African Institute for Development Policy

Reliable short-term forecasts enable urban health systems to anticipate dengue surges and allocate resources effectively. We assembled monthly dengue case counts for Freetown, Sierra Leone (2015-2024), and compared four probabilistic model families under a leakage-safe, rolling-origin evaluation at 1-3-month horizons: a negative binomial generalized linear model (NB-GLM), a negative binomial INGARCH model (INGARCH-NB), a mechanistic renewal model with negative binomial observations (Renewal-NB), and a bidirectional long short-term memory network with a negative binomial output (BiLSTM-NB). All models used the same seasonal harmonics and autoregressive lags; "light" climate inputs (rainfall, temperature, and relative humidity) were restricted to lag-1 covariates to reflect real-time availability. We evaluated probabilistic performance using mean log score (primary), empirical coverage, and median widths of 50% and 90% predictive intervals, calibration diagnostics based on the probability integral transform, and Diebold-Mariano tests with Newey-West standard errors. For the main comparison, we evaluated models on a strictly matched set of common issue-target pairs within each horizon (n = 32 per horizon). On this aligned set, INGARCH-NB achieved the best mean log score at all horizons, indicating the strongest overall distributional accuracy. BiLSTM-NB remained competitive and provided more conservative upper-tail uncertainty at longer horizons (e.g., 90% interval coverage of 100% at h = 3), at the cost of wider intervals. NB-GLM variants produced the sharpest intervals but were substantially undercovered, indicating overconfidence, while renewal-based forecasts attained nominal coverage largely through uncertainty inflation that degraded sharpness and log score. In a leakage-safe light-climate ablation, adding lag-1 climate covariates yielded small, statistically non-significant gains for NB-GLM and did not improve renewal forecasts. Overall, the results support a horizon-aware toolkit for operational dengue forecasting: INGARCH-NB as a strong default when distributional accuracy is prioritized, complemented by calibrated deep learning (BiLSTM-NB) when conservative tail reliability is preferred. The aligned indices, per-issue forecasts, and code provide a transparent baseline for future work in similar urban settings.

Background Introducing Medical Licentiates (MLs) into the Zambian health system has significantly improved the availability of health services in rural areas. Despite their importance in the delivery of health services, MLs face challenges. Limited literature exists on the barriers and enablers to MLs practice in Zambia. This study aimed to investigate these factors. Methods A qualitative case study design was used to investigate the barriers and enablers to ML practice in Zambia. Data were collected through semi-structured, in-depth interviews with 18 purposively selected MLs. Thematic analysis used a top-down approach to identify and develop emerging themes. Results The study identified several barriers to ML practice, including inadequate remuneration, lack of professional recognition, strained working relationships with medical doctors and unregulated scopes of practice that blur the distinctions between the roles of MLs and medical doctors. Medical Licentiates felt they were on an inappropriate salary scale, unsuitable for holders of Bachelor of Science degrees with no clear pathway for academic advancement. The working relationships between MLs and medical doctors were mixed, with some MLs reporting acceptable interactions, while others experienced conflict. Enablers of ML practice were linked to professional fulfilment derived from exercising their full competencies and contributing to the recovery of patients. Conclusion Our study revealed significant barriers with few enablers to ML practice in Zambia. MLs are deeply demotivated by what they perceive as an inappropriate salary scale, exacerbated by an unregulated scope of work that sees them perform similar roles to those of medical doctors. Our results indicate a pressing need for the government to ensure that MLs are placed on a salary scale that appropriately reflects their qualifications and scope of work.

ABSTRACT Amid rising food and fertilizer prices, understanding farmers' policy preferences is critical for effective crisis response. We use best‐worst scaling experiment to assess Kenyan mobile‐owning crop farmers' preferences for government support under high and normal price scenarios. Farmers consistently favored market‐oriented and public goods investments—for example, market access, infrastructure, and extension—over subsidies and cash transfers. Input subsidies ranked fifth out of seven policy options in both scenarios. While overall rankings were stable, preference intensities sharpened under high prices. These findings challenge subsidy‐focused crisis responses and highlight the need to align agricultural policy with farmer priorities to build long‐term resilience.

A common misconception that prevails within some research communities postulates that research results 'speak for themselves' and are thus sufficient to influence policy. Yet, high-fidelity uptake of research is rarely a passive process; more often, researchers need to actively engage with policymakers. This process of policy engagement strives towards producing robust science that contributes to the betterment of our societies-but it is a process for which many researchers are not adequately trained. If publicly funded research fails to influence policy, many would regard it as falling short of fulfilling its potential value to society. Herein, we provide a framework for research-policymaker engagement, framed around the questions of why, on what, with whom, when, where and how clinical and public-health researchers can and should undertake engagement with policymakers. The views presented in this Perspective are a synthesis of the diverse, collective experience of the authors across global health contexts, supported by real-world illustrative case studies. We provide tangible recommendations for researchers, funders and policymakers to facilitate bridging the gap between evidence and policy.

Particular attention has been paid to the nutritional potential of edible insects as well as the health benefits associated with their bioactive compounds. This paper focused on an in-depth review compiling the most recent information on health benefits of insect bioactive metabolites as well as their purification and identification, in addition to consumer attitudes towards edible insects. It was found that, insect bioactive metabolites, including marcocarpal, grandinol, trolline, pancratistatin, narciclasin, ungeremin, cantharidin, cordycepin, roseoflavin, lecithin, reblastatin, chitin, chitosan and desmosterol deemed to have biological activities, such as tumor suppression, anticancer, antihypertensive, anti-inflammatory, antioxidant, immunomodulator, neuroprotective, glycemic and lipid regulation, blood pressure reduction, regulation of intestinal bacterial flora and cardiovascular protection among others. Furthermore, proper sample preparation and extraction is the first step in the purification of bioactive metabolites from edible insects. After concentration, bioactive metabolites are purified using chromatographic and separation techniques including High-Performance Liquid Chromatography (HPLC), Gas Chromatography (GC), Thin-Layer Chromatography (TLC), Size-Exclusion Chromatography (SEC). Finally, their nutritional potential, health benefits, environmentally friendly, great taste, traditions, taboo, safety concerns, unpleasant past experiences, allergies, and unnaturalness are among the main factors influencing attitudes towards insect consumption.

Global dementia cases are rising, particularly in low- and middle-income countries with limited health-care access and scarce resources, calling for preventive strategies that align with local capital and cultural practices. The Africa-FINGERS project, an adaptation of the Finnish FINGER trial, pioneers a culturally relevant, multidomain approach to dementia risk reduction for African settings. This Perspective article explores the efficacy of multimodal lifestyle interventions in reducing risks associated with cognitive decline, addressing the unique challenges involvedand examining opportunities for implementing such programmes in Africa. Drawing on preliminary insights from ongoing implementation efforts in Africa and lessons from the WorldWide FINGERS global network, we describe a standardized, evidence-based precision brain health model that aims to dynamically and equitably optimize protective factors for brain health in Africa. This model is tailored to accommodate the diverse cultural, socioeconomic and logistical contexts of Africa, emphasizing culturally adapted, scalable and resource-sensitive solutions for sustainable implementation. Building on thesuccessful execution of regional lifestyle-based interventions for other non-communicable diseases, we highlight the potential of the Africa-FINGERS programme to improve brain health and mitigate dementia risks across diverse global settings.

Abstract Background Mpox remains a critical public health challenge in Central Africa, where endemic circulation of the virulent Clade I virus persists through zoonotic and human-to-human transmission. This systematic review and meta-analysis synthesize 40 years of evidence (1984-2024) to characterize Mpox epidemiology, vaccination gaps and clinical pattern in the Central African Republic (CAR), informing targeted control strategies for this re-emerging threat. Methods Following PRISMA guidelines, we conducted a comprehensive search of PubMed, ScienceDirect, Cochrane Library, and Scopus for studies reporting laboratory-confirmed Mpox cases in CAR. Pooled estimates were calculated using random/fixed-effects models with R Statistics version 4.4.2 with subgroup analysis conducted for period, region, participants and disease burden. Heterogeneity (I 2) and publication bias (funnel plots, Egger’s and Begg’s tests) were rigorously assessed. The confidence intervals (CIs) were estimated at 95% level of confidence. Results Among 15 included studies representing 1984-2024 surveillance data, the pooled severity rate was 60.9% (95%CI:47.5-72.8) - highest in Health Region 6 (77.3%, 95%CI: 55.6-90.2). The Case fatality rate (CFR) among confirmed cases was 10.9% (95% CI: 5.9-19.0). There was non-significant decrease in CFR from 11.5%; (95% CI: 6.1-20.7) before 2022 to 7.14% (95% CI: 0.7-1.9) from 2022 on. There was a persistent post-2022 CFR elevations in high-burden areas (13.5% for >10 cases). Higher mortality was observed in Eastern Health Regions (11.11%; 95% CI: 5.08-22.60) compared to Western Health Regions with no reported death. Among suspected cases, the CFR was 10.7% (95%CI: 6.6-17.0). Vaccination uptake was low (20.0%, 95%CI: 10.3-35.2). The clinical profile included fever (91.1%, 42.9-99.3), rash (85.5%, 95%CI: 75.7-91.8), lymphadenopathy (57.0%, 95%CI: 34.3-77.1). Severe manifestations like hemorrhagic lesions (22.2%) and mucosal involvement (oral:59.2%; genital:57.4%) were also reported. Conclusion The CAR faces a disproportionate Mpox burden characterized by high severity, elevated mortality, and suboptimal vaccine coverage, particularly in eastern regions. These findings suggest the urgent need for: (1) enhanced surveillance systems with genomic sequencing capacity; (2) prevention of disease lethality through early case detection and appropriate care provision; (3) strengthening vaccine distribution prioritizing high-risk populations; and (4) context-specific interventions, including community education and healthcare worker training, to curb future outbreaks.

Malnutrition is a common yet often neglected issue in patients with Chronic Liver Disease (CLD) and cirrhosis, as clinical care typically emphasizes medication and laboratory monitoring over nutritional support. The lack of dietary guidance from healthcare providers contributes to poor health outcomes and a diminished quality of life. This study evaluated the impact of dietary advice on nutritional status, liver function, and quality of life in CLD patients. A quasi-experimental study was conducted at CMH Lahore, involving 56 patients divided into two groups of 28. Group A received standard medical care, while Group B received dietary advice in addition to routine treatment. Assessments at baseline and after three months included anthropometric measurements, serum albumin levels, calorie intake, and Chronic Liver Disease Questionnaire (CLDQ) scores. Results showed that Group B patients had significantly improved outcomes at follow-up, including higher body mass index (20.2 vs. 23.4), tricep skinfold thickness (1.3 vs. 1.9), mid-upper arm circumference (24.3 vs. 27.8), and mid-arm muscle circumference (10.4 vs. 23.6) compared to Group A. Significant improvements were also observed in CLDQ domains such as abdominal symptoms, fatigue, systemic symptoms, and overall quality of life scores. The study concluded that dietary advice positively influences anthropometric parameters, calorie intake, liver function, and quality of life in patients with CLD

Abstract BackgroundEmergency medicine systems are vital for reducing mortality and disability, yet Cameroon faces significant healthcare access challenges, with only 0.6% of GDP allocated to public health and 70% of health expenditures paid out-of-pocket. This study assessed proportion of population benefiting from health coverage, patterns, and associated factors in Cameroon to inform policies aimed at achieving universal health coverage (UHC).MethodsA nationally representative cross-sectional survey was conducted from February to March 2024, involving 1,200 adults selected via multistage random sampling. Data were collected through face-to-face interviews by national Afrobarometer team, and analyzed with R Statistics version 4.4.2. Logistic regression identified factors associated with medical coverage, adjusting for sociodemographic, economic, and occupational variables.ResultsA proportion of 7.9% (95% CI: 6.4–9.6) of respondents reported benefiting from a health coverage in 2024, with the lowest rates reported in the North, Adamawa, Centre, and North-West regions. Private health insurance was the most common (44.3%), followed by civil servant schemes (20.5%) and community-based insurance (15.9%). Unemployed individuals were twice as likely to lack coverage (aOR = 2.22, 95% CI: 1.42–3.51). Those with secondary education had twice the odds of being uninsured compared to tertiary-educated individuals (aOR = 2.00, 95% CI: 1.21–3.27). Insured individuals were more likely to use healthcare services (9.6%; p = 0.028), reported easier access to medical care (15.8%; p = 0.010), and expressed fewer concerns about healthcare access (23.4%; p < 0.001). Barriers among the uninsured included high costs (37.1%), lack of information (31.6%), complex registration processes (8.5%) and geographical constraints. Most of the community members reported being quite (51.1%) or very satisfied (23.9%) by the medical coverage they are benefiting from. Notably, 68% of respondents supported higher taxes to improve healthcare access.ConclusionCameroon’s suboptimal medical coverage reflects systemic inequities tied to employment and education. Expanding employer-independent schemes, subsidizing premiums, and leveraging community-based models are critical to advancing UHC. Public willingness to contribute through taxes suggests political viability for systemic reforms.

Background Digital repositories and databases facilitate faster dissemination, transparency, and stakeholder collaboration. This review aimed to map and evaluate such digital infrastructures, focusing on their scope, content, functionality, adherence to FAIR (Findability, Accessibility, Interoperability and Reuse) principles, and user interface and experiences (UI/UX). Methods A review of global digital health policy repositories was conducted across multiple search engines and databases. The review targeted digital repositories that systematically collate health policy documents at a global level. Two country-specific repositories with a bearing on global health policies were also included. Results The study identified 59 global health policy repositories, with 15 matching our inclusion criteria evaluated in detail. These repositories contain vast amounts of data and are generally freely accessible, rendering them immensely rich sources for health policy documents, though with significant variability in content and coverage. The majority have a health focus, including HIV/AIDS, non-communicable diseases (NCDs), and maternal, newborn, and child health (MNCH); about a third are more broad and emerging health threats are often neglected. Accessibility and usability are limited, with basic user interface features such as search and filtering tools are present for almost all repositories and a notable lack of advanced analytics or artificial intelligence capabilities. Furthermore, many repositories struggle to adhere to FAIR principles, reducing their utility and potential for integration. Sustainability is also a concern, as funding often relies on short-term projects or philanthropic support, undermining long-term viability. Conclusion These issues collectively hinder the ability of digital health policy repositories to support comprehensive and timely global health policy development. To unlock the full potential of existing or new repositories for health policy, identified challenges should be tackled systematically. We provide specific recommendations aimed at driving the development of equitable, inclusive, high-functioning repositories and strengthening evidence-driven global health policy systems.