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This paper critically explores the use of satire and humour by fast-foods outlets in South Africa and Zimbabwe to advertise and market their menu through digital media platforms, Facebook and Twitter. Using Nando's South Africa and Mambo's Chicken, in Zimbabwe, as case studies, we examine how satire and humour are used as advertising strategies, and as a reflection of these countries' economic and political environments. Consumers are overwhelmed with information coming from different sources such as Television, radio, newspapers and Internet. The paper's theoretical approach is gleaned from advertising and satire. We argue that through their encounter with food, consumers tend to understand the reason behind their 'empty stomach', and mediate on prevailing socio-political and economic issues. [ABSTRACT FROM AUTHOR]

This paper examines the asymmetric link between carbon pricing and the comparative advantage in environmental goods exports in South Africa from 1995 to 2021. The non‐linear autoregressive distributed lag model is utilized to investigate the effects of both minor and major positive and negative fluctuations in carbon taxes, technological innovation, and energy transition on comparative advantage. The results reveal that carbon taxes have an asymmetric effect on comparative advantage in both the short and long runs, with positive shocks exerting a greater beneficial influence than negative shocks. Specifically, it is found that a 1% reduction in carbon taxes corresponds to a 1.24% decline in the response variable, whereas a 1% increase in carbon taxes is associated with a 2.72% increase in comparative advantage in environmental goods exports, which is twice as large. The study also uncovers evidence of an asymmetric relationship between low‐carbon technological innovation and comparative advantage in environmental goods exports. However, strong evidence of a long‐run asymmetric linkage between the energy transition and comparative advantage is not established. Nevertheless, it is noteworthy that a positive shift in energy transition is linked with a 0.32% rise in comparative advantage in environmental goods exports, whereas a negative shift in energy transition corresponds to a 0.11% decrease. The practical policy implications are also discussed. [ABSTRACT FROM AUTHOR]

Firm-level innovation in sub-Saharan Africa remains under-researched. To address this gap, this paper examines the obstacles to innovation faced by small, micro, and medium-sized enterprises (SMMEs) in South Africa. Using the 2018 Business Innovation Survey, we apply the double-hurdle model to investigate factors determining a firm's decision to invest, and the intensity of innovation. Our results show that cost and institutional obstacles were significantly more important as disincentive factors for medium-sized enterprises while knowledge obstacles were significant disincentive factors for large enterprises. In addition, market obstacles hampered investment among large enterprises. Interestingly, none of these factors was found to deter innovation intensity among small and micro enterprises. The study findings suggest that there is no one-size-fits-all approach to innovation policy and intervention programmes to support innovation within firms of different sizes. [ABSTRACT FROM AUTHOR]

While the existence and significance of transnational municipal networks (TMNs) in the realm of environmental governance have been well documented, the implementation and impacts of their local programmes, especially in sub-Saharan Africa, remain underexplored. This paper contributes to addressing this gap of knowledge by examining what obstructs or facilitates TMNs' local actions and the extent to which they can catalyse wider transformative impacts on local environmental governance. We focus on an urban wetlands programme implemented by ICLEI Africa from 2015 to 2018 in 9 district and 2 metropolitan municipalities in South Africa – the Local Action for Biodiversity: Wetlands SA (LAB Wetlands SA) Programme. From an insider perspective, this paper reviews the implementation of the LAB Wetlands SA Programme in three locations, namely the Overberg, iLembe, and Frances Baard District Municipalities of South Africa. Based on comparative analysis, the paper identifies three key influential factors – political buy-in, policy champions and institutional capacity – that interact in combination to affect the practices of the LAB Wetlands SA Programme. These three factors are closely interlinked and strongly depend on the social, economic, political and cultural aspects of local context. In advancing local environmental actions and promoting transformative environmental governance, the design and practices of TMNs' local programmes and projects must be informed by, tailored to, and able to adapt to the local context. [ABSTRACT FROM AUTHOR]

Objective: To identify the factors enabling and limiting family medicine (FM) programmes in Sub-Saharan Africa (SSA). Design: A narrative review was conducted by searching a variety of databases. Papers focusing on the training, deployment, or contribution to healthcare systems of doctors with postgraduate training in FM in SSA, published in peer-reviewed journals from 2015 onwards and in English language were included. Included papers underwent qualitative analysis. Results: Seventy-one papers were included in the review. 38% focussed on South Africa, while papers focussing on FM in a further 15 countries in SSA were identified. Key factors enabling FM programmes are support from key stakeholders, recognition of family practitioners (FP) as specialists, international collaboration, and dedicated FPs. Key factors limiting FM programmes are a lack of sufficient and well-trained faculty, inappropriate training settings, higher rates of trainee attrition, lack of FM in undergraduate curriculums, lack of career pathways, inappropriate deployment, and a lack of a critical mass. Conclusions: Support from national stakeholders, the recognition of FPs as specialists, and sustainable international collaboration promote FM programmes. The absence of a defined role within the healthcare system, low numbers of FM faculty, a poor presence in undergraduate curriculum, high attrition rate of trainees and the lack of a critical mass limit FM programmes. The standardisation of the role of FM and the implementation of undergraduate and postgraduate FM programmes with national and international collaboration could enable FM to reach a critical mass and realise its full potential in strengthening primary healthcare in SSA. [ABSTRACT FROM AUTHOR]

Abstract Background Despite advances in combination antiretroviral therapy (cARTs), children in Sub-Saharan Africa continue to experience neurocognitive deficits due to the virus crossing the blood-brain barrier (BBB). Based on the principles of neuroplasticity, our study sought to investigate the feasibility of introducing a pencil and paper cognitive rehabilitation tool called Brainwave-R, to ameliorate the effects of HIV neurocognition amongst children from a low socioeconomic background in rural South Africa. Material/Methods Five HIV positive and six HIV negative children were assigned to either an experimental or control group. The experimental group underwent two months of cognitive rehabilitation therapy to remediate sustained attention, using Brainwave-R, whereas the noncontact control group took part in placebo activities. Sustained attention measures were taken before and after the intervention training sessions, using a sustained attention subtest. The control group later received cognitive intervention three months following the conclusion of the research study. Results A Mann Whitney U Test revealed that the experimental group (Mdn=38.50) did not differ significantly from the control group (Mdn=37.00) after the cognitive rehabilitation intervention, U= 12.00, z= -.55, p= 0.66, r= -0.17. A Wilcoxon Signed Rank Test found that there was a significant improvement from pretest scores (Mdn=31.00) to post test scores (Mdn=38.00) following the rehabilitation for HIV positive participants in the sample, T=15.00, z = -2.02, p= 0.04, r= -0.90. Conclusions The findings of our study raise the feasibility of a pencil and paper cognitive rehabilitation method to supplement antiretroviral (ARV) therapy in paediatric HIV. [ABSTRACT FROM AUTHOR]

The paper explores the contributions of undergraduate university education to the Sustainable Development Goals (SDGs)' goals and development outcomes, proposing a normative capability-based approach oriented to human development. The approach is aligned with a developmental model of the university and development policy in sub-Saharan Africa and South Africa, where the study is located. It draws empirically from a four and a half year mixed-methods research project conducted with low-income, mostly rural students at five historically diverse universities in South Africa. The paper presents a justification for using the capability approach, and outlines the rationale and methodology for synthesising a specific capability set generated by theorising and empirical data. A set of corresponding functioning indicators offers an expansive approach to understanding 'learning outcomes' in contrast to dominant neoliberal approaches that seek quantification and efficiency, overlooking what cannot be easily measured. An indicative sketch of university arrangements required to advance and evaluate each functioning for development outcomes is then outlined. [ABSTRACT FROM AUTHOR]

Introduction: Hip arthroplasty and revision surgery are growing exponentially in OECD countries. In developing countries, it is an infrequent intervention and its practice is limited. It is exposed to a higher rate of infectious and mechanical failures than in developed countries. The aim of the actual study is to provide a review of the literature on total hip arthroplasty series in sub-Saharan Africa followed by an overview of the interest and perspectives of the use of dual mobility (DM) cups. Materials and methods: Scopus, EMBASE, Medline, PubMed, and Safoonline databases were searched including papers published at any date. The Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines were followed. All papers from South Africa were excluded. Results: We identified 22 series of total hip arthroplasty in 14 SSA countries. The practice of total hip arthroplasty is not very widespread. The cups used are mostly conventional implants, and complications (mechanical and infectious) are frequent. Discussion: The interest for the use of dual mobility cups in sub-Saharan Africa can be summarized in two points: mechanical and socio-economical. Dual mobility cups provide more mechanical stability and a reduction in the overall cost of treatment by reducing the rate of complications. These prospects will make it possible to evaluate this medical device in the long term in a hostile environment conductive to complications. Conclusion: The use of dual mobility deserves to be developed in African settings. [ABSTRACT FROM AUTHOR]

Background: Medicinal plants (MPs) are widely accepted and used in most rural communities in sub-Saharan Africa and beyond to treat and control village chicken (VC) diseases and parasites. They are readily available, accessible and cheap. Moreover, they are nature friendly and have adapted to the local environment, making them easy to produce. Over and above, their use has health benefits for consumers. Little is known about the opportunities and challenges faced when commercialising these MPs. Aim: It imperative to unpack the opportunities and challenges that are encountered while commercialising MPs used for treating VC diseases and controlling parasites. Despite these multiple benefits, the commercialisation of these plants seems to be under researched. In South Africa, different rural communities use various MPs in their locality. For instance, most rural families in South Africa are using Aloe ferox, Helichrysum petiolare, Tagetes minuta, Lippia javanica, Agave sisalana, Gunnera perpensa and Millettia grandis. Conspicuously, not much is known about the efforts made to commercialise these products. Method: Through a systematic review of the literature, this paper unpacks the trends, opportunities and challenges faced in commercialising MPs used to treat VC disease and control parasites. Results: Results have revealed that globally MPs for VC management are not widely recognised, despite their wide usage by local communities. If properly harnessed, they have the potential to strengthen local economic development through income generation. However, currently, little is derived from the sale of these products because of the presence of middlemen. Their commercialisation efforts are hampered by the lack of organised support systems and networks, lack of regularisation strategies and clear criteria for supporting quality, protection and presumed efficiency. Conclusion: By commercialising MPs, local farmers can exploit MPs beyond the village chickens to broiler and layer chickens, thus offering alternative chicken health and affordable medicinal options for the farmers. Contribution: The study contributes to understanding the available opportunities and challenges in commercialising MPs used for village chicken health management. It further demonstrates that MPs for village health can be used to transform the livelihoods of the custodians of these plants. [ABSTRACT FROM AUTHOR]

Background: A major disparity exists in access to specialised healthcare between rural and urban areas. Specialist outreach programmes are one of the ways in which rural specialist healthcare inequality is being addressed. A number of rural district hospitals (RDH) employ local, private specialists (LPS) to supplement public specialist outreach. Limited research exists on private specialist outreach and support (PSOS) in sub-Saharan Africa or South Africa. Methods: This was a descriptive, exploratory, qualitative study using thematic analysis of semi-structured interviews. Non-probability, purposive sampling was used to obtain a sample size of 16 participants. The audio recordings were transcribed verbatim and analysed with the framework method and ATLAS.ti version 8© software. Results: Four major themes emerged, namely roles of LPS, effects, sustainability and feasibility of PSOS. Overall PSOS was considered sustainable, feasible and had positive effects in and beyond the sub-districts. The value of PSOS was supported by improved access and timeliness of services, improved competency of RDH medical practitioners, improved coordination, comprehensiveness and continuity of care. Private specialist outreach and support was, however, associated with increased burden on the RDH resources and required a basic level of RDH infrastructure to function effectively. Conclusion: The perceived contribution of private specialist outreach services was positive overall. Implementation in RDHs is feasible, but should involve consideration of factors in the hospital, town, sub-district and district prior to implementation. Contribution: This paper provides evidence that private specialist outreach and support services are feasible in the state health sector, provided that certain considerations are taken into account. [ABSTRACT FROM AUTHOR]

Disabilities are increasing globally, which is attributed to the overall ageing of populations in affluent countries. This trend may differ in low and middle-income countries. This paper assesses the change over time in Years Lived with Disability (YLD) for South Africa and how this compares to regional and global trends. This secondary analysis of the Global Burden of Disease Study 2017 dataset describes the observed contribution of YLD to Disability-Adjusted Life Years (DALYs) per 100 000 people over the period 1990–2016, and forecast to 2030 using simple linear prediction. South African trends are compared to global and sub-Saharan African (SSA) trends to highlight the effect of HIV and policy implications. Globally, the contribution of YLD to DALYs has increased from ±21.7% in 1990 to ±34% by 2016, with high socio-demographic index countries having a higher contribution (49%). HIV, mental health, musculoskeletal, neurological, and sense organ disorders are the five main contributors to YLD in South Africa (54%). Removing the effects of HIV/AIDS and sexually transmitted infections on YLD, South Africa's trend appears similar to the global trend, yet opposite to the SSA trend. Our analysis shows there is a growing burden of disability in South Africa. Differences in trends with the regional and global patterns can be attributed to the high burden of HIV and non-communicable diseases in South Africa. Therefore, strategies are urgently needed to increase integration of disability and rehabilitation services into chronic HIV and non-communicable disease management. This calls for disability screening to identify functional limitations in routine data collection and case management. South Africa has experienced an increase in disability prevalence over time. This requires strengthening of services such as mental health interventions, physiotherapy, optometry, and audiology, and linking major disease clusters, such as HIV and the NCDs, to rehabilitation services. The greatest contributors towards disability adjusted life years in South Africa are currently mental disorders (13.8%), HIV and sexually transmitted infections (11.8%), musculoskeletal disorders (10.4%), neurological disorders (8.2%), and sense organ diseases (7.5%). Routine data collection and case management needs to include disability screening to identify developing functional limitations. [ABSTRACT FROM AUTHOR]

Background: Mental health is a critical and neglected public health problem for adolescents in sub-Saharan Africa. In this paper we aim to determine the prevalence of depressive symptoms and the association with HIV risk behaviours in adolescents aged 15–19 years in Zambia and SA. Methods: We conducted a cross-sectional survey from August-November 2017 in seven control communities of HPTN 071 (PopART) trial (a community-randomised trial of universal HIV testing and treatment), enrolling approximately 1400 eligible adolescents. HIV-status was self-reported. Depressive symptoms were measured with the Short Mood and Feelings Questionnaire (SMFQ), with a positive screen if adolescents scored ≥12. We fitted a logistic regression model to identify correlates of depressive symptoms with subgroup analyses among those who self-reported ever having had sex, by gender and country. Results: Out of 6997 households approached, 6057 (86.6%) were enumerated. 2546 adolescents were enumerated of whom 2120 (83.3%) consented to participate and were administered the SMFQ. The prevalence of depressive symptoms was 584/2120 (27.6%) [95%CI: 25.7%-29.5%]. Adolescents in SA were less likely to experience depressive symptoms (Adjusted Odds Ratio [AOR] = 0.63 (95% CI: 0.50, 0.79), p-value<0.0001). Female adolescents (AOR = 1.46 (95% CI: 1.19, 1.81), p-value<0.0001); those who reported ever having sex and being forced into sex (AOR = 1.80 (95% CI: 1.45, 2.23), p-value<0.001) and AOR = 1.67 (95% CI: 0.99, 2.84); p-value = 0.057 respectively) were more likely to experience depressive symptoms. Among 850 (40.1%) adolescents who self-reported to ever having had sex; those who used alcohol/drugs during their last sexual encounter were more likely to experience depressive symptoms (AOR = 2.18 (95% CI: 1.37, 3.47); p-value = 0.001), whereas those who reported using a condom were less likely to experience depressive symptoms (AOR = 0.74 (95% CI: 0.55, 1.00); p-value = 0.053). Conclusion: The prevalence of depressive symptoms among adolescents ranged from 25–30% and was associated with increased HIV-risk behaviour. [ABSTRACT FROM AUTHOR]

• Cowpea is a highly valued fruit and leafy vegetable crop contributing to food, nutrition, and health security. • Low cowpea production and productivity in sub-Saharan Africa and globally are due to a lack of improved cultivars with multiple disease, and insect pest resistance and drought tolerant; moreover, there is a lack of seed system research in cowpea. • The extensive phenotypic and genotypic variation found in cowpea genetic resources is useful for the development of cultivars with enhanced grain yield, leafy yield and nutritional values as well as drought tolerant. Despite the contribution of cowpeas to food security and the crop's numerous nutritional and health attributes, consumers in South Africa have labelled cowpeas, among other leguminous crops as a "poor people's food" ; this contributed to the gradual decline in the cultivation and use of the crop. This, in turn, resulted in the observed high reliance on limited number of plant based protein crops and excessive consumption of livestock products. In this paper, three aspects are interrogated, i.e., genetic resource management, production constraints as well as the trade performance and consumption of cowpeas in South Africa. A clear understanding of these aspects renders an informed decision upon which recommendations for the necessary practical interventions that are needed to be put in place to spur the development of target products and cowpea's value chain. The assessment of genetic resource management and seed production constraints of cowpeas was based on a review of relevant literature, while descriptive analysis of secondary data spanning a period of 10 years (2010-2019) obtained from Trade Map and FAOSTAT databases was used to interrogate the trade performance and consumption of cowpeas. Findings reveal that seed production constraints are largely anchored on the limited attention government and policy making institutions have accorded to the seed system of orphaned crops, thereby compromising their potential by failing to supply affordable good quality seeds to smallholder and commercial farmers. However, South Africa has one of the largest and most diverse collections of cowpea germplasm housed at the Agricultural Research Council. With regard to trade performance and consumption, results show that South Africa is a net exporter of cowpeas, with a 10 years' period annual average worth R2.9 million. Given that South Africa does not re-export cowpeas, yet on average 4848 tonnes are produced annually, it is a clear indication that the country produces lightly more than what is consumed domestically – on average 4634 tonnes per annum. Therefore, recommendation is made to bolster cowpea production and productivity through mainstreaming the legume seed system towards boosting local and export markets as well as strongly enhancing local consumption by creating awareness of the nutritional and health benefits of cowpeas. Furthermore, there is a need to increase awareness about the nutritional and health benefits of cowpeas and other leguminous crops, among other socio-economic benefits. This is important in spurring cowpeas consumption domestically, while countering the over reliance on animal products as protein sources and the associated risks such as such as high greenhouse gas emissions and obesity for people. [ABSTRACT FROM AUTHOR]

There is a scarcity of long-term groundwater hydrographs from sub-Saharan Africa to investigate groundwater sustainability, processes and controls. This paper presents an analysis of 21 hydrographs from semi-arid South Africa. Hydrographs from 1980 to 2000 were converted to standardised groundwater level indices and rationalised into four types (C1–C4) using hierarchical cluster analysis. Mean hydrographs for each type were cross-correlated with standardised precipitation and streamflow indices. Relationships with the El Niño–Southern Oscillation (ENSO) were also investigated. The four hydrograph types show a transition of autocorrelation over increasing timescales and increasingly subdued responses to rainfall. Type C1 strongly relates to rainfall, responding in most years, whereas C4 notably responds to only a single extreme event in 2000 and has limited relationship with rainfall. Types C2, C3 and C4 have stronger statistical relationships with standardised streamflow than standardised rainfall. C3 and C4 changes are significantly (p < 0.05) correlated to the mean wet season ENSO anomaly, indicating a tendency for substantial or minimal recharge to occur during extreme negative and positive ENSO years, respectively. The range of different hydrograph types, sometimes within only a few kilometres of each other, appears to be a result of abstraction interference and cannot be confidently attributed to variations in climate or hydrogeological setting. It is possible that high groundwater abstraction near C3/C4 sites masks frequent small-scale recharge events observed at C1/C2 sites, resulting in extreme events associated with negative ENSO years being more visible in the time series. [ABSTRACT FROM AUTHOR]

Introduction: In sub-Saharan Africa (SSA), the physicians' ratio is increasing. There are clear indications that many of them have opted to work at the first-line of healthcare delivery systems, i.e. providing primary care. This constitutes an important change in African healthcare systems where the first line has been under the responsibility of nurse-practitioners for decades. Previous reviews on primary care physicians (PCPs) in SSA focused on the specific case of family physicians in English-speaking countries. This scoping review provides a broader mapping of the PCPs' practices in SSA, beyond family physicians and including francophone Africa. For this study, we defined PCPs as medical doctors who work at the first-line of healthcare delivery and provide generalist healthcare. Methods: We searched five databases and identified additional sources through purposively selected websites, expert recommendations, and citation tracking. Two reviewers independently selected studies and extracted and coded the data. The findings were presented to a range of stakeholders. Findings: We included 81 papers, mostly related to the Republic of South Africa. Three categories of PCPs are proposed: family physicians, "médecins généralistes communautaires", and general practitioners. We analysed the functioning of each along four dimensions that emerged from the data analysis: professional identity, governance, roles and activities, and output/outcome. Our analysis highlighted several challenges about the PCPs' governance that could threaten their effective contribution to primary care. More research is needed to investigate better the precise nature and performance of the PCPs' activities. Evidence is particularly needed for PCPs classified in the category of GPs and, more generally, PCPs in African countries other than the Republic of South Africa. Conclusions: This review sheds more light on the institutional, organisational and operational realities of PCPs in SSA. It also highlighted persisting gaps that remain in our understanding of the functioning and the potential of African PCPs. [ABSTRACT FROM AUTHOR]

Background: Reflecting global norms, South Africa is associated with high levels of cross-border and internal population mobility, yet migration-aware health system responses are lacking. Existing literature highlights three methodological challenges limiting the development of evidence-informed responses to migration and health: (1) lack of engagement with the process of migration; (2) exclusion of internal migrants; and (3) lack of methodologies that are able to capture 'real-time' data about health needs and healthcare seeking experiences over both time and place. In this paper, we reflect on a four-month pilot project which explored the use of WhatsApp Messenger - a popular mobile phone application used widely in sub-Saharan Africa - and assessed its feasibility as a research tool with migrant and mobile populations in order to inform a larger study that would address these challenges.Method: A four-month pilot was undertaken with eleven participants between October 2019 and January 2020. Using Survey Node, an online platform that allows for the automatic administration of surveys through WhatsApp, monthly surveys were administered. The GPS coordinates of participants were also obtained. Recruited through civil society partners in Gauteng, participants were over the age of 18, comfortable engaging in English, and owned WhatsApp compatible cell phones. Enrolment involved an administered survey and training participants in the study protocol. Participants received reimbursement for their travel costs and monthly cell phone data.Results: Out of a possible eighty eight survey and location responses, sixty one were received. In general, participants responded consistently to the monthly surveys and shared their location when prompted. Survey Node proved an efficient and effective way to administer surveys through WhatsApp. Location sharing via WhatsApp proved cumbersome and led to the development of a secure platform through which participants could share their location. Ethical concerns about data sharing over WhatsApp were addressed.Conclusions: The success of the pilot indicates that WhatsApp can be used as a tool for data collection with migrant and mobile populations, and has informed the finalisation of the main study. Key lessons learnt included the importance of research design and processes for participant enrolment, and ensuring that the ethical concerns associated with WhatsApp are addressed. [ABSTRACT FROM AUTHOR]

Understanding the scale of energy poverty remains elusive. It is, however, a key metric in the global effort to eradicate poverty. The analysis presented in this paper provides insights into the true scale and impacts of unreliable electricity service provision. The paper introduces a simple and novel approach to quantifying the difference between electricity supply and demand, accounting for both met and unmet demand in Sub-Saharan Africa (SSA). To assess unmet demand, generator use, reduced utilization due to unreliable electricity service, unrealized demand from unelectrified households, and the effect of tariff reductions are considered. We find that at 2018 prices, SSA (excluding South Africa) on-grid power networks had annual unmet demand of 8.83 TWh for on-grid users and 42.9 TWh with the inclusion of the off-grid sector. With a 50% reduction in tariff by country, the on-grid power sector would face a 21.46 TWh of unmet demand in the region, rising to 55.53 TWh with the inclusion of off-grid. [ABSTRACT FROM AUTHOR]