Jónína Einarsdóttir

Research increasingly examines initial access to higher education (HE) in sub-Saharan Africa, yet less is known about the persistence of enrolled students in fragile contexts where costs are high and outcomes are uncertain. This study provides the first large-scale quantitative analysis of perceived HE worth in Guinea-Bissau, a resource-scarce Lusophone state. Drawing on Human Capital Investment (HCI), Behavioural Economics (BE), and Afrocentric perspectives on resilience and hope, we analysed survey data from 2255 students across six HE institutions (HEIs). A binary indicator of whether HE was worth the cost was used to assess ongoing valuation, and the data were analysed using sequential block-entry logistic regression after multiple imputation. Overall, 30.1% of students did not affirm that HE was worth the cost, indicating that enrolment does not guarantee sustained valuation. While cost-benefit reasoning remains important, perceptions were strongly shaped by campus climate and forward-looking expectations. Perceived advantages of HE, even without completion, outweighed the value of credentials alone, suggesting a pragmatic evaluation. We suggest anticipatory resilience as a lens for understanding students’ sustained valuations of HE amid uncertainty, grounded in anticipated benefits, institutional experience, and relational resources. Policy should prioritise campus climate, reduce financial strain, and reinforce the intrinsic value of HE.

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.

This article investigates the underlying causes of COVID-19 vaccine hesitancy in three sub-Saharan African countries: the Republic of Congo, the Democratic Republic of the Congo (DRC), and Guinea-Bissau. Employing a qualitative ethnographic design, the study engaged 752 participants, including healthcare professionals, community mem-bers, traditional practitioners, and various local leaders, through semi-structured inter-views and focus group discussions. Findings indicate that vaccine hesitancy is fluid and contextual with three principal drivers: (1) denial of COVID-19’s existence, often rein-forced by skepticism among healthcare workers and the belief that the disease is foreign or a governmental scheme for financial gain; (2) misinformation, including rumors about vaccine incompatibility with certain foods, and fears of sterility and witchcraft; and (3) a firm reliance on traditional medicine, seen as effective alternative to biomedical inter-ventions. The study highlights the significant role of inconsistent public health messaging and conspiracy theories in fueling resistance to vaccination. It reflects the necessity of a multisectoral approach that integrates government, health authorities, anthropologists, and other social scientists, as well as community leaders, to foster trust and improve vaccine acceptance. Enhanced education, transparent risk communication, and culturally sensitive community engagement and dialogue are recommended as critical strategies to counter misinformation and build public confidence. While the study’s multidisciplinary and multi-country scope strengthens its conclusions, it only included three countries and provided limited socio-demographic data about the participants. Ultimately, overcoming vaccine hesitancy in these settings requires addressing both historical and contemporary distrust, as well as integrating traditional health systems into public health strategies

Background: Socioeconomic determinants of health are well-documented, yet adolescents’ perspectives are often under-represented. The study aimed to engage adolescents in a low-income sub-Saharan setting to explore their daily experiences and analyse their perceptions of inequality within their local environment. Methods: A photovoice project was conducted from January to March 2024 with six adolescents aged 16–19 years in Bissau, the capital of Guinea-Bissau. Participants used disposable cameras to capture up to 15 photos each, representing daily inequalities and documented reflections through narratives using the PHOTO method, that is, writing notes about the photo, its context and potential implications for change. After 2 weeks, participants selected key images and engaged in a focus group discussion to analyse their photos. Thematic analysis was conducted using Atlas.ti. Results: Four themes of inequality emerged: education, health and sanitation, environment and economy. Adolescents highlighted inadequate access to healthcare and sanitation facilities, environmental degradation, disparities between public and private schools and economic hardship limiting access to education and work. Their narratives revealed frustration over systemic barriers, yet demonstrated awareness and creativity in navigating challenges. Conclusions: Adolescents’ visual narratives provide insights into their experiences of inequality, highlighting the value of participatory methods in amplifying youth voices. The findings suggest the need for equity-focused interventions addressing structural determinants for inequality across the four identified themes. Including adolescents in policy development is important to promote social justice and their well-being.

Decolonisation has become a global health priority, addressing inequities rooted in colonial histories that continue to shape power dynamics and knowledge systems. Nordic global health programmes bring together students and faculty from diverse backgrounds in a region defined by inclusive ideals but shaped by underexamined colonial legacies. This context offers a valuable setting to examine how decolonial perspectives are integrated or overlooked in global health education. To explore students’ perspectives on decolonisation in global health education, focusing on their understanding, experiences, and views on potential pedagogical change. A qualitative study involving 72 students from Nordic countries and other world regions, enrolled in global health programmes at 11 academic institutions across five Nordic countries. Fourteen focus group discussions were conducted, and the data were analysed using qualitative content analysis principles. Students shared nuanced understandings of systemic power imbalances in global health practice and education and expressed the need for structural changes. They identified gaps in curricula and pedagogy, including limited integration of decolonial perspectives and inequities in knowledge production. Students called for more inclusive and culturally relevant curricula that reflect diverse contexts. They emphasised student agency in shaping education while acknowledging barriers such as institutional biases and inconsistent faculty engagement. Decolonising Nordic global health education is a long-term process requiring sustained institutional commitment. Student-informed strategies include embedding reflexivity into curricula, engaging with Nordic colonial histories, and designing reciprocal international learning arrangements. While context-specific, these findings may inform broader efforts to decolonise global health educational practices. Nordic global health students perceive colonial legacies to persist in curricula, pedagogy, and institutional practices, undermining the equitable representation of diverse knowledge in their study programmes This study reveals students’ experiences with and perspectives on decolonisation in Nordic global health education and offers concrete strategies to embed diverse knowledge systems and foster equity. These insights call for structural reforms in global health education, including curriculum diversification, reciprocal partnerships, and enhanced faculty training to promote inclusive and decolonised global health practices and learning environments.

This study examines children's experiences in Iceland during the COVID‐19 pandemic through their creative expressions submitted to the Ombudsman for Children. Analysing 454 submissions, including narratives, drawings and videos from children aged 6–16, the research identified two main themes: the ‘COVID‐School’ addressing educational disruptions and peer relationships, and ‘Social responsibility’ reflecting children's engagement with health measures. Using Spray's framework of embodied, social and public child dimensions, the study reveals how children navigated pandemic restrictions while demonstrating remarkable health literacy and social consciousness. The findings emphasise children's agency and the importance of including their perspectives in public health crisis responses.

Substance use is a growing problem among young people in sub-Saharan Africa who increasingly adopt the habit of smoking cigarettes. The aim was to analyse prevalence rates and identify predictors for cigarette smoking among school-attending adolescents in Bissau, Guinea-Bissau. In June 2017, a survey questionnaire was implemented in 16 schools in a class-based, random sample of 2039 adolescents aged 14–19 (52% girls). The chi-square (p < 0.05) and odds ratios (OR) were calculated with 95% confidence intervals (CI). Potential explanatory variables for the dependent variables were introduced into a multinomial logistic regression model, and p-values were transformed to LogWorth values. The prevalence rate for lifetime smoking experience was 14.8%, 4.0% for occasional smoking (<30 days), and 2.4% for daily smoking. The most significant predictors for cigarette smoking included having friends who smoke, being a boy, attending a private school, smoking initiation at a young age, other substance use, and violent behaviour. It is imperative to initiate preventive actions against smoking and other use of tobacco in Guinea-Bissau. Considering the significant impact of the peer group, policymakers need to engage young people in developing primary prevention strategies to curb the use of tobacco and other substances.