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Data science health research promises tremendous benefits for African populations, but its implementation is fraught with substantial ethical governance risks that could thwart the delivery of these anticipated benefits. We discuss emerging efforts to build ethical governance frameworks for data science health research in Africa and the opportunities to advance these through investments by African governments and institutions, international funding organizations and collaborations for research and capacity development. In this Review article, the authors discuss emerging efforts to build ethical governance frameworks for data science health research in Africa and the opportunities to advance these through investments by African governments and institutions, international funding organizations and collaborations for research and capacity development.

Gut dysbiosis has been associated with several disease outcomes including diabetes in human populations. Currently, there are no studies of the gut microbiome composition in relation to type 2 diabetes (T2D) in Africans. Here, we describe the profile of the gut microbiome in non-diabetic adults (controls) and investigate the association between gut microbiota and T2D in urban West Africans. Gut microbiota composition was determined in 291 Nigerians (98 cases, 193 controls) using fecal 16S V4 rRNA gene sequencing done on the Illumina MiSeq platform. Data analysis of operational taxonomic units (OTU) was conducted to describe microbiome composition and identify differences between T2D and controls. The most abundant phyla were , and . , and were significantly lower in cases than controls ( < 0.001). Feature selection analysis identified a panel of 18 OTUs enriched in cases that included . A panel of 17 OTUs that was enriched in the controls included , and . OTUs with strain-level annotation showing the largest fold-change included (log FC = -3.1; = 4.2 × 10 ), (log FC = -2.5; = 0.005), (log FC = -1.76; = 0.01), all lower in cases. These findings are notable because supplementation with and has been shown to improve hyperglycemia and reduce insulin resistance in murine models. This first investigation of gut microbiome and diabetes in urban Africans shows that T2D is associated with compositional changes in gut microbiota highlighting the possibility of developing strategies to improve glucose control by modifying bacterial composition in the gut.

ObjectiveStudies, mainly from high-income countries, suggest that there are ethnic and racial variations in prevalence of uterine fibroids (UF). However, there have been few studies of the epidemiology of UF in sub-Saharan Africa (SSA). We reviewed published articles on the epidemiology of UF in SSA.DesignThis was a scoping review of literature.SettingsWe searched three databases (PubMed, African Wide Information (EBSCO) and African Journals OnLine (AJOL)). The search for eligible articles was conducted between December 2019 and January 2021.Primary and secondary outcome measuresTo describe the reported prevalence/incidence of, and risk factors for UF in SSA.ResultsOf the 1052 articles retrieved, 9 met the inclusion criteria for review. The articles were from Nigeria (4/9), Ghana (2/9), Cameroon (1/9), Kenya (1/9) and South Africa (1/9). Two studies from pathology departments and three studies from radiology departments reported prevalence of UF. We did not find any study on the incidence or genomics of UF in SSA. Of the three studies that reported on the risk factors of UF, only one case–control study that was conducted using retrospective data of attendees at a gynaecological clinic conducted multivariable analysis.ConclusionThere is lack of robust epidemiological studies of the prevalence, incidence and risk factors of UF in SSA. There is urgent need to study epidemiological and genomics risk factors of UF in SSA because UF is the most common gynaecological neoplasm in this population where it is associated with significant morbidity and occasional, usually perioperative, mortality.

Purpose Knowledge of the prevalence of HPV infection among adolescent and early adult girls is essential to determining the best age for the introduction of HPV vaccine, monitoring vaccine efficacy, and giving insight into determinants of persistent high-risk HPV infection, a necessary cause of cervical cancer. Yet, there have been limited studies of HPV infection among adolescent and early adult girls in low-and-middle-income countries. Methods In this cross-sectional study, we randomly selected 205 girls, aged 9–20 years, from 10 schools in central Nigeria. We obtained informed consent and assent, collected data, and trained participants to self-collect vaginal samples using swab stick. We genotyped HPV using SPF 10 -DEIA/LiPA 25 and analyzed data using Stata 14®. Results The mean (SD) age of the girls was 14.9 (2.3) years. We found HPV in 13.2% of vaginal swabs. The earliest age at which anyHPV and hrHPV infections were detected was 10 and 12 years respectively. The prevalence of any HPV peaked at 16 and 17 years, hrHPV at 16 years, lrHPV at 17 and 18 years and multiple hrHPV 18 years of age. The prevalence of hrHPV infection was 1.5% among the 9–12 years age group, 2.9% among 13–16 years and 3.4% among 17–20 years old. The commonest hrHPV types detected were 52 (3.9%), 18 (1.5%) and 51 (2.4%). The most common lrHPV types was 6 (2.9%). Conclusion The prevalence of HPV infection in these urbanized young girls in Nigeria is high and commences after 9 years of age. HPV vaccination in this population should start at 9 years of age or younger to prevent the establishment of persistent HPV infection. Key Messages The prevalence of HPV was 13.2% among adolescent girls in Jos, North-Central Nigeria. The earliest age at vaginal HPV infection was 11 years of age. The most predominant hrHPV type in vaginal swab was HPV 52. These findings point to the need for introduction of HPV vaccine starting at 9 years of age among girls in Nigeria to give maximum protection.

Background Poor diet quality is a significant and modifiable risk factor associated with numerous non-communicable diseases. Despite its critical importance, there is a paucity of comprehensive data concerning diet quality in Nigeria. In this study, we evaluated the healthiness of food intake among Nigerian adults to identify the factors associated with them and seasonal variations in food consumption patterns. Methods We used a validated semi-quantitative Food Frequency Questionnaire (FFQ). to collect dietary data from adults in Ibadan, Nigeria, on four occasions over two years. We assessed food intake healthiness using the Global Diet Quality Score (GDQS), which ranges from 0 to 49 based on 25 food groups, and its sub-metrics GDQS + (0–32, 16 food groups) and GDQS − (0–17, 9 food groups). We used Generalized Linear Models (GLMs) to examine the relationships between GDQS, demographic factors, and participants’ dietary habits. Results There were 205 participants (110 women, 95 men) with mean(SD) age of 45.0(13.4) years and mean(SD) GDQS of 29.0(4.0). Some 91.7% of the participants had a GDQS ≥ 23, signifying a low risk of poor diet quality. The multivariable analysis showed that the GDQS of those who frequently consumed home-cooked meal was higher than those who did not by 2.04 (95%CI: 0.11 to 4.07). The GDQS + of men was higher than women by 1.64 (95%CI: 0.11 to 3.03). The GDQS − of men was 0.88 lower than that of women (95%CI: − 1.53 to − 0.24), while younger participants (< 40 years) had lower GDQS − compared to older (60 + years) participants (2.51, 95%CI: − 1.58 to − 3.43) indicating a higher intake of unhealthy foods by these groups. Most participants (~ 95%) reported low intake of cruciferous vegetable. Conclusions Despite the overall healthiness of foods consumed by Nigerian adults and low risk of poor diet quality across seasons, men and younger adults tend to consume more unhealthy foods and fewer home cooked meals. Both genders, irrespective of age, had low intakes of cruciferous vegetables. These findings highlight opportunities for targeted interventions to improve the overall healthiness of dietary intakes among Nigerian adults.

There has been no previous systematic, epidemiological study of the reproductive risk factors for uterine fibroids (UF) in African populations despite African women having the highest burden of UF in the world. Improved knowledge of the associations between UF and reproductive factors would contribute to better understanding of the etiology of UF and may suggest novel opportunities for prevention and therapeutic interventions. We used nurse administered questionnaires to survey the demographic and reproductive risk factors of UF among 484 women who are members of the African Collaborative Center for Microbiome and Genomics Research (ACCME) Study Cohort in central Nigeria, and who had transvaginal ultrasound diagnosis (TVUS). We used logistic regression models to the evaluate associations between reproductive risk factors and UF, adjusted for significant covariates. In our multivariable logistic regression models, we found inverse associations with number of children (OR = 0.83, 95%CI = 0.74–0.93, p-value = 0.002), parity (OR = 0.41, 95%CI = 0.24–0.73, p-value = 0.002), history of any type of abortion (OR = 0.53, 95%CI = 0.35–0.82, p-value = 0.004), duration of use of Depot Medroxyprogesterone Acetate (DMPA) (p-value for trend = 0.02), menopausal status (OR = 0.48, 95%CI = 0.27–0.84, p-value = 0.01), and a non-linear positive association with age (OR = 1.04, 95%CI = 1.01–1.07, p-value = 0.003). Other reproductive risk factors that have been reported in other populations (age at menarche and menopause, and oral contraceptives) were not associated with UF in this study. Our study confirms some of the reproductive risk factors for UF that have been found in other populations and shows that some of them are stronger in the Nigerian population. The associations we found with DMPA suggest opportunities for further research to understand the mechanisms of action of progesterone and its analogues in the etiology of UF, their potential use for prevention and treatment of UF.

Self-report of uterine fibroids (UF) has been used for epidemiologic research in different environments. Given the dearth of studies on the epidemiology of UF in Sub-Saharan Africa (SSA), it is valuable to evaluate its performance as a potential tool for much needed research on this common neoplasm in SSA women. We conducted a cross-sectional study of self-report of UF compared with transvaginal ultrasound diagnosis (TVUS) among 486 women who are members of the African Collaborative Center for Microbiome and Genomics Research (ACCME) Study Cohort in central Nigeria. We used log-binomial regression models to compute the classification, sensitivity, specificity, and predictive values of self-report compared to TVUS, adjusted for significant covariates. The prevalence of UF on TVUS was 45.1% (219/486) compared to 5.4% (26/486) based on self-report of abdominal ultrasound scan and 7.2% (35/486) based on report of healthcare practitioner’s diagnosis. Self-report correctly classified 39.5% of the women compared to TVUS in multivariable adjusted models. The multivariable adjusted sensitivity of self-report of healthcare worker diagnosis was 38.8%, specificity was 74.5%, positive predictive value (PPV) was 55.6%, and negative predictive value (NPV) was 59.8%. For self-reported abdominal ultrasound diagnosis, the multivariable adjusted sensitivity was 40.6%, specificity was 75.3%, PPV was 57.4%, and NPV was 60.6%. Self-report significantly underestimates the prevalence of UF and is not accurate enough for epidemiological research on UF. Future studies of UF should use population-based designs and more accurate diagnostic tools such as TVUS.

Uganda’s cervical cancer age standardized incidence rate is four times the global estimate. Although Uganda’s ministry of health recommends screening for women aged 25–49 years, the screening remains low even in the most developed region (Central Uganda) of the country. This study examined the demographic, social, and economic predictors of cervical cancer screening in Central Uganda with the aim of informing targeted interventions to improve screening. The cross-sectional survey was conducted in Wakiso and Nakasongola districts in Central Uganda. A total of 845 women age 25–49 years participated in the study. Data were analyzed at bivariate and multivariate levels to examine the predictors of CC (cervical cancer) screening. Only 1 in 5 women (20.6%) had ever screened for cervical cancer. Our multivariate logistic regression model indicated that wealth index, source of information, and knowledge about CC and CC screening were significantly associated with cervical cancer screening. The odds of cervical cancer screening were higher among rich women compared with poor women [AOR = 1.93 (95%CI: 1.06–3.42), p = 0.031)], receiving information from health providers compared with radios [AOR = 4.14 (95%CI: 2.65–6.48), p<0.001, and being more knowledgeable compared with being less knowledgeable about CC and CC screening [AOR = 2.46 (95%CI: 1.49–3.37), p<0.001)]. Overall cervical cancer screening uptake in central Uganda was found to be low. The findings of the study indicate that women from a wealthy background, who had been sensitized by health workers and with high knowledge about CC and CC screening had higher odds of having ever screened compared with their counterparts. Efforts to increase uptake of screening must address disparities in access to resources and knowledge.

IntroductionThe use of data science for health research produces complex ethical, legal and social challenges that traditional ethical oversight mechanisms struggle to address. In Nigeria, the current ethical guidelines were not designed for these challenges which include pervasive data environments, consent for secondary data use, algorithmic decision-making and bias, privacy risks, involvement of commercial entities, data colonisation, inequitable benefit-sharing and commercial data holdings. To address these gaps, we developed a draft guideline incorporating principles like trust, veracity, global justice and alternative ethical approval mechanisms. Here, we describe the protocol for a study aimed at validating the guideline through stakeholder consensus on the content, feasibility and acceptability of this subcode for national implementation.Methods and analysisWe describe the use of a modified e-Delphi approach to iteratively synthesize expert opinions about ethical oversight for data science health research (DSHR) led by a multidisciplinary working group from the Bridging Gaps in the ELSI of Data Science Health Research in Nigeria (BridgELSI) team. We will invite 65 experts, including health researchers, ethics committee members, data scientists, health policymakers, funders and key opinion leaders in Nigeria to participate. Participants will rate 13 core principles, including global justice, algorithmic bias, data governance and related governance provisions on importance, desirability for inclusion in national guidelines, feasibility and confidence in implementation, using 5-point Likert scales, with optional free-text comments. We will summarise responses using descriptive statistics, assess consensus and polarity using pre-specified thresholds for the mean and IQR, and iteratively refine statements between rounds using qualitative content analysis of comments.Ethics and disseminationEthical approval was obtained from the Nigerian National Health Research Ethics Committee and the University of Maryland IRB, and participants will provide informed consent. Results will be shared with the expert panel and national regulators and disseminated via publications and conferences.

The vaginal microbiota is thought to play a role in modulating risk of high-risk human papillomavirus (hrHPV) infection. We examined the relationship between the vaginal microbiota and persistent hrHPV infection in HIV-negative and HIV-positive women. We used 16S-rRNA sequencing to characterize the vaginal microbiota of two serial samples taken six months apart from 211 Nigerian women (67%, 142/211 HIV-positive and 33%, 69/211 HIV-negative) and evaluated the association between the vaginal microbiota and persistent hrHPV infection using generalized estimating equation logistic regression models and linear discriminant analysis effect size (LEfSe) algorithm to identify phylotypic biomarkers of persistent hrHPV infection. The high diversity microbiota, Community State Type IV-B, was the most prevalent in both HIV-negative (38% at baseline, 30% at the follow-up visit) and HIV-positive (27% at baseline, 35% at the follow-up visit) women. The relationship between the vaginal microbiota and persistent hrHPV was modified by HIV status. In HIV-negative women, women with Lactobacillus dominant microbiota had lower odds (OR: 0.35, 95% CI 0.14–0.89, p  = 0.03) of persistent hrHPV compared to women with Lactobacillus deficient microbiota. While among HIV-positive women, the odds of being persistently infected with hrHPV was higher in women with Lactobacillus dominant microbiota (OR: 1.25, 95% CI 0.73–2.14 p  = 0.41). This difference in effect estimates by HIV was statistically significant (p = 0.02). A high diversity vaginal microbial community with paucity of Lactobacillus species was associated with persistent hrHPV infection in HIV-negative women but not in HIV-positive women.