Journal Articles

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    Is equity meaningfully incorporated into pandemic preparedness and response? A scoping review and critical analysis of Ebola andCOVID-19 outbreak responses in Uganda 2019-2023
    (Taylor and Francis Group, 2025-12-31) Redondo G; Murray L; Bromhead C; Makumbi I
    Societal inequities produce vulnerabilities that infectious disease can exploit. Current approaches to pandemic prevention, detection and response are led by the International Health Regulations IHR and the Global Health Security Agenda. However, to contain the spread of infectious diseases, localised action to address systemic inequities must be considered. The purpose of this scoping review and equity analysis is to 1) Synthesise the available information on Uganda’s Ebola Virus Disease (EVD) and COVID-19 preparedness and outbreak responses between 2019 and 2023, and 2) Critique if and how Uganda’s Ministry of Health incorporated concepts of health equity in its EVD and COVID-19 interventions, while building national capacity to identify and prevent public health emergencies. This scoping review and critical analysis was conducted following the five-stage process defined by Levac et al. After identification and screening, the scoping review was based on six preparedness and response plans, three after-action reviews, and 20 grey literature and peer-reviewed articles. The findings revealed that the EVD and COVID-19 preparedness and response plans in Uganda show the country’s commitment and readiness for early detection and response to infectious disease outbreaks. However, further examination of the plans reveals missed opportunities to address systemic inequities. The ongoing mpox outbreak, declared a PHEIC by WHO on July 23, 2022, with significant impacts in African countries including Uganda, further underscores the need for a paradigm shift in managing infectious disease outbreaks. Such a shift may be similar to that experienced by the field of disaster risk reduction, which underwent a significant transformation at the Sendai Conference in 2015 towards a more holistic and proactive approach that addresses underlying systemic issues and focuses on building resilience. The exclusive focus on biomedical strategies to manage infectious diseases fails to address the social aspects of transmission, the local perceptions of illness, and community vulnerabilities often associated with social and historical perspectives. The social determinants of health disparities should be incorporated into pandemic planning and response. This will contribute to fostering equitable health outcomes and resilience in the face of the multifaceted challenges posed by future pandemics and environmental changes.
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    Incorporating hydrology into climate suitability models changes projections of malaria transmission in Africa.
    (Springer Nature Limited, 2020-08-28) Smith MW; Willis T; Alfieri L; James WHM; Trigg MA; Yamazaki D; Hardy AJ; Bisselink B; De Roo A; Macklin MG; Thomas CJ
    Continental-scale models of malaria climate suitability typically couple well-established temperature-response models with basic estimates of vector habitat availability using rainfall as a proxy. Here we show that across continental Africa, the estimated geographic range of climatic suitability for malaria transmission is more sensitive to the precipitation threshold than the thermal response curve applied. To address this problem we use downscaled daily climate predictions from seven GCMs to run a continental-scale hydrological model for a process-based representation of mosquito breeding habitat availability. A more complex pattern of malaria suitability emerges as water is routed through drainage networks and river corridors serve as year-round transmission foci. The estimated hydro-climatically suitable area for stable malaria transmission is smaller than previous models suggest and shows only a very small increase in state-of-the-art future climate scenarios. However, bigger geographical shifts are observed than with most rainfall threshold models and the pattern of that shift is very different when using a hydrological model to estimate surface water availability for vector breeding.
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    Ectoparasite and bacterial population genetics and community structure indicate extent of bat movement across an island chain.
    (Cambridge University Press, 2024-05-24) McKee CD; Peel AJ; Hayman DTS; Suu-Ire R; Ntiamoa-Baidu Y; Cunningham AA; Wood JLN; Webb CT; Kosoy MY
    Few studies have examined the genetic population structure of vector-borne microparasites in wildlife, making it unclear how much these systems can reveal about the movement of their associated hosts. This study examined the complex host-vector-microbe interactions in a system of bats, wingless ectoparasitic bat flies (Nycteribiidae), vector-borne microparasitic bacteria (Bartonella), and bacterial endosymbionts of flies (Enterobacterales) across an island chain in the Gulf of Guinea, West Africa. Limited population structure was found in bat flies and Enterobacterales symbionts compared to that of their hosts. Significant isolation by distance was observed in the dissimilarity of Bartonella communities detected in flies from sampled populations of Eidolon helvum bats. These patterns indicate that, while genetic dispersal of bats between islands is limited, some nonreproductive movements may lead to the dispersal of ectoparasites and associated microbes. This study deepens our knowledge of the phylogeography of African fruit bats, their ectoparasites, and associated bacteria. The results presented could inform models of pathogen transmission in these bat populations and increase our theoretical understanding of community ecology in host-microbe systems.
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    Dysphagia management in community/home settings: A scoping review investigating practices in Africa.
    (Taylor & Francis Group, 2024-02-21) Jayes M; Madima V; Marshall J; Pillay M
    PURPOSE: Little is known about how people living with dysphagia in rural, socioeconomically impoverished contexts in Africa are supported and manage their disability. This scoping review sought to map and synthesise evidence relating to the management of dysphagia in adults in community/home settings in Africa as a starting point for a broader study on this topic. METHOD: A multifaceted search strategy involved searches of electronic databases and grey literature, hand searches, ancestry searches, and consultation with expert advisors. Records were screened by two blinded researchers. Characteristics of included studies were summarised, and their findings synthesised using the Framework approach. RESULT: Six studies were included, relating to services for people with dysphagia secondary to various aetiologies. No grey literature was identified that provided service delivery descriptions or practice guidance. This limited evidence suggests little professional support is available to people living with dysphagia in the community. Individuals and carers use a range of strategies, including choosing different food and drink items and modifying how food is chewed and swallowed. CONCLUSION: Further research is required to understand current practice in managing dysphagia in the community in Africa, and the needs and priorities of community members who experience dysphagia and their carers.
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    Prevalence of unmet health care need in older adults in 83 countries: measuring progressing towards universal health coverage in the context of global population ageing.
    (BioMed Central Ltd, 2023-09-15) Kowal P; Corso B; Anindya K; Andrade FCD; Giang TL; Guitierrez MTC; Pothisiri W; Quashie NT; Reina HAR; Rosenberg M; Towers A; Vicerra PMM; Minicuci N; Ng N; Byles J
    Current measures for monitoring progress towards universal health coverage (UHC) do not adequately account for populations that do not have the same level of access to quality care services and/or financial protection to cover health expenses for when care is accessed. This gap in accounting for unmet health care needs may contribute to underutilization of needed services or widening inequalities. Asking people whether or not their needs for health care have been met, as part of a household survey, is a pragmatic way of capturing this information. This analysis examined responses to self-reported questions about unmet need asked as part of 17 health, social and economic surveys conducted between 2001 and 2019, representing 83 low-, middle- and high-income countries. Noting the large variation in questions and response categories, the results point to low levels (less than 2%) of unmet need reported in adults aged 60+ years in countries like Andorra, Qatar, Republic of Korea, Slovenia, Thailand and Viet Nam to rates of over 50% in Georgia, Haiti, Morocco, Rwanda, and Zimbabwe. While unique, these estimates are likely underestimates, and do not begin to address issues of poor quality of care as a barrier or contributing to unmet need in those who were able to access care. Monitoring progress towards UHC will need to incorporate estimates of unmet need if we are to reach universality and reduce health inequalities in older populations.
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    The value of discretion in Africa: Evidence from acquired intangible assets under IFRS 3
    (World Scientific Publishing Company, 2020-06) Tunyi A; Ehalaiye D; Gyapong E; Ntim C; Chaney, PK
    This paper examines the value of managerial discretion in financial reporting by exploring the value relevance of intangible assets acquired in business combinations (AIA) before and after the 2008 International Financial Reporting Standard (IFRS) 3 amendment. The 2008 IFRS 3 amendment gave managers the discretion to recognize previously unrecognized intangibles in the target firm, hence, we posit that if managerial discretion improves the quality of financial reporting, we should observe an increase in the value relevance of AIA after the amendment. Our empirical analysis is based on a dataset of 603 mergers announced between 2004 and 2016, across seven African countries. Consistent with our main hypothesis, we find that the value relevance of AIA, predominantly acquired goodwill (AGW), increased after the amendment, suggesting that managerial discretion improves the quality of financial information. Our results further show that the value of discretion is moderated by the underlying institutional quality, with the value relevance of AIA being greater in high-quality institutional contexts. Our findings are robust to alternative measures of AIA, alternative models for testing value relevance, and various controls for endogeneity. Overall, our findings have important implications for accounting standard-setters, governments, investors, and practitioners.