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Objective:We evaluated the relationship between food availability, as the only dietary exposure data available across Africa, and age-standardised cancer incidence rates (ASR) in eighteen countries.Design:Ecological study.Setting:Availability of food groups and dietary energy was considered for five hypothetical time points: years of collection of ASR (T 0) and 5, 10, 15 and 20 preceding years (T –5, T –10, T –15, T –20). Ecological correlations adjusted for human development index, smoking and obesity rates were calculated to evaluate the relationship between food availability and ASR of breast, prostate, colorectal, oesophageal, pancreatic, stomach and thyroid cancer.Results:Red meat was positively correlated with pancreatic cancer in men (T –20: r –20 = 0·61, P < 0·05), stomach cancer in women (T 0: r 0 = 0·58, P < 0·05), and colorectal cancer in men (T 0: r 0 = 0·53, P < 0·05) and women (T –20: r –20 = 0·58, P < 0·05). Animal products including meat, animal fats and higher animal-sourced energy supply tended to be positively correlated with breast, colorectal, pancreatic, stomach and thyroid cancer. Alcoholic beverages were positively correlated to oesophageal cancer in men (r 0 = 0·69, P < 0·001) and women (r –20 = 0·72, P < 0·001).Conclusions:The present analysis provides initial insights into the impact of alcoholic beverages, and increasing use of animal over plant products, on the incidence of specific cancers in Africa. The findings support the need for epidemiological studies to investigate the role of diet in cancer development in Africa.

This study analysed the reported incidence of COVID-19 and associated epidemiological and socio-economic factors in the WHO African region. Data from COVID-19 confirmed cases and SARS-CoV-2 tests reported to the WHO by Member States between 25 February and 31 December 2020 and publicly available health and socio-economic data were analysed using univariate and multivariate binomial regression models. The overall cumulative incidence was 1846 cases per million population. Cape Verde (21 350 per million), South Africa (18 060 per million), Namibia (9840 per million), Eswatini (8151 per million) and Botswana (6044 per million) recorded the highest cumulative incidence, while Benin (260 per million), Democratic Republic of Congo (203 per million), Niger (141 cases per million), Chad (133 per million) and Burundi (62 per million) recorded the lowest. Increasing percentage of urban population (β= −0.011,P= 0.04) was associated with low cumulative incidence, while increasing number of cumulative SARS-CoV-2 tests performed per 10 000 population (β= 0.0006,P= 0.006) and the proportion of population aged 15–64 years (adjustedβ= 0.174,P< 0.0001) were associated with high COVID-19 cumulative incidence. With limited testing capacities and overwhelmed health systems, these findings highlight the need for countries to increase and decentralise testing capacities and adjust testing strategies to target most at-risk populations.

The World Health Organization African region recorded its first laboratory-confirmed coronavirus disease-2019 (COVID-19) cases on 25 February 2020. Two months later, all the 47 countries of the region were affected. The first anniversary of the pandemic occurred in a changed context with the emergence of new variants of concern (VOC) and growing COVID-19 fatigue. This study describes the epidemiological trajectory of COVID-19 in the region, summarises public health and social measures (PHSM) implemented and discusses their impact on the pandemic trajectory. As of 24 February 2021, the African region accounted for 2.5% of cases and 2.9% of deaths reported globally. Of the 13 countries that submitted detailed line listing of cases, the proportion of cases with at least one co-morbid condition was estimated at 3.3% of all cases. Hypertension, diabetes and human immunodeficiency virus (HIV) infection were the most common comorbid conditions, accounting for 11.1%, 7.1% and 5.0% of cases with comorbidities, respectively. Overall, the case fatality ratio (CFR) in patients with comorbid conditions was higher than in patients without comorbid conditions: 5.5% vs. 1.0% (P < 0.0001). Countries started to implement lockdown measures in early March 2020. This contributed to slow the spread of the pandemic at the early stage while the gradual ease of lockdowns from 20 April 2020 resulted in an upsurge. The second wave of the pandemic, which started in November 2020, coincided with the emergence of the new variants of concern. Only 0.08% of the population from six countries received at least one dose of the COVID-19 vaccine. It is critical to not only learn from the past 12 months to improve the effectiveness of the current response but also to start preparing the health systems for subsequent waves of the current pandemic and future pandemics.

Successive waves of COVID-19 transmission have led to exponential increases in new infections globally. In this study, we have applied a decision-making tool to assess the risk of continuing transmission to inform decisions on tailored public health and social measures (PHSM) using data on cases and deaths reported by Member States to the WHO Regional Office for Africa as of 31 December 2020. Transmission classification and health system capacity were used to assess the risk level of each country to guide implementation and adjustments to PHSM. Two countries out of 46 assessed met the criteria for sporadic transmission, one for clusters of cases, and 43 (93.5%) for community transmission (CT) including three with uncontrolled disease incidence (Eswatini, Namibia and South Africa). Health system response's capacities were assessed as adequate in two countries (4.3%), moderate in 13 countries (28.3%) and limited in 31 countries (64.4%). The risk level, calculated as a combination of transmission classification and health system response's capacities, was assessed at level 0 in one country (2.1%), level 1 in two countries (4.3%), level 2 in 11 countries (23.9%) and level 3 in 32 (69.6%) countries. The scale of severity ranged from 0 to 4, with 0 the lowest. CT coupled with limited response capacity resulted in a level 3 risk assessment in most countries. Countries at level 3 should be considered as priority focus for additional assistance, in order to prevent the risk rising to level 4, which may necessitate enforcing hard and costly lockdown measures. The large number of countries at level 3 indicates the need for an effective risk management system to be used as a basis for adjusting PHSM at national and sub-national levels.

The global outbreak of coronavirus disease 2019 (COVID-19) is greatly threatening the public health in the world. We reconstructed global transmissions and potential demographic expansions of severe acute respiratory syndrome coronavirus 2 based on genomic information. We found that intercontinental transmissions were rare in January and early February but drastically increased since late February. After world-wide implements of travel restrictions, the transmission frequencies decreased to a low level in April. We identified a total of 88 potential demographic expansions over the world based on the star-radiative networks and 75 of them were found in Europe and North America. The expansion numbers peaked in March and quickly dropped since April. These findings are highly concordant with epidemic reports and modelling results and highlight the significance of quarantine validity on the global spread of COVID-19. Our analyses indicate that the travel restrictions and social distancing measures are effective in containing the spread of COVID-19.

Corona virus disease 2019 (COVID-19), caused by the novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), was first detected in the city of Wuhan, China in December 2019. Although, the disease appeared in Africa later than other regions, it has now spread to virtually all countries on the continent. We provide early spatio-temporal dynamics of COVID-19 within the first 62 days of the disease's appearance on the African continent. We used a two-parameter hurdle Poisson model to simultaneously analyse the zero counts and the frequency of occurrence. We investigate the effects of important healthcare capacities including hospital beds and number of medical doctors in different countries. The results show that cases of the pandemic vary geographically across Africa with notably high incidence in neighbouring countries particularly in West and North Africa. The burden of the disease (per 100 000) mostly impacted Djibouti, Tunisia, Morocco and Algeria. Temporally, during the first 4 weeks, the burden was highest in Senegal, Egypt and Mauritania, but by mid-April it shifted to Somalia, Chad, Guinea, Tanzania, Gabon, Sudan and Zimbabwe. Currently, Namibia, Angola, South Sudan, Burundi and Uganda have the least burden. These findings could be useful in guiding epidemiological interventions and the allocation of scarce resources based on heterogeneity of the disease patterns.

Improving understanding of the pathogen-specific seasonality of enteric infections is critical to informing policy on the timing of preventive measures and to forecast trends in the burden of diarrhoeal disease. Data obtained from active surveillance of cohorts can capture the underlying infection status as transmission occurs in the community. The purpose of this study was to characterise rotavirus seasonality in eight different locations while adjusting for age, calendar time and within-subject clustering of episodes by applying an adapted Serfling model approach to data from a multi-site cohort study. In the Bangladesh and Peru sites, within-subject clustering was high, with more than half of infants who experienced one rotavirus infection going on to experience a second and more than 20% experiencing a third. In the five sites that are in countries that had not introduced the rotavirus vaccine, the model predicted a primary peak in prevalence during the dry season and, in three of these, a secondary peak during the rainy season. The patterns predicted by this approach are broadly congruent with several emerging hypotheses about rotavirus transmission and are consistent for both symptomatic and asymptomatic rotavirus episodes. These findings have practical implications for programme design, but caution should be exercised in deriving inferences about the underlying pathways driving these trends, particularly when extending the approach to other pathogens.

ObjectiveWhen planning severe acute malnutrition (SAM) treatment services, estimates of the number of children requiring treatment are needed. Prevalence surveys, used with population estimates, can directly estimate the number of prevalent cases but not the number of subsequent incident cases. Health managers often use a prevalence-to-incidence conversion factor (J) derived from two African cohort studies to estimate incidence and add the expected number of incident cases to prevalent cases to estimate expected SAM caseload for a given period. The present study aimed to estimate J empirically in different contexts.DesignObservational study, with J estimated by correlating expected numbers of children to be treated, based on prevalence surveys, population estimates and assumed coverage, with the observed numbers of SAM patients treated.SettingSurvey and programme data from six African and Asian countries.SubjectsTwenty-four data sets including prevalence surveys and programme admissions data for 5 months following the survey.ResultsA statistically significant relationship between the number of SAM cases admitted to SAM treatment services and the estimated burden of SAM from prevalence surveys was found. Estimate for the slope (intercept forced to be zero) was 2·17 (95 % CI 1·33, 3·79). Estimates for the prevalence-to-incidence conversion factor J varied from 2·81 to 11·21, assuming programme coverage of 100 % and 38 %, respectively.ConclusionsEstimation of expected caseload from prevalence may require revision of the currently used prevalence-to-incidence conversion factor J of 1·6. Appropriate values for J may vary between different locations.

Background.Mental health literacy is foundational for mental health promotion, prevention, stigma reduction and care. Integrated school mental health literacy interventions may offer an effective and sustainable approach to enhancing mental health literacy for educators and students globally.Methods.Through a Grand Challenges Canada funded initiative called ‘An Integrated Approach to Addressing the Issue of Youth Depression in Malawi and Tanzania’, we culturally adapted a previously demonstrated effective Canadian school mental health curriculum resource (the Guide) for use in Malawi, the African Guide: Malawi version (AGMv), and evaluated its impact on enhancing mental health literacy for educators (teachers and youth club leaders) in 35 schools and 15 out-of-school youth clubs in the central region of Malawi. The pre- and post-test study designs were used to assess mental health literacy – knowledge and attitudes – of 218 educators before and immediately following completion of a 3-day training programme on the use of the AGMv.Results.Results demonstrated a highly significant and substantial improvement in knowledge (p d = 1.16) and attitudes (p d = 0.79) pertaining to mental health literacy in study participants. There were no significant differences in outcomes related to sex or location.Conclusions.These positive results suggest that an approach that integrates mental health literacy into the existing school curriculum may be an effective, significant and sustainable method of enhancing mental health literacy for educators in Malawi. If these results are further found to be sustained over time, and demonstrated to be effective when extended to students, then this model may be a useful and widely applicable method for improving mental health literacy among both educators and students across Africa.

Background.The objective of this study was to evaluate the impact of a brief parenting intervention, ‘Parents Make the Difference‘(PMD), on parenting behaviors, quality of parent-child interactions, children's cognitive, emotional, and behavioral wellbeing, and malaria prevention behaviors in rural, post-conflict Liberia.Methods.A sample of 270 caregivers of children ages 3–7 were randomized into an immediate treatment group that received a 10-session parent training intervention or a wait-list control condition (1:1 allocation). Interviewers administered baseline and 1-month post-intervention surveys and conducted child-caregiver observations. Intent-to-treat estimates of the average treatment effects were calculated using ordinary least squares regression. This study was pre-registered at ClinicalTrials.gov (NCT01829815).Results.The program led to a 55.5% reduction in caregiver-reported use of harsh punishment practices (p p p Conclusions.PMD is a promising approach for preventing child abuse and promoting positive parent-child relationships in low-resource settings.

SUMMARYMeasles vaccination is estimated to have averted 13·8 million deaths between 2000 and 2012. Persisting heterogeneity in coverage is a major contributor to continued measles mortality, and a barrier to measles elimination and introduction of rubella-containing vaccine. Our objective is to identify determinants of inequities in coverage, and how vaccine delivery must change to achieve elimination goals, which is a focus of the WHO Decade of Vaccines. We combined estimates of travel time to the nearest urban centre (⩾50 000 people) with vaccination data from Demographic Health Surveys to assess how remoteness affects coverage in 26 African countries. Building on a statistical mapping of coverage against age and geographical isolation, we quantified how modifying the rate and age range of vaccine delivery affects national coverage. Our scenario analysis considers increasing the rate of delivery of routine vaccination, increasing the target age range of routine vaccination, and enhanced delivery to remote areas. Geographical isolation plays a key role in defining vaccine inequity, with greater inequity in countries with lower measles vaccine coverage. Eliminating geographical inequities alone will not achieve thresholds for herd immunity, indicating that changes in delivery rate or age range of routine vaccination will be required. Measles vaccine coverage remains far below targets for herd immunity in many countries on the African continent and is likely to be inadequate for achieving rubella elimination. The impact of strategies such as increasing the upper age range eligible for routine vaccination should be considered.

This paper presents an analysis of trends in sexual activity by marital status and age, and their associations with contraceptive use. Understanding levels of, and trends in, sexual activity is important for assessing the needs for family planning services and for analysing commonly used family planning indicators. Data were taken from 220 Demographic and Health Surveys (DHSs) and 62 Multiple Indicator Cluster Surveys (MICSs) to provide insights into sexual activity by marital status and age in a total of 94 countries in different regions of the world. The results show the sensitivity of the indicator with respect to the definition of currently sexually active, based on the timing of last sexual intercourse (during the last 4 weeks, 3 months, or 1 year). Substantial diversity in sexual activity by marital status and age was demonstrated across countries. The proportion of married women reporting recent sexual activity (sexual intercourse during the last 4 weeks) ranged from 50% to 90%. The proportion of unmarried women reporting recent sexual activity did not exceed 50% in any of the 94 countries with available data, but showed substantial regional differences: it appeared to be rare in Asia and extremely varied within Africa, Europe and Latin America and the Caribbean. Among married women, sexual activity did not vary much by age group, while for unmarried women, there was an inverted U-pattern by age, with the youngest age group (15–19 years old) having the lowest proportion sexually active. The proportion of women who reported currently using contraception and reported not being sexually active varied by the contraceptive method used and was overall much greater among unmarried women. The evidence presented in this paper can be used to improve family planning policies and programmes to serve the diverse needs, for example regarding method choice and service provision, of unmarried women.

Addressing contemporary nutrition problems often requires application of knowledge from multiple disciplines. The scaling up nutrition (SUN) movement harnesses multiple sectors for effective global and in-country planning and implementation. Although the role of knowledge networks (academia and research institutions) is recognised, the how of engaging knowledge networks in the current SUN architecture is only now becoming apparent. For relevant sectors to play their roles effectively, observed capacity gaps, particularly in developing country settings, need to be addressed. The present paper presents the work being undertaken by the Ghana SUN Academic Platform (AP), a local knowledge network, towards strengthening nutrition capacity in Ghana. The AP presently provides technical support, evidence and capacity towards scaling up effective nutrition interventions in Ghana and beyond. The data presented draws heavily on the observations and collective experiences of the authors in practice, complemented by a review of relevant literature. The ultimate goal of the AP is to build capacity of professionals from nutrition and cognate sectors (including planning, agriculture, health, economics, research and academia). This is an essential ingredient for effective and durable SUN efforts. The paper recognises that both disciplinary and interdisciplinary capacity is required for effective SUN efforts in Africa, and offers an approach that utilises cross-sector/inter-professional, peer-learning and experiential learning initiatives.

The aim of the present paper is to review capacity building in public health nutrition (PHN), the need for which has been stressed for many years by a range of academics, national and international organisations. Although great strides have been made worldwide in the science of nutrition, there remain many problems of undernutrition and increasingly of obesity and related chronic diseases. The main emphasis in capacity building has been on the nutrition and health workforce, but the causes of these health problems are multifactorial and require collaboration across sectors in their solution. This means that PHN capacity building has to go beyond basic nutrition and beyond the immediate health workforce to policy makers in other sectors. The present paper provides examples of capacity building activities by various organisations, including universities, industry and international agencies. Examples of web-based courses are given including an introduction to the e-Nutrition Academy. The scope is international but with a special focus on Africa. In conclusion, there remains a great need for capacity building in PHN but the advent of the internet has revolutionised the possibilities.

Mental health policy internationally varies in its support for recovery. The aims of this study were to validate an existing conceptual framework and then characterise by country the distribution, scientific foundations and emphasis in published recovery conceptualisations.Update and modification of a previously published systematic review and narrative synthesis of recovery conceptualisations published in English.A total of 7431 studies were identified and 429 full papers reviewed, from which 105 conceptualisations in 115 papers were included and quality assessed using established rating scales. Recovery conceptualisations were identified from 11 individual countries, with 95 (91%) published in English-speaking countries, primarily the USA (47%) and the UK (25%). The scientific foundation was primarily qualitative research (53%), non-systematic literature reviews (24%) and position papers (12%). The conceptual framework was validated with the 18 new papers. Across the different countries, there was a relatively similar distribution of codings for each of five key recovery processes.Recovery as currently conceptualised in English-language publications is primarily based on qualitative studies and position papers from English-speaking countries. The conceptual framework was valid, but the development of recovery conceptualisations using a broader range of research designs within other cultures and non-majority populations is a research priority.

This paper examines the acquisition of the grammatical tone system of Sesotho, a southern Bantu language where tone sandhi is rich, and where surface and underlying representations are often quite distinct. Results of the longitudinal case study show that rule-assigned tone on subject markers is generally marked appropriately by age two. In contrast, underlying tonal representations on verb roots are learned gradually over time, showing an early Default High tone pattern. The study also finds that, while some tone sandhi rules are in the process of being acquired between 2;6 and 3;0, problems in the mapping between tonal representations and segments persist. The paper raises methodological and theoretical issues not only for the acquisition of tonal systems, but for the acquisition of phonology in general.

This paper proposes three theoretical mechanisms through which polygyny may be related to social unrest. The mechanisms are related to different dimensions of grievance-inducing and, partly, greed-related inequality, which may occur in polygynous societies. These dimensions include (i) economic, reproductive and social inequality resulting in relative deprivation among non-elite men; (ii) inequality within elites when it comes to the distribution of resources and inheritance, both related to the relative position of dependent family members in a clan; and (iii) gender inequality in general. Using data for 41 African countries from 1990-2014, we provide evidence for these mechanisms and their relationship to social unrest. We find that the first and third dimension of inequality are especially correlated with social unrest. Furthermore, we consider several potential counterarguments but do not find support for them.

This paper discusses the principal findings of a new integrated dataset of transnational armed conflict in Africa. Existing Africa conflict datasets have systematically under-represented the extent of cross-border state support to belligerent parties in internal armed conflicts as well as the number of incidents of covert cross-border armed intervention and incidents of using armed force to threaten a neighbouring state. Based on the method of ‘redescribing’ datapoints in existing datasets, notably the Uppsala Conflict Data Project, the Transnational Conflict in Africa (TCA) data include numerous missing incidents of transnational armed conflict and reclassify many more. The data indicate that (i) trans-nationality is a major feature of armed conflict in Africa, (ii) most so-called ‘civil wars’ are internationalised and (iii) the dominant definitions of ‘interstate conflict’ and ‘civil war’ are too narrow to capture the particularities of Africa's wars. While conventional interstate war remains rare, interstate rivalry using military means is common. The dataset opens up a research agenda for studying the drivers, patterns and instruments of African interstate rivalries. These findings have important implications for conflict prevention, management and resolution policies., Zahlreiche Bürgerkriege, aber vergleichsweise sehr wenige zwischenstaatliche Konflikte, so lautet der Konsens in der wissenschaftlichen Literatur zu Konflikten im postkolonialen Afrika. Dieser Artikel stellt diesen Konsens nun in Frage. Basierend auf einem neuen Datensatz argumentieren die Autoren, dass transnationale Verbindungen ein wesentliches Merkmal von bewaffneten Konflikten in Afrika sind. Politische Entscheidungsträger sollten die Lösung und Prävention von Konflikten nicht länger als eine rein interne Angelegenheit für das betreffende Land betrachten. Vielmehr gilt es sowohl die politischen Interessen der Nachbarn als auch jene der dominanten Regionalmächte systematisch in die Planungen von Friedensverhandlungen und friedensfördernden Massnahmen einzubeziehen., Journal of Modern African Studies, 57 (3)

Biofortification is an approach used to increase micronutrient content of crops through agronomic practices, conventional or modern biotechnology. Through a plethora of projects, partnerships were formed to advocate for policy changes, and increased investments in research, production and utilisation of biofortified crops. One of such projects is the Building Nutritious Food Baskets project, which has been appraised in order to draw and share successes, challenges and lessons for the improvement of similar future projects to achieve substantial impacts. The paper provides an overview of the role of biofortification in addressing nutritional challenges and highlights the efficacy of biofortified crops in improving micronutrient status. Through advocacy at the African Regional and sub-regional levels, awareness has been created on biofortification among governments, investors, development partners, farmers and consumers. This awareness has resulted in the incorporation of biofortification in some key policies, strategies and investment programmes. Key lessons learnt from regional advocacy are (1) in order to integrate biofortification in regional policies, strategies and programmes, it is important to identify champions from key and strategic regional organisations as they provide information on potential opportunities for influencing policies, (2) having a common advocacy message helps to highlight the role of biofortification in contributing to the prevention of micronutrient problems as well as evidence of impact on nutrition outcome, (3) champions need to be allocated a budget to support their advocacy work and (4) to engender adoption of biofortification, it is important to align biofortification with relevant initiatives as well as ongoing opportunities for advocacy.

Despite the rich biodiversity of the African continent and the tremendous progress so far made in food production, Africa is still struggling with the problems of food insecurity, hunger and malnutrition. To combat these problems, the production and consumption of nutritious and safe foods need to be promoted. This cannot be achieved without reliable data on the quantity and quality of nutrients and other components provided through these foods. Food composition data (FCD) are compiled as food composition tables (FCT) or food composition databases (FCDB). These are subsequently used for a variety of purposes, ranging from clinical practice, research, public health/education, food industry to planning and policy, as well as nutrition monitoring and surveillance. To perform these functions effectively, the importance of reliable FCT/FCDB cannot be overemphasised. Poor quality FCT/FCDB have serious consequences on the health of the population, and provide skew evidence towards developing nutrition and health-related policies. The present paper reviews different methods to generate FCT/FCDB, their importance and use in assisting nutrition/dietetic professionals in solving Africa's nutrition problems; current status of FCT/FCDB generation, compilation and dissemination in Africa, constraint to their use by professionals and the role of FAO/INFOODS/AFROFOODS and other stakeholders towards improvement and future initiatives. The information provided will create awareness on the need for up-to-date and high-quality FCT/FCDB and facilitate the identification of data gaps and prioritisation of future efforts in FCD generation, compilation and dissemination in Africa and subsequent strategies for the alleviation of the food and nutrition problems in Africa.

For more than 200 years the fibre in plant foods has been known by animal nutritionists to have significant effects on digestion. Its role in human nutrition began to be investigated towards the end of the 19th century. However, between 1966 and 1972, Denis Burkitt, a surgeon who had recently returned from Africa, brought together ideas from a range of disciplines together with observations from his own experience to propose a radical view of the role of fibre in human health. Burkitt came late to the fibre story but built on the work of three physicians (Peter Cleave, G. D. Campbell and Hugh Trowell), a surgeon (Neil Painter) and a biochemist (Alec Walker) to propose that diets low in fibre increase the risk of CHD, obesity, diabetes, dental caries, various vascular disorders and large bowel conditions such as cancer, appendicitis and diverticulosis. Simply grouping these diseases together as having a common cause was groundbreaking. Proposing fibre as the key stimulated much research but also controversy. Credit for the dietary fibre hypothesis is given largely to Burkitt who became known as the ‘Fibre Man’. This paper sets out the story of the development of the fibre hypothesis, and the contribution to it of these individuals.

Trematode infections cause serious economic losses to livestock worldwide. Global production losses due to fasciolosis alone exceed US$3 billion annually. Many trematode infections are also zoonotic and thus a public health concern. The World Health Organization has estimated that about 56 million people worldwide are infected by at least one zoonotic trematode species, and up to 750 million people are at risk of infection. Fasciolosis caused by the flukeFasciola giganticais endemic in Nigeria and is one of the most common causes of liver condemnation in abattoirs. Total cattle losses fromFasciolainfection in Nigeria have been estimated to cost £32.5 million. Other trematode infections of cattle, including paramphistomosis, dicrocoeliasis and schistosomiasis, have all been reported in various parts of Nigeria, with varying prevalence. Most publications on trematode infections are limited to Nigerian local and national journals, with very few international reports. This paper therefore summarized the current data on distribution, control and zoonotic trematode infections in Nigeria and other African countries. We also identified research gaps and made recommendations for future research and areas for funding for policy/planning.

IntroductionLittle is known about the existence, distribution, and characteristics of Emergency Medical Services (EMS) systems in Africa, or the corresponding epidemiology of prehospital illness and injury.MethodsA survey was conducted between 2013 and 2014 by distributing a detailed EMS system questionnaire to experts in paper and electronic versions. The questionnaire ascertained EMS systems’ jurisdiction, operations, finance, clinical care, resources, and regulatory environment. The discovery of respondents with requisite expertise occurred in multiple phases, including snowball sampling, a review of published scientific literature, and a rigorous search of the Internet.ResultsThe survey response rate was 46%, and data represented 49 of 54 (91%) African countries. Twenty-five EMS systems were identified and distributed among 16 countries (30% of African countries). There was no evidence of EMS systems in 33 (61%) countries. A total of 98,574,731 (8.7%) of the African population were serviced by at least one EMS system in 2012. The leading causes of EMS transport were (in order of decreasing frequency): injury, obstetric, respiratory, cardiovascular, and gastrointestinal complaints. Nineteen percent of African countries had government-financed EMS systems and 26% had a toll-free public access telephone number. Basic emergency medical technicians (EMTs) and Basic Life Support (BLS)-equipped ambulances were the most common cadre of provider and ambulance level, respectively (84% each).ConclusionEmergency Medical Services systems exist in one-third of African countries. Injury and obstetric complaints are the leading African prehospital conditions. Only a minority (Mould-MillmanNK, DixonJM, SefaN, YanceyA, HollongBG, HagahmedM, GindeAA, WallisLA. The state of Emergency Medical Services (EMS) systems in Africa. Prehosp Disaster Med. 2017;32(3):273–283.

ObjectiveMalnutrition in Africa has not improved compared with other regions in the world. Investment in the build-up of a strong African research workforce is essential to provide contextual solutions to the nutritional problems of Africa. To orientate this process, we reviewed nutrition research carried out in Africa and published during the last decade.DesignWe assessed nutrition research from Africa published between 2000 and 2010 from MEDLINE and EMBASE and analysed the study design and type of intervention for studies indexed with major MeSH terms for vitamin A deficiency, protein–energy malnutrition, obesity, breast-feeding, nutritional status and food security. Affiliations of first authors were visualised as a network and power of affiliations was assessed using centrality metrics.SettingAfrica.SubjectsAfricans, all age groups.ResultsMost research on the topics was conducted in Southern (36 %) and Western Africa (34 %). The intervention studies (9 %; n 95) mainly tested technological and curative approaches to the nutritional problems. Only for papers on protein–energy malnutrition and obesity did lead authorship from Africa exceed that from non-African affiliations. The 10 % most powerfully connected affiliations were situated mainly outside Africa for publications on vitamin A deficiency, breast-feeding, nutritional status and food security.ConclusionsThe development of the evidence base for nutrition research in Africa is focused on treatment and the potential for cross-African networks to publish nutrition research from Africa remains grossly underutilised. Efforts to build capacity for effective nutrition action in Africa will require forging a true academic partnership between African and non-African research institutions.

Food labelling is costly. Food labelling is often demanded with the introduction of new food products such as genetically modified (GM) food. If consumers do not have trust in the label, scarce resources are wasted. This paper investigates factors affecting the trust in food labels among Ugandan consumers. The results suggest that older, less-educated individuals of smaller household sizes and with trust in government institutions have more trust in food labels. Other factors were also found to be important. The government has to consider those differences in consumer trust when designing a GM labelling policy.

The spread of cell phone technology across Africa has transforming effects on the economic and political sphere of the continent. In this paper, we investigate the impact of cell phone technology on violent collective action. We contend that the availability of cell phones as a communication technology allows political groups to overcome collective action problems more easily and improve in-group cooperation, and coordination. Utilizing novel, spatially disaggregated data on cell phone coverage and the location of organized violent events in Africa, we are able to show that the availability of cell phone coverage significantly and substantially increases the probability of violent conflict. Our findings hold across numerous different model specifications and robustness checks, including cross-sectional models, instrumental variable techniques, and panel data methods.

This paper examines how older adults living in rural Malawi explain and understand their sex lives. We present sex in this setting as a field in which broader understandings of ageing, aged identities, and conceptions of person- or adulthood in older age are played out and constructed. Qualitative data were collected from men (N=20) and women (N=23) aged 50 to around 90 using in-depth multiple dependent interviews (N=135) between 2008 and 2010. The giving and receipt of sexual pleasure was considered natural and God-given. Primarily understood as a matter of ‘power’, sex was on the one hand, beneficial to older bodies, but on the other, not accessible to such bodies. Declining sexual frequency was associated with declining desire for sex, or frustration stemming from continued desire for sex. These discourses emerged from the way the ageing body was constructed as a weakened body, incompatible with understandings of adulthood based on physical productivity. Older men and women used sex to discursively respond to these challenges to their adulthood in two ways. Firstly, sex was used to confirm strength, physical productivity, and therefore, identity as an ‘adult’. Secondly, adulthood itself was redefined as being based on moral, rather than physical productivity, and refraining from sex was used to demonstrate wisdom, self-control and therefore their ‘adult’ identity. Our results provide in-depth understanding of the ways constructions of ageing and sex can influence complex experiences of marital and non-marital sex in older age. We contribute to debates on sexuality in the gerontological literature by moving discussion beyond the presentation of continued sexuality as somehow exceptional or an indicator of successful ageing. Finally, in a setting of considerable HIV prevalence at older ages, our results challenge a preoccupation with fertility and chronological age in the collection of sexual health data in Africa.

Background. Recent anthropological studies have documented the importance of understanding the relation of culture to the experience of mental illness. The use of interviews that elicit explanatory models has facilitated such research, but currently available interviews are lengthy and impractical for epidemiological studies. This paper is a preliminary report on the development of a brief instrument to elicit explanatory models for use in field work.Method. The development of the SEMI, a short interview to elicit explanatory models is described. The interview explores the subject's cultural background, nature of presenting problem, help-seeking behaviour, interaction with physician/healer and beliefs related to mental illness.Results. The SEMI was employed to study the explanatory models of subjects with common mental disorders among Whites, African-Caribbean and Asians living in London and was also used in Harare, Zimbabwe. Data from its use in four different ethnic groups is presented with the aim of demonstrating its capacity to show up differences in these varied settings.Conclusions. The simplicity and brevity of the SEMI allow for its use in field studies in different cultures, data can be used to provide variables for use in quantitative analysis and provide qualitative descriptions.

Background. This paper reports on a two-stage community-based epidemiological study of selected minor psychiatric disorders conducted on an adult African population in South Africa.Methods. Using a modified random cluster sampling method, 354 adults were identified as the first-stage sample, with the SRQ-20 being used as a first-stage screen. Clinical interviews based on DSM-IV checklists for generalized anxiety disorder, major depression and dysthymia were administered as the second-stage criterion to 81 subjects from the sample.Results. The weighted prevalence for generalised anxiety and depressive disorders was 23·9% (95% CI 15·1%–32·7%), comprising: generalized anxiety 3·7%, major depression 4·8%, dysthymia 7·3%, and major depression and dysthymia 8·2%. Statistically significant associations were found between caseness and age, marital status, employment, income and educational level.Conclusions. The results are discussed in relation to comparative local and international data as well as in the context of the current restructuring of the mental-health care system in South Africa from tertiary curative care to integrated primary mental-health care.

SUMMARYDistributions of the intensities of helminth infections within their host populations are invariably aggregated. In the case of the intestinal nematodes, the degrees of aggregation have been shown to be species specific, and constant for any given species despite geographical variation in study sites. This species-specific aggregation can be quantified and used as a tool in planning control interventions. One practical application is that the prevalence of infection can be used to predict the prevalence of heavy infection and thus the risks of morbidity. This paper investigates the patterns of aggregation in schistosome egg counts in different endemic areas in Africa (data sets were obtained from Burundi, Cameroon, Tanzania, Zambia and Zaire). The analysis demonstrates that the degree of parasite aggregation, for both Schistosoma mansoni and S. haematobium, differs amongst the different study localities. This is probably due to area-specific differences in host exposure and immunity. This implies that for these schistosome species, it is not possible to predict egg count distributions or morbidity levels from prevalence data alone.

Two reviews on child development from the International Child Development Steering Group (ICDSG) have been published this year in the Lancet. According to ICDSG the magnitude of the problem is immense: about 200 million children under 5 years of age are unable to reach their potential in cognitive and psychosocial development. Failing to reach this developmental potential is likely to perpetuate the vicious circles of poverty and low education. The ICDSG points out the following four causes: malnutrition (stunting) deficiency of iron deficiency of iodine and lack of stimulation in infancy. The ICDSG reveals the following prevalences among children in developing countries during the first five years of life: stunting 31% mild-to-severe iodine deficiency 35% iron-deficiency anaemia 23-33%. Poverty armed conflict crop failure climate change displacement and inequity within and between countries obviously do not help. We look forward to the third ICDSG review pointing out possible strategies for the future. In previous years the Bellagio Study Group on Child Survival published several ground-breaking papers on child survival and nutrition transition valuable material for all nutrition educators and policy planners. A follow-up meeting is planned for this year. (excerpt)

This paper examines some of the moral meanings of aids, and argues that in addition to understanding aids in the context of the sexual counter-revolution, it also needs to be placed in the wider context of global economic and ideological crises, and the ‘New Right's’ struggle for hegemony. Denis Altman refers to aids as ‘the most political of diseases’ (Altman 1986, p. 11). A few years ago, Evans Stark pointed out that all epidemics are ‘social events’, even though they may appear as natural, random phenomena. This is because they have become the focus of struggles for control over resources (principally housing, medicines, and sanitation) (Stark 1977). Epidemics further tend to throw into relief deeply held social tensions and anxieties, which can become triggers for social reorganisation around traditional values. It is not difficult to see how this is the case with aids, which is infused in particular with tensions over sexuality and desire. In relation to this it is important to emphasize first, that sexual contact is estimated to be responsible for around two-thirds of reported aids cases amongst adults in the U.S.A. (Gracie et al. 1986), but it is not actually an exclusively sexually transmitted disease; and secondly that compared with other major causes of morbidity and mortality, aids remains a relatively rare condition in many parts of the world. It is sociologically significant though, that the two major routes of transmission, IV use and penetrative sexual intercourse, involve issues of control over body boundaries.

SummaryThis paper focuses upon the social factors regulating sexual behaviour and fertility in the later years of the female reproductive period. Information from India, Africa and Europe is presented on traditional beliefs and constraints concerning the cessation of procreation and the modification of sexual relations in middle age. Data showing the diversity of attitudes and practices in India, Bangladesh, Nigeria, the USA and Australia are discussed. Findings are that, in all the areas examined, coital frequency declines with advancing age although the timing and extent of the decline varies. However, the extent to which procreation is expected to cease prior to the onset of biological infecundity varies markedly even between neighbouring cultures at the same level of development. In Western cultures, for personal reasons, wives expect that childbearing should cease well before the onset of infecundity and can state an exact age at which this should occur. In those African and Asian cultures where there is a social limit to continued reproduction, this is most commonly defined in terms of a life-cycle stage attained by the family as a whole; chronological age is rarely of any importance.

Opening ParagraphColonial rule brought about significant changes in the regional economies of West Africa, which had already been influenced by Europeans through the slave trade and the succeeding period of legitimate trade. Colonial administration extended the cultivation of export crops, introduced new systems of taxation and currencies, reorientated trading networks, and introduced policies aimed at ending domestic slavery. Levels of population mobility also increased, especially in the agricultural sector, as the seasonal redistribution of labour became an integral part of the production of export crops. This paper looks at the origins and development of dry season labour migration from Sokoto in north-western Nigeria, a migratory system which is generally accepted as being a product of colonialism. The argument takes the opening years of colonial rule in Sokoto and tries to uncover the nature and type of migration which obtained at this time. It is suggested that early migration was influenced by the economy of the central Sudan of the late nineteenth century, and there was an overlap, rather than a sharp break, between pre-colonial and colonial economies. The likely influence of pre-colonial structures is especially pertinent in an area which was the centre of the Sokoto caliphate, the largest and most populous state in nineteenth-century West Africa. But, in the early 1930s, dry season migration changed as the volume of migrants increased and their destination altered; it is the identification of this point of change which distinguishes the early period of migration and the changing impact of colonial policies.