Dr. Derbew Fikadu Berhe

Introduction: Antibiotic resistance (ABR) is a global issue that requires a One Health approach, addressing human, animal, and environmental health sectors together. The PRESAR network aims to reduce the emergence and spread of ABR in the Nile Valley, seeks to fill research gaps in ABR. This scoping review (ScR) focuses on mapping the existing literature and data on ABR in Egypt, Ethiopia, and Sudan, specifically examining the application of the One Health approach and reviewing the national action plans (NAPs) of these countries. Methods: The ScR was conducted using the PCC framework (population, concept, and context) and incorporated relevant keywords and MeSH terms in: Medline, Scopus, and Web of Knowledge. Two reviewers per sector (animal, environment/agriculture, human) screened articles, including peer-reviewed studies published in English across all years. Studies on non-bacterial or mycobacterial infections, and systematic reviews, were excluded. Data such as infection type, sample source, and observed resistance were recorded. The NAPs were compared with the WHO Global Action Plan (GAP) to assess similarities and differences. Results: The review included 492 articles from Ethiopia, 331 from Egypt, and 31 from Sudan. Preliminary findings show that multidrug-resistant (MDR) S. aureus and K. pneumoniae dominate human infections, while Staphylococcus spp. and ESBL-producing Enterobacterales are more prevalent in animal and environmental sectors. There was large variability in diagnostic methodologies used across the sectors and countries, which in turn may lead to discrepancies in identification of bacteria at the species level and thereby inaccurate epidemiological data on prevalence and burden. While NAPs are generally aligned with the GAP, variations exist in areas like process ownership, research capacity, and funding. Discussion: The review underscores the need for more research in non-human sectors and highlights the importance of One Health in tackling ABR. We strongly advocate for a unified and strategic approach among local stakeholders, scientists, and international agencies to prioritize and fund research, aiming for a sustainable reduction in antibiotic resistance.

Background: The quality of anticoagulation with warfarin is often assessed through the time in therapeutic range (TTR). However, achieving optimal TTR and maintaining therapeutic INR levels presents significant challenges in Sub-Saharan Africa. This review aims to summarize the existing evidence on the quality of warfarin anticoagulation among patients in Sub-Saharan Africa. Method: We searched MEDLINE via Ovid, PubMed, Embase via Ovid, and Scopus, and citation analysis from Google Scholar. The review’s primary focus was therapeutic INR and TTR ≥ 65. Meta-analysis was conducted using R version 4.3.3. A mixed-effects meta-regression model was used to examine the influence of moderators, with heterogeneity estimated using I2 and prediction intervals (PI), and publication bias assessed through funnel plots and Egger’s test, with p < 0.05 indicating potential bias. The robustness of pooled proportions was tested using a leave-one-out sensitivity analysis. The preparation of this review adhered to the guidelines outlined in the PRISMA. Results: We identified 15 observational studies for inclusion in this systematic review and meta-analysis. Egger’s test confirmed an absence of publication bias across these studies. Sensitivity analyses showed consistency in individual therapeutic INR (pooled estimate: 0.37; range: 0.37–0.40) and TTR (pooled estimate: 0.16; range: 0.15–0.17), closely aligning with pooled proportions. Meta-analysis of high-quality TTR measurements yielded a pooled prevalence of 17% (I2 = 89%), with study-specific values ranging from 10 to 29% and predicted effect sizes between 0.05 and 0.34. The therapeutic INR was observed at a pooled prevalence of 40% (I2 = 86%; prediction interval: 0.16, 0.67). Conclusion: Warfarin therapy is associated with very low percentage of TTR suggests poor quality of anticoagulation management. Sensitivity analyses confirmed the robustness of these findings.

Background Workforce shortages, resource limitations, and inadequate capacity in African higher education institutions are significant challenges that hinder their global competitiveness in generating knowledge products. Academic partnerships have been established to address these gaps. It is essential to evaluate these partnerships to ensure they align with principles of ethics, equity, reciprocity, and the achievement of shared goals. The University of Global Health Equity (UGHE) is an institution that employs a partnership-based model to deliver high-quality surgical education. The aim of the study was to assess its partnership based surgical education programs. Methods This study was conducted at UGHE using a sequential exploratory mixed-methods design that incorporates perspectives of learners, facility and partners. Qualitative interviews were conducted with students, faculty, and partners involved in UGHE’s surgical education programs within the last three years. Thematic analysis was employed to interpret the interview data. Quantitative data were summarized using descriptive statistics and presented in charts and tables with integration in a joint display. Results Twenty-one interviews were conducted, revealing 4 key themes from the thematic analysis: (1) A needs-based approach is used to determine the suitability of partnerships (2), UGHE and its partners worked towards equitable outcomes (3), Positive outcomes of the partnership model (4) Challenges faced in delivering surgical education using a partnership model and proposed solutions. Most participants viewed the model positively, identifying benefits such as diverse exposure, improved student experiences, faculty development, and technology transfer. However, institutional and systemic gaps that limit maximum benefits were noted. The quantitative survey had a 42% response rate with 31 responses from undergraduate and postgraduate students. All students agreed that didactic and simulation sessions led by UGHE partners enhanced their learning. A significant difference (p <.001) was found between postgraduate and undergraduate students’ responses regarding the adequacy of time for partner-facilitated sessions. Conclusions The results underscore the significant positive impact of UGHE’s institutional partnership-based model in delivering surgical education, especially in enhancing student learning and faculty capacity. However, communication gaps, lack of resources, and time prevent the partnership-based model from reaching full potential.

Introduction Community health workers (CHWs) are critical to healthcare delivery in low-resource settings but often lack formal clinical training, limiting their decisionmaking. Large language models (LLMs) could provide real-time, context-specific support to improve referrals and management plans. This study aims to evaluate the potential utility of LLMs in assisting CHW decision-making in Rwanda. Methods and analysis This is a prospective, observational study conducted in Nyabihu and Musanze districts, Rwanda. Audio recordings of CHW-patient consultations will be transcribed and analysed by an LLM to generate referral decisions, differential diagnoses and management plans. These outputs, alongside CHW decisions, will be evaluated against a clinical expert panel’s consensus. The primary outcome is the appropriateness of referral decisions. Secondary outcomes include diagnostic accuracy, management plan quality, and patient and user perceptions to ambient recording of consultations. Sample size is set at 800 consultations (400 per district), powered to detect a 15–20 percentage point improvement in referral appropriateness. Ethics and dissemination Ethical approval has been obtained from the Rwandan National Ethics Committee (RNEC) (Ref number: RNEC 853/2025) in June 2025, recruitment started in July 2025 and results are expected in late 2025. Results will be disseminated via stakeholder meetings, academic conferences and peer-reviewed publication.

Background: Research ethics committees (RECs) in Africa face challenges, including inadequate institutional support, low member engagement, and limited ethical review capacity. The COVID-19 pandemic added another layer of pressure on RECs. Aim: To delineate the activities of African RECs and pinpoint challenges encountered during the COVID-19 pandemic. Setting: The study was conducted across multiple RECs in various African countries. Methods: This cross-sectional study was conducted across multiple African countries to provide an overview of the functioning of RECs during the COVID-19 pandemic. Results: Chairs reported a substantial increase in protocol reviews, from 5860 in 2019 to a 12% (n = 744) increment in 2020. Amid the pandemic, there was a noticeable rise in research protocol amendments (79%, n = 38) and deviations. The vast majority of RECs (96%, n = 46) adhered to COVID-19 prevention institutional policies and limited face-to-face meetings. Challenges encountered in reviewing COVID-19-related proposals were linked to risk and/or benefit assessments and scientific designs. Conclusion: The study underscores the impact of the COVID-19 pandemic on REC functioning in Africa, marked by a surge in proposal volumes and the emergence of new ethical challenges. To address these challenges, there is a pressing need to nurture RECs in the region through diverse strategies, including capacity-building initiatives such as the Strategic Initiative for Developing Capacity in Ethical Review (SIDCER) recognition programme. Additionally, establishing periodic training opportunities through suitable platforms can further enhance the resilience and effectiveness of RECs. Contribution: This study contributes to understanding how RECs in African countries adapted their review processes during the COVID-19 pandemic, highlighting the need for establishing periodic training opportunities through suitable platforms. Keywords: research ethics committee; Africa; COVID-19; PABIN; SIDCER.

Background Statin-induced myopathy is reported to be associated with the solute carrier organic anion transporter family member 1B1 gene single nucleotide polymorphism, c.521 T > C. There is no epidemiologic data on this gene polymorphism in several countries. Therefore, this study aimed at assessing the genotype and allele frequencies of the gene variant in three countries. Methods This study involved healthy individuals from Colombia, Mozambique, and Portugal. Genomic DNA was isolated from blood samples using the Qiamp DNA Extraction Kit (Qiagen). The isolated DNA was genotyped using novel Polymerase Chain Reaction—Restriction Fragment Length Polymorphism. Microstat and GraphPad QuickCal software were used for the Chi-square test and the evaluation of Hardy–Weinberg equilibrium respectively. Results A total of 181 individuals’ blood samples were analyzed. Overall, the TT (74.0%) genotype was the highest and the CC (7.8%) was the lowest. Country wise genotypic frequencies were Colombia 47(70.2%) TT, 12(17.9%) TC and 8(11.9%) CC; Mozambique 47(88.7%) TT, 5(9.4%) TC, and 1(1.9%) CC; and Portugal 40(65.6%) TT, 16(26.2%) TC, and 5(8.2%) CC. The reference (T) allele was highest among Mozambicans (93.4%) compared to Colombians (79.1%) and Portuguese (78.7%). Mozambicans showed statistically significant genotypic and allelic frequency differences compared to Colombians (p < 0.01) and Portuguese (p < 0.01). Conclusions Overall and country-wise, CC genotype was less frequent and it is relatively high for Colombians and Portuguese populations. This finding may imply statins risk–benefit variability associated with CC genotype among these populations that needs further understanding.

ABSTRACTBackgroundWarfarin use in Sub‐Saharan Africa is associated with elevated risks of thromboembolic events and bleeding, but precise prevalence estimates are lacking. This systematic review and meta‐analysis aimed to quantify the prevalence of bleeding and thromboembolic events among patients on warfarin in Sub‐Saharan Africa.MethodsComprehensive searches were conducted in MEDLINE via Ovid, PubMed, Embase via Ovid, Scopus, and Google Scholar to identify relevant studies. Primary outcomes included major and minor bleeding events, while thromboembolic events were secondary outcomes. Meta‐analysis was conducted using RStudio version 4.3.3 with the meta and metaprop packages. Proportions were transformed using the Freeman–Tukey double arcsine method, and meta‐regression was performed with the metafor package's escal, rma, and res functions. Publication bias was assessed via funnel plots and Egger's test, with a p value < 0.05 indicating potential bias. Sensitivity analysis was conducted through leave‐one‐out analysis. The review was performed in adherence to PRISMA guidelines.ResultsWe identified 10 observational studies for inclusion in this systematic review and meta‐analysis. Egger's test indicated no publication bias. Meta‐regression analysis showed that moderators (publication year, sample size, setting, and follow‐up duration) did not significantly impact bleeding risk. The pooled prevalence of major and minor bleeding was 18% (95% CI: 0.10–0.27; I2: 96%, prediction interval: 0.00–0.53), with rates ranging from 4% to 46%. Thromboembolic events occurred in 7% of warfarin users (95% CI: 0.01–0.07).ConclusionWarfarin therapy in Sub‐Saharan Africa is associated with considerable bleeding and thromboembolic risks. The robustness of these findings was confirmed through meta‐regression and sensitivity analyses, underscoring the need for improved therapeutic monitoring and safety strategies in this population.