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In sub-Saharan Africa, accessing HIV testing services is a significant challenge for men who have sex with men (MSM) and transgender women (TGW). In this qualitative evidence synthesis, our aim is to understand social and structural barriers and how they hinder MSM's and TGW's access to HIV testing services in sub-Saharan African countries. We searched four selective databases (PubMed, Web of Science and CINAHL complemented with Google Scholar) for qualitative studies, published in English between January 2005 and December 2023, generated 1507 articles, of which 22 were included. Thematic synthesis was conducted for data synthesis. This led to five barriers that hinder HIV test uptake among MSM and TGW, which included: non-availability of tailored HIV testing services, stigma, lack of trust among service providers, sexual and physical violence, and criminalization of same sex relationship. To navigate these social and structural barriers and cope with fears of discrimination and criminalization, MSM and TGW engaged into riskier behaviors, including avoiding HIV testing, non-disclosure, or relying on informal or alternative sources of HIV testing. Decriminalization of same-sex relationship and peer-led HIV testing services were noted to address structural barriers, including stigma and poor access, and subsequently increase the participation in HIV testing services. [ABSTRACT FROM AUTHOR]

Breast cancer is by far the leading cancer both in terms of incidence and mortality in the Republic of Mauritius, a Small Island Developing State (SIDS). However, few studies assessed its survival by age, stage at diagnosis and molecular subtype. We identified 1399 breast cancer cases newly diagnosed between 2017 and 2020 at the Central Health Laboratory, Victoria Hospital. Cancers were categorized into five molecular subtypes: (1) luminal A, (2) luminal B Her2 negative, (3) luminal B Her2 positive, (4) Her2 enriched and (5) Triple negative. The net 1 and 3‐year survival were estimated for different age groups, staging at time of diagnosis and molecular subtype. We also estimated the excess hazards using a multivariate Cox proportional hazards model. While early stage at diagnosis (stage 1 [44.4%] and stage 2 [20.1%]) were most common compared to late presentation (Stage 3 [25.4%] and stage 4 [10.1%]), luminal B Her2 negative (36.7%) was the most frequent molecular subtype. The net 1‐ and 3‐year breast cancer survival rates were 93.9% (92.3–95.4) and 83.4% (80.4–86.4), respectively. Breast cancer three‐year survival rates were poorest among the youngest patients (<50 years), 77.1% (70.7–83.5), those diagnosed with stage 4 (28.5% [17.1–39.9]) and cancer with a triple negative molecular subtype (71.3% [63.3–79.3]). Emphasis on a national breast cancer screening programme, down staging breast cancer at diagnosis and systematic molecular subtyping of all breast tissues could be pivotal in improving breast cancer survival outcomes in the Republic of Mauritius. [ABSTRACT FROM AUTHOR]

Drought has consistently threatened cowpea [Vigna unguiculata (L.) Walp] production, and it has become important to identify drought-tolerant, stable, and high-yielding accessions from cowpea germplasm to accelerate breeding of new drought-tolerant varieties for sub-Saharan Africa (SSA). This study assessed 112 cowpea accessions for drought tolerance and yield stability across three locations in 2 years using an 8 × 14 Alpha lattice design replicated thrice. Data collected were subjected to combined analysis of variance, broad-sense heritability, phenotypic, and genotypic correlations. Yield stability was assessed through the Additive Mean and Multiplicative Interaction (AMMI) and Genotype and Genotype × Environment (GGE) Biplot techniques. Significant variations were found among the accessions across the test environments for measured traits and reduction of grain yield due to water-stress. Genotypic correlations were higher in all the locations and environments. AMMI and GGE Biplot analysis both identified TVu-74 as the highest yielding accession and TVu-9913 as the most stable accession. Notable differences in response to drought stress indicated genetic variability and allowed the selection of drought tolerant accessions. The identified high-yielding and stable accessions could serve as potential parents in breeding climate-resilient cowpea varieties for SSA. [ABSTRACT FROM AUTHOR]

Small, and medium-sized enterprises (SMEs) play significant roles in economic growth, development, and job creation in sub-Saharan Africa (SSA). This study employed a Systematic Literature Review (SLR) approach to identify empirical evidence on the impact of innovation and business support activities on SMEs’ performance across countries in SSA. Based on geographic concentration and approaches, the study focused on 48 articles that evaluated programmes aimed at supporting SMEs in SSA. The results show that, on average, innovation and support programmes had positive implications on firm performance, employment generation, export performance and labour productivity. Furthermore, socioeconomic factors and inclusivity, technical expertise of employees, access to finance and credit, firm’s social capital and enabling government policies among others were found to drive successful integration of innovation and business support programmes and its subsequent impacts among SMEs. Few of the studies identified focused on equity, diversity, and inclusivity issues. The study concludes that unlocking the region’s growth potential will require bridging the credit gap, strengthening SME value chains and boosting productivity through digitalization, technology adoption, and adaptation. Further studies should pay attention to equity, diversity, and inclusivity issues, as well as embed both qualitative and quantitative approaches in the enquiry of programme impact. [ABSTRACT FROM AUTHOR]

Purpose: This study integrates Eisenegger and Imhof's (EI) reputation theory and the reputation-building hypothesis to explore how corporate reputation (CREP) concerns constrain real earnings management (REM). Motivation of the study: This study empirically tests the combined and individual effects of the dimensions of Eisenegger and Imhof's corporate reputation theory on real earnings management practices. Design/methodology/approach: The study used the least-square dummy variable (LSDV) two-way fixed effects estimator on a panel data constructed from 203 non-financial firms listed in 12 sub-Saharan African stock exchanges from 2014 to 2020. Main findings: The study provides empirical evidence that CREP, consistent with Eisenegger and Imhof's reputation theory, curtails REM practices. Functional, social, and expressive reputation concerns reduce the managerial tendency to manipulate real activities, while considering other REM influencing factors. This result is consistent across REM components, country-level analysis, and endogeneity tests. Practical implications/Managerial impact: The results of this study are anticipated to motivate the use of corporate reputation building as a preventive strategy against REM, as it deters managers from manipulating business operations. The findings provide managers with a valuable approach to evaluating a firm's various reputations and how they can be leveraged to curb REM. Novelty/Contribution: The study offers new perspectives on assessing firm reputation from various stakeholder viewpoints and how CREP serves as a complement to existing CG mechanisms to mitigate managerial opportunism. [ABSTRACT FROM AUTHOR]

Background: The effect of the progressive utilization of virtual learning (VL) in postgraduate medical education (PGME) is contentious. During the COVID-19 pandemic, VL was up-scaled to bridge the education delivery gap. How this impacted learning experiences in PGME is an area that needs to be explored for the progressive context-specific application of VL. Objective: This phenomenological study aimed to explore the postgraduate medical faculty's and residents' experiences with the rapid shift to VL. Methods: Through an interpretivist paradigm, this study used in-depth individual semi-structured interviews and prompts to explore the full breadth of the participants' experiences. A purposive sampling method was used, and qualitative content analysis was employed in an iterative process until data saturation. Data was collected between January 2021 and July 2021. Member checking was done to ensure validity. The AKU-ERC granted ethical approval, with reference AKU/2020/098/fb. Results: Ten participants were recruited for the study. Positive experiences were greater access to learning materials and improved learner confidence. In contrast, limited supervision, and lack of assurance of participants' engagement emerged as a negative VL experience. The components of critical thinking and problem-solving skills were unaffected by virtual case-based learning. However, the aspects of acquiring clinical and surgical skills emerged as a difficulty in accepting VL as a valid mode for attaining these competencies. Conclusions: To improve experiences of VL, participants' drive, engagement, technological inadequacies, and instructional design should be optimized. [ABSTRACT FROM AUTHOR]

Background: Prostate cancer (PCa) was the most common noncutaneous cancer among Nigerian men in 2020. Despite this high incidence, documented rates may be an underestimation. Objectives: This study aimed to determine the hospital incidence rate, trends, and characterise the clinicopathologic features, and treatment outcomes of patients with PCa in our institution. Materials and Methods: A 5-year retrospective review of patients managed for PCa at the Federal Teaching Hospital, Lokoja (FTHL), Nigeria, from 2016 to 2020. Medical abstraction was done on clinicopathologic features, treatment received, serum prostate specific antigen (PSA) at diagnosis, 3, and 7 months of androgen deprivation therapy (ADT). Data obtained were analysed using SPSS 25, and trends analysis of the annual incidence rate and number of patients with PCa in the period was done using joinpoint regression modelling. Results: Of 89 patients, 83 had complete medical records. The average annual hospital incidence rate was 174/100,000, and the mean age at diagnosis was 70.4 years. Locally advanced disease was found in 81.9% of patients, and tumours were ISUP grade groups 4 and 5 in 54.2% of patients. ADT was done in 62.6% of the patients, while 28.9% of the patients defaulted after diagnosis. The mean serum PSA was 71.9 ng/mL (7.7–156) at diagnosis and was 11.1 ng/mL (0.1–102) and 15.3 ng/mL at 3 and 7 months of ADT, respectively. Only 40.6% of the treated patients had a serum PSA ≤ 4 ng/mL at 7 months of ADT. Conclusions: Patients with PCa in FTHL, Nigeria, have mostly locally advanced disease at diagnosis. Over half have a high-grade pattern and fail to achieve a serum PSA ≤ 4 ng/mL after 7 months of ADT. [ABSTRACT FROM AUTHOR]

Background: Stroke registers are recommended as a key priority by the Lancet Neurology World Stroke Organization Commission for Stroke, 2023, and the African Stroke Leaders' Summit, 2022. Aims: This scoping review aims to map where stroke registers have been implemented in Sub-Saharan Africa (SSA). The article then compares and critiques the methods and definitions used and summarizes key results from the registers. The scoping review searched EMBASE, MEDLINE, and CABI Global Health databases and included all studies with a prospective longitudinal design in SSA, where adult acute stroke was the primary condition studied. Articles were screened against inclusion and exclusion criteria independently by two authors. Summary: We identified 42 unique stroke registers from 48 individual studies. The registers were located in 19 countries, with 19 from East Africa, 15 West Africa, 6 Central Africa, and 2 from Southern Africa. Cumulatively, the registers recruited 12,345 participants with stroke, the median number of participants was 183 (interquartile range (IQR): 121–312), and the range was 50–1018. Only one study was a population-based register, and 41 were hospital-based registers. Of the hospital-based registers, 29 were single site, 10 were conducted at two sites, and 2 at three sites. Twenty-three (54.7%) of the registers were located in the capital city of their respective country, and only one of the hospital-based registers was in a self-described rural area. Length of recruitment ranged from 4 months to 6 years; the median length of recruitment was 12 months. Methodology and definitions were heterogenous between the registers. Only seven (19.4%) registers referenced the WHO STEPwise approach to implementing stroke registers. Twenty-seven (64.3%) registers used the WHO definition of stroke. The mean neuroimaging rate was 84%, and ranged from 0% to 100%. Stroke severity was measured using the National Institute of Health Stroke Scale (NIHSS) in 22 (52.4%) registers, four registers used the Glasgow Coma Scale (GCS), two registers used the miniNIHSS, one used the Scandinavian Stroke Scale, one modified Rankin Scale (mRS), and 11 registers did not report a stroke severity measure. Seventeen (40.5%) registers used the mRS to measure function, six registers used Barthel Index alone, and three registers used both mRS and Barthel Index. Only two registers included a quality-of-life measure, the EQ-5D. Eight registers included a quality-of-care measure, and 26 (61.9%) registers recorded socioeconomic status or a socioeconomic status proxy, most frequently educational attainment. Conclusions: This scoping review found high heterogeneity of methods and definitions used by stroke registers, with low uptake of the WHO stepwise method of stroke surveillance. A drive to standardize methodology would improve the comparability of stroke data in SSA. The shared use of educational attainment by registers in our review may enable future meta-analyses of inequities in stroke in SSA. Incorporating health-related quality-of-life measures, such as EQ-5D, into stroke registers should be encouraged, bringing a patient perspective, and allow the estimation of quality-adjusted life years lost to stroke. Agreement on a standardized register methodology or further promotion and uptake of the WHO stepwise method is essential to produce comparable data to improve stroke prevention and care. [ABSTRACT FROM AUTHOR]

Child malnutrition is a major health problem in Sub‐Saharan Africa. Complementary foods made from African indigenous and locally available raw materials are often low in protein and nutrients. It is, therefore, important to supply complementary foods that are nutritious and affordable, and with an acceptable consistency and taste. The objective of this study was to develop, on a pilot scale, food‐to‐food fortified, convenient, canned complementary porridges based on blends of African indigenous crops, i.e., orange fleshed sweet potato (OFSP) flour, and leguminous (i.e., cowpea, and Bambara groundnut) and cereal flours (i.e., teff, finger millet, maize, and amaranth), and milk powder. Plant‐based, African complementary foods are often lacking in vitamin A, zinc, iron, and energy. Porridge with OFSP on a 32% dry weight (dw) basis achieved recommended levels of vitamin A (530 µg per 100 g dw). Satisfactory energy (431 Kcal per 100 g dw) was obtained by supplementation of vegetable oil. A nutritious, low‐cost porridge (costing 0.15 € per 100 g can) that fulfills consistency constraints was obtained by including supplements of zinc and iron salts as ingredients. The solids content and thus protein/energy could be significantly increased using protein fractionated or germinated cowpea flours without compromising on viscosity. The sensory profile was characterised by more intense vegetable, leguminous, and malty flavours as compared to traditional reference porridges. Key messages: In developing countries, complementary foods are often plant‐based, which may lead to deficiencies of e.g., vitamin A, zinc, and iron, and does not support sufficient energy. This study shows that vitamin A content can be increased by use of Orange Fleshed Sweet Potato (OFSP) flour as an ingredient in complementary porridges. Mineral‐rich foods are expensive, and with only local crops available, a minimum cost is hardly achieved without supplementation with cost‐limiting nutrients zinc and iron salts.Fat content may be improved by whole milk powder and vegetable oils, also leading to more energy. Solids content, and hence energy and protein, may be increased by the use of protein fractionated and germinated legume flour, ‐ without compromising on viscosity.The present study shows that low‐cost complementary nutritious porridges that fulfills the consistency constraints can be developed based on indigenous African crops by including supplements of zinc and iron salts. [ABSTRACT FROM AUTHOR]

Feminist scholars have long recognized the gender‐based challenges that women in academia face relative to men. Although numerous strategies have been designed and implemented to tackle this problem, the attainment of gender equality in academia has proved futile globally. Integrating Acker's notion of the ideal worker with Bourdieu's concepts of symbolic violence and capital, we undertake a qualitative study of how women in African universities navigate the masculinized ideal academic norm, and how their efforts to break free from this symbolic image reproduces and legitimizes gender inequality. Drawing on the narratives of 36 women researchers in Ghana, Nigeria, Malawi, Kenya, Botswana, and Zambia, our analysis reveals how the perpetual struggle for power, positions, and resources in academia influences women researchers within these contexts to enact three strategies for legitimacy―(1) 'Engage the patriarchal order,' (2) 'Contest normative femininity,' and (3) 'Appropriate normative femininity.' In contributing to the ongoing efforts to achieve sustainable development goals 5 and 8, we develop a theoretical framework that illuminates the subtle and sophisticated mechanisms that (re)produce, sustain, and legitimize the gendered structures and cultures in academia that serve to disadvantage women. The implications of these findings for theory and practice are outlined. [ABSTRACT FROM AUTHOR]

This study evaluated the concentrations of polycyclic aromatic hydrocarbons (PAHs) and the carcinogenic risks of cattle and goat meats singed with either firewood, Liquefied Petroleum Gas (LPG) or tyres from five cities in Ghana. The meat samples, before and after singeing, as well as after scraping and washing, were collected from abattoirs and sent to Clinical Analysis Laboratory (Can-Lab) of Kwame Nkrumah University of Science and Technology (KNUST) for PAH analysis. Tyre-singed meats exhibit significantly higher PAHs concentrations (P =.01304) compared to those singed with firewood and LPG. Benzo[a]pyrene was the predominant PAH in tyre-singed cattle and goat meats, with concentrations of 23.1 mg/kg and 12.16 mg/kg, respectively. Washing singed meats reduced PAH levels, yet tyre-singed samples retained higher and dangerous concentrations than those singed with other fuels. Statistical analysis using ANOVA confirmed a significant effect of fuel type on PAH16 concentrations (P =.01304). The Tukey HSD test indicated a significant difference between LPG and tyre (P =.0105). Estimated daily intake (EDI) calculations highlighted potential health risks, particularly from tyre-singed meats, which exceeded regulatory limits set by health authorities. The findings emphasize the health hazards associated with consuming meats singed with tyres in Ghana and underscore the need for stringent regulatory measures and public awareness to mitigate PAH exposure. Plain language summary: This paper highlights the health risk concern associated with polycyclic aromatic hydrocarbons in meat. [ABSTRACT FROM AUTHOR]

This study considers the effects of female genital circumcision (FGC) on household income inequality in Nigeria. To the extent that FGC has adverse health consequences, it can lower female labour productivity and earnings relative to males. Theoretically, we motivate our inquiry within a simple game-theoretic household norm bargaining framework in which there are several possible equilibria based on the decisions of representative males to require FGC, and representative females accepting, or not. We link regional data on Nigeria from the Afrobarometer survey to existing regional FGC surveillance data in Nigeria to estimate with Ordinal Logit specifications, the effect of regional FGC rates on a household's position in the income distribution. Our parameter estimates reveal that as the ratio of daughter to mother genital circumcision increases in a region, the odds of a household being in the lower income decile increases. The FGC effects are consistent with a political economy of gender bargaining about FGC choices in which males have more bargaining power in governing/managing the household relative to females. Our results suggest that any policy intervention that eradicates FGC, including interventions that affect a political economy of bargaining that at least equalises bargaining power between males and females, could reduce household income inequality in Sub-Saharan Africa. JEL: I14, I18, J16, O5, Z13 [ABSTRACT FROM AUTHOR]

Entrepreneurship is growing in popularity as a tool to combat the challenges of unemployment and economic development in sub-Saharan Africa. A host of training programme offerings have emerged to mitigate the challenges of starting and sustaining a business in this context. Non-formal trainings (educational activities outside formal places of learning such as universities or schools) can help entrepreneurs develop essential business skills. A systematic literature review demonstrates how non-formal training programmes for entrepreneurship are evaluated across sub-Saharan Africa. We searched SCOPUS and EBSCO databases with the following keywords and their synonyms: 'training', 'entrepreneurship' and 'sub-Saharan Africa'. The final selection returned 49 articles that discuss non-formal training programmes in sub-Saharan Africa. Our results suggest significant variation in training types and their effectiveness. Beyond descriptive analytics, we show that a more nuanced understanding of the context-specific entrepreneurial environment needs to be considered when implementing and designing a programme and that this should be coupled with more rigorous effectiveness evaluations. We propose a deeper analysis of the role of human capital within the setting of local entrepreneurial ecosystems as well as the contextualization of training material and participant selection as a promising start to develop more effective training programmes for entrepreneurship. [ABSTRACT FROM AUTHOR]

Background and Aims: There is a paucity of literature available on the prevalence of paediatric rare and syndromic tumours in Sub-Saharan Africa, furthered by a lack of consensus on the definition of a “rare” tumour. The aim of this study was to describe the types, incidence, management, and overall survival of rare and syndromic tumours in South Africa to improve future management and outcomes. Methods: A retrospective review of patients below 18 years of age presenting to Chris Hani Baragwanath Academic Hospital, South Africa, from the period of 1st January 2004 to 31st December 2017, with rare or syndromic tumours was conducted. Tumours were classified according to criteria described by international literature. (Ethics: M190920) Results: One hundred and eighty-six tumours were identified, with an average incidence of 10 %. The mean age of presentation was 8.3 years. Ten anatomical regions were identified: soft tissue (N = 68, OS= 62 %), head and neck (N = 35, OS= 77 %), renal (N = 19, OS=74 %), skin (N = 17, OS=47 %), hepatic (N = 16, OS=38 %), adrenal (N = 10, OS= 80 %), female reproductive system (N = 8, OS=75 %), pulmonary, chest wall and mediastinum (N = 7, OS=86 %), gastrointestinal (N = 4, OS=75 %) and male reproductive system (N = 2, OS=100 %). The 10 most common variants included: malignant peripheral nerve sheath tumours (N = 15, 8 %, OS=47 %), nasopharyngeal carcinoma (N = 14, 8 %, OS=64 %), malignant melanoma (N = 14, 8 %, OS=43 %), Ewings sarcoma (N = 13, 7 %, OS=54 %), clear cell sarcoma of the kidney (N = 9, 5 %, OS=67 %), hepatocellular carcinoma (N = 9, 5 %, OS=22 %), desmoplastic small round cell tumour (N = 7, 4 %, OS=57 %), synovial sarcoma (N = 7, 4 %, OS=71 %), undifferentiated sarcoma (N = 6, 3 %, OS=66 %), infantile fibrosarcoma (N = 6, 3 %, OS=66 %). Treatment modalities included: surgery (N = 24, 13 %, OS=79 %), palliation (N = 21, 11 %, OS=0 %), surgery and chemotherapy (N = 19, 10 %, OS=58 %), and surgery, chemotherapy, and radiation (N = 16, 9 %, OS=75 %). Thirteen (7 %) were associated with the syndromes: Xeroderma pigmentosa (N = 4, 2 %), Neurofibromatosis (N = 3, 2 %), Tuberous Sclerosis (N = 2, 1 %), Giant congenital nevus syndrome (N = 2, 1 %), Li-Fraumeni (N = 1, 0.5 %) and 31q Deletion syndrome (N = 1, 0.5 %). Overall, there was a 66 % survival rate. Conclusion: The diagnosis of rare tumours in the paediatric population is rising but are rarely associated with a syndrome. Most require definitive surgical treatment; others required the addition of adjuvant chemotherapy and radiation. Overall, although lower than that reported in higher income countries, the prognosis of these tumours remains good. Level of evidence: IV

We examined the impact of a family-based economic empowerment intervention on viral suppression and mental health among ALHIV. Between 2013 and 2014, 702 participants aged 10–16, living with HIV, and taking antiretroviral therapy, were recruited from 39 clinics in Uganda. Twenty clinics (n = 358 participants) were randomized to the intervention and 19 clinics (n = 344 participants) were randomized to the control conditions. The intervention comprised a matched savings account, financial literacy training, and microenterprise workshops. The primary outcome was viral suppression, while the secondary outcomes included depression, hopelessness, and self-concept. We ran mixed-effects models to determine the intervention effects. At enrollment, participants' mean age was 12 years. The intervention improved viral suppression, evidenced by significant intervention-by-time interaction effects [χ2(5) = 12·81, p = 0·025], further qualified by increased viral suppression in the intervention group at year two, OR = 1.89 (95% CI: 1.14–3.15), year three, OR = 2.31 (95% CI: 1.05–5.04), and year four, OR = 2.34 (95% CI: 1.03–5.33). Regarding mental health, we did not find significant intervention main effects or intervention-by-time interaction effects for depressive symptoms, hopelessness, or self-concept for the entire sample. However, for participants owning fewer assets, we found significant intervention-by-time interaction effects for hopelessness [χ2(5) = 12·33, p = 0·031], and self-concept [χ2(5) = 27·26, p < 0·001], suggesting beneficial intervention effect for this demographic. Family EE interventions have the potential to improve viral suppression and mental health outcomes among ALHIV. These findings offer insights in designing programs and policies to improve outcomes among ALHIV. • ALHIV have poor adherence to ART leading to low viral suppression. • Only 60% of ALHIV in our sample achieved viral suppression at baseline. • Economic empowerment improves viral suppression and mental health among ALHIV. • Intervention impacts were greater among ALHIV from households with fewer assets. [ABSTRACT FROM AUTHOR]

Crop diversification, or growing multiple crops in farmland, has received attention as a risk-reducing strategy for smallholders. This study attempts to show that poor and non-poor farmers adopt different strategies of crop diversification. We first conceptualize farmers' heterogeneous motivations for crop diversification by introducing a subsistence constraint into a utility maximization problem under uncertainty. Using the Tanzanian National Panel Survey, we then examine whether past experiences of shocks affect the adoption of crop diversification differently between poor and non-poor farmers. We rely on a threshold model to estimate heterogeneous impacts between poor and non-poor farmers. We find that poor farmers adopt crop diversification for robust food securities in response to drought/flood and large increases in food prices for purchase. In contrast, non-poor farmers adopt crop diversification to stabilize market income in response to large increases in input prices and large declines in crop prices for sale. • Crop diversification in farmland is a risk-reducing strategy for poverty reduction. • Tanzanian farmers have different motivations for crop diversification, depending on the level of their food consumption. • Poor farmers pursue crop diversification for robust food securities. • Non-poor farmers adopt crop diversification to stabilize market income. [ABSTRACT FROM AUTHOR]

• Illegal gold mining presents numerous and seemingly intractable societal challenges in many developing countries. • The article introduces the concept of institutional coalescence to explain power relations. • Coalescence also explains how illegality becomes socially embedded and legitimate. • This contributes to understandings of social organization, agency, and emerging institutions. Across sub-Saharan Africa powerful sites of illegal gold mining challenge and change the workings of a range of statutory and non-statutory institutions, providing rich contexts for investigating institutional complexity. In Ghana, illegal mining contributes an increasing share of gold produced, attracting a large and diverse body of scholarship. This article provides an original and critical analysis of the emerging institutional forms and processes of social accept around the illegal extraction. In so doing it contributes to scholarship on two fronts: By exploring the interconnectedness and changeability of institutions it contributes empirically to understandings and evidence of social processes around the illegal extraction of gold in the Global south, and more broadly about contested sites of resource extraction. Second, it introduces the concept of institutional coalescence to explain and interpret the sociopolitical landscape of shifting power relations at the local level, which successfully meld and change the workings of formal state law, officialdom, and customary norms. In a broader perspective this contributes to understandings of relations between individual agency, organisational behaviour, institutions, and social context. [ABSTRACT FROM AUTHOR]

This study investigates the economic impact of China's "stadium diplomacy" in Sub-Saharan Africa. Exploiting the staggered timing of the construction in a difference-in-differences framework, we analyze the effect of Chinese-built and financed stadiums on local economic development. Employing nighttime light satellite data, we provide both an aggregate and spatially disaggregated assessment of these investments. We find that a stadium's city nighttime light intensity increases by about 24 percent, on average, after stadium completion. The effects can be attributed to the stadiums but are not only visible close to the stadium's location. Estimates on nighttime light activity are mirrored by individual-level employment effects in the stadiums' surrounding area. For stadiums not built or financed by China, we cannot find similar effects. Our results contrast with the widely held notion that China's development finance projects constitute "white elephants". • Estimation of causal effect of the Chinese "stadium diplomacy" on local economic development in Sub-Saharan Africa. • Stadiums have large and persistent effect on nighttime light emissions. • On average, a stadium increases local economic development proxied by nightlights by 27 percent over the whole post-treatment period at the city level. • We use DHS enumeration areas within 5 and 10km of the stadiums and find an increase in employment of up to 10 percentage points. [ABSTRACT FROM AUTHOR]

The need for development interventions to be context-specific in the Global South has become a mantra in the academic research over the last decade. However, there is ambiguity about which type of context actually matters, using the term to either mean different countries, sub-national regions, or specific communities. Here, ordinal logistic regression models are applied to novel survey data (N = 1016) on household and small business energy needs in rural Uganda and Zambia to analyse the extent to which current and aspirational energy consumption differ at the national, regional, district, and village levels. These results indicate that domestic energy needs vary statistically significantly between the two countries, and, notably, between districts and villages. By contrast, differences in productive energy aspirations appear to differ mostly at the national and regional level, with no significant variations associated with local district and village levels within each region. These results yield two central implications that contribute to discussions on multi-scale linkages within sustainability transitions research. First, conceptually, the results suggest that a multi-level assessment is beneficial to fully understand energy consumption and aspirations of a particular location while analyses at a singular level can overlook wider disaggregated patterns that transcend one specific level. Second, the variance of local-level household energy needs means that including local-level participatory elements into energy access policymaking and implementation might be required to adequately capture and respond to these different needs. By contrast, to meet productive use aspirations, associated initiatives may benefit particularly from factoring in economic differences between sub-national regions. [Display omitted] • Context-specific approaches are crucial, but unclear which context matters most. • Energy surveys were conducted to understand the salience of geographic levels. • Different levels appear to be salient for energy consumption and aspirations. • Countries should prioritise productive use of electricity in energy policy. • Multi-level energy assessments allow for a more holistic and inclusive approach. [ABSTRACT FROM AUTHOR]

Objective: To explore the prevalence and determinants of undernutrition among infants and children aged 6 months to 5 years in sub-Saharan African countries., Background: Despite substantial progress over the past 20 years, undernutrition has remained an alarming global challenge. Sub-Saharan Africa is the only region where the prevalence of stunting in children younger than 5 years has significantly increased. This study seeks to update the evidence on the prevalence and determinants of childhood undernutrition in this vulnerable region., Methods: This systematic scoping review was conducted following the 2018 Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) extension for scoping reviews. Five electronic databases were searched on December 14, 2022, with no date or language restrictions. Primary studies presenting evidence on the prevalence and determinants of childhood undernutrition among infants and children aged 6 months to 5 years were included. Data on the prevalence of stunting, wasting, and underweight, and on determinants of undernutrition were extracted, described, and compared with national survey data., Results: A total of 59 publications from 11 countries were included, with most studies conducted in Ethiopia (n = 38) and Tanzania (n = 7). Stunting prevalence ranged from 8% to 64%, wasting prevalence ranged from 1% to 58%, and the prevalence of underweight ranged from 2% to 63%. The most frequently reported determinants of undernutrition were the child's age (>24 months), male sex, maternal illiteracy, diarrhea or illness in the past 2 weeks, low household socioeconomic status, or living in a larger household (n > 4 members). Overall, 56% of the included studies reported higher stunting prevalence, 60% reported higher wasting prevalence, and 57% reported a higher prevalence of underweight than reported by relevant national surveys., Conclusion: The prevalence of childhood undernutrition reported by primary studies is often higher than that reported by national surveys. Several immediate and underlying determinants influence childhood undernutrition. Future research should incorporate the findings from primary research to develop holistic, multistrategy approaches to address childhood undernutrition in sub-Saharan African countries., (© The Author(s) 2025. Published by Oxford University Press on behalf of the International Life Sciences Institute.)

Introduction: Sub-Saharan Africa is facing a severe crisis in human resources for health. Primary healthcare is the most affected. This problem is aggravated by absenteeism, implying that healthcare workers are absent on duty during scheduled working hours. This scoping review maps existing literature on absenteeism among primary healthcare workers in Sub-Saharan Africa., Methods: This scoping review complies with the Population Concept Context guidelines of Arksey and O'Malley and the PRISMA 2020 checklist. A literature search (Medline, Embase, Scopus, Africa Index Medicus) was performed from inception until December 2023 in collaboration with a medical information specialist. Peer-reviewed English-published literature was considered. Two independent reviewers screened titles, abstracts, and full-texts., Results: Twenty-four studies were included from 7 of 46 Sub-Saharan countries (15%). Prevalence of absenteeism varied from 14% to 49%. Causes at individual and health-system levels were explored in 16 studies (67%) and included physician dual practices (75%), low wages (69%), and insufficient supervision (56%). Consequences at the healthcare worker and patient level were described in 14 studies (58%) and included hindered/delayed access to care (64%), high workload (29%), and increased treatment costs when patients are forced to attend private facilities (22%). Recommendations to address absenteeism were provided in 18 studies (75%) and included regular supervision (33%), performance-based rewards/punishments (33%), and augmented salaries (33%)., Conclusion: Absenteeism is highly prevalent among primary healthcare workers in Sub-Sahara Africa. Its adverse impact on both healthcare workers and patients is profound. The complexity of different individual and health system causal factors shows that a multifactorial approach to address absenteeism is warranted., (© 2025 The Author(s). The International Journal of Health Planning and Management published by John Wiley & Sons Ltd.)

Background: Snakebite envenoming is a neglected tropical disease that causes significant morbidity and mortality in rural sub-Saharan Africa. However, there is a notable lack of data concerning the management and treatment outcomes for those affected. This study addresses this gap by examining the management and treatment outcomes of snakebite victims in Uganda., Methods: We reviewed retrospective data of 532 snakebite cases attending 16 Ugandan health facilities from January 2017 to December 2021. Demographic characteristics and clinical data were extracted from patient records and summarized using descriptive statistics., Results: The snakebite victims had a median age of 26 y, most were male (55.3%) and had bites of unidentified snake species (92.3%). Among the 465 treated patients, 71.6% received antibiotics, 66.0% hydrocortisone, 36.3% analgesics and only 6.9% antivenom. No adverse antivenom reactions were documented. The majority (89.5%) were discharged; 1.3% died and 5.5% had unknown outcomes., Conclusions: These results suggest that snakebite envenoming affects vulnerable Ugandans, particularly young males and children. Treatment is primarily supportive, with antibiotic overuse and infrequent antivenom administration. Health provider training on appropriate snakebite management is needed to optimize outcomes., (© The Author(s) 2024. Published by Oxford University Press on behalf of Royal Society of Tropical Medicine and Hygiene.)