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Maternal depression affects one in five women in Malawi. Integrated interventions simultaneously addressing multiple risks are a promising strategy to improve mental health. This study evaluated the impact of a nutrition-sensitive social behaviour change (SBC) intervention (agriculture and livelihoods, male engagement and Caring for the Caregiver) with or without cash transfers on maternal perinatal depression during the lean season in rural Malawi. A midline survey for a cluster-randomised controlled trial was conducted, where 156 clusters were randomly assigned to four arms (39 clusters/arm): (1) standard of care (SoC), (2) SBC, (3) SBC+low cash (US$17 per month) and (4) SBC+high cash (US$43 per month). Pregnant women and mothers of children <2 years of age (n=2677) were enrolled at baseline (May–June 2022). A subsample of 1303 women was followed-up at midline (November–December 2023). Maternal perinatal depression was assessed using the Self-Reporting Questionnaire with a score of ≥8 indicating symptoms consistent with depression. Intervention effects were estimated using linear mixed effects models. At midline, SBC+high cash reduced depression scores relative to SoC (mean difference −1.13 (95% CI −1.96 to –0.31)) but had no impact on the proportion of women with depressive symptoms. Relative to SoC, SBC+low cash and SBC alone had no impact on depression scores or the proportion of women with depressive symptoms. Relative to SBC alone, adding cash to SBC reduced depression scores and the proportion of women with depressive symptoms regardless of the size of the cash transfer. Cash transfers integrated with SBC can benefit maternal perinatal mental health in rural Malawi during the lean season. Trial registration number ISRCTN53055824.

Kenya detected the first case of COVID-19 on March 13, 2020, and as of July 30, 2020, 17 975 cases with 285 deaths (case fatality rate (CFR) = 1.6%) had been reported. This study described the cases during the early phase of the pandemic to provide information for monitoring and response planning in the local context. We reviewed COVID-19 case records from isolation centres while considering national representation and the WHO sampling guideline for clinical characterization of the COVID-19 pandemic within a country. Socio-demographic, clinical, and exposure data were summarized using median and mean for continuous variables and proportions for categorical variables. We assigned exposure variables to socio-demographics, exposure, and contact data, while the clinical spectrum was assigned outcome variables and their associations were assessed. A total of 2796 case records were reviewed including 2049 (73.3%) male, 852 (30.5%) aged 30-39 years, 2730 (97.6%) Kenyans, 636 (22.7%) transporters, and 743 (26.6%) residents of Nairobi City County. Up to 609 (21.8%) cases had underlying medical conditions, including hypertension (n = 285 (46.8%)), diabetes (n = 211 (34.6%)), and multiple conditions (n = 129 (21.2%)). Out of 1893 (67.7%) cases with likely sources of exposure, 601 (31.8%) were due to international travel. There were 2340 contacts listed for 577 (20.6%) cases, with 632 contacts (27.0%) being traced. The odds of developing COVID-19 symptoms were higher among case who were aged above 60 years (odds ratio (OR) = 1.99, P = 0.007) or had underlying conditions (OR = 2.73, P < 0.001) and lower among transport sector employees (OR = 0.31, P < 0.001). The odds of developing severe COVID-19 disease were higher among cases who had underlying medical conditions (OR = 1.56, P < 0.001) and lower among cases exposed through community gatherings (OR = 0.27, P < 0.001). The odds of survival of cases from COVID-19 disease were higher among transport sector employees (OR = 3.35, P = 0.004); but lower among cases who were aged ≥60 years (OR = 0.58, P = 0.034) and those with underlying conditions (OR = 0.58, P = 0.025). The early phase of the COVID-19 pandemic demonstrated a need to target the elderly and comorbid cases with prevention and control strategies while closely monitoring asymptomatic cases.

Despite important strides in the fight against poverty in the past two decades, child poverty remains widespread and persistent, particularly in Africa.Poverty in all its dimensions is detrimental for early childhood development and leads to often unreversed damage for the lives of girls and boys, locking children and families into.

Background BPSD are common in persons living with dementia and are often associated with disease severity and caregivers’ distress. In Low‐ and Middle‐Income Countries, they are often the symptom complex that compel family to seek medical help. However, the association of BPSD with dementia severity and specific cognitive domains is underexplored in African populations. This study aims to evaluate BPSD among indigenous Africans and the association with specific cognitive domains. Method This cross‐sectional study analyzes data collected from nine African countries (Nigeria, Benin, Ghana, Cameroon, Ethiopia, Kenya, Uganda, Tanzania, and Mozambique) participating in the Recruitment and Retention for Alzheimer's Disease Diversity Cohorts in the Alzheimer's Disease Sequencing Project (READD‐ADSP) project, from June 2023 to December 2024. Data on neurocognitive factors were collected using the Uniform Data Set (UDS), Neuropsychiatric Inventory Questionnaire (NPI‐Q) for BPSD, and the Clinical Dementia Rating (CDR) scale for dementia severity. Data was managed on REDCap and analysis was performed using STATA (v16). Descriptive statistics were employed for symptom prevalence, and Spearman's rank correlation was used to analyze the relationship between NPI‐Q and CDR scores. Association between cognitive domains and behavioral symptoms was examined using hierarchical linear model adjusting for covariates such as age, gender, education, and illness duration. Result A total of 641 Africans with dementia (61% female, mean age 76.7±10.1 years) were included. The mean (±SD) NPI and CDR scores were 4.91 (±6.25) and 1.84 (±1.25), respectively. The most prevalent BPSD symptoms were apathy (32%), agitation/aggression (28.7%), and depression (28.1%). Spearman's correlation revealed a weak but significant positive association between NPI‐Q severity scores and CDR scores (rho = 0.264, p < 0.001). Behavioral symptoms were significantly associated with dementia severity (β = 1.59, CI: 1.15–2.03) as well as specific cognitive domains, particularly memory (digit span backward: β = ‐0.38, CI: ‐0.64 to ‐0.13). However, the duration of illness was not a significant predictor of behavioral symptoms in this cohort. Conclusion The findings suggest that BPSD are both an indicator and consequence of dementia severity, particularly in memory function. This study posits the need for targeted management of BPSD and improvement in overall patient care in LMICs

BPSD are common in persons living with dementia and are often associated with disease severity and caregivers' distress. In Low- and Middle-Income Countries, they are often the symptom complex that compel family to seek medical help. However, the association of BPSD with dementia severity and specific cognitive domains is underexplored in African populations. This study aims to evaluate BPSD among indigenous Africans and the association with specific cognitive domains. This cross-sectional study analyzes data collected from nine African countries (Nigeria, Benin, Ghana, Cameroon, Ethiopia, Kenya, Uganda, Tanzania, and Mozambique) participating in the Recruitment and Retention for Alzheimer's Disease Diversity Cohorts in the Alzheimer's Disease Sequencing Project (READD-ADSP) project, from June 2023 to December 2024. Data on neurocognitive factors were collected using the Uniform Data Set (UDS), Neuropsychiatric Inventory Questionnaire (NPI-Q) for BPSD, and the Clinical Dementia Rating (CDR) scale for dementia severity. Data was managed on REDCap and analysis was performed using STATA (v16). Descriptive statistics were employed for symptom prevalence, and Spearman's rank correlation was used to analyze the relationship between NPI-Q and CDR scores. Association between cognitive domains and behavioral symptoms was examined using hierarchical linear model adjusting for covariates such as age, gender, education, and illness duration. A total of 641 Africans with dementia (61% female, mean age 76.7±10.1 years) were included. The mean (±SD) NPI and CDR scores were 4.91 (±6.25) and 1.84 (±1.25), respectively. The most prevalent BPSD symptoms were apathy (32%), agitation/aggression (28.7%), and depression (28.1%). Spearman's correlation revealed a weak but significant positive association between NPI-Q severity scores and CDR scores (rho = 0.264, p < 0.001). Behavioral symptoms were significantly associated with dementia severity (β = 1.59, CI: 1.15-2.03) as well as specific cognitive domains, particularly memory (digit span backward: β = -0.38, CI: -0.64 to -0.13). However, the duration of illness was not a significant predictor of behavioral symptoms in this cohort. The findings suggest that BPSD are both an indicator and consequence of dementia severity, particularly in memory function. This study posits the need for targeted management of BPSD and improvement in overall patient care in LMICs.

Africa has undergone a progressive aridification during the last 20 My that presumably impacted organisms and fostered the evolution of life history adaptations. We test the hypothesis that shift to living in ant nests and feeding on ant brood by larvae of phyto‐predaceous Lepidochrysops butterflies was an adaptive response to the aridification of Africa that facilitated the subsequent radiation of butterflies in this genus. Using anchored hybrid enrichment we constructed a time‐calibrated phylogeny for Lepidochrysops and its closest, non‐parasitic relatives in the Euchrysops section (Poloyommatini). We estimated ancestral areas across the phylogeny with process‐based biogeographical models and diversification rates relying on time‐variable and clade‐heterogeneous birth‐death models. The Euchrysops section originated with the emerging Miombo woodlands about 22 million years ago (Mya) and spread to drier biomes as they became available in the late Miocene. The diversification of the non‐parasitic lineages decreased as aridification intensified around 10 Mya, culminating in diversity decline. In contrast, the diversification of the phyto‐predaceous Lepidochrysops lineage proceeded rapidly from about 6.5 Mya when this unusual life history likely first evolved. The Miombo woodlands were the cradle for diversification of the Euchrysops section, and our findings are consistent with the hypothesis that aridification during the Miocene selected for a phyto‐predaceous life history in species of Lepidochrysops, with ant nests likely providing caterpillars a safe refuge from fire and a source of food when vegetation was scarce. Africa has undergone a progressive aridification during the last 20 My that presumably impacted organisms and fostered the evolution of life history adaptations. Using anchored hybrid enrichment we constructed a time‐calibrated phylogeny for Lepidochrysops and its closest, non‐parasitic relatives in the Euchrysops section (Poloyommatini, Lycaenidae) and performed ancestral area analysis and diversification analyses. We found that Tte Miombo woodlands were the cradle for diversification of the Euchrysops section, and our findings are consistent with the hypothesis that aridification during the Miocene selected for a phyto‐predaceous life history in species of Lepidochrysops, with ant nests likely providing caterpillars a safe refuge from fire and a source of food when vegetation was scarce.

BackgroundResource-limited settings are increasingly experiencing a ‘triple burden’ of disease, composed of trauma, non-communicable diseases (NCDs) and known communicable disease patterns. However, the epidemiology of acute and emergency care is not well characterised and this limits efforts to further develop emergency care capacity.ObjectiveTo define the burden of disease by describing the patient population presenting to the Accident and Emergency Department (A&E) at Kenyatta National Hospital (KNH) in Kenya.MethodsWe completed a prospective descriptive assessment of patients in KNH’s A&E obtained via systematic sampling over 3 months. Research assistants collected data directly from patients and their charts. Chief complaint and diagnosis codes were grouped for analysis. Patient demographic characteristics were described using the mean and SD for age and n and percentages for categorical variables. International Classification of Disease 10 codes were categorised by 2013 Global Burden of Disease Study methods.ResultsData were collected prospectively on 402 patients with an average age of 36 years (SD 19), and of whom, 50% were female. Patients were most likely to arrive by taxi or bus (39%), walking (28%) or ambulance (17%). Thirty-five per cent of patients were diagnosed with NCDs, 24% with injuries and 16% with communicable diseases, maternal and neonatal conditions. Overall, head injury was the single most common final diagnosis and occurred in 32 (8%) patients. The most common patient-reported mechanism for head injury was road traffic accident (39%).ConclusionThis study estimates the characteristics of the A&E population at a tertiary centre in Kenya and highlights the triple burden of disease. Our findings emphasise the need for further development of emergency care resources and training to better address patient needs in resource-limited settings, such as KNH.