The Lancet regional health. Africa最新文献

{"title":"Drought-attributable mortality in Somalia, 2015-2024: a retrospective and modelling study.","authors":"Yamna Ouchtar, Dahir Abdi Ali, Yahye Abukar Ahmed, Mohamed Hussein Adam, Najib Isse Dirie, Abdihamid Warsame, Mohamed Yusuf, Chris Grundy, Oliver John Watson, Francesco Checchi","doi":"10.1016/j.lanafr.2026.100072","DOIUrl":"10.1016/j.lanafr.2026.100072","url":null,"abstract":"<p><strong>Background: </strong>Over the past 17 years Somalia and the Horn of Africa have experienced four droughts. We aimed to retrospectively estimate excess population mortality across Somalia during a period encompassing the last two droughts.</p><p><strong>Methods: </strong>We estimated all-age and under 5 years old excess mortality by district and month by (i) reanalysing household mortality surveys; (ii) reconstructing population denominators from census records and displacement data; (iii) assembling predictors of mortality; (iv) fitting a model to predict death rates and tolls; and (v) subtracting counterfactual mortality levels, corresponding to non-drought periods.</p><p><strong>Findings: </strong>Assuming pre-2017 levels as counterfactual, we estimated 71,100 excess deaths across Somalia during the 2022-2024 period, 64,500 (91%) of which were among children under 5 years. During the 2017-2019 period, an estimated 79,600 excess deaths occurred, 49,000 (61%) among children under 5 years. An alternative counterfactual based on 2020 trends yielded a higher number of excess deaths. Regional disparities were marked: north-eastern regions had relatively low mortality despite high food insecurity, while south-central areas (including Banadir, Bay, and Lower Shabelle) bore the majority of excess deaths.</p><p><strong>Interpretation: </strong>The mortality impact of the latest drought crisis (2022-2024) in Somalia appears comparable to that witnessed during the 2017-2019 period. The combination of intensifying droughts attributable to climate change in the Horn of Africa, substantially declined global humanitarian assistance budgets, and steep population growth threaten to cause persistent and potentially worsened health impacts over the coming decades, including a large number of lives lost.</p><p><strong>Funding: </strong>This study was funded by the United Nations Children's Fund (UNICEF) East Africa office, award number 2022/1291432-0.</p>","PeriodicalId":521330,"journal":{"name":"The Lancet regional health. Africa","volume":"8 ","pages":"None"},"PeriodicalIF":0.0,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13672283/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149218084","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Treatment outcomes and post-treatment mortality among people with multidrug/rifampicin-resistant tuberculosis in Sierra Leone: a national cohort study.","authors":"Faye Greenwood, Rashidatu Fouad Kamara, Ronnie Harding, Ousman Conteh, Lynda Foray, Matthew J Saunders, Tom Wingfield","doi":"10.1016/j.lanafr.2026.100061","DOIUrl":"10.1016/j.lanafr.2026.100061","url":null,"abstract":"<p><strong>Background: </strong>Evidence on biosocial factors driving adverse outcomes in multidrug/rifampicin-resistant tuberculosis (MDR/RR-TB) can inform design of person-centred interventions. We evaluated treatment outcomes, post-treatment mortality, and their associated risk factors among people with multidrug/rifampicin-resistant tuberculosis (MDR/RR-TB) in Sierra Leone.</p><p><strong>Methods: </strong>We did a national cohort study of people with MDR/RR-TB in Lakka Hospital, Freetown, 2017-2022. Treatment was with WHO-recommended short (9-11 month) or long (18-24 month) regimens, with adverse treatment outcome (death or loss to follow-up before or during treatment, or treatment failure) following WHO definitions. Participants with treatment success had 12-months follow-up to ascertain post-treatment mortality. We used directed acyclical graph-informed logistic regression to investigate biosocial factors associated with adverse treatment outcome and post-treatment mortality.</p><p><strong>Findings: </strong>We recruited 739 people with MDR/RR-TB, median age 34-years (IQR: 25-45), 70% (517/739) male and 22% (160/734) HIV-positive. 22% (161/739) had adverse treatment outcome, with 18% (134/739) dying before or during treatment. Adverse treatment outcome was associated with age ≥45-years versus 25-44-years (adjusted odds ratio [aOR] = 1.9; 95% confidence interval: 1.1-3.2); unemployment (aOR = 2.9; 1.8-4.8); HIV (aOR = 1.8; 1.1-2.7); chronic lung disease (aOR = 1.7; 1.0-2.9); renal impairment (aOR = 4.8; 1.8-12.9); underweight (aOR = 1.6; 1.1-2.4); and long regimen (aOR = 2.0; 1.3-3.2). Among those with treatment success, 9.9% (57/578) had post-treatment mortality. This was associated with HIV (aOR = 2.0, 1.0-3.9), smoking (aOR = 2.7, 1.3-5.5), chronic lung disease (aOR = 2.2, 1.1-4.7), previous loss-to-follow-up (aOR = 3.1, 1.1-8.7) and severe TB on their original chest radiography (aOR = 2.4, 1.2-4.5).</p><p><strong>Interpretation: </strong>Adverse outcomes, including death after treatment success, were common among people with MDR/RR-TB in Sierra Leone and associated with modifiable risk factors, highlighting the urgent need for holistic, person-centred biosocial interventions for people with MDR/RR-TB throughout and beyond treatment.</p><p><strong>Funding: </strong>Medical Research Council-MR/Y503216/1; Medical Research Foundation-MRF-131-0006-RG-KHOS-C0942.</p>","PeriodicalId":521330,"journal":{"name":"The Lancet regional health. Africa","volume":"8 ","pages":"None"},"PeriodicalIF":0.0,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13672282/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149218112","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prevalence of target organ damage in rural Kenya and The Gambia: a cross-sectional study.","authors":"Alexander D Perkins, Modou Jobe, Ruth Lucinde, Juliet Otieno Awori, Sampa Sanneh, Catherine Kalu, Clement Mwagwabi, Elminah Saru, Gabriela M M Paixão, Kieran Mwazo, David A Leon, Tim Clayton, Emily Herrett, Adrianna Murphy, Elijah Nyainda Ogola, Georg Ehret, Aletta E Schutte, Andrew M Prentice, Anoop S V Shah, Anthony Etyang, Pablo Perel","doi":"10.1016/j.lanafr.2026.100087","DOIUrl":"10.1016/j.lanafr.2026.100087","url":null,"abstract":"<p><strong>Background: </strong>Sub-Saharan Africa is experiencing a hypertension crisis, potentially contributing to early development of target organ damage (TOD), a cardiovascular disease (CVD) predictor. However, comprehensive TOD prevalence data are lacking in rural SSA. This study aimed to provide the first population-level assessment of TOD prevalence in rural SSA.</p><p><strong>Methods: </strong>We conducted a cross-sectional, population-based study in Kilifi (Kenya) and Kiang West (The Gambia) from July 2023-December 2024. We assessed an age-stratified random sample of adults (≥30 years) for 24-h ambulatory blood pressure (BP), electrocardiography, echocardiography, pulse-wave velocity, and renal function. TOD was defined as left ventricular hypertrophy (LVH), reduced global longitudinal strain (GLS), left ventricular systolic dysfunction (LVSD), arterial stiffness, or renal dysfunction.</p><p><strong>Findings: </strong>Of 1819 screened, 1379 were recruited, and 1212 were analysed. The mean age was 56.8 ± 14.8 years, 62.9% were female, 33.5% had hypertension. Overall, 57.4% had TOD and prevalence increased with BP (non-elevated BP: 35.0%; hypertension: 77.3% for; p < 0.001) and age (30-39 years: 32.7%; ≥70 years: 77.0%; p < 0.001). TOD prevalence varied by marker: electrocardiogram LVH (31.1%), echocardiogram LVH (10.0%), GLS (16.7%), LVSD (9.8%), arterial stiffness (38.0%), and renal dysfunction (3.8%). Prevalence was higher in The Gambia (64.8%) than Kenya (50.9%) (p < 0.001). Clustering of TOD markers increased with BP.</p><p><strong>Interpretation: </strong>TOD is common in rural SSA. These findings provide important information to guide the implementation of TOD assessment in cardiovascular care pathways and inform the optimal ages for CVD screening.</p><p><strong>Funding: </strong>National Institute for Health and Care Research, Medical Research Council, and Wellcome Trust.</p>","PeriodicalId":521330,"journal":{"name":"The Lancet regional health. Africa","volume":"7 ","pages":"None"},"PeriodicalIF":0.0,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13561962/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148957825","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Extending seasonal malaria chemoprevention to older children: a non-inferiority randomized controlled trial of Dihydroartemisinin-piperaquine as a policy alternative in Mali.","authors":"Mahamoudou Toure, Soumba Keita, Fousseyni Kane, Daouda Sanogo, Ibrahim Sanogo, Moussa Keita, Ibrahim M Sissoko, Mountaga Diallo, Hamady Coulibaly, Bourema Cisse, Drissa Konate, Issaka Guindo, Mossa Ag Malle, Cheick Oumar Tangara, Sory I Diawara, Mady Cissoko, Vincent Sanogo, Aissata Kone, Sidi Niare, Aissatou Maiga, Nafomon Sogoba, Helle Holm Hansonn, Michael Alifrangis, Mahamadou Diakite, Jeffrey G Shaffer, Seydou Doumbia","doi":"10.1016/j.lanafr.2026.100122","DOIUrl":"10.1016/j.lanafr.2026.100122","url":null,"abstract":"<p><strong>Background: </strong>Seasonal malaria chemoprevention (SMC) with Sulfadoxine-pyrimethamine plus amodiaquine (SPAQ) reduces malaria in children under five, but substantial burden remains among children 5-9 years. Emerging SP/AQ resistance and adherence challenges underscore the need for alternative regimens. Dihydroartemisinin-piperaquine (DHAPQ) is a promising option, although evidence from multi-season programmatic settings in the Sahel is limited. We aimed to evaluate the effectiveness and safety of DHAPQ compared with SPAQ when SMC was extended to children aged 3 months to 9 years.</p><p><strong>Methods: </strong>We conducted a two-year, three-arm, cluster-randomized crossover trial in nine health-catchment clusters in Mali. Clusters received standard SPAQ SMC (<5 years), extended-age SPAQ (<10 years), or (3) extended-age DHAPQ (<10 years), crossing over to a different regimen in year two. The primary outcome was the incidence of clinical malaria, analyzed using mixed-effects negative binomial models that accounted for clustering, period effects, and recurrent events. Non-inferiority was predefined as an upper 95% CI < 1.25.</p><p><strong>Findings: </strong>Among 12,854 children, DHAPQ was non-inferior to extended-age SPAQ (HR = 0.7, 95% CI 0.6-0.9) and achieved higher intervention coverage, with no serious adverse events reported. Children aged 5-9 years had a lower hazard of clinical malaria than children younger than 5 years (HR = 0.9, 95% CI 0.8-0.9).</p><p><strong>Interpretation: </strong>Extending SMC to children aged 5-9 years substantially reduced malaria burden. DHAPQ was safe, effective, and operationally feasible, supporting its consideration as an alternative to SPAQ where adherence or resistance threatens SMC effectiveness.</p><p><strong>Funding: </strong>NIH/NIAID-ICEMR-WAF.</p>","PeriodicalId":521330,"journal":{"name":"The Lancet regional health. Africa","volume":" ","pages":"100122"},"PeriodicalIF":0.0,"publicationDate":"2026-08-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13618436/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149077513","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Incidence and risk factors for stillbirth in Kenya, Mozambique and the Gambia: the PRECISE cohort study.","authors":"Grace Mwashigadi, Joseph Akuze, Angela Koech, Hawanatu Jah, Anna Roca, Umberto D'Alessandro, Esperança Sevene, Sonia Maculuve, Anifa Valá, Sanjukta Singh, Bethany Atkins, Geoffrey Omuse, Moses Mukhanya, Marie-Laure Volvert, Laura Magee, Rachel Craik, Marleen Temmerman, Peter von Dadelszen, Hannah Blencowe","doi":"10.1016/j.lanafr.2026.100089","DOIUrl":"https://doi.org/10.1016/j.lanafr.2026.100089","url":null,"abstract":"<p><strong>Background: </strong>Stillbirth is a critical public health challenge in sub-Saharan Africa, but prospective data on incidence and risk factors remain limited. We conducted a multi-country study in Kenya, Mozambique, and The Gambia to determine stillbirth rates and underlying risk factors.</p><p><strong>Methods: </strong>We analysed pooled data from 5772 women aged 16-49 with birth outcomes enrolled from seven health facilities in Mozambique, Kenya, and The Gambia participating in the PRECISE (PREgnancy Care Integrating translational Science, Everywhere) cohort (2019-2022). We used bivariable and multivariable modified Poisson regression models to assess associations between maternal socio-demographic, environmental, medical, including obstetric, and health system factors with stillbirth (≥20 weeks gestation or weighing ≥500 g).</p><p><strong>Findings: </strong>Overall stillbirth incidence was 29.2 per 1000 total births (95%CI 24.8-33.6): 17.5 (95% CI:12.5-22.5) in Kenya, 32.8 (95% CI:24.7-40.9) in Mozambique, and 49.8 (95%CI: 37.4-62.4) in The Gambia. The majority (89.1%) occurred at ≥28 weeks gestation. Significant risk factors were a history of previous stillbirth (attributable risk ratio (aRR) = 3.18, 95% CI: 1.85-5.46), Stage 2 hypertension (aRR = 3.25, 95% CI: 1.42-7.44), antepartum haemorrhage (aRR = 3.10, 95% CI: 1.77-5.42), Caesarean delivery aRR = 1.74 (95%CI:1.01-3.01), and small-for-gestational age (aRR = 2.05 (95%CI:1.34-3.12)).</p><p><strong>Interpretation: </strong>Stillbirth rates remain unacceptably high across these settings, with country variations. Multifactorial determinants underscore the need for integrated antenatal and intrapartum care strategies addressing systemic barriers to early detection of risk, robust referral systems and timely access to high-quality emergency obstetric care towards ending preventable stillbirths in these contexts.</p><p><strong>Funding: </strong>The PRECISE Network was funded by the UK Research and Innovation Grand Challenges Research Fund GROW Award scheme (grant number: MR/P027938/1). The PRECISE cohort extension in Kenya after January 2022 was funded by the Office of the Director, National Institutes of Health, the National Institute of Biomedical Imaging and Bioengineering, the National Institute of Mental Health, and the Fogarty International Center AT THE NATIONAL INSTITUTES OF HEALTH under award number U54TW012089. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.</p>","PeriodicalId":521330,"journal":{"name":"The Lancet regional health. Africa","volume":"6 ","pages":"None"},"PeriodicalIF":0.0,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13473389/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148763433","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of the Strengthening Teamwork and Respect (STAR) intervention on organisational learning culture and person-centred maternity care in rural South Africa: an uncontrolled before-and-after implementation study.","authors":"Tanya Doherty, Veronique Filippi, Vaughn John, Lyn Haskins, Sandra Land, Cleo Phewa, Sphindile Mapumulo, Silondile Luthuli, Loveday Penn-Kekana, Samuel Manda, Neil Moran, Rose Sibiya, Hlengiwe Myeza, Christiane Horwood","doi":"10.1016/j.lanafr.2026.100070","DOIUrl":"https://doi.org/10.1016/j.lanafr.2026.100070","url":null,"abstract":"<p><strong>Background: </strong>Respectful maternity care is essential for quality maternal and newborn health services. Interventions to promote respectful care often focus on training, overlooking organisational culture underpinning disrespectful behaviour. This study aimed to evaluate the implementation and effects of the Strengthening Teamwork and Respect (STAR) intervention on organisational learning culture and person-centred maternity care (PCMC).</p><p><strong>Methods: </strong>This implementation research used an uncontrolled before-and-after design with continuous process evaluation in nine district hospitals in KwaZulu-Natal, South Africa. Surveys with postpartum women (baseline n = 893; endline n = 918) and maternity staff (baseline n = 104; endline n = 102) assessed changes in PCMC using the validated PCMC scale and organisational learning culture using the Dimensions of Learning Organisations Questionnaire (DLOQ). Descriptive statistics and Wilcoxon-Rank Sum test explored changes in the DLOQ. PCMC scores were modelled using mixed-effects linear regression including interaction terms with time period (pre-vs post) to examine variation across key predictors.</p><p><strong>Findings: </strong>Five of seven DLOQ dimensions improved, particularly amongst attendees of STAR learning sessions. Mean re-scaled PCMC scores increased from 61.5/100 to 65.7/100 post-intervention (p < 0.0001), with significant improvements in communication and autonomy (53.5/100-59.4/100; p < 0.0001) and supportive care (57.5/100-63.0/100; p < 0.0001). Mixed-effects analysis showed an overall increase of 4.56 percentage points. Women in the lowest socio-economic status group and those with fewer antenatal care visits experienced the largest gains.</p><p><strong>Interpretation: </strong>Modest improvements in organisational learning culture and PCMC were observed following STAR implementation, with larger gains among disadvantaged women. While causal attribution is limited, the findings suggest that participatory approaches targeting organisational culture may support more equitable and respectful maternity care in resource constrained settings.</p><p><strong>Funding: </strong>The Health Systems Research Initiative, supported by the Medical Research Council, the Foreign, Commonwealth and Development Office and Wellcome funded the study in collaboration with the Economic and Social Research Council (grant number MR/V020951/1).</p>","PeriodicalId":521330,"journal":{"name":"The Lancet regional health. Africa","volume":"6 ","pages":"None"},"PeriodicalIF":0.0,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13473396/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148763748","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Assessment of point-of-care creatinine testing in pregnancy: a prospective cohort study in Sierra Leone.","authors":"Katy Kuhrt, Rossetta Cole, Moses M'Bayoh, Christiana Squire, Alhaji Kamara, Gabriel Ganyaglo, Joshua Coker, Katherine Clark, Alice Beardmore-Gray, Alexandra Ridout, Christina Fernandez-Turienzo, Jackie Campbell, Adetunji Adeniji, Lucy C Chappell, Andrew H Shennan, Kate Bramham","doi":"10.1016/j.lanafr.2026.100069","DOIUrl":"https://doi.org/10.1016/j.lanafr.2026.100069","url":null,"abstract":"<p><strong>Background: </strong>Pregnancy-associated acute kidney injury (PrAKI) is a major contributor to maternal and perinatal morbidity and mortality in low-and middle-income countries, where detection is often delayed due to limited access to creatinine testing. Point-of-care creatinine (POC-Cr) devices may offer a practical alternative. We aimed to describe the incidence, resolution, and clinical consequences of presumed PrAKI or kidney dysfunction among high-risk pregnant and postpartum women, and to assess feasibility of POC-Cr testing.</p><p><strong>Methods: </strong>We conducted a study of pregnant or postpartum women at high risk of PrAKI at a hospital in Freetown, Sierra Leone (April-August 2023). Eligibility criteria were systolic blood pressure ≥140 mmHg, diastolic ≥90 mmHg, and/or shock index ≥0.9. Women underwent POC-Cr testing at enrolment and 24 and 48 h. PrAKI was defined as POC-Cr >77 μmol/L, or a change ≥26 μmol/L, and staged where possible. Associations with maternal and perinatal outcomes were assessed. Multivariable logistic regression identified risk factors. Feasibility was evaluated by refusal and test failure.</p><p><strong>Findings: </strong>Of 1746 eligible women, 1669 (96%) were tested; two declined and one failed. PrAKI or chronic kidney disease occurred in 427 (25.6%). Affected women had maternal (15.4%, 66/427 versus 8.7%, 108/1239) and perinatal (19.3%, 23/119 versus 4.8%, 20/413) adverse outcomes (<i>p</i> < 0.0001). At discharge, 47%, 202/427 had unresolved kidney injury or underlying disease. Independent risk factors included age, mean arterial pressure, and pre-eclampsia or eclampsia.</p><p><strong>Interpretation: </strong>Kidney dysfunction complicates a quarter of pregnancies and is associated with adverse outcomes. POC-Cr testing may enable earlier detection and improved care in resource-limited settings.</p><p><strong>Funding: </strong>This study was funded by the UK Medical Research Council (MR/T038594/1) and the National Institute for Health and Care Research (NIHR133232).</p>","PeriodicalId":521330,"journal":{"name":"The Lancet regional health. Africa","volume":"6 ","pages":"None"},"PeriodicalIF":0.0,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13473385/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148763465","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Decentralizing testing capacity of mpox in Africa: a narrative review.","authors":"Yao Selom Atrah, Nicksy Gumede, Joseph Nyombe, Nebiyu Dereje, Wazih N Cho, Kyeng Mercy, Michel Muteba, Jeanine Nkakulu Luzolo, Olga Ntumba-Tshitenge, Passy Kimema, Collins Kipngetich Tanui, Noah Takah Fongwen, Armel Mbouna, Rose Mary Nakame, Biruh Tesfaye Kebede, Yap Boum, Ngashi Ngongo, Mory Keita, Sofonias Kifle Tessema, Yenew Kebede Tebeje, Jean Kaseya","doi":"10.1016/j.lanafr.2026.100046","DOIUrl":"10.1016/j.lanafr.2026.100046","url":null,"abstract":"<p><p>Decentralized diagnostics are essential for the timely detection and control of mpox outbreaks. Burundi and the Democratic Republic of Congo (DRC) transitioned from centralized testing to decentralized models using GeneXpert platforms, mobile labs, and real-time feedback systems. Burundi expanded from one to 56 diagnostic sites, reducing site-level turnaround times to 2-4 h and achieving nearly 100% testing coverage. The DRC scaled up from 2 to 28 labs, deploying multiplex platforms and stabilizing testing rates. Genomic surveillance also advanced, with over 3000 mpox virus (MPXV) genomes sequenced across 23 countries, revealing new clades and informing public health responses. Africa reached the 8% sequencing threshold, enabling real-time viral tracking. The mpox epidemic accelerated reforms, including continental guidelines for laboratory decentralization and the launch of a new initiative to expand testing, training, and local manufacturing. This article describes the mpox laboratory decentralization efforts, achievements, lessons, and best practices across Africa.</p>","PeriodicalId":521330,"journal":{"name":"The Lancet regional health. Africa","volume":"5 ","pages":"None"},"PeriodicalIF":0.0,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13352945/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148428277","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Incidence rates of non-Hodgkin lymphoma subtypes among Black Africans with and without HIV in South Africa: a national registry-based study.","authors":"Carole Metekoua, Yann Ruffieux, Tracey Wiggill, Tinashe Tombe-Nyahuma, Jenny Mary Mathew, Judith Mwansa-Kambafwile, Julia Bohlius, Meredith S Shiels, Jun Tao, Mazvita Muchengeti, Eliane Rohner","doi":"10.1016/j.lanafr.2026.100058","DOIUrl":"https://doi.org/10.1016/j.lanafr.2026.100058","url":null,"abstract":"<p><strong>Background: </strong>The impact of HIV on incident non-Hodgkin lymphoma (NHL) varies by subtype. We compared the incidence rates of NHL subtypes (aggressive and indolent) between Black Africans with and without HIV in South Africa from 2010 to 2021.</p><p><strong>Methods: </strong>We identified incident NHL among children and adults from the South African National Cancer Registry and stratified yearly population by HIV status, sex, age group and health care sector. We applied Poisson regression models, adjusting for sex, age, and calendar period, to estimate adjusted incidence rate ratios (aIRRs) for NHL and its subtypes among Black Africans with and without HIV. We calculated aIRR stratified by calendar period, sex, and age group.</p><p><strong>Findings: </strong>We identified 11,187 new NHL; 54% (n = 6023) occurred in male individuals. The risk of all NHL combined was higher among Black Africans with HIV than those without HIV, but the strength of the association varied by subtype. The aIRRs were highest for cutaneous T-cell lymphoma, diffuse large B-cell lymphoma and Burkitt lymphoma. There was no evidence that the strength of association changed over calendar period for most subtypes. The positive association with HIV was stronger among male individuals and those <45 years for all NHL combined and many subtypes.</p><p><strong>Interpretation: </strong>In South Africa, incidence rates of all NHL subtypes are higher among Black Africans with HIV than those without HIV. Further context specific studies are needed to clarify the underlying mechanisms such as immune dysfunction, chronic inflammation, or oncogenic co-infections to inform early NHL diagnosis and timely treatment.</p><p><strong>Funding: </strong>US National Institutes of Health, Swiss National Science Foundation and Swiss Cancer Research foundation.</p>","PeriodicalId":521330,"journal":{"name":"The Lancet regional health. Africa","volume":" ","pages":"100058"},"PeriodicalIF":0.0,"publicationDate":"2026-05-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13652135/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149169337","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Virologic outcomes among people living with HIV on dolutegravir-based antiretroviral therapy in Kenya, 2018-2024: a comparison retrospective longitudinal analysis.","authors":"Helen M Chun, Sherri L Pals, Mary Gikura, Pacific Akinyi, Ashley Odhiambo, Emilio Dirlikov, Appolonia Aoko, Freda Kinoti, Kyle Milligan, Ruzuna Moturi, Jared Mecha, Catherine Njigua, Junghae Muthoni, Frank Basiye, Kenneth Masamaro","doi":"10.1016/j.lanafr.2026.100028","DOIUrl":"10.1016/j.lanafr.2026.100028","url":null,"abstract":"<p><strong>Background: </strong>Long-term virologic outcome data of tenofovir fumarate disoproxil-lamivudine-dolutegravir (TLD) versus tenofovir fumarate disoproxil-lamivudine-efavirenz (TLE) from resource-constrained settings remain limited. This study evaluates virologic suppression (VS) among people living with HIV (PLWH) ≥15 years in Kenya following TLD introduction in 2019.</p><p><strong>Methods: </strong>We analyzed Kenya's National AIDS and STIs Control Programme data (2018-2024) including ART-naïve and treatment-experienced PLWH initiating TLD (TLD1), transitioning to TLD (TLD2), or initiating TLE (TLE1). Outcomes included virologic suppression (VS: <1000 copies/mL)-including undetectable (UD: <50 copies/mL), durable undetectable (durable UD: <50 copies/mL for the three most recent results), and low-level viremia (LLV: 50-999 copies/mL), viral load non-suppression (VLNS: ≥1000 copies/mL), and virologic failure (VF: ≥2 consecutive VLNS). We fit logistic regression models to assess associations with virologic outcomes.</p><p><strong>Findings: </strong>Among 1,072,209 PLWH records, 758,398 (70.7%) had ≥1 VL. VS was highest in TLD2 (96.3-97.1%), followed by TLD1 (94.4-96.2%) and TLE1 (91.1-92.7%). Long-term VS (at 24-36 months) exceeded 95% for TLD1 and TLD2 but remained approximately 92% for TLE1 (p < 0.0001). Durable UD was higher in TLD2 (aOR) 1.95 [95% CI 1.88-2.01] and TLD1 (aOR 1.56 [95% CI 1.51-1.61]; p < 0.0001) versus TLE1, even with initial VLNS: TLD1 (aOR 2.31 [95% CI 1.94-2.76] and TLD2 aOR 2.39 [95% CI 2.00-2.85]). Even with initial VS, adolescents (15-19 years) had higher odds of VF: females aOR 2.07 [95% CI 1.49-2.87] and males aOR 5.39 [95% CI 3.64-7.98]. Pre-transition and initial LLV increased the risk of post-transition VLNS (aOR 1.51 [95% CI 1.42-1.60]; p < 0.0001) and VF, highest at 500-999 copies/mL (aOR 3.88 [95% CI 3.33-4.53]; p < 0.0001).</p><p><strong>Interpretation: </strong>Kenya's ART optimization with TLD was associated with superior outcomes compared to TLE, with higher early and sustained VS, better re-suppression post-VF, and improved durability of UD. Targeted interventions are needed for adolescents, those with LLV, and higher pre-transition VL to enhance long-term virologic control and end HIV as a public health threat.</p><p><strong>Funding: </strong>No specific funding was received for the analysis. HIV program support was provided by the U.S. President's Emergency Plan for AIDS Relief (PEPFAR) through the CDC.</p>","PeriodicalId":521330,"journal":{"name":"The Lancet regional health. Africa","volume":"2 ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13588494/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149009755","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}