and EMBASE) for articles published from 2000 to 2022 on TB prevalence and factors in immigrants and explored government websites for TB management strategies.Results: Nineteen out of 530 initially identified articles were included. The included studies reported a prevalence rate of TB among immigrants ranging from 0.04 to 52.1%, showing a decrease in the burden over time. Additionally, a higher number of TB cases were observed among immigrants from the Asian region, particularly immigrants from South Asia, followed by those from sub-Saharan Africa. Stigma, misconception about the disease, language barrier, lack of confidentiality, and unfriendly healthcare system for immigrants were the main drivers of the TB burden among immigrants. The TB management approaches in the UK include pre-entry screening for active TB, LTBI testing for a specific population group, and antibacterial therapy for 3– 6 months for TB patients.Conclusion: The UK's control and prevention efforts in reducing tuberculosis prevalence among immigrants show optimism, but challenges persist. Key improvements include healthcare delivery, TB improvement programs, and policies addressing stigma and patient confidentiality. [ABSTRACT FROM AUTHOR]

Background: Entamoeba histolytica, Giardia, and Cryptosporidium are common intestinal protozoan parasites that contribute to a high burden of childhood morbidity and mortality. Our study quantified the association between intestinal protozoan parasites and child anthropometric outcomes among children under-5. Methods: We analyzed data from 7,800 children enrolled in the Global Enteric Multicenter Study (GEMS) across seven study sites that were positive for intestinal protozoan parasites between December 2007 and March 2011. Parasites were assessed using stool immunoassays (ELISA). We applied multiple linear regression to test the association between any or concurrent parasite and child anthropometric outcomes: length/height-for-age (HAZ), weight-for-age (WAZ), and weight-for-length/height (WHZ) z-score after 60 days of enrollment. Models were stratified by diarrheal symptoms, driven by the study design, and adjusted for potential covariates. Findings: Among the asymptomatic children, negative associations were observed between Giardia with HAZ [β: -0.13; 95% CI: -0.17, -0.09; p<0.001] and WAZ [β -0.07; 95% CI: -0.11, -0.04; p<0.001], but not WHZ [β: -0.02; 95% CI:-0.06, 0.02; p = 0.36]; Cryptosporidium with WAZ [β: -0.15; 95% CI: -0.22, -0.09; p<0.001] and WHZ [β: -0.18; 95%CI: -0.25, -0.12; p<0.001], but not with HAZ [β: -0.03; 95% CI: -0.09, 0.04; p = 0.40]. For symptomatic children, no associations were found between Giardia and anthropometry; negative associations were found between Cryptosporidium with HAZ [β: -0.17; 95% CI: -0.23, -0.11; p<0.001], WAZ [β: -0.25; 95% CI: -0.31, -0.19; p<0.001] and WHZ [β: -0.23; 95% CI: -0.30, -0.17; p<0.001]. Among the asymptomatic 24–59 months children, Giardia had a negative association with HAZ [β: -0.09; 95% CI: -0.15, -0.04; p = 0.001]. No significant associations were found between E. histolytica with child growth. Conclusions: While some studies have found that Giardia is not associated with (or protective against) acute diarrhea, our findings suggest that it is associated with growth shortfall. This observation underscores the need for preventive strategies targeting enteric protozoan parasites among young children, to reduce the burden of childhood malnutrition. Author summary: Intestinal protozoan parasites such as Entamoeba histolytica, Giardia, and Cryptosporidium are significant causes of childhood morbidity and mortality. A study analyzed data from 7,800 children enrolled in the Global Enteric Multicenter Study (GEMS) across seven study sites who tested positive for these parasites using stool immunoassays. The study aimed to quantify the association between intestinal protozoan parasites and child anthropometric outcomes among children under the age of 5. The results of the study showed negative associations between Giardia and weight-for-age and length/height-for-age among asymptomatic children. Similarly, Cryptosporidium was negatively associated with weight-for-age and weight-for-length/height among asymptomatic children and with weight-for-age, weight-for-length/height, and length/height-for-age among symptomatic children. No significant associations were found between Entamoeba histolytica and child growth. The study findings suggest that while Giardia may not cause acute diarrhea, it is associated with growth shortfall among young children. These observations highlight the need for preventive strategies to target enteric protozoan parasites among young children to reduce the burden of childhood malnutrition. [ABSTRACT FROM AUTHOR]

Sugar-sweetened beverages (SSBs) are associated with cardiometabolic diseases and social inequities. For most nations, recent estimates and trends of intake are not available; nor variation by education or urbanicity. We investigated SSB intakes among adults between 1990 and 2018 in 185 countries, stratified subnationally by age, sex, education, and rural/urban residence, using data from the Global Dietary Database. In 2018, mean global SSB intake was 2.7 (8 oz = 248 grams) servings/week (95% UI 2.5-2.9) (range: 0.7 (0.5-1.1) in South Asia to 7.8 (7.1-8.6) in Latin America/Caribbean). Intakes were higher in male vs. female, younger vs. older, more vs. less educated, and urban vs. rural adults. Variations by education and urbanicity were largest in Sub-Saharan Africa. Between 1990 and 2018, SSB intakes increased by +0.37 (+0.29, +0.47), with the largest increase in Sub-Saharan Africa. These findings inform intervention, surveillance, and policy actions worldwide, highlighting the growing problem of SSBs for public health in Sub-Saharan Africa. Recent estimates of sugar-sweetened beverages (SSBs) intake are generally unavailable. Here the authors show a global SSBs intake of 2.7 servings/week in 2018 in adults (range: 0.7 South Asia, 7.8 Latin America/Caribbean); intakes were higher among males, younger, more educated, and urban adults. [ABSTRACT FROM AUTHOR]

Background : Preterm birth or low birth weight is the single largest cause of death in newborns, however this mortality can be reduced through newborn care interventions, including Kangaroo Mother Care (KMC). Previously, a multi-country randomized controlled trial, coordinated by the World Health Organization (WHO), reported a significant survival advantage with initiation of continuous KMC immediately after birth compared with initiation of continuous KMC a few days after birth when the baby is considered clinically stable. Whether the survival advantage would lead to higher rates of neurodevelopmental morbidities, or the immediate KMC will also have a beneficial effect on cognitive development also, has not been investigated. We therefore propose to test the hypothesis that low-birth-weight infants exposed to immediate KMC will have lower rates of neurodevelopmental impairment in comparison to traditional KMC-treated infants, by prospectively following up infants already enrolled in the immediate KMC trial for the first 2 years of life, and assessing their growth and neurodevelopment. Methods: This prospective cohort study will enroll surviving neonates from the main WHO immediate KMC trial. The main trial as well as this follow-up study are being conducted in five low- and middle-income countries in South Asia and sub-Saharan Africa. The estimated sample size for comparison of the risk of neurodevelopmental impairment is a total of 2200 children. The primary outcome will include rates of cerebral palsy, hearing impairment, vision impairment, mental and motor development, and epilepsy and will be assessed by the age of 3 years. The analysis will be by intention to treat. Discussion: Immediate KMC can potentially reduce low-birth-weight-associated complications such as respiratory disease, hypothermia, hypoglycemia, and infection that can result in impaired neurocognitive development. Neuroprotection may also be mediated by improved physiological stabilization that may lead to better maturation of neural pathways, reduced risk of hypoxia, positive parental impact, improved sleep cycles, and improved stress responses. The present study will help in evaluating the overall impact of KMC by investigating the long-term effect on neurodevelopmental impairment in the survivors. Trial registration: Clinical Trials Registry-India CTRI/2019/11/021899. Registered on 06 November 2019. Trials registration of parent trial: ACTRN12618001880235; Clinical Trials Registry-India: CTRI/2018/08/015369. [ABSTRACT FROM AUTHOR]

The accurate prediction of accident severity has become an active area of research in recent years, although studies in certain regions such as South Asia and Sub-Saharan Africa are comparatively less. In this study, we aim to contribute in many ways: (i) we conduct an analytical review of the literature to gauge the interest and scope of existing studies and identify the direction for further research, and (ii) a mixture of old and relatively new artificial intelligence (AI) techniques is applied to road accident data of India (iii) we employ shapley additive explanations (SHAP) for interpretation of AI model predictions, and (iv) an AI-enabled accident management system is proposed. The findings suggest that AI models are capable of predicting the accident severity. Precisely, the gradient boosting machine attains the best test accuracy. Among features, commercial vehicles, excess speed, national highways, and pedestrians' fault are responsible for accidental road killings. [ABSTRACT FROM AUTHOR]

Non-technical losses (NTLs) are one of the main problems that electricity distribution utilities face in developing regions such as Latin America, the Caribbean, sub-Saharan Africa, and South Asia. Particularly in Brazil, based on the socioeconomic and market variables concerning all the distribution utilities, the National Electric Energy Agency (ANEEL) has formulated several specifications of econometric models for panel data with random effects, all aimed at determining an index that reflects the difficulty of combating NTLs according to the intrinsic characteristics of each distribution area. Nevertheless, given the exhaustive search for combinations of explanatory variables and the complexity inherent to defining regulatory NTL targets, this process still requires the evaluation of many models through hypothesis and goodness-of-fit tests. In this regard, this article proposes an automatic model-selection technique for panel data regressions to better assist the Agency in establishing NTL regulatory targets for the distribution of utilities in this country. The proposed technique was applied to panel data containing annual observations from 62 Brazilian electricity distribution utilities from 2007 to 2017, thus generating 1,097,789 models associated with the regression types in the panel data. The main results are three selected models that showed more adherence to the actual capacity of Brazilian distribution utilities to reduce their NTLs. [ABSTRACT FROM AUTHOR]

A large literature has demonstrated the link between poverty and mental ill-health. Yet, the potential causal effects of poverty alleviation measures on mental disorders are not well-understood. In this systematic review, we summarize the evidence of the effects of a particular kind of poverty alleviation mechanism on mental health: the provision of cash transfers in low- and middle-income countries. We searched eleven databases and websites and assessed over 4,000 studies for eligibility. Randomized controlled trials evaluating the effects of cash transfers on depression, anxiety, and stress were included. All programs targeted adults or adolescents living in poverty. Overall, 17 studies, comprising 26,794 participants in Sub-Saharan Africa, Latin America, and South Asia, met the inclusion criteria of this review. Studies were critically appraised using Cochrane's Risk of Bias tool and publication bias was tested using funnel plots, egger's regression, and sensitivity analyses. The review was registered in PROSPERO (CRD42020186955). Meta-analysis showed that cash transfers significantly reduced depression and anxiety of recipients (dpooled = -0.10; 95%-CI: -0.15, -0.05; p<0.01). However, improvements may not be sustained 2–9 years after program cessation (dpooled = -0.05; 95%-CI: -0.14, 0.04; ns). Meta-regression indicates that impacts were larger for unconditional transfers (dpooled = -0.14; 95%-CI: -0.17, -0.10; p<0.01) than for conditional programs (dpooled = 0.10; 95%-CI: 0.07, 0.13; p<0.01). Effects on stress were insignificant and confidence intervals include both the possibility of meaningful reductions and small increases in stress (dpooled = -0.10; 95%-CI: -0.32, 0.12; ns). Overall, our findings suggest that cash transfers can play a role in alleviating depression and anxiety disorders. Yet, continued financial support may be necessary to enable longer-term improvements. Impacts are comparable in size to the effects of cash transfers on, e.g., children's test scores and child labor. Our findings further raise caution about potential adverse effects of conditionality on mental health, although more evidence is needed to draw robust conclusions. [ABSTRACT FROM AUTHOR]

Student dropout in secondary schools is a major issue in developing countries, particularly in Sub-Saharan Africa. Sub-Saharan African countries had the highest dropout rate (37.5%), followed by South Asia (15.5%), the Middle East (11%), East Asia (9.5%), Latin America (7%), and Central Asia (3.5%). Various initiatives such as the big results now initiatives, no child left behind, and secondary education development programme as well as machine learning prediction models have been used to reduce the severity of the problem in Sub-Saharan countries. The ongoing dropout problem, particularly in secondary schools is ascribed to improper root cause identification and the absence of formal procedures that can be used to estimate the severity of the issue. This study has compared the AutoML model, ensemble learning approach, and KNORA-AutoML to predict student dropout problems. The KNORA-AutoML model scored 97% of accuracy, precision = 71%, and AUC = 87% when compared to the conventional ensemble of optimized ML models with accuracy = 96%, precision = 70%, and AUC = 78%. KNORA-AutoML model performance increased by 0.6% accuracy, 0.8% precision, and 8.7% AUC. An optimized model draws a lot of attention to the findings related to student dropout rates in developing countries. [ABSTRACT FROM AUTHOR]

Objectives: To present an empirical description of the association between height and lifetime fertility in women from low‐ and middle‐income countries, allowing for flexible functional relationships. Methods: A pooled sample (N = 846 257) of women ages 35–49 in Demographic and Health Surveys (DHS) from 64 countries, with regional samples for Latin America, South Asia, and sub‐Saharan Africa. Flexibly‐estimated structured additive regression models estimate variations in the height‐fertility relationship over the height distribution. Results: Across samples, height is shown to have nonlinear relationships with number of children ever born and age at first birth. Number of children increases with height until a maximum below average height, after which the number of children decreases. Age at first marriage decreases with height until a minimum below average height, and then increases. Except at the shortest heights, much of the variation in fertility is suggested to reflect socioeconomic differences across heights. At the shortest heights, variation is suggested to reflect later ages at first birth, except for women in sub‐Saharan Africa. Conclusion: A nonlinear relationship is indicated between height and fertility. Much of the relationship is suggested to reflect height‐variations in socioeconomic status and age at first birth. [ABSTRACT FROM AUTHOR]

More than three billion people worldwide suffer from iron deficiency associated anemia and an equal number people suffer from zinc deficiency. These conditions are more prevalent in Sub-Saharan Africa and South Asia. In developing countries, children under the age of five with stunted growth and pregnant or lactating women were found to be at high risk of zinc and iron deficiencies. Biofortification, defined as breeding to develop varieties of staple food crops whose grain contains higher levels of micronutrients such as iron and zinc, are one of the most promising, cost-effective and sustainable ways to improve the health in resource-poor households, particularly in rural areas where families consume some part of what they grow. Biofortification through conventional breeding in wheat, particularly for grain zinc and iron, have made significant contributions, transferring important genes and quantitative trait loci (QTLs) from wild and related species into cultivated wheat. Nonetheless, the quantitative, genetically complex nature of iron and zinc levels in wheat grain limits progress through conventional breeding, making it difficult to attain genetic gain both for yield and grain mineral concentrations. Wheat biofortification can be achieved by enhancing mineral uptake, source-to-sink translocation of minerals and their deposition into grains, and the bioavailability of the minerals. A number of QTLs with major and minor effects for those traits have been detected in wheat; introducing the most effective into breeding lines will increase grain zinc and iron concentrations. New approaches to achieve this include marker assisted selection and genomic selection. Faster breeding approaches need to be combined to simultaneously increase grain mineral content and yield in wheat breeding lines. [ABSTRACT FROM AUTHOR]

Zinc deficiency affects one third of the population worldwide, and vitamin A deficiency is a prevalent public health issue in Sub-Saharan Africa and South-Asia, including Nepal. Crop biofortification is the sustainable solution to these health—related problems, thus we conducted two different field trials in an alpha lattice design to identify zinc and provitamin A biofortified maize genotypes consistent and competitive in performance over the contrasting seasons (Season 1: 18 February to 6 July 2020 and Season 2: 31 August to 1 February, 2020/21). In our study, the performance of introduced maize genotypes (zinc—15 and provitamin A biofortified—24) were compared with that of the local check, focusing on the overall agro-morphology, yield attributes, yield, and kernel zinc and total carotenoid content. Zinc and total carotenoid in the tested genotypes were found in the range between 14.2 and 24.8 mg kg−1 and between 1.8 and 3.6 mg 100 g−1. Genotypes A1831-8 from zinc and EEPVAH-46 from provitamin A biofortified maize trial recorded kernel zinc and total carotenoid as high as 52.3, and 79.5%, respectively, compared to the local check (DMH849). The provitamin A genotypes EEPVAH-46 and EEPVAH-51 (total carotenoid: 3.6 and 3.3 mg 100 g−1), and zinc biofortified genotypes A1847-10 and A1803-42 (20.4 and 22.4 mg kg−1 zinc) were identified as superior genotypes based on their yield consistency over the environments and higher provitamin A and zinc content compared to the check. In addition, farmers can explore August sowing to harvest green cobs during December-January to boost up the emerging green cob business. [ABSTRACT FROM AUTHOR]

Research shows that risk management will be key if an agricultural transformation that includes the smallholder farm sector is to occur in sub‐Saharan Africa and South Asia. While the smallholder farm sector has historically had poor access to financial and other risk management tools, digital technologies are rapidly impacting the cost and availability of savings, credit, and insurance services in remote rural regions. While these services are all different ways of moving money through time, and thus would seem to be substitutes for each other, they are characterized by quite different pre‐requisites in terms of trust and understanding, and in terms of required tangible and reputational assets. This observation suggests that resilience and an inclusive agricultural transformation might be best promoted by a flexible system that offers indexed risk management tools that can meet the needs of households that enjoy different assets and beliefs. This article lays out this logic and models the use and impacts of a system of flexible financial tools for risk management and an inclusive agricultural transformation. Key findings include that farmers will optimally combine all three financial instruments. The model also shows that these combined financial risk management tools are by themselves sufficient to induce agricultural intensification for less poor, but not for the deeply poor households who have already been decapitalized by shocks. [ABSTRACT FROM AUTHOR]

Snakebite envenoming is an important cause of preventable death. The World Health Organization (WHO) set a goal to halve snakebite mortality by 2030. We used verbal autopsy and vital registration data to model the proportion of venomous animal deaths due to snakes by location, age, year, and sex, and applied these proportions to venomous animal contact mortality estimates from the Global Burden of Disease 2019 study. In 2019, 63,400 people (95% uncertainty interval 38,900–78,600) died globally from snakebites, which was equal to an age-standardized mortality rate (ASMR) of 0.8 deaths (0.5–1.0) per 100,000 and represents a 36% (2–49) decrease in ASMR since 1990. India had the greatest number of deaths in 2019, equal to an ASMR of 4.0 per 100,000 (2.3—5.0). We forecast mortality will continue to decline, but not sufficiently to meet WHO's goals. Improved data collection should be prioritized to help target interventions, improve burden estimation, and monitor progress. Snakebite envenoming is a leading cause of mortality among neglected tropical diseases. Here, the authors analyze a global data repository and estimate that snakebite envenoming caused over 63,000 deaths in 2019, primarily concentrated in South Asia and Sub-Saharan Africa. [ABSTRACT FROM AUTHOR]

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Background: The influence of urbanicity on hypertension prevalence remains poorly understood. We conducted a systematic review and meta-analysis to assess the difference in hypertension prevalence between urban and rural areas in low-income and middle-income countries (LMICs), where the most pronounced urbanisation is underway. Methods and findings: We searched PubMed, Web of Science, Scopus, and Embase, from 01/01/1990 to 10/03/2022. We included population-based studies with ≥400 participants 15 years and older, selected by using a valid sampling technique, from LMICs that reported the urban-rural difference in hypertension prevalence using similar blood pressure measurements. We excluded abstracts, reviews, non-English studies, and those with exclusively self-reported hypertension prevalence. Study selection, quality assessment, and data extraction were performed by 2 independent reviewers following a standardised protocol. Our primary outcome was the urban minus rural prevalence of hypertension. Hypertension was defined as systolic blood pressure ≥140 mm Hg and/or diastolic blood pressure as ≥90 mm Hg and could include use of antihypertensive medication, self-reported diagnosis, or both. We investigated heterogeneity using study-level and socioeconomic country-level indicators. We conducted meta-analysis and meta-regression using random-effects models. This systematic review and meta-analysis has been registered with PROSPERO (CRD42018091671). We included 299 surveys from 66 LMICs, including 19,770,946 participants (mean age 45.4 ± SD = 9 years, 53.0% females and 63.1% from rural areas). The pooled prevalence of hypertension was 30.5% (95% CI, 28.9, 32.0) in urban areas and 27.9% (95% CI, 26.3, 29.6) in rural areas, resulting in a pooled urban-rural difference of 2.45% (95% CI, 1.57, 3.33, I-square: 99.71%, tau-square: 0.00524, Pheterogeneity < 0.001). Hypertension prevalence increased over time and the rate of change was greater in rural compared to urban areas, resulting in a pooled urban-rural difference of 5.75% (95% CI, 4.02, 7.48) in the period 1990 to 2004 and 1.38% (95% CI, 0.40, 2.37) in the period 2005 to 2020, p < 0.001 for time period. We observed substantial heterogeneity in the urban-rural difference of hypertension, which was partially explained by urban-rural definition, probably high risk of bias in sampling, country income status, region, and socioeconomic indicators. The urban-rural difference was 5.67% (95% CI, 4.22, 7.13) in low, 2.74% (95% CI, 1.41, 4.07) in lower-middle and −1.22% (95% CI, −2.73, 0.28) in upper-middle-income countries in the period 1990 to 2020, p < 0.001 for country income. The urban-rural difference was highest for South Asia (7.50%, 95% CI, 5.73, 9.26), followed by sub-Saharan Africa (4.24%, 95% CI, 2.62, 5.86) and reversed for Europe and Central Asia (−6.04%, 95% CI, −9.06, −3.01), in the period 1990 to 2020, p < 0.001 for region. Finally, the urban-rural difference in hypertension prevalence decreased nonlinearly with improvements in Human Development Index and infant mortality rate. Limitations included lack of data available from all LMICs and variability in urban and rural definitions in the literature. Conclusions: The prevalence of hypertension in LMICs increased between 1990 and 2020 in both urban and rural areas, but with a stronger trend in rural areas. The urban minus rural hypertension difference decreased with time, and with country-level socioeconomic development. Focused action, particularly in rural areas, is needed to tackle the burden of hypertension in LMICs. Otavio T. Ranzani and colleagues explore urban-rural differences in hypertension prevalence in low- and middle-income countries from 1990-2020. Author summary: Why was this study done?: Hypertension is one of the main risk factors for morbidity and mortality worldwide. Urbanisation is a dynamic process that is occurring mainly in low-income and middle-income countries (LMICs) nowadays. Whether urban-rural differences in hypertension prevalence vary by region, country-level income status, calendar time, or socioeconomic indicators is largely unknown yet important for understanding the public health implications of urbanisation. What did the researchers do and find?: We performed a systematic database search, and after standardised study selection, data extraction, and risk of bias assessment, we analysed 299 surveys including information from over 19.7 million individuals in 66 LMICs. We observed a slightly higher prevalence of hypertension in urban compared with rural areas in a meta-analysis. The urban-rural difference varied with urbanisation stage and socioeconomic development, and decreased over time as prevalence in rural areas converged with, and eventually overtook, that of urban areas. What do these findings mean?: The prevalence of hypertension in LMICs has increased over the past 2 decades; the rate of change appears greater in rural compared to urban areas. Overall patterns in the urban-rural difference indicate that as country-level socioeconomic indicators improved, hypertension in rural began to surpass that of urban areas. These results have important implications for public health planning: Tackling the global burden of hypertension will require targeted action, particularly in rural areas of LMICs, where there are important opportunities for prevention in the face of socioeconomic development and urbanisation. [ABSTRACT FROM AUTHOR]

The COVID-19 pandemic has changed the course of human development. In this manuscript we analyze the long-term effect of COVID-19 on poverty at the country-level across various income thresholds to 2050. We do this by introducing eight quantitative scenarios that model the future of Sustainable Development Goal 1 (SDG1) achievement using alternative assumptions about COVID-19 effects on both economic growth and inequality in the International Futures model. Relative to a scenario without the pandemic (the No COVID scenario), the COVID Base scenario increases global extreme poverty by 73.9 million in 2020 (the range across all scenarios: 43.5 to 155.0 million), 63.6 million in 2030 (range: 9.8 to 167.2 million) and 57.1 million in 2050 (range: 3.1 to 163.0 million). The COVID Base results in seven more countries not meeting the SDG1 target by 2030 that would have achieved the target in a No COVID scenario. The most pessimistic scenario results in 17 more countries not achieving SDG1 compared with a No COVID scenario. The greatest pandemic driven increases in poverty occur in South Asia and sub-Saharan Africa. [ABSTRACT FROM AUTHOR]

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Background: Sexually transmitted infections (STIs) in low- and middle-income countries (LMICs) are predominantly managed by syndromic management. However, most STIs are asymptomatic. These untreated STIs cause individual morbidity, and lead to high STI prevalences. There is increasing interest in the use of point-of-care tests (POCTs) for STIs in LMICs, which could facilitate same day testing and treatment. To best utilise these tests, we must understand the facilitators and barriers to their implementation. The aim of this review is to explore how point-of-care testing for STIs has been implemented into healthcare systems in LMIC and the facilitators and barriers to doing so.Methods: A scoping review was conducted by searching MEDLINE, Embase, Emcare, CINAHL, Scopus, LILACS, the Cochrane Library, and ProQuest Dissertations and Theses for studies published between 1st January 1998 and 5th June 2020. Abstracts and full articles were screened independently by two reviewers. Studies were considered for inclusion if they assessed the acceptability, feasibility, facilitators, or barriers to implementation of point-of-care testing for chlamydia, gonorrhoea, trichomoniasis or syphilis in LMICs. Thematic analysis was used to analyse and present the facilitators and barriers to point-of-care STI testing.Results: The literature search revealed 82 articles suitable for inclusion; 44 (53.7%) from sub-Saharan Africa; 21 (25.6%) from Latin American and the Caribbean; 10 (12.2%) from East Asia and the Pacific; 6 (7.3%) from South Asia; and one (1.2%) multi-regional study. Thematic analysis revealed seven overarching themes related to the implementation of POCTs in LMICs, namely (i) Ideal test characteristics, (ii) Client factors, (iii) Healthcare provision factors, (iv) Policy, infrastructure and health system factors, (v) Training, audit, and feedback, (vi) Reaching new testing environments, and (vii) Dual testing.Conclusion: Implementation of POCTs in LMICs is complex, with many of the barriers due to wider health system weakness. In addition to pressing for broader structural change to facilitate basic healthcare delivery, these themes may also be used as a basis on which to develop future interventions. The literature was heavily skewed towards syphilis testing, and so more research needs to be conducted assessing chlamydia, gonorrhoea, and trichomoniasis testing, as well as home or self-testing. [ABSTRACT FROM AUTHOR]

Background: Neonatal mortality remains a public health problem in the developing world. Globally, around 2.5 million neonatal deaths are reported annually with the highest mortality concentrated in sub-Saharan Africa and South Asia. In comparison with countries demonstrating the lowest neonatal mortality, the risk of mortality is over 30 times higher in sub-Saharan Africa. Ethiopia is among the countries with a high neonatal mortality rate, and the burden of this mortality remains unreported in many pastoralist areas such as Somali Regional State, Eastern Ethiopia. We aimed to investigate factors associated with neonatal mortality in public Hospitals of the Somali Regional State in Eastern Ethiopia. Methods: A facility-based cross-sectional study was conducted from May 1st to 30th, 2020 in three public Hospitals of Somali Regional State in Eastern Ethiopia. A total of 510 neonates admitted to neonatal intensive care units from January 2018 to December 2019 were enrolled in the study. The charts of neonates were randomly selected and retrieved. Data were collected using a pretested and validated structured questionnaire. The collected were entered into Epidata version 3.1 and exported to SPSS version 22 (IBM SPSS Statistics, 2013) for further analysis. Descriptive statistics were carried out using frequency tables, proportions, and summary measures. Predictors were assessed using a multivariable logistic regression analysis model and reported using adjusted odds ratio (AOR) with 95% Confidence Interval (CI). Statistical significance was considered at a p-value <0.05. Results: Overall, the neonatal mortality was 18.6% [95%CI (15.31, 22.30)], equating to a rate of 186 per 1000 live births. The most common causes of mortality were prematurity (44.6%), low birth weight (33.5%), and birth asphyxia (27.6%). In the final model of multivariable analysis, predictors such as: lack of antenatal care follow-up[AOR = 3.71, 95%CI (2.13, 6.44)], neonatal sepsis [AOR = 1.84, 95%CI (1.07, 3.19], preterm birth [AOR = 2.20, 95%CI (1.02, 4.29], and birth asphyxia [AOR = 2.40, 95%CI(1.26,4.43)], and birth weight of less than 2500gms[AOR = 3.40, 95%CI(1.92, 6.01)] were statistically associated with neonatal mortality. Conclusion: In this study, the neonatal mortality rate was high compared to national and global targets because one in five neonates dies due to preventable causes. Modifiable and non-modifiable risk factors were identified as predictors. This result calls for all stakeholders to provide due attention to low birth weight and premature babies. Early identification and management of birth asphyxia and neonatal sepsis are also very crucial to reduce the risks of neonatal deaths. [ABSTRACT FROM AUTHOR]

It appears to be essential to reflect different perspectives for doing media development work in contexts where foreign actors are not insiders. Here, their outside views on the needs of supported countries and on how to work together can be difficult for implementing projects, especially for actors on-site on which this article focuses. It aims to bring practical and academic reflections together for a broader understanding of how insiders and outsiders perceive media development work differently. These different perceptions bring challenges for their relationship and cooperation. Based on the author's research, a literature review, and interviews with practitioners from south-Asian media organizations, critical aspects will be discussed, such as cooperation dynamics, the effect of power inequalities and subsequent trust difficulties. The article will not only give the perspective of actors on-site and their struggles with media development "cooperation," but also suggest constructive approaches to work on an eye-level with mutual understanding. [ABSTRACT FROM AUTHOR]

In recent years, farmer-led irrigation development has gained the interest of development partners and governments in the Global South following its success in enhancing agricultural production and livelihoods in South Asia. However, little is known about the socio-economic situation of farmers who receive public support for its expansion. Considering its rapid expansion in sub-Saharan Africa, we take the case of Ethiopia and explore the relationship between irrigation suitability and farmers' socio-economic status. We find that high-value crop producers and wealthier farmers are most likely to make private investments and also benefit from public support in farmer-led irrigation expansion if investments are directed to land areas highly suitable for irrigation. Cultivation of high-value crops (fruit, vegetables) was common in areas more suitable for irrigation but staple crop cultivation (cereals, legumes) was negatively associated with irrigation suitability. Wealth status (consumption expenditure, asset index, and land size) was also positively correlated with irrigation suitability. A 10 per cent increase in groundwater irrigation suitability score was associated with a 2 per cent increase in per-capita consumption expenditure. Results imply that policies aiming to facilitate farmer-led irrigation development should combine biophysical information on land and water suitability for irrigation with household socio-economic characteristics and existing agricultural systems. [ABSTRACT FROM AUTHOR]

The globalization of pipes and smoking in the early modern world is often thought of as a linear movement from the Americas to Africa and Eurasia. While this is true of tobacco smoking, other early modern cultures of smoking (such as the use of cannabis pipes) diffused from sub-Saharan Africa and South Asia, not from the Americas. This article traces the technological, linguistic, and cultural translations of smoking in the seventeenth and eighteenth centuries, with a focus on the Atlantic world. These movements provoked significant new questions. Early modern smokers (and their critics) grappled with the question of how pipes and other "pyric technologies" of elemental transformation interacted with the body and mind—and with debates about racialized theories of health, long-distance travel, the African slave trade, and the translatability of knowledge and habits. [ABSTRACT FROM AUTHOR]

Typhoid is endemic in many countries in South Asia and sub-Saharan Africa. The high burden of this age-old, preventable disease exacerbates constraints on the health systems of these countries. Currently, most patients are treated effectively in the community or outpatient departments, but with rising antimicrobial resistance and the dearth of novel antimicrobials in the horizon, we risk losing our primary defense against typhoid. Extensively drug-resistant Salmonella Typhi is spreading, and azithromycin is the last oral drug to continue treating typhoid in the community. With increasing azithromycin resistance, emergence of pan-oral drug resistant Salmonella Typhi is imminent. The high burden of typhoid is also an underlying cause of the unnecessary use of antimicrobials. In addition to implementing water sanitation and hygiene interventions to prevent typhoid, it is imperative to rapidly roll out typhoid conjugate vaccines in endemic countries. This will not only reduce the burden of typhoid but will also help interrupt the trend of increasing antimicrobial resistance. [ABSTRACT FROM AUTHOR]

Background: The association between childhood diarrheal disease and linear growth faltering in developing countries is well described. However, the impact attributed to specific pathogens has not been elucidated, nor has the impact of recommended antibiotic treatment.Methods: The Global Enteric Multicenter Study enrolled children with moderate to severe diarrhea (MSD) seeking healthcare at 7 sites in sub-Saharan Africa and South Asia. At enrollment, we collected stool samples to identify enteropathogens. Length/height was measured at enrollment and follow-up, approximately 60 days later, to calculate change in height-for-age z scores (ΔHAZ). The association of pathogens with ΔHAZ was tested using linear mixed effects regression models.Results: Among 8077 MSD cases analyzed, the proportion with stunting (HAZ below -1) increased from 59% at enrollment to 65% at follow-up (P < .0001). Pathogens significantly associated with linear growth decline included Cryptosporidium (P < .001), typical enteropathogenic Escherichia coli (P = .01), and untreated Shigella (P = .009) among infants (aged 0-11 months) and enterotoxigenic E. coli encoding heat-stable toxin (P < .001) and Cryptosporidium (P = .03) among toddlers (aged 12-23 months). Shigella-infected toddlers given antibiotics had improved linear growth (P = .02).Conclusions: Linear growth faltering among children aged 0-23 months with MSD is associated with specific pathogens and can be mitigated with targeted treatment strategies, as demonstrated for Shigella. [ABSTRACT FROM AUTHOR]

The aim of this study is to examine the evolution of inequality by focusing on the impacts of the economic structure. The technique of decomposition by income sources is employed to evaluate the contribution of the three major sectors, namely the agricultural, industrial, and service sectors to overall inequality. The data cover almost all the countries in the world from 2001 to 2017 for a total of 18 years. There are four stages of analysis in this study. The first stage of study is to provide an overall view of the evolutionary trend of global inequality, the second stage focuses on the North-South divide, the third stage determines the impacts of income groups, and the fourth stage investigates the impacts for each region. There are several salient findings: First, global inequality had declined in the study period. Second, the service sector is identified as the largest contributor to global inequality, followed by the industrial sector, while the contribution of the agricultural sector is negligible. For the North-South divide, disparity in the service sector was more marked in the North than in the South. The industrial sector played a major role in the South and contributed more than 40% to overall inequality. For the comparison amongst the income groups, our findings show that the higher the income, the higher the percentage contribution of the service sector (except for the low-income group). Finally, for the comparison across regions, although the contribution of the agricultural sector in most regions are below 1.5%; however, the contribution of the agricultural sector in both Sub-Saharan Africa and South Asia is more than 8%. It implies that a lot of people in these regions still rely on the agricultural sector for a living, and the development in the industrial and service sectors in these two regions lagged behind those of the other regions. Our analysis show that the evolution pattern is very different for each region, therefore, it is necessary to take the effects of income and geographical location into consideration in formulating development policies. [ABSTRACT FROM AUTHOR]

The COVID-19 pandemic has caused a huge impact on global service sector. In the pandemic background, to understand the disparity in service sector outputs at the global level is crucial for assessing the effectiveness of development policies in different countries. This study investigate the global service sector and it aims to investigate the transitional dynamics of the output from the service sector by adopting stochastic kernel analyses. Distribution dynamics analyses are carried out for all the countries in the world. The data are then divided into different regional and income groups to evaluate the impacts of geographical location and income on the development of the service sector. The results show that the Global North will continue to make greater strides, while the output capacity in many Global South countries struggles to reach the global average. Moreover, it is shown that countries with higher per capita income will perform better in the development of their service sector than those with low per capita income, thereby highlighting the persistence of global inequality. Finally, this study shows that the Sub-Saharan Africa region and the South Asia region both are very important in the alleviation of global inequality. [ABSTRACT FROM AUTHOR]

Background: The infant mortality rate (IMR) is a critical indicator of population health, but its measurement is subject to response bias in countries without complete vital registration systems who rely instead on birth histories collected via sample surveys. One of the most salient bias is the fact that child deaths in these birth histories tend to be reported with a large amount of heaping at age 12 months. Because of this issue, analysts and international agencies do not directly use IMR estimates based on surveys such as Demographic and Health Surveys (DHS); they rely instead on mortality models such as model life tables. The use of model life tables in this context, however, is arbitrary, and the extent to which this approach appropriately addresses bias in DHS-based IMR estimates remains unclear. This hinders our ability to monitor IMR levels and trends in low-and middle-income countries. The objective of this study is to evaluate age heaping bias in DHS-based IMR estimates and propose an improved method for adjusting this bias. Methods and findings: Our method relies on a recently-developed log-quadratic model that can predict age-specific mortality by detailed age between 0 and 5. The model's coefficients were derived from a newly constituted database, the Under-5 Mortality Database (U5MD), that represents the mortality experience of countries with high-quality vital registration data. We applied this model to 204 DHS surveys, and compared unadjusted IMR values to IMR values adjusted with the log-quadratic model as well as with the classic model life table approach. Results show that contrary to existing knowledge, age heaping at age 12 months rarely generates a large amount of bias in IMR estimates. In most cases, the unadjusted IMR values were not deviating by more than +/- 5% from the adjusted values. The model life table approach, by contrast, introduced an unwarranted, downward bias in adjusted IMR values. We also found that two regions, Sub-Saharan Africa and South Asia, present age patterns of under-5 mortality that strongly depart from the experience represented in the U5MD. For these countries, neither the existing model life tables nor the log-quadratic model can produce empirically-supported IMR adjustments. Conclusions: Age heaping at age 12 months produces a smaller amount of bias in DHS-based IMR estimates than previously thought. If a large amount of age heaping is present in a survey, the log-quadratic model allows users to evaluate, and whenever necessary, adjust IMR estimates in a way that is more informed by the local mortality pattern than existing approaches. Future research should be devoted to understanding why Sub-Saharan African and South Asian countries have such distinct age patterns of under-five mortality. [ABSTRACT FROM AUTHOR]

Introduction: Diarrhea is responsible for the death of more than 90% of under-five children in low and lower-middle income countries. Regionally, South Asia and sub-Saharan Africa accounted for 88% of deaths with the same age group. Therefore, the aim of this study was to determine the prevalence and associated factors of diarrhea among children under-five years in sub-Saharan Africa. Methods: The appended, most recent demographic and health survey datasets of 34 sub-Saharan African countries were used to determine the prevalence and associated factors of diarrhea among under-five children in the region. A total weighted sample of 330,866 under-five children were included in the study. Both bivariable and multivariable multilevel logistic regression were done to determine the associated factors of diarrhea among under five children in sub-Saharan Africa. The Odds Ratio (OR) with a 95% Confidence Interval (CI) was calculated for those potential factors included in the final model. Result: The overall prevalence of diarrhea in this study was 15.3% (95% CI: 15.1–15.4). Those children of mothers aged 15–24 (AOR = 1.26; 95% CI: 1.23, 1.30) and 25–34 years (AOR = 1.15; 95%CI: 1.12, 1.18), those children of mothers with no education (AOR = 1.69; 95%CI: 1.57–1.82), primary education (AOR = 1.73; 95%CI: 1.61–1.86) and secondary education (AOR = 1.49; 95%CI: 1.38–1.59) had higher odds of having diarrhea. Those children from poorest (AOR = 1.14; 95%CI: 1.10, 1.19), poorer (AOR = 1.12; 95%CI: 1.08–1.17), middle (AOR = 1.06; 95%CI: 1.02, 1.10), and richer (AOR = 1.14; 95%CI: 1.04–1.12) households had higher chance of having diarrhea compared to their counterparts. Conclusion: This study found that the prevalence of childhood diarrhea morbidity in sub-Saharan Africa was high. Maternal age, wealth index, maternal education, maternal occupation, age of child, time of initiation of breast feeding and time to get water source were significantly associated with diarrhea. Therefore, intervention through health education and health promotion for mothers/caretakers who are poor, less educated, and young should be designed to prevent diarrhea in the region. [ABSTRACT FROM AUTHOR]

Objective: The current study aimed to address the key areas of concern for child nutrition, both during and after the COVID-19 pandemic, and proposes strategic responses to reduce child undernutrition in the short and long term.Design: A descriptive literature review was performed. The search of the literature was conducted through using electronic databases including PubMed, Web of Science, Google Scholar and Cochrane library.Setting: A wide range of published articles focused on child malnutrition were reviewed.Participants: The study was focused on children especially those under 5 years.Results: The current study proposes strategic responses to reduce child undernutrition. These responses include strengthening access to community-based nutrition services that support the early detection and treatment of undernourished children and emergency food distribution, including fortified foods with vitamins and minerals, to vulnerable households, particularly those with children under 5 years. Moreover, counseling and promotion programmes should be reinforced to revitalise community nutrition education in areas such as gestation, exclusive breast-feeding and complementary feeding, and hygienic practices involving handwashing, proper sanitation and other basic behavioural changes.Conclusions: The COVID-19 pandemic has affected many countries especially those in the regions of South Asia and sub-Saharan Africa in which there has been an ongoing burden of child undernutrition. However, malnutrition is preventable and can be eliminated through a multisectoral strategic approach. The effective execution of a multisectoral approach towards preventing childhood malnutrition will require not only a financial investment but also the collective efforts from different ministries of the governments, UN-affiliated agencies and non-governmental organisations. [ABSTRACT FROM AUTHOR]