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The deep evolutionary history of African populations, since the emergence of modern humans more than 300,000 years ago, has resulted in high genetic diversity and considerable population structure. Selected genetic variants have increased in frequency due to environmental adaptation, but recent exposures to novel pathogens and changes in lifestyle render some of them with properties leading to present health liabilities. The unique discoverability potential from African genomic studies promises invaluable contributions to understanding the genomic and molecular basis of health and disease. Globally, African populations are understudied, and precision medicine approaches are largely based on data from European and Asian-ancestry populations, which limits the transferability of findings to the continent of Africa. Africa needs innovative precision medicine solutions based on African data that use knowledge and implementation strategies aligned to its climatic, cultural, economic and genomic diversity.Africa is a continent with deep evolutionary history, which has implications for the genetic underpinnings of disease. In this Review, the authors discuss how genetic features of African populations provide both challenges and opportunities for understanding disease genetics in Africa. They describe how this genetic knowledge — combined with initiatives including capacity-building, data sharing and increased representation of African genomes in genetic variation databases — can be leveraged towards achieving precision medicine approaches in African healthcare.

Would genetics research be a priority for Rwanda while the country was rebuilding just after the 1994 genocide against Tutsi? This was a question that I needed to consider. Sometimes, it is very hard to make the best choice for your career in a new scientific discipline when you have no role models and the only way forward is to start from scratch. Later, however, you can look back on what you have accomplished with surprise, and pride, when you see all your efforts paying off. Here I tell the story of my journey in genetics research, from rebuilding a country after trauma to facing our current COVID-19 pandemic challenges.

Several studies have indicated that the presence of periodontitis during pregnancy could increase the risk of developing pre-eclampsia, thereby negatively influencing pregnancy outcomes for both the mother and child. Notably, despite the high prevalence of both periodontitis and adverse pregnancy outcomes in Rwanda, there exists a crucial evidence gap concerning the precise relationship between periodontitis and pre-eclampsia. The aim of this study was to assess the association between periodontitis and pre-eclampsia amongst pregnant women in Rwanda. Employing an unmatched 1:2 case-control design, we studied 52 pre-eclamptic and 104 non-pre-eclamptic pregnant women aged ≥18 years at two referral hospitals in Rwanda. Pre-eclampsia was defined as a systolic blood pressure ≥ 140 and diastolic blood pressure ≥ 90 mm Hg, diagnosed after 20 weeks of gestation and proteinuria of ≥300mL in 24 hours of urine collection. Periodontitis was defined as the presence of two or more teeth with one or more sites with a pocket depth ≥ 4mm and clinical attachment loss >3 mm at the same site, assessed through clinical attachment loss measurement. Bivariate analysis and logistic regression were used to estimate Odds ratio (ORs) and 95% confidence interval. The prevalence of periodontitis was significantly higher among women with pre-eclampsia, compared to pregnant women without pre-eclampsia, at 90.4% and 55.8%, respectively (p< 0.001). Pregnant Women with periodontitis were 3.85 times more likely to develop pre-eclampsia after controlling for relevant confounders (adjusted Odds Ratio [aOR] = 3.85, 95%CI = 1.14-12.97, p<0.05). This study results indicates that periodontitis is significantly associated with pre-eclampsia among pregnant women in Rwanda. These findings suggest that future research should explore whether enhancing periodontal health during pregnancy could contribute to reducing pre-eclampsia in this specific population.

The health, economic, and social burden of neglected tropical diseases (NTDs) in Africa remains substantial, with elimination efforts hindered by persistent sociopolitical instability, including ongoing conflicts among political and ethnic groups that lead to internal displacement and migration. Here, we explore how innovative technologies can support Africa in addressing NTDs amidst such instability, through analysis of WHO and UNHCR data and a systematic literature review. Countries in Africa facing sociopolitical instability also bear a high burden of NTDs, with the continent ranking second globally in NTD burden (33%, 578 million people) and first in internal displacement (50%, 31.6 million people) in 2023. Studies have investigated technologies for their potential in NTD prevention, surveillance, diagnosis, treatment and management. Integrating the evidence, we discuss nine promising technologies—artificial intelligence, drones, mobile clinics, nanotechnology, telemedicine, augmented reality, advanced point-of-care diagnostics, mobile health Apps, and wearable sensors—that could enhance Africa’s response to NTDs in the face of persistent sociopolitical instability. As stability returns, these technologies will evolve to support more comprehensive and sustainable health development. The global health community should facilitate deployment of health technologies to those in greatest need to help achieve the NTD 2030 Roadmap and other global health targets. Countries in Africa facing sociopolitical instability also bear a high burden of neglected tropical diseases (NTDs). Here, the authors explore the potential of health technologies to address NTDs through a systematic literature review.

Background Undernutrition and severe malaria continue to be major public health concerns worldwide, particularly in African countries. While the association between malaria and malnutrition has been widely studied in various settings, limited research has focused on asymptomatic malaria and its link to nutritional status in Rwanda, leaving a gap in understanding this relationship in the local context. This study aimed to investigate the possible relationship between children's nutritional health and asymptomatic malaria infections. Specifically, the study assessed the prevalence of undernutrition and asymptomatic malaria infection in relation to implemented policies and the link between stunting, wasting, underweight, and asymptomatic malaria infections. Methods Data from three Demographic and Health Surveys (DHS) conducted in Rwanda in 2010, 2014–15, and 2019–20 were used in the study, including children aged 6 to 59 months and confirmed malaria diagnoses via blood smear. The odds ratio of stunting, underweight, and wasting on malaria outcomes were calculated using logistic regression, with and without adjusting for factors such as age, gender, mother’s education, wealth index, type of residence, and region within each survey. The present study examined data from three DHSs conducted in Rwanda, which included 10,411 children aged less than five years who were tested for malaria and 11,424 children who had anthropometric measurements. Despite this variation, the available sample size (n = 10,409) remains robust for drawing meaningful conclusions, and potential biases due to missing data in the analysis were taken into account. This study used unadjusted (OR) and adjusted odds ratios (AOR) to evaluate the relationships between stunting, underweight, age, wealth index, and malaria outcomes. All independent variables with a p-value below 0.05 in the unadjusted regression were included and considered significant in the adjusted regression analysis. A p-value < 0.05 was used to determine statistical significance. Results Asymptomatic malaria was found to be present in 1.3% (95% confidence interval (CI) 1.14%–1.59%) of the population (140/10,411). The study also discovered that 38.3% (95% CI 37.42%–39.21%) of the children were stunted (Z-score < − 2.0). Moreover, the results indicate that malaria was more frequent in children with stunting (OR = 1.85, 95% CI = [1.32; 2.59], p < 0.001). Underweight children were also found to have an increased prevalence of malaria (AOR = 1.59, 95% CI [1.14–2.95], p = 0.01). Age was also an important variable correlated with malaria infection since the prevalence of malaria was found to be higher in children over 24 months of age (AOR = 2.72, 95% CI [1.78–4.16], p < 0.001). Children from the richest families were found to be protected from malaria AOR = 0.38 (95% CI [0.24–0.58], p < 0.001) in all 3 DHS. Conclusion This study revealed that undernutrition indexes such as stunting and underweight as well as poor wealth index are significant risk factors for asymptomatic malaria in children under the age of five years. Malaria itself can worsen nutrition status, creating a vicious cycle. Monitoring and enhancing this dual relationship of nutritional status and malaria highlights the essential needs of children in this age group in malaria-endemic settings.

Background Undernutrition and malaria remain major global public health challenges. The relationship between nutritional status and malaria infection is complex. Better understanding of their association is needed to improve prevention and control of these health conditions. Undernutrition can be assessed by evaluating nutrient intake (macronutrient and micronutrient intake) measured through Food Frequency Questionnaire or by using indicators for chronic undernutrition, including the stunting parameter defined by the World Health Organization as child being too short for age. This study aims to investigate associations between inadequate nutrient intake or indicators for undernutrition and malaria infection. Methods The analysis compares malaria cases diagnosed by a positive blood smear against controls composed of other malaria free people living in the same households with the cases (same household grouping). Data collection was conducted between November 2021 and December 2023 across 9 endemic districts located in all four provinces and Kigali City. Regression models were developed to investigate the association between undernutrition (i.e. inadequate nutrient intake or stunting) and malaria infection. Results Despite numerous nutrition interventions aimed at reducing the burden of undernutrition, the dietary patterns observed in this study remain predominantly imbalanced. The food composition was predominantly made up of starchy staples, accounting for 56.7% of total energy intake. Such foods are typically rich in macronutrients but low in essential micronutrients. The findings revealed a high prevalence of micronutrient deficiency risk, with a reported risk of vitamin A, B2, B12, calcium, zinc, and selenium deficiency between 50 and 80% in the studied population. Regarding stunting, even if the percentage of severe chronic stunting was higher in malaria cases (17%) compared to controls (10,6%), the association between stunting and malaria infection was not statistically significant. After adjusting for covariates, risk of vitamin E deficiency and risk of iron deficiency were positively associated with malaria (aOR = 7.46; 95% CI 4.43–12.58; p  < 0.001 and aOR = 1.80; 95% CI 1.11–2.93; p  = 0.017 , respectively). Conversely, age, sex, and risk of selenium deficiency intake were inversely associated with malaria. Increasing age (aOR = 0.58; 95% CI 0.36–0.95; p  < 0.04), female sex (aOR = 0.67; 95% CI 0.46–0.97; p  < 0.001), and selenium deficiency (aOR = 0.62; 95% CI 0.43–0.91; p  = 0.013) were all linked to lower odds of malaria infection. Conclusions These findings highlight the critical role of nutrient imbalances in influencing malaria infections. Therefore tackling these preventable deficiencies is required through targeted strategies as guided by UNICEF conceptual framework 2020–2030. For instance, improving dietary diversity, regularly monitoring nutritional status, and establishing a comprehensive national food composition database could support such strategies. These approaches will support effective nutrition policies and interventions.

Leon Mutesa highlights a 2009 article by Yehuda and Bierer that considered the relevance of epigenetic mechanisms to post-traumatic stress disorder, which inspired his own research on the importance of DNA methylation changes in trauma survivors.

This study explores the motivational factors and barriers to participate in a citizen science program for malaria control in Rwanda. It assesses the changes in motivational factors over time and compares these factors among age and gender groups. Using a qualitative approach, this study involved 44 participants. At the initial stage, people participated in the program because of curiosity, desire to learn new things, helping others, and willingness to contribute to malaria control. As the engagement continued, other factors including ease of use of materials to report observations, the usefulness of the program, and recognition also played a crucial role in the retention of volunteers. Lack of time and information about the recruitment process, perceived low efficacy of the mosquito trap, and difficulties in collecting observations were reported as barriers to get and stay involved. Some variations in the motivational factors were observed among age and gender groups. At the initial phase, young adults and adults, as well as men and women were almost equally motivated to contribute to malaria control. For the ongoing phase, for age, the two groups were almost equally motivated by recognition of their effort. Also, the opportunity for learning was an important factor among young adults while ease of use of the materials was central for adults. For gender, the usefulness of the project, ease of use of materials, and learning opportunities were important motivational factors among women, while men were more motivated by recognition of their efforts. A framework including motivational factors and barriers at each stage of participation is presented. This framework may be used to explore motivations and barriers in future citizen science projects and might help coordinators of citizen science programs to determine whom to target, by which message, and at what stage of participation to retain volunteers in citizen science projects.

Circulating microRNAs are non-invasive biomarkers that can be used for breast cancer diagnosis. However, differences in cancer tissue microRNA expression are observed in populations with different genetic/environmental backgrounds. This work aims at checking if a previously identified diagnostic circulating microRNA signature is efficient in other genetic and environmental contexts, and if a universal circulating signature might be possible. Two populations are used: women recruited in Belgium and Rwanda. Breast cancer patients and healthy controls were recruited in both populations (Belgium: 143 primary breast cancers and 136 healthy controls; Rwanda: 82 primary breast cancers and 73 healthy controls; Ntot = 434), and cohorts with matched age and cancer subtypes were compared. Plasmatic microRNA profiling was performed by RT-qPCR. Random Forest was used to (1) evaluate the performances of the previously described breast cancer diagnostic tool identified in Belgian-recruited cohorts on Rwandan-recruited cohorts and vice versa; (2) define new diagnostic signatures common to both recruitment sites; (3) define new diagnostic signatures efficient in the Rwandan population. None of the circulating microRNA signatures identified is accurate enough to be used as a diagnostic test in both populations. However, accurate circulating microRNA signatures can be found for each specific population, when taken separately.

Background: Respiratory viral infections such as influenza, COVID-19, and respiratory syncytial virus (RSV) are considered as major public health threats in Africa. Despite global advancements in vaccine development, persistent inequities in access, delivery infrastructure, and public trust limit the continent’s capacity to control these diseases effectively. This review aimed at providing insights on challenges, efforts, impacts, and opportunities for the future related to vaccination against respiratory viral infections in Africa. Methods: This narrative review synthesizes the peer-reviewed literature and global health reports to examine vaccination efforts against respiratory viruses in Africa. The analysis focuses on disease burden, vaccine coverage, barriers to uptake, enabling factors, progress in local vaccine production, and strategies for integrating vaccines into national immunization programs (NIPs). Results: Respiratory vaccines have significantly reduced hospitalizations and mortality among high-risk groups in African countries. Nonetheless, key challenges, including limited cold chain capacity, vaccine hesitancy, donor-reliant supply chains, and under-resourced health systems, continue to undermine vaccine delivery. Successful interventions include community mobilization, use of mobile health technologies, and leveraging existing immunization platforms. Emerging initiatives in local vaccine manufacturing, including Rwanda’s modular mRNA facility and Senegal’s Institut Pasteur, signal a shift toward regional self-reliance. Conclusions: Maximizing the impact of respiratory vaccines in Africa requires a multifaceted strategy: integrating vaccines into NIPs, strengthening domestic production, expanding cold chain and digital infrastructure, and addressing sociocultural barriers through community-driven communication. These efforts are essential to achieving vaccine equity, health resilience, and pandemic preparedness across the continent.