Since the 1970s, twin birth rates have increased sharply in developed countries. In Africa, where the rate is the highest globally, its evolution and variation are poorly understood. This article aims to estimate the twinning rate in sub-Saharan African (SSA) countries throughout 1986–2016 and analyze its spatial, temporal, and ethnic variations. It also seeks to identify social and demographic factors associated with a high probability of twin births and outline a forecast of the twinning rate. We used data from 174 Demographic and Health Surveys from 42 countries. We supplemented them with the UN World Population Prospects (WPP). The twinning rate was calculated by reporting the number of twin births per thousand total births. We used logistic regression to analyze the factors associated with twin births. We projected the twinning rate based on WPP. The overall SSA twinning rate is 17.4 per 1000, but it has changed very little over time, and we expect it will grow a little between 2015 and 2050, increasing at most from 17.4 per 1000 to 18.4 per 1000. We also show significant differences in the twinning rate in SSA according to mother ethnicity. Most ethnic groups with high twinning rates belong to the large Bantu ethnic family. SSA remains the ‘land of twins’, with the twinning rate changing slowly. However, specific health policies must target twin births in SSA to address the public health challenges they present.

Reproductive health indicators in many developing countries including Nigeria are poor, and this is due to the less-than-optimum utilization of reproductive healthcare that has been linked to numerous factors including the educational attainment of women and their partners. In societies like Nigeria, marriage is nearly universal and upheld by patriarchal practices, while education is one of the determining factors for the choice of partner in the marriage market, as it also influences household power dynamics. Despite the plethora of studies investigating the link between education and utilization of these services, there is a paucity of research examining educational assortative mating (EAM) and its link to reproductive healthcare utilization. Hence, this study investigated EAM and explored its association with reproductive healthcare utilization from the perspective of family systems theory. Data from the 2018 Nigeria Demographic and Health Survey (n = 19,950) was analysed with frequencies presented and binary logistic regression models fitted. The result showed that high-education (34%) and low-education (46%) homogamy are the most prevalent types of EAM, while 40% of the partnered women reported facility delivery, 11% used modern contraceptives and 20% reported 8+ antenatal care visits. The multivariate analysis showed that compared to women in hypergamy, women in both high-education homogamy and hypogamy are more likely to deliver at a health facility but women in low-education are less likely. Women in both high-education homogamy and hypogamy are more likely, but those in low-education homogamy are less likely to use modern contraceptives. For antenatal care, only women in high-education homogamy are more likely to have 8 or more visits during pregnancy compared to women in hypergamy, while women in low-education homogamy and hypogamy are less likely. These findings provide evidence of the importance of an indicator of social stratification for important family decisions like healthcare utilization.

The aim of this paper is to analyse the role of climate change on state fragility in sub-Saharan Africa (SSA). To do this, we estimate a country-time fixed effects panel data model using the two-way fixed effects estimator over the period 1995 to 2020 for 45 SSA countries. Our results show that climate change increases fragility in SSA; specifically, rising temperatures and decreasing rainfall increase the social, economic, political and security fragility of SSA countries. The study also reveals that gross domestic product, population growth, migrant remittances, foreign direct investment, natural resources, inflation and agricultural price volatility are mechanisms through which climate change exacerbates state fragility. Based on these results, we recommend climate change adaptation measures such as increasing water storage to cope with periods of extreme drought, growing climate-smart crops, and the introduction of environmental public policies.

Even though Sub-Saharan Africa (SSA) is lagging in digital technology adoption among the global average, there is substantial progress in terms of Information and Communication Technology (ICT) access and use, where it plays a crucial role in increasing the quality of life in the regions. However, digital gaps still exist within the continents, even though technology adoption across African nations has shown an increase in progress. This paper aims to explore factors that contribute to different adoption rates among three digital technologies in SSA, specifically mobile phones, fixed broadband, and fixed telephones. The methodology utilizes panel regression analysis to examine data sourced from the World Bank, which consists of 48 SSA countries from 2006 to 2022. The findings show a consistent growth in mobile phone subscriptions, different from fixed telephone and broadband internet that shows stagnant progress. Furthermore, infrastructure, and human capital are the most significant factors in addition to other influencing factors. The results of this study provide the African governments with insightful advice on addressing the digital divide and accelerating their digital transformation.

Studies show that mental health promotion is an effective strategy that can reduce the burden of mental health disorders and improve overall well-being in both children and adults. In addition to promoting high levels of mental well-being and preventing the onset of mental illness, these mental health promotion programmes, including mental illness prevention interventions, help increase levels of mental health literacy in community members. While there is evidence showing the effectiveness of mental health promotion, much of what is known about this field is informed by studies conducted in high-income countries. There is a need to gather evidence about the effectiveness of such interventions in low- and middle-income countries (LMICs) where mental health services are often inadequate. In this systematic review, we synthesised the available published primary evidence from sub-Saharan Africa (SSA) on the types and effectiveness of mental health promotion programmes for young people. We performed a search of selected global databases (PubMed, PsycINFO, ScienceDirect and Google Scholar) and regional databases (Sabinet African Journals). We included observational, mixed methods, trials, pilots and quantitative original papers published from 2013 to 2023. We used the Mixed Methods Appraisal Tool (MMAT) to evaluate the quality of methods in selected studies, and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement (PRISMA-2020) for reporting the evidence gathered. We identified 15 types of youth mental health promotion and illness prevention interventions. Among those identified, we found that school-based interventions enhanced mental health literacy, mental health-seeking behaviours and self-assurance and confidence among young people. Family-based interventions also showed a potential to improve relationships between young people and their caregivers. Future studies should explore how to further strengthen school- and family-based interventions that promote mental health among young people.

Food insecurity remains a global issue, particularly in developing countries like Ethiopia. Thus, this study focused on identifying factors contributing to food insecurity and the strategies used to cope with it among agrarian and pastoralist communities of South Ari and Benatsemay Woreda, respectively. A facility-based qualitative study was carried out in Southern Ethiopia. Participants were selected using a purposefully targeting health extension workers, health centre directors, woreda programme experts, district health managers, and pregnant women staying in maternity waiting homes. The selection process included one health facility from each district, focusing on those with the highest number of pregnant women in maternity waiting homes. A total of 17 participants were involved in in-depth interviews, and 2 focus group discussions were conducted with 27 pregnant women, continuing until data saturation was achieved. Field notes were taken, and sessions were voice recorded. Participants in both in-depth interviews and focus group discussions frequently identified several causes of food insecurity in the community, such as food shortages, climate change, rising prices of agricultural products, inadequate agricultural technology, scarcity of farmland, and income constraints. Tailored intervention is highly demanding to implement policies to stabilise food supply chains and mitigate food shortages in both agrarian and pastoralist areas, invest in modern agricultural technologies to boost productivity, encourage the adoption of climate-smart agricultural practices to help farmers adapt to changing weather patterns, optimise the productive use of available farmland, promote income-generating activities, and diversify livelihoods to alleviate income constraints and improve food security.

This proof-of-concept study evaluated an optimization strategy for the Community Case Detection Tool (CCDT) aimed at improving community-level mental health detection and help-seeking among children aged 6–18 years. The optimization strategy, CCDT+, combined data-driven supervision with motivational interviewing techniques and behavioural nudges for community gatekeepers using the CCDT. This mixed-methods study was conducted from January to May 2023 in Palorinya refugee settlement in Uganda. We evaluated (1) the added value of the CCDT+ in improving the accuracy of detection and mental health service utilization compared to standard CCDT, and (2) implementation outcomes of the CCDT+. Of the 1026 children detected, 801 (78%) sought help, with 656 needing mental health care (PPV = 0.82; 95% CI: 0.79, 0.84). The CCDT+ significantly increased detection accuracy, with 2.34 times higher odds compared to standard CCDT (95% CI: 1.41, 3.83). Additionally, areas using the CCDT+ had a 2.05-fold increase in mental health service utilization (95% CI: 1.09, 3.83). The CCDT+ shows promise as an embedded quality-optimization process for the detection of mental health problems among children and enhance help-seeking, potentially leading to more efficient use of mental health care resources.

Systematic review and meta-analysis were conducted to provide comprehensive information on the prevalence of amphistome infections in domestic ruminants in sub-Saharan Africa. A systematic search of peer-reviewed articles published between 2002 and 2023 was conducted. Prevalence estimates and meta-analysis were based on 76 peer-reviewed articles which met the inclusion criteria. Of the 55,122 domestic ruminants screened, 12,858 were infected, and the overall pooled prevalence was 22% (95% confidence interval [CI], 10-37). The highest prevalence was recorded in southern Africa 25% (95% CI, 0-62), and central Africa 16% (95% CI, 0-61) the lowest. Cattle were the most frequently sampled hosts (76.56%, n = 42,202) and sheep (8.78%, n = 4838) the lowest, and cattle recorded the highest pooled prevalence of 28% (95% CI, 12-47), and goats the lowest at 5% (95% CI, 0-14). Prevalence rate was the high in males 32% (95% CI, 21-44), adult ruminants 37% (95% CI, 15-62) and animals with poor body condition 47% (95% CI, 34-60), and during the wet season 36% (95% CI, 0-94). The highest pooled prevalence was recorded at postmortem 23% (95% CI, 8-43) compared to coprology 20% (95% CI, 6-39) studies. The meta-regression model demonstrated that the body condition score, host, and period, and the interactions of different factors significantly influenced the prevalence. The lowest prevalence rate was noted for the period between 2013 and 2023. This is the first systematic review and meta-analysis in sub-Saharan Africa that provides a comprehensive review of the prevalence of amphistome infections in domestic ruminants in the past 20 years.

Youth in sub-Saharan Africa (SSA) face limited access to professional mental health resources. A comprehensive assessment of the prevalence of mental disorders would build an understanding of the scope of the need.

We conducted systematic searches in PsycInfo, Pubmed, AfriBib and Africa Journals Online to identify prevalence rates for five disorders (anxiety, depression, conduct disorder, attention problems and post-traumatic stress) among SSA youth with a mean age of less than 19 years. We calculated a random-effects pooled prevalence for each disorder and assessed possible moderators.

The meta-analysis included 63 studies with 55,071 participants. We found the following pooled prevalence rates: 12.53% post-traumatic stress disorder (PTSD), 15.27% depression, 6.55% attention-deficit hyperactivity disorder, 11.78% anxiety and 9.76% conduct disorder. We found high heterogeneity across the studies, which may have resulted from differences in samples or measurement tools. Reported prevalence rates were not explained by the sample (i.e., special or general population), but whether the psychometric tool was validated for SSA youth affected the reported prevalence of PTSD and anxiety. In a meta-regression, prevalence rates were associated with the disorder type, with a higher prevalence of depression and PTSD. We found the mean age significantly moderated the prevalence in univariate meta-regression, with increased age correlated with greater prevalence.

Our findings suggest there is a need to explore reasons for varying prevalence rates further and to develop interventions that support youth mental health in SSA, particularly interventions for depression and PTSD. Limitations included a lack of standardization in psychometric tools and limited reporting on research methods, which influenced quality rating. Importantly, the search only considered studies published in English and was conducted 2 years ago. Although recent estimates reported slightly higher than our prevalence estimates, these reviews together highlight the prevalence and importance of youth mental health difficulties in SSA.

Although most people in sub-Saharan Africa are very religious, state support for religion (such as through policies legislating religious values and supporting religious institutions) is very low in the region. Why is this? This paper explores this phenomenon using data from Pew Research Centre and Religion and State Project. While population religiosity is ordinarily correlated with state support for religion elsewhere in the world, sub-Saharan Africa is indeed anomalous. Yet contrary to popular explanations, this is not explained by limited state capacity, weak democracies, religious and ethnic pluralism, or majority religion. Using case studies of Rwanda and Mozambique, the paper considers whether challenges to the moral authority of religious actors as leaders of “the nation” may help explain why state support for religion is so low in sub-Saharan Africa. Taken together, these findings challenge assumptions that high religiosity in sub-Saharan Africa is a threat to secular governance.

This review summarises studies on distribution, diversity, and prevalence of gastrointestinal helminth infections in wild ruminants in sub-Saharan Africa. The results showed that 109 gastrointestinal tract (GIT) helminth species or species complexes were recorded in 10 sub-Saharan African countries. South Africa reported the highest number of species because most studies were carried out in this country. Eighty-eight nematode species or species complexes were recorded from 30 wild ruminant species across eight countries. The genus Trichostrongylus recorded the highest number of species and utilised the highest number of wild ruminant species, and along with Haemonchus spp., was the most widely distributed geographically. Fifteen trematode species or species complexes were reported from seven countries. The genus Paramphistomum recorded the highest number of species, and Calicophoron calicophoron was the most commonly occurring species in sub-Saharan African countries and infected the highest number of hosts. Six cestode species or species complexes from one family were documented from 14 wild hosts in seven countries. Moniezia spp. were the most commonly distributed in terms of host range and geographically. Impala were infected by the highest number of nematodes, whilst Nyala were infected by the highest number of trematode species. Greater kudu and Impala harbored the largest number of cestodes. The prevalence amongst the three GIT helminths taxa ranged between 1.4% and 100% for nematodes, 0.8% and 100% for trematodes, and 1.4% and 50% for cestodes. There is still limited information on the distribution and diversity of GIT helminths in wild ruminants in most sub-Saharan African countries.

Aphidius colemani is an important biological control agent, used in greenhouses and open fields against aphid pests. Despite this economical importance, A. colemani, along with A. transcaspicus and A. platensis, has gone through a complex taxonomical history. The three species have only recently gained status as separate species again, comprising the morphologically defined Aphidius colemani species group. Other than sporadic records probably as a consequence of escape from greenhouses, the A. colemani species group members prefer warmer regions and there are numerous records from South America, Southern Europe and Asia. Based on slide-mounted material collected in the period 1964–2001 in Africa, we describe five new species belonging to this group, and report A. colemani, A. transcaspicus and A. platensis from several African countries. This data opens questions about the origin of the group and presents potential for the diversification of biological control agents against aphid pests.