Akim Tafadzwa Lukwa

Background: The rapidly growing burden of non-communicable diseases (NCDs) in sub-Saharan Africa necessitates a better understanding of access gaps along the care continuum. This study assessed the prevalence and inequality in unmet need for hypertension and diabetes care in Tanzania, South Africa, and Lesotho using a care cascade framework. Methods: We conducted a cross-sectional analysis of nationally representative Demographic Health Survey (DHS) datasets from Tanzania (2022), South Africa (2016), and Lesotho (2023/24), focusing on adults aged 15 years and older. The study estimated the proportion of adults with hypertension or diabetes who had not been screened, diagnosed, treated, or achieved disease control. Inequality was assessed using Erreygers Normalized Concentration Indices (ENCI), stratified by sex and residence. Results: Hypertension prevalence was 12.6% (95% CI: 11.7–13.4) in Tanzania, 46.7% (95% CI: 45.0–48.4) in South Africa, and 15.4% (95% CI: 13.8–17.2) in Lesotho. In Lesotho, 9.1% (95% CI: 7.8–10.6) of adults had diabetes. Unmet need was substantial across all countries: 96.5% for hypertension in Tanzania, 84.2% in South Africa, 65.8% in Lesotho, and 84.2% for diabetes in Lesotho. The care cascade framework revealed critical bottle-necks at screening and treatment stages. Inequality analyses revealed strong pro-poor gradients, particularly in screening (ENCIs: Tanzania −0.19, South Africa −0.17, Lesotho hypertension −0.15, Lesotho diabetes −0.24; all p < 0.01), with poor men experiencing the most disparities. Conclusion: Substantial and inequitable gaps exist in hypertension and diabetes care. Policy strategies should prioritize community-based screening, primary care integration, and equity-focused interventions targeting poor men to improve NCD outcomes in the region.

Background: Sexual health remains an understudied dimension of wellbeing among older adults in Nigeria. This review synthesised existing evidence on sexual health among Nigerians aged 60 years and over, and identified gaps in knowledge, policy, and practice. Despite global recognition of sexual health as a lifelong concern, cultural taboos, gender norms, and health system neglect continue to marginalise older adults’ sexual wellbeing. Methods: A systematic review was conducted according to PRISMA 2020 guidelines (PROSPERO: CRD420251064655). Peer-reviewed empirical studies from PubMed, Web of Science, and Scopus were eligible if they reported on sexual activity, dysfunction, satisfaction, condom use, STI and HIV knowledge, or health service use among Nigerian adults aged ≥60 years. Using narrative synthesis and an aggregative from Synthesis Without Meta-analysis, data were abstracted using a structured form, and findings were narratively synthesised through thematic analysis to identify key themes and evidence gaps. Results: Seventeen studies (2003–2024) met inclusion criteria. Evidence reveals that older Nigerians remain sexually active but face significant barriers to sexual wellbeing. Gendered expectations privilege male sexuality while discouraging female expression. Misconceptions around HIV transmission persist despite widespread awareness, and condom use remains low. Cultural norms and provider discomfort inhibit uptake of sexual and reproductive health services, while traditional healers are often preferred for their perceived respectfulness. Older women, rural populations, and those with disabilities remain underrepresented in the literature. Conclusion: Sexual health in older Nigerians is shaped by a complex interplay of cultural norms, structural neglect, and limited policy attention. Integrating age-sensitive and gender-sensitive approaches into geriatric care and sexual and reproductive health programming is essential to meet the needs of this growing population.

Objective: To discuss the growing challenge of the double burden of malnutrition (DBM), the co-existence of undernutrition and obesity, and the associated clinical and policy complexities in low- and middle-income countries (LMIC). Design: This commentary synthesises evidence from recent multi-country and country-specific studies in sub-Saharan Africa and other LMIC. Many LMIC are typified by food insecurity, socio-economic inequalities and fragile health systems which drive DBM patterns, as well as informal community structures such as rotating savings groups which influence access to healthier diets. Results: Evidence indicates that DBM disproportionately affects disadvantaged households and complicates obesity management. Current clinical guidelines remain obesity-centric and often overlook contexts where individuals with obesity may also experience stunting or micronutrient deficiencies. Conclusions: This commentary aligns with global frameworks including WHO’s double-duty actions for nutrition, the UN Decade of Action on Nutrition (2016–2025) and the FAO-WFP food systems agenda. To achieve health equity, a coordinated approach is needed: clinical practice must improve diagnosis of co-existing undernutrition and obesity, while public policy must ensure that efforts to manage obesity are supported by food systems that provide equitable access to affordable, nutritious diets.

Background: Food insecurity is a persistent socio-economic challenge in South Africa that was sharply exacerbated by the COVID-19 pandemic. This study compares household hunger during the acute pandemic period and the early recovery phase and examines how socio-economic inequalities in food security evolved. Methods: We analyzed five waves of the National Income Dynamics Study—Coronavirus Rapid Mobile Survey (NIDS-CRAM, 2020–2021) and the National Food and Nutrition Security Survey (NFNSS, 2022). A harmonized 7-day household hunger indicator was recoded as “no household hunger” and modeled using survey-weighted logistic regression. Socio-economic-related inequality in being hunger-free was assessed using the Erreygers Concentration Index and decomposition analysis, with sensitivity checks for alternative socio-economic status (SES) specifications and model diagnostics. Results: Hunger peaked at 26.47% in Wave 1 of NIDS-CRAM and declined to 16.07% by Wave 5, before falling to 8.19% in NFNSS. Improvements were uneven; several provinces, notably the Northern Cape, Free State and North West, remained comparatively food insecure. Across all waves and NFNSS, higher SES was strongly associated with a lower risk of hunger, and living in informal or traditional dwellings and larger household size were consistently associated with a higher risk of hunger. Erreygers indices were positive in all periods, indicating pro-rich inequality in food security that intensified during the pandemic and narrowed only modestly post-pandemic, with SES the dominant contributor. Conclusion: Although household hunger declined below pandemic peaks, the recovery in food security has been unequal and remains strongly patterned by socio-economic status and place, underscoring the need for structural, equity-focused policy responses.

Background: Despite expanded antiretroviral therapy (ART) coverage in Nigeria, socioeconomic disparities continue to limit equitable access to HIV and reproductive health services, especially for women living with HIV (WLHIV). This study examines socioeconomic inequalities in ART access, modern contraceptive use, and unmet need for modern contraception. It further decomposes contributing factors and assesses marginal effects of key predictors. Methods: A cross-sectional survey was conducted among WLHIV (aged 18–49 years) at three HIV treatment centers in Ibadan, Nigeria. We used Erreygers-normalized concentration indices (ENCIs), Lorenz curves, dominance testing, Erreygers decomposition, and marginal effects regression to assess inequalities. Results: Modern contraceptive use was significantly pro-poor (ENCI = −0.09, P = 0.03), whereas unmet need was pro-rich (ENCI = 0.08, P = 0.11), and access to HIV care was pro-poor (ENCI = −0.05, P = 0.40), although both were not statistically significant. Dominance tests confirmed systematic inequality across all outcomes. Decomposition revealed education as the dominant driver; primary education explained 24.49% of the pro-poor pattern in contraceptive use, 23.30% of the pro-rich inequality in unmet need, and 10.96% of the pro-poor inequality in HIV care access. Marginal effects indicated that employed women were 15% more likely to access HIV care, contraceptive use declined by 0.5% with each additional year of age, and unmet need was 17% higher among women with comorbidities. Conclusion: Contrary to most population-level evidence in Nigeria and sub-Saharan Africa, contraceptive use was more concentrated among poorer WLHIV, possibly reflecting the success of targeted family planning interventions. Policy should consolidate pro-poor gains in contraceptive use while safeguarding method choice, tailor services across the life course, and integrate family planning with HIV and chronic care to reduce unmet need and strengthen equity.