Baobab Index

Enteric infectious diseases claim more than 1 million lives annually and are among the top ten causes of death in children younger than 5 years. Remarkable global investment has been dedicated to enteric infectious disease prevention and control; however, the shifting global health landscape is testing the continuance of progress. To evaluate the current status and guide future interventions, we present the latest epidemiological estimates of enteric infectious diseases from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2023 and assess progress towards the Global Action Plan for the Prevention and Control of Pneumonia and Diarrhoea (GAPPD) mortality target of fewer than 20 deaths per 100 000 children younger than 5 years by 2025. We quantified the incidence, mortality, and disability-adjusted life-years (DALYs) of enteric infectious diseases by age, sex, and year across 204 countries and territories from 1990 to 2023. In GBD 2023, the following were considered under the category of enteric infectious diseases: diarrhoeal diseases, enteric fever (typhoid and paratyphoid), invasive non-typhoidal Salmonella spp (iNTS) infections, and other intestinal infectious diseases. We also examined 15 aetiologies contributing to diarrhoeal diseases. Incidence and prevalence were estimated with DisMod-MR (version 2.1), a Bayesian meta-regression tool, drawing on data from systematic reviews, population-based surveys, claims data, and hospital sources. Cause-specific mortality was modelled with Cause of Death Ensemble Modelling based on data from sources including vital registration, mortality surveillance, verbal autopsy, and minimally invasive tissue sampling. Years of life lost and years lived with disability were computed and combined to derive DALYs. For aetiology-specific estimation, population-attributable fractions (PAFs) for 15 pathogens were derived with a counterfactual framework. Point estimates and 95% uncertainty intervals (UIs) were generated from 250 draws from the posterior distribution. In 2023, enteric infectious diseases resulted in an estimated 1·27 million (95% UI 0·963-1·68) deaths globally, declining from 3·69 million (3·04-4·56) in 1990. The global age-standardised mortality rate (ASMR) decreased from 74·1 (62·0-92·9) per 100 000 population to 16·4 (12·6-21·3) per 100 000 population during the same period. Diarrhoeal diseases accounted for most deaths in 2023 (1·11 million [0·811-1·54]), followed by enteric fever and iNTS. South Asia and sub-Saharan Africa remained the most affected regions in 2023, with 599 000 (441 000-882 000) and 501 000 (373 000-648 000) deaths due to enteric infectious diseases, respectively, predominantly from diarrhoeal disease. Rotavirus was the leading cause of all-age diarrhoeal disease deaths (PAF 16·3% [12·0-21·5]), followed by norovirus (10·2% [2·4-17·0]) and Shigella spp (9·3% [5·4-15·2]). Among children younger than 5 years, PAFs of deaths due to diarrhoeal diseases were 40·2% (32·5-48·5) for rotavirus, 24·0% (15·1-36·7) for Shigella spp, and 23·4% (13·7-34·3) for adenovirus. Across 204 countries and territories, 141 met the GAPPD mortality target in 2023. The driving aetiologies among countries that did not meet the target in 2023 varied slightly by GBD super-region, but the highest or second-highest number of deaths in children younger than 5 years were consistently attributed to rotavirus. Astrovirus and sapovirus, newly included in GBD 2023, were responsible for 24 600 (6290-49 000) and 18 800 (4650-44 400) deaths, respectively, in 2023, mainly in children younger than 5 years. Our findings show that mortality and ASMRs of enteric infectious diseases declined substantially between 1990 and 2023. This decline is consistent with the expansion of public health measures and broader socioeconomic development. However, the burden in 2023 remains considerably high, with the highest mortality concentrated in sub-Saharan Africa and south Asia. Considering that more than a quarter of all countries had yet to meet the GAPPD mortality target in 2023, sustained efforts are needed to address the persistent burden in affected countries and to adapt to the changing global health landscape. Gates Foundation.

Breeding root, tuber, and cereal crops faces the critical challenge of unlocking extensive genetic variation and addressing complex gene-environment interplays to boost yield, quality, and resilience. Recent technological advances in pangenomics, multi-omics data integration, and artificial intelligence (AI)-driven predictive modeling offer unparalleled opportunities to transform crop improvement. Pangenomics transcends the limitations of single reference genomes by encompassing the full genomic diversity within species, capturing critical structural variations and rare alleles that underpin stress tolerance and productivity traits. When layered with multi-omics datasets spanning genomics, transcriptomics, proteomics, and metabolomics, a holistic insight is gained into molecular networks governing plant adaptation and development. State-of-the-art AI methodologies harness these complex datasets, enabling precise genomic selection, accurate trait prediction, and discovery of novel candidate genes, thereby optimizing breeding pipelines. This review presents current knowledge on how this synergistic approach heralds a new era of climate-smart agriculture, empowering resilient, high-performing cultivars essential for global food security amid escalating environmental uncertainties with a particular focus on root, tuber and cereal crop genetic enhancement through pangenomics and multi-omics integration and AI-driven predictive modeling. Together, these innovations enable tailored breeding strategies that align genetic potential with environmental specificity and farmer needs, while highlighting the remaining hurdles-data standards, model interpretability, computational cost, and equitable access-that must be addressed to realize widespread impact. Demonstrated in staple crops such as maize, rice, wheat, potato, and cassava, this integrated framework accelerates genetic gain by reducing breeding cycles and facilitating allele introgression from wild relatives. The integrative approach also provides a better understanding of resolving persistent hurdles around data standardization, interpretability, computational demands, and equitable technology access. We recommend, (i) training on diverse, field-collected datasets; (ii) integrating envirotyping covariates into genomic selection to quantify G×E interactions; (iii) adopting standardized metadata schemas; and (iv) fostering interdisciplinary collaboration.

The large 2025 Mpox clade IIb outbreak in Sierra Leone underscores the urgent need for portable, low-cost diagnostics in decentralized settings. While CRISPR-based assays offer high sensitivity and flexibility, their deployment during active outbreaks remains limited. Here we show the rapid development and field evaluation of Mpox SHINE, a CRISPR-Cas13 assay that integrates lyophilized reagents, ambient-temperature lysis, and automated fluorescence detection on the portable DxHub device. The assay achieves analytical sensitivity down to 10 copies/µL. Clinical validation in Sierra Leone, using 56 clinical specimens, confirms complete concordance with qPCR, demonstrating 100% sensitivity and 100% specificity. Crucially, Mpox SHINE also detects the virus directly from unextracted lesion swabs while maintaining 100% sensitivity and specificity. The mean time-to-result is fast, averaging 11.4 minutes for extracted samples and 27.9 minutes for unextracted samples. These findings demonstrate that CRISPR-based diagnostics translate quickly from genomic sequence to clinically validated, deployable tools within a single outbreak window.

• First set of three complete genomic sequences of RABV strains was obtained from Sierra Leone. • Phylogenetic analysis identified the endemic Africa 2H subclade with high homology to those from neighboring countries. • Low dog vaccination coverage underscores urgent need for coordinated vaccination and surveillance.

Lassa fever is a viral zoonotic disease that sickens tens of thousands of people each year when it spills over from its rodent reservoir throughout West Africa. Despite the burden this persistent spillover places on public health, stopping it has proven to be an intractable challenge despite decades of investment and effort. A revolutionary solution is the development of a transmissible vaccine that can spread through the rodent population resulting in immune coverage sufficient to eliminate Lassa virus transmission. Here, we evaluate the feasibility of a transmissible vaccine constructed from native cytomegaloviruses (CMVs) previously isolated from the natural reservoir of Lassa virus, Mastomys natalensis. Using a combination of field sampling, large-scale CMV genome characterization, and mathematical models parameterized using Bayesian methods, we quantified transmission rates and interactions among viruses in northern Sierra Leone. The results demonstrate that two of the three previously isolated CMVs co-infect freely and have R0 values consistent with autonomous elimination of Lassa virus from its rodent reservoir. These results set the stage for the development of a CMV vectored transmissible vaccine that could stop the spillover of Lassa virus throughout West Africa.

Infectious diseases, particularly acquired immunodeficiency syndrome (AIDS) caused by the human immunodeficiency virus (HIV), remain a major global health burden, especially in low- and middle-income countries, despite advances in antiretroviral therapy. Emerging genome-editing technologies, such as CRISPR/Cas systems, hold promise for transforming the diagnosis and treatment of infectious diseases. However, little is known about how these technologies are understood and perceived by individuals in high-burden regions, where significant implementation challenges may limit their adoption. This study assessed knowledge, perceptions, and the potential application of CRISPR technology for infectious disease control in Ghana, Nigeria, and Sierra Leone. This multi-center cross-sectional study was conducted among 300 participants, including students, healthcare professionals, and researchers across the three countries. Data was collected using a well-structured questionnaire and analyzed using logistic regression and structural equation modeling (SEM) to identify the predictors of potential CRISPR applications. The study revealed a significant gap, such that the majority (87.0%) of the participants demonstrated inadequate knowledge, with 70.7% exhibiting poor perception of CRISPR technology. Major barriers to implementation included funding constraints (81.7%) and inadequate infrastructure (62.3%). Adjusted multivariable logistic regression identified inadequate knowledge (aOR: 3.90; p < 0.0001) and poor perception (aOR: 1.96; p = 0.0060) as independent predictors of low CRISPR application potential. Structural equation modeling confirmed that knowledge significantly enhances perception (β = 0.55), and both constructs jointly influence the potential application of CRISPR gene editing technology. There is a critical deficit in knowledge and perception regarding CRISPR gene editing in Sub-Saharan Africa, which significantly hinders its potential application for infectious diseases. Comprehensive educational strategies and capacity building are essential to foster the adoption of CRISPR technology, especially in resource-limited settings.

Gender equity and community engagement are increasingly recognised as important for the implementation of equitable One Health (OH) actions, yet no published studies examine how these are operationalised in policies and programmes. We analyse policy content and stakeholder perspectives on community engagement and gender equity in OH policies and programmes in Guinea, Liberia, Nigeria and Sierra Leone. Mixed methods encompassed: content analysis of OH documents (7 core and 9 supporting); key informant interviews (KIIs) with policy stakeholders ( All countries have national OH strategic plans. All except Liberia contain substantive mention of community engagement, but only Sierra Leone provides any operational details. No country operationalises gender equity in their OH policies, although Sierra Leone has taken steps towards this and has a Gender Equality Act.Across all countries, policy stakeholders highlighted community engagement as indispensable to OH implementation but showed little urgency in tackling challenges and completely overlooked gender equity, which highlights a critical gap.Community members revealed how community engagement in OH is gendered across all contexts. Cultural norms often limited women's full participation, though this improved over time, while women's lower literacy limited their leadership roles and ability to report disease cases, with Nigeria an exception.Trust emerged as fragile but foundational to OH engagement. In all countries, community trust was mediated by chiefs, elders, and religious leaders, but trust in surveillance activities could be lost when government response or action to OH reporting was lacking. Gender-equitable community engagement is a structural necessity for effective One Health programmes. Our research has shown that there is potential for OH actions to be transformed at the community level through strong, inclusive engagement with women as equal partners.

Clinical pharmacology and pharmacometrics are central to understanding patient response to new and existing therapies, yet access to training in Africa remains limited, particularly in francophone countries where language is a barrier. We report the design and implementation of a 12-week French-language online course combining asynchronous lessons with live interactive sessions. The inaugural cohort enrolled 72 students from Senegal (n = 37), Tunisia (n = 24), and the Democratic Republic of the Congo (n = 11). While only one-third completed the full program, all survey respondents judged the course useful, highlighting clear objectives and adequate preparation time. Challenges related to perceived workload, time-zone difference in scheduling, and internet connectivity were reported by participants. A second iteration of the course hosted by the Tunisia Chapter of Pharmacometrics Africa has just completed and will gather further feedback and attempt to address lessons learnt. This proof-of-concept hands-on educational program demonstrates that delivering training in French through an online format can effectively expand access to pharmacometrics education in Africa. Strengthening local institutional partnerships to take on technical support will be critical to improving participant retention and ensuring program sustainability. Moreover, this model could be adapted to other languages and extended to additional regions, thereby promoting more inclusive global capacity building.