Health in Africa

Drawing on perspectives from West and Southern Africa, this Comment critically examines the current state of neuroscience progress in Africa, describing the unique landscape and ongoing challenges as embedded within wider socio-political realities. Distinct research opportunities in the African context are explored to include genetic and bio-diversity, multilingual and multicultural populations, life-course development, clinical neuroscience and neuropsychology, with applications to machine learning models, in light of complex post-colonial legacies that often impede research progress. Key determinants needed to accelerate African neuroscience are then discussed, as well as cautionary underpinnings that together create an equitable neuroscience framework.

The African continent demonstrated decisive leadership throughout its response to the COVID-19 pandemic, leveraging lessons learned from previous outbreaks and acting quickly to limit the impact of the SARS-CoV-2 virus. We propose a framework to build on these successes that calls for greater collaboration between African leaders, and greater inclusion of African voices in the global health ecosystem.

Tuberculosis is the leading cause of death from a single infectious agent, with over 25% of these occurring in the African region. Multi-drug resistant strains which do not respond to first-line antibiotics continue to emerge, putting at risk numerous public health strategies which aim to reduce incidence and mortality. Here, we speak with Professor Valerie Mizrahi, world-leading researcher and former director of the Institute of Infectious Disease and Molecular Medicine at the University of Cape Town, regarding the tuberculosis burden in South Africa. We discuss the challenges faced by researchers, the lessons that need to be learnt and current innovations to better understand the overall response required to accelerate progress.

Africa is undergoing a demographic transition¹ that has led to significant reductions in the number of individuals living in extreme poverty, and to positive shifts in related health outcomes, across its diverse populations². Building on these successes requires a consideration of intersecting factors that impact health metrics, which is the focus of the United Nations Sustainable Development Goals³. To support researchers in their efforts towards reaching these goals, Nature Communications, Communications Medicine and Scientific Reports invite submissions of papers that advance our understanding of all aspects of health in Africa.

Magnetic Resonance Imaging (MRI) is a crucial diagnostic tool within modern healthcare, yet its availability remains largely confined to high-income nations. The imperative to extend MRI accessibility to lower-income countries aligns with the pursuit of universal health coverage, a key target of the UN’s Sustainable Development Goal 3. In an interview with Nature Communications, three scientists dedicated to advancing MRI accessibility in Africa share their insights. These experts include Dr Udunna Anazodo (Assistant Professor at McGill University, Canada and Scientific Director, Medical Artificial Intelligence (MAI) Lab, Lagos, Nigeria), Dr Johnes Obungoloch (Lecturer at Mbarara University of Science and Technology, Uganda) and Dr Ugumba Kwikima (Neuroradiologist, Lugalo General Military Hospital, Tanzania). Our discussion considers the current MRI landscape across African countries and the associated challenges and opportunities. We also cover technological innovations making a difference, such as low field MRI, alongside the role of advocacy initiatives in bolstering accessibility. We finally look ahead to the future of MRI in Africa.

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.

Wollburg et al. use high frequency phone surveys in six African countries to investigate COVID-19 vaccine hesitancy, uptake, and barriers to delivery. Vaccine acceptance is high but variable across countries, with poor access to vaccines at a local level contributing to the rates of unvaccinated individuals.

Murray et al. conduct a systematic review, meta-analysis and modelling study to estimate the numbers of adverse perinatal outcomes attributable to HIV and antiretroviral therapy (ART) in sub-Saharan Africa from 1990 to 2020. They find that large numbers of adverse outcomes are attributable to HIV/ART, increasingly amongst women receiving preconception ART.

Here, authors present an approach to assess subnational healthcare quality, leveraging health facility survey data. The method jointly estimates indicators over space and time, and may provide insights to decision-makers and health service program managers.

COVID-19 has impacted health systems unequally and widespread SARS-CoV-2 testing for community surveillance has been limited globally. This work in Malawi highlights how river and wastewater can be used to detect emerging SARS-CoV-2 waves, identify variants of concern, and provide an early warning system.

Senegal has initiated a national sentinel surveillance program for malaria parasite genetics. Here, the authors report data from the first year of the program and use it to investigate local malaria incidence, patterns of transmission, and genetic loci under selection.

Pregnant people visiting antenatal clinics may represent a useful sentinel surveillance population for monitoring infections such as malaria. Here, the authors investigate the potential of this approach by comparing malaria prevalence in pregnant people and children living in the same area of southern Mozambique.

SARS-CoV-2-associated mortality estimates for sub-Saharan Africa are uncertain due to lack of comprehensive surveillance systems. Here, the authors analyse data from a detailed surveillance system in Kilifi, Kenya and find that excess mortality rates were relatively low, except for older adults.

Non-falciparum malaria may cause a significant disease burden in highly endemic regions, but epidemiological data is limited. In this study, the authors estimate the incidence and prevalence of P. malariae, P. ovale spp., in Kinshasa, Democratic Republic of Congo and compare to P. falciparum, which known to be common in the region.

SARS-CoV-2 wastewater surveillance could provide an important means of monitoring population trends as clinical testing decreases. Here, the authors demonstrate the use of wastewater to track variants of concern through a sentinel wastewater surveillance system in South Africa.

Childhood malnutrition in Africa is a glaring example of global inequality, and mortality remains high. Here, the authors report the results of the TAME randomized phase II clinical trial, in which intestinal healing was the target of four potential interventions in malnourished children in Zambia and Zimbabwe.

Mosaic chromosomal alterations (mCAs) in peripheral blood leukocytes are associated with an increased risk of malignancy. Here, the authors use genome-wide genotyping array data to investigate the prevalence of mCAs in sub-Saharan African children with versus those without Burkitt lymphoma.

Most genetic studies for prostate cancer have been performed outside the context of Sub-Saharan Africa. Here, the authors interrogate 247,780 exomic variants for 798 Black South African men and identify genes associated with aggressive disease.

Routine sampling of pregnant women at first antenatal care (ANC) visits could be used for malaria surveillance. Here, the authors compare the genetic structure of Plasmodium falciparum parasite populations between samples from first ANC users and children from the community in Mozambique, and show that it can inform about changes in transmission beyond epidemiological data.

There is limited data on immune factors contributing to SARS-CoV-2 viral clearance in people living with HIV. Here, the authors show that re-emergence of the neutralizing antibody response may be key to clearing persistent SARS-CoV-2 infection in ART-mediated recovery from immunosuppression in advanced HIV disease.