Category: The Conversation – Canada

Source: – By Jan Pospisil, Associate Professor at the Centre for Peace and Security, Coventry University

The civil war in Sudan between the Sudanese army and paramilitary Rapid Support Forces, which began in April 2023, has had an impact on its neighbours. One of the most keenly affected countries is South Sudan, which became an independent state in 2011 and went on to endure its own civil war. This ended in 2018 with a tenuous peace agreement.

The impact of the Sudanese war on South Sudan, however, isn’t a straightforward spillover catastrophe. The picture is more nuanced, and this is most clearly seen in South Sudan’s oil economy. Jan Pospisil, who has studied the dynamics in Sudan and South Sudan, explains.

What is the current status of oil exports from South Sudan through Sudan?

Landlocked South Sudan is reliant on its neighbour to the north to transport oil from its fields to the international market. Crude oil is transported via pipeline to Port Sudan on the Red Sea.

However, recent drone strikes on Port Sudan carried out by the Rapid Support Forces targeted power plants that supply electricity to pumping stations along Sudan’s critical oil pipelines.

Soon after, the Sudanese army formally notified South Sudan that it would have to halt exports. Following hectic negotiations, the South Sudanese government released a statement that the stoppage could be prevented.

This back and forth has reopened the pressing question of the impact of Sudan’s war on South Sudan’s economy and, in particular, the role of crude oil.

Assessments of the impact of Sudan’s war on South Sudan suggest the worst: oil revenues would account for 80% of South Sudan’s budget and 90% of its fiscal revenue.

This informs the International Monetary Fund’s warnings of looming economic collapse in case of a breakdown of oil exports. The predominant view is that a shutdown of the oil pipeline through Sudan would lead to a collapse of dollar inflows to South Sudan, triggering a severe economic crisis.

However, South Sudan’s 2024-25 budget suggests a high reliance on non-oil revenue.

In fact, government oil revenues for 2024-25 are based on a volume of only around 16,000 barrels per day. This is the share of total production of about 130,000 barrels per day controlled by South Sudan. Attempts to increase production to pre-war levels of up to 400,000 barrels failed. The substantial drop in production is explained by a decline in the quality of South Sudan’s oil wells, especially in Paloch in the north-east’s Upper Nile State, and Unity State in the north-central region.

South Sudan additionally lacks the operational capacity to extract the oil it has in the ground.

The 2024-25 budget projects a hefty fiscal deficit. The revenues projected will cover only about half of total planned state spending. Oil and non-oil revenues – which mainly include tax income from international NGOs and businesses – each account for about half of the revenue that’s expected to come in.

Oil income has to account for debt (capital and interest) repayments on loans, as well as pipeline transport fees paid to Sudan. This means that even the optimistically assessed net contributions of oil revenue would only pay for 16% of planned government spending. South Sudan remains with a hefty deficit.

What are the challenges South Sudan is facing in growing oil revenues?

First, Petronas, a Malaysian multinational oil and gas company, withdrew from South Sudan in August 2024 after three decades.

It left behind substantial challenges, including an arbitration process worth more US$1 billion. This followed the government preventing Petronas from selling its shares to the British-Nigerian group Savannah Energy.

As a short-term solution, South Sudan de facto nationalised Petronas’ shares. It did this by transferring the shares to the state’s oil and gas company, Nile Petroleum Corporation (NilePet). This was perhaps in the hope of increasing revenue in the short term.

However, NilePet hasn’t been able to replace Petronas’ production logistics. This has resulted in huge challenges in restoring production to levels before the 2024 pipeline disruptions.

A second factor is the sale of oil forward. The then finance minister said in 2022 that most of the oil production had been sold in advance until 2027. He later retracted the statement, saying instead that some oil advances were merely “spread up to 2027”. While this walk-back attempted to soften the political fallout, it reinforced wider uncertainty about how much control NilePet actually retains over the revenues formally under its authority.

Given the limited relevance of oil revenues for the official South Sudanese budget, why the major concern about disruptions?

There are three reasons.

First, NilePet plays a structural role in South Sudan’s informal and often dubious hard currency circulation, which international observers would call large-scale corruption. NilePet’s accounts rarely appear in any official financial accounts and are often channelled off-budget. NilePet functions as a black box within the public finance system where real money flows can only rarely be traced. Recent intentions by the president to structurally reform the company might implicitly confirm this.

Second, there are indirect oil revenues that are important to the country’s security apparatus. This includes protection rents which come from protecting South Sudanese oil fields. This revenue never hits the budget. It pays the National Security Service either directly as salaries, or is reinvested in the considerable conglomerate of companies owned by the security service to multiply profits. Losing this revenue could destabilise the country because the funds are used to pay the salaries of the best-trained and best-equipped security service in the country.

Third, South Sudan’s ability to attract new loans depends on the repayment of existing ones. These repayments largely depend on oil production. As the 2024-24 budget shows, South Sudan desperately needs new loans to keep even core state functions operational. Yet, funding from multilateral agencies has dwindled to small-scale loans from the African Development Bank. The International Monetary Fund has currently ended all its funding programmes.

This is not a result of the war in Sudan. It is due to persistent concerns over insufficient financial governance in South Sudan and the state’s performance. Negotiations with Qatar and the United Arab Emirates for new loans appear to have stalled, not least because of a default in repayments to Qatar.

These factors show that the flow of oil to Port Sudan is significant to the availability of hard currency in South Sudan’s economy. But this is in more indirect ways than the outdated claim of an 80% budgetary dependency would suggest.

The war in Sudan has a significant yet multifaceted impact on South Sudan’s economic health. But Juba’s biggest challenges are internal.

South Sudan’s economy over the last six years has been mainly dependent on international loans coming in – a flow which has now dried up, resulting in a severe economic crisis unprecedented in the young country’s history.

Jan Pospisil receives funding from the Peace and Conflict Resolution Evidence Platform (PeaceRep), funded by UK International Development from the UK government. However, the views expressed are those of the authors and do not necessarily reflect the UK government’s official policies. Any use of this work should acknowledge the authors and the Peace and Conflict Resolution Evidence Platform.

– ref. Is Sudan’s war the reason for South Sudan’s economic crisis? What’s really going on with oil revenue – https://theconversation.com/is-sudans-war-the-reason-for-south-sudans-economic-crisis-whats-really-going-on-with-oil-revenue-257375

Source: – By Francisca Mutapi, Professor in Global Health Infection and Immunity. and co-Director of the Global Health Academy, University of Edinburgh

The increasing trend of reducing foreign aid to Africa is forcing the continent to reassess its approach to healthcare delivery.

African countries face a major challenge of dealing with high rates of communicable diseases, such as malaria and HIV/Aids, and rising levels of non-communicable diseases. But the continent’s health systems don’t have the resources to provide accessible and affordable healthcare to address these challenges.

Historically, aid has played a critical role in supporting African health systems. It has funded key areas, including medical research, treatment programmes, healthcare infrastructure and workforce salaries. In 2021, half of sub-Saharan Africa’s countries relied on external financing for more than one-third of their health expenditures.

As aid dwindles, a stark reality emerges: many African governments are unable to achieve universal health coverage or address rising healthcare costs.

The reduction in aid restricts healthcare services and threatens to reverse decades of health progress on the continent. A fundamental shift in healthcare strategy is necessary to address this crisis.

The well-known maxim that “prevention is better than cure” holds not just for health outcomes but also for economic efficiency. It’s much more affordable to prevent diseases than it is to treat them.

As an infectious diseases specialist, I have seen how preventable diseases can put a financial burden on health systems and households.

For instance, each year, there are global economic losses of over US$33 billion due to neglected tropical diseases. Many conditions, such as lymphatic filariasis, often require lifelong care. This places a heavy burden on families and stretches national healthcare systems to their limits.

African nations can cut healthcare costs through disease prevention. This often requires fewer specialist health workers and less expensive interventions.

To navigate financial constraints, African nations must rethink and redesign their healthcare systems.

Three key areas where cost-effective, preventive strategies can work are: improving water, sanitation, and hygiene; expanding vaccination programmes; and making non-communicable disease prevention part of community health services.

A shift in healthcare delivery

Improving water, sanitation, and hygiene infrastructure

Many diseases prevalent in Africa are transmitted through contact with contaminated water and soil. Investing in safe water, sanitation, and hygiene (WASH) infrastructure is an opportunity. This alone can prevent a host of illnesses such as parasitic worms and diarrhoeal diseases. It can also improve infection control and strengthen epidemic and pandemic disease control.

Currently, WASH coverage in Africa remains inadequate. Millions are vulnerable to preventable illnesses. According to the World Health Organization (WHO), in 2020 alone, about 510,000 deaths in Africa could have been prevented with improved water and sanitation. Of these, 377,000 deaths were caused by diarrhoeal diseases.

Unsafe WASH conditions also contribute to secondary health issues, such as under-nutrition and parasitic infections. Around 14% of acute respiratory infections and 10% of the undernutrition disease burden – such as stunting – are linked to unsafe WASH conditions.

By investing in functional WASH infrastructure, African governments can significantly reduce the incidence of these diseases. This will lead to lower healthcare costs and improved public health outcomes.

Local production of relevant vaccines

Vaccination is one of the most cost-effective health interventions available for preventing infection. Immunisation efforts save over four million lives every year across the continent.

There is an urgent need for vaccines against diseases prevalent in Africa whose current control is heavily reliant on aid. Neglected tropical diseases are among them.

Vaccines can also prevent some non-communicable diseases. A prime example is the human papillomavirus (HPV) vaccine, which can prevent up to 85% of cervical cancer cases in Africa.

HPV vaccination is also more cost-effective than treating cervical cancer. In some African countries, the cost per vaccine dose averages just under US$20. Treatment costs can reach up to US$2,500 per patient, as seen in Tanzania.

It is vital to invest in a comprehensive vaccine ecosystem. This includes strengthening local research and building innovation hubs. Regulatory bodies across the continent must also be harmonised and markets created to attract vaccine investment.

Integrating disease prevention into community healthcare services

Historically, African healthcare systems were designed to address communicable diseases, such as tuberculosis and HIV. This left them ill-equipped to handle the rising burden of non-communicable diseases, such as type 2 diabetes and cardiovascular diseases. One cost-effective approach is to integrate the prevention and management of these diseases into existing community health programmes.

Community health workers currently provide low-cost interventions for health issues such as pneumonia and malaria. They can be trained to address non-communicable diseases as well.

In some countries, community health workers are already filling the service gap. Getting them more involved in prevention strategies will strengthen primary healthcare services in Africa. This investment will ultimately reduce the long-term financial burden of treating chronic diseases.

A treatment-over-prevention approach will not be affordable

Current estimates suggest that by 2030, an additional US$371 billion per year – roughly US$58 per person – will be required to provide basic primary healthcare services across Africa.

Adding to the challenge is the rising global cost of healthcare, projected to increase by 10.4% this year alone. This marks the third consecutive year of escalating costs. For Africa, costs also come from population growth and the rising burden of non-communicable diseases.

By shifting focus from treatment to prevention, African nations can make healthcare accessible, equitable and financially sustainable despite the decline in foreign aid.

Francisca Mutapi is affiliated with Uniting to Combat NTDs

– ref. Africa’s healthcare funding crisis: 3 strategies to manage deadly diseases – https://theconversation.com/africas-healthcare-funding-crisis-3-strategies-to-manage-deadly-diseases-253644

Source: – By Florence Malongane, Senior lecturer, University of South Africa

Fermentation is a process where microorganisms like bacteria and yeast work together to break down complex carbohydrates and protein into simpler, more digestible forms.

The fermentation process not only extends the shelf life of food but also enhances its nutritional content. During fermentation, beneficial microorganisms produce essential vitamins and minerals.

Fermented foods have many benefits and have been shown to reduce inflammation and infections.

As nutrition researchers we undertook an in-depth assessment of fermented African foods and their potential to improve human health cost-effectively.

By gaining a deeper understanding of the diverse microbiomes present in various fermented indigenous African foods, we aim to enhance human health through targeted dietary interventions.

Going back in history

Fermentation as a preservation method can be traced back a long way.

In the Middle East, between 1,000 and 15,000 years ago, people moved from foraging and hunting to organised food cultivation and production.

Evidence of the alcoholic fermentation of barley into beer and grapes into wine dates back to between 2000 and 4000 BC.

In the Middle East and the Indian subcontinent milk was fermented to create yoghurt and other sweet and savoury fermented milks. White cabbage pickles and fermented olives are very popular in the Middle East.

In India and the Philippines, rice flour was fermented to produce products like noodles.

Africa’s traditions

In Africa, fermented foods hold great cultural significance and health benefits, yet this topic has not been thoroughly researched.

Foods are mostly fermented at home and trends vary by region.

The primary ingredients in African fermented foods are mainly cereals, tubers and milk.

Most of the fermented foods are plants that grow on their own in the wild and are often considered weeds in cropped and cultivated land. These include amaranths, Bidens pilosa, cleome and Corchorus species. The increased availability of African indigenous foods could expand the range of commercially available fermented African foods.

While some products like marula beer have entered the commercial market, the overall consumption of fermented foods among Africans has declined.

This drop is largely due to the widespread availability of refrigeration systems and a growing loss of interest in traditional African foods.

Improving health in Africa

Fermented root plants such as cassava and yam have been shown to decrease creatinine levels, which may indicate enhanced renal function and kidney health. This suggests that the fermentation process not only enriches these root plants with probiotics, but also promotes better physiological responses in the body.

Among the diverse array of fruits native to Africa, baobab and marula are the most popular fermented fruits. Fermenting them enhances their protein and fibre content. Consuming fermented baobab fruits has been shown to reduce the activity of α-amylase, an enzyme that may have implications for regulating blood sugar.

Millet, maize, African rice and sorghum are the most fermented grains in Africa. When these foods are fermented, they can help reduce blood glucose levels, serum triglycerides and cholesterol.

Amahewu is a traditional beverage produced through the fermentation of sorghum or maize, mostly enjoyed in South Africa and Zimbabwe for its tangy flavour and smooth texture.

In Kenya, a similar fermented cereal beverage known as uji is made of millet and flavoured with milk, adding to its rich and nutritious profile.

Ghana boasts its own version called akasa, which is prepared from a combination of sorghum, corn and millet and known for its unique taste and cultural significance.

In Sudan, the beverage referred to as abreh varies in preparation but shares the same essence of fermentation, while in Nigeria, ogi is another fermented cereal paste, from similar small grains like sorghum and millet, which produce a creamy beverage.

Fermenting sorghum and millet provides essential nutrients and supports metabolic health and gut function.

In Nigeria, fermented cereal beverages are widely used to control diarrhoea in young children.

Sour milk is the most fermented food in Africa, celebrated for its rich flavour and numerous health benefits.

During the fermentation process, bacteria convert the milk sugar, called lactose, into lactic acid.

Kulenaoto, a traditional fermented milk drink enjoyed in Kenya, is known for its creamy texture and slightly tangy flavour. South Africa produces sour milk known as amasi. Nigeria and Togo share a common fermented dairy product known as wara, which is made from fermented soybeans and is often served as a snack.

In Ghana, nyamie is a rich, thick yogurt-like product. In Cameroon, pendidam is a unique fermented milk product that is cherished for its distinctive taste and nutritional benefits, making it a staple in many households.

Regular consumption of fermented sour milk can play a significant role in weight management, decreasing visceral (gut) fat, which is a risk factor for cardiovascular diseases.

Moreover, fermented milk offers valuable protection against folate deficiency.

Looking forward

African fermented foods could be the easiest and least expensive way of introducing beneficial microbes to the gastrointestinal tract, replacing expensive pharmaceutical probiotics.

These processes should be encouraged, and younger generations need to be exposed to the benefits of these traditions.

Vanishing plants could be preserved and distributed through seed banks.

The tradition of fermentation should be encouraged at both household and commercial levels to promote overall health.

The authors do not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.

– ref. Africa’s traditional fermented foods – and why we should keep consuming them – https://theconversation.com/africas-traditional-fermented-foods-and-why-we-should-keep-consuming-them-243287

Source: – By Taneshka Kruger, UP ISMC: Project Manager and Coordinator, University of Pretoria

Healthcare in Africa faces a perfect storm: high rates of infectious diseases like malaria and HIV, a rise in non-communicable diseases, and dwindling foreign aid.

In 2021, nearly half of the sub-Saharan African countries relied on external financing for more than a third of their health expenditure. But donor fatigue and competing global priorities, such as climate change and geopolitical instability, have placed malaria control programmes under immense pressure. These funding gaps now threaten hard-won progress and ultimately malaria eradication.

The continent’s healthcare funding crisis isn’t new. But its consequences are becoming more severe. As financial contributions shrink, Africa’s ability to respond to deadly diseases like malaria is being tested like never before.

Malaria remains one of the world’s most pressing public health threats. According to the World Health Organization there were an estimated 263 million malaria cases and 597,000 deaths globally in 2023 – an increase of 11 million cases from the previous year.

The WHO African region bore the brunt, with 94% of cases and 95% of deaths. It is now estimated that a child under the age of five dies roughly every 90 seconds due to malaria.

Yet, malaria control efforts since 2000 have averted over 2 billion cases and saved nearly 13 million lives globally. Breakthroughs in diagnostics, treatment and prevention have been critical to this progress. They include insecticide-treated nets, rapid diagnostic tests, artemisinin-based combination therapies (drug combinations to prevent resistance) and malaria vaccines.

Since 2017, the progress has been flat. If the funding gap widens, the risk is not just stagnation; it’s backsliding. Several emerging threats such as climate change and funding shortfalls could undo the gains of the early 2000s to mid-2010s.

New challenges

Resistance to drugs and insecticides, and strains of the malaria parasite Plasmodium falciparum that standard
diagnostics can’t detect, have emerged as challenges. There have also been changes in mosquito behaviour, with vectors increasingly biting outdoors, making bed nets less effective.

Climate change is shifting malaria transmission patterns. And the invasive Asian mosquito species Anopheles stephensi is spreading across Africa, particularly in urban areas.

Add to this the persistent issue of cross-border transmission, and growing funding shortfalls and aid cuts, and it’s clear that the fight against malaria is at a critical point.

As the world observes World Malaria Day 2025 under the theme “Malaria ends with us: reinvest, reimagine, reignite”, the call to action is urgent. Africa must lead the charge against malaria through renewed investment, bold innovation, and revitalised political will.

Reinvest: Prevention is the most cost-effective intervention

We – researchers, policymakers, health workers and communities – need to think smarter about funding. The economic logic of prevention is simple. It’s far cheaper to prevent malaria than to treat it. The total cost of procuring and delivering long-lasting insecticidal nets typically ranges between US$4 and US$7 each and the nets protect families for years. In contrast, treating a single case of severe malaria may cost hundreds of dollars and involve hospitalisation.

In high-burden countries, malaria can consume up to 40% of public health spending.

In Tanzania, for instance, malaria contributes to 30% of the country’s total disease burden. The broader economic toll – lost productivity, work and school absenteeism, and healthcare costs – is staggering. Prevention through long-lasting insecticidal nets, chemoprevention and health education isn’t only humane; it’s fiscally responsible.

Reimagine: New tools, local solutions

We cannot fight tomorrow’s malaria with yesterday’s tools. Resistance, climate-driven shifts in transmission, and urbanisation are changing malaria’s patterns.

This is why re-imagining our approach is urgent.

African countries must scale up innovations like the RTS,S/AS01 vaccine and next-generation mosquito nets. But more importantly, they must build their own capacity to develop, test and produce these tools.

This requires investing in research and development, regional regulatory harmonisation, and local manufacturing.

There is also a need to build leadership capacity within malaria control programmes to manage this adaptive disease with agility and evidence-based decision-making.

Reignite: Community and collaboration matters

Reigniting the malaria fight means shifting power to those on the frontlines. Community health workers remain one of Africa’s greatest untapped resources. Already delivering malaria testing, treatment and health education in remote areas, they can also be trained to manage other health challenges.

Integrating malaria prevention into broader community health services makes sense. It builds resilience, reduces duplication, and ensures continuity even when external funding fluctuates.

Every malaria intervention delivered by a trusted, local health worker is a step towards community ownership of health.

Strengthened collaboration between partners, governments, cross-border nations, and local communities is also needed.

The cost of inaction is unaffordable

Africa’s malaria challenge is part of a deeper health systems crisis. By 2030, the continent will require an additional US$371 billion annually to deliver basic primary healthcare – about US$58 per person.

For malaria in 2023 alone, US$8.3 billion was required to meet global control and elimination targets, yet only US$4 billion was mobilised. This gap has grown consistently, increasing from US$2.6 billion in 2019 to US$4.3 billion in 2023.

The shortfall has led to major gaps in the coverage of essential malaria interventions.

The solution does not lie in simply spending more, but in spending smarter by focusing on prevention, building local innovation, and strengthening primary healthcare systems.

The responsibility is collective. African governments must invest boldly and reform policies to prioritise prevention.

Global partners must support without dominating. And communities must be empowered to take ownership of their health.

The authors do not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.

– ref. Beating malaria: what can be done with shrinking funds and rising threats – https://theconversation.com/beating-malaria-what-can-be-done-with-shrinking-funds-and-rising-threats-255126

Source: – By Shüné Oliver, Medical scientist, National Institute for Communicable Diseases

Sub-Saharan Africa continues to bear the brunt of malaria cases in the world. In this region 11 countries account for two-thirds of the global burden.

World Malaria Day is marked on 25 April. What progress has been made against the disease, where are the gaps and what’s being done to plug them?

As scientists who research malaria in Africa, we believe that the continent can defeat the disease. New, effective tools have been added to the malaria toolbox.

Researchers and malaria programmes, however, must strengthen collaborations. This will ensure the limited resources are used in ways that make the most impact.

The numbers

Some progress has been made, but in some cases there have been reverses.

• Between 2000 and 2015 there was an 18% reduction in new cases from 262 million in 2000 to 214 million in 2015. Since then, progress has stalled.

• The World Health Organization estimates that approximately 2.2 billion cases have been prevented between 2000 and 2023. Additionally, 12.7 million deaths have been avoided. In 2025, 45 countries are certified as malaria free. Only nine of those countries are in Africa. These include Egypt, Seychelles and Lesotho.

• The global target set by the WHO was to reduce new cases by 75% compared to cases in 2015. Africa should have reported approximately 47,000 cases in 2023. Instead there were 246 million.

• Almost every African country with ongoing malaria transmission experienced an increase in malaria cases in 2023. Exceptions to this were Rwanda and Liberia.

So why is progress stagnating and in many cases reversing?

The setbacks

Effective malaria control is extremely challenging. Malaria parasite and mosquito populations evolve rapidly. This makes them difficult to control.

Africa is home to malaria mosquitoes that prefer biting humans to other animals. These mosquitoes have also adapted to avoid insecticide-treated surfaces.

It has been shown in South Africa that mosquitoes may feed on people inside their homes, but will avoid resting on the sprayed walls.

Mosquitoes have also developed mechanisms to resist the effects of insecticides. Malaria vector resistance to certain insecticides used in malaria control is widespread in endemic areas. Resistance levels vary around Africa.

Resistance to the pyrethroid class is most common. Organophosphate resistance is rare, but present in west Africa. As mosquitoes become resistant to the chemicals used for mosquito control, both the spraying of houses and insecticide treated nets become less effective. However, in regions with high malaria cases, nets still provide physical protection despite resistance.

An additional challenge is that malaria parasites continue to develop resistance to anti-malarial drugs. In 2007 the first evidence began to emerge in south-east Asia that parasites were developing resistance to artemisinins. These are key drugs in the fight against malaria.

Recently this has been shown to be happening in some African countries too. Artemisinin resistance has been confirmed in Eritrea, Rwanda, Tanzania and Uganda. Molecular markers of artemisinin resistance were recently detected in parasites from Namibia and Zambia.

Malaria parasites have also developed mutations that prevent them from being being detected by the most widely used rapid diagnostic test in Africa.

Countries in the Horn of Africa, where parasites with these mutations are common, have changed the malaria rapid diagnostic tests used to ensure early diagnosis.

The progress

Nevertheless, the fight against malaria has been strengthened by novel control strategies.

Firstly, after more than 30 years of research, two malaria vaccines – RTS,S and R21 – have finally been approved by the WHO. These are being deployed in 19 African countries.

These vaccines have reduced disease cases and deaths in the high-risk under-five-years-old age group. They have reduced cases of severe malaria by approximately 30% and deaths by 17%.

Secondly, effectiveness of long-lasting insecticide-treated nets has been improved.

New insecticides have been approved for use. Chemical components that help to manage resistance have also been included in the nets.

Thirdly, novel tools are showing promise. One option is attractive toxic sugar baits. This is because sugar is what mosquitoes naturally eat. Biocontrol by altering the native gut bacteria of mosquitoes may also prove effective.

Fourthly, reducing mosquito populations by releasing sterilised male or genetically modified mosquitoes into wild mosquito populations is also showing promise. Trials are currently happening in Burkina Faso. Genetically sterilised males have been released on a small scale. This strategy has shown promise in reducing the population.

Fifthly, two new antimalarials are expected to be available in the next year or two. Artemisinin-based combination therapies are standard treatment for malaria. An improvement to this is triple artemisinin-based combination therapy. This is a combination of this drug with an additional antimalarial. Studies in Africa and Asia have shown these triple combinations to be very effective in controlling malaria.

The second new antimalarial is the first non-artemisinin-based drug to be developed in over 20 years. Ganaplacide-lumefantrine has been shown to be effective in young children. Once available, it can to be used to treat parasites that are resistant to artemisinin. This is because it has a completely different mechanism of action.

The end game

It has been several years since the malaria control toolbox has been strengthened with novel tools and strategies that target both the vector and the parasite. This makes it an ideal time to double down in the fight against this deadly disease.

In 2020, the WHO identified 25 countries with the potential to stop malaria transmission within their borders by 2025. While none of these countries eliminated malaria, some have made significant progress. Costa Rica and Nepal reported fewer than 100 cases. Timor-Leste reported only one case in recent years.

Three southern African countries are included in this group: Botswana, Eswatini and South Africa. Unfortunately, all these countries showed increases in cases in 2023.

With the new tools, these and other countries can eliminate malaria, getting us closer to the dream of a malaria-free world.

Shüné Oliver receives funding from the National Research Foundation of South Africa and the South African Medical Research Council. She is associated with both the National Institute for Communicable Diseases and the Wits Research Institte for Malaria.

Jaishree Raman receives funding from the Gates Foundation, Global Fund, Wellcome Trust, National Research Foundation, National Institute for Communicable Diseases, South African Medical Research Council, and the Research Trust. She is affiliated with the National Institute for Communicable Diseases, the Wits Institute for Malaria Research, University of Witwatersrand, and the Institute for Sustainable Malaria Control, University of Pretoria.

– ref. Malaria scorecard: battles have been won and advances made, but the war isn’t over – https://theconversation.com/malaria-scorecard-battles-have-been-won-and-advances-made-but-the-war-isnt-over-255230

Source: – By Annettee Nakimuli, Associate Professor of Obstetrics and Gynecology, Makerere University

Pre-eclampsia is a danger to pregnant women. It’s a complication characterised by high blood pressure and organ damage, arising during the second half of pregnancy, in labour or in the first week after delivery.

It plays a major role in about 16% of the deaths of pregnant women in sub-Saharan Africa.

And it’s on the rise: between 2010 and 2018, the incidence of pre-eclampsia in Africa jumped by around 20%.

Pre-eclampsia usually occurs in young mothers during a first pregnancy. Girls under the age of 18 years are most at risk. The probability that a 15-year-old girl will die from complications of pregnancy is one in 150 in developing countries, versus one in 3,800 in developed countries, according to the World Health Organization.

Not only does pre-eclampsia pose a serious health threat to women, it also harms babies. It contributes to stillbirth, preterm birth and low birth weight.

Yet we still do not know enough about pre-eclampsia. This gap has driven my research into the disease.

I conducted the first genetic case-control study on pre-eclampsia among African women in comparison to European women over a decade ago for my PhD research.

My work revealed that both African and European populations have a gene (KIR AA genotype) that increases the chance of pre-eclampsia. However, African women are at greater risk of pre-eclampsia than other racial groups. This is because they’re more at risk of carrying a fetus with a C2-type HLA-C gene from the father. African populations have a higher frequency of this gene, which raises the likelihood of risky mother-fetus combinations.

An additional finding from my research is that genetic protection from pre-eclampsia works differently across populations – and African populations carry unique protective genes. However, even with these additional protections, African women are at greater risk of developing severe pre-eclampsia due to the other challenges, like access to healthcare and socio-economic constraints.

There’s inequality in the treatment of the condition too. In my experience, wealthier and better-educated African women often receive the necessary diagnosis and treatment. Poorer and less-educated African women too often do not.

Pre-eclampsia research, especially in Africa, requires a lot more funding, as does broader research related to the maternal health of African women.

Pre-eclampsia in Uganda

Around 287,000 women worldwide die during pregnancy and childbirth every year. Shockingly, 70% of these are African women.

Most of these deaths are preventable. For example, around 10% are the result of high blood pressure-related conditions during pregnancy.

Uganda’s Ministry of Health recorded in 2023 that out of 1,276 maternal deaths reported, 16% were associated with high blood pressure.

Hospitals are being overwhelmed by patients with the illness. For example, Kawempe National Referral Hospital in Kampala receives around 150 patients with the condition every month. It has set up a special ward to treat them.

The maternal mortality rate (death due to complications from pregnancy or childbirth) in Uganda is 284 per 100,000 live births. In Australia it is 2.94. The neonatal mortality rate (death during the first 28 completed days of life) is 19 per 1,000 live births in Uganda against 2.37 in Australia. Infant mortality (death before a child turns one) is 31 per 1,000 live births in Uganda versus 3.7 in Australia, according to the WHO’s Global Health Observatory.

This stark contrast highlights an enormous gap in care that the two countries’ pregnant mothers and babies receive.

Part of the problem in Uganda, as in many developing countries, is persistent challenges in healthcare infrastructure. There are shortages of healthcare workers, medical supplies and facilities, particularly in the rural areas.

Early detection is key

As a clinician and researcher working at the centre of Uganda’s healthcare system, I witness mothers arriving at hospitals already in a critical condition, with limited options to treat the complications associated with pre-eclampsia. It is heartbreaking.

The condition is both preventable and treatable if caught early. My research focuses on identifying biological signs of the likelihood of complications during pregnancy, using data analysis informed by Artificial Intelligence.

These predictive biomarkers, as they are called, enable us to categorise patients based on their risk levels and identify those most likely to benefit from specific treatments or preventive measures.

The precise causes of pre-eclampsia are not certain, but factors beyond genetics are thought to be problems with the immune system and inadequate development of the placenta. But much of what researchers know comes from work done in high-income countries, often with a limited sample size of African women.

Consequently, the findings may not apply directly to the genetics of sub-Saharan African women. My research addresses this knowledge gap.

Building on my findings about genetic determinants, I am leading a research team at Makerere University to design interventions tailored to specific prevention and treatment strategies for African populations.

Raising pre-eclampsia awareness

Research alone is not enough. There is an urgent need to bridge the gap between research and practice.

During my fieldwork, I have witnessed first-hand how many Ugandan women are not aware of pre-eclampsia’s warning signs and miss out on vital prenatal care. These warning signs often include headache, disturbances with vision, upper pain in the right side of the abdomen and swelling of the legs.

But we can develop screening algorithms so that healthcare professionals can rapidly diagnose women at higher risk early in their pregnancy. Timely intervention, including specific treatment and plans for delivery, would reduce the risk of adverse outcomes for both mother and baby.

In my capacity as a national pre-eclampsia champion appointed by Uganda’s Ministry of Health, I am spearheading initiatives to raise awareness and improve access to maternal healthcare services.

Through community outreach programmes and educational campaigns, we want to empower all women, rich and poor, with knowledge about the condition and encourage them to seek medical assistance at an early stage.

More resources must be allocated to genetics research to realise our goals of prevention, early detection, diagnosis and treatment of pre-eclampsia and its associated complications.

This investment will drive the development of predictive technology for precise diagnosis, and enable timely intervention for at-risk mothers.

Moreover, investigating the genetic roots of pre-eclampsia could lead to novel therapies that reduce the need for costly medical procedures or prolonged care for those affected.

This would reduce the strain on already overburdened African healthcare systems.

Annettee Nakimuli receives funding from the Gates Foundation, GSK and the Royal Society.

– ref. African women at higher risk of pre-eclampsia – a dangerous pregnancy complication – https://theconversation.com/african-women-at-higher-risk-of-pre-eclampsia-a-dangerous-pregnancy-complication-249222