
Decentralization and Integration of Advanced Cardiac Care for the World’s Poorest Billion Through the PEN-Plus Strategy for Severe Chronic Non-Communicable Disease
By: Sheila L. Klassen, Emmy Okello, Jose M. E. Ferrer, Faraz Alizadeh, Prebo Barango, Pilly Chillo, Yamikani Chimalizeni, Wubaye Walelgne Dagnaw, Jean-Luc Eiselé, Lauren Eberly, Anu Gomanju, Neil Gupta, Bhagawan Koirala, Jacques Kpodonu, Gene Kwan, Bright G. D. Mailosi, Lilian Mbau, Reuben Mutagaywa, Colin Pfaff, Daniel Piñero, Fausto Pinto, Emmanuel Rusingiza, Usman Abiola Sanni, Amy Sanyahumbi, Urmila Shakya, Sanjib Kumar Sharma, Kunjang Sherpa, Isaac Sinabulya, Emily B. Wroe, Gene Bukhman and Ana Mocumbi
References
- Callender T, Woodward M, Roth G, Farzadfar F, Lemarie J-C, Gicquel S, Atherton J, Rahimzadeh S, Ghaziani M, Shaikh M, Bennett D, Patel A, Lam CSP, Sliwa K, Barretto A, Siswanto BB, Diaz A, Herpin D, Krum H, Eliasz T, Forbes A, Kiszely A, Khosla R, Petrinic T, Praveen D, Shrivastava R, Xin D, MacMahon S, McMurray J, Rahimi K. Heart failure care in low- and middle-income countries: A systematic review and meta-analysis. PLoS Med. 2014; 11(8):
e1001699 . DOI: 10.1371/journal.pmed.1001699 - UnitedNations, Department of Economic and SocialAffairs, PopulationDivision. World urbanization prospects: The 2018 revision. 2019.
https://population.un.org/wup/Publications/Files/WUP2018-Report.pdf . - United National Development Programme and Oxford Poverty and Human DevelopmentInitiative. Global Multidimensional Poverty Index. 2022.
https://ophi.org.uk/multidimensional-poverty-index/ . - Agbor VN, Essouma M, Ntusi NAB, Nyaga UF, Bigna JJ, Noubiap JJ. Heart failure in sub-Saharan Africa: A contemporaneous systematic review and meta-analysis. Int J Cardiol. 2018; 257: 207–215. DOI: 10.1016/j.ijcard.2017.12.048
- Damasceno A, Mayosi BM, Sani M, Ogah OS, Mondo C, Ojji D, Dzudie A, Kouam CK, Suliman A, Schrueder N, Yonga G, Ba SA, Maru F, Alemayehu B, Edwards C, Davison BA, Cotter G, Sliwa K. The causes, treatment, and outcome of acute heart failure in 1006 Africans from 9 countries: Results of the Sub-Saharan Africa Survey of Heart Failure. Arch Intern Med. 2012; 172(18): 1386. DOI: 10.1001/archinternmed.2012.3310
- Joseph P, Roy A, Lonn E, Störk S, Floras J, Mielniczuk L, Rouleau JL, Zhu J, Dzudie A, Balasubramanian K, Karaye K, AlHabib KF, Gómez-Mesa JE, Branch KR, Makubi A, Budaj A, Avezum A, Wittlinger T, Ertl G, Mondo C, Pogosova N, Maggioni AP, Orlandini A, Parkhomenko A, ElSayed A, López-Jaramillo P, Grinvalds A, Temizhan A, Hage C, Lund LH, Kazmi K, Lanas F, Sharma SK, Fox K, McMurray JJV, Leong D, Dokainish H, Khetan A, Yonga G, Kragholm K, Wagdy Shaker K, Mwita JC, Al-Mulla AA, Alla F, Damasceno A, Silva-Cardoso J, Dans AL, Sliwa K, O’Donnell M, Bazargani N, Bayés-Genís A, McCready T, Probstfield J, Yusuf S. Global variations in heart failure etiology, management, and outcomes. JAMA. 2023; 329(19): 1650–1661. DOI: 10.1001/jama.2023.5942
- Yusuf S, Rangarajan S, Teo K, Islam S, Li W, Liu L, Bo J, Lou Q, Lu F, Liu T, Yu L, Zhang S, Mony P, Swaminathan S, Mohan V, Gupta R, Kumar R, Vijayakumar K, Lear S, Anand S, Wielgosz A, Diaz R, Avezum A, Lopez-Jaramillo P, Lanas F, Yusoff K, Ismail N, Iqbal R, Rahman O, Rosengren A, Yusufali A, Kelishadi R, Kruger A, Puoane T, Szuba A, Chifamba J, Oguz A, McQueen M, McKee M, Dagenais G. Cardiovascular risk and events in 17 low-, middle-, and high-income countries. N Engl J Med. 2014; 371(9): 818–827. DOI: 10.1056/NEJMoa1311890
- Okello E, Longenecker C, Beaton A, Kamya MR, Lwabi P. Rheumatic heart disease in Uganda: Predictors of morbidity and mortality one year after presentation. BMC Cardiovascular Disorders. 2017; 17: Article 20. DOI: 10.1186/s12872-016-0451-8
- Dokainish H, Teo K, Zhu J, Roy A, AlHabib KF, ElSayed A, Palileo-Villaneuva L, Lopez-Jaramillo P, Karaye K, Yusoff K, Orlandini A, Sliwa K, Mondo C, Lanas F, Prabhakaran D, Badr A, Elmaghawry M, Damasceno A, Tibazarwa K, Belley-Cote E, Balasubramanian K, Yacoub MH, Huffman MD, Harkness K, Grinvalds A, McKelvie R, Yusuf S. Heart failure in Africa, Asia, the Middle East and South America: The INTER-CHF study. Int J Cardiol. 2016; 204: 133–141. DOI: 10.1016/j.ijcard.2015.11.183
- Eberly LA, Rusingiza E, Park PH, Ngoga G, Dusabeyezu S, Mutabazi F, Harerimana E, Mucumbitsi J, Nyembo PF, Borg R, Gahamanyi C, Mutumbira C, Ntaganda E, Rusangwa C, Kwan GF, Bukhman G. Understanding the etiology of heart failure among the rural poor in sub-Saharan Africa: A 10-year experience from district hospitals in Rwanda. J Card Fail. 2018; 24(12): 849–853. DOI: 10.1016/j.cardfail.2018.10.002
- Bukhman G, Mocumbi AO, Atun R, Becker AE, Bhutta Z, Binagwaho A, Clinton C, Coates MM, Dain K, Ezzati M, Gottlieb G, Gupta I, Gupta N, Hyder AA, Jain Y, Kruk ME, Makani J, Marx A, Miranda JJ, Norheim OF, Nugent R, Roy N, Stefan C, Wallis L, Mayosi B. The Lancet NCDI Poverty Commission: Bridging a gap in universal health coverage for the poorest billion. The Lancet. 2020; 396: 991–1044. DOI: 10.1016/S0140-6736(20)31907-3
- Kennedy N, Miller P. The spectrum of paediatric cardiac disease presenting to an outpatient clinic in Malawi. BMC Res Notes. 2013; 6(1): Article 53. DOI: 10.1186/1756-0500-6-53
- Namuyonga J, Lubega S, Aliku T, Omagino J, Sable C, Lwabi P. Pattern of congenital heart disease among children presenting to the Uganda Heart Institute, Mulago Hospital: A 7-year review. Afr Health Sci. 2020; 20(2): 745–752. PMID: 33163039. PMCID: PMC7609125. DOI: 10.4314/ahs.v20i2.26
- Majani N, Chillo P, Slieker MG, Sharau G, Mlawi V, Mongella S, Nkya D, Khuboja S, Kwesigabo G, Kamuhabwa A, Janabi M, Grobbee D. Newborn screening for critical congenital heart disease in a low-resource setting; Research protocol and preliminary results of the Tanzania Pulse Oximetry Study. Global Heart. 2022; 17(1): 32. DOI: 10.5334/gh.1110
- Eberly LA, Rusingiza E, Park PH, Ngoga G, Dusabeyezu S, Mutabazi F, Gahamanyi C, Ntaganda E, Kwan GF, Bukhman G. 10-year heart failure outcomes from nurse-driven clinics in rural sub-Saharan Africa. J Am Coll Cardiol. 2019; 73(8): 977–980. DOI: 10.1016/j.jacc.2018.12.028
- Malamba-Lez D, Ngoy-Nkulu D, Steels P, Tshala-Katumbay D, Mullens W. Heart failure etiologies and challenges to care in the developing world: An observational study in the Democratic Republic of Congo. J Card Fail. 2018; 24(12): 854–859. DOI: 10.1016/j.cardfail.2018.10.008
- Burnett H, Earley A, Voors AA, Senni M, McMurray JJ, Deschaseaux C, Cope S. Thirty years of evidence on the efficacy of drug treatments for chronic heart failure with reduced ejection fraction: A network meta-analysis. Circ Heart Fail. 2017; 10(1):
e003529 . DOI: 10.1161/CIRCHEARTFAILURE.116.003529 - Gupta N, Coates MM, Bekele A, Dupuy R, Fénelon DL, Gage AD, Getachew T, Karmacharya BM, Kwan GF, Lulebo AM, Masiye JK, Mayige MT, Ndour Mbaye M, Mridha MK, Park PH, Dagnaw WW, Wroe EB, Bukhman G. Availability of equipment and medications for non-communicable diseases and injuries at public first-referral level hospitals: A cross-sectional analysis of service provision assessments in eight low-income countries. BMJ Open. 2020; 10(10):
e038842 . DOI: 10.1136/bmjopen-2020-038842 - Carlson S, Duber HC, Achan J, Ikilezi G, Mokdad AH, Stergachis A, Wollum A, Bukhman G, Roth GA. Capacity for diagnosis and treatment of heart failure in sub-Saharan Africa. Heart. 2017; 103(23): 1874–1879. DOI: 10.1136/heartjnl-2016-310913
- Frenk J, Chen L, Bhutta ZA, Cohen J, Crisp N, Evans T, Fineberg H, Garcia P, Ke Y, Kelley P, Kistnasamy B, Meleis A, Naylor D, Pablos-Mendez A, Reddy S, Scrimshaw S, Sepulveda J, Serwadda D, Zurayk H. Health professionals for a new century: Transforming education to strengthen health systems in an interdependent world. The Lancet. 2010; 376(9756): 1923–1958. DOI: 10.1016/S0140-6736(10)61854-5
- Strasser R, Kam SM, Regalado SM. Rural health care access and policy in developing countries. Annu Rev Public Health. 2016; 37: 395–412. DOI: 10.1146/annurev-publhealth-032315-021507
- Vervoort D, Premkumar A, Ghandour H, Kpodonu J. Health system needs to establish cardiac surgery centers. Thorac Cardiovasc Surg. 2021; 69(8): 729–732. Epub 2021 Jan 9. PMID: 33421965. DOI: 10.1055/s-0040-1721395
- Kwan GF, Yan LD, Isaac BD, Bhangdia K, Jean-Baptiste W, Belony D, Gururaj A, Martineau L, Vertilus S, Pierre-Louis D, Fenelon DL, Hirschhorn LR, Benjamin EJ, Bukhman G. High poverty and hardship financing among patients with noncommunicable diseases in rural Haiti. Global Heart. 2020; 15(1): 7. DOI: 10.5334/gh.388
- Yan LD, Pierre-Louis D, Isaac BD, Jean-Baptiste W, Vertilus S, Fenelon D, Hirschhorn LR, Hibberd PL, Benjamin EJ, Bukhman G, Kwan GF. Does distance from a clinic and poverty impact visit adherence for noncommunicable diseases? A retrospective cohort study using electronic medical records in rural Haiti. BMC Public Health. 2020; 20(1): Article 1545. DOI: 10.1186/s12889-020-09652-y
- Gamble J-M, Eurich DT, Ezekowitz JA, Kaul P, Quan H, McAlister FA. Patterns of care and outcomes differ for urban versus rural patients with newly diagnosed heart failure, even in a universal healthcare system. Circ Heart Fail. 2011; 4(3): 317–323. DOI: 10.1161/CIRCHEARTFAILURE.110.959262
- Connor SR, Bermedo MCS, Worldwide Palliative Care Alliance, World Health Organization. Global atlas of palliative care at the end of life. 2014.
https://www.who.int/nmh/Global_Atlas_of_Palliative_Care.pdf . - Kimani KN, Murray SA, Grant L. Multidimensional needs of patients living and dying with heart failure in Kenya: a serial interview study. BMC Palliat Care. 2018; 17(1): Article 28. DOI: 10.1186/s12904-018-0284-6
- Stewart S, Pearson S, Horowitz JD. Effects of a home-based intervention among patients with congestive heart failure discharged from acute hospital care. Arch Intern Med. 1998; 158(1): 1067. DOI: 10.1001/archinte.158.10.1067
- de la Porte PWFB-A, Lok DJA, van Veldhuisen DJ, van Wijngaarden J, Cornel JH, Zuithoff NP, Badings E, Hoes AW. Added value of a physician-and-nurse-directed heart failure clinic: Results from the Deventer–Alkmaar heart failure study. Heart. 2007; 93(7): 819–825. DOI: 10.1136/hrt.2006.095810
- Cline CMJ, Israelsson BYA, Willenheimer RB, Broms K, Erhardt LR. Cost effective management programme for heart failure reduces hospitalisation. Heart. 1998; 80(5): 442–446. DOI: 10.1136/hrt.80.5.442
- Savarese G, Lund LH, Dahlström U, Strömberg A. Nurse-led heart failure clinics are associated with reduced mortality but not heart failure hospitalization. J Am Heart Assoc. 2019; 8(10):
e011737 . DOI: 10.1161/JAHA.118.011737 - Riegel B, Carlson B, Kopp Z, LePetri B, Glaser D, Unger A. Effect of a standardized nurse case-management telephone intervention on resource use in patients with chronic heart failure. Arch Intern Med. 2002; 162(6): 705. DOI: 10.1001/archinte.162.6.705
- Srisuk N, Cameron J, Ski CF, Thompson DR. Randomized controlled trial of family-based education for patients with heart failure and their carers. J Adv Nurs. 2017; 73(4): 857–870. DOI: 10.1111/jan.13192
- Bader F, Atallah B, Sadik ZG, Tbishat L, Gabra G, Soliman M, Bakr K, Ferrer R, Stapleton J, Khalil M. Nurse-led education for heart failure patients in developing countries. Br J Nurs. 2018; 27(12): 690–696. DOI: 10.12968/bjon.2018.27.12.690
- Yazew KG, Beshah DT, Salih MH, Zeleke TA. Factors associated with depression among heart failure patients at cardiac follow-up clinics in Northwest Ethiopia, 2017: A cross-sectional study. Psychiatry J. 2019; 2019: 1–8. DOI: 10.1155/2019/6892623
- Eberly LA, Rusingiza E, Park PH, Ngoga G, Dusabeyezu S, Mutabazi F, Harerimana E, Mucumbitsi J, Nyembo PF, Borg R, Gahamanyi C, Mutumbira C, Ntaganda E, Rusangwa C, Kwan GF, Bukhman G. Nurse-driven echocardiography and management of heart failure at district hospitals in rural Rwanda. Circ Cardiovasc Qual Outcomes. 2018; 11(12):
e004881 . DOI: 10.1161/CIRCOUTCOMES.118.004881 - Rusingiza EK, El-Khatib Z, Hedt-Gauthier B, Ngoga G, Dusabeyezu S, Tapela N, Mutumbira C, Mutabazi F, Harelimana E, Mucumbitsi J, Kwan GF, Bukhman G. Outcomes for patients with rheumatic heart disease after cardiac surgery followed at rural district hospitals in Rwanda. Heart. 2018; 104(20): 1707–1713. DOI: 10.1136/heartjnl-2017-312644
- Mailosi BGD, Ruderman T, Klassen SL, Kachimanga C, Aron MB, Boti M, Kumwenda K, Bukhman G, Muula AS, Banda NPK, Kwan GF. Decentralized heart failure management in Neno, Malawi. Global Heart. 2023; 18(1): 35. DOI: 10.5334/gh.1210
- Kavita, Thakur JS, Vijayvergiya R, Ghai S. Task shifting of cardiovascular risk assessment and communication by nurses for primary and secondary prevention of cardiovascular diseases in a tertiary health care setting of Northern India. BMC Health Serv Res. 2020; 20: 10. DOI: 10.1186/s12913-019-4864-9
- Vedanthan R, Kamano JH, Bloomfield GS, Manji I, Pastakia S, Kimaiyo SN. Engaging the entire care cascade in western Kenya: A model to achieve the cardiovascular disease secondary prevention roadmap goals. Global Heart. 2015; 10(4): 313. DOI: 10.1016/j.gheart.2015.09.003
- Siabani S, Driscoll T, Davidson PM, Leeder SR. Efficacy of a home-based educational strategy involving community health volunteers in improving self-care in patients with chronic heart failure in western Iran: A randomized controlled trial. Eur J Cardiovasc Nurs. 2016; 15(5): 363–371. DOI: 10.1177/1474515115585651
- Ogedegbe G, Gyamfi J, Plange-Rhule J, Surkis A, Rosenthal DM, Airhihenbuwa C, Iwelunmor J, Cooper R. Task shifting interventions for cardiovascular risk reduction in low-income and middleincome countries: A systematic review of randomised controlled trials. BMJ Open. 2014; 4:
e005983 . DOI: 10.1136/bmjopen-2014-005983 - Joshi R, Alim M, Kengne AP, Jan S, Maulik PK, Peiris D, Patel AA. Task shifting for non-communicable disease management in low and middle income countries – a systematic review. PLoS ONE. 2014; 9(8):
e103754 . DOI: 10.1371/journal.pone.0103754 - Marangou J, Beaton A, Aliku TO, Nunes MCP, Kangaharan N, Reményi B. Echocardiography in Indigenous populations and resource poor settings. Heart Lung Circ. 2019; 28(9): 1427–1435. DOI: 10.1016/j.hlc.2019.05.176
- Beaton A, Nascimento BR, Diamantino AC, Nunes MCP, Kangaharan N, Reményi B. Efficacy of a standardized computer-based training curriculum to teach echocardiographic identification of rheumatic heart disease to nonexpert users. Am J Cardiol. 2016; 117(11): 1783–1789. DOI: 10.1016/j.amjcard.2016.03.006
- Kirkpatrick JN, Nguyen HTT, Doan LD, Le TT, Thai SP, Adams D, Sanchez LY, Sprague N, Inafuku J, Quang R, Hahn R, Van Hoever AM, Nguyen T, Kirkpatrick TG, Banchs J. Focused cardiac ultrasound by nurses in rural Vietnam. J Am Soc Echocardiogr. 2018; 31(10): 1109–1115. DOI: 10.1016/j.echo.2018.05.013
- DeWyer A, Scheel A, Otim IO, Longenecker CT, Okello E, Ssinabulya I, Morris S, Okwir M, Oyang W, Joyce E, Nabongo B, Sable C, Alencherry B, Tompsett A, Aliku T, Beaton A. Improving the accuracy of heart failure diagnosis in low-resource settings through task sharing and decentralization. Glob Health Action. 2019; 12(1): 1684070. DOI: 10.1080/16549716.2019.1684070
- Strasser R, Kam SM, Regalado SM. Rural health care access and policy in developing countries. Annu Rev Public Health. 2016; 37: 395–412. DOI: 10.1146/annurev-publhealth-032315-021507
- DeWyer A, Scheel A, Kamarembo J, Akech R, Asiimwe A, Beaton A, Bobson B, Canales L, DeStigter K, Kazi DS, Kwan GF, Longenecker CT, Lwabi P, Murali M, Ndagire E, Namuyonga J, Sarnacki R, Ssinabulya I, Okello E, Aliku T, Sable C. Establishment of a cardiac telehealth program to support cardiovascular diagnosis and care in a remote, resource-poor setting in Uganda. PLoS ONE. 2021; 16(8):
e0255918 . DOI: 10.1371/journal.pone.0255918 - McLaren ZM, Ardington C, Leibbrandt M. Distance decay and persistent health care disparities in South Africa. BMC Health Serv Res. 2014; 14: Article 541. DOI: 10.1186/s12913-014-0541-1
- Bukhman, G, Mocumbi A, Wroe E, Gupta N, Pearson L, Bermejo R, Dangou JM, Moeti M. The PEN-Plus Partnership: Addressing severe chronic non-communicable diseases among the poorest billion. Lancet Diabetes Endocrinol. 2023; 11(6): 384–38. DOI: 10.1016/S2213-8587(23)00118-3
- Ruderman T, Chibwe E, Boudreaux C, Ndarama E, Wroe EB, Connolly E, Bukhman G. Training mid-level providers to treat severe non-communicable diseases in Neno, Malawi through PEN-Plus Strategies. Ann Glob Health. 2022; 88(10): 69. DOI: 10.5334/aogh.3750
- Kingery JR, Yango M, Wajanga B, Kalokola F, Brejt J, Kataraihya J, Peck R. Heart failure, post-hospital mortality and renal function in Tanzania: A prospective cohort study. Int J Cardiol. 2017; 243: 311–317. DOI: 10.1016/j.ijcard.2017.05.025
- Bukhman G, Mocumbi AM, Gupta N, Amuyunzu-Nyamongo M, Echodu M, Gomanju A, Jain Y, Karmacharya B, Kapambwe S, Lulebo A, Makani J, Masiye JK, Mategeko PK, Owino E. From a Lancet Commission to the NCDI Poverty Network: Reading the poorest billion through integration science. Lancet. 2021; 398: 2217–2220. DOI: 10.1016/S0140-6736(21)02321-7
- Kwan GF, Bukhman AK, Miller AC, Ngoga G, Mucumbitsi J, Bavuma C, Dusabeyezu S, Rich ML, Mutabazi F, Mutumbira C, Ngiruwera JP, Amoroso C, Ball E, Fraser HS, Hirschhorn LR, Farmer P, Rusingiza E, Bukhman G. A simplified echocardiographic strategy for heart failure diagnosis and management within an integrated noncommunicable disease clinic at district hospital level for sub-Saharan Africa. JACC Heart Fail. 2013; 1(3): 230–236. DOI: 10.1016/j.jchf.2013.03.006
- Bukhman G, Kidder A. eds.
The partners in health guide to chronic care integration for endemic non-communicable diseases. Rwanda edition . Cardiac, renal, diabetes, pulmonary, and palliative care. Boston, MA: Partners In Health. 2011. - Kingue S, Dzudie A, Menanga A, Akono M, Ouankou M, Muna W.
A new look at adult chronic heart failure in Africa in the age of the Doppler echocardiography: Experience of the medicine department at Yaounde General Hospital . Ann Cardiol Angeiol. Paris. 2005. - Amoah AG, Kallen C. Aetiology of heart failure as seen from a National Cardiac Referral Centre in Africa. Cardiology. 2000; 93: 11–18. DOI: 10.1159/000006996
- Freers J, Mayanja-Kizza H, Ziegler JL, Rutakingirwa M. Echocardiographic diagnosis of heart disease in Uganda. Trop Doct. 1996; 26: 125–128. DOI: 10.1177/004947559602600310
- World Health Organization Regional Office for Africa. Noncommunicable diseases.
https://www.afro.who.int/about-us/programmes-clusters/noncummunicable-diseases-cluster . - Bukhman G, Mocumbi AO, Atun R, Becker AE, Bhutta Z, Binagwaho A, Clinton C, Coates MM, Dain K, Ezzati M, Gottlieb G, Gupta I, Gupta N, Hyder AA, Jain Y, Kruk ME, Makani J, Marx A, Miranda JJ, Norheim OF, Nugent R, Roy N, Stefan C, Wallis L, Mayosi B. The Lancet NCDI Poverty Commission: Bridging a gap in universal health coverage for the poorest billion. The Lancet. 2020; 396: 991–1044. DOI: 10.1016/S0140-6736(20)31907-3
- World Health Organization. Regional Committee for Africa. PEN-Plus: A regional strategy to address severe noncommunicable diseases at first level referral health facilities. AFR/RC72/4.
- Moeti M, Mocumbi A, Bukhman, G. Why there is new hope for the care of chronic diseases in Africa. BMJ. 2023; 383: 2382. DOI: 10.1136/bmj.p2382
- Lwabi P, Namuyonga J, Lubega S, Oketcho M, Mwambu T, Sebatta E, Okello E, Omagino J, Sliwa K. Developing cardiovascular care for the 45 million population is the objective of the Uganda Heart Association. European Heart Journal. 2019; 40(29): 2396–2397. DOI: 10.1093/eurheartj/ehz472
DOI: https://doi.org/10.5334/gh.1313 | Journal eISSN: 2211-8179
Language: English
Submitted on: Dec 12, 2023
Accepted on: Feb 27, 2024
Published on: Mar 27, 2024
Published by: Ubiquity Press
In partnership with: Paradigm Publishing Services
Publication frequency: 1 issue per year
© 2024 Sheila L. Klassen, Emmy Okello, Jose M. E. Ferrer, Faraz Alizadeh, Prebo Barango, Pilly Chillo, Yamikani Chimalizeni, Wubaye Walelgne Dagnaw, Jean-Luc Eiselé, Lauren Eberly, Anu Gomanju, Neil Gupta, Bhagawan Koirala, Jacques Kpodonu, Gene Kwan, Bright G. D. Mailosi, Lilian Mbau, Reuben Mutagaywa, Colin Pfaff, Daniel Piñero, Fausto Pinto, Emmanuel Rusingiza, Usman Abiola Sanni, Amy Sanyahumbi, Urmila Shakya, Sanjib Kumar Sharma, Kunjang Sherpa, Isaac Sinabulya, Emily B. Wroe, Gene Bukhman, Ana Mocumbi, published by Ubiquity Press
This work is licensed under the Creative Commons Attribution 4.0 License.