Background: Malaria remains a public health challenge in low- and middle-income countries (LMICs). Despite gains from strategies like Insecticide-Treated Nets (ITNs) and Intermittent Preventive Treatment during pregnancy (IPTp), significant socioeconomic inequalities persist, particularly among pregnant women and children under five. This study analyzed temporal and socioeconomic inequalities in malaria prevention in sub-Saharan Africa (SSA). Methods: Nationally representative Demographic Health Surveys from 10 SSA countries (Mozambique, Burkina Faso, Tanzania, Côte d’Ivoire, Madagascar Kenya, Rwanda, Nigeria, Uganda, and Cameroon) were used, comparing two time periods. Changes in ITN use by pregnant women and children under five, as well as IPTp coverage, were assessed. Inequalities based on socioeconomic status (SES) and residence were analyzed using the Erreygers Normalized Concentration Index and Theil index. Results: The results revealed significant variability in ITN use and IPTp coverage within countries. Eight countries showed improvements in ITN use during pregnancy, with Nigeria seeing a 173.9% increase over five years. Burkina Faso and Tanzania consistently reported high ITN use (~87%) in children under five. IPTp coverage increased in all countries except Kenya. Decomposition using the Theil index indicated that within-group inequalities, particularly based on SES and residence, were the primary drivers of disparities. Conclusions: To ensure progress toward universal health coverage, malaria prevention programs must prioritize vulnerable populations and be continuously evaluated.

Background: South Africa uses government-funded return-of-service (RoS) schemes to train, recruit and retain skilled health professionals in underserved areas. These educate health professionals locally or internationally in return for a commitment to serve in a specified area for an agreed period. While such schemes are used widely and are funded by substantial public funds, their exact makeup differs across jurisdictions, and little is known about why these differences have emerged or how they influence their effectiveness or impact on the health system. We aimed to fill these gaps through an analysis of the origins, architecture, and evolution of RoS schemes in South Africa. Methods: A multimethod research study including a policy review, a literature review, and semi-structured interviews of policymakers was undertaken between October 2020 and August 2022. The included policy documents and literature were analysed using the Walt and Gilson framework and narrative synthesis. Qualitative data were analysed using inductive, thematic analysis in NVIVO 12. Results: RoS schemes are used as a recruitment and retention strategy and a mechanism to address equity in access to medical education. Whilst there is evidence of RoS schemes existing in 1950, no evidence of beneficiaries was found in databases until 1989. The impact of these schemes is likely being limited by sub-optimal institutional arrangements and poor transparency in their design and implementation. Conclusion: Despite rigorous research methods, the origins of RoS policies in South Africa could not be established due to poor preservation of institutional memory. Opportunities to monitor the value of public investment into RoS programs are being missed and often the underlying objective of the programs has not been well-specified. Policies were found to have been developed and operate in isolation from other health workforce planning activities and thus may not be maximising their impact as a retention and training tool.

Background: The need for competent research managers and administrators (RMAs) has increased due to the complexity in managing research projects between disparate and international partners. To facilitate the creation of robust training and professional development programmes it is essential to first understand the status quo. A collaborative project, Sustainable Management and Administration for Research: Training across the project Lifecycle (SMARTLife), made up of RMAs from South Africa, Zimbabwe and the United Kingdom (UK) developed a set of competencies to conduct an RMA competency-based training needs assessment scoping tool. Method: Nine areas were identified: Equitable partnership; Finance Management; Project Management; Monitoring and Evaluation; Reporting and Communications; Equity, Diversity & Inclusion; Training and Capacity Development; Impact a& Sustainability; and Ethical, Social, Legal a& Social Implications. Tasks for each competency area were identified to develop an scoping tool that had 168 data collection points. The tool was advertised through press releases, mailing lists and social media. Results: 108 responses were obtained: with 49% from 15 Africa countries/the remainder from the UK. The UK (71%) had more permanent RMA staff members compared to Africa (39%). There were more respondents in Africa with the title of Research Manager/Coordinator(p=0.0132) compared to the UK where most of the RMAs were employed as Finance/Contract officers. 60% of respondents from the UK had more than three years experience while only 35% from Africa had experience. While most RMAs had formal higher education qualifications, their training was not in research management and administration, which requires a diverse range of skills. Confidence in specific tasks varied between the UK and Africa whereas collaborative partnerships challenges and enablers were similar. Conclusion This work highlights differences in RMA training and experience RMA between Africa and UK, this work could inform much needed competency-based training for RMAs and partnership strategies that aid mutual-learning.

Malaria remains a public health challenge in low- and middle-income countries (LMICs). Despite gains from strategies like Insecticide Treated Nets (ITNs) and Intermittent Preventive Treatment during pregnancy (IPTp), significant socioeconomic inequalities persist, particularly among pregnant women and children under five. This study analysed temporal and socioeconomic inequalities in malaria prevention in sub-Saharan Africa (SSA). Methods: Nationally representative Demographic Health Surveys from 10 SSA countries were used, comparing two time periods. Changes in ITN use by pregnant women and children under five, as well as IPTp coverage, were assessed. Inequalities based on socioeconomic status (SES) and residence were analysed using the Erreygers Normalized Concentration Index and Theil index.. Results: Results revealed significant variability in ITN use and IPTp coverage between and within countries. Eight countries showed improvements in ITN use during pregnancy, with Nigeria seeing a 173.9% increase over five years. Burkina Faso and Tanzania consistently reported high ITN use (~87%) in children under five. IPTp coverage increased in all countries except Kenya. Decomposition using the Theil index indicated that within-group inequalities, particularly based on SES and residence, were the primary drivers of disparities. Conclusion: To ensure progress toward universal health coverage, malaria prevention programs must prioritize vulnerable populations and be continuously evaluated.

Background Malaria is one of the leading causes of mortality among pregnant women and children in Africa. Despite efforts to distribute insecticide-treated nets (ITNs) and provide intermittent preventive treatment in pregnancy (IPTp) in Ghana, significant socioeconomic inequalities persist. This study investigates the temporal trends in socioeconomic inequalities related to ITN and IPTp coverage among children and pregnant women in Ghana. Methods We utilized data from the Ghana Demographic and Health Surveys (DHS) for 2003, 2008, 2014, and 2022. We assessed ITN use by pregnant women and children under five, and IPTp coverage, employing the Erreygers normalized concentration index (ENCI) and Theil index to measure and decompose inequalities by socioeconomic status (SES) and residence. Results ITN use among children under five increased from 58.11% in 2003 to 62.86% in 2022, while ITN use among pregnant women showed fluctuations, dropping in 2008 and 2014 but rising to 60% in 2022. IPTp coverage increased steadily from 0.85% in 2003 to 60% in 2022. Overall socioeconomic inequalities in ITN use and IPTp coverage were predominantly driven by within-group rather than between-group inequalities. ITN use was higher among the poorest households, while IPTp coverage showed a pro-rich distribution in recent years. Conclusion Despite improvements in malaria prevention uptake, significant inequalities persist in Ghana. Addressing these disparities requires a multipronged approach, including strengthening supply chains, tailoring interventions to specific population needs, and reducing healthcare access barriers. Policies must focus on localized factors and specific barriers faced by disadvantaged groups to achieve equitable health outcomes in malaria prevention.