Over the past decade, Sub-Saharan Africa has entered a new phase in the evolution of the global syndemic of undernutrition, obesity, and climate change. Earlier reviews, largely based on evidence before 2018, documented the emergence of overlapping nutritional and environmental vulnerabilities. This review provides an updated synthesis of epidemiological evidence published between 2019 and 2025 to capture recent shifts in magnitude, distribution, and interactions of the syndemic components across Africa. Recent data indicate that adult obesity prevalence in the African region reached 12
BackgroundThe rapid emergence of generative artificial intelligence (AI) tools such as ChatGPT is transforming teaching and learning practices in higher education. This study assessed the awareness, attitudes, and usage patterns of ChatGPT among university students in Zambia and examined factors associated with students’ attitudes toward the technology.MethodsA multi-institutional cross-sectional study was conducted among 1,829 university students in Zambia using a structured questionnaire adapted from instruments informed by the Technology Acceptance Model (TAM). Data were analysed using SPSS version 26.0, with statistical significance set at p < 0.05.ResultsAmong the 1,829 participants, 81.7% were aged 18–25 years, 52.5% were female, and 92.4% were unmarried. Overall, 96.8% of the students had heard of ChatGPT, and 85.6% reported having used it before this study. Among AI-usage constructs, 74.8% of respondents perceived high risks associated with AI use, 73.3% perceived ChatGPT as easy to use, 64.0% perceived it as useful, and 56.8% reported behavioural intention to use AI tools. In multivariable analysis, students aged ≥40 years were more likely to report positive attitudes toward ChatGPT compared with those aged 18–25 years (aOR = 5.91; 95% CI: 1.23–28.33; p = 0.026). Technology/social influence was also significantly associated with positive attitudes (aOR = 2.04; 95% CI: 1.55–2.68; p < 0.001). Conversely, perceived risks were associated with lower odds of positive attitudes (aOR = 0.57; 95% CI: 0.43–0.75; p < 0.001). Regarding ChatGPT use, perceived usefulness significantly predicted higher usage (aOR = 1.49; 95% CI: 1.17–1.89; p = 0.001), while perceived risks were associated with reduced usage (aOR = 0.61; 95% CI: 0.45–0.84; p = 0.003).ConclusionAwareness and use of ChatGPT are widespread among university students in Zambia, with more than four out of five students reporting prior use. Perceived usefulness and social influence were positively associated with adoption, whereas perceived risks were linked to lower attitudes and reduced use. These findings highlight the need for higher education institutions to develop clear policies and integrate AI literacy into curricula to promote responsible and effective use of generative AI technologies in academic environments.
INTRODUCTION:Breathlessness is a common cause of hospital admission globally and is associated with high mortality, particularly in low-income countries. In sub-Saharan Africa, there is a paucity of data on breathlessness, with existing data focused on individual diseases. There is a need for patient-centred approaches to understand interactions between multiple conditions to address population needs and inform health system responses. This multicentre prospective study in Malawi aimed to characterise the aetiologies, outcomes and biomarker accuracy for breathless patients. METHODS:Adults (aged ≥18 years) admitted to medical wards were consecutively recruited within 24 hours of hospital presentation and followed up for 1 year. Participants with breathlessness (defined as a composite of patient-reported shortness of breath; tachypnoea (respiratory rate ≥25/min); hypoxaemia (SpO2 <94%) or treatment with oxygen) were systematically screened against internationally accepted diagnostic criteria. We estimated disease prevalence, survival, health-related quality of life and functional status. We also evaluated diagnostic accuracy of natriuretic peptides for heart failure, and procalcitonin (PCT) and C reactive peptide (CRP) for pneumonia. RESULTS:Of 751 participants, 44% (n=334) had breathlessness, and 316 underwent enhanced diagnostic screening. One-year mortality was higher in breathless patients (51% (157/307)) than those without (26% (100/385)); adjusted HR 1.8 (95% CI 1.4 to 2.3). We identified high prevalence and mortality of heart failure (35% (112/316) prevalence; 69% (75/109) 1-year mortality), anaemia (40% (126/316); 57% (70/122)), pneumonia (41% (131/316); 53% (68/129)) and tuberculosis (29% (91/316); 47% (41/87)). Most participants (63% (199/316)) had multiple conditions. Diagnostic accuracy (area under the curve) for heart failure was 0.89 (brain natriuretic peptide) and 0.88 (N-terminal pro-B-type natriuretic peptide); for pneumonia, CRP was 0.77 and PCT was 0.69. DISCUSSION:Breathlessness-related hospital admissions in Malawi are common, multifactorial and associated with poor survival. This study demonstrates that co-existing conditions are common, highlighting the limitation of single-disease-focused health system responses. Integrated care pathways with context-sensitive diagnostic and treatment approaches are urgently needed to improve survival.
Antimicrobial resistance threatens global health and is largely driven by inappropriate antimicrobial use. In Malawi, infectious diseases remain the leading health burden, fueling high antibiotic consumption. However, systematic data on antibiotic prescribing practices are scarce. This study evaluated the prevalence and pattern of antibiotic use for inpatients admitted in hospitals participating in Malawi’s antimicrobial resistance sentinel surveillance network. A multisite point prevalence survey on antibiotic use was conducted in June 2021 across seven hospitals in the sentinel surveillance network: Queen Elizabeth Central Hospital, Zomba Central Hospital, Kamuzu Central Hospital, Mzuzu Central Hospital, Mangochi District Hospital, Mzimba South District Hospital, and Malamulo Adventist Hospital. Antibiotic prescription data was collected from randomly selected patient medical records using the World Health Organization methodology for point prevalence surveys on antibiotic use. Four domains were described: antibiotic-use prevalence, patterns of antibiotic use, local guideline compliance, and microbiology diagnostic service use. A total of 1,030 eligible patient files were reviewed across the surveyed hospitals, of which 46.1
