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The ideals of education in Ujamaa philosophy as enunciated by Julius Kambarage Nyerere, the founding president of Tanzania, are neglected phenomena in African education. In about fifty decades of offering education in Africa, from the end of colonialism to the present, education has not enabled Africans to be self-reliant and to live peacefully as brothers and sisters. The paper analyses Nyerere's ideals embedded in Ujamaa philosophy and realises that African education portrays a neglect of the ideals of Nyerere and this does not auger well for the continent. The continent requires education that can make it self-reliant in economics, politics and cultural practices. It calls upon African educationists to rethink and revisit Nyerere's ideals with a view to charting appropriate education for the continent. Three action plans to be carried out by African philosophers of education that focus on constant reviews on interpreting Nyerere's ideas, political participation and forming organisations which specifically deal with African philosophy of education are posited. It is recommended that more interpretation of Nyerere's ideas should be a continuous process. What also warrants further research is combining academic work with vocational training.

This study examines the relationship between general studies, information and communication technology (ICT), and contemporary evangelism in Nigeria. Information and communication technology (is defined as a diverse set of technological tools and resources used to transmit, store, create, share or exchange information. These technological tools and resources include computers, the Internet (websites, blogs and emails), live broadcasting technologies (radio, television and webcasting), recorded broadcasting technologies (podcasting, audio and video players, and storage devices) and telephony (fixed or mobile, satellite, visio/video conferencing, etc.). Contemporary evangelism and mission in Africa is a radical approach embarked upon by agents of modern religious thoughts and practices to expand the horizons of the mission of religion to mankind in the present dispensation through general studies (GS) and ICT programmes. Through the medium of ICT, Christian evangelism has received a boost in television, radio broadcasts, computers, and the Internet across cities and nations. This work is an attempt to examine the methods adopted by early missionaries in evangelising Africa vis-à-vis the modern techniques of GS and ICT, the challenges of mission, the concept of ICT and its various forms such as phones, television, radio, computers, and the Internet, and their relevance to mission. This work therefore adopted historical, missiological, and phenomenological approaches in the analysis of data. Contribution: This work discovers that radical development in communication across the globe has influenced and affected Christian methods and practices of carrying out 'the mission of religion' and its evangelical perspective, among others. [ABSTRACT FROM AUTHOR]

Major part of African economy such as Nigerian economy has been experiencing high rate of adult financial exclusion, and poor usage of novel financial technologies. Several factors have been shown from developed nations to have significant effect on how customers use and adopt financial innovations. The study investigates the acceptance and use of fingerprint biometric authentication in an African context. This is critical because of the driving cashless policies of most African nations like Nigeria and the proliferation of different financial innovations to which a significant few have gained user traction. The paper is centered on advancing structural model to fit the African context of fingerprint authentication, and assess how customers’ perception of its usefulness can have mediating influence on its adoption. Thus, how do customers perceive usefulness of fingerprint authentication in adopting the device when associated with other determinant factors? Cross-sectional design was adopted while adapted structured questionnaire was used to pool 311 responses using snowball sampling. Confirmatory factor analysis was carried out while structural equation modeling was used to prove the hypotheses. Convenience, perceived security, personal innovativeness, perceived usefulness and subjective norm are the key drivers of fingerprint biometric authentication in Africa. However, convenience is the key contributor in deepening the cashless market while perceived usefulness partially mediate behavioral intention. The predictive power of 76% intention to use biometric authentication indicates inclusion of major factors that enables understanding of the implications while the mediation analysis portrays the value of such factors in deepening cashless market. Also it is one of scarce literature on deepening cashless market in African context through biometric authentication. Therefore, it is concluded that in African context of customer reaction to biometric authentication, convenience has paramount influence while customers significantly value usefulness as it mediates the relationship of other factors to the adoption of the innovation. [ABSTRACT FROM AUTHOR]

Background: Albizia coriaria Welw ex. Oliver (A. coriaria) is one of the treasured medicinal plants in Africa. In continuity of our study verifying the claim of using its leaves for managing bacterial diseases and oxidative stress-mediated complications in Ugandan traditional phytomedicine, we characterized its most active (ethanolic) extract using ultraviolet–visible (UV–Vis) spectroscopy, Fourier transform infrared (FTIR) spectroscopy, thin layer chromatography, column chromatography and gas chromatography–mass spectrometry. Results: UV–Vis absorption peaks occurred between 338 and 664 nm, which indicated the presence of alkaloids, flavonoids and terpenoids. FTIR spectrum of the extract indicated the presence of O–H, C=O and aromatic–C=C which confirmed the presence of alcohols, carboxylic acids and aromatics in the extract. Four known bioactive triterpenoids: lupeol (1), lupenone (2), betulinic acid (3), betulin (4) along with an aromatic alcohol: benzyl alcohol (5) were tentatively identified in different fractions of A. coriaria ethanolic leaf extract. Compound 4 was identified for the first time in this species. Conclusions: All the compounds identified in the fractions of the A. coriaria ethanolic leaf extract have reported pharmacological activities, including antioxidant and antibacterial activities. This supports the traditional use of A. coriaria leaves in the management of oxidative stress-mediated conditions and bacterial diseases in Uganda. [ABSTRACT FROM AUTHOR]

Background: The hair-on-end (HOE) sign is a rare finding seen in the diploic space on skull radiographs, computed tomography (CT) and magnetic resonance imaging (MRI) with the appearance of long, thin vertical striations of calcified spicules perpendicular to the bone surface that looks like hair standing on end. It is classically seen in children/adolescents with hemolytic anemias, in particular, thalassemia major and sickle cell disease. Here, we present a 9-year-old Ugandan girl who presented with stroke in whom head CT demonstrated cerebral intraparenchymal hemorrhage and multiple infarcts on the left with HOE sign. Hb electrophoresis confirmed the diagnosis of sickle cell anemia. Case Summary: We present a 9-year-old Ugandan girl who presented with an unexplained stroke that preceded an episode of acute headache, vomiting, followed by focal convulsions and altered consciousness. Clinical findings revealed severe pallor of the conjunctivae and mild scleral icterus. CT demonstrated right cerebral intraparenchymal hemorrhage, multiple high cerebral infarcts on the right and evidence of extra medullary hematopoiesis with a classical HOE sign. Hemoglobin (Hb) electrophoresis confirmed sickle cell disease (SCD). The child was then initiated on hydroxyurea, antibiotics, analgesics and intravenous fluids. She improved and was discharged 16 days later. Follow-up of the child was uneventful. Conclusion: HOE sign is a complication of chronic hemolysis usually seen in patients with thalassemia and sickle cell anemia. It is a rare finding that clinicians should be well conversant with, especially in Africa where sickle cell disease is common. [ABSTRACT FROM AUTHOR]

Background: Emerging and re-emerging diseases with pandemic potential continue to challenge fragile health systems in Africa, creating enormous human and economic toll. To provide evidence for the investment case for public health emergency preparedness, we analysed the spatial and temporal distribution of epidemics, disasters and other potential public health emergencies in the WHO African region between 2016 and 2018.Methods: We abstracted data from several sources, including: the WHO African Region's weekly bulletins on epidemics and emergencies, the WHO-Disease Outbreak News (DON) and the Emergency Events Database (EM-DAT) of the Centre for Research on the Epidemiology of Disasters (CRED). Other sources were: the Program for Monitoring Emerging Diseases (ProMED) and the Global Infectious Disease and Epidemiology Network (GIDEON). We included information on the time and location of the event, the number of cases and deaths and counter-checked the different data sources.Data Analysis: We used bubble plots for temporal analysis and generated graphs and maps showing the frequency and distribution of each event. Based on the frequency of events, we categorised countries into three: Tier 1, 10 or more events, Tier 2, 5-9 events, and Tier 3, less than 5 or no event. Finally, we compared the event frequencies to a summary International Health Regulations (IHR) index generated from the IHR technical area scores of the 2018 annual reports.Results: Over 260 events were identified between 2016 and 2018. Forty-one countries (87%) had at least one epidemic between 2016 and 2018, and 21 of them (45%) had at least one epidemic annually. Twenty-two countries (47%) had disasters/humanitarian crises. Seven countries (the epicentres) experienced over 10 events and all of them had limited or developing IHR capacities. The top five causes of epidemics were: Cholera, Measles, Viral Haemorrhagic Diseases, Malaria and Meningitis.Conclusions: The frequent and widespread occurrence of epidemics and disasters in Africa is a clarion call for investing in preparedness. While strengthening preparedness should be guided by global frameworks, it is the responsibility of each government to finance country specific needs. We call upon all African countries to establish governance and predictable financing mechanisms for IHR implementation and to build resilient health systems everywhere. [ABSTRACT FROM AUTHOR]

Background: Africa has the highest rates of child mortality. Little is known about outcomes after hospitalization for children with very severe anemia. Objective: To determine one year mortality and predictors of mortality in Tanzanian children hospitalized with very severe anemia. Methods: We conducted a prospective cohort study enrolling children 2–12 years hospitalized from August 2014 to November 2014 at two public hospitals in northwestern Tanzania. Children were screened for anemia and followed until 12 months after discharge. The primary outcome measured was mortality. Predictors of mortality were determined using Cox regression analysis. Results: Of the 505 children, 90 (17.8%) had very severe anemia and 415 (82.1%) did not. Mortality was higher for children with very severe anemia compared to children without over a one year period from admission, 27/90 (30.0%) vs. 59/415 (14.2%) respectively (Hazard Ratio (HR) 2.42, 95% Cl 1.53–3.83). In-hospital mortality was 11/90 (12.2%) and post-hospital mortality was 16/79 (20.2%) for children with very severe anemia. The strongest predictors of mortality were age (HR 1.01, 95% Cl 1.00–1.03) and decreased urine output (HR 4.30, 95% Cl 1.04–17.7). Conclusions: Children up to 12 years of age with very severe anemia have nearly a 30% chance of mortality following admission over a one year period, with over 50% of mortality occurring after discharge. Post-hospital interventions are urgently needed to reduce mortality in children with very severe anemia, and should include older children. [ABSTRACT FROM AUTHOR]

Spatial policies and interventions that focus on promoting sustainable city development from the end of the 20th century in South Africa have been informed by two main underlying imperatives. There has been an urgent need to positively transform the apartheid legacy of socio-economic spatial disequilibrium along racial lines in cities. The intensification of economic global linkages and integration in the era of globalization has also meant that the spatial structure of cities has to be responsive to new rules of competitiveness in the era of economic change regardless of the localized need for political transformation. These spatial imperatives for South African cities in the era of social, political and economic transformation are articulated in various government policy documents which agitate for the integration and transformation of city spaces to promote sustainable development. This paper empirically evaluates the socio-economic spatial imprint of this policy discourse in South Africa, using the case study of Durban. Based on various strategic architectural and urban design projects, the paper argues that the policy discourse of sustainable city transformation is nothing but mere rhetoric, as it is not being successfully articulated in architectural, urban design and housing spatial interventions. Transformation for sustainable development in strategic urban design and architectural spatial intervention projects is still at cross-roads, as socio-economic integration is being relegated to the background by market forces of free enterprise and class relations. The paper recommends a way forward to address the policy claims in respect of sustainable development. [ABSTRACT FROM AUTHOR]

Background: Pharmacovigilance programmes monitor and help ensuring the safe use of medicines which is critical to the success of public health programmes. The commonest method used for discovering previously unknown safety risks is spontaneous notifications. In this study we examine the use of data mining algorithms to identify signals from adverse events reported in a phase IIIb/IV clinical trial evaluating the efficacy and safety of several Artemisinin-based combination therapies (ACTs) for treatment of uncomplicated malaria in African children. Methods: We used paediatric safety data from a multi-site, multi-country clinical study conducted in seven African countries (Burkina Faso, Gabon, Nigeria, Rwanda, Uganda, Zambia, and Mozambique). Each site compared three out of four ACTs, namely amodiaquine-artesunate (ASAQ), dihydroartemisinin-piperaquine (DHAPQ), artemether-lumefantrine (AL) or chlorproguanil/dapsone and artesunate (CD+A). We examine two pharmacovigilance signal detection methods, namely proportional reporting ratio and Bayesian Confidence Propagation Neural Network on the clinical safety dataset. Results: Among the 4,116 children (6–59 months old) enrolled and followed up for 28 days post treatment, a total of 6,238 adverse events were reported resulting into 346 drug-event combinations. Nine signals were generated both by proportional reporting ratio and Bayesian Confidence Propagation Neural Network. A review of the manufacturer package leaflets, an online Multi-Drug Symptom/Interaction Checker (DoubleCheckMD) and further by therapeutic area experts reduced the number of signals to five. The ranking of some drug-adverse reaction pairs on the basis of their signal index differed between the two methods. Conclusions: Our two data mining methods were equally able to generate suspected signals using the pooled safety data from a phase IIIb/IV clinical trial. This analysis demonstrated the possibility of utilising clinical studies safety data for key pharmacovigilance activities like signal detection and evaluation. This approach can be applied to complement the spontaneous reporting systems which are limited by under reporting. [ABSTRACT FROM AUTHOR]

Summary: Artemisinin-resistant Plasmodium falciparum malaria has emerged in western Cambodia and has been detected in western Thailand. The situation is ominously reminiscent of the emergence of resistance to chloroquine and to sulfadoxine–pyrimethamine several decades ago. Artemisinin resistance is a major threat to global public health, with the most severe potential effects in sub-Saharan Africa, where the disease burden is highest and systems for monitoring and containment of resistance are inadequate. The mechanisms that underlie artemisinin resistance are not fully understood. The main phenotypic trait associated with resistance is a substantial delay in parasite clearance, so far reported in southeast Asia but not in Africa. One of the pillars of the WHO global plan for artemisinin resistance containment is to increase monitoring and surveillance. In this Personal View, we propose strategies that should be adopted by malaria-endemic countries in Africa: resource mobilisation to reactivate regional surveillance networks, establishment of baseline parasite clearance profiles to serve as benchmarks to track emerging artemisinin resistance, improved data sharing to allow pooled analyses to identify rare events, modelling of risk factors for drug resistance, and development and validation of new approaches to monitor resistance. [ABSTRACT FROM AUTHOR]

An essay is presented on the use of text messaging (SMS) for the control of malaria in Africa. It states that there are six major areas within malaria control in which simple text messaging could offer the solution to improve the delivery of health services. It is stated that effective malaria control depends on disease and treatment effectiveness surveillance; monitoring the availability of antimalarial medicines, and monitoring of adverse drug events.

Background: Artemisinin-based combination therapy (ACT), the treatment of choice for uncomplicated falciparum malaria, is unaffordable and generally inaccessible in the private sector, the first port of call for most malaria treatment across rural Africa. Between August 2007 and May 2010, the Uganda Ministry of Health and the Medicines for Malaria Venture conducted the Consortium for ACT Private Sector Subsidy (CAPSS) pilot study to test whether access to ACT in the private sector could be improved through the provision of a high level supply chain subsidy. Methods: Four intervention districts were purposefully selected to receive branded subsidized medicines - "ACT with a leaf", while the fifth district acted as the control. Baseline and evaluation outlet exit surveys and retail audits were conducted at licensed and unlicensed drug outlets in the intervention and control districts. A survey-adjusted, multivariate logistic regression model was used to analyse the intervention's impact on: ACT uptake and price; purchase of ACT within 24 hours of symptom onset; ACT availability and displacement of sub-optimal anti-malarial. Results: At baseline, ACT accounted for less than 1% of anti-malarials purchased from licensed drug shops for children less than five years old. However, at evaluation, "ACT with a leaf" accounted for 69% of anti-malarial purchased in the interventions districts. Purchase of ACT within 24 hours of symptom onset for children under five years rose from 0.8% at baseline to 26.2% (95% CI: 23.2-29.2%) at evaluation in the intervention districts. In the control district, it rose modestly from 1.8% to 5.6% (95% CI: 4.0-7.3%). The odds of purchasing ACT within 24 hours in the intervention districts compared to the control was 0.46 (95% CI: 0.08-2.68, p=0.4) at baseline and significant increased to 6.11 (95% CI: 4.32-8.62, p<0.0001) at evaluation. Children less than five years of age had "ACT with a leaf" purchased for them more often than those aged above five years. There was no evidence of price gouging. Conclusions: These data demonstrate that a supply-side subsidy and an intensive communications campaign significantly increased the uptake and use of ACT in the private sector in Uganda. [ABSTRACT FROM AUTHOR]

Introduction: Severe malaria is a life-threatening medical emergency and requires prompt and effective treatment to prevent death. There is paucity of published information on current practices of severe malaria case management in sub-Saharan Africa; we evaluated the management practices for severe malaria in Ugandan health facilities Methods and Findings: We did a cross sectional survey, using multi-stage sampling methods, of health facilities in 11 districts in the eastern and mid-western parts of Uganda. The study instruments were adapted from the WHO hospital care assessment tools. Between June and August 2009, 105 health facilities were surveyed and 181 health workers and 868 patients/caretakers interviewed. None of the inpatient facilities had all seven components of a basic care package for the management of severe malaria consistently available during the 3 months prior to the survey. Referral practices were appropriate for <10% (18/196) of the patients. Prompt care at any health facility was reported by 29% (247/868) of patients. Severe malaria was correctly diagnosed in 27% of patients (233).Though the quinine dose and regimen was correct in the majority (611/868, 70.4%) of patients, it was administered in the correct volumes of 5% dextrose in only 18% (147/815). Most patients (80.1%) had several doses of quinine administered in one single 500 ml bottle of 5% dextrose. Medications were purchased by 385 (44%) patients and medical supplies by 478 patients (70.6%). Conclusions: Management of severe malaria in Ugandan health facilities was sub-optimal. These findings highlight the challenges of correctly managing severe malaria in resource limited settings. Priority areas for improvement include triage and emergency care, referral practises, quality of diagnosis and treatment, availability of medicines and supplies, training and support supervision. [ABSTRACT FROM AUTHOR]

Abstract: Mesoscale oceanographic features, such as upwellings, are known to play an important role in regulating the structure and productivity of nearshore marine communities. Stable isotope (δ13C and δ15N) and fatty acid analyses were employed to assess the influence of an upwelling cell along the south-eastern coastline of southern Africa on the diet of the mussel, Perna perna. Eight sites were sampled: two upstream, three in the vicinity and three downstream of the upwelling cell. Stable isotope and fatty acid signatures indicated that the mussels consumed a diet of detritus derived mainly from macroalgae, diatoms and dinoflagellates. One-way ANOVA on the δ13C and δ15N signatures and the principal component analysis of the fatty acid profiles of the mussels identified distinct groups corresponding to the above mentioned regions. The proportion of diatom biomarkers in the fatty acid profiles decreased downstream of the upwelling region while the proportion of dinoflagellate biomarkers increased. Upwelling regions are typically associated with elevated levels of productivity; however, these systems usually become silicon depleted and result in the replacement of diatoms with dinoflagellates. The highest proportions of the dinoflagellate markers were recorded in the two furthest sites downstream of the upwelling cell. The spatial variation in the diet of the mussels, therefore, appears to reflect the presence of the upwelling cell in the nearshore biology of the region. [Copyright &y& Elsevier]

Background: Home-based management of malaria (HMM) is promoted as a major strategy to improve prompt delivery of effective malaria treatment in Africa. HMM involves presumptively treating febrile children with prepackaged antimalarial drugs distributed by members of the community. HMM has been implemented in several African countries, and artemisinin-based combination therapies (ACTs) will likely be introduced into these programmes on a wide scale. Case presentations: The published literature was searched for studies that evaluated the health impact of community- and home-based treatment for malaria in Africa. Criteria for inclusion were: 1) the intervention consisted of antimalarial treatment administered presumptively for febrile illness; 2) the treatment was administered by local community members who had no formal education in health care; 3) measured outcomes included specific health indicators such as malaria morbidity (incidence, severity, parasite rates) and/or mortality; and 4) the study was conducted in Africa. Of 1,069 potentially relevant publications identified, only six studies, carried out over 18 years, were identified as meeting inclusion criteria. Heterogeneity of the evaluations, including variability in study design, precluded meta-analysis. Discussion and evaluation: All trials evaluated presumptive treatment with chloroquine and were conducted in rural areas, and most were done in settings with seasonal malarial transmission. Conclusions regarding the impact of HMM on morbidity and mortality endpoints were mixed. Two studies showed no health impact, while another showed a decrease in malaria prevalence and incidence, but no impact on mortality. One study in Burkina Faso suggested that HMM decreased the proportion of severe malaria cases, while another study from the same country showed a decrease in the risk of progression to severe malaria. Of the four studies with mortality endpoints only one from Ethiopia showed a positive impact, with a reduction in the under-5 mortality rate of 40.6% (95% CI 29.2 — 50.6). Conclusion: Currently the evidence base for HMM in Africa, particularly regarding use of ACTs, is narrow and priorities for further research are discussed. To optimize treatment and maximize health benefits, drug regimens and delivery strategies in HMM programmes may need to be tailored to local conditions. Additional research could help guide programme development, policy decision-making, and implementation. [ABSTRACT FROM AUTHOR]

The origin of Australopithecus, the genus widely interpreted as ancestral to Homo, is a central problem in human evolutionary studies. Australopithecus species differ markedly from extant African apes and candidate ancestral hominids such as Ardipithecus, Orrorin and Sahelanthropus. The earliest described Australopithecus species is Au. anamensis, the probable chronospecies ancestor of Au. afarensis. Here we describe newly discovered fossils from the Middle Awash study area that extend the known Au. anamensis range into northeastern Ethiopia. The new fossils are from chronometrically controlled stratigraphic sequences and date to about 4.1–4.2 million years ago. They include diagnostic craniodental remains, the largest hominid canine yet recovered, and the earliest Australopithecus femur. These new fossils are sampled from a woodland context. Temporal and anatomical intermediacy between Ar. ramidus and Au. afarensis suggest a relatively rapid shift from Ardipithecus to Australopithecus in this region of Africa, involving either replacement or accelerated phyletic evolution. [ABSTRACT FROM AUTHOR]

Pharmacovigilance, defined as "the science and activities relating to the detection, assessment, understanding and prevention of adverse effects or any other possible drug related problem", is increasingly being recognized in Africa. Many African countries have simultaneously adopted artemisinin derivative based combination therapy (ACT) as first-line treatment for uncomplicated malaria, offering an opportunity to assess the safety of these drugs when used widely. While ACTs appear to be safe and well-tolerated, there is little experience with these medicines in Africa, outside clinical trials. Pharmacovigilance for ACTs and other combination treatments in Africa is essential. Malaria transmission intensity is high and antimalarial medicines are used frequently. Presumptive treatment of fever with antimalarials is common, often in the absence of a confirmed diagnosis, using drugs obtained without a prescription. Informal use of antimalarial drugs may increase the risk of incorrect dosing, inappropriate treatment, and drug interactions, which may impact negatively on drug safety. Furthermore, the administration of antimalarial treatments in patients with a concomitant illness, including HIV/AIDs, tuberculosis and malnutrition, is a concern. African countries are being encouraged to establish pharmacovigilance systems as ACTs are rolled out. However, pharmacovigilance is difficult, even in countries with a well-developed health care system. The rationale for pharmacovigilance of antimalarial drugs is discussed here, outlining the practical challenges and proposing approaches that could be adopted in Africa. [ABSTRACT FROM AUTHOR]

One of the options for achieving an adequate food supply in tropical Africa is by bringing more land into production. This often requires clearing and developing new vegetation areas for agricultural production. In sub-Saharan Africa, large areas of forest are being cleared for cultivation without adequate knowledge as to the consequences of the clearing method employed. This study was therefore initiated to, among other objectives, assess the effects of some forest clearing methods on soil compaction, texture, and micronutrients. Treatments were the following five clearing methods: (1) mechanical (MC), (2) semi-mechanical (SMC), (3) slash and burn (manual) (SB), (4) mechanical – no planting (MCNP), and (5) slash and burn – no planting (SBNP). After clearing, we planted maize and cowpea in every other row during the first year, and planted maize and cassava during the second year in the plots of treatments 1–3. Changes in soil texture, bulk density, and exchangeable Fe, Zn, Mn, and Cu were determined. Soil bulk density increased (with depth) in all treatments from the intitial (0–15 cm) level of 1.1 g cm-3 to between 1.27 and 1.39 g cm-3 2 years after clearing, with the highest levels occurring in the MC plots. This indicated that clearing was accompanied by soil compaction. Some changes were noted in soil textural composition, but these were not of practical significance. Exchangeable Mn, Fe, and Cu (0–15 cm) decreased markedly after clearing, especially under MC in the first year. Zinc levels changed little during the study period. The decline in micronutrient levels was paralleled by a decline in soil organic carbon. [ABSTRACT FROM AUTHOR]

African cities are faced with problems emanating from their colonial past, with new challenges that contribute to the continuation of poverty. This paper addresses contemporary challenges such as a lack of attention to gender issues, proliferating debt crises, and the problems of urban management. A significant problem is that these and other issues are viewed separately and are not treated holistically. [Copyright &y& Elsevier]

Previous studies have shown the taxonomic value of vocal repertoires and hand (volar) pad characteristics in the classification of cryptic nocturnal primates such as bush babies. However, no study included quantitative comparisons within the geographical range of any one species. We investigated levels of intraspecific variation in calls and hand pad characteristics of the southern lesser bush baby (Galago moholi ), using the northern lesser bush baby (Galago senegalensis ) for interspecific comparisons. Examination of calls recorded from different regions along a transect of 1500 km across southern Africa revealed low levels of intraspecific variation in Galago moholi , whereas comparisons with homologous call-types in G. senegalensis revealed them to be significantly different. Volar pad measurements across the ranges of both species also showed low levels of intraspecific variation and relatively high interspecific variation. These findings demonstrate that vocal and volar pad characteristics can be used as consistent measures of difference between species that look almost identical. These methods provide a practical means of distinguishing between cryptic species, whether in the field, in captivity, or, in the case of volar pads, of preserved specimens. [ABSTRACT FROM AUTHOR]

Focuses on the perspective of Christians in Africa discussed in the seventh assembly of the World Council of Churches. Frustration and humiliation of the African delegates during the assembly; Suggestion for dialogue on the problem posed by Islam to Christians in Africa; Significance of the sub-theme of the assembly to understand mission.

The Affordable Medicines Facility-malaria (AMFm) has put into place a bold financing plan for artemisinin-combination therapy in a pilot phase in seven countries covering half the population at risk of malaria in Africa. A report of the AMFm independent evaluation, conducted by ICF International and the London School of Hygiene and Tropical Medicine, describes the success of the programme in the pilot sites: Ghana, Kenya, Madagascar, Niger, Nigeria, Tanzania (mainland and Zanzibar) and Uganda, comparing availability and affordability of high-quality artemisinin-combination therapies before and after AMFm launched. Proof of concept was achieved: AMFm increased availability and kept prices low, meeting its initial, ambitious benchmarks in most settings. Despite this overwhelming success, opposition to the programme and dwindling resources for malaria control conspire to cripple or kill AMFm. [ABSTRACT FROM AUTHOR]

Abstract: Mansonella perstans is a vector-borne human filarial nematode, transmitted by tiny blood-sucking flies (biting midges). It is widespread in many parts of Sub-Saharan Africa and also occurs in parts of Central and South America. Despite the commonness of this parasite very few studies have been carried out on its epidemiology and on the morbidity resulting from it, and only few thorough drug trials have been conducted to look for effective and suitable drugs and drug regimens for treatment and control. Here, we review currently available knowledge on M. perstans infections in Africa, including documented aspects of biology, vectors, transmission, diagnosis, epidemiology, morbidity and treatment. It is concluded that there is an urgent need for more research on this widespread but greatly neglected infection in order to properly assess its public health significance and as a background for identifying and recommending optimal means and strategies for treatment and control. [Copyright &y& Elsevier]

The article reports on the prevalence of counterfeit artesunate in Africa and Asia. It notes that fakes containing subtherapeutic amounts of artesunate could result in the emergence and spread of resistance to the artemisinin drugs, shortening the life of these vital medicines. Artemisinin derivatives are rapid in their antimalarial effects and they are very well tolerated.

Radiocarbon dates from secure cultural contexts along the Sudanese Nile are crucial for understanding the potential role of the Nile as a corridor for postglacial human dispersal across northern Africa. Dates from this region show reoccupation of the Sudanese Nile south of the Second Nile Cataract was delayed by 0.4–0.7 ka compared with the Sahara, where a dramatic increase in the number of radiocarbon dates suggests a massive colonisation of the previously hyper-arid region as early as 10.9–10.6 ka. We present a series of 44 radiocarbon dates from the site of Sphinx at the Sixth Nile Cataract in central Sudan that moves the beginnings of postglacial reoccupation of the Sudanese Nile from 10.2 to 10.7 ka and synchronizes occupation here with the first wave of early Holocene human expansion across northern Africa. These new dates support the role of the Nile as a corridor for expansion from sub-Saharan Africa. In addition to radiocarbon dates, this study also presents evidence for expansion from material culture. Our data show that the early Holocene Early Khartoum culture, which includes one of the earliest pottery traditions in Africa, appears in central Sudan as a "package" and may have been brought into the region from unknown settlement enclaves located further to the south, possibly in the upper White Nile or Blue Nile. The four-millennia-long and nearly continuous sequence of dates from Sphinx attests to stability of hunter-gatherer settlement around the Sixth Nile Cataract. It also suggests adaptability and resilience of local hunter-gatherers in the face of climatic and environmental fluctuations that affected northern Africa during the early to middle Holocene. • The Nile was a viable corridor of postglacial reoccupation of northern Africa. • The Sudanese Nile and the Sahara were reoccupied synchronously. • 14C dates and material culture point to southern origin of the incoming groups. • 14C dataset suggests resilience to climatic and other shifts between 10.7 and 6.7 ka. • A burial phase between 8.6 and 7.9 ka signals innovations in lifeways along the Nile. [ABSTRACT FROM AUTHOR]

Abstract: Ethnopharmacological relevance: Hypoxis species (Hypoxidaceae) are popular medicinal plants used in the African traditional medicine to treat numerous ailments and are reported to have a wide spectrum of pharmacological properties. In this paper we reviewed and evaluated the traditional uses, pharmacological, phytochemistry and toxicity aspects of the genus Hypoxis. Potential medicinal prospects and possible knowledge gaps and pitfalls are discussed. Materials and methods: A comprehensive and systematic review of literature on Hypoxis species was done using numerous resources such as books and scientific databases that include Pubmed, Scopus, Scirus, Google scholar, Web of Science and others. Information on the various pharmacological and chemical properties of Hypoxis extracts was critically analysed and discussed under the various topics. Results: The literature indicated a broad range of uses, pharmacological and toxicological properties of different Hypoxis species extracts and their relevance to African healthcare systems. Several compounds, mostly glucosides, sterols and sterolins, have been isolated, identified and tested in various in vitro and in vivo models as well as in a couple of clinical trials with a lot of promising prospects reported in some studies. Conclusion: A critical analysis of the available literature and studies identifies positive potential for the future use of Hypoxis species in both traditional and modern medicine and concurrently so with possible pitfalls and research gaps in current knowledge. An integrated and holistic approach to addressing research issues, particularly toxicology aspects could be more effectively applied and incorporate conservation strategies for the species. [Copyright &y& Elsevier]

The article focuses on the scientific value of human biological samples obtained in the course of clinical research. The collection and storage of biological samples obtained from individuals in Africa is thought to be especially worrisome. While limited to Ugandans, most living in rural areas, the results do not support the concerns raised over storing biological samples obtained from Africans for future research purposes. The study was conducted at four sites in Uganda, selected because of malaria transmission rates, geographical representation and presence of a stable population. The index study also included a separate consent form.

• Morbidity and mortality in children due to COVID-19 remained low • Adolescents had higher reported cases than younger children • Reported cases were lower in pediatric population than adult population • Testing protocols vary between countries; reflects bias in reported cases Few data on the COVID-19 epidemiological characteristics among the pediatric population in Africa exists. This paper examines the age and sex distribution of the morbidity and mortality rate in children with COVID-19 and compares it to the adult population in 15 Sub-Saharan African countries. A merge line listing dataset shared by countries within the Regional Office for Africa was analyzed. Patients diagnosed within 1 March and 1 September 2020 with a confirmed positive RT-PCR test for SARS-CoV-2 were analyzed. Children's data were stratified into three age groups: 0-4 years, 5-11 years, and 12-17 years, while adults were combined. The cumulative incidence of cases, its medians, and 95% confidence intervals were calculated. 9% of the total confirmed cases and 2.4% of the reported deaths were pediatric cases. The 12-17 age group in all 15 countries showed the highest cumulative incidence proportion in children. Adults had a higher case incidence per 100,000 people than children. The cases and deaths within the children's population were smaller than the adult population. These differences may reflect biases in COVID-19 testing protocols and reporting implemented by countries, highlighting the need for more extensive investigation and focus on the effects of COVID-19 in children. [ABSTRACT FROM AUTHOR]

Abstract: Between 70 and 50 ka BP, anatomically modern humans dispersed across and out of Africa to eventually populate all inhabitable continents. Knowledge of paleoenvironments and human behavioral patterns in Africa prior to and during these dispersals is crucial for understanding how and why hunter-gatherers were able to adapt rapidly to the new environments they encountered. However, few well-dated sites from this time period are known from the Horn of Africa, one of the purported staging areas for population movements into southern Arabia and Asia. Excavations at Mochena Borago Rockshelter, situated on the western slopes of a dormant volcano where the SW Ethiopian Highlands meet the Ethiopian Rift, have yielded the first securely dated archaeological sequence for later periods of the dispersal. Three major lithostratigraphic groups incorporating occupational episodes have yielded charcoal radiocarbon ages ∼53–38 ka calBP; deeper deposits have been tested but remain undated. Archaeological assemblages consist mainly of obsidian flaked stone artifacts manufactured from small, minimally prepared, single- to multi-platform flake cores; radially prepared cores are rare and blade cores are absent. Small unifacial to bifacial points from non-radial cores dominate the earliest shaped tool assemblages, and backed pieces first appear by ∼45 ka calBP. By ∼43 ka calBP, scrapers and backed pieces are predominant, rather than points. However, there is little evidence for technological change other than the appearance of bipolar technology. Mochena Borago''s archaeological sequence thus cannot be neatly classified as Middle Stone Age, Later Stone Age or “transitional” and calls into question some of the principles by which archaeologists have attempted to classify African toolmaking traditions. [Copyright &y& Elsevier]

Summary: Several African countries that have adopted artemisinin-based combination therapy (ACT) as first-line treatment of uncomplicated Plasmodium falciparum malaria also use quinine monotherapy as second-line therapy. This policy goes against WHO recommendations for combination therapy and could be considered an inappropriate public health policy. Adherence to a 7-day quinine treatment schedule is likely to be poor and may increase the risk of selecting resistant parasites. Furthermore, because quinine has limited post-treatment prophylaxis, it will not prevent, in areas of intense transmission, recurrent malaria infections, which can lead to additional morbidity, including anaemia. Therefore, ACTs and not quinine should be used as second-line treatment, because these are well tolerated, highly efficacious, and have the advantage of reducing gametocyte carriage and consequently malaria transmissibility, particularly in areas of less intense transmission. [Copyright &y& Elsevier]

This article presents the view that the World Bank has made false financial and statistical claims in its "Global Strategy & Booster Program," the Bank's management plan for controlling malaria. The mission of the World Bank is to reduce global poverty; malaria destroys about 1 million lives annually and is the leading cause of death for children in Africa and for the impoverishment of their families. The Bank's plan is inadequate to reverse their history of neglect toward malaria. The Bank claimed success for its malaria programs with the use of false epidemiological data and has approved clinically obsolete therapies for a potentially deadly form of malaria. The Bank should reallocate its funding to other agencies better placed to manage malaria.

Competing Interests: Competing interests: None declared.

Investment in severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) sequencing in Africa over the past year has led to a major increase in the number of sequences that have been generated and used to track the pandemic on the continent, a number that now exceeds 100,000 genomes. Our results show an increase in the number of African countries that are able to sequence domestically and highlight that local sequencing enables faster turnaround times and more-regular routine surveillance. Despite limitations of low testing proportions, findings from this genomic surveillance study underscore the heterogeneous nature of the pandemic and illuminate the distinct dispersal dynamics of variants of concern-particularly Alpha, Beta, Delta, and Omicron-on the continent. Sustained investment for diagnostics and genomic surveillance in Africa is needed as the virus continues to evolve while the continent faces many emerging and reemerging infectious disease threats. These investments are crucial for pandemic preparedness and response and will serve the health of the continent well into the 21st century.

Introduction: Estimating COVID-19 cumulative incidence in Africa remains problematic due to challenges in contact tracing, routine surveillance systems and laboratory testing capacities and strategies. We undertook a meta-analysis of population-based seroprevalence studies to estimate SARS-CoV-2 seroprevalence in Africa to inform evidence-based decision making on public health and social measures (PHSM) and vaccine strategy., Methods: We searched for seroprevalence studies conducted in Africa published 1 January 2020-30 December 2021 in Medline, Embase, Web of Science and Europe PMC (preprints), grey literature, media releases and early results from WHO Unity studies. All studies were screened, extracted, assessed for risk of bias and evaluated for alignment with the WHO Unity seroprevalence protocol. We conducted descriptive analyses of seroprevalence and meta-analysed seroprevalence differences by demographic groups, place and time. We estimated the extent of undetected infections by comparing seroprevalence and cumulative incidence of confirmed cases reported to WHO., Prospero: CRD42020183634., Results: We identified 56 full texts or early results, reporting 153 distinct seroprevalence studies in Africa. Of these, 97 (63%) were low/moderate risk of bias studies. SARS-CoV-2 seroprevalence rose from 3.0% (95% CI 1.0% to 9.2%) in April-June 2020 to 65.1% (95% CI 56.3% to 73.0%) in July-September 2021. The ratios of seroprevalence from infection to cumulative incidence of confirmed cases was large (overall: 100:1, ranging from 18:1 to 954:1) and steady over time. Seroprevalence was highly heterogeneous both within countries-urban versus rural (lower seroprevalence for rural geographic areas), children versus adults (children aged 0-9 years had the lowest seroprevalence)-and between countries and African subregions., Conclusion: We report high seroprevalence in Africa suggesting greater population exposure to SARS-CoV-2 and potential protection against COVID-19 severe disease than indicated by surveillance data. As seroprevalence was heterogeneous, targeted PHSM and vaccination strategies need to be tailored to local epidemiological situations., Competing Interests: Competing interests: WHO had a role in study design, data collection, data analysis, data interpretation and writing of the report. No other funders had any such role. The corresponding authors had full access to all the data in the study and had final responsibility for the decision to submit for publication. Authors were not precluded from accessing data in the study, and they accept responsibility to submit for publication. Potential other competing interests of named coauthors include: RKA reports personal fees from the Public Health Agency of Canada and the Bill and Melinda Gates Foundation Strategic Investment Fund, as well as equity in Alethea Medical (outside the submitted work). MPC reports personal fees from GEn1E Lifesciences (outside the submitted work), nplex biosciences (outside the submitted work) and Kanvas biosciences (outside the submitted work). JP reports grants from MedImmune (outside the submitted work) and Sanofi-Pasteur (outside the submitted work), grants and personal fees from Merck (outside the submitted work) and AbbVie (outside the submitted work) and personal fees from AstraZeneca (outside the submitted work). CCo reports funding from Sanofi Pasteur (outside of the submitted work). KE reports being cochairman of ANRS group on public health and social science in France (outside of the submitted work). JDS reports consulting fees from ASLM, GIZ health-focus and l’Oréal (all outside of the submitted work)., (© Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Objectives: We conducted a review of intra-action review (IAR) reports of the national response to the COVID-19 pandemic in Africa. We highlight best practices and challenges and offer perspectives for the future., Design: A thematic analysis across 10 preparedness and response domains, namely, governance, leadership, and coordination; planning and monitoring; risk communication and community engagement; surveillance, rapid response, and case investigation; infection prevention and control; case management; screening and monitoring at points of entry; national laboratory system; logistics and supply chain management; and maintaining essential health services during the COVID-19 pandemic., Setting: All countries in the WHO African Region were eligible for inclusion in the study. National IAR reports submitted by March 2021 were analysed., Results: We retrieved IAR reports from 18 African countries. The COVID-19 pandemic response in African countries has relied on many existing response systems such as laboratory systems, surveillance systems for previous outbreaks of highly infectious diseases and a logistics management information system. These best practices were backed by strong political will. The key challenges included low public confidence in governments, inadequate adherence to infection prevention and control measures, shortages of personal protective equipment, inadequate laboratory capacity, inadequate contact tracing, poor supply chain and logistics management systems, and lack of training of key personnel at national and subnational levels., Conclusion: These findings suggest that African countries' response to the COVID-19 pandemic was prompt and may have contributed to the lower cases and deaths in the region compared with countries in other regions. The IARs demonstrate that many technical areas still require immediate improvement to guide decisions in subsequent waves or future outbreaks., Competing Interests: Competing interests: AT, JO, MS, EOM, BLH, OPCR, DY, MN, AM, FMB, ABD, RKW, CM, HKN, MT, AO, BB, LNM, INC, FS, SC, BI, NN, ZY and ASG are WHO staff members and have supported countries to conduct IARs but were not involved in the writing of country IAR reports included in the analysis. CI and CSW have no competing interests to declare., (© Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY. Published by BMJ.)

The need for resilient health systems is recognized as important for the attainment of health outcomes, given the current shocks to health services. Resilience has been defined as the capacity to "prepare and effectively respond to crises; maintain core functions; and, informed by lessons learnt, reorganize if conditions require it". There is however a recognized dichotomy between its conceptualization in literature, and its application in practice. We propose two mutually reinforcing categories of resilience, representing resilience targeted at potentially known shocks, and the inherent health system resilience, needed to respond to unpredictable shock events. We determined capacities for each of these categories, and explored this methodological proposition by computing country-specific scores against each capacity, for the 47 Member States of the WHO African Region. We assessed face validity of the computed index, to ensure derived values were representative of the different elements of resilience, and were predictive of health outcomes, and computed bias-corrected non-parametric confidence intervals of the emergency preparedness and response (EPR) and inherent system resilience (ISR) sub-indices, as well as the overall resilience index, using 1000 bootstrap replicates. We also explored the internal consistency and scale reliability of the index, by calculating Cronbach alphas for the various proposed capacities and their corresponding attributes. We computed overall resilience to be 48.4 out of a possible 100 in the 47 assessed countries, with generally lower levels of ISR. For ISR, the capacities were weakest for transformation capacity, followed by mobilization of resources, awareness of own capacities, self-regulation and finally diversity of services respectively. This paper aims to contribute to the growing body of empirical evidence on health systems and service resilience, which is of great importance to the functionality and performance of health systems, particularly in the context of COVID-19. It provides a methodological reflection for monitoring health system resilience, revealing areas of improvement in the provision of essential health services during shock events, and builds a case for the need for mechanisms, at country level, that address both specific and non-specific shocks to the health system, ultimately for the attainment of improved health outcomes., Competing Interests: The authors have declared that no competing interests exist.

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.

Monitoring and evaluation (M&E) is an essential component of public health emergency response. In the WHO African region (WHO AFRO), over 100 events are detected and responded to annually. Here we discuss the development of the M&E for COVID-19 that established a set of regional and country indicators for tracking the COVID-19 pandemic and response measures. An interdisciplinary task force used the 11 pillars of strategic preparedness and response to define a set of inputs, outputs, outcomes and impact indicators that were used to closely monitor and evaluate progress in the evolving COVID-19 response, with each pillar tailored to specific country needs. M&E data were submitted electronically and informed country profiles, detailed epidemiological reports, and situation reports. Further, 10 selected key performance indicators were tracked to monitor country progress through a bi-weekly progress scoring tool used to identify priority countries in need of additional support from WHO AFRO. Investment in M&E of health emergencies should be an integral part of efforts to strengthen national, regional and global capacities for early detection and response to threats to public health security. The development of an adaptable M&E framework for health emergencies must draw from the lessons learned throughout the COVID-19 response.

Competing Interests: Competing interests: None declared.

Introduction: Physical and social distancing refer to purposeful reduction of close contact between people, such as school closures and workplace closures. These measures are useful in containing coronavirus disease 2019 (COVID-19) but have negative effects on social structures and the economy. There is thus a need for optimal timing on when to setup and relax them. We examined the evidence regarding the initiation and lifting of these public health measures., Methods: We searched for eligible studies in PubMed, Scopus, and Google Scholar in April 2020, and conducted a qualitative synthesis of the study findings., Results: We searched for eligible studies in PubMed, Scopus, and Google Scholar in April 2020, and conducted a qualitative synthesis of the study findings. The electronic searches yielded 2503 records, from which we included 10 observational and mathematical modeling studies. These studies used data from one or multiple countries on COVID-19 (nine studies) or another viral epidemic such as Zika (one study). Most of the studies show the importance of using physical and social distancing at the start of the epidemic and utilising a staggered approach when easing the restrictions, while scaling up testing. The lifting of lockdown measures should be accompanied by continued use of personal protective equipment, the limiting of workdays, and wide-scale testing., Conclusion: This review highlights the importance of timeous action when faced with an epidemic, let alone a pandemic. The setting up and relaxation of public measures are time sensitive and data-driven actions. In the absence of a safe and effective vaccine, these findings are relevant for the sustainable containment of COVID-19 in African countries., Competing Interests: The authors declare no competing interests., (© Jill Ryan et al.)

The spread of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) has been unprecedented in its speed and effects. Interruption of its transmission to prevent widespread community transmission is critical because its effects go beyond the number of COVID-19 cases and deaths and affect the health system capacity to provide other essential services. Highlighting the implications of such a situation, the predictions presented here are derived using a Markov chain model, with the transition states and country specific probabilities derived based on currently available knowledge. A risk of exposure, and vulnerability index are used to make the probabilities country specific. The results predict a high risk of exposure in states of small size, together with Algeria, South Africa and Cameroon. Nigeria will have the largest number of infections, followed by Algeria and South Africa. Mauritania would have the fewest cases, followed by Seychelles and Eritrea. Per capita, Mauritius, Seychelles and Equatorial Guinea would have the highest proportion of their population affected, while Niger, Mauritania and Chad would have the lowest. Of the World Health Organization's 1 billion population in Africa, 22% (16%-26%) will be infected in the first year, with 37 (29 - 44) million symptomatic cases and 150 078 (82 735-189 579) deaths. There will be an estimated 4.6 (3.6-5.5) million COVID-19 hospitalisations, of which 139 521 (81 876-167 044) would be severe cases requiring oxygen, and 89 043 (52 253-106 599) critical cases requiring breathing support. The needed mitigation measures would significantly strain health system capacities, particularly for secondary and tertiary services, while many cases may pass undetected in primary care facilities due to weak diagnostic capacity and non-specific symptoms. The effect of avoiding widespread and sustained community transmission of SARS-CoV-2 is significant, and most likely outweighs any costs of preventing such a scenario. Effective containment measures should be promoted in all countries to best manage the COVID-19 pandemic., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Background: The Ministry of Health and Sanitation (MOHS) in Sierra Leone partially rolled out the implementation of Integrated Disease Surveillance and Response (IDSR) in 2003. After the Ebola virus disease outbreak in 2014-2015, there was need to strengthen IDSR to ensure prompt detection and response to epidemic-prone diseases. We describe the processes, successes and challenges of revitalizing public health surveillance in a country recovering from a protracted Ebola virus disease outbreak., Methods: The revitalization process began with adaptation of the revised IDSR guidelines and development of customized guidelines to suit the health care systems in Sierra Leone. Public health experts defined data flow, system operations, case definitions, frequency and channels of reporting and dissemination. Next, phased training of IDSR focal persons in each health facility and the distribution of data collection and reporting tools was done. Monitoring activities included periodic supportive supervision and data quality assessments. Rapid response teams were formed to investigate and respond to disease outbreak alerts in all districts., Results: Submission of reports through the IDSR system began in mid-2015 and by the 35th epidemiologic week, all district health teams were submitting reports. The key performance indicators measuring the functionality of the IDSR system in 2016 and 2017 were achieved (WHO Africa Region target ≥80%); the annual average proportion of timely weekly health facility reports submitted to the next level was 93% in 2016 and 97% in 2017; the proportion of suspected outbreaks and public health events detected through the IDSR system was 96% (n = 87) in 2016 and 100% (n = 85) in 2017., Conclusion: With proper planning, phased implementation and adequate investment of resources, it is possible to establish a functional IDSR system in a country recovering from a public health crisis. A functional IDSR system requires well trained workforce, provision of the necessary tools and guidelines, information, communication and technology infrastructure to support data transmission, provision of timely feedback as well as logistical support.

Background: Nearly 40% of Global Fund money goes toward procurement. However, no analyses have been published to show how costs vary across regions and time, despite the availability of procurement data collected through the Global Fund's price and quality reporting system., Methodology: We analyzed data for the 3 most widely procured commodities for the prevention, diagnosis, and treatment of HIV. These were male condoms, HIV rapid tests, and the antiretroviral (ARV) combination of lamivudine/nevirapine/zidovudine. The compared costs, first across time (2005-2012), then across regions, and finally, between individual procurement reported through the price and quality reporting and pooled procurement reported through the Global Fund's voluntary pooled procurement system. All costs were adjusted for inflation and reported in US dollars., Key Findings: There were 2337 entries from 578 grants in 125 countries. The procurement cost for the ARV dropped substantially over the period, whereas those for condoms and HIV tests remained relatively stable. None of the commodity prices increased. Regional variations were pronounced for HIV tests, but minimal for condoms and the ARV. The unit cost for the 3-table ARV combination, for instance, varied between US$0.15 and US$0.23 in South Asia and the Eastern Europe/Central Asia regions, respectively, compared with a range of $0.23 (South Asia)-$1.50 (Eastern Europe/Central Asia) for a single diagnostic test. Pooled procurement lowered costs for condoms but not the other commodities., Conclusions: We showed how global procurement costs vary by region and time. Such analyses should be done more often to identify and correct market insufficiencies.

Background: Artemisinin combination therapies (ACTs) are currently the preferred option for treating uncomplicated malaria. Dihydroartemisinin-piperaquine (DHA-PQP) is a promising fixed-dose ACT with limited information on its safety and efficacy in African children., Methodology/principal Findings: The non-inferiority of DHA-PQP versus artemether-lumefantrine (AL) in children 6-59 months old with uncomplicated P. falciparum malaria was tested in five African countries (Burkina Faso, Kenya, Mozambique, Uganda and Zambia). Patients were randomised (2:1) to receive either DHA-PQP or AL. Non-inferiority was assessed using a margin of -5% for the lower limit of the one-sided 97.5% confidence interval on the treatment difference (DHA-PQP vs. AL) of the day 28 polymerase chain reaction (PCR) corrected cure rate. Efficacy analysis was performed in several populations, and two of them are presented here: intention-to-treat (ITT) and enlarged per-protocol (ePP). 1553 children were randomised, 1039 receiving DHA-PQP and 514 AL. The PCR-corrected day 28 cure rate was 90.4% (ITT) and 94.7% (ePP) in the DHA-PQP group, and 90.0% (ITT) and 95.3% (ePP) in the AL group. The lower limits of the one-sided 97.5% CI of the difference between the two treatments were -2.80% and -2.96%, in the ITT and ePP populations, respectively. In the ITT population, the Kaplan-Meier estimate of the proportion of new infections up to Day 42 was 13.55% (95% CI: 11.35%-15.76%) for DHA-PQP vs 24.00% (95% CI: 20.11%-27.88%) for AL (p<0.0001)., Conclusions/significance: DHA-PQP is as efficacious as AL in treating uncomplicated malaria in African children from different endemicity settings, and shows a comparable safety profile. The occurrence of new infections within the 42-day follow up was significantly lower in the DHA-PQP group, indicating a longer post-treatment prophylactic effect., Trial Registration: Controlled-trials.com ISRCTN16263443.