Background:Malaria is a preventable disease that causes serious illness and death. In 2022, it remained the leading cause of death among children under five years of age in Burkina Faso, despite significant intervention efforts over the past two decades. Research on the effects of interventions and climatic factors on malaria morbidity has expanded, but their effects on malaria mortality remain unclear. We aimed to estimate the effects of interventions and lagged climatic factors on malaria mortality among children under five years of age in northwest Burkina Faso. We further evaluated the role of climatic seasonality in patterns of malaria mortality. Methods:We investigated the seasonal patterns of malaria mortality among children under five years of age and their association with climatic factors, such as rainfall and land surface temperature (LST), using wavelet analysis on mortality data from the Nouna Health Demographic Surveillance System spanning 2002-2021. Furthermore, we assessed the effects of interventions, including coverage of insecticide-treated nets (ITNs) and artemisinin-based combination therapies (ACTs), on malaria mortality alongside climate effects using Bayesian negative binomial temporal models for the period 2013-2021. Results:The lag time in the effects of climatic factors varied over time. Malaria mortality, rainfall, and LST showed a 12-month seasonal cycle throughout the years, while LST also had a six-month cycle in specific years. Rainfall lagged by 1.5 to 2 months and LST by 1 to 1.5 months, depending on the seasonal cycle and year. Rainfall was positively associated with malaria mortality (mortality rate ratio (MRR) = 1.59; 95% Bayesian credible interval (BCI) = 1.18, 1.95), LST showed a decrease in mortality (MRR = 0.68; 95% BCI = 0.52, 0.86), and ITN was associated with a reduction in mortality (MRR = 0.59; 95% BCI = 0.42, 0.79); however, ACT was not statistically important. Conclusions:We found that ITN was more effective in reducing malaria mortality than temperature, but rainfall had a greater opposing impact on increasing malaria mortality. The seasonal mortality pattern was more influenced by rainfall than by temperature. Varying climatic lag times highlight the need for adaptive strategies. Policymakers should focus on climate-informed planning, sustained ITN coverage, and reassessment of ACT strategies to further reduce malaria mortality.

Non-communicable chronic diseases disproportionately affect people living in low- and middle-income countries, with low linkage to care and healthcare utilization identified as contributors to the considerable unmet treatment need in these settings. Here we assess the effect of labelled cash transfers (LCTs) to incentivize clinic-based uptake of care for chronic conditions in rural Burkina Faso (German Clinical Trials Register DRKS00014734). N = 1,242 adults aged 40 years and older with diagnoses of hypertension, hyperlipidaemia and diabetes were randomized to one of three trial arms to receive a high LCT of 1,000 Franc de la Communauté Financière d'Afrique (FCFA) (~US$2), a lower payment of 500 FCFA or no cash transfer. Cash transfers were labelled with an explanation of their intent. The primary trial endpoints of linkage to care and treatment uptake were not found to be significantly affected by LCT receipt. Most secondary endpoints also did not meet significance. The secondary outcome of rates of face-to-face examinations was paradoxically significantly lower in LCT recipient groups than controls; however, this finding should be interpreted with caution.

Climate variability and climate change are among many interacting drivers of human migration, alongside social, geopolitical, and economic factors. Environmental stressors such as crop failures, rising sea levels, and water insecurity may contribute to mobility, but their influence is complex, indirect, and highly context-specific. Populations in Sub Saharan Africa are particularly vulnerable due to high exposure to climate change and limited adaptive capacity. Although migration patterns in Africa are increasingly well documented, empirical evidence directly linking long-term migration trends to specific climate impacts, such as crop yield variability, remains limited. In this study, we analyzed longitudinal data from 196,320 individuals in rural Burkina Faso, collected through a Health and Demographic Surveillance System from 1994 to 2016. We used Prentice-Williams-Peterson regression to assess the association between annual weather-induced crop yield variations and individual-level migration events. We found that reductions in crop yields were strongly associated with increased out-migration, particularly among male farmers, individuals with lower household wealth, and those with prior migration experience. These findings highlight the role of climate related livelihood impacts on shaping migration patterns and highlight the importance of effective climate adaptation strategies that account for migration dynamics in vulnerable settings.

Global health research requires the integration of diverse datasets and continuous updates to enable more effective monitoring and interpretation of global health trends. However, traditional tabular datasets often fall short in accommodating multiple datasets with heterogeneous schemas and evolving structures, and they hinder the efficient updating of such datasets once integrated. Graph databases offer a natural solution to these challenges by providing a flexible data structure that can explicitly represent complex relationships and accommodate incremental updates without requiring modifications to existing data. This paper presents an initial attempt to apply graph database technology to global health research by proposing a structured roadmap for constructing a Neo4j-based knowledge graph from heterogeneous data sources. The application of knowledge graphs in global health research enables comprehensive, up-to-date representation of complex datasets, facilitates direct insights into multifaceted relationships, supports multi-perspective analyses, and establishes a foundation for scalable and analytically robust research in the field.

Climate change is anticipated to significantly affect human migration, driven by factors such as crop failures, rising sea levels, and water insecurity. The African continent is particularly vulnerable due to its population's limited adaptive capacity. However, collecting migration data is challenging, especially in regions lacking reliable demographic and epidemiological census data. Consequently, empirical evidence linking migration patterns to climate variability in Africa is scarce. We analysed data from 196,320 individuals in rural Burkina Faso from 1994 to 2016, assessing the relationship between weather-induced crop yield variations and migration. We found that annual reductions in crop yields were strongly associated with increased out-migration, particularly among male farmers, individuals with lower wealth, and those with prior migration experience. These findings underscore the need for effective climate change adaptation and mitigation strategies to reduce forced migration and displacement in the context of climate change.

Rising temperatures in Africa present an increasing threat to agricultural productivity and public health, particularly among subsistence farming communities reliant on rain-fed agriculture. Heat exposure can impair farmers’ work capacity, disrupt harvests, and heighten health risks, especially for young children vulnerable to undernutrition. The Heat to Harvest (H2H) study investigates how environmental heat exposure influences farmers’ physiological and behavioral responses, and how these in turn affect harvest yields and child nutrition. It also examines differences in labor performance and recovery between households with and without cool roof coatings, although this intervention is not the central focus. H2H is designed as a prospective cohort study nested within two Health and Demographic Surveillance Systems (HDSS) in Nouna, Burkina Faso, and Siaya, Kenya. The study integrates environmental monitoring (temperature and humidity sensors used to compute Wet Bulb Globe Temperature), biometric data (via wearables tracking heart rate, temperature, physical activity, energy expenditure, and sleep), and GPS tracking (capturing spatial mobility and labor duration). The study is embedded within a larger cluster-randomized controlled trial, facilitating comparative analysis under varying thermal conditions. Findings will provide evidence-based insights into how climate-related heat stress affects health and agricultural outcomes, supporting the development of targeted adaptation strategies to enhance resilience, health, and food security in vulnerable farming communities.

With the goal of eradication by 2030, Malaria poses a significant health threat, profoundly influenced by meteorological and hydrological conditions. In support of malaria vector control efforts, we present a high‐resolution, coupled physically‐based modeling approach integrating WRF‐Hydro and VECTRI. This model approach accurately captures topographic details at the scale of larvae habitats in the Nouna Health and Demographic Surveillance Systems in Sub‐Saharan Africa. Our study demonstrates the proficiency of the high‐resolution hydrometeorological model, WRF‐Hydro, in replicating observed climate characteristics. Comparisons with in‐situ local weather data reveal root mean square errors between 0.6 and 0.87 mm/day for rainfall and correlations ranging from 0.79 to 0.87 for temperatures. Additionally, WRF‐Hydro's surface hydrology reproduces the seasonal and intraseasonal variability of the ponded water fraction with 96% accuracy, validated against Sentinel‐1 data at a 100‐m resolution. The VECTRI model demonstrates sensitivity to surface hydrology representation, particularly when comparing conceptual and detailed physical process models, for variables such as larvae density, mosquito abundance, and EIR. The model's ability to replicate the seasonality of malaria transmission aligns well with available cohort malaria data suggesting its potential for predicting the impacts of climate change on mosquito abundance and transmission intensity in endemic tropical and subtropical zones. This integrated approach opens avenues for enhanced understanding and proactive management of malaria.

Objectives: Long-acting reversible contraception (LARC) initiation has been well-studied and intervened upon. Because LARC requires provider intervention for initiation and removal, it is critical to measure informed choice at the time of desired discontinuation as well. We examined perceptions of access to LARC discontinuation among women at two sites in Burkina Faso, where LARC is the dominant method in the contraceptive mix. Study design: We analyzed data from a 2017-2018 population-based, cross-sectional survey of 281 implant users and 55 intrauterine device users at two sites in Burkina Faso. We measured perceptions of access to LARC discontinuation through survey items assessing whether participants (1) were informed on how to discontinue the method, (2) believed they could have LARC removed without a lot of difficulty, (3) believed cost would be a barrier to discontinuation, (4) had ever attempted to have a provider remove LARC, and (5) successfully had LARC removed. The distribution of these measures was examined in the population and for differences by gravida, parity, domestic partnership, fertility desires, and recency of last childbirth. Results: Thirty-eight (11%) of current LARC users reported that they were not informed on how to discontinue, 56 (17%) believed having their device removed would be difficult, and 54 (16%) believed cost would be a barrier to removal. Of women who attempted removal, providers did not immediately remove LARC on request for 10 (28%). Conclusions: Findings indicate that LARC uptake is an insufficient measure of reproductive access or choice. Future studies should include patient-centered measures that span the full duration of contraceptive use. Implications: This paper finds that a sizable proportion of LARC users lack information about method dis-continuation and perceive or experience barriers to method removal. These findings call for a re-consideration of free and informed contraceptive choice to include the entire duration of contraceptive use, not only the time of method provision.(c) 2023 Elsevier Inc. All rights reserved.

Background High ambient air temperatures in Africa pose significant health and behavioral challenges in populations with limited access to cooling adaptations. The built environment can exacerbate heat exposure, making passive home cooling adaptations a potential method for protecting occupants against indoor heat exposure. Methods We are conducting a 2-year community-based stratified cluster randomized controlled trial (cRCT) implementing sunlight-reflecting roof coatings, known as “cool roofs,” as a climate change adaptation intervention for passive indoor home cooling. Our primary research objective is to investigate the effects of cool roofs on health, indoor climate, economic, and behavioral outcomes in rural Burkina Faso. This cRCT is nested in the Nouna Health and Demographic Surveillance System (HDSS), a population-based dynamic cohort study of all people living in a geographically contiguous area covering 59 villages, 14305 households and 28610 individuals. We recruited 1200 participants, one woman and one man, each in 600 households in 25 villages in the Nouna HDSS. We stratified our sample by (i) village and (ii) two prevalent roof types in this area of Burkina Faso: mud brick and tin. We randomized the same number of people (12) and homes (6) in each stratum 1:1 to receiving vs. not receiving the cool roof. We are collecting outcome data on one primary endpoint - heart rate, (a measure of heat stress) and 22 secondary outcomes encompassing indoor climate parameters, blood pressure, body temperature, heat-related outcomes, blood glucose, sleep, cognition, mental health, health facility utilization, economic and productivity outcomes, mosquito count, life satisfaction, gender-based violence, and food consumption. We followed all participants for 2 years, conducting monthly home visits to collect objective and subjective outcomes. Approximately 12% of participants ( n = 152) used smartwatches to continuously measure endpoints including heart rate, sleep and activity. Discussion Our study demonstrates the potential of large-scale cRCTs to evaluate novel climate change adaptation interventions and provide evidence supporting investments in heat resilience in sub-Saharan Africa. By conducting this research, we will contribute to better policies and interventions to help climate-vulnerable populations ward off the detrimental effects of extreme indoor heat on health. Trial registration German Clinical Trials Register (DRKS) DRKS00023207. Registered on April 19, 2021.

There is growing consensus in the family planning community around the need for novel measures of autonomy. Existing literature highlights the tension between efforts to pursue contraceptive targets and maximize uptake on the one hand, and efforts to promote quality, person-centeredness, and contraceptive autonomy on the other hand. Here, we pilot a novel measure of contraceptive autonomy, measuring it at two Health and Demographic Surveillance System sites in Burkina Faso. We conducted a population-based survey with 3,929 women of reproductive age, testing an array of new survey items within the three subdomains of informed choice, full choice, and free choice. In addition to providing tentative estimates of the prevalence of contraceptive autonomy and its subdomains in our sample of Burkinabè women, we critically examine which parts of the proposed methodology worked well, what challenges/limitations we encountered, and what next steps might be for refining, improving, and validating the indicator. We demonstrate that contraceptive autonomy can be measured at the population level but a number of complex measurement challenges remain. Rather than a final validated tool, we consider this a step on a long road toward a more person-centered measurement agenda for the global family planning community.

Family planning researchers have traditionally focused efforts on understanding contraceptive non-use and promoting contraceptive uptake. Recently, however, more scholars have been exploring method dissatisfaction, questioning the assumption that contraceptive users necessarily have their needs met. Here, we introduce the concept of "non-preferred method use", which we define as the use of one contraceptive method while having the desire to use a different method. Non-preferred method use reflects barriers to contraceptive autonomy and may contribute to method discontinuation. We use survey data collected from 2017 to 2018 to better understand non-preferred contraceptive method use among 1210 reproductive-aged family planning users in Burkina Faso. We operationalise non-preferred method use as both (1) use of a method that was not the user's original preference and (2) use of a method while reporting preference for another method. Using these two approaches, we describe the prevalence of non-preferred method use, reasons for using non-preferred methods, and patterns in non-preferred method use by current and preferred methods. We find that 7% of respondents reported using a method they did not desire at the time of adoption, 33% would use a different method if they could and 37% report at least one form of non-preferred method use. Many women cite facility-level barriers, such as providers refusing to give them their preferred method, as reasons for non-preferred method use. The high prevalence of non-preferred method use reflects the obstacles that women face when attempting to fulfil their contraceptive desires. Further research on reasons for use of non-preferred methods is necessary to promote contraceptive autonomy.

Background: Climate change significantly impacts health in low-and middle-income countries (LMICs), exacerbating vulnerabilities. Comprehensive data for evidence-based research and decision-making is crucial but scarce. Health and Demographic Surveillance Sites (HDSSs) in Africa and Asia provide a robust infrastructure with longitudinal population cohort data, yet they lack climate-health specific data. Acquiring this information is essential for understanding the burden of climate-sensitive diseases on populations and guiding targeted policies and interventions in LMICs to enhance mitigation and adaptation capacities. Objective: The objective of this research is to develop and implement the Change and Health Evaluation and Response System (CHEERS) as a methodological framework, designed to facilitate the generation and ongoing monitoring of climate change and health-related data within existing Health and Demographic Surveillance Sites (HDSSs) and comparable research infrastructures. Methods: CHEERS uses a multi-tiered approach to assess health and environmental exposures at the individual, household, and community levels, utilizing digital tools such as wearable devices, indoor temperature and humidity measurements, remotely sensed satellite data, and 3D-printed weather stations. The CHEERS framework utilizes a graph database to efficiently manage and analyze diverse data types, leveraging graph algorithms to understand the complex interplay between health and environmental exposures. Results: The Nouna CHEERS site, established in 2022, has yielded significant preliminary findings. By using remotely-sensed data, the site has been able to predict crop yield at a household level in Nouna and explore the relationships between yield, socioeconomic factors, and health outcomes. The feasibility and acceptability of wearable technology have been confirmed in rural Burkina Faso for obtaining individual-level data, despite the presence of technical challenges. The use of wearables to study the impact of extreme weather on health has shown significant effects of heat exposure on sleep and daily activity, highlighting the urgent need for interventions to mitigate adverse health consequences. Conclusion: Implementing the CHEERS in research infrastructures can advance climate change and health research, as large and longitudinal datasets have been scarce for LMICs. This data can inform health priorities, guide resource allocation to address climate change and health exposures, and protect vulnerable communities in LMICs from these exposures.

BackgroundSub-Saharan Africa faces prolonged COVID-19 related impacts on economic activity, livelihoods and nutrition, with recovery slowed down by lagging vaccination progress.ObjectiveThis study investigated the economic impacts of COVID-19 on food prices, consumption and dietary quality in Burkina Faso, Ethiopia, Ghana, Nigeria, and Tanzania.MethodsWe conducted a repeated cross-sectional study using a mobile platform to collect data from July-December, 2021 (round 2). We assessed participants' dietary intake of 20 food groups over the previous seven days and computed the primary outcome, the Prime Diet Quality Score (PDQS), and Dietary Diversity Score (DDS), with higher scores indicating better quality diets. We used generalized estimating equation (GEE) linear regression models to assess factors associated with diet quality during COVID-19.ResultsMost of the respondents were male and the mean age was 42.4 (±12.5) years. Mean PDQS (±SD) was low at 19.4(±3.8), out of a maximum score of 40 in this study. Respondents (80%) reported higher than expected prices for all food groups. Secondary education or higher (estimate: 0.73, 95% CI: 0.32, 1.15), medium wealth status (estimate: 0.48, 95% CI: 0.14, 0.81), and older age were associated with higher PDQS. Farmers and casual laborers (estimate: -0.60, 95% CI: -1.11, -0.09), lower crop production (estimate: -0.87, 95% CI: -1.28, -0.46) and not engaged in farming (estimate: -1.38, 95% CI: -1.74, -1.02) were associated with lower PDQS.ConclusionHigher food prices and lower diet quality persisted during the COVID-19 pandemic. Economic and social vulnerability and reliance on markets (and lower agriculture production) were negatively associated with diet quality. Although recovery was evident, consumption of healthy diets remained low. Systematic efforts to address the underlying causes of poor diet quality through transforming food system value chains, and mitigation measures, including social protection programs and national policies are critical.

Unmet need for contraception is a widely used but frequently misunderstood indicator. Although calculated from measures of pregnancy intention and current contraceptive use, unmet need is commonly used as a proxy measure for (1) lack of access to contraception and (2) desire to use it. Using data from a survey in Burkina Faso, we examine the extent to which unmet need corresponds with and diverges from these two concepts, calculating sensitivity, specificity, and positive/negative predictive values. Among women assigned conventional unmet need, 67 percent report no desire to use contraception and 61 percent report access to a broad range of affordable contraceptives. Results show unmet need has low sensitivity and specificity in differentiating those who lack access and/or who desire to use a method from those who do not. These findings suggest that unmet need is of limited utility to inform family planning programs and may be leading stakeholders to overestimate the proportion of women in need of expanded family planning services. We conclude that more direct measures are feasible at the population level, rendering the proxy measure of unmet need unnecessary. Where access to and/or desire for contraception are the true outcomes of interest, more direct measures should be used.

Introduction: Provider bias has become an important topic of family planning research over the past several decades. Much existing research on provider bias has focused on the ways pro-viders restrict access to contraception. Here, we propose a dis-tinction between the classical "downward" provider bias that discourages contraceptive use and a new conception of "up-ward" provider bias that occurs when providers pressure or en-courage clients to adopt contraception. Methods: Using cross-sectional data from reproductive-aged women in Burkina Faso, we describe lifetime prevalence of experiencing provider encouragement to use contraception due to provider perceptions of high parity (a type of upward pro-vider bias) and provider discouragement from using contra-ception due to provider perceptions of low parity (a type of downward provider bias). We also examine associations between sociodemographic characteristics and experiences of provider en-couragement to use contraception due to perceptions of high parity. Results: Sixteen percent of participants reported that a provider had encouraged them to use contraception due to provider per-ceptions of high parity, and 1% of participants reported that a provider had discouraged them from using contraception be-cause of provider perceptions of low parity. Being married, being from the rural site, having higher parity, and having attended the 45th-day postpartum check-up were associated with increased odds of being encouraged to use contraception due to provider perceptions of high parity. Conclusion: We find that experiences of upward provider bias linked to provider perceptions of high parity were considerably more common in this setting than downward provider bias linked to perceptions of low parity. Research into the mechanisms through which upward provider bias operates and how it may be mitigated is imperative to promote contraceptive autonomy.

BACKGROUND:Extreme weather is becoming more common due to climate change and threatens human health through climate-sensitive diseases, with very uneven effects around the globe. Low-income, rural populations in the Sahel region of west Africa are projected to be severely affected by climate change. Climate-sensitive disease burdens have been linked to weather conditions in areas of the Sahel, although comprehensive, disease-specific empirical evidence on these relationships is scarce. In this study, we aim to provide an analysis of the associations between weather conditions and cause-specific deaths over a 16-year period in Nouna, Burkina Faso. METHODS:In this longitudinal study, we used de-identified, daily cause-of-death data from the Health and Demographic Surveillance System led by the Centre de Recherche en Santé de Nouna (CRSN) in the National Institute of Public Health of Burkina Faso, to assess temporal associations between daily and weekly weather conditions (maximum temperature and total precipitation) and deaths attributed to specific climate-sensitive diseases. We implemented distributed-lag zero-inflated Poisson models for 13 disease-age groups at daily and weekly time lags. We included all deaths from climate-sensitive diseases in the CRSN demographic surveillance area from Jan 1, 2000 to Dec 31, 2015 in the analysis. We report the exposure-response relationships at percentiles representative of the exposure distributions of temperature and precipitation in the study area. FINDINGS:Of 8256 total deaths in the CRSN demographic surveillance area over the observation period, 6185 (74·9%) were caused by climate-sensitive diseases. Deaths from communicable diseases were most common. Heightened risk of death from all climate-sensitive communicable diseases, and malaria (both across all ages and in children younger than 5 years), was associated with 14-day lagged daily maximum temperatures at or above 41·1°C, the 90th percentile of daily maximum temperatures, compared with 36·4°C, the median (all communicable diseases: 41·9°C relative risk [RR] 1·38 [95% CI 1·08-1·77], 42·8°C 1·57 [1·13-2·18]; malaria all ages: 41·1°C 1·47 [1·05-2·05], 41·9°C 1·78 [1·21-2·61], 42·8°C 2·35 [1·37-4·03]; malaria younger than 5 years: 41·9°C 1·67 [1·02-2·73]). Heightened risk of death from communicable diseases was also associated with 14-day lagged total daily precipitation at or below 0·1 cm, the 49th percentile of total daily precipitation, compared with 1·4 cm, the median (all communicable diseases: 0·0 cm 1·04 [1·02-1·07], 0·1 cm 1·01 [1·006-1·02]; malaria all ages: 0·0 cm 1·04 [1·01-1·08], 0·1 cm 1·02 [1·00-1·03]; malaria younger than 5 years: 0·0 cm 1·05 [1·01-1·10], 0·1 cm 1·02 [1·00-1·04]). The only significant association with a non-communicable disease outcome was a heightened risk of death from climate-sensitive cardiovascular diseases in individuals aged 65 years and older associated with 7-day lagged daily maximum temperatures at or above 41·9°C (41·9°C 2·25 [1·06-4·81], 42·8°C 3·68 [1·46-9·25]). Over 8 cumulative weeks, we found that the risk of death from communicable diseases was heightened at all ages from temperatures at or above 41·1°C (41·1°C 1·23 [1·05-1·43], 41·9°C 1·30 [1·08-1·56], 42·8°C 1·35 [1·09-1·66]) and risk of death from malaria was heightened by precipitation at or above 45·3 cm (all ages: 45·3 cm 1·68 [1·31-2·14], 61·6 cm 1·72 [1·27-2·31], 87·7 cm 1·72 [1·16-2·55]; children younger than 5 years: 45·3 cm 1·81 [1·36-2·41], 61·6 cm 1·82 [1·29-2·56], 87·7 cm 1·93 [1·24-3·00]). INTERPRETATION:Our results indicate a high burden of death related to extreme weather in the Sahel region of west Africa. This burden is likely to increase with climate change. Climate preparedness programmes-such as extreme weather alerts, passive cooling architecture, and rainwater drainage-should be tested and implemented to prevent deaths from climate-sensitive diseases in vulnerable communities in Burkina Faso and the wider Sahel region. FUNDING:Deutsche Forschungsgemeinschaft and the Alexander von Humboldt Foundation.

Even though climate change is one of the most significant global health challenges, empirical population-based data on its impacts and adaptation measures to protect population health are still limited. The 56 long-term health cohorts in Africa and Asia, called Health and Demographic Surveillance Systems (HDSSs) are excellent for monitoring climate impact on health and adaptation measures as they: (i) follow quality controlled protocols of data collection across all sites, (ii) provide long-term continuous data, (iii) cover diverse climate hotspots, including coastal areas, rainforests, savannah and highlands, and, (iv) capture about 100-million-person years of data. However, HDSSs have not leveraged their potential for climate and health research and policy, as (i) local meteorological data or remotely sensed data is not incorporated; (ii) there are limited links to downscaled climate impact models for HDSSs; (iii) and at its core, demographic dynamics are captured, with cause of death being the major health indicator tracked over time. We introduced major improvements in data collection, database architecture, data transmission, as well as links to locally downsized climate models to capitalize on the strong potential of HDSSs sites for measuring health impacts of climate change, identifying particularly vulnerable groups, and testing the costs and effectiveness of adaptation interventions and policies to protect populations from these climate impacts. This bundle of methods called Climate and Health Surveillance and Response System (CHES-RS) aims to provide a consistent set of climate and health data which are routinely collected. The CHES-RS has already been piloted in the HDSS at the Nouna Health Research Center in Burkina Faso, and it is currently being rolled out to two other HDSS sites, one in sub-Saharan Africa, respectively in the Siaya HDSS, Kenya, and the other in the South East Asia Community Observatory (SEACO) HDSS in Malaysia. CHES-RSs are ready to conduct research in the following major health sectors: climate/weather, land use and coverage/biodiversity, agriculture/household harvest, food security, household economics, as well as research in the field of one health, including zoonotic disease surveillance. CHES-RS uses digital sensors to measure three levels of exposure: (i) Individual-level data: consumer-grade wearable devices yield objective measures in vulnerable and rural populations, and an expanded HDSS questionnaire includes a full morbidity evaluation (ii) Household-level data comprises both indoor temperature measurements and remote sensing data captured through satellites (iii) Community-level data: comes from fully automated weather stations that record temperature, precipitation, solar radiation, wind speed, and direction. To handle heterogeneous data, we leverage graph databases for data management. NA To address current and emerging global health challenges over the next few decades, CHES-RSs will serve as a novel architecture for existing HDSSs and similar infrastructures of population-based surveillance cohorts. They may encourage ecosystems for climate change and health research, as well as big data analysis using artificial intelligence (AI), potentially providing the foundation for calculating climate change-induced disability-adjusted life years (cDALYs) and loss and damages. Using a routine morbidity panel survey and objectively measured health data, CHES-RS generate data-rich cohorts in countries where good quality health data is scarce, allowing for early interventions and earlier detection of risk factors for illnesses.

Purpose: This multicountry survey assessed the levels and the determinants of the impacts of the pandemic on education and mental health among adolescents in sub-Saharan Africa and the po-tential factors that may exacerbate these adverse impacts.Methods: A phone survey was conducted among adolescents in nine diverse areas in Burkina Faso, Ethiopia, Ghana, Nigeria, and Tanzania between July and December 2021. Approximately 300 adolescents per area and 2,803 adolescents in total were included. The survey collected infor-mation on adolescents' sociodemographic characteristics, current COVID-19 preventive measures, and the impacts of the pandemic on daily activities, education, and mental health. Log-binomial models were used to calculate the adjusted prevalence ratios (aPRs) for determinants of educa-tion and mental health outcomes.Results: Overall, 17% of the adolescents were not receiving any education. Compared to boys, girls were 15% more likely than boys to lack fully in-person education (aPR: 1.15; 95% confidence in-terval [CI]: 1.02, 1.30). Rural residence was associated with 2.7 times the prevalence of not currently receiving any education (aPR: 2.68; 95% CI: 2.23, 3.22). Self-reported experience of the current impacts of the pandemic on daily activities was associated with a higher prevalence of possible psychological distress (aPR: 1.86; 95% CI: 1.55, 2.24), high anxiety level (aPR: 3.37; 95% CI: 2.25, 5.06), and high depression level (aPR: 3.01; 95% CI: 2.05, 4.41).Discussion: The COVID-19 pandemic presents continued challenges to adolescents' education and mental health. Multisectoral efforts are needed to ensure that adolescents in sub-Saharan Africa do not fall further behind due to the pandemic.(c) 2022 Society for Adolescent Health and Medicine. All rights reserved.

IntroductionBiannual mass azithromycin distribution to children aged 1–59 months has been shown to reduce all-cause mortality. Children under 28 days of age were not treated in studies evaluating mass azithromycin distribution for child mortality due to concerns related to infantile hypertrophic pyloric stenosis (IHPS). Here, we report the design of a randomised controlled trial to evaluate the efficacy and safety of administration of a single dose of oral azithromycin during the neonatal period.Methods and analysisTheNouveaux-nés et Azithromycine: une Innovation dans le Traitement des Enfants(NAITRE) study is a double-masked randomised placebo-controlled trial designed to evaluate the efficacy of a single dose of azithromycin (20 mg/kg) for the prevention of child mortality. Newborns (n=21 712) aged 8–27 days weighing at least 2500 g are 1:1 randomised to a single, directly observed, oral dose of azithromycin or matching placebo. Participants are followed weekly for 3 weeks after treatment to screen for adverse events, including IHPS. The primary outcome is all-cause mortality at the 6-month study visit.Ethics and disseminationThis study was approved by the Institutional Review Boards at the University of California, San Francisco in San Francisco, USA (Protocol #18-25027) and the Comité National d’Ethique pour la Recherche in Ouagadougou, Burkina Faso (Protocol #2018-10-123). The findings of this trial will be presented at local, regional and international meetings and published in open access peer-reviewed journals.Trial registration numberNCT03682653; Pre-results.

Even though formal education is considered a key determinant of individual well-being globally, enrollment in secondary schooling remains low in many low- and middle-income countries, suggesting that the perceived returns to such schooling may be low. We jointly estimate survival and monetary benefits of secondary schooling using detailed demographic and surveillance data from the Boucle du Mouhoun region, Burkina Faso, where national upper secondary schooling completion rates are among the lowest globally (<10%). We first explore surveillance data from the Nouna Health and Demographic Surveillance System from 1992 to 2016 to determine long-term differences in survival outcomes between secondary and higher and primary schooling using Cox proportional hazards models. To estimate average increases in asset holdings associated with secondary schooling, we use regionally representative data from the Burkina Faso Demographic Health Surveys (2003, 2010, 2014, 2017-18; N = 3,924). Survival was tracked for 14,892 individuals. Each year of schooling was associated with a mortality reduction of up to 16% (95% CI 0.75-0.94), implying an additional 1.9 years of life expectancy for men and 5.1 years for women for secondary schooling compared to individuals completing only primary school. Relative to individuals with primary education, individuals with secondary or higher education held 26% more assets (SE 0.02; CI 0.22-0.30). Economic returns for women were 3% points higher than male returns with 10% (SE 0.03; CI 0.04-0.16) vs. 7% (SE 0.02; CI 0.02-0.012) and in rural areas 20% points higher than in urban areas with 30% (SE 0.06; CI 0.19-0.41) vs. 4% (SE 0.01; CI 0.02-0.07). Our results suggest that secondary education is associated with substantial health and economic benefits in the study area and should therefore be considered by researchers, governments, and other major stakeholders to create for example school promotion programs.