Joseph Okeibunor

Background: We investigated the prevalence, temporal trends and associated factors of overweight and obesity among adults in the WHO African region. Methods: We analysed individual-level data from 54 nationally/sub-nationally representative STEPS surveys conducted between 2003 and 2022 among adults aged 18–69 years. Prevalence estimates were weighted and age-standardised. Time trends were estimated using a Bayesian spatiotemporal modelling approach. Factors associated with body mass index (BMI) categories were identified in hierarchical multinomial mixed-effects logistic regression with random effects for country and survey year, using the normo-weighted as the reference group. Results: The study population included 198 901 adults (50.3% women) with a mean age of 36.3 years. The mean BMI was 23.3±2.0 kg/m ² (24.23±1.60 in women and 22.11±1.53 in men, p for sex difference <0.001). The prevalence of overweight and obesity was 17.8% and 9.0%, respectively, higher in women (20.8% and 13.3%) than in men (14.9% and 4.6%). There was no significant time trend in mean BMI (23.25 kg/m² (95% CI 20.1 to 26.6) in 2003 and 23.43 kg/m² (95% CI 19.3 to 27.8) in 2022, p for trend=0.75). However, obesity prevalence increased from 15.39% to 16.71% (p for trend <0.001), and underweight from 12.07% to 12.76% (p for trend <0.001), whereas overweight plateaued. In multivariate analysis, sex, older age, higher education, physical inactivity and low fruit and vegetable consumption increased the odds of overweight and obesity, whereas past and current smoking showed inverse associations. Specifically, adjusted odds ratios for overweight and obesity for females versus males were 2·07 [(95% CI: 1·83– to 2·34]) and 4.92 [(95% CI: 4·13– to 5·89]); for tertiary education versus no education, they were 2·07 [(95% CI: 1·63– to 2·63]) and 3·77 [(95% CI: 2·77– to 5·11]), respectively. Conclusion: These findings support the urgent need to intensify preventive programmes to fight obesity in the WHO African region.

Introduction: Cholera is an indicator of inequity and lack of social development and it majorly affects poor and vulnerable people. Cholera outbreaks linked to seasonality continue to occur unabated in Africa, necessitating better understanding of the disease trends. This study describes the trend of cholera outbreaks in the AFRO region between January 2022 and December 2023 and examines the temporal co-occurrence with major climatic events at the period. Method: We undertook a descriptive ecological trend analysis of secondary surveillance data on cholera and overlaid outbreak trends with the timing of major climate events from 1 January 2022 to 31 December 2023 from affected countries in the AFRO region. Negative binomial regression with country fixed effects and seasonal harmonics was used to quantify the association between climate event exposure and weekly cholera incidence. Results: Cumulative cases and deaths reported in 2022 were 90 227 and 2296, with case fatality ratio (CFR) of 2.55% across nine countries. In 2023, a total of 197 132 cases and 2830 deaths (CFR 1.4%) were reported from 17 countries, with the number of affected countries nearly doubling. Population-adjusted attack rates increased from 13.5 per 100 000 in 2022 to 21.9 per 100 000 in 2023. Climatic events ranging from droughts, excessive rainfall, floods and tropical cyclones occurred at different times across the 2-year study period. Negative binomial regression showed that cyclone (incidence rate ratio (IRR) 3.88, 95% CI 2.57 to 5.85), flood (IRR 1.93, 95% CI 1.46 to 2.54) and drought exposures (IRR 3.89, 95% CI 2.93 to 5.16) were each independently associated with higher cholera incidence (all p<0.001). Conclusion: The seasonality of cholera outbreaks and climatic events continue to be a challenge for countries to deal with. Between 2022 and 2023 in the African region, extreme weather events overlapped with waves of cholera epidemics. It is important to integrate preparedness for cholera and control into contingency planning for climatic events.

Objectives: This scoping review mapped antimicrobial resistance (AMR)-related interventions in WHO African region against the five strategic objectives of the WHO Global Action Plan (GAP) on AMR and identified evidence gaps limiting progress. Design: A scoping review using the Arksey and O’Malley framework, enhanced by Levac et al and Joanna Briggs Institute methodology; reported according to the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for scoping reviews (PRISMA-ScR). Data sources: PubMed, CINAHL, Web of Science and Scopus searched on 9 December 2025, with grey literature from Google Scholar and Google (first 100 hits). Eligibility criteria: Studies of any design reporting interventions addressing GAP strategic objectives—stewardship, surveillance, infection prevention, education or economic approaches in the WHO African region. Data extraction and synthesis: Data were charted using a pilot-tested Excel tool by GAP strategic objective and evidence gaps and research considerations were synthesised thematically. Results: Forty-nine studies (2016–2025) were included, with country-specific evidence concentrated in South Africa, Ethiopia, Kenya, Ghana and Nigeria. Most evaluated antimicrobial stewardship or awareness/training interventions in tertiary hospitals, showing improvements in prescribing, knowledge and occasional cost savings but few assessed long-term effects or resistance trends. Surveillance had advanced but remained limited by weak laboratory capacity, diagnostic coverage, data quality and limited use of AMR/antimicrobial use data in practice. Evidence on infection prevention, vaccination and One Health interventions was scarce and no full economic evaluations were identified. Conclusions: AMR research in the African region clusters around antimicrobial stewardship and awareness in tertiary hospitals, leaving infection prevention, vaccination, One Health approaches and economic evaluation substantially underrepresented across the GAP framework. Closing these gaps will require longer-term implementation research, context-specific economic analyses and broader geographical coverage to generate the evidence needed to operationalise the global AMR research agenda in Africa.

The rollout of COVID-19 vaccines marked a turning point in pandemic control, yet vaccine hesitancy emerged as a significant obstacle in sub-Saharan Africa (SSA). The study aims to investigate socio-behavioural drivers of vaccine hesitancy in three high-resistance countries: the Republic of Congo, the Democratic Republic of the Congo, and the Republic of Guinea-Bissau. By employing a qualitative ethnographic design, in the period from April to October 2022, the study enrolled 752 participants in semi-structured in-depth interviews and focus group discussions, involving community leaders, women’s leaders, healthcare providers, traditional practitioners, traditional leaders, drivers, and youth leaders, ensuring diverse perspectives. Findings indicate that vaccine hesitancy is fluid and contextual with three principal drivers: (1) denial of COVID-19’s existence, often reinforced by scepticism among healthcare providers and the belief that the disease is foreign or a governmental scheme for financial gain; (2) misinformation, including rumours about vaccine incompatibility with certain foods, and fears of sterility and witchcraft; (3) a firm reliance on traditional medicine, seen as effective alternative to biomedical interventions. Vaccine hesitancy can only be addressed through culturally responsive, multisectoral approaches centred on community dialogue, improved communication, and the integration of trusted networks. Without inclusive strategies, resistance will undermine pandemic response and future health interventions in SSA.

Background: Lassa fever is among the top emerging infectious diseases whose effective control depends on behavioural insights regarding its transmission, prevention and control. The study sought to explore behavioural insights - awareness, knowledge, lived experiences and behaviours – to inform Lassa fever transmission, prevention and control efforts in Eastern Sierra Leone. Methods: This was a qualitative cross-sectional study conducted through focus group discussions (FGDs) and key informant interviews (KIIs), targeting diverse, information-rich community members. Thematic data analysis in Atlas.ti.22 involved analysis of interview transcripts to derive concepts, the classification and interpretation of these concepts to generate themes, capturing the essence of related behavioural insights. Results: Total study participants were 114 - ten FGDs and 14 KIIs. Four themes emerged: knowledge gap on Lassa fever causation and transmission pathways; syndromic overlap between Lassa fever and other diseases; Lassa fever-related cultural and traditional health dilemmas and gendered health paradox. Conclusions: Determinants of health behaviour extend beyond awareness, knowledge and understanding, to include crucial aspects like behavioural enablers and cultural factors. A context-aware approach is required wherein Lassa fever-related policies and programs prioritize the generation and utilization of context-specific behavioural data to drive effective health behaviour change.

Background: Lassa fever is among the top emerging infectious diseases whose effective control depends on behavioural insights regarding its transmission, prevention and control. The study sought to explore behavioural insights - awareness, knowledge, lived experiences and behaviours – to inform Lassa fever transmission, prevention and control efforts in Eastern Sierra Leone. Methods: This was a qualitative cross-sectional study conducted through focus group discussions (FGDs) and key informant interviews (KIIs), targeting diverse, information-rich community members. Thematic data analysis in Atlas.ti.22 involved analysis of interview transcripts to derive concepts, the classification and interpretation of these concepts to generate themes, capturing the essence of related behavioural insights. Results: Total study participants were 114 - ten FGDs and 14 KIIs. Four themes emerged: knowledge gap on Lassa fever causation and transmission pathways; syndromic overlap between Lassa fever and other diseases; Lassa fever-related cultural and traditional health dilemmas and gendered health paradox. Conclusions: Determinants of health behaviour extend beyond awareness, knowledge and understanding, to include crucial aspects like behavioural enablers and cultural factors. A context-aware approach is required wherein Lassa fever-related policies and programs prioritize the generation and utilization of context-specific behavioural data to drive effective health behaviour change.

Background: Lassa fever is one of the top emerging infectious diseases that requires contextual insights on risk factors and transmission determinants to effectively interrupt the spread. We investigated contextual risk factors and determinants of Lassa fever transmission to inform behaviour change and response efforts. Methods: This was a descriptive cross-sectional study composed of a random sample size of 1033 household head participants from 2 hotspot districts of Eastern Sierra Leone. Data was collected through structured questionnaires and analysed in SPSS® version 29 to generate relevant frequencies and associations. Results: Male gender (adjusted odds ratio, AOR = 0.69; 95% CI: 0.51–0.94; p < 0.05) and male gender roles (p < 0.05), younger age (p < 0.05), lower educational level (AOR = 2.25; 95% CI: 1.23–4.13; p < 0.05), lower wealth status (p < 0.05), traditional belief-based burial practices (AOR = 8.69, 95% CI: 5.39–14.01; p < 0.05) were associated with poor practices. Again, existence of geographic, financial, provider-related and family influence barriers were associated with poor practices (p < 0.05 respectively). Awareness of recommended public health measures for Lassa fever, knowledge of how Lassa fever is transmitted, and its signs and symptoms were associated with good practices (p < 0.05). Conclusions: To effectively combat Lassa fever, policies and programs must integrate behavioural insights, foster intersectoral collaboration, and adopt a comprehensive approach that addresses the interconnectedness of risk factors and determinants of transmission, prevention and control.

Background: Lassa fever is one of the top emerging infectious diseases that requires contextual insights on risk factors and transmission determinants to effectively interrupt the spread. We investigated contextual risk factors and determinants of Lassa fever transmission to inform behaviour change and response efforts. Methods: This was a descriptive cross-sectional study composed of a random sample size of 1033 household head participants from 2 hotspot districts of Eastern Sierra Leone. Data was collected through structured questionnaires and analysed in SPSS® version 29 to generate relevant frequencies and associations. Results: Male gender (adjusted odds ratio, AOR = 0.69; 95% CI: 0.51–0.94; p < 0.05) and male gender roles (p < 0.05), younger age (p < 0.05), lower educational level (AOR = 2.25; 95% CI: 1.23–4.13; p < 0.05), lower wealth status (p < 0.05), traditional belief-based burial practices (AOR = 8.69, 95% CI: 5.39–14.01; p < 0.05) were associated with poor practices. Again, existence of geographic, financial, provider-related and family influence barriers were associated with poor practices (p < 0.05 respectively). Awareness of recommended public health measures for Lassa fever, knowledge of how Lassa fever is transmitted, and its signs and symptoms were associated with good practices (p < 0.05). Conclusions: To effectively combat Lassa fever, policies and programs must integrate behavioural insights, foster intersectoral collaboration, and adopt a comprehensive approach that addresses the interconnectedness of risk factors and determinants of transmission, prevention and control.