African Population and Health Research Center

Background Attrition is a challenge in parameter estimation in both longitudinal and multi-stage cross-sectional studies. Here, we examine utility of machine learning to predict attrition and identify associated factors in a two-stage population-based epilepsy prevalence study in Nairobi. Methods All individuals in the Nairobi Urban Health and Demographic Surveillance System (NUHDSS) (Korogocho and Viwandani) were screened for epilepsy in two stages. Attrition was defined as probable epilepsy cases identified at stage-I but who did not attend stage-II (neurologist assessment). Categorical variables were one-hot encoded, class imbalance was addressed using synthetic minority over-sampling technique (SMOTE) and numeric variables were scaled and centered. The dataset was split into training and testing sets (7:3 ratio), and seven machine learning models, including the ensemble Super Learner, were trained. Hyperparameters were tuned using 10-fold cross-validation, and model performance evaluated using metrics like Area under the curve (AUC), accuracy, Brier score and F1 score over 500 bootstrap samples of the test data. Results Random forest (AUC = 0.98, accuracy = 0.95, Brier score = 0.06, and F1 = 0.94), extreme gradient boost (XGB) (AUC = 0.96, accuracy = 0.91, Brier score = 0.08, F1 = 0.90) and support vector machine (SVM) (AUC = 0.93, accuracy = 0.93, Brier score = 0.07, F1 = 0.92) were the best performing models (base learners). Ensemble Super Learner had similarly high performance. Important predictors of attrition included proximity to industrial areas, male gender, employment, education, smaller households, and a history of complex partial seizures. Conclusion These findings can aid researchers plan targeted mobilization for scheduled clinical appointments to improve follow-up rates. These findings will inform development of a web-based algorithm to predict attrition risk and aid in targeted follow-up efforts in similar studies.

Background The suspension and/or termination of many programmes funded through the United States Agency for International Development (USAID) by the new US administration has severe short- and long-term negative impacts on the health of people worldwide. We draw attention to the termination of the Demographic and Health Surveys (DHS) Program, which includes nationally representative surveys of households, DHS, Malaria Indicator Surveys [MIS]) and health facilities (Service Provision Assessments [SPA]) in over 90 low- and middle-income countries. USAID co-funding and provision of technical support for these surveys has been shut down. Main body The impact of these disruptions will reverberate across local, regional, national, and global levels and severely impact the ability to understand the levels and changes in population health outcomes and behaviours. We highlight three key impacts on (1) ongoing data collection and data processing activities; (2) future data collection and consequent lack of population-level health indicators; and (3) access to existing data and lack of support for its use. Conclusions We call for immediate action on multiple fronts. In the short term, universal access to existing data and survey materials should be restored, and surveys which were planned or in progress should be completed. In the long term, this crisis should serve as a tipping point for transforming these vital surveys. We call on national governments, regional organisations, and international partners to develop sustainable alternatives that preserve the principles (standardised questionnaires, backward compatibility, open access data with rigorous documentation) which made the DHS Program an invaluable global health resource.

Child wasting is a major public health problem in low‐ and middle‐income countries. Our study aimed to identify immediate, underlying and basic factors influencing wasting among children in Turkana and Samburu, two arid and semi‐arid regions in Kenya. Data are from a longitudinal study of children under 3 years of age at baseline, with follow‐up every 4 months for 2 years. Generalized estimating equations were used to assess risk factors of wasting in this population. Among immediate factors, children who recently experienced diarrhoea had 19% and 23% higher odds of wasting, and those who consumed animal‐source foods had 12% and 22% lower odds of wasting in Turkana and Samburu, respectively. Among underlying factors, children in Turkana whose caregivers used alcohol had 32% higher odds of wasting, whereas there was no effect of household food insecurity or factors related to water and sanitation on wasting in either county. Children in Turkana whose caregivers had 3–5 or 6 or more children had 39% and 70% higher odds, whereas those in female‐headed households had 34% and 81% higher odds of wasting in Turkana and Samburu, respectively. Male children also had increased odds of wasting; 21% and 41% in Turkana and Samburu, respectively. Children in Turkana's fisherfolk communities had 36% higher odds of wasting compared with those in urban or peri‐urban areas. Key risk factors for wasting included child sex, reported diarrhoea, caregiver's use of alcohol (in Turkana), caregiver's number of children, female‐headed households and fisherfolk livelihood (in Turkana) while consuming animal‐source foods was associated with lower risk. Interventions should target these intersecting factors to reduce wasting in these counties.

Presently, in Nigeria, as in many other developing countries, oral health promotion programs remain the responsibility of the public health dentists. This responsibility is now being threatened, particularly with persistent short supply of dentists in general. Recent evidence showed that peers and school-teachers trained by dentists can effectively anchor oral health promotion programs. However, the sustainability of this method of oral health promotion is further threatened by the emigration of dentists needed to train these peers and teachers. Therefore, the assessment of the feasibility of a training alternative, such as the use of pre-recorded video, has become crucial. This study reports the development and validation of an animated video as an oral health training tool for adolescents and teachers in Ibadan, Nigeria. The narrative video was developed by a team of experts from various specialties, which included public health dentists, pediatric dentists, epidemiologists, communication scientists, animation experts, dental surgery residents, a pediatric surgeon, and science educators. The steps involved in the development included pre-video production research, development of the key oral health education messages, development of the script and storyboarding, creation, design, and selection of characters, visual style decision, voice-over narration recording, production, and post-production processing. The script for the video was developed from information adopted from a manual on oral health care of students. The video produced was validated for face and content quality among dentists, teachers, and adolescents in secondary schools through individual feedback and focus group discussions. Relevant comments and observations were considered in the final editing and postproduction process to yield a final video after series of editing. The video was found to be simple to use, clearly illustrative and highly educative. This is a report on the development, production, and validation of the School Oral Health Promotion Program animated video for training adolescents and teachers.

This work provides three contributions that straddle the medical literature on multimorbidity and the data science community with an interest on exploratory analysis of health-related research data. First, we propose a definition for multimorbidity as the co-occurrence of (at least) two disease diagnoses from a pre-determined list. This interpretation adds to a growing body of working definitions emerging from the literature. Second, we apply this novel outcome of-interest to two sub-Saharan populations located in Nairobi, Kenya and Agincourt, South Africa. The source data for this analysis was collected as part of the Africa Wits-INDEPTH Partnership for Genomic Studies project. Third, we stratify this outcome-of-interest across all possible sub-populations and identify sub-populations with anomalously high (or low) rates of multimorbidity. Critically, the automatic stratification approach emphasizes efficient, disciplined exploratory-based analysis as a complementary alternative to more commonly-used confirmation analysis methods. Our results show that high-risk sub-populations identified in one part of the continent transfer to the other location (and vice-versa) with the equivalent sub-population at the other location also experiencing higher rates of multimorbidity. Second, we discover a real-world scenario where a more-at risk sub-population existed beyond the simpler sub-populations traditionally stratified by age and sex. This is in contrast to existing literature which commonly stratifies disease diagnoses by sex when reporting results. Patterns in diseases, and healthcare more generally, are likely more nuanced than manual approaches may be able to describe. This work helps introduce public health researchers to data science methods that scale to the size and complexity of modern day datasets.

Diarrheal illness remains a major global health challenge, causing millions of deaths annually. Non-typhoidal Salmonella (NTS), Shiga toxin-producing Escherichia coli (STEC), and Campylobacter species (CAMPY) significantly contribute to this burden. Given the limited information on these pathogens in Ethiopia, this study aimed to estimate their prevalence among diarrhea patients in Ethiopia and identify risk factors for infection. A cross-sectional study was conducted from October 2021 to November 2022 in three hospitals in Ethiopia (Addis Ababa, Gondar, and Harar). Sociodemographic characteristics, clinical signs and symptoms were collected from study participants using a structured questionnaire. Stool samples were tested for NTS, STEC, and CAMPY using standardized methods. The prevalence of targeted pathogens was estimated overall and by study sites. Univariable and multivariable logistic regression were used to identify associated factors. A total of 2,331 patients were enrolled. The overall prevalence of NTS, STEC (stx only), STEC (stx + eae), and CAMPY was 1.29% (95%CI: 0.91, 1.84), 12.56% (95%CI: 11.29, 13.98), 3.43% (95%CI: 2.77, 4.25), and 4.46% (95%CI: 4.61, 8.00), respectively. Harar had the highest prevalence of all the pathogens compared to Addis Ababa and Gondar. Odds of NTS in Harar were over 10 (AOR: 10.43: 95%CI: 2.95, 69.20) and 3.5 times (AOR: 3.57: 95%CI: 1.50, 9.90) higher than that in Addis Ababa and Gondar, respectively. Odds of STEC (stx only) in the dry (AOR: 1.97: 95%CI: 1.37, 2.90) and long rainy (AOR: 1.80: 95%CI: 1.20, 2.69) seasons were nearly twice the odds in the short rainy season. Odds of CAMPY infection decreased by 3.29% (AOR: 0.97: 95%CI: 0.95, 0.98) with every one-year increase in age. Moreover, the odds of CAMPY infection for rural residents (AOR: 1.93, 95%CI: 1.15, 3.19) were nearly twice that of urban residents. This is the first study to estimate the prevalence of NTS, STEC, and CAMPY simultaneously across all age groups and diverse regions in Ethiopia, revealing significant variations. Results can be used to understand the burden of disease, inform clinical management and risk mitigation strategies to reduce illness in Ethiopia.

Background Post sexual-based violence (SBV) services are crucial for mitigating SBV-induced consequences. However, these services are reportedly rare and often underutilized, particularly by young women in Sub-Saharan Africa. This study aimed to explore the barriers and facilitators to accessing post-SBV services among young women (18–24 years) attending higher education institutions in Nigeria. Methods An online survey, using a piloted questionnaire, was administered to a purposive sample of 114 participants recruited from social media platforms between the 8th and 22nd March 2022. Descriptive statistics were used to summarize the study findings. Results The majority (71.1%) of the participants were between the ages of 21 and 24 years. Of the 37 participants who indicated they have had their first sexual intercourse, a quarter (9, 24.3%) indicated it was non-consensual. Also, 1 in 5 respondents did not identify SBV/abuse as abnormal. Half of the participants (50.9%) strongly agreed that a post-SBV health service should be the first place to seek care following an incident of rape, however, over half (53.2%) reported a lack of awareness of existing post-SBV health services as a key barrier affecting access. Less than half of the participants strongly agreed that healthcare workers could provide the post-SBV services highlighted in the study, including emergency contraceptives to prevent pregnancy (42.9%) and post-exposure prophylaxis (PEP) to prevent human immunodeficiency virus (HIV) (39.6%), highlighting awareness gaps. Other significant barriers included stigma, shame, and a lack of support systems. Key facilitators included assurance of confidentiality and access to free post-SBV health services. Conclusion Significant barriers and facilitators affect access to post-SBV health services in Nigeria, particularly among young women. Multilevel efforts by families, civil society organizations, communities, and governments are essential to address these barriers and improve access to post-SBV health services.

Background The association between witnessing intimate partner violence against women (IPVAW) and experiencing violence against children (VAC) has received limited attention in humanitarian settings. We examined the prevalence of witnessing IPVAW in childhood and its association with experiencing caregiver-perpetrated physical and emotional VAC and sexual VAC by any perpetrator in Uganda refugee settlements. Methods Data were from the first-ever Ugandan Humanitarian Violence against Children and Youth Survey (HVACS), conducted from March to April 2022, involving 1,338 females and 927 males aged 13–24 years. Indicators of VAC included ever experiencing sexual (by any perpetrator), physical, or emotional (by a caregiver) violence among 13-17-year-olds and experiencing such violence prior to age 18 among 18-24-year-olds. The analysis entailed cross-tabulation with a chi-square (χ²) test and a multivariate logistic regression model. Results The prevalence of witnessing IPVAW in childhood was significantly higher among males (31.2%) compared to females (16.5%). Witnessing IPVAW in childhood was associated with increased odds of experiencing physical VAC by a caregiver for both females (AOR = 2.53; 95% CI = 1.41–4.52) and males (AOR = 3.37; 95% CI = 1.72–6.59). It also significantly increased the odds of experiencing sexual VAC for females (AOR = 3.62; 95% CI = 1.65–7.92) and males (AOR = 5.52; 95% CI = 3.42–8.91). Additionally, witnessing IPVAW increased the odds of experiencing emotional VAC by a caregiver for both females (AOR = 2.61; 95% CI = 1.36–5.03) and males (AOR = 2.78; 95% CI = 1.53–5.07), compared to their peers who did not witness IPVAW. Conclusion Witnessing IPVAW in childhood is common in refugee settlements in Uganda and is strongly associated with experiencing VAC perpetrated by a caregiver. Violence prevention and response programs should pay attention to IPVAW as a risk factor for VAC, emphasizing integrated approaches that target both forms of violence within households.

Aims A systematic review and meta-analysis was conducted to investigate the prevalence and antecedents/outcomes of loneliness and social isolation among individuals with severe mental disorders (SMD), such as schizophrenia, schizoaffective disorder, bipolar disorder or major depressive disorder. Methods Five well-known electronic databases (PubMed, PsycINFO, CINAHL, Web of Science and Scopus) were searched (plus a hand search). Observational studies that report the prevalence and, if available, antecedents and consequences of loneliness/isolation among individuals with SMD were included. Key characteristics were extracted, and a meta-analysis was performed. Our systematic review was preregistered on PROSPERO (ID: CRD42024559043). The PRISMA guidelines were followed. The Joanna Briggs Institute (JBI) standardized critical appraisal tool developed for prevalence studies was applied to assess the quality of the included studies. Results The initial search yielded 4506 records, and after duplicate removal and screening, a total of 10 studies were finally included. The studies included used data from Europe, Asia, North America, and Oceania. Two studies employed a longitudinal design, while all other studies had a cross-sectional design. Most of the studies included between 100 and 500 individuals with SMD. All studies involved both male and female participants, with women typically comprising about 40% of the sample. The average age of participants often ranged from approximately 30 to 40 years. The estimated prevalence of loneliness was 59.1% (95% CI: 39.6% to 78.6%, I ² = 99.3, P < .001) among individuals with any diagnosis of SMD. Furthermore, the estimated prevalence of objective social isolation was 63.0% (95% CI: 58.6% to 67.4%) among individuals with schizophrenia or schizophrenia spectrum disorder. The quality of the studies was moderate to good. Subjective well-being and depressive symptoms in particular were found to contribute to loneliness in the included studies. Conclusions The present systematic review with meta-analysis identified high levels of loneliness and objective social isolation among those with SMD. These findings stress the importance of monitoring and addressing social needs in this vulnerable group, which may have a positive effect on the life quality of individuals with SMD. Future research in neglected regions (e.g. South America and Africa) is recommended. Different diagnoses within severe mental disorders should be distinguished in future studies. Furthermore, additional longitudinal studies are required to explore the antecedents and consequences of loneliness and social isolation among individuals with SMD.

Objective The burden of non-communicable diseases is rising in low-and-middle-income countries, with diet being a key risk factor. This study aimed to assess the patterns, socioeconomic inequalities and determinants of eating healthy in Kenya. The study is the first in Kenya to use a healthy diet index to assess dietary patterns. Design and methods We analysed cross-sectional data from the 2015/16 Kenya Integrated Household Budget Survey. The study’s outcome variable was a continuous healthy diet index (HDI) constructed using principal component analysis from nine WHO/Food and Agriculture Organization (FAO) healthy diet recommendations. The HDI score and WHO/FAO healthy diet recommendations met were summarised for Kenyan households. Using the concentration index, we examined the socioeconomic disparities in healthy eating. In addition, multivariable linear regression was used to determine factors that influence healthy eating in Kenya. Results A total of 21 512 households in Kenya were included, of which 60% were rural and about two-thirds headed by males. The HDI score ranged between −1.13 and 1.70, with a higher value indicating healthier eating. Overall, the average HDI score was 0.24 (95% CI: 0.24 to 0.25), interpreted as moderate. We identified key determinants including socioeconomic status and urban–rural residency differences. Healthy eating was concentrated among higher socioeconomic households, regardless of gender or location. Higher socioeconomic status (β=0.28, 95% CI 0.26 to 0.30), rural residence (β=0.18, 95% CI 0.15 to 0.20), household head being in union (β=0.04, 95% CI 0.02 to 0.06) or employed (β=0.05, 95% CI 0.02 to 0.08) were significantly associated with increased HDI scores, whereas male-headed households and lack of education were associated with significant decreases in HDI scores on average. Conclusions Most Kenyan households do not meet all the healthy dietary recommendations, and socioeconomic inequalities exist in eating healthy. Targeted interventions that promote healthy eating based on key determinants in Kenya are required.

Background Despite a growing body of evidence on maternal mental health in Africa, significant gaps remain in understanding its overall landscape, risk factors/determinants, immediate and long-term effects, accessibility to healthcare and services, and availability of practicable/effective interventions. This paper provides a thorough review of both peer-reviewed and grey literature and makes key recommendations and directions for future research and development. Methods We systematically reviewed extant evidence using the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) 2020 guidelines. Peer-reviewed studies published in English between 2010, and June 2024 were included based on a priori criteria. The National Institutes of Health (NIH) and Critical Appraisal Skill Program (CASP) quality assessment tools were used to critically appraise the reliability, validity and overall quality of included articles. A qualitative narrative synthesis was perfomed to summarize the findings effectively. Results A total of 206 full-text articles evaluated for eligibility and inclusion in the systematic review, predominantly observational studies with a minority employing randomized controlled trial (RCT) designs, were included, with 70%, 22%, and 8% of the articles rated as good, fair, and poor quality, respectively. Women in Africa experience a wide range of common perinatal mental disorders, including major depressive disorders and psychosis, either discretely or comorbid. Socioeconomic disadvantages and other intertwined poverty-related factors at the individual, family, social, and environmental levels are implicated in maternal mental health disorders. Currently, there is insufficient evidence regarding the short- and long-term health, development, and social impacts of maternal mental health. Addtionally, there is limited knowledge about the availability and accessibility of mental healthcare, evidence-based context-specific interventions, and healthcare-seeking behaviors of women in Africa, as well as their access to and utilization of mental health services. Conclusion The evidence base on maternal mental health in Africa suffers from considerable variability, inconsistency, and equivocal findings resulting from heterogeneity across the studies. This restricts generalizability and the ability to draw valid conclusions. Published studies also likely underestimate the scale and health impacts of perinatal mental disorders. Evidence from these studies are rarely used to inform policies and programs. The maternal mental health ecosystem in Africa needs to be better understood. More rigorous study designs should be implemented to focus on evidence generation and the evaluation of interventions, alongside robust integration of mental health services within health systems. Policy initiatives aimed at reducing socioeconomic disparities in maternal, newborn, and child health, particularly concerning maternal mental health, must be supported by these studies. Article Highlights • Women across Africa suffer from various mental health problems, including major depressive disorders, anxiety, and psychosis, occurring separately or in combination. • The evidence base on maternal mental health in Africa displays significant variability, inconsistency, and ambiguous findings, largely attributed to study heterogeneity. • Factors at the individual, familial, societal, and environmental levels contribute to poverty-related issues that can lead to or worsen maternal mental health disorders. • Current evidence has not been synthesized to improve our understanding of the short- and long-term health impacts, developmental consequences, and social implications of maternal mental health conditions, as well as the healthcare-seeking behaviors and access to mental health services. • Insufficient policy prioritization and funding for maternal mental health in Africa hinder the development, evaluation, and sustainability of interventions. • There is an urgent need to integrate mental health services into primary healthcare, particularly in resource-limited settings across Africa. This integration should be guided by evidence from rigorous research that uses longitudinal designs. It is also essential to emphasize the importance of investing in digital and community-based approaches to improve the accessibility to mental health services.

During COVID-19, people with type 2 diabetes (T2D) experienced increased vulnerability, including severe COVID-19 complications, disruptions in diabetes management, and social isolation. These aspects were heightened in many sub-Saharan African countries, such as Kenya and Tanzania, where healthcare systems already face critical challenges in coping with increasing non-communicable diseases (NCDs). Little is known about how people with T2D in these countries managed their diabetes or how the different approaches to COVID-19 control (Kenya imposed lockdown and curfew, whereas Tanzania adopted less strict measures) impacted their T2D management. This qualitative study aimed to compare the accounts of T2D patients in both countries to examine similarities and differences in the illness management challenges they faced during the COVID-19 pandemic.Semi-structured interviews were conducted with 52 patients (Kenya, n=22; Tanzania, n=30), and the transcripts were analyzed thematically. Despite different COVID-19 control measures, patients in both countries faced similar direct health challenges, such as difficulties accessing diabetic consultations and treatment, but they also experienced distinct socio-structural challenges. Direct health challenges included difficulties in accessing diabetic consultations and treatment, limited availability of diabetic medicine at health facilities and mental health distress. These were exacerbated by socio-structural challenges, many of which pre-dated COVID-19 but intensified during the pandemic. These included closure of diabetic clinics in Dar es Salaam, business instability, financial difficulties, health insurance challenges, higher food prices impacting patients’ adherence to T2D dietary recommendations (in both countries), and price inflation of diabetic medicine and test kits (in Kenya). Together, these challenges led to patients practicing self-medication, missing doses and resulted in poor blood sugar control. People with T2D in Kenya and Tanzania have described similar illness management challenges. In both countries, future contingency planning is essential to ensure adequate routine management of T2D and to improve access to care in emergency situations. Affordable comprehensive health insurance, economic support, and psychosocial services are required to increase patient resilience and support the health and wellbeing of people with T2D.

Introduction The COVID-19 pandemic highlighted the significance of mathematical modelling in decision-making and the limited capacity in many low-income and middle-income countries (LMICs). Thus, we studied how modelling supported policy decision-making processes in LMICs during the pandemic (details in a separate paper). We found that strong researcher–policymaker relationships and co-creation facilitated knowledge translation, while scepticism, political pressures and demand for quick outputs were barriers. We also noted that routine use of modelled evidence for decision-making requires sustained funding, capacity building for policy-facing modelling, robust data infrastructure and dedicated knowledge translation mechanisms. These lessons helped us co-create a framework and policy roadmap for improving the routine use of modelling evidence in public health decision-making. This communication paper describes the framework components and provides an implementation approach and evidence for the recommendations. The components include (1) funding, (2) capacity building, (3) data infrastructure, (4) knowledge translation platforms and (5) a culture of evidence use. Key arguments Our framework integrates the supply (modellers) and demand (policymakers) sides and contextual factors that enable change. It is designed to be generic and disease-agnostic for any policy decision-making that modelling could support. It is not a decision-making tool but a guiding framework to help build capacity for evidence-based policy decision-making. The target audience is modellers and policymakers, but it could include other partners and implementers in public health decision-making. Conclusion The framework was created through engagements with policymakers and researchers and reflects their real-life experiences during the COVID-19 pandemic. Its purpose is to guide stakeholders, especially in lower-resourced settings, in building modelling capacity, prioritising efforts and creating an enabling environment for using models as part of the evidence base to inform public health decision-making. To validate its robustness and impact, further work is needed to implement and evaluate this framework in diverse settings.

Objective To explore the perceptions, drivers, and potential solutions to consumption of unhealthy, ultra-processed foods (UPF) and foods high in fat, salt and sugar (HFSS), and their contribution to the double burden of malnutrition in adolescents living in urban slums, Kenya. Design Qualitative participatory research, through Photovoice, group discussions and community dialogues. Inductive, thematic analysis was undertaken. Setting Three major slums, Nairobi. Participants Adolescents 10-19 years (n=102: 51 boys, 51 girls) and adults (n=62). Results UPF/HFSS consumption emerged as a predominant theme on the causes of undernutrition and overweight/obesity and foods commonly consumed by adolescents. Adolescents described UPF/HFSS as junk, oily, sugary or foods with chemicals, and associated UPF/HFSS consumption with undernutrition, obesity, non-communicable diseases. They perceived UPF/HFSS as modern, urban, classy, appealing to young people, and minimally processed foods as boring, primitive, for older people, and those in rural areas. Individual-level drivers of UPF/HFSS consumption were organoleptic attributes (taste/aroma), body size/shape, illicit drug use, convenience, adolescents’ autonomy. Social environment drivers were peer-pressure and social status/aspirations. Physical environment drivers were UPF/HFSS availability and accessibility in the slums. Education on healthy eating and adverse effects of consuming UPF/HFSS, through existing structures (youth groups, school, community health strategy) was proposed as potential solution to UPF/HFSS consumption. Conclusion UPF/HFSS were perceived as associated with poor nutrition and health, yet were preferred over unprocessed/minimally processed foods. Interventions to promote healthy diets beyond raising awareness are important, while address the underlying perceptions and drivers of UPF/HFSS consumption at individual-level, and social and physical food environments.

Background/Aims Particularly among the oldest old, there is restricted knowledge regarding the factors associated with mild cognitive impairment and dementia using data from large, nationally representative samples. Thus, our aim was to address this knowledge gap. Methods/Design We used data from the nationally representative “Old Age in Germany (D80+)” study covering community-dwelling and institutionalized individuals in the entire country (n = 2,555). Mean age was 85.5 years (SD: 4.2), ranging from 80 to 100 years (61.7% of the participants were female). The DemTect was used to measure cognitive impairment in terms of probable mild cognitive impairment and probable dementia. Sociodemographic, lifestyle-related, psychosocial and health-related independent variables were included in the multinomial regression analysis. Results In the analytic sample, 57.8% of the individuals did not have cognitive impairment, 24.2% of the individuals had mild cognitive impairment and 18.0% had probable dementia. Regression analysis identified some sociodemographic (e.g., advanced age, being male, lower education), lifestyle-related (lower cognitive activities), psychosocial (higher loneliness and absence of meaning in life), as well as health-related (e.g., functional impairment) factors associated with probable MCI and probable dementia. Loneliness was only associated with these outcomes among women, but not men. Discussions Based on large, nationally representative data, this study revealed several factors associated with probable MCI and dementia – which enhances our current understanding mainly based on small or selective samples. Conclusion Such knowledge may help to address those at risk for cognitive impairment. Longitudinal studies are required to gain further insights.

Physical fitness is a key indicator of children’s health, yet amidst rising inactivity and obesity, data on Kenyan children are scarce. This study assessed health- and skill-related fitness differences between rural and urban Kenyan children while examining demographic influences. Cardiorespiratory fitness (CRF), BMI, strength, flexibility, speed, agility, and coordination were assessed in 1131 children aged 11.07 ± 0.9 years (52.7% girls) recruited using stratified cluster random sampling. Significant rural–urban disparities were observed. In urban areas, 16.6% were overweight and 2.8% obese, compared to 4% and 0.6% in rural areas (p < 0.001). Conversely, 44.5% of the rural cohort were underweight versus 13.7% urban cohort (p < 0.001). Multivariable regression revealed that rural children demonstrated superior CRF (β = −4.68 laps, p < 0.001) and lower back flexibility (β = −2.77 cm, p < 0.001), while urban children excelled in speed and coordination (β = 3.68 bounces, p < 0.001) and grip strength (β = 2.16 kg, p < 0.001). Boys outperformed girls in explosive leg power (β = −6.75 cm, p < 0.001) and CRF (β = −6.92 laps, p < 0.001). These findings highlight fitness inequities among Kenyan children, emphasising the need for equitable, targeted, and inclusive physical activity opportunities.

This study examined the flood frequencies and amplitudes of annual maximum precipitation and discharge within the Mono River Basin (MRB) in Togo, West Africa. We scrutinized daily historical data from 1961 to 2020, alongside Shared Socio-economic Pathway SSP5-8.5 scenario derived from the Coupled Model Intercomparison Project phase 6 (CMIP6) data for 2035 to 2094. The observational data were initially evaluated in conjunction with innovative CMIP6 data collected between 1985 and 2014, and employing the Pearson correlation (r), Percent of Bias (PBIAS), Standardized Root Mean Square Error (RSR), Kling–Gupta efficiency (KGE) validation statistical metrics. Subsequently, Generalized Extreme Value (GEV) probability distributions were utilized to predict flood amplitudes and frequencies, leveraging annual maximum precipitation, discharge, and return period values. The findings revealed new insights regarding flood amplitudes for discharge and precipitation; categorized as moderate, limited, or critical. This classification depended on whether the amplitude fell below or exceeded the specified thresholds under various climate conditions. However, it’s essential to note the intricacies involved in this classification process, as it reflects the complex nature of climate impacts. Our investigation uncovered strong statistical metrics between observation and CMIP6 multi-model ensemble datasets, with acceptable RSR, KGE, and r values above 0.70, and PBIAS lower than − 20%. We determined that the Gumbel probability distribution is the most accurate model for annual maximums at a 95% confidence level. Flood amplitudes were initially categorized into three distinct classes: limited, moderate, or critical (based on their amplitude). This classification was applied to the northern, central, and southern regions. However, the frequency of return periods was observed to be below 25 years for more likely floods across all locations, but they exceeded 25 years for less probable floods in certain regions and scenarios. Although this analysis provides insightful data, it also reveals complexities that warrant further exploration. We projected an increase in less severe floods in the MRB over the next 25 years, with changing flood amplitudes and increased frequencies for most south regions from past to future periods. These results highlight the pressing need to enhance early warning systems and strengthen societal resilience through sustainable policies and governance.