Olalekan John Okesanya

BACKGROUND: Suboptimal water, sanitation, and hygiene (WASH) practices constitute a serious public health risk, affecting one-third of the world's population. Remarkable progress has been made to improve WASH; however, challenges remain, with rapid population growth adding pressure on WASH systems. This study explores the current state of WASH practices and diseases in Africa, identifies challenges, and proposes public health recommendations for sustainable implementation. MAIN BODY: The staggering burden of WASH-related diseases in low- and middle-income countries (LMICs), particularly in Africa, threatens public health, with millions of deaths and disability-adjusted life years (DALYs) attributed to poor WASH practices annually. Notable challenges plaguing WASH practices in the region include poverty, malnutrition, poor data reporting, illiteracy, climate change, and poor healthcare financing. This results in adverse health consequences, including waterborne infections like cholera, typhoid, dysentery, and diarrheal diseases. Additionally, neglected tropical diseases (NTDs) such as intestinal worms, schistosomiasis, trachoma, lost productivity, and environmental pollution from soil and underground water contamination have been implicated. Geographical disparities, cultural norms, and inadequate funding further complicate efforts to improve WASH infrastructure and practices. Globally concerted efforts are required to address these issues and permit WASH practices to protect human health by preventing infectious diseases and contributing to economic growth. Strong financial frameworks, skills training, and tools like WASH Fit are recommended for a stronger WASH approach in Africa. CONCLUSION: The consequences of poor WASH extend beyond public health, impacting economic growth, gender equality, and environmental sustainability. WaterAid's policy recommendations prioritizing government administration, institutional capacity enhancement, and more financial resources are expedient.

Digital health innovations are reshaping global healthcare systems by enhancing access, efficiency, and quality of care. Technologies such as artificial intelligence, telemedicine, mobile health applications, and big data analytics have been widely applied to support disease surveillance, enable remote care, and improve clinical decision making. This review critically identifies persistent implementation challenges that hinder the equitable adoption of digital health solutions, such as the digital divide, limited infrastructure, and weak data governance, particularly in low- and middle-income countries (LMICs). It aims to propose strategic pathways for integrating digital innovations to strengthen universal health coverage (UHC) and bridge health disparities in the region. By analyzing the best global practices and emerging innovations, this study contributes to the ongoing dialogue on leveraging digital health for inclusive, scalable, and sustainable healthcare delivery in underserved regions.

Background: Antimicrobial resistance (AMR) is a critical global health concern that threatens the efficacy of existing antibiotics and poses significant challenges to public health and the economy worldwide. This review explores the potential of CRISPR-Cas systems as a novel approach to combating AMR and examines current applications, limitations, and prospects. Methods: A comprehensive literature search was conducted across multiple databases, including PubMed, Google Scholar, Scopus, and Web of Science, covering publications published from 2014 to August 2024. This review focuses on CRISPR-Cas technologies and their applications in AMR. Results: CRISPR-Cas systems have demonstrated efficacy in combating antimicrobial resistance by targeting and eliminating antibiotic-resistance genes. For example, studies have shown that CRISPR-Cas9 can effectively target and eliminate colistin resistance genes in MCR-1 plasmids, restoring susceptibility to carbapenems in bacteria such as E. coli and Klebsiella pneumoniae . Further molecular findings highlight the impact of CRISPR-Cas systems on various bacterial species, such as Enterococcus faecalis, in which CRISPR systems play a crucial role in preventing the acquisition of resistance genes. The effectiveness of CRISPR-Cas in targeting these genes varies due to differences in CRISPR locus formation among bacterial species. For instance, variations in CRISPR loci influence the targeting of resistance genes in E. faecalis , and CRISPR-Cas9 successfully reduces resistance by targeting genes such as tetM and ermB. Conclusion: CRISPR-Cas systems are promising for fighting AMR by targeting and eliminating antibiotic-resistant genes, as demonstrated by the effective targeting of colistin resistance genes on MCR-1 plasmids and their similar activities. However, the effectiveness of CRISPR-Cas is affected by variations in the CRISPR loci among bacterial species. Challenges persist, such as optimizing delivery methods and addressing off-target effects to ensure the safety and precision of CRISPR-Cas systems in clinical settings. Keywords: CRISPR-Cas systems, antimicrobial resistance, gene editing, bacteriophage delivery

The healthcare industry is constantly evolving to bridge the inequality gap and provide precision care to its diverse population. One of these approaches is the integration of digital health tools into healthcare delivery. Significant milestones such as reduced maternal mortality, rising and rapidly proliferating health tech start-ups, and the use of drones and smart devices for remote health service delivery, among others, have been reported. However, limited access to family planning, migration of health professionals, climate change, gender inequity, increased urbanization, and poor integration of private health firms into healthcare delivery rubrics continue to impair the attainment of universal health coverage and health equity. Health policy development for an integrated health system without stigma, addressing inequalities of all forms, should be implemented. Telehealth promotion, increased access to infrastructure, international collaborations, and investment in health interventions should be continuously advocated to upscale the current health landscape and achieve health equity.

Mental health is a crucial but frequently neglected aspect of general health and well-being that faces numerous challenges, including underfunding, shortage of trained professionals, pervasive stigma, inadequate infrastructure, and insufficient policies in sub-Saharan Africa. This review reports the significant progress and initiatives that have been made in this region. South Africa, Nigeria, Uganda, Kenya, Tanzania, Ethiopia, Rwanda, and Ghana have developed national policies and integrated mental health services into primary healthcare, marking a shift towards community-based care and reducing stigma through awareness campaigns. Countries such as South Africa and Rwanda have robust infrastructure, while Ethiopia and Kenya emphasize training primary healthcare providers and community-based models. Ghana's Mental Health Act and Uganda's collaboration with NGOs has enhanced awareness and resource mobilization. Mental healthcare-targeted programs, such as Kenya's Friendship Bench and Ethiopia's Health Extension Program, have demonstrated the efficacy of community-based interventions. South Africa has leveraged innovative approaches, such as telepsychiatry, to expand access to holistic mental health services, particularly in rural areas. Partnerships with traditional healers in Uganda and Rwanda have enhanced early identification and referral. Despite these advancements, challenges persist. Common issues include a severe shortage of mental health professionals, inadequate budget allocation, limited access to services in rural areas, and the need for comprehensive policy frameworks that continue to stall the desired goals. Urban-centric services in Nigeria, financial constraints in Tanzania, and resource limitations in Ethiopia and Rwanda have hindered equitable access. While public-private partnerships and technological innovations are emerging, the dominance of institutionalized care in several regions limits community outreach. To chart the path forward, improving mental health services in Sub-Saharan Africa requires increased funding, expanded training programs for mental health professionals, and incorporation of mental health into basic healthcare systems. Utilizing technology such as telemedicine and mobile health applications holds promise for overcoming geographical barriers and supporting ongoing education. Community-based models and advocacy efforts are essential for reducing stigma, promoting sustainable mental healthcare, and enhancing the overall well-being of citizens insub-Saharan Africa.