Virtualized 5G Core Architecture using Open-Source Technologies for Resource-Constrained Environments

Russian foreign policy aims to subvert the West-centered world order established after the Cold War. While promoting the post-Western civilizational and “post-colonial” ideology since the mid-2010s, Moscow has been pragmatic and dependent on its limited foreign policy resources, on the one hand, and the mixed receptivity of different audiences to Russia's ideological message, on the other. To test this argument, the paper selects three cases from Sub-Saharan Africa, where Russia has been increasingly active since the 2000s, for a closer investigation. Moscow has advanced limited and nonideological goals in Nigeria as a status quo country. Toward South Africa, Russia has promoted the message of gradual change and building new global institutions because Johannesburg shares a considerable part of Moscow's ideological agenda of confronting Western “(neo)colonialism.” Finally, in the Central African Republic, Russia has embraced radically anti-Western policies, providing security, weapons, and ideological justification for anti-Western leaders in power. These ideologically diverse relations have brought Moscow significant political dividends despite its considerably more limited resources than during the Cold War era.

The cost of compound feed is a constraint in intensive fish and poultry farming, contributing 60-80% of the total production costs, 70% of which is due to fish and soy meal used as protein source. This review presents the extent to which insects have been utilised as an alternative protein source in feed in sub-Saharan Africa (SSA). A key word search of agricultural, biological and multi-disciplinary databases and academic search engines was conducted for literature on the extent of research and utilisation of insects in poultry and fish feed in SSA. There is limited published information on the practice as well as technical and economic feasibility of the use of insects as alternative protein ingredients in compound feed. This is likely because research on the subject is fairly recently initiated and yet to be published. Excluding South Africa, rearing, processing and use of insects is still at experimentation level at laboratory scale. Insects (grasshoppers, house fly maggots, Westwood larvae, termites and garden snail) meal replaced conventional protein sources by 10-100% without affecting the growth performance of fish and poultry. In some cases, insect based feed performed better than conventional feed. Nutritional composition data of insects published for SSA majorly focused on proximate composition and not characterisation of the nutritional quality. Several research and development projects on the technical and economic feasibility, social acceptability and potential social-economic impact are ongoing and expected to increase available data when completed. Published research confirms the potential of insects for use in poultry and fish production systems and mass production and processing of target insects is the next necessary step. Based on available and ongoing research, piloting and up-scaling the use of insects as alternative protein sources in animal feed in partnership with private sector in SSA is necessary. This will confirm and enhance the technical and economic feasibility of using of insects as an alternative protein source on a commercial scale.

BackgroundSub-Saharan Africa (SSA) is facing a double burden of disease with a rising prevalence of non-communicable diseases (NCDs) while the burden of communicable diseases (CDs) remains high. Despite these challenges, there remains a significant need to understand how or under what conditions health interventions implemented in sub-Saharan Africa are sustained. The purpose of this study was to conduct a systematic review of empirical literature to explore how health interventions implemented in SSA are sustained.MethodsWe searched MEDLINE, Biological s, CINAHL, Embase, PsycInfo, SCIELO, Web of Science, and Google Scholar for available research investigating the sustainability of health interventions implemented in sub-Saharan Africa. We also used narrative synthesis to examine factors whether positive or negative that may influence the sustainability of health interventions in the region.ResultsThe search identified 1819 citations, and following removal of duplicates and our inclusion/exclusion criteria, only 41 papers were eligible for inclusion in the review. Twenty-six countries were represented in this review, with Kenya and Nigeria having the most representation of available studies examining sustainability. Study dates ranged from 1996 to 2015. Of note, majority of these studies (30 %) were published in 2014. The most common framework utilized was the sustainability framework, which was discussed in four of the studies. Nineteen out of 41 studies (46 %) reported sustainability outcomes focused on communicable diseases, with HIV and AIDS represented in majority of the studies, followed by malaria. Only 21 out of 41 studies had clear definitions of sustainability. Community ownership and mobilization were recognized by many of the reviewed studies as crucial facilitators for intervention sustainability, both early on and after intervention implementation, while social and ecological conditions as well as societal upheavals were barriers that influenced the sustainment of interventions in sub-Saharan Africa.ConclusionThe sustainability of health interventions implemented in sub-Saharan Africa is inevitable given the double burden of diseases, health care worker shortage, weak health systems, and limited resources. We propose a conceptual framework that draws attention to sustainability as a core component of the overall life cycle of interventions implemented in the region.

BackgroundPeople living in sub-Saharan Africa (SSA) are disproportionately exposed to trauma and may be at increased risk for posttraumatic stress disorder (PTSD). However, a dearth of population-level representative data from SSA is a barrier to assessing PTSD. This manuscript sought to calculate pooled PTSD prevalence estimates from nationally and regionally representative surveys in SSA.Methods and findingsThe search was conducted in PubMed, Embase, PsycINFO, and PTSDpubs and was last run between October 18, 2019, and November 11, 2019. We included studies that were published in peer-reviewed journals; used probabilistic sampling methods and systematic PTSD assessments; and included ≥ 450 participants who were current residents of an SSA country, at least 50% of whom were aged between 15 and 65 years. The primary outcomes were point prevalence estimates of PTSD across all studies, and then within subgroups. The protocol was registered with the International Prospective Register of Systematic Reviews (PROSPERO) (registration number CRD42016029441). Out of 2,825 unique articles reviewed, 25 studies including a total of 58,887 eligible participants (54% female) in 10 out of the 48 countries in SSA were identified. Most studies enrolled any adult aged 18 years or older. However, some studies only enrolled specific age brackets or persons as young as 15 years old. Six studies were national surveys, and 19 were regional.There were 4 key findings in the meta-analysis: (1) the overall pooled prevalence of probable PTSD was 22% (95% CI 13%–32%), while the current prevalence—defined as 1 week to 1 month—was 25% (95% CI 16%–36%); (2) prevalence estimates were highly variable, ranging from 0% (95% CI 0%–0%) to 74% (95% CI 72%–76%); (3) conflict-unexposed regions had a pooled prevalence of probable PTSD of 8% (95% CI 3%–15%), while conflict-exposed regions had a pooled prevalence of probable PTSD of 30% (95% CI 21%–40%; p < 0.001); and (4) there was no significant difference in the pooled prevalence of PTSD for men and women. The primary limitations of our methodology are our exclusion of the following study types: those published in languages other than English, French, and Portuguese; smaller studies; those that focused on key populations; those that reported only on continuous measures of PTSD symptoms; and unpublished or non–peer-reviewed studies.ConclusionsIn this study, PTSD symptoms consistent with a probable diagnosis were found to be common in SSA, especially in regions exposed to armed conflict. However, these studies only represent data from 10 of the 48 SSA countries, and only 6 studies provided national-level data. Given the enormous heterogeneity expected across the continent, and also within countries and regions, this review cannot speak to rates of PTSD in any regions not included in this review. Thus, substantial gaps in our knowledge of PTSD prevalence in SSA remain. More research on population-level prevalence is needed to determine the burden of trauma symptoms and PTSD in SSA and to identify acceptable and feasible approaches to address this burden given limited mental healthcare resources.

3 billion people lack proper home hand hygiene facilities globally. Of these, 1.4 billion (18%) lack soap or water, while 1.6 billion (22%) have neither. This analysis explores the link between living conditions and the use of essential agents in sub-Saharan Africa. This secondary data analysis examines potential associations between the domiciliary environment and the use of essential agents in sub-Saharan Africa. Eighteen demographic and health surveys were used to analyze the association between household environmental factors and handwashing with essential agents. STATA version 16 was used to analyze data from 203,311 households across weighted samples. Using a multivariable multilevel mixed effect logistic regression analysis, it was possible to determine how each independent factor affected the outcome while taking the data clustering into account. The adjusted odds ratio and its associated 95% confidence interval were used to assess the independent factors' statistical significance. Only one in three households 34.84%, practiced handwashing with essential agents, with the highest prevalence in Angola (70.2%) and the lowest in Malawi (6.5%). Educational status [aOR = 1.77; 95%(CI = 1.68-1.86)], female headship[aOR = 1.09; 95%(CI = 1.06-1.2)], household wealth[aOR = 4.08; 95%(CI = 3.84-4.33)], not sharing toilets with other homes[aOR = 1.13; 95%(CI = 1.10-1.17)], having a fixed place for hand washing[aOR = 1.49; 95%(CI = 1.45-1.54)], not having regular access to water [aOR = 0.09; 95%(CI = 0.095-0.10)]and being a rural resident [aOR = 0.85; 95%(CI = 0.82-0.88)] were associated with handwashing. sub-Saharan nations are failing to demonstrate advancements in handwashing practices. There are still a lot of homes without access to basic infrastructure for handwashing and household water sources. For essential agent adoption programs to be successful in an environment with limited resources, Water, Sanitation, and Hygiene measures must be implemented. Furthermore, it is critical to include contextual factors from the current study as well as socio-cultural and psychological characteristics that dissuade people from using essential agents in intervention strategies.

Future Directions for HIV Prevention Research

Purpose This study aims to assess linkages between education, technology and agricultural transformation in sub-Saharan Africa. In developing countries, agriculture struggles with limited resources, poor infrastructure and climate change impacts. Access to information technologies (IT) has become crucial for boosting production and resilience. However, farmers’ lack of understanding of IT can negatively affect their food production. Thus, education is necessary to help farmers understand and use IT to improve their food production. Design/methodology/approach This study analyzes the role of education in the IT-agricultural production nexus in sub-Saharan African nations (SSA) using panel data on 34 countries over the period 2004–2020. The system generalized moments technique was used for the model estimation. Findings The results show that IT can be effectively complemented by education to enhance agricultural production. The thresholds of education needed for IT to increase agricultural production are provided. The established thresholds are as follows: 0.651 for “fixed broadband,” 0.641 for “fixed telephone”, 0.476 for “internet,” 0.538 for “mobile cellular subscription” and 0.489 for “IT.” These findings suggest that the reinforcement of educational quality could help consolidate IT to enhance agricultural production. Originality/value This study complements the extant literature by examining the nexus between education and technology in light of agricultural transformation in sub-Saharan Africa.

Globally there is no consensus on the ideal set of indications for obtaining a blood culture in paediatric and neonatal practice. In sub-Saharan Africa, where paediatric sepsis is associated with worse outcomes than other regions, early and accurate detection of bacteraemia is particularly important. However, use of blood culture in sub-Saharan Africa is complicated by resource limitation, variable availability of microbiological laboratory services, and prevalence of coinfections such as malaria, tuberculosis and HIV. Additional factors, such as different vaccination profiles and disease severity at presentation, limit generalisability of approaches developed for use in high-income countries. We review the literature on clinical indications for blood cultures in paediatric and neonatal practice, including current practices from sub-Saharan Africa and low-middle income countries, and propose a simple, practical set of clinical indications for blood culture in paediatric and neonatal practice in this setting.

Few data are available on the treatment of rheumatoid arthritis (RA) in sub-Saharan Africa, where the diagnosis is often substantially delayed. Disease-modifying antirheumatic drugs (DMARDs) are more effective when started early. Biotherapies are not available. Given the socioeconomic constraints in sub-Saharan Africa, treatments must be selected based on locally available resources. The objective of this study was to evaluate outcomes 6 months after initiation of conventional DMARDs in Senegalese patients with RA. We retrospectively studied consecutive RA patients seen at the rheumatology outpatient clinic of the Le Dantec Teaching Hospital, Dakar, Senegal, from January 2005 through June 2009. All patients met the ACR criteria for RA. ACR and EULAR response criteria were evaluated 6 months after treatment initiation. The study included 205 patients. Corticosteroids were used in 205 patients, hydroxychloroquine in 190, methotrexate in 137, and sulfasalazine in 11. Combined corticosteroid, methotrexate, and hydroxychloroquine therapy was used in 122 patients and combined corticosteroid and hydroxychloroquine therapy in 63. DMARD treatment was interrupted for at least 5 days per month for 26% of the patients, either because the drugs were out of stock at the local pharmacies and/or because the patients could not afford to purchase them. During the first 6 months of treatment, patients had a mean of 4 clinic visits, and 48% of patients missed at least one scheduled visit. After 6 months, all clinical variables had improved significantly, except the swollen joint count. The ACR20, 50, and 70 response criteria were met in 50%, 31%, and 6.9% of patients, respectively. The EULAR response was good in 53.9% of patients, moderate in 12.7%, and poor in 23.1%. DMARD therapy failed in 10.3% of patients. Half the patients had their treatment modified during the 6-month study period. DMARD therapy was discontinued in 10 patients for the following reasons: plans to become pregnant, n = 5; pregnancy during treatment, n = 2; and tuberculosis, n = 3. In Senegal, the treatment of RA relies chiefly on variable combinations of methotrexate, hydroxychloroquine, and corticosteroids. The six-month outcomes are satisfactory. Biotherapy is required in 7% to 10% of patients, a rate that could be decreased by optimizing patient follow-up. The management of chronic inflammatory joint disease couple be improved despite the limited financial resources in sub-Saharan Africa with better physician training and the incorporation of osteoarticular diseases within a vast information and education program for the general population.

BackgroundBrain tumors pose a significant health challenge globally, with limited comprehensive data on their surgical outcomes in Africa. This review explores the surgical landscape, challenges, and future directions for brain tumor management on the continent. Main bodyThe prevalence of brain tumors in Sub-Saharan Africa, notably in Nigeria, Egypt, and Uganda, underscores the need for improved strategies. Despite challenges such as limited resources, studies demonstrate the feasibility and safety of neurosurgical interventions, emphasizing the adaptability of practices in resource-constrained environments. The review addresses risk factors, genetic considerations, and highlights the urgent need for expanded genomic studies in Africa. Challenges, including limited healthcare access, lack of specialized services, and socioeconomic factors, hinder optimal outcomes. Policymakers are urged to prioritize neurosurgical infrastructure, implement training programs, and foster international collaborations. Telemedicine, public awareness campaigns, and research initiatives are crucial components for enhancing surgical outcomes. ConclusionThe proposed comprehensive policy approach aims to overcome barriers, improve access, and ultimately contribute to global efforts in combating brain tumors in Africa.

IntroductionHIV drug resistance (HIVDR) remains a significant challenge in sub-Saharan Africa (SSA) due to limited effective Treatment and healthcare resources vary. Using the first widely available HIVDR surveillance data in SSA, we calculated the prevalence and associated factors of HIVDR amongst the persons that were on ART between 2015 and 2019 using the Population-based HIV Impact Assessment (PHIA).MethodsA secondary analysis of the combined PHIA HIVDR data from Cameroon, Malawi, Eswatini, Ethiopia, Namibia, Rwanda, Tanzania, Zambia and Zimbabwe over the 2015–2019 period. All the 1,008 persons with HIVDR information were included in the analysis. We calculated frequencies, proportions, 95% confidence intervals (95%CI), crude/adjusted odds ratios (cOR/aOR), chi-Square statistics using in R. HIVDR was determined through genotypic testing of blood samples from HIV positive individuals with detectable viral load. We examined the prevalence and associated factors of HIVDR in SSA. Standard assays were used to identify mutations linked to resistance to NRTIs, NNRTIs, and PIs. Presence of at least one mutation indicated HIVDR status. Supervised machine learning models were developed in RStudio using the SuperLearner and caret packages, training six algorithms to predict HIVDR. Variable importance was assessed using a random forest model, while predicted probabilities were Generated via Elastic Net LASSO regression with 10-fold cross-validation. Statistical significance was set at P < 0.05.ResultsAn overall prevalence of HIVDR was 35%. Not reaching HIV viral load suppression, experiencing antiretroviral treatment, and certain sociodemographic characteristics including age (35 + years), living in a rural area, and particular national contexts (e.g., higher resistance in Rwanda and Zimbabwe) were important factors linked to higher HIVDR likelihood. Additionally, the study revealed that having viral load suppression was associated with lower HIVDR likelihood (aOR: 0.31, 95% CI: 0.21–0.45, P < 0.001), whereas experiencing antiretroviral treatment was associated with higher HIVDR likelihood (aOR: 2.6, 95% CI: 1.75–3.91, P < 0.001). Machine learning models confirmed that programmatic and contextual factors outweighed individual characteristics in shaping resistance risk. Predicted probabilities were highest among ART-experienced individuals with unsuppressed viral load, reaching up to 45%. While the LASSO model showed moderate accuracy, the Super Learner ensemble outperformed all models.ConclusionThis study concludes by highlighting the substantial prevalence of HIVDR in SSA, which varies significantly among nations and sociodemographic characteristics. The results highlight the importance of ART use and viral load suppression in determining HIVDR prevalence, underscoring the necessity of focused interventions to enhance viral load monitoring and ART adherence. To combat the growing threat of HIVDR and guarantee the long-term efficacy of HIV treatment programs in the area, ongoing surveillance and context-specific approaches are crucial.

Dear Sir With HIV seroprevalence rates of up to 36% in the adult population, health care facilities in sub-Saharan Africa are being overwhelmed by HIV-positive individuals. In most settings, sophisticated laboratory markers of HIV disease progression are unavailable. To allow a balanced distribution of scarce health care resources, low-cost prognostic indicators are required. Hosp et al. have used the immunoalkaline phosphatase method to determine CD4 counts in HIV-positive individuals in Zambia[1]. A good correlation with fluorescence-activated cell sorter (FACS)-obtained CD4 counts was documented, and the value of FACS CD4 counts correlated with degree of immune suppression, judged by clinical events. Total lymphocyte counts (TLC) were noted to be lower if patients had oral candidiasis, became ill or died during follow-up, but a TLC < 2000 cells/μL had poor predictive value for a CD4 count below 200 cells/μL[1]. The authors did not advocate the use of TLC for prognostic purposes. In a large cohort of South African HIV-positive patients, we previously evaluated the role of the TLC to predict HIV disease progression[2]. A TLC of 1250 cells/μL correlated with a CD4 count of 200 cells/μL, and a TLC < 750 cells/μL was equivalent to a CD4 count below 50 cells/μL. Total lymphocyte and CD4 counts, when added to the World Health Organization (WHO) clinical stage, were equal predictors of progression from WHO stages 1–3 to AIDS, and from AIDS to death. We suggested that a TLC < 1250 cells/μL could be used as a laboratory criterion to commence co-trimoxazole prophylaxis[2]. Others have confirmed the good correlation between CD4 counts and TLC[3]. Tuberculosis (TB) is the commonest opportunistic infection in our region, and a major health care burden in sub-Saharan Africa. When available, chest radiographic pattern can both predict CD4 count and survival in HIV-infected patients[4, 5]. Typical upper-lobe cavitatory disease is associated with a preserved CD4 count and excellent outcome, whereas patients with atypical patterns had low CD4 counts and 50% mortality at 1 year. Lymphopenic patients with TB had a significantly higher mortality than those with a normal TLC[5]. Patients with HIV-related tuberculosis were shown to benefit from co-trimoxazole prophylaxis in a West African study[6]. In our opinion, the combination of WHO clinical stage, performance status and total lymphocyte count allows prognostication of patients with HIV infection, such that individuals at risk of opportunistic infections can be identified and considered for prophylaxis, and that limited resources available may be targeted at patients that are likely to benefit most.

The College of Surgeons of East, Central, and Southern Africa (COSECSA) addresses the severe shortage of neurosurgeons in Sub-Saharan Africa through its fellowship programs. Neurosurgical trainees record their operative experiences in e-logbooks, aligning with COSECSA's procedural bundles, to ensure comprehensive surgical training. However, limited resources and access to specialized procedures continue to challenge the quality of neurosurgical care in the region. This study evaluates the operative exposure and procedural diversity of COSECSA neurosurgical trainees and assesses the effectiveness of the original COSECSA bundles compared to a newly proposed ICD-10-PCS-based system. This retrospective analysis reviewed data from 15 neurosurgical trainees who completed their COSECSA training between 2015 and 2023, across 25 hospitals in 5 countries. Operative data were extracted from the COSECSA e-logbook, which was standardized using the ICD-10-PCS coding system. Procedures were categorized into both the original COSECSA bundles and the new ICD-10-PCS-based bundles. Descriptive statistics were used to evaluate the total number of operations performed, the diversity of procedures, and compliance with training requirements. Trainees logged a total of 12,352 operations, exceeding the minimum required 400 cases. The original COSECSA bundles had variable completion rates (26%-64%), while the ICD-10-PCS-based bundles demonstrated higher and more consistent completion (76%-100%). Hospital participation was broader under the new system, but specialized procedures, such as cranial nerve and vertebral vessel surgeries, were still underrepresented in certain hospitals. While COSECSA's volume-based requirements ensure adequate operative exposure, they fail to address the procedural diversity needed for comprehensive neurosurgical training. The ICD-10-PCS-based system better captures the full range of trainee experiences and offers a more adaptable framework for evaluating training quality, though regional disparities in procedural availability remain a challenge. The ICD-10-PCS-based bundle system provides a more effective method for tracking neurosurgical training, enhancing its relevance in resource-limited settings. To further improve training, COSECSA should focus on increasing access to specialised procedures and refining training requirements to ensure a more diverse and comprehensive surgical education.

Sustainable agriculture is vital for food security and environmental conservation in Sub-Saharan Africa (SSA), where smallholder farmers encounter challenges like limited resources and market access. E-commerce platforms offer potential solutions by enhancing connectivity and sustainable practices. This review assesses the impact of such platforms on smallholder agriculture in the region, analysing the literature, reports, and case studies from 2010 to 2024 sourced from databases like Google Scholar and Scopus. Inclusion criteria focused on market access, economic outcomes, and sustainability. Findings indicate that e-commerce platforms notably improve market access, leading to better prices and reduced post-harvest losses. They also facilitate information flow, encouraging sustainable practices. However, challenges such as digital literacy and infrastructure deficits persist. E-commerce platforms positively influence sustainable agriculture in SSA by improving market access and supporting sustainable practices. Overcoming barriers through policy interventions and capacity-building is crucial for maximising these benefits. Further research is needed to explore long-term impacts and scalable models.

Tuberculosis, HIV/AIDS and Malaria Health Services in sub-Saharan Africa – A Situation Analysis of the Disruptions and Impact of the COVID-19 Pandemic