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In many countries of sub-Saharan Africa, the release of each year's results for the end of high school examinations heralds an annual ritual of public commentary on the poor state of national education systems. However, the exoglossic/monolingual language regime for these examinations is infrequently acknowledged as contributing to the dismal performance of students. Even less attended to is the manner in which the language of examinations, through shaping students' performances, may be exacerbating social inequalities. This article politicizes the language of examinations in the region in the hope of generating policy and research interest in what is arguably an insidious source of inequality. The article makes three arguments. Firstly, it is argued that current exoglossic/monolingual practices in these examinations constitute a set of sociolinguistic aberrations, with demonstrable negative effects on students' performance. Secondly, it is argued that the gravity of these paradoxical sociolinguistic disarticulations is better appreciated when their social ramifications are viewed in terms of structural violence and social inequality. Thirdly, in considering how to evolve a more socially equitable examination language regime, it is argued that the notion of consequential validity in testing positions translanguaging as a more ecologically valid model of language use in examinations.

Candida auris is a World Health Organization critical priority fungal pathogen. We conducted a systematic review to describe its epidemiology in Africa. PubMed and Google scholar databases were searched between January 2009 and September 2023 for clinical studies on C. auris cases and/or isolates from Africa. Reviews were excluded. We included 19 studies, involving at least 2529 cases from 6 African countries with the most, 2372 (93.8%), reported from South Africa. Whole-genome sequencing of 127 isolates identified 100 (78.7%) as clade III. Among 527 isolates, 481 (91.3%) were resistant to fluconazole, 108 (20.5%) to amphotericin B, and 9 (1.7%) to micafungin. Ninety of 211 (42.7%) patients with clinical outcomes died. C. auris is associated with high mortality and antifungal resistance, yet this critical pathogen remains underreported in Africa. Collaborative surveillance, fungal diagnostics, antifungals, and sustainable infection control practices are urgently needed for containment. [ABSTRACT FROM AUTHOR]

Objective: A mixed‐methods systematic review to determine reported symptoms, concerns, and experiences of women living with and beyond breast cancer in Africa. Methods: Literature searches were conducted in Medline, Embase, PsycINFO, Global Health, Web of Science, CINAHL, and the Cochrane Library. Quantitative and qualitative studies that comprised study populations of women with breast cancer from countries in Africa, detailing symptoms, concerns, and experiences of living with and beyond breast cancer were included. Inductive framework analysis was applied to organise existing literature with the Adversity, Restoration, and Compatibility framework and quality was assessed using the Mixed Methods Appraisal Tool. Results: In total, 48 studies were included, comprising quantitative (n = 24), qualitative (n = 23) and mixed method (n = 1) studies. Women reported multiple complex and burdensome symptoms at all stages of the breast cancer disease trajectory. Multiple pervasive factors influencing participants' experiences included a lack of cancer knowledge, being removed from decision‐making, religion, and the presence and use of traditional medicines. Literature relating to benefit finding, understanding identity for the future, and broader perspectives of well‐being was absent. Conclusions: This review contributes insights and mapping of symptoms, concerns, and experiences of women with breast cancer in Africa. There is a great necessity to increase an understanding of the needs and experiences of women with breast cancer in Africa following cancer treatment, stages of remission, and longer‐term monitoring and follow‐up. This is required to ensure access to prompt and timely clinical and individualized supportive care for women with breast cancer in Africa. [ABSTRACT FROM AUTHOR]

Africa faces a significant burden of infectious diseases, including Malaria and HIV/AIDS, along with an increasing prevalence of non-infectious diseases such as diabetes and cancer. This dual health challenge is amplified by socioeconomic difficulties, restricted access to healthcare, and lifestyle changes, thus present unique scientific needs. Effectively addressing these issues requires a skilled scientific workforce adept in comprehensive healthcare strategies. This analysis explores the critical landscape of health research in Africa, emphasizing the unique opportunity presented by the continent's youthful population, projected to reach almost 1 billion by 2050. The youth's innovative potential and fresh perspectives offer a chance to overcome development barriers in health research. Nevertheless, challenges such as under-resourced education, limited research training, inadequate mentorship, and funding difficulties persist. This paper urgently calls upon African leaders, international partners, and stakeholders to prioritize health research, mobilize funding, forge strategic partnerships, and empower the youth as essential steps to capitalize on the continent's dynamic youth for breakthrough health outcomes. Such investments are vital not just for health but for the overall economic, social, and strategic growth of the continent. Through shared responsibility and a united effort, the potential of African youth can be harnessed, leading to transformative research, improved health outcomes, and a prosperous future. This perspective represents the collective voice of passionate young researchers and advocates across Africa, calling for a new era of health research on the continent. [ABSTRACT FROM AUTHOR]

The increasing recognition of hydrogen as a critical element in the global net-zero transition and its clear role in decarbonizing challenging sectors coincide with the growing urgency to address climate change. Africa's favourable renewable-energy capacity, ranging from 28% to 36% for solar, has been reported by the global solar irradiance index. However, the majority of hydrogen production today relies on fossil fuels (96%), with only a small fraction (4%) being produced through water electrolysis. Even though there have been many studies on climate change mitigation with a focus on Africa, a green hydrogen production from a photovoltaic power station approach has not been reported. Also, literature with a focus on Nigeria is lacking. This study focuses on the African green hydrogen production industry, utilizing Nigeria as a case study to explore the feasibility of generating clean hydrogen vectors from a percentage of photovoltaic power output in various regions of the country through stand-alone solar grid electrification projects. Analyses of the usage and effectiveness of the produced hydrogen fuel in each region are carried out, with the highest region having an annual output of 12 247 278 kg of green hydrogen and 8 573 094 kg of ammonia and the lowest region having an output of 511 245 kg of green hydrogen and 357 871 kg of ammonia, and the expected production from the proposed usage of 50% of the power generation output of the installed 1.6-MWp and 80-kWp solar power minigrids in the regions is calculated. The analyses were repeated for the other considered regions in the country. The results showcased the enormous advantages of the electrolytic production of hydrogen and how the greener economy project can play a major role in mitigating climate change effects and overreliance on fossil fuels as the driver of the economy in many African countries. [ABSTRACT FROM AUTHOR]

Mucorales fungi cause mucormycosis, an invasive and rapidly progressive disease which increasingly affects mostly immunocompromised but also immunocompetent individuals. The objective of this study was to highlight the epidemiology, diagnostic modalities, treatment and overall survival of mucormycosis in Africa. We searched for relevant publications in PubMed, Google Scholar and African Journal Online databases covering the period 1960–2022. A total of 147 articles were identified, of which 66 were included in the review, detailing 408 individual cases from 12 African countries; 330 (80.9%) from North Africa, 63 (15.4%) from Southern Africa, seven (1.7%) from East Africa, seven (1.7%) from West Africa and a single case (0.2%) from Central Africa. The most frequently described clinical forms were rhino‐orbital‐cerebral (n = 307, 75.2%) and gastrointestinal (n = 51, 12.5%). Diabetes mellitus, COVID‐19, malignancies and neutropaenia were the commonest underlying risks in 203 (49.8%), 101 (24.8%), 65 (15.9%) and 53 (13.0%) cases respectively. Most cases, 296 (72.5%) were diagnosed by histopathology. Fungal aetiology was identified in 38 (9.3%), of which the commonest was Rhizopus oryzae/arrhizus (27/38, 71.1%). Of the 408 cases, 334 (81.9%) patients received antifungal therapy, while 244 (59.8%) had surgery. In cases with a specified outcome, survival rate was 59.1% (228/386). Based on case reporting, a substantial burden of mucormycosis occurs in North Africa but the disease is rarely reported in most of the sub‐Saharan region. Establishing a comprehensive registry for standardised data collection could improve understanding of the epidemiology of mucormycosis in the region. [ABSTRACT FROM AUTHOR]

Objective: The declaration of the coronavirus disease (COVID-19), a pandemic in early 2020, has seen an upsurge in research globally to fill gaps in the epidemiology of the SARS-CoV-2 virus impact on health care and clinical management, as well as possible prevention and treatment modalities. Published literature on the different types of COVID-19 research conducted globally is varied and is particularly limited in Africa. This study sets out to describe the COVID-19-related research registered and conducted on the African continent.Methods: This is a cross-sectional study of all COVID-19-related studies available in the WHO's International Clinical Trials Registry Platform (ICTRP) repository. We extracted studies registered from March 1, 2020, to July 15, 2021. A descriptive analysis of the extracted data was performed, and the findings were presented.Results: At extraction, a total of 12,533 COVID-19-related studies were listed on the ICTRP portal. We included 9803 studies, after excluding 2060 duplicate records and 686 records without a site/country. While 9347 studies (96%) were conducted outside of Africa, only 456 studies (4%) were conducted in the African continent, of which 270 (59.2%) were interventional studies, and 184 (40.4%) were observational studies. About 80% of the studies were conducted in Egypt and South Africa, and most of these involved testing of drugs and biologicals.Conclusion: The African continent hosts considerably fewer COVID-19-related research compared to other parts of the world. This may have implications on scientific evidence available for implementing COVID-19 control efforts. There is, therefore, a need for local funding and ownership of research projects and north-south collaboration in research. [ABSTRACT FROM AUTHOR]

The accelerated development of coronavirus disease (COVID-19) candidate vaccines is intended to achieve worldwide immunity. Ensuring COVID-19 vaccination is crucial to stemming the pandemic, reclaiming everyday life, and helping restore economies. However, challenges exist to deploying these vaccines, especially in resource-limited sub-Saharan Africa. In this article, we highlight lessons learned from previous efforts to scale up vaccine distribution and offer considerations for policymakers and key stakeholders to use for successful COVID-19 vaccination rollout in Africa. These considerations range from improving weak infrastructure for managing data and identifying adverse events after immunization to considering financing options for overcoming the logistical challenges of vaccination campaigns and generating demand for vaccine uptake. In addition, providing COVID-19 vaccination can be used to promote the adoption of universal healthcare, especially in sub-Saharan Africa countries. [ABSTRACT FROM AUTHOR]

The article makes the case for the precautionary principle, where the balance of nature needs to trump the immediate profit of innovation. The penetration of technology in Africa revives old stereotypes about the continent, hegemonic dynamics reminiscent of colonization, and stir a verity of social conflicts as profits and corporate interests come before the people and the environment. [ABSTRACT FROM AUTHOR]

The romanticization, Europeanization and Americanization of the African mindset have not helped Africans especially Nigeria to rapidly advance technologically and scientifically as the African continent still sees itself like a slave to the Western countries. This paper seeks to argue that the relationship between Africa and the west intends to benefit the west completely without a corresponding measure of benefits to the African people. This contention is evidenced in the application of western methodology in attempting a solution and resolution of the African challenges. The Igbo notion Ahamefula is derived from two words "Aham" and "Efula" which means "my name will not be lost or my identity will not be lost" These are words used to connote the identity (Ejirimara) of a person, family a community or a nation. Ahamefula is founded on the logic of unity and identity which stand as hallmark for determining and discovering the weight and potentials of any given individual, family, community and nation. It is argued in this paper that leadership that is anchored on internal mechanism of local circumstance with full conviction and adoption of native ideology will lead the Nigerian State to an enviable political, social, scientific, religious and economic heights. [ABSTRACT FROM AUTHOR]

Most African societies operate a patriarchal system of male headship and female submission in social relations and marriage. This means male headship and women submission are both cultural and religious values within African society. Since these values define the position and role of sexes within African societies, they also present challenges to the gender equality championed by modernity. This paper attempts to show how some cultural and religious values in Africa contribute to the problem of gender inequality. This paper maintains that these values should be critically assessed, and those found to be inimical to the well-being and holistic development of society, be discarded. In such a way, African culture and values can have their relevance established and sustained in order to give credence to authentic African identity. The paper adopts a philosophical method of critical analysis and exposition. [ABSTRACT FROM AUTHOR]

This review highlights the current level of waste plastics valorization through thermal treatment and its potential for African countries. Improved thermal treatment options are needed to convert the over 40% of mismanaged waste plastics in Africa to generate electrical and chemical energy. The values of measured and calculated energy yields from high-quality data are compared for treatment options such as pyrolysis, gasification, incineration, catalytic and plasma gasification. The investigation revealed that, for chemical energy production, catalytic gasification offers the best valuable product yield for single-use plastics with a promising liquid output of up to 80% with a low heating value (LHV) of 44 MJ/kg, gas output 6–7% with heating value of 48 MJ/m3, and solid output of 10–20%. The liquid and gas products obtained at this quality could be used as fuel in a conventional gas/diesel engine for electricity generation. For the treatment of multi-layered and composite waste plastics, plasma gasification offers the best energy recovery approach with a potential of producing syngas with LHV of 10.8 MJ/m3 and consisting of H 2 and CO weight fraction of 62.5% and 34%, respectively. The feasible waste plastics treatment options are presented based on waste plastics profiles in selected regions of Africa. [Display omitted] • Thermal treatment processes for plastic wastes and their conversion are presented. • Energetic characteristics of the derived products from each process are highlighted. • Characteristics and quantification of waste plastics generation in selected African countries are presented. • Applicability of each process in the selected countries are assessed and discussed. • The potential of the most suitable method is derived. [ABSTRACT FROM AUTHOR]

Female genital cutting as practiced in most African countries has attracted wide condemnation. This practice involves partial or total removal of the external female genital organ for nonmedical reasons. Consequently, it causes damage to healthy or normal genital tissue and thus, interferes with the natural function of the girls or woman's body. Female genital cutting is usually carried out on girls within the ages of 10 and 22 years old. Most health experts attribute so many infections suffered by women of child bearing age to it. Also, barrenness, excessive bleeding during child birth or delivery is sometimes blamed on female genital cutting. A lot of infections including HIV have been associated with this cruel practice. It is the position of this paper that, such act is barbaric, and a violation of the human rights of the girl child and womanhood. Therefore, it should in all quarters be discouraged and possibly stopped because it violates a person's right to health, freedom from torture and security, and integrity. [ABSTRACT FROM AUTHOR]

Purpose Cardiovascular disease risk factors have been associated with androgen-deprivation therapy (ADT) in white and Hispanic populations. It is therefore relevant to determine if there exists a relationship between these parameters in the African population. Patients and Methods The design of the studywas cross sectional. Prostate-specific antigen concentration, waist circumference, body mass index (BMI), lipid profile, glucose level, and insulin level were determined in 153 patients with prostate cancer and 80 controls. The patients with prostate cancer were divided into subgroups of treatment-naïve patients and those receiving ADT. Results Mean total cholesterol (P = .010), LDL cholesterol (P = .021), BMI (P = .001), and waist circumference (P = .029) values were significantly higher in patients treated with ADT when compared with treatment-naïve patients. In patients treated with ADT for up to 1 year, only mean BMI was significantly higher than in treatment-naïve patients, whereas those treated with ADT for more than 1 year had significantly higher mean BMI, waist circumference, total cholesterol, and LDL cholesterol values when compared with treatment-naïve patients. There were no significant differences in insulin or glucose levels. Those undergoing hormone manipulation after orchiectomy had fewer cardiovascular risk factors compared with those undergoing hormone manipulation alone. Conclusion This study shows that ADT results in elevated total cholesterol, LDL cholesterol, BMI, and waist circumference values, all of which are risk factors of cardiovascular disease. Screening for cardiovascular risk factors should be included in treatment plans for patients with prostate cancer. [ABSTRACT FROM AUTHOR]

Abstract: Objective: To determine the causes of death among human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) patients as a step to planning strategies to improve mortality from this condition. Methods: This study retrospectively analyzed the mortality pattern of adult HIV/AIDS patients in the University of Calabar Teaching Hospital from January 2005 to December 2007. The data were obtained from sexually transmitted infection/acquired immunodeficiency syndrome (STI/AIDS) clinic register, admissions and discharge/death registers as well as the patients'' case records and the hospitals monthly mortality reviews. Information obtained included age, sex, diagnosis and cause(s) of death. The causes of death considered were the direct causes of death, since the originating antecedent cause of death is the same in all the patients, in this case, HIV/AIDS. Data was analysed using Epi Info 2002. Results: The total number of mortalities during the study period was 350,100 were HIV positive representing 28.6% of all deaths. While advanced HIV/AIDS disease was the leading cause of death in our study representing 27.0%, tuberculosis was the single leading cause of deaths in HIV/AIDS patients constituting about 24.0% of deaths. This was followed by sepsis and septicaemia (13.0%), meningitis and encephalitis, and anaemia accounting for 11.0%, while respiratory diseases constituted 5.0% of the mortality burden. The highest number of deaths occurred in those aged between 21–50 years (82.0%). Conclusions: The study has shown that HIV/AIDS is a major cause of morbidity and mortality in our hospital. The causes of death reflect the varied spectrum of infection and other forms of organ involvement that affect HIV/AIDS patients. The present dismal situation of adult patients living with HIV/AIDS calls for enhanced strategies to decrease the mortality trend observed in Nigeria and sub-Saharan Africa. [Copyright &y& Elsevier]

Background: Collection of data concerning men's health generally and urological health particularly has always had its challenges, especially in the African setting. Some of the difficulties stem from cultural factors that consider sensitive topics pertaining to men's health as taboo. Aim: To determine how to overcome barriers in conducting a transatlantic prostate cancer familial study in Africans. Methods: After the first phase of the TRANSATLANTIC PROSTATE CANCER FAMILIAL PROJECT STUDY, a survey was carried out among the data collectors and principal investigators using Qualtrix software to collect qualitative feedback on the study. The data from the survey was analyzed using SPSS version 18. Results: Presently, 625 people are enrolled for the study and more are waiting to be recruited in the next phase. About 73% of the participants requested a home or office visit rather than visit a data collection center. On the average, the questionnaire required an average of two hours of personal interview rather than the one hour that had been envisaged. However the participants declared that participant incentives were well worth it. 80% of the participants had no preference for interviewer gender. 80% of the interviewers agreed that answers to questions about participants' sexuality were most difficult to obtain but with an in-depth explanation of the importance of the study and assurance of privacy, the answers were obtained. About 46% of the participants requested that their results be typed and given to them personally, 21% requested results be sent as to them as text messages while 26% requested general results of the study be made available to them in form of booklets, flyers and orally in town hall meetings. Conclusion: The TRANSATLANTIC PROSTATE CANCER FAMILIAL PROJECT STUDY survey questionnaire is a very workable tool that has a high acceptance rate among participants. The best practice for engaging the community for research include community mobilization through sensitization visits and one-on-one talks, use of community 'gatekeepers', introduction by relatives, assurance of privacy of health data obtained, the use of incentives and a promise to give feedback on the results of the study both on a personal and community level. [ABSTRACT FROM AUTHOR]

Presents the experiences of a patient with sickle cell disease living in rural Africa. Development of swellings on his fingers and feet as a child, and the use of a traditional doctor and herbalist to address his pain; Bedwetting problem, jaundice, and abdominal pain; Help he received from the organization Health Sustenance Action.

To examine the prevalence of depression and suicidality among children with HIV infection and determine the clinical characteristics associated with depression, we interviewed 150 children and adolescent with HIV and without HIV infection respectively using Major Depressive and Suicidality Modules of Mini- International Neuropsychiatric Interview for children and adolescents at a Paediatric Outpatient Clinic of a Teaching Hospital. The prevalence of depression was higher among children and adolescents with HIV infection than those without HIV infection (p = 0.01). Older age group (14-16 years), children who experienced academic failure, the orphans, and those who had more than one hospitalization were more likely to experience depression. The higher prevalence of depression among children and adolescents with HIV infection compared to the control group indicates a need to incorporate psychiatric liaison services into management of children with HIV/AIDS. [ABSTRACT FROM AUTHOR]

This paper brings together researchers, clinicians, technology developers and digital innovators to outline current applications of remote symptom monitoring being developed for palliative cancer care delivery in Africa. We outline three remote symptom monitoring approaches from three countries, highlighting their models of delivery and intended outcomes, and draw on their experiences of implementation to guide further developments and evaluations of this approach for palliative cancer care in the region. Through highlighting these experiences and priority areas for future research, we hope to steer efforts to develop and optimise remote symptom monitoring for palliative cancer care in Africa.

Fungal diseases impose an escalating burden on public health in Africa, exacerbated by issues such as delayed diagnosis, inadequate therapy, and limited access to healthcare resources, resulting in significant morbidity and mortality. Effectively tackling these challenges demands a comprehensive approach encompassing research, training, and advocacy initiatives. Recent clinical mycology surveys conducted by Global Action for Fungal Infection (GAFFI) and the European Confederation of Medical Mycology/International Society for Human and Animal Mycology (ECMM/ISHAM) have underscored gaps in fungal diagnostics and the availability and accessibility of antifungal therapy in Africa. The World Health Organization (WHO) Fungal Priority Pathogens List (FPPL) identifies fungi of critical or high importance to human health, providing a roadmap for action and highlighting the urgent need for prioritizing fungal diseases and developing targeted interventions within the African context. To enhance diagnosis and treatment, it is imperative to invest in comprehensive training programs for healthcare workers across all levels and disciplines. Equipping them with the necessary knowledge and skills will facilitate early detection, accurate diagnosis, and appropriate management of fungal infections. Moreover, implementation science research in medical mycology assumes a pivotal role in bridging the gap between knowledge and practice. By identifying the barriers and facilitators that influence the adoption of diagnostic techniques and public health interventions, tailored strategies can be formulated to improve their implementation within healthcare settings. Advocacy plays a critical role in raising awareness regarding the profound impact of fungal diseases on public health in Africa. Engaging policymakers, healthcare providers, researchers, industry experts and communities underscore the importance of addressing these diseases and galvanize efforts for change. Substantial investment in surveillance, research and development specifically focused on fungal diseases is indispensable for advancing our understanding of local epidemiology, developing effective interventions, and ultimately improving patient outcomes. In conclusion, closing the gaps in diagnosing and treating fungal diseases in Africa demands concerted research and advocacy initiatives to ensure better healthcare delivery, reduced mortality rates, and improved public health outcomes., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023 SFMM. Published by Elsevier Masson SAS. All rights reserved.)

Onychomycosis is commonly studied in Africa but not in patients with diabetics despite having a significant number of her population living with diabetes mellitus (DM). Our review highlights a total of 15 studies with only two from Africa over the past two decades; 8 (53.3%) from Asia, 4 (26.7%) from Europe, 2 (13.3%) from Africa and 1 (6.7%) from North America. A total number of 4321 participants were involved with onychomycosis prevalence of 35.3% (1527/4321). Seven studies documented preponderance of onychomycosis in males, one showed preponderance in females, one showed no statistically significant difference in gender, while correlation with gender was unclear in the remainder. The risk factors identified were duration of diabetes, increasing age, occupation (agriculture), subclinical atherosclerosis, metabolic syndrome, obesity, triglyceride levels, and glycosylated haemoglobin. Three case control studies showed a statistically significant correlation between onychomycosis and individuals with DM. Diagnosis was mainly by microscopy and culture with Trichophyton (T) rubrum as the predominant isolate. Fungal nail infections are grossly underdiagnosed and/or underreported in Africa and hence the need for improved awareness and diagnosis especially in patients with DM. Although focused on Africa, this study also revealed paucity of data on onychomycosis in diabetic patients living in the Americas despite evidence from the literature showing a significant number of individuals from that region are living with diabetes. The need to evaluate this at-risk population for onychomycosis cannot be over emphasized., (© 2022. The Author(s), under exclusive licence to Springer Nature B.V.)

Background: The current burden of >5 million deaths yearly is the focus of the Sustainable Development Goal (SDG) to end preventable deaths of newborns and children under 5 years old by 2030. To accelerate progression toward this goal, data are needed that accurately quantify the leading causes of death, so that interventions can target the common causes. By adding postmortem pathology and microbiology studies to other available data, the Child Health and Mortality Prevention Surveillance (CHAMPS) network provides comprehensive evaluations of conditions leading to death, in contrast to standard methods that rely on data from medical records and verbal autopsy and report only a single underlying condition. We analyzed CHAMPS data to characterize the value of considering multiple causes of death., Methods and Findings: We examined deaths identified from December 2016 through November 2020 from 7 CHAMPS sites (in Bangladesh, Ethiopia, Kenya, Mali, Mozambique, Sierra Leone, and South Africa), including 741 neonatal, 278 infant, and 241 child <5 years deaths for which results from Determination of Cause of Death (DeCoDe) panels were complete. DeCoDe panelists included all conditions in the causal chain according to the ICD-10 guidelines and assessed if prevention or effective management of the condition would have prevented the death. We analyzed the distribution of all conditions listed as causal, including underlying, antecedent, and immediate causes of death. Among 1,232 deaths with an underlying condition determined, we found a range of 0 to 6 (mean 1.5, IQR 0 to 2) additional conditions in the causal chain leading to death. While pathology provides very helpful clues, we cannot always be certain that conditions identified led to death or occurred in an agonal stage of death. For neonates, preterm birth complications (most commonly respiratory distress syndrome) were the most common underlying condition (n = 282, 38%); among those with preterm birth complications, 256 (91%) had additional conditions in causal chains, including 184 (65%) with a different preterm birth complication, 128 (45%) with neonatal sepsis, 69 (24%) with lower respiratory infection (LRI), 60 (21%) with meningitis, and 25 (9%) with perinatal asphyxia/hypoxia. Of the 278 infant deaths, 212 (79%) had ≥1 additional cause of death (CoD) beyond the underlying cause. The 2 most common underlying conditions in infants were malnutrition and congenital birth defects; LRI and sepsis were the most common additional conditions in causal chains, each accounting for approximately half of deaths with either underlying condition. Of the 241 child deaths, 178 (75%) had ≥1 additional condition. Among 46 child deaths with malnutrition as the underlying condition, all had ≥1 other condition in the causal chain, most commonly sepsis, followed by LRI, malaria, and diarrheal disease. Including all positions in the causal chain for neonatal deaths resulted in 19-fold and 11-fold increases in attributable roles for meningitis and LRI, respectively. For infant deaths, the proportion caused by meningitis and sepsis increased by 16-fold and 11-fold, respectively; for child deaths, sepsis and LRI are increased 12-fold and 10-fold, respectively. While comprehensive CoD determinations were done for a substantial number of deaths, there is potential for bias regarding which deaths in surveillance areas underwent minimally invasive tissue sampling (MITS), potentially reducing representativeness of findings., Conclusions: Including conditions that appear anywhere in the causal chain, rather than considering underlying condition alone, markedly changed the proportion of deaths attributed to various diagnoses, especially LRI, sepsis, and meningitis. While CHAMPS methods cannot determine when 2 conditions cause death independently or may be synergistic, our findings suggest that considering the chain of events leading to death can better guide research and prevention priorities aimed at reducing child deaths., Competing Interests: I have read the journal’s policy and the authors of this manuscript have the following competing interests: QB, a co-author of this paper is also a Guest Editor on this special issue on Global Child Health: From Birth to Adolescence and Beyond. QB was not directly involved in editorial decisions regarding this paper. JAGS reports current funding for other projects to his institution (London School of Hygiene & Tropical Medicine) from the UK Medical Research Council, Wellcome Trust, Gavi, Bill & Melinda Gates Foundation, and the UK National Institute for Health Research.

Increasingly, with globalization, various countries including Canada are becoming ethno-racially and culturally diverse. Health professionals face the challenge of working effectively across these ethno-racial and cultural boundaries. In acknowledgement of the need to generate knowledge that informs the development of effective health care policies, this paper discusses the findings of a qualitative study that examined the childbirth experiences of African-Canadian women. The meaning of childbirth, which is the primary focus of this paper, includes: sense of responsibility, childbirth as a positive life event, the uniqueness of childbirth as a life experience, childbirth as a bitter-sweet paradox, and childbirth as a spiritual event. The paper will conclude with a discussion of study implications including the need to provide opportunity for nurses to learn about the client's values, beliefs, and practices. This is necessary for the attainment of desired health outcomes such as having a healthy mother and the safe birth of a healthy baby.