Two decades of research capacity strengthening and reciprocal learning on sexual and reproductive health in East Africa - a point of (no) return.

As the world is facing challenges such as pandemics, climate change, conflicts, and changing political landscapes, the need to secure access to safe and high-quality abortion care is more urgent than ever. On 27th of June 2023, the Swedish government decided to cut funding resources available for developmental research, which has played a fundamental role in the advancement of sexual and reproductive health and rights (SRHR) globally, including abortion care. Withdrawal of this funding not only threatens the fulfilment of the United Nations sustainable development goals (SDGS) - target 3.7 on ensuring universal access to SRHR and target 5 on gender equality - but also jeopardises two decades of research capacity strengthening. In this article, we describe how the partnerships that we have built over the course of two decades have amounted to numerous publications, doctoral graduates, and important advancements within the field of SRHR in East Africa and beyond.

Main findings: The two-decade long collaboration between Sweden and East Africa, funded by the Swedish government, has resulted in important partnerships, research findings, and advancements within sexual and reproductive health and rights in East Africa.Added knowledge: The Swedish government is now cutting funding for development research, which jeopardises the progress made so far.Global health impact for policy and action: Governments need to prioritise women's sexual and reproductive health and rights.

Comprehensive knowledge of mother-to-child HIV/AIDS transmission, prevention, and associated factors among reproductive-age women in East Africa: insights from recent demographic and national health surveys.

BACKGROUND: More than 90% of babies acquire HIV/AIDS through vertical transmission, primarily due to low maternal comprehensive knowledge about Mother-To-Child Transmission (MTCT) of HIV/AIDS and its prevention, which is a cornerstone for eliminating MTCT of HIV/AIDS. However, there are limitations in terms of population data and literature evidence based on recent Demographic and Health Surveys (DHS) reports in East Africa. Therefore, this study aims to assess the comprehensive knowledge and PMTCT of HIV/AIDS among women, as well as the associated factors in East Africa. METHODS: Our data was obtained from the most recent DHS conducted in East African countries between 2011 and 2022. For our research, we included DHS data from ten nations, resulting in a total weighted sample of 133,724 women for our investigation. A generalized linear model (GLM) with a log link and binomial family to directly estimate prevalence ratios (PR) and 95% confidence intervals (CI) for the association between the independent variables, and the outcome variable. Finally, we reported the adjusted prevalence ratios along with their corresponding 95% CIs. Factors with p-values ≤ 0.2 for univariate logistic regression and < 0.05 were considered statistically significant factors of HIV/AIDS knowledge and prevention in the final model. RESULTS: In this study, 59.41% (95% CI: 59.15-59.67) of respondents had a comprehensive knowledge about MTCT of HIV/AIDS and its prevention among reproductive-age women in East Africa. Being in the older age group, better education level, being from a rich household, employment status, having ANC follow up, institutional delivery, and modern contraception usage were associated with higher prevalence ratios of comprehensive knowledge about MTCT of HIV/AIDS and its prevention. However, being single in marital status, rural women, and traditional contraception utilization were associated with lower ratios of comprehensive knowledge about MTCT of HIV/AIDS and its prevention. CONCLUSION: Our findings indicate a significant deficiency in comprehensive knowledge and prevention of HIV/AIDS MTCT among women in East Africa. These results emphasize the need for significant improvements in maternal-related health services. It is crucial to effectively target high-risk populations during interventions, raise awareness about this critical public health issue, and address the catastrophic consequences associated with MTCT. By implementing these measures, we can make substantial progress in reducing the transmission of HIV/AIDS from mother to child and ensuring better health outcomes for both mothers and their children.

Simplified molecular diagnosis of visceral leishmaniasis: Laboratory evaluation of miniature direct-on-blood PCR nucleic acid lateral flow immunoassay.

BACKGROUND: Diagnosis of visceral leishmaniasis (VL) in resource-limited endemic regions is currently based on serological testing with rK39 immunochromatographic tests (ICTs). However, rK39 ICT frequently has suboptimal diagnostic accuracy. Furthermore, treatment monitoring and detection of VL relapses is reliant on insensitive and highly invasive tissue aspirate microscopy. Miniature direct-on-blood PCR nucleic acid lateral flow immunoassay (mini-dbPCR-NALFIA) is an innovative and user-friendly molecular tool which does not require DNA extraction and uses a lateral flow strip for result read-out. This assay could be an interesting candidate for more reliable VL diagnosis and safer test of cure at the point of care. METHODOLOGY/PRINCIPLE FINDINGS: The performance of mini-dbPCR-NALFIA for diagnosis of VL in blood was assessed in a laboratory evaluation and compared with the accuracy of rK39 ICTs Kalazar Detect in Spain and IT LEISH in East Africa. Limit of detection of mini-dbPCR-NALFIA was 650 and 500 parasites per mL of blood for Leishmania donovani and Leishmania infantum, respectively. In 146 blood samples from VL-suspected patients from Spain, mini-dbPCR-NALFIA had a sensitivity of 95.8% and specificity 97.2%, while Kalazar Detect had a sensitivity of 71.2% and specificity of 94.5%, compared to a nested PCR reference. For a sample set from 58 VL patients, 10 malaria patients and 68 healthy controls from Ethiopia and Kenya, mini-dbPCR-NALFIA had a pooled sensitivity of 87.9% and pooled specificity of 100% using quantitative PCR as reference standard. IT LEISH sensitivity and specificity in the East African samples were 87.9% and 97.4%, respectively. CONCLUSIONS/SIGNIFICANCE: Mini-dbPCR-NALFIA is a promising tool for simplified molecular diagnosis of VL and follow-up of treated patients in blood samples. Future studies should evaluate its use in endemic, resource-limited settings, where mini-dbPCR-NALFIA may provide an accurate and versatile alternative to rK39 ICTs and aspirate microscopy.

The magnitude of stunting and its determinants among late adolescent girls in East Africa: Multilevel binary logistics regression analysis.

BACKGROUND: Stunting poses a significant health risk to adolescent girls aged 15-19 in low- and middle-income countries, leading to lower education levels, reduced productivity, increased disease vulnerability, and intergenerational malnutrition. Despite the inclusion of adolescent nutrition services in the Sustainable Development Goals, little progress has been made in addressing malnutrition among adolescent girls in several African nations. Limited evidence exists in East Africa due to small sample sizes and methodological limitations. To overcome these constraints, this study utilizes the latest Demographic and Health Survey data to estimate the prevalence and factors influencing stunting among late adolescent girls in ten East African countries. METHODS: This study utilized the most recent Demographic and Health Survey (DHS) data from 10 East African countries, including a total sample weight of 22,504 late-adolescent girls. A multilevel mixed-effect binary logistic regression model with cluster-level random effects was employed to identify factors associated with stunting among these girls. The odds ratio, along with the 95% confidence interval, was calculated to determine individual and community-level factors related to stunting. A p-value less than 0.05 was considered statistically significant in determining the factors influencing stunting among late-adolescent girls. RESULTS: The prevalence of stunting among late adolescent girls in East Africa was found to be 13.90% (95% CI: 0.13-0.14). Religion, relationship to the head, presence of under-five children in the household, lactating adolescent, marital status, Time to get water source, and country of residence were significantly associated with Stunting. CONCLUSION: This study highlights the complexity of stunting in East Africa and identifies key factors that need attention to reduce its prevalence. Interventions should focus on improving water access, supporting lactating girls, addressing socioeconomic disparities, promoting optimal care practices, and implementing country-specific interventions to combat stunting and improve adolescent girls' nutrition.

The importance of self-management for better treatment outcomes for HIV patients in a low-income setting: perspectives of HIV experts and service providers.

BACKGROUND: Self-management is the most important strategy to improve quality of life in patients with a chronic disease. Despite the increasing number of people living with HIV (PLWH) in low-income countries, very little research on self-management is conducted in this setting. The aim of this research is to understand the perspectives of service providers and experts on the importance of self-management for PLWH. METHODS: A systematizing expert interview type of qualitative methodology was used to gain the perspectives of experts and service providers. The study participants had experience in researching, managing, or providing HIV service in east and southern African (ESA) countries. All the interviews were audio recorded, transcribed, and translated to English. The quality of the transcripts was ensured by randomly checking the texts against the audio record. A thematic analysis approach supported by Atlas TI version 9 software. RESULT: PLWH face a variety of multi-dimensional problems thematized under contextual and process dimensions. The problems identified under the contextual dimension include disease-specific, facility-related, and social environment-related. Problems with individual origin, such as ignorance, outweighing beliefs over scientific issues, low self-esteem, and a lack of social support, were mostly highlighted under the process dimensions. Those problems have a deleterious impact on self-management, treatment outcomes, and the quality of life of PLWH. Low self-management is also a result of professional-centered service delivery in healthcare facilities and health service providers' incapacity to comprehend a patient's need beyond the medical concerns. Participants in the study asserted that patients have a significant stake in enhancing treatment results and quality of life through enhancing self-management. CONCLUSION AND RECOMMENDATION: HIV patients face multifaceted problems beyond their medical issues. The success of medical treatment for HIV is strongly contingent upon patients' self-management practices and the supportive roles of their family, society, and health service providers. The development and integration of self-management practices into clinical care will benefit patients, their families, and the health system.

Seasonal fish larvae abundance and composition in seagrass habitats of coastal East Africa.

Seagrass habitats play a major role in fisheries productivity through nursery functions and feeding grounds for diverse fish species. However, little is known about the seasonal distribution of fish larvae at large spatial scales in coastal East Africa. We investigated drivers of the seasonal fish larvae abundance and composition in seagrass habitats in Kenya and Tanzania. We found a high diversity of fish larvae (54 families) inhabiting seagrass habitats that differed between sites and seasons. Fish larvae abundance were highest in Kenya, particularly during the northeast monsoon season. Overall, total larval abundances per site were low, reaching less than 190 individuals/100 m3 in Kenya and less than 40 individuals/100 m3 in Tanzania, likely related to the low productivity and strong hydrodynamic processes in this region. Our data suggests that most of the fish spawn year-round in these tropical waters as we did not find strong seasonal patterns. All sites had a high relative abundance of larvae from demersal spawning fishes, indicating that many fish species move to coastal sites for spawning. Primary productivity and dissolved oxygen, driven by hydrodynamics conditions are positively related to fish larvae productivity both in Kenya and Tanzania. These findings indicate that the occurrence of both resident and transient fish larvae in seagrass meadows is driven by strong hydrodynamic and tidal processes that transport fish larvae across adjacent habitats.

Prediction of incomplete immunization among under-five children in East Africa from recent demographic and health surveys: a machine learning approach.

The World Health Organization as part of the goal of universal vaccination coverage by 2030 for all individuals. The global under-five mortality rate declined from 59% in 1990 to 38% in 2019, due to high immunization coverage. Despite the significant improvements in immunization coverage, about 20 million children were either unvaccinated or had incomplete immunization, making them more susceptible to mortality and morbidity. This study aimed to identify predictors of incomplete vaccination among children under-5 years in East Africa. An analysis of secondary data from six east African countries using Demographic and Health Survey dataset from 2016 to the recent 2021 was performed. A total weighted sample of 27,806 children aged (12-35) months was included in this study. Data were extracted using STATA version 17 statistical software and imported to a Jupyter notebook for further analysis. A supervised machine learning algorithm was implemented using different classification models. All analysis and calculations were performed using Python 3 programming language in Jupyter Notebook using imblearn, sklearn, XGBoost, and shap packages. XGBoost classifier demonstrated the best performance with accuracy (79.01%), recall (89.88%), F1-score (81.10%), precision (73.89%), and AUC 86%. Predictors of incomplete immunization are identified using XGBoost models with help of Shapely additive eXplanation. This study revealed that the number of living children during birth, antenatal care follow-up, maternal age, place of delivery, birth order, preceding birth interval and mothers' occupation were the top predicting factors of incomplete immunization. Thus, family planning programs should prioritize the number of living children during birth and the preceding birth interval by enhancing maternal education. In conclusion promoting institutional delivery and increasing the number of antenatal care follow-ups by more than fourfold is encouraged.

Asymmetric genetic population structures at the range edges of a mangrove whelk.

Many marine species are distributed across incredibly wide geographical ranges spanning thousands of kilometers often due to movement along prevailing ocean currents. However, data are lacking on genetic connectivity among populations of such widespread species within or among ecoregions, possibly due to the lack of appropriate datasets. In this study, we investigated the genetic structure of populations of the mangrove whelk, Terebralia palustris, using mitochondrial cytochrome oxidase subunit I (COI) sequences. Sequences generated for this study from Okinawa, Japan, were compared to samples from the coast of East Africa analyzed in a previous study. Interestingly, despite considerable distance separating them, the African and Japanese populations share major haplotypes and do not show clear genetic differentiation. At lower latitudes, core African populations exhibited higher genetic diversity than either the more southerly African and Japanese populations. Genetic ß-diversity revealed that the northern edge population in Japan has a greater proportion of ßSNE (the nestedness-resultant component), indicating contemporary migration, whereas the southern edge population in Africa is characterized by a predominant ßSIM (the turnover component), suggesting historical demography. A potential cause of this dissimilarity could be due to the strong Kuroshio Current along the Ryukyu Islands, which may promote larval dispersal. These differing patterns suggest that there may be divergent responses to future climate change at the population level at the periphery of the range of T. palustris.

Access to drinking safe water and its associated factors among households in East Africa: a mixed effect analysis using 12 East African countries recent national health survey.

BACKGROUND: More than half of the population in Sub-Saharan Africa (SSA) faces limited access to safe drinking water. Unimproved water sources can pose risks to the health of entire households, particularly women and children. Despite the fact that East African countries have some of the poorest drinking water infrastructures globally, there is a lack of published data on this issue. Consequently, the objective of this study was to examine access to safe drinking water and its determinants among households in East Africa, utilizing recent nationally representative data. METHODS: This study analyzed data from recent demographic and health surveys conducted in 12 East African nations between 2011 and 2022. Data were gathered from 204,275 households. A stratified two-stage cluster sampling method was employed, with enumeration areas serving as the main sampling units and households serving as the secondary sampling units. Binary and multiple multilevel logistic regression were used to examine the relevant factors associated with the use of different sources of drinking water in the region. In binary regression and multiple regression, P values of ≤ 0.2 and < 0.05, respectively, were used to determine the statistical significance of variables in the final model. RESULTS: Approximately 72.62% (95% CI = 72.43, 72.83) of households have utilized improved sources of drinking water. Household heads aged 25-35 years (AOR = 1.09, 95% CI = 1.04, 1.14), 36-45 years (AOR = 1.09, 95% CI = 1.04, 1.14), and > 45 years (AOR = 1.08, 95% CI = 1.04, 1.14), those with secondary/higher education (AOR = 1.24, 95% CI = 1.20-1.29), and individuals in wealth index categories of poorest (AOR = 0.17, 95% CI = 0.16, 0.18), poorer (AOR = 0.21, 95% CI = 0.19, 0.22), middle (AOR = 0.25, 95% CI = 0.24, 0.27), and richer (AOR = 0.36, 95% CI = 0.34, 0.38) were associated with improved sources of drinking water. Additionally, female household leaders (AOR = 1.23, 95% CI = 1.20, 1.26), > 30 min of time taken to access the water source (AOR = 2.00, 95% CI = 1.95, 2.05), improved toilet facilities (AOR = 2.25, 95% CI = 2.19, 2.31), rural residence (AOR = 0.43, 95% CI = 0.42, 0.45), high community wealth (AOR = 1.31, 95% CI = 1.13-1.51), community media exposure (AOR = 1.32, 95% CI = 1.15, 1.51) were associated with improved sources of drinking water, respectively. CONCLUSION: Approximately three-quarters of the population in East Africa has access to improved drinking water, although the quality of water in the region is still considered poor. It is important for relevant organizations to collaborate in order to improve the quality of drinking water, with special attention given to high-risk groups such as communities with high poverty and low literacy rates, poor households, and rural residents. Strengthening women's empowerment and increasing mass media exposure can also play a crucial role in accelerating the adoption of improved drinking water sources in East Africa.

Coverage and determinants of second-dose measles vaccination among under-five children in East Africa countries: a systematic review and meta-analysis.

Background: One of the biggest breakthroughs of contemporary medicine is measles vaccination. It is essential for the total elimination of measles. Understanding the magnitude and determinants of effective second-dose measles vaccination coverage is a critical task. Accordingly, we set out to check the best available evidence of the pooled second-dose measles vaccination coverage among under-five children in East Africa. Method: We searched electronic databases such as PubMed, Google Scholar, Cochrane, and others. Two reviewers separately carried out the search of the Joanna Briggs Institute, selection of studies, critical appraisal, and data extraction. A third party was involved in resolving the disagreement among the reviewers. Seven studies included in this study, four from Ethiopia, two from Kenya, and one from Tanzania were cross-sectional and published in English language, with publication dates before 29 November 2023. Articles lacking full-text, the intended outcome, and that are not qualitative studies were excluded from the analysis. The Microsoft Excel checklist was used to extract the data and then exported to STATA 11. In addition, I2, Funnel plots, and Egger's test were employed to measure heterogeneity and detect publication bias, respectively. A random effect model was used. Result: The meta-analysis includes a total sample size of 4,962 children from seven articles. The pooled prevalence of second-dose measles vaccination among under-five children in East Africa was found to be 32.22% [95% CI; (18.82, 45.63)], and the significant factors were as follows: birth order (1.72; OR = 95% CI: 1.32, 2.23), information about measles-containing second-dose vaccine (MCV 2) (7.39; OR = 95% CI: 5.21, 10.50), mother's marital status (1.47; OR = 95% CI: 1.05, 2.07), complete immunization for other vaccines (2.17; OR = 95% CI: 1.49, 3.17), and distance of vaccination site (3.31; OR = 95% CI: 2.42, 4.53). Conclusion: The current study found that pooled prevalence of second-dose measles vaccination coverage among under-five children was still very low. It was also observed that birth order, distance of the vaccination site, complete immunization for other vaccines, mother's marital status, and information about MCV were factors associated with second-dose measles vaccination. These factors imply that there is a need for countries and their partners to act urgently to secure political commitment, expand primary health service and health education, and increase vaccination coverage.

Sustaining indigenous Maasai Alalili silvo-pastoral conservation systems for improved community livelihood and biodiversity conservation in East African rangelands.

Alalili system is one among the fewest remnant African indigenous and local knowledge systems that is traditionally practiced by Maasai pastoral communities to conserve certain portions of rangeland resources such as pastures and water for subsequent grazing during dry seasons. Despite its existence, East African rangelands face diverse threats from tenure security, unsustainable practices, climate, and land-use change that are notably endangering the biodiversity, livelihoods, and ecosystems in the landscape. Like other indigenous conservation systems, the sustainability of Alalili systems is being threatened, as Maasai communities are in transition due to continuous socio-cultural transformations coupled with increased livestock and human populations. We aimed to capture and document the existing occurrence and potential of Alalili systems as a pathway to improve resilience and sustain both biodiversity conservation and community livelihoods in rangeland areas of northern Tanzania. A cross-sectional research design was applied with the adoption of both purposive and stratified random sampling techniques to distinctively characterize the Alalili systems by land use and tenure types. Our results identified the existence of both communal and private Alalili systems. Their sizes varied significantly across types (t = 4.4646, p < 0.001) and land uses (F = 3.806, df = 3, p = 0.0123). While many (82%) of these Alalili systems are found in the communal land, our observations show a re-practice of Alalili systems in the private land is considered largely a re-emerging strategy for securing pastures in the face of local and global change. More than half (73%) of Alalili systems were found within game-controlled areas with little representation (about 8%) in non-protected land. Therefore, their sustainability is threatened by anthropogenic and climatic pressures, making their persistence more vulnerable to extinction. We recommend mainstreaming these practices into core pasture production and management areas, facilitating their reinforcement into policy and practices.

Neurology Training and Medical Education in Resource-Limited Settings: Building and Growing the First Neurology Residency Program in East Africa.

The burden of neurological disease disproportionately affects low- and middle-income countries, where the lowest number of neurologists are located. Building local training opportunities in resource-limited settings is a foundational step to enhancing the neurological workforce and improving access to neurological care in these regions. In this article, we describe the development and growth of the first neurology residency program in East Africa, which was established in 2006 at Zewditu Memorial Hospital and the Tikur Anbessa Specialized Hospital, Addis Ababa University, Ethiopia. We highlight the impact of the program on clinical care, research, collaborations between neurologists across Ethiopia, and ways to build educational opportunities and mentorship while faced with limited resources. The main challenges in starting the residency program included lack of faculty with neurological expertise, lack of a precedent for subspecialty training in our setting, as well as limited resources and space. The formation of sustainable international collaborations with clinicians at established institutions in high-income countries and neurological societies has been a major source of support in developing the initial infrastructure, curriculum and educational content, knowledge assessments, and mentored research projects. Local partnerships with related medical specialties, including internal medicine, critical care, neurological surgery, and psychiatry, were also instrumental in creating training opportunities. As the program continues to evolve, many challenges remain, including limited diagnostics, lack of access to advanced treatment modalities, lack of fellowship training opportunities in various neurological subspecialties, and insufficient training and experience in scientific writing. Despite these challenges, the residency program has persevered and its creation resulted in many positive changes: since its inception in 2006, we graduated 80 neurologists and the number of practicing neurologists in Ethiopia has increased from 5 to 78, our institution has evolved into a national referral center for neurology, graduates have published 61 articles in the past 3 years and contributed to international neurology research, and alumni of the program have grown the Association of Ethiopian Neurologists. Future directions include development of fellowship opportunities, creation of international rotations, and implementation of teleneurology to further strengthen neurological care across Ethiopia.

Understanding the uptake and determinants of prevention of mother-to-child transmission of HIV services in East Africa: Mixed methods systematic review and meta-analysis.

BACKGROUND: Prevention of mother-to-child transmission (PMTCT) of HIV service is conceptualized as a series of cascades that begins with all pregnant women and ends with the detection of a final HIV status in HIV-exposed infants (HEIs). A low rate of cascade completion by mothers' results in an increased risk of HIV transmission to their infants. Therefore, this review aimed to understand the uptake and determinants of key PMTCT services cascades in East Africa. METHODS: We searched CINAHL, EMBASE, MEDLINE, Scopus, and AIM databases using a predetermined search strategy to identify studies published from January 2012 through to March 2022 on the uptake and determinants of PMTCT of HIV services. The quality of the included studies was assessed using the Mixed Methods Appraisal Tool. A random-effects model was used to obtain pooled estimates of (i) maternal HIV testing (ii) maternal ART initiation, (iii) infant ARV prophylaxis and (iv) early infant diagnosis (EID). Factors from quantitative studies were reviewed using a coding template based on the domains of the Andersen model (i.e., environmental, predisposing, enabling and need factors) and qualitative studies were reviewed using a thematic synthesis approach. RESULTS: The searches yielded 2231 articles and we systematically reduced to 52 included studies. Forty quantitative, eight qualitative, and four mixed methods papers were located containing evidence on the uptake and determinants of PMTCT services. The pooled proportions of maternal HIV test and ART uptake in East Africa were 82.6% (95% CI: 75.6-88.0%) and 88.3% (95% CI: 78.5-93.9%). Similarly, the pooled estimates of infant ARV prophylaxis and EID uptake were 84.9% (95% CI: 80.7-88.3%) and 68.7% (95% CI: 57.6-78.0) respectively. Key factors identified were the place of residence, stigma, the age of women, the educational status of both parents, marital status, socioeconomic status, Knowledge about HIV/PMTCT, access to healthcare facilities, attitudes/perceived benefits towards PMTCT services, prior use of maternal and child health (MCH) services, and healthcare-related factors like resource scarcity and insufficient follow-up supervision. CONCLUSION: Most of the identified factors were modifiable and should be considered when formulating policies and planning interventions. Hence, promoting women's education and economic empowerment, strengthening staff supervision, improving access to and integration with MCH services, and actively involving the community to reduce stigma are suggested. Engaging community health workers and expert mothers can also help to share the workload of healthcare providers because of the human resource shortage.

Introgression and disruption of migration routes have shaped the genetic integrity of wildebeest populations.

The blue wildebeest (Connochaetes taurinus) is a keystone species in savanna ecosystems from southern to eastern Africa, and is well known for its spectacular migrations and locally extreme abundance. In contrast, the black wildebeest (C. gnou) is endemic to southern Africa, barely escaped extinction in the 1900s and is feared to be in danger of genetic swamping from the blue wildebeest. Despite the ecological importance of the wildebeest, there is a lack of understanding of how its unique migratory ecology has affected its gene flow, genetic structure and phylogeography. Here, we analyze whole genomes from 121 blue and 22 black wildebeest across the genus' range. We find discrete genetic structure consistent with the morphologically defined subspecies. Unexpectedly, our analyses reveal no signs of recent interspecific admixture, but rather a late Pleistocene introgression of black wildebeest into the southern blue wildebeest populations. Finally, we find that migratory blue wildebeest populations exhibit a combination of long-range panmixia, higher genetic diversity and lower inbreeding levels compared to neighboring populations whose migration has recently been disrupted. These findings provide crucial insights into the evolutionary history of the wildebeest, and tangible genetic evidence for the negative effects of anthropogenic activities on highly migratory ungulates.

Designing and delivering bioinformatics project-based learning in East Africa.

BACKGROUND: The Eastern Africa Network for Bioinformatics Training (EANBiT) has matured through continuous evaluation, feedback, and codesign. We highlight how the program has evolved to meet challenges and achieve its goals and how experiential learning through mini projects enhances the acquisition of skills and collaboration. We continued to learn and grow through honest feedback and evaluation of the program, trainers, and modules, enabling us to provide robust training even during the Coronavirus disease 2019 (COVID-19) pandemic, when we had to redesign the program due to restricted travel and in person group meetings. RESULTS: In response to the pandemic, we developed a program to maintain "residential" training experiences and benefits remotely. We had to answer the following questions: What must change to still achieve the RT goals? What optimal platforms should be used? How would we manage connectivity and data challenges? How could we avoid online fatigue? Going virtual presented an opportunity to reflect on the essence and uniqueness of the program and its ability to meet the objective of strengthening bioinformatics skills among the cohorts of students using different delivery approaches. It allowed an increase in the number of participants. Evaluating each program component is critical for improvement, primarily when feedback feeds into the program's continuous amendment. Initially, the participants noted that there were too many modules, insufficient time, and a lack of hands-on training as a result of too much focus on theory. In the subsequent iterations, we reduced the number of modules from 27 to five, created a harmonized repository for the materials on GitHub, and introduced project-based learning through the mini projects. CONCLUSION: We demonstrate that implementing a program design through detailed monitoring and evaluation leads to success, especially when participants who are the best fit for the program are selected on an appropriate level of skills, motivation, and commitment.

Testcross performance and combining ability of early-medium maturing quality protein maize inbred lines in Eastern and Southern Africa.

Limited commercial quality protein maize (QPM) varieties with low grain yield potential are currently grown in Eastern and Southern Africa (ESA). This study was conducted to (i) assess the performance of single-cross QPM hybrids that were developed from elite inbred lines using line-by-tester mating design and (ii) estimate the general (GCA) and specific (SCA) combining ability of the QPM inbred lines for grain yield, agronomic and protein quality traits. One hundred and six testcrosses and four checks were evaluated across six environments in ESA during 2015 and 2016. Significant variations (P ≤ 0.01) were observed among environments, genotypes and genotype by environment interaction (GEI) for most traits evaluated. Hybrids H80 and H104 were the highest-yielding, most desirable, and stable QPM hybrids. Combining ability analysis showed both additive and non-additive gene effects to be important in the inheritance of grain yield. Additive effects were more important for agronomic and protein quality traits. Inbred lines L19 and L20 depicted desirable GCA effects for grain yield. Various other inbred lines with favorable GCA effects for agronomic traits, endosperm modification, and protein quality traits were identified. These inbred lines could be utilized for breeding desirable QPM cultivars. The QPM hybrids identified in this study could be commercialized after on-farm verification to replace the low-yielding QPM hybrids grown in ESA.

Leishmania blood parasite dynamics during and after treatment of visceral leishmaniasis in Eastern Africa: A pharmacokinetic-pharmacodynamic model.

BACKGROUND: With the current treatment options for visceral leishmaniasis (VL), recrudescence of the parasite is seen in a proportion of patients. Understanding parasite dynamics is crucial to improving treatment efficacy and predicting patient relapse in cases of VL. This study aimed to characterize the kinetics of circulating Leishmania parasites in the blood, during and after different antileishmanial therapies, and to find predictors for clinical relapse of disease. METHODS: Data from three clinical trials, in which Eastern African VL patients received various antileishmanial regimens, were combined in this study. Leishmania kinetoplast DNA was quantified in whole blood with real-time quantitative PCR (qPCR) before, during, and up to six months after treatment. An integrated population pharmacokinetic-pharmacodynamic model was developed using non-linear mixed effects modelling. RESULTS: Parasite proliferation was best described by an exponential growth model, with an in vivo parasite doubling time of 7.8 days (RSE 12%). Parasite killing by fexinidazole, liposomal amphotericin B, sodium stibogluconate, and miltefosine was best described by linear models directly relating drug concentrations to the parasite elimination rate. After treatment, parasite growth was assumed to be suppressed by the host immune system, described by an Emax model driven by the time after treatment. No predictors for the high variability in onset and magnitude of the immune response could be identified. Model-based individual predictions of blood parasite load on Day 28 and Day 56 after start of treatment were predictive for clinical relapse of disease. CONCLUSION: This semi-mechanistic pharmacokinetic-pharmacodynamic model adequately captured the blood parasite dynamics during and after treatment, and revealed that high blood parasite loads on Day 28 and Day 56 after start of treatment are an early indication for VL relapse, which could be a useful biomarker to assess treatment efficacy of a treatment regimen in a clinical trial setting.

Six in ten female youths in low-income East African countries had problems in accessing health care: a multilevel analysis of recent demographic and health surveys from 2016-2021.

BACKGROUND: Access to health care services is a basic human right, and an individual's health and overall quality of life may suffer as a result of barriers to accessing health services. Access to comprehensive and quality health care is fundamental for promoting and maintaining health, preventing and treating diseases, and reducing premature deaths. However, only half of the African population has access to modern health services. Therefore, this study aimed to assess the health care access and associated factors among female youths in low-income East African countries. METHODS: This study used secondary data from 2016 to 2021 demographic and health surveys of 7 low-income East African countries. A total weighted sample of 51,064 youths was included. A multilevel binary logistic regression was employed to identify the associated factors of access to health care since the data has a hierarchical structure. Adjusted Odds Ratio (AOR) with a 95% confidence interval (CI) at a p-value less than 0.05 was used to measure the association of variables whereas Intra-class correlation coefficient (ICC), Median Odds Ratio (MOR), and proportional change in variance (PCV) were used to measure random effects. RESULT: The overall magnitude of access to healthcare among female youths in low-income East African countries was 38.84% (95% CI: 38.41, 39.26). Youth's educational level, rich wealth status, media exposure, and community level education were the positive while higher youth's age and rural residence were the negative predictors of access to healthcare among female youths. Besides, living in different countries compared to Burundi was also an associated factor for accessing healthcare in low-income East African countries. CONCLUSION: About six in ten female youths were not accessing health care in low-income East African countries. Therefore, to increase healthcare access, health managers and policymakers needed to develop strategies to improve the poor household wealth index, and redistribution of health services for rural residents. The decision-makers and program planners should also work on increasing access to education and media exposure for youths. Further research including health system and quality of service-related factors for accessing healthcare should also be considered by researchers.

Productivity declines threaten East African soda lakes and the iconic Lesser Flamingo.

Soda lakes are some of the most productive aquatic ecosystems.1 Their alkaline-saline waters sustain unique phytoplankton communities2,3 and provide vital habitats for highly specialized biodiversity including invertebrates, endemic fish species, and Lesser Flamingos (Phoeniconaias minor).1,4 More than three-quarters of Lesser Flamingos inhabit the soda lakes of East Africa5; however, populations are in decline.6 Declines could be attributed to their highly specialized diet of cyanobacteria7 and dependence on a network of soda lake feeding habitats that are highly sensitive to climate fluctuations and catchment degradation.8,9,10,11,12 However, changing habitat availability has not been assessed due to a lack of in situ water quality and hydrology data and the irregular monitoring of these waterbodies.13 Here, we combine satellite Earth observations and Lesser Flamingo abundance observations to quantify spatial and temporal trends in productivity and ecosystem health over multiple decades at 22 soda lakes across East Africa. We found that Lesser Flamingo distributions are best explained by phytoplankton biomass, an indicator of food availability. However, timeseries analyses revealed significant declines in phytoplankton biomass from 1999 to 2022, most likely driven by substantial rises in lake water levels. Declining productivity has reduced the availability of healthy soda lake ecosystems, most notably in equatorial Kenya and northern Tanzania. Our results highlight the increasing vulnerability of Lesser Flamingos and other soda lake biodiversity in East Africa, particularly with increased rainfall predicted under climate change.14,15,16 Without improved lake monitoring and catchment management practices, soda lake ecosystems could be pushed beyond their environmental tolerances. VIDEO ABSTRACT.