African Centre for Global Health and Social Transformation

BackgroundWe assessed the willingness of female students at a Ugandan public university to use long-acting Cabotegravir (CAB-LA) for HIV prevention, given their high prevalence of HIV risk behaviours.MethodsUsing an online questionnaire, this cross-sectional study surveyed 346 female undergraduate students aged 18–25. Factors influencing their willingness were analysed with modified Poisson regression and robust standard errors.ResultsMore than half, 56.7% (95% CI: 51.4 to 61.8), were willing to use CAB-LA. Willingness was significantly associated with being sexually active in the past 3 months, using alcohol in the past 6 months, or being in the 4th year of study compared to the 1st year.ConclusionEducational initiatives on innovative HIV prevention strategies, such as CAB-LA, should be introduced early in university students’ studies to increase awareness and acceptance.

In January 2023, the Science and Security Board of the Bulletin of Atomic Scientists moved the hands of the Doomsday Clock forward to 90 s before midnight, reflecting the growing risk of nuclear war [1]. In August 2022, UN Secretary-General António Guterres warned that the world is now in ‘a time of nuclear danger not seen since the height of the Cold War’ [2]. The danger has been underlined by growing tensions between many nuclear-armed states [1, 3]. As editors of health and medical journals worldwide, we call on health professionals to alert the public and our leaders to this major danger to public health and the essential life support systems of the planet, and we urge action to prevent it. Current nuclear arms control and non-proliferation efforts are inadequate to protect the world's population against the threat of nuclear war by design, error or miscalculation. The Treaty on the Non-Proliferation of Nuclear Weapons (NPT) commits each of the 190 participating nations to pursue negotiations in good faith on effective measures relating to the cessation of the nuclear arms race at an early date and to nuclear disarmament and on a treaty on general and complete disarmament under strict and effective international control [4]. Progress has been disappointingly slow, and the most recent NPT review conference in 2022 ended without an agreed statement [5]. Many examples of near disasters have exposed the risks of depending on nuclear deterrence for the indefinite future [6]. Modernisation of nuclear arsenals could increase risks: for example, hypersonic missiles decrease the time available to distinguish between an attack and a false alarm, increasing the likelihood of rapid escalation. Any use of nuclear weapons would be catastrophic for humanity. Even a ‘limited’ nuclear war involving only 250 of the 13,000 nuclear weapons in the world could kill 120 million people outright and cause global climate disruption leading to a nuclear famine, putting two billion people at risk [7, 8]. A large-scale nuclear war between the USA and Russia could kill 200 million people or more in the near term and potentially cause a global ‘nuclear winter’ that could kill five to six billion people, threatening the survival of humanity [7, 8]. Once a nuclear weapon is detonated, escalation to all-out nuclear war could occur rapidly. The prevention of any use of nuclear weapons is therefore an urgent public health priority, and fundamental steps must also be taken to address the root cause of the problem – by abolishing nuclear weapons. The health community has played a crucial role in efforts to reduce the risk of nuclear war and must continue to do so in the future [9]. In the 1980s, the efforts of health professionals, led by International Physicians for the Prevention of Nuclear War (IPPNW), helped to end the Cold War arms race by educating policy makers and the public on both sides of the Iron Curtain about the medical consequences of nuclear war. This was recognised when the 1985 Nobel Peace Prize was awarded to IPPNW [10] (http://www.ippnw.org). In 2007, IPPNW launched the International Campaign to Abolish Nuclear Weapons, which grew into a global civil society campaign with hundreds of partner organisations. A pathway to nuclear abolition was created with the adoption of the Treaty on the Prohibition of Nuclear Weapons in 2017, for which the International Campaign to Abolish Nuclear Weapons was awarded the 2017 Nobel Peace Prize. International medical organisations, including the International Committee of the Red Cross, IPPNW, the World Medical Association, the World Federation of Public Health Associations, and the International Council of Nurses, played key roles in the process leading up to the negotiations and in the negotiations themselves, presenting the scientific evidence on the catastrophic health and environmental consequences of nuclear weapons and nuclear war. They continued this important collaboration during the First Meeting of the States Parties to the Treaty on the Prohibition of Nuclear Weapons, which currently has 92 signatories, including 68 member states [11]. We now call on health professional associations to inform their members worldwide about the threat to human survival and to join with IPPNW to support efforts to reduce the near-term risks of nuclear war, including three immediate steps on the part of nuclear-armed states and their allies: first, adopt a no first-use policy [12]; second, take their nuclear weapons off hair-trigger alert; and, third, urge all states involved in current conflicts to pledge publicly and unequivocally that they will not use nuclear weapons in these conflicts. We further ask them to work towards a definitive end to the nuclear threat by supporting the urgent commencement of negotiations among the nuclear-armed states for a verifiable, time-bound agreement to eliminate their nuclear weapons in accordance with commitments in the NPT, opening the way for all nations to join the Treaty on the Prohibition of Nuclear Weapons. The danger is great and growing. The nuclear-armed states must eliminate their nuclear arsenals before they eliminate us. The health community played a decisive part during the Cold War and more recently in the development of the Treaty on the Prohibition of Nuclear Weapons. We must take up this challenge again as an urgent priority, working with renewed energy to reduce the risks of nuclear war and to eliminate nuclear weapons. The respective authors were paid by their employers. CZ's time was funded by International Physicians for the Prevention of Nuclear War. IH and AH developed the idea of the editorial and led drafting, along with CZ. All other coauthors contributed significantly to the editorial content.

This is a repository copy of Reducing the risks of nuclear war -the role of health professionals.

Despite notable scientific and medical advances, broader political, socioeconomic and behavioural factors continue to undercut the response to the COVID-19 pandemic1,2. Here we convened, as part of this Delphi study, a diverse, multidisciplinary panel of 386 academic, health, non-governmental organization, government and other experts in COVID-19 response from 112 countries and territories to recommend specific actions to end this persistent global threat to public health. The panel developed a set of 41 consensus statements and 57 recommendations to governments, health systems, industry and other key stakeholders across six domains: communication; health systems; vaccination; prevention; treatment and care; and inequities. In the wake of nearly three years of fragmented global and national responses, it is instructive to note that three of the highest-ranked recommendations call for the adoption of whole-of-society and whole-of-government approaches1, while maintaining proven prevention measures using a vaccines-plus approach2 that employs a range of public health and financial support measures to complement vaccination. Other recommendations with at least 99% combined agreement advise governments and other stakeholders to improve communication, rebuild public trust and engage communities3 in the management of pandemic responses. The findings of the study, which have been further endorsed by 184 organizations globally, include points of unanimous agreement, as well as six recommendations with >5% disagreement, that provide health and social policy actions to address inadequacies in the pandemic response and help to bring this public health threat to an end.

Introduction: Altered glycemic status in people with or without chronic diseases is likely to be associated with a higher risk of cardiovascular diseases and increased risk of morbidity and mortality in African adults. Although physical activity interventions are imminent public health measures in regulating glucose control and resulting diabetes risk, the summary of evidence to inform public health experts about advocating the physical activity interventions in low-middle income countries in Africa is lacking. Objective: The objective of this study was to provide a summary of evidence regarding the effects of physical activity interventions on glycemic control in African adults with and without chronic diseases. Methodology: Six electronic databases (Scopus, Web of Science, CINAHL, Embase, Ovid, and PubMed) will be utilized for synthesizing evidence from randomized controlled studies investigating the effects of physical activity interventions on blood glucose levels in African adults. The data (time, duration, and frequency of physical activity interventions, wash-out period, mean differences, and standard deviations of outcomes such as glucose, insulin, and glycosylated hemoglobin within and between groups) will be extracted from the included studies. The quality of the included studies will be assessed by the Cochrane Risk of Bias tool and GRADE criteria. Clinical Relevance: To the best of our knowledge, this will be the first systematic review to appraise the empirical evidence that would investigate the effectiveness of physical activity interventions on glycemic control in African adults. The evidence is proposed to serve as a guide for public health experts to design effective physical activity interventions aimed at achieving optimum glycemic control among African adults. Results and conclusion: The systematic review will collate empirical evidence exploring the effectiveness of physical activity intervention on glycaemic control in African adults. The findings may inform the stakeholders and policymakers in designing and implementing physical activity interventions for appropriate glucose control in African adults.

Sustainable and equitable partnerships and collaborations between the Global North and Global South (as well as within the Global South) have been aspirations (if seldom achieved) of the “global health” endeavor over the past couple of decades. The COVID-19 pandemic led to global lockdowns that disrupted international travel and severely challenged these partnerships, providing a critical space for self-reflection on global health as a discipline. One major global north-south partnership is that between the African Forum for Research and Education in Health (AFREhealth) and the Consortium of Universities for Global Health (CUGH). This article reports on a recent Satellite meeting of the AFREhealth-CUGH Working Group (ACWG) at the CUGH 2021 virtual conference in March 2021 that provided insights on North-South and South-South global health partnerships, against the backdrop of the COVID-19 pandemic. The authors describe challenges and opportunities for research and education in these partnerships (as discussed at this ACWG Satellite meeting), and implications for the field of global health going forward as we emerge from the pandemic.

Abstract Background: Recent increases in health professions education (HPE) research in sub-Saharan Africa (SSA), though substantial, have predominantly originated from single institutions and remained uncoordinated. A shared research agenda can guide the implementation of HPE practices to ultimately influence the recruitment and retention of the health workforce. Thus, the authors aimed to generate and prioritise a list of research topics for HPE research (HPER) in SSA. Methods: A modified Delphi process was designed to prioritise a shared agenda. Members of the African Forum for Research and Education in Health (AFREhealth) technical working group (TWG) were asked to first list potential research topics. Then, members of the same TWG and attendees at the annual AFREhealth academic symposium held in Lagos, Nigeria in August 2019 rated the importance of including each topic on a 3-point Likert scale, through two rounds of consensus seeking. Consensus for inclusion was predefined as ³ 70% of respondents rating the topic as “must be included.”Results: Health professions educators representing a variety of professions and 13 countries responded to the survey rounds. Twenty-three TWG members suggested 26 initial HPER topics; subsequently 90 respondents completed round one, and 51 completed round 2 of the modified Delphi. The final list of 12 research topics which met predetermined consensus criteria were grouped into three categories: (1) creating an enabling environment with sufficient resources and relevant training; (2) enhancing student learning; and (3) identifying and evaluating strategies to improve pedagogical practice.Conclusions: Establishing research priorities for HPE is important to ensure efficient and appropriate allocation of resources. This study serves as a reminder of how the prevailing context within which HPE, and by implication research in the field, is undertaken will inevitably influence choices about research foci. It further points to a potential advocacy role for research that generates regionally relevant evidence.