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OBJECTIVE: We evaluate the mid-intervention (8 weeks) and short-term (16 weeks) impact of a culturally adapted multiple family group (MFG) intervention, "Amaka Amasanyufu," on the mental health of children with disruptive behavior disorders (DBDs) and primary caregivers in Uganda. METHOD: We analyzed data from the Strengthening mental health and research training in Sub-Saharan Africa (SMART) Africa-Uganda study. Schools were randomized to the following: a control group; an MFG facilitated by parent peers (MFG-PP); or an MFG facilitated by community health workers (MFG:CHW). All participants were blinded to interventions provided to other participants and study hypotheses. At 8 weeks and 16 weeks, we evaluated differences in depressive symptoms and self-concept among children and in mental health and caregiving-related stress among caregivers. Three-level linear mixed-effects models were fitted. Pairwise comparisons of post-baseline group means were performed using the Sidak adjustment for multiple comparisons and standardized mean differences. Data from 636 children with DBDs and caregivers (controls: n = 243, n = 10 schools; MFG-PP: n = 194, n = 8 schools; MFG-CHW: n = 199, n = 8 schools) were analyzed. RESULTS: There were significant group-by-time interactions for all outcomes, and differences were observed mid-intervention, with short-term effects at 16 weeks (end-intervention). MFG-PP and MFG-CHW children had significantly lower depressive symptoms and higher self-concept, whereas caregivers had significantly lower caregiving-related stress and fewer mental health problems, than controls. There was no difference between intervention groups. CONCLUSION: Amaka Amasanyufu MFG intervention is effective for reducing depressive symptoms and improving self-concept among children with DBDs while reducing parental stress and mental health problems among caregivers. Given the paucity of culturally adapted mental health interventions, this provides support for adaptation and scale-up in Uganda and other low-resource settings. CLINICAL TRIAL REGISTRATION INFORMATION: SMART Africa (Strengthening Mental Health Research and Training); https://clinicaltrials.gov/: NCT03081195.
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Mental Health , Problem Behavior , Humans , Child , Problem Behavior/psychology , Uganda , Attention Deficit and Disruptive Behavior DisordersABSTRACT
African traditional medicine is one of the oldest forms of health-care system in the continent that has continued to be relevant. It is usually holistic, treating mind and body, and includes aromatherapy, bone setting, circumcision, herbs, homeopathy massaging, spiritual therapies, maternity care, psychiatric care, music therapy, and many more. It is a very old and culturally informed method of health management that humans have used against diseases that have threatened existence. More than 60,000 of the world's higher plant species can be found in sub-Saharan Africa and the Indian Ocean Islands. These are about one-fourth of the global total and less than the 8% of the medicinal plants sold internationally from Africa. This scarcity could be due to lack of data on the traditional uses of many African plants as the knowledge is transferred orally by storytellers and traditional healers though in recent times, there are some information in print. Immunomodulation is seen as an essential feature of immunotherapy whereby immune responses are provoked, heightened, decreased, or avoided. Immune responses have been observed to be either cellular co-receptor expression, class switching, cytokine secretion, histamine release, immunoglobulin secretion, lymphocyte expression, or phagocytosis. Immune system dysfunction is responsible for various diseases like allergies, asthmas, arthritis, cancers, and infectious diseases. So modulation of immune responses is required in controlling diseases. This is requisite nowadays because of the upsurge of infectious diseases like superbugs caused by Multi-Resistant Staphylococcus aureus (MRSA) and the coronavirus (COVID-19) plus other emerging diseases. The historical view of African Traditional Medicine (ATMs) will be discussed from the point of view of specific plants used for immunomodulation in the ATMs and their efficacies following the trend of use and development of herbal medicines from crude formulations to refined dosage forms and procedures over time. Most of the ATMs are prepared as tonics and bitters to heighten and keep up immune defenses. © The Editor(s) (if applicable) and The Author(s), under exclusive license to Springer Nature Singapore Pte Ltd. 2022.
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"Young People, Violence and Strategic Interventions in Sub-Saharan Africa (SSA)" brings together data and case studies from a range of SSA countries. While the findings are diverse, a set of themes predominate: they reveal that violence, embedded in everyday lived realities, is a complex and urgent issue that should be comprehensively probed. While moments of political and xenophobic violence are reflected upon, critical attention is firmly on young women and their grappling with sexual and gender-based violence. The COVID lens has magnified micro-struggles and long-standing structural problems showing how inequities and disadvantages have created an infrastructure through which violence has been exacerbated. There is also a focus on masculinities constructed by oppressive histories, social and economic crises, and state disregard, but with the message that marginality should not be reified, nor the gendered practices of young men oversimplified. In all the chapters, contextual specificities and insightful case studies offer thoughts and arguments about the ways in which violence manifests, what interventionist strategies are compelling, and how young people's proactive involvement in interventions could begin to address the problem of violence. (PsycInfo Database Record (c) 2023 APA, all rights reserved)
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Risk and predisposing factors for viral zoonoses abound in the sub-Saharan Africa (SSA) region with significant public health implications. For several decades, there have been several reports on the emergence and re-emergence of arbovirus infections. The lifetime burden of arboviral diseases in developing countries is still poorly understood. Studies indicate significant healthcare disruptions and economic losses attributed to the viruses in resource-poor communities marked by impairment in the performance of daily activities. Arboviruses have reportedly evolved survival strategies to aid their proliferation in favorable niches, further magnifying their public health relevance. However, there is poor knowledge about the viruses in the region. Thus, this review presents a survey of zoonotic arboviruses in SSA, the burden associated with their diseases, management of diseases as well as their prevention and control, mobility and determinants of infections, their vectors, and co-infection with various microorganisms. Lessons learned from the ongoing coronavirus disease 2019 (COVID-19) pandemic coupled with routine surveillance of zoonotic hosts for these viruses will improve our understanding of their evolution, their potential to cause a pandemic, control and prevention measures, and vaccine development.Copyright © GERMS 2022.
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Globally, gender-based violence (GBV) continues to be a serious global health, human rights, and development issue. There is no standard definition of GBV, but it can be enacted under different forms such as physical violence, sexual violence, economic violence, psychological and emotional aggression (including coercive tactics) directed at someone because of their biological sex or gender identity. Most literature focuses on violence against females (both heterosexual and homosexual) and children, with little focus on males' perspectives. Most GBV narratives present males as perpetrators of violence. Recent statistics show that intimate partner violence (IPV) increased during the COVID-19 pandemic due to increased unemployment, substance abuse and reduced economic status. Recent country specific statistics are sparse but understanding the males' perceptions and experiences of GBV can assist with identifying appropriate interventions to deal with GBV. This critical review highlights critical knowledge gaps in the existing literature and a need for future research within Sub-Saharan Africa (SSA). (PsycInfo Database Record (c) 2023 APA, all rights reserved)
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This book explores the resilience of constitutional government in the wake of the COVID-19 pandemic, connecting and comparing perspectives from ten countries in sub-Saharan Africa to global trends. In emergency situations, such as the COVID-19 pandemic, a state has the right and duty under both international law and domestic constitutional law to take appropriate steps to protect the health and security of its population. Emergency regimes may allow for the suspension or limitation of normal constitutional government and even human rights. Those measures are not a license for authoritarian rule, but they must conform to legal standards of necessity, reasonableness, and proportionality that limit state action in ways appropriate to the maintenance of the rule of law in the context of a public health emergency. Bringing together established and emerging African scholars from ten countries, this book looks at the impact government emergency responses to the pandemic have on the functions of the executive, the legislature, and the judiciary, as well as the protection of human rights. It also considers whether and to what extent government emergency responses were consistent with international human rights law, in particular with the standards of legality, necessity, proportionality, and non-discrimination in the Siracusa Principles. © The Author(s), under exclusive license to Springer Nature Switzerland AG 2022.
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In Africa, refusal of COVID-19 and other vaccines is widespread for different reasons, including disbelief in the existence of the virus itself and faith in traditional remedies. In sub-Saharan countries, refusal is often made worse by opposition to vaccines by the religious establishments. This is a pressing problem, as Africa has the highest vaccine-avoidable mortality rate for children under the age of five in the world. Dialogue between those wishing to promote vaccines and those who resist them is essential if the situation is to be improved. This article argues that Western and other aid agencies seeking to promote vaccination programs need to develop a dialogue with resisters, and in this process to embrace and commend the ancient African philosophical tradition of Ubuntu, incorporating it into these programs as a way to overcome such entrenched resistance. The paper concludes with concrete recommendations for how to accomplish this goal.
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Before the influx of Information Communication Technologies (ICTs) in Sub-Saharan Africa (SSA), Africa was seen as a dark continent (Agwe-Mbarika et al., 2011). In 2016, the United Nations General Assembly passed a non-binding resolution declaring Internet access a human right and the intentional Internet disruption a human rights violation. This is contained in resolution A/HRC/32/L.20 of 2016. Recent reports also declare that Internet access falls under the freedom of expression (La Rue, 2011). (PsycInfo Database Record (c) 2023 APA, all rights reserved)
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The SARS-CoV-2 virus causing the coronavirus disease (COVID-19) global pandemic heightened restrictions on sexual and reproductive health and rights (SRHR), especially concerning safe abortion access. The African region has been particularly susceptible to the impact of COVID-19 on sexual and reproductive health services. Using a framework of reproductive justice, we interviewed key informants from the Mobilizing Action around Medication Abortion (MAMA) Network regarding the impacts of structural violence and COVID-19 on SRHR programming in Africa, particularly programming on self-managed abortion. We identified themes of lacking infrastructures of support, emergent marginality, and neocolonial funding environments as facets of structural violence within the context of the MAMA Network, as heightened by the COVID-19 global pandemic.
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BACKGROUND: Human Papilloma Virus (HPV) is the most common sexually transmitted infection worldwide. Globally, both men and women have a 50% risk of being infected at least once in their life. HPV prevalence is among the highest in sub-Saharan Africa (SSA), at an average of 24%. HPV causes different types of cancers, including cervical cancer (CC), which is the leading cause of cancer deaths among women in SSA. HPV-vaccination has been proven to be effective in reducing HPV induced cancers. SSA countries are delayed in reaching the WHO's target of fully vaccinating 90% of girls within the age of 15 by 2030. Our systematic review aims to identify barriers and facilitators of HPV-vaccination in SSA to inform national implementation strategies in the region. METHODS: This is a mixed method systematic review based on the PRISMA statement and The Joanna Briggs Institute Reviewers' Manual. Search strategies were adapted to each selected database: PubMed/MEDLINE, Livivo, Google Scholar, Science Direct, and African Journals Online for papers published in English, Italian, German, French and Spanish between 1 December 2011 and 31 December 2021. Zotero and Rayyan were the software used for data management. The appraisal was conducted by three independent reviewers. RESULTS: A total of 20 articles were selected for appraisal from an initial 536 articles. Barriers included: limited health system capacities, socio-economic status, stigma, fear and costs of vaccines, negative experience with vaccinations, COVID-19 pandemic, lack of correct information, health education (HE) and consent. Additionally, we found that boys are scarcely considered for HPV-vaccination by parents and stakeholders. Facilitators included: information and knowledge, policy implementation, positive experience with vaccinations, HE, stakeholders' engagement, women's empowerment, community engagement, seasonality, and target-oriented vaccination campaigns. CONCLUSIONS: This review synthesizes barriers and facilitators of HPV-vaccinations in SSA. Addressing these can contribute to the implementation of more effective HPV immunization programs targeted at eliminating CC in line with the WHO 90/70/90 strategy. REGISTRATION AND FUNDING: Protocol ID: CRD42022338609 registered in the International Prospective Register of Systematic Reviews (PROSPERO). Partial funds: German Centre for Infection research (DZIF) project NAMASTE: 8,008,803,819.
Subject(s)
COVID-19 , Papillomavirus Infections , Papillomavirus Vaccines , Uterine Cervical Neoplasms , Male , Humans , Female , Papillomavirus Infections/epidemiology , Pandemics , COVID-19/epidemiology , COVID-19/prevention & control , Africa South of the Sahara/epidemiology , Vaccination/adverse effects , Uterine Cervical Neoplasms/epidemiologyABSTRACT
The study contributes to the understanding of the societal impact of the coronavirus disease 2019 pandemic in the Global South by examining longer term implications of pandemic-induced disruptions and deprivations for social ties and psychosocial well-being. Using data from a survey of middle-aged women in rural Mozambique, the author finds a negative association between the pandemic-triggered household economic decline and perceived changes in the quality of relations with marital partners, non-coresident children, and relatives, but not with generally more distant actors, such as coreligionists and neighbors. In turn, multivariable analyses detect a positive association of changes in the quality of family and kin ties with participants' life satisfaction, regardless of other factors. Yet women's expectations for changes in their household living conditions in the near future show a significant association only with changes in the quality of relations with marital partners. The author situates these findings within the context of women's enduring vulnerabilities in low-income patriarchal settings.
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Low vaccination rates, inferior-quality vaccines, limited testing, and a lack of funding forced many institutions in Sub-Saharan Africa into online-learning-only environments for two years during the COVID-19 pandemic. Instructors scrambled to put classes online. Only in 2022 did some face-to-face classes resume. Unforeseeable and unprecedented circumstances forced university personnel to function with reduced budgets and without regard for the return to in-person classes. We taught, studied, and analyzed a cohort of third-year Sub-Saharan African students who spent their first two years of studies online. We describe the struggles they faced and what can be done to make up for their shortcomings and missed opportunities. We quantify the shortcomings through focus groups, an analysis of what parts of an accredited program would have fallen short, interviews, and through anecdotal evidence. Our findings can help those who suffered a similar fate. These observations can be applied to non-STEM disciplines. © 2023 IEEE.
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The Novel Coronavirus (COVID-19) was detected in December 2019 in the Hubei Province of China. Also known as 2019-nCoV, the outbreak was declared a pandemic by the World Health Organization (WHO) in March 2020. The WHO thus proposed country and technical guidelines in responding to the COVID-19 pandemic. This paper reviewed the preparedness of sub-Saharan African (SSA) countries in ending the pandemic through the adoption of the WHO guidelines. The Socio-Ecological Model was adopted as a conceptual framework in conducting our analysis. We realized that while striving to implement the WHO guidelines, a plethora of microsystem, mesosystem, exosystem, macrosystem, and chronosystem factors make it difficult for SSA countries to achieve the desired results aimed at halting the spread of the virus. SSA countries may, therefore, not be able to end the COVID-19 pandemic soon. We recommend various interventions including short-and long-term loan facilities from donor agencies, decentralization of COVID-19 testing to sub-national levels, and increased community engagement to improve risk communication and adherence to public health measures to end the spread of COVID-19 in SSA. © 2023 Kamuzu University of Health Sciences and the Medical Association of Malawi.
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" Words Matter: Presidents Obama and Trump, Twitter, and U.S. Soft Power. Graph [9] concentrate on the issues that soured the initial optimism for a U.S.-U.K. free trade agreement between President Trump and Prime Minister Johnson which did not come to its planned fruition by 2020. EN Social Media Foreign Policy Twitter Soft Power Obama Trump Boris Johnson Humanitarian Intervention President Clinton Bosnia Kosovo China Sri-Lanka Kazakhstan South Korea ASEAN Sub-Saharan Africa Information Technology. NOTE FROM THE EDITOR: Presidential Tweets, the U.S.-U.K. Free Trade Agreement, Humanitarian Intervention, and China's Bilateral Relations. [Extracted from the article] Copyright of World Affairs is the property of Sage Publications Inc. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full . (Copyright applies to all s.)
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The COVID-19 pandemic and the policy responses adopted to curtail it have drastically altered how health services are delivered around the globe. To enable the public to continue accessing health care, e-health innovations have become the most viable tool to provide convenient, timely, effective and safe care, while reducing the spread of the virus. This paper utilized data from existing literature to explore the benefits and challenges of implementing e-health technologies in Sub Saharan Africa (SSA) amid this pandemic. Evidence suggests that these technologies have the potential to strengthen public health systems in SSA as they have in First World countries. However, there are a number of challenges that need to be addressed first in order to realize the full promises of e-health on the continent. The paper proposes that African governments should come together and implement similar e-health policies, share software, expertise and other critical ICT infrastructure as it can result in the successful implementation of e-health innovations, while reducing the financial burden associated with their set up.
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Data on mpox in pregnancy are currently limited. Historically, only 65 cases in pregnancy have been reported globally since mpox was discovered in 1958. This includes 59 cases in the current outbreak. Vertical transmission was confirmed in one patient. Pregnant women are at high risk of severe disease owing to immunological and hormonal changes that increase susceptibility to infections in pregnancy. African women appear to be at higher risk of mpox infection and adverse outcomes in pregnancy for epidemiological and immunologic reasons, in addition to the background high rates of adverse feto-maternal outcomes in the region. This risk is potentially heightened during the COVID-19 pandemic due to the possibility of mpox virus exportation/importation as a result of the lifting of movement restrictions and trans-border travels between countries affected by the current outbreak. Furthermore, coinfection with mpox and COVID-19 in pregnancy is possible, and the clinical features of both conditions may overlap. Challenges of diagnosis and management of mpox in pregnancy in Africa include patients concealing their travel history from healthcare providers and absconding from/evading isolation after diagnosis, shortage of personal protective equipment and polymerase chain reaction testing facilities for diagnosis, vaccine hesitancy/resistance, and poor disease notification systems. There is a need for local, regional and global support to strengthen the capacity of African countries to address these challenges and potentially reduce the disease burden among pregnant women in the continent.
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Worldwide, the recent SARS-CoV-2 virus has infected more than 670 million people and killed nearly 67.0 million. In Africa, the number of confirmed COVID-19 cases was approximately 12.7 million as of January 11, 2023, that is about 2% of the infections around the world. Many theories and modeling techniques have been used to explain this lower-than-expected number of reported COVID-19 cases in Africa relative to the high disease burden in most developed countries. We noted that most epidemiological mathematical models are formulated in continuous-time interval, and taking Cameroon in Sub-Saharan Africa, and New York State in the USA as case studies, in this paper we developed parameterized hybrid discrete-time-continuous-time models of COVID-19 in Cameroon and New York State. We used these hybrid models to study the lower-than-expected COVID-19 infections in developing countries. We then used error analysis to show that a time scale for a data-driven mathematical model should match that of the actual data reporting.
Subject(s)
COVID-19 , Humans , COVID-19/epidemiology , SARS-CoV-2 , Africa South of the Sahara/epidemiology , Cost of IllnessABSTRACT
Introduction: We investigated whether prior SARS-CoV-2-specific IFN-γ and antibody responses in Ugandan COVID-19 pre-pandemic specimens aligned to this population's low disease severity. Methods: We used nucleoprotein (N), spike (S), NTD, RBD, envelope, membrane, SD1/2-directed IFN-γ ELISpots, and an S- and N-IgG antibody ELISA to screen for SARS-CoV-2-specific cross-reactivity. Results: HCoV-OC43-, HCoV-229E-, and SARS-CoV-2-specific IFN-γ occurred in 23, 15, and 17 of 104 specimens, respectively. Cross-reactive IgG was more common against the nucleoprotein (7/110, 15.5%; p = 0.0016, Fishers' Exact) than the spike (3/110, 2.72%). Specimens lacking anti-HuCoV antibodies had higher rates of pre-epidemic SARS-CoV-2-specific IFN-γ cross-reactivity (p-value = 0.00001, Fishers' exact test), suggesting that exposure to additional factors not examined here might play a role. SARS-CoV-2-specific cross-reactive antibodies were significantly less common in HIV-positive specimens (p=0.017; Fishers' Exact test). Correlations between SARS-CoV-2- and HuCoV-specific IFN-γ responses were consistently weak in both HIV negative and positive specimens. Discussion: These findings support the existence of pre-epidemic SARS-CoV-2-specific cellular and humoral cross-reactivity in this population. The data do not establish that these virus-specific IFN-γ and antibody responses are entirely specific to SARS-CoV-2. Inability of the antibodies to neutralise SARS-CoV-2 implies that prior exposure did not result in immunity. Correlations between SARS-CoV-2 and HuCoV-specific responses were consistently weak, suggesting that additional variables likely contributed to the pre-epidemic cross-reactivity patterns. The data suggests that surveillance efforts based on the nucleoprotein might overestimate the exposure to SARS-CoV-2 compared to inclusion of additional targets, like the spike protein. This study, while limited in scope, suggests that HIV-positive people are less likely than HIV-negative people to produce protective antibodies against SARS-CoV-2.
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COVID-19 , HIV Seropositivity , Humans , Pandemics , SARS-CoV-2 , Antibody Formation , COVID-19/epidemiology , Uganda/epidemiology , Antibodies, Viral , Enzyme-Linked Immunospot AssayABSTRACT
BACKGROUND: Studies have shown that mobile health technologies (mHealth) enhance the use of maternal health services. However, there is limited evidence of the impact of mHealth use by community health workers (CHWs) on the use of maternal health services in sub-Saharan Africa. OBJECTIVE: This mixed method systematic review will explore the impact of mHealth use by CHWs on the use of the maternal health continuum of care (antenatal care, intrapartum care, and postnatal care [PNC]), as well as barriers and facilitators of mHealth use by CHWs when supporting maternal health services. METHODS: We will include studies that report the impact of mHealth by CHWs on the use of antenatal care, facility-based births, and PNC visits in sub-Saharan Africa. We will search 6 databases (MEDLINE, CINAHL, Web of Science, Embase, Scopus, and Africa Index Medicus), with additional articles identified from Google Scholar and manual screening of references of the included studies. The included studies will not be limited by language or year of publication. After study selection, 2 independent reviewers will perform title and abstract screening, followed by full-text screening to identify the final papers to be included. Data extraction and risk-of-bias assessment will be performed using Covidence software by 2 independent reviewers. We will use a Mixed Methods Appraisal Tool to perform risk-of-bias assessments on all included studies. Finally, we will perform a narrative synthesis of the outcomes, integrating information about the effect of mHealth on maternal health use and barriers and facilitators of mHealth use. This protocol follows the PRISMA-P (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocols) guidelines. RESULTS: In September 2022, we conducted an initial search in the eligible databases. After removing duplicates, we identified 1111 studies that were eligible for the title and abstract screening. We will finalize the full-text assessment for eligibility, data extraction, assessment of methodological quality, and narrative synthesis by June 2023. CONCLUSIONS: This systematic review will present new and up-to-date evidence on the use of mHealth by CHWs along the pregnancy, childbirth, and PNC continuum of care. We anticipate the results will inform program implementation and policy by highlighting the potential impacts of mHealth and presenting contextual factors that should be addressed to ensure the success of the programs. TRIAL REGISTRATION: PROSPERO CRD42022346364; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=346364. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/44066.
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The Nigerian Cardiovascular Symposium is an annual conference held in partnership with cardiologists in Nigeria and the diaspora to provide updates in cardiovascular medicine and cardiothoracic surgery with the aim of optimising cardiovascular care for the Nigerian population. This virtual conference (due to the COVID-19 pandemic) has created an opportunity for effective capacity building of the Nigerian cardiology workforce. The objective of the conference was for experts to provide updates on current trends, clinical trials and innovations in heart failure, selected cardiomyopathies such as hypertrophic cardiomyopathy and cardiac amyloidosis, pulmonary hypertension, cardiogenic shock, left ventricular assist devices and heart transplantation. Furthermore, the conference aimed to equip the Nigerian cardiovascular workforce with skills and knowledge to optimise the delivery of effective cardiovascular care, with the hope of curbing 'medical tourism' and the current 'brain drain' in Nigeria. Challenges to optimal cardiovascular care in Nigeria include workforce shortage, limited capacity of intensive care units, and availability of medications. This partnership represents a key first step in addressing these challenges. Future action items include enhanced collaboration between cardiologists in Nigeria and the diaspora, advancing participation and enrollment of African patients in global heart failure clinical trials, and the urgent need to develop heart failure clinical practice guidelines for Nigerian patients.