The increasing burden of non-communicable diseases (NCDs), particularly cardiovascular diseases (CVD) in low- and middle-income countries (LMICs) poses a considerable threat to public health. Community-driven CVD risk screening, referral and follow-up of those at high CVDs risk is essential to supporting early identification, treatment and secondary prevention of cardiovascular events such as stroke and myocardial infarction. This protocol describes a multi-country study that aims to implement and evaluate a community health worker (CHW)-led CVD risk screening programme to enhance referral linkages within the local primary care systems in sub-Saharan Africa (SSA), using a participatory implementation science approach. The study builds upon a prior community-driven multicentre study conducted by the Collaboration for Evidence-based Health Care and Public Health in Africa (CEBHA+). This is a participatory implementation research. The study will leverage on the CVD risk citizen science pilot studies conducted in the four selected CEBHA+ project countries (viz. Ethiopia, Rwanda, Malawi, and South Africa). Through planned engagements with communities and health system stakeholders, CHWs and lay health worker volunteers will be recruited and trained to screen and identify persons that are at high risk of CVD, provide referral services, and follow-up at designated community health clinics. In each country, we will use a multi-stage random sampling to select and then screen 1000 study participants aged 35–70 years from two communities (one rural and one urban). Screening will be done using a simple validated non-laboratory-based CVD risk assessment mobile application. The RE-AIM model will be used in evaluating the project implementation outcomes, including reach, fidelity, adoption and perceived effectiveness. Developing the capacities of CHWs and lay health worker volunteers in SSA to support population-based, non-invasive population-based CVD risk prevention has the potential to impact on early identification, treatment and secondary prevention of CVDs in often under-resourced communities. Using a participatory research approach to implementing mobile phone-based CHW-led CVD risk screening, referral and follow-up in SSA will provide the evidence needed to determine the effectiveness of CVD risk screening and the potential for scaling up in the wider region.

Artificial intelligence (AI) is a rapidly evolving technology with transformative potential across many fields, including health. Interest in AI is growing globally, including in low- and middle-income countries (LMICs), but few studies have assessed the knowledge, experiences, and ethical practices of innovators in this space. This study aimed to assess the knowledge, experiences, challenges, and ethical practices of researchers and innovators, involved in AI-driven health research, to support the responsible integration of AI into health innovation. A cross-sectional, semi-quantitative online survey was conducted between February and May 2025 among health AI innovators in LMICs, primarily through the Grand Challenges network and its partners. Fifty respondents from 13 countries participated, the majority (92%) emphasized the importance of ethical principles, and 80% perceived AI-related ethical risks as greater than moderate. However, the majority of respondents (74%) were not sure about their competence in identifying and addressing the risks associated with AI practices and the same proportion reported having received no formal training in AI ethics. Respondents identified key challenges such as weak governance, limited ethics capacity, and risks of bias and data misuse. There was strong demand for training on ethics, bias mitigation, explainability, data governance, and privacy. The findings reveal an encouraging level of awareness but emphasize the need for formal training, clearer guidelines, and context-specific frameworks to ensure ethical AI development and deployment in health research.

Background: The rise in non-communicable diseases (NCDs) burden, particularly, cardiovascular diseases (CVDs) in Ethiopia is driven by rapid urbanization, globalization, urban poverty, a shift in diet and physical inactivity. To tackle this, adoption of appropriate lifestyle and behaviour modifications are required. Such behavioural adoption in turn demands appropriate knowledge about the risk factors, and a reasonably perception of threat of CVDs. Objective: To explore CVDs risk perception, communication, and health seeking intentions of residents of rural and urban communities in Ethiopia.Methods: We conducted four focus group discussions (FGDs) and semi-structured risk communication interviews with residents of two communities (urban and rural) in Ethiopia. Two FGDs were conducted in each of the rural and urban communities with separate groups for men and women. The FGD participants were purposively selected with the help of local health extension workers. The FGDs were facilitated by a trained public health researcher, using a FGD guide, and risk communication cue cards. The textual data was analyzed using thematic analysis approach. Results: In general, awareness of CVDs and conceptualization of disease risk in both setting were low, and risk scores concepts were based on cultural beliefs and setting-specific knowledge, especially in the rural areas. Many participants had not perceived any threat, and indicated limited susceptibility to CVDs, despite their belief that the risk factors are common. Participants that indicated having a prior CVDs diagnosis, did not readily accept their diagnosis, or disclose their status to others, or seek medical care. Some urban participants thought that CVDs are untreatable owing to inaccessibility of care and the common belief that this ‘is the will of God’. Consequently, participants had often opted for traditional or ‘miraculous’ religious healing practices, and, therefore, did not rely on chronic disease management advice.Interviews using communication cue cards revealed that how and by whom a risk message was communicated was an important consideration for a message to be accepted, and to elicit subsequent health-seeking intention, and possible action(s).Conclusion: Supporting community-level collaborative learning about CVDs, and their risk factors can support optimal evaluation of personal risk and perception of the threat of CVDs.