Worldwide, women carry the greatest burden of malnutrition. More than two-thirds of women of childbearing age don’t get enough of at least one micronutrient. These are the vitamins and minerals, such as iron, that the body needs in small amounts to stay healthy. A shortage is often called “hidden hunger” because a woman can eat enough to feel full yet still not have enough essential nutrients.

Despite decades of intervention, the prevalence of anaemia has worsened among women, rising from 28% to 31% since 2012. Anaemia is an iron deficiency condition in which the number of red blood cells or the haemoglobin concentration within them is lower than normal. It mainly affects women and children.

The gender gap in food insecurity is widening, especially in sub-Saharan Africa, where 80% of women of reproductive age are affected by micronutrient deficiencies.

Why is progress on women’s nutrition stalling?

As a multidisciplinary team of experts in global nutrition, public health and equitable food systems, we conducted a systematic scoping review of 518 studies across 125 low- and middle-income countries. We identified 143 drivers of what a woman can eat. The result is the first evidence-based framework of women’s food environments, the factors that influence the quality of women’s diets.

The central finding of our research was striking: the single most important thing shaping women’s dietary quality is not food availability or household income. It is agency, a woman’s ability to make decisions about food, to control household finances, to manage her own time, and to move freely.

Who decides what a woman eats?

Why does a woman in low-resource settings in Africa, Latin America, or the Asia-Pacific not eat enough of certain foods? Often the answer is that men or older women control what’s spent on food, and social norms dictate that other household members eat first. Younger women with lower social status face particular barriers: less control over financial resources, less time because of the unpaid work they do, and restricted mobility.

Decades of agriculture and nutrition interventions have largely overlooked these realities. The dominant approach has assumed that educating women about healthy eating is enough. Our review revealed that the research has not focused on the greatest need. The numbers bear this out. Across the 518 studies we reviewed, food literacy – what women know about nutrition – was the most-studied factor, appearing in 57% of studies. Women’s agency, which our analysis identified as the most important lever, featured in only about a third.

Why this matters

The implications go well beyond nutrition science. Telling a woman to diversify her diet without addressing the fact that she has limited decision-making or bargaining power is not an intervention. It places the burden of change on the person with the least power to act.

Our framework also shows that women’s diets are shaped by a web of structural, sociocultural and financial drivers, not personal food preferences or nutrition knowledge alone. Climate change, urbanisation and globalised food systems all affect the ability to eat nutritious foods, and these pressures interact with gender inequalities. When droughts reduce harvests or conflict disrupts markets, women often bear the consequences first. This is because they have less control over household resources and because women tend to put other people’s needs before their own.

A household can look food-secure on paper while the woman in it goes without. Our findings reinforce the case for the United Nations’ move to adopt Minimum Dietary Diversity for Women as a new global development indicator as of March 2025. This indicator is a proxy for whether women are getting the vitamins and minerals they need.

Much of what is known about nutrition comes from research conducted in places that are easy to reach: communities near roads or existing health infrastructure. This is called roadside bias, and it is pervasive. Our review laid bare how uneven the evidence base is. Women in remote areas, climate-affected regions and conflict zones, those most at risk of poor nutrition, are underrepresented in the evidence base. If programmes are designed around evidence from easy-to-reach populations, they will miss the women who need help most.

But the review also found positive patterns. Women with strong social networks, family, friends, and neighbours nearby, often experienced better dietary quality. Those networks helped share the burdens of procuring food, cooking, and caring for children.

What should change

If agency is the primary lever, then nutrition interventions must be designed around it.

Agricultural policies should address barriers to women’s decision-making and bargaining power, and control over income.

When designing programmes or making infrastructure decisions, policymakers need to account for women’s time burdens and mobility constraints, including cultural norms around intra-household allocation of food, and that restrict movement and the walkability of roads.

Context matters. The relative importance of different barriers varies based on geography, socioeconomic conditions and culture. This means working with communities rather than imposing external solutions.

Filling the gaps in the evidence base also requires investment in primary data collection. This is important in partnership with national researchers who bring expertise in language, context and social dynamics.

Our research in northern Uganda also shows how low-cost tools such as automated mobile phone surveys can reach people where sending a research team is not feasible.

As global nutrition funding is reconstructed in the wake of international aid cuts, the decisions made now about what counts as credible evidence will shape what gets built. If the realities that constrain women’s dietary quality are not taken seriously, new interventions will repeat the failures of the old ones.

What a woman eats can shape both her health and that of her children for years and generations to come. Improving women’s nutrition was never only a matter of teaching women what to eat. It is also about giving them the power to act on this knowledge. Until programmes take that seriously, progress will keep stalling.

*Lydia O’Meara is Postdoctoral Fellow, Cornell University; Paula Dominguez-Salas is Assistant Professor of Nutrition-Sensitive Agriculture, London School of Hygiene & Tropical Medicine

Banditry is widespread in Nigeria. It has been defined as “a loose collection of various criminal groups involved in kidnap-for-ransom, armed robbery, cattle rustling, rape and sexual violence, pillage and attacks on traders, farmers and travellers, particularly in Nigeria’s northwest region”.

This criminal activity has caused deaths, displacement, destruction of property and widespread fear. In 2025 alone, 599 attacks were reported, with 2,742 casualties. This was a sharp increase from 2024, when 256 attacks and 1,585 deaths were recorded. Banditry has also extended its reach to the northwest and southwest of Nigeria.

Studies have examined its costs and implications, and possible mechanisms for addressing it. Still, knowledge about the nature and character of banditry remains limited.

As a sociologist, I investigated this national security threat with a view to understanding how the victims experienced it.

The study unpacks the method and timing of attacks and identities of the bandits, providing insights that can inform security planning. Knowing more about how bandits operate can help government and vulnerable communities to design preventive measures and adopt safety behaviours.

Rural banditry in Nigeria

The study used data collected through in-depth interviews with focus group discussions in four of the six geopolitical zones where the problem of banditry is most widespread and prevalent: North-Central, North-West, South-West and South-East. The sample included 48 communities. Two key informant interviews were conducted in each local area: one with a state security official (police, military, paramilitary, or community vigilante) and one with traditional or community leader.

All the participants reported that their communities had experienced violent attacks by bandits, although at different times and in different ways and to varying degrees. They also emphasised the brutal nature of bandit violence.

Experiences ranged from farm invasion and destruction to animal theft, killing and kidnapping, gang rape and sexual violence, displacement of people and the pillaging of communities.

Responses highlighted that:

• the timing was typically late at night or early in the morning
• men were more frequently killed than women
• women were more likely to be abducted and forced into marriages with bandits instead of being killed
• although bandits were often strangers to the locations of attacks, insiders often helped them carry out attacks
• bandit groups imposed levies on some communities
• bandits often carries out operations on market days or Sundays.

Alluding to the brutality of bandit attacks, a participant noted:

There was an attack by bandits where we lost over 20 people. We had the mass burial in a single day.

Participants, especially from rural communities in the North-Central and North-West regions, reported how frequent violent attacks forced many residents to vacate their villages, becoming internally displaced, suffer trauma, and live in perpetual fear.

According to a survivor of bandit attacks in Plateau State:

A month will not go by without someone being killed in this village by bandits. That is how bad and frequent it is.

How bandit attacks happen

Data showed consistent patterns of attack across all four selected regions in Nigeria. Typically, participants reported that bandits come armed with knives, daggers, sticks, guns, machetes and cutlasses. When they launch an attack, they shoot their victims; afterwards, they may slaughter them with knives to ensure death.

At other times, to destroy entire communities, bandits reportedly bring gas to burn villages. Participants also identified the weapons associated with bandits as AK-47, G3S and K2 rifles, swords and pump-action guns, among others.

Bandits ensure that their victims are attacked at times when people are off guard. A traditional leader said:

they come even twice or even thrice in a week. I think their plan is to stop us from going to the farm. Whenever we go, they either kill us or others on the farm, or they wait until people are returning home then attack them on the road, snatch their machines, and either kill or injure them

Victim targeting

Participants explained that everyone in any community affected is a potential victim. They might be farmers, when farms are destroyed. When villages are destroyed, everybody, young and old, male and female, becomes a victim, as houses are burnt, property stolen and lives endangered. In cases of kidnapping, the bandits sometimes have specific targets, which vary depending on their mission.

Most victims of kidnapping are wealthy and highly placed individuals in society, especially those whose families are believed to be able to raise the ransom.

Men are the main victims of rural banditry, as they can challenge the attackers. But as men are killed, women became widows and children are left fatherless. Participants said the bandits often abducted women. One stated:

Whenever they come, they say ‘men come out’ but they only take women they find attractive and take them away, and make them their wives.

In some other areas, women fell victim to rape, theft, and in some cases, murder. After the death of their parents, children became destabilised and some were withdrawn from school. During attacks, men sometimes fled for their safety, leaving their families behind, whereas mothers could not abandon their children.

Moving forward

The study found the character and nature of banditry to be violent and associated with specific times and spaces. Banditry manifested in the activities carried out by organised armed groups, including cattle rustling, farm destruction, kidnapping, looting and killings. These activities have heightened insecurity, led to deaths and displacement, and disrupted the livelihoods of households and farming communities.

Rural communities need to know how to detect and report security threats in time to prevent them. Informal security organisations in such communities should align with the formal state security. Federal and state governments should also collaborate to find bandits where they hide.

* Tade is Professor of Sociology (Criminology, Victimology and Security Studies), University of Ibadan

Nigeria’s electricity regulator triggered a big tariff shock in April 2024. It increased rates for some consumers by over 240%, citing the cost of producing and delivering power.

The regulator classifies consumers into five bands, A through E, based on how many hours of power their local distribution feeder receives each day. Band A gets 20 hours or more and Band E just 4-7 hours. The tariff changes primarily affect Band A customers. Their tariff rose from ₦67 to ₦225 (US$0.049 to US$0.16) per kilowatt-hour.

The public backlash was immediate and fierce. Labour unions protested nationwide and picketed the offices of the regulator and distribution companies. They demanded reversal of the hike, and shut down electricity sector offices in several cities.

But they didn’t ask the main question: why is the cost so high in the first place? The answer is not simply gas prices, exchange rates or inflation, though all play a role.

Another driver is inefficiency of the system’s operations. The electricity generated and used, and the revenue received, don’t match up.

As an economist specialising in energy policy, with a doctoral thesis examining the impact of power sector reform on Nigeria’s electricity supply chain, I submit that Nigerians are paying for inefficiency.

Until this is confronted directly, tariff increases will fail to deliver the sector transformation they promise.

The maths of the problem

Under Nigeria’s Multi-Year Tariff Order Framework, the Nigerian Electricity Regulatory Commission sets electricity tariffs. It does this by dividing its total revenue requirement (such as operating costs, capital recovery, and a regulated return on assets) by the volume of electricity that is actually billed and paid for.

This formula has a weakness. The more revenue is lost through inefficiency, the more consumers have to pay.

And actual losses have exceeded the targets that are allowed.

The scale of this failure in Nigeria is extraordinary when set against both international benchmarks and the performance of comparable developing economies.

The measure used is called “aggregate technical, commercial and collection loss”. It’s a composite figure capturing electricity lost to infrastructure failures, theft, unmetered consumption and uncollected bills. Nigeria’s distribution companies reported average losses far above the global average of around 6-9% and the 15% that is considered good practice for developing economies.

Nigeria’s aggregate losses across all distribution companies in the first quarter of 2024 stood at 36.36%. This comprised technical and commercial losses of 19.55% and collection losses of 20.83%.

By the third quarter of 2024, they had worsened to 39.10%. Also, none of the distribution companies achieved the target set by the regulatory pricing framework of the Nigerian Electricity Regulatory Commission. The Kaduna distribution company recorded an actual loss of 70.84% against a target of 25%.

The most recent data – first quarter 2025 – shows no resolution. Aggregate technical and commercial losses stood at 39.6%, almost double the 20.5% target set under the framework. This translates to an estimated ₦200.5 billion (about US$146 million) in forgone revenue in that quarter alone.

That Nigeria’s average electricity revenue loss consistently exceeds 36% is extraordinary even by regional standards. Ghana, itself in a distribution crisis, recorded 32% losses in 2024; Kenya has been working to bring its losses down to 21.7%. In India, after a decade of costly federal reform programmes, losses reached 16.16%, against a global average of around 6%-9%.

A metering crisis at the heart of the problem

A key driver of commercial losses is one of the most persistent failures in Nigeria’s electricity sector: the metering gap. Without a meter, a consumer cannot be accurately billed. Without accurate billing, collection is contested and payment culture erodes.

As of December 2024, only 6.29 million out of 13.5 million registered electricity customers across the 12 distribution companies were metered. The metering rate was just 46.57%. More than half of Nigeria’s electricity consumers are still billed through estimated billing because of the metering gap.

Multiple government programmes designed to provide meters, such as the National Mass Metering Programme, the Meter Asset Provider scheme and others, have fallen short of their targets. Meter installations reached a four-year low in 2024, declining 34% since 2021.

The World Bank’s Nigeria Distribution Sector Recovery Programme identified the metering deficit as central to the sector’s financial distress. It estimated that nearly half of the seven million metering gap could be closed through smart meters under its current financing programme. This, however, is only if the distribution companies follow through on procurement and installation commitments.

The fiscal cost of inefficiency

These losses do not simply inconvenience consumers. They have placed the federal government in an unsustainable fiscal position. The 2024 annual report of the electricity commission revealed that the government would have to cover ₦1.94 trillion – 62.59% of what’s owed, which averages over ₦161 billion per month (about US$117 million).

This is a subsidy for operational failure rather than a deliberate social transfer. The World Bank has estimated annual economic losses from Nigeria’s unreliable electricity at 5%-7% of GDP, approximately US$25 billion. This figure exceeds the Nigerian government’s spending on health annually. Total spending on health was 4.08% of GDP in 2021, and 4.19% in 2023.

The burden extends beyond what appears on electricity bills. Faced with an unreliable grid, businesses and households fall back on self-generation. Over 22 million diesel and gasoline generators power approximately 26% of Nigerian households and 30% of micro, small and medium enterprises. These generators represent a parallel electricity system which is expensive, polluting, and absent from any tariff discussion. The discussion that also excludes every Nigerian who cannot afford one.

The policy implication

None of this means cost-reflective tariff reform is wrong. A sector that cannot recover its costs cannot invest, and a sector that cannot invest cannot improve. But the sequence matters enormously. Tariff increases that are not paired with credible, enforceable efficiency commitments from distribution companies simply transfer the cost of failure upward. That is, from the distribution companies to consumers and government.

What is needed is a regulatory framework that places efficiency at the centre of tariff determination. The regulator should ensure that any tariff increase is tied to measurable improvements in metering, reduction in electricity losses, and better service delivery. Consumers should not continue to bear the cost of inefficiencies within the electricity distribution system. Until distribution companies demonstrate real operational improvement, higher tariffs will continue to appear punitive rather than justified.

At the same time, infrastructure investment must happen. Without a physically reliable network, financial reform will not restore credibility.

Nigeria’s electricity consumers are not simply paying for power. They are paying for a system’s failure to deliver it – and being asked to do so again and again, with no end in sight. That is not reform. It is a transfer of liability dressed as policy.

*Taiwo Hassan Odugbemi is a Lecturer in Economics at the University of Abuja

Severe bleeding after birth (postpartum haemorrhage) is the leading cause of maternal mortality globally. It causes approximately 70,000 deaths annually. About 80% occur in Africa and South Asia. A recently published World Health Organization analysis shows postpartum haemorrhage accounts for 28% of maternal deaths in sub-Saharan Africa, compared to 14% in northern Europe.

Another leading cause of maternal mortality globally is pregnancy-related infections. The body’s natural response to infection sometimes causes injury to its own tissues and organs during pregnancy, childbirth, post-abortion or the postpartum period. This life-threatening condition is known as maternal sepsis.

A 2024 global maternal sepsis study involving 2,466 women across 43 countries reported the highest proportion of infection-related serious maternal outcomes in low and middle-income countries. These included maternal death or severe, life-threatening illness. Of the six world regions studied, serious outcomes were highest in Africa at 19.5%.

Most of these deaths are associated with delayed or missed diagnoses and subsequent timing of interventions. Early identification, based on prompt detection of abnormal vital signs such as heart rate and blood pressure, is crucial to prevent maternal deaths from postpartum haemorrhage and maternal sepsis.

This is problematic in resource-constrained healthcare systems in many low- and middle-income settings, including sub-Saharan Africa.

We are on a team of maternal health researchers – obstetricians, physicians and midwives – with a vision to save mothers and babies through capacity research, innovation and building maternity systems. Our focus is on developing local leadership and international collaborative learning.

Our most recent prospective study in Sierra Leone examined the experimental use of a simple tool – known as Shock Index – to monitor changes in the ratio of heart rate and blood pressure in response to blood loss or sepsis.

Originally developed to identify shock in non-pregnant surgical and major trauma patients, it is emerging as a critical tool in maternity care. It is particularly valuable in low- and middle-income settings where sophisticated monitoring equipment is scarce, but the burden of maternal mortality is highest.

Our findings showed that Shock Index can predict serious outcomes and enabled stratification of risks, including maternal death.

Landmark study in Sierra Leone

Sierra Leone has one of the highest maternal mortality ratios globally. Most preventable maternal deaths result from haemorrhage, hypertension or sepsis. Yet many facilities do not have the basic tools for vital sign monitoring.

Early identification of maternal complications is a cornerstone of effective maternity care. Our team developed the CRADLE vital signs alert intervention as a simple, low-cost, point-of-care technology to identify these complications. It combines an accurate, semi-automated blood pressure and pulse device with an embedded traffic-light warning system.

Previous evaluations showed that the technology improved detection, referral and health worker confidence, with potential to reduce morbidity and mortality. However, evidence on effectiveness at scale, and integration into routine systems in low-resource settings, remains sparse.

Our Sierra Leone study evaluated whether national scale-up of this intervention could reduce adverse maternal and perinatal outcomes and be sustainably integrated into routine care. The study was carried out in three maternity hospitals in Sierra Leone among 495 women with bleeding and 855 women at risk of maternal sepsis.

We found that Shock Index can predict serious outcomes and establish levels of risk. For example, a woman with Shock Index of at least 1.7 (very abnormal) had a 10-fold greater risk of maternal death compared to women with Shock Index 0.9 to 1.7 (abnormal).

Importantly, Shock Index requires no specialised equipment. It is a practical, cheap solution, enabling triage of patients in resource-limited environments.

This is particularly valuable where sophisticated monitoring equipment is scarce.

History of the Shock Index and women’s health

Early identification and timely intervention is key to saving lives in maternity, particularly in bleeding and sepsis. This is because the heart rate rises long before the woman appears to be sick. Falling blood pressure, too, may only be noticed too late. Relying on heart rate or blood pressure alone may lead to life threatening delays.

Early retrospective studies from Nigeria, Egypt and the UK in pregnant women with bleeding and suspected sepsis showed that combining blood pressure and heart rate in a ratio – the Shock Index – enabled impending shock to be identified earlier.

The Shock Index was incorporated into the CRADLE vital signs alert device to alert the users to abnormal readings. The research found that if Shock Index was greater than 1.7 (red light), there was a high risk of a serious maternal outcome. The woman might need a large blood transfusion or a hysterectomy.

On the other hand a Shock Index less than 0.9 (green light) indicated that the woman was at low risk.

Expanding applications

Beyond bleeding and sepsis, researchers are exploring additional uses for Shock Index, including:

• Antenatal anaemia screening. An unpublished study in Karnataka, India, found abnormal Shock Index was strongly associated with severe maternal anaemia. This could be used to identify women at risk of related complications like postpartum haemorrhage, preterm birth and foetal growth restriction.
• Malaria detection. Work in Bidibidi refugee settlement, Uganda, showed Shock Index can help identify patients with malaria.

Future steps

The research team is now conducting qualitative work to understand how best to integrate CRADLE vital sign alert and Shock Index into existing early warning scores and management pathways. The end goal is to embed Shock Index into routine maternity care, ensuring timely, life-saving interventions for women most at risk.

Our research has showcased the impact of the CRADLE vital sign alert. Furthermore the Shock Index is now incorporated in the new World Health Organization integrated Postpartum Haemorrhage Guideline. In addition, the WHO is recommending a postpartum haemorrhage treatment trolley, including the CRADLE vital sign alert.

Our team is developing an updated CRADLE device which will display the Shock Index number to users, and store multiple readings. This will be useful in the care of the sickest patients where serial readings are required in quick succession to monitor response to emergency, life-saving treatments.

*This article was originally published by TheConversation

Walking: It’s simple, it’s easy and it definitely deserves its shiny health halo. This low-impact activity not only breaks up dreaded sedentary time, it’s also free — and helps you manage everything from your cardiovascular health to your mood to your risk of diabetes.

But while you may regularly keep up with how many steps you take daily, there’s something else important to keep tabs on: how fast you’re moving. In fact, research shows that walking speed can be considered a vital sign.

Vital signs, according to Dr. Marie Therese Kanagie-McAleese, a physician at the University of Maryland Upper Chesapeake Medical Center, “provide information on the basic physiologic functioning of the body.” They’re the markers your doctors check during an annual check-up, such as your body temperature, pulse rate, respiratory rate and blood pressure. Oxygen saturation, which measures how much oxygen your blood is carrying, is also often included, as is weight — albeit not without some controversy.

Together, vital signs offer a snapshot of your overall health and may help identify potential issues — although it should be noted that just because one sign is off its normal target, that doesn’t necessarily mean there’s a larger overall problem. When you factor in walking speed as a vital sign, you’ll get an even clearer picture of your health.

How fast do people typically walk?
According to a 2020 study, how fast you walk is correlated with your age and biological sex, with men walking slightly faster than women. In general, individuals under 30 walk at an average speed of 3 miles per hour. Those aged 30 to 39, as well as 40 to 49, walk at an average speed of 2.8 mph. People 50 to 59 average 2.75 mph, while those over 60 move at 2.7 mph. After age 65, people tend to walk at an average speed of 2.1 mph.

Why is walking speed a marker of health?
Multiple studies have shown that walking speed is a viable marker of our health — but what makes gait so important? The simplest reason: Having the ability to walk at a faster pace is an indicator that you’re in good physical shape.

According to Dr. Anthony Giuffrida, a specialist in interventional spine and pain management at the Cantor Spine Center in Florida, those who walk quickly show “strong muscle strength, coordination and neuromuscular function,” as well as “efficient heart and lung function.”

On the flip side, people who struggle to walk at a quick pace may be limited because of certain health conditions, such as arthritis, heart disease or chronic obstructive pulmonary disease (COPD).

Peggy Cawthon, a scientific director at Sutter Health’s California Pacific Medical Center Research Institute who studied the correlation between gait and health, tells Yahoo Life that there’s also a connection between your cognitive abilities and walking quickly.

“We do a lot of tests of older people to measure cognitive function in a bunch of different domains, and walking speed is strongly related to how well your brain is working,” Cawthon says. “People who have cognitive impairment walk slower than people who are cognitively normal.”

The reason for this, Cawthon says, is that “walking is such a complex task.” If you have a cognitive impairment, it’s harder to figure out how to “put one step in front of the other and continue to walk quickly,” she notes. So if you’re unable to walk quickly or normally, it could possibly indicate cognitive issues — such as a disease like Parkinson’s, for example.

Why you should walk more
Your walking speed can indicate health concerns, but it’s also important to note that walking — and, in particular, walking at a brisk pace — can help ward off future health issues.

Walking is an easy way to incorporate more movement into your life — and increasing your pace is one way to ramp up the intensity of your exercise, which is important for improving cardiovascular health, boosting metabolism and supporting overall physical fitness. The Centers for Disease Control and Prevention (CDC) recommends at least 150 minutes of moderate-intensity aerobic activity, such as brisk walking, per week, along with muscle-strengthening activities on at least two days per week.

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The Independent
“One of the common questions I get from people is, ‘So if I walk faster, does that mean I’m going to live longer?’ And the answer is: Well, maybe,” Cawthon says. But she stresses that simply trying to “walk really fast” isn’t the ultimate goal. Instead, increasing your walking speed by improving your fitness or losing weight can have “longer-term benefits on your health.”

Giuffrida says that patients need to prioritize exercise, like walking, to make it a habit. “Just as many brush their teeth two to three times a day to keep their teeth healthy, our muscles, heart, lungs and other organs need to be maintained daily,” he says. “Incorporating walking into daily routines, such as taking short walks at work or using the stairs instead of elevators, will help make walking a priority in people’s lives.”

Kanagie-McAleese, who works with the organization Walk With a Doc, says it’s a good idea to focus both on episodes of brisk walking and aiming for at least 4,000 to 7,000 steps daily. You can break this up however you wish — for example, she says, you can walk briskly for 10 minutes three times daily, five days a week. This type of walking counts toward the CDC’s 150 minutes of moderate activity.

“If you aren’t sure how to determine moderate activity level, use the ‘talk test’ — you should be able to have a conversation, but would get out of breath if you tried to sing,” she says.

As far as your daily step count goes, Kanagie-McAleese notes that more is better: You can start tracking your typical number of steps with your phone or a pedometer and then set goals to increase your daily step count by 500 to 1,000 steps every few weeks.

How different types of walking can affect your health
Giuffrida says that the “best type of walking depends on an individual’s age, overall health and personal goals.” Here are several different walking styles he recommends, with their benefits:

Brisk walking
What it is: Walking at a fast pace, typically 3 to 4 mph, where you can talk but not sing.

How to do it: Maintain good posture, swing your arms naturally and aim for a pace that increases your heart rate without making you feel out of breath.

Benefits: Improves cardiovascular health, burns calories, strengthens the lower body and boosts energy levels.

Interval walking
What it is: Alternating between fast walking and slower recovery walking.

How to do it: Walk briskly for one to three minutes, then slow down to a moderate pace for one to two minutes. Repeat as desired. If you are on a treadmill, you can also follow a program that includes an incline, such as the 12-3-30 method.

Benefits: Enhances endurance, increases metabolism and can be more effective for calorie burn than steady-paced walking.

Mindful walking
What it is: Walking slowly and focusing on the present moment, including your breathing and surroundings.

How to do it: Choose a quiet outdoor location. Walk at a gentle, comfortable pace and focus on your breath and/or the sensations in your body. If helpful, you can also listen to a guided meditation recording while you walk.

Benefits: Reduces stress, promotes relaxation, improves focus and supports mental health.

Hiking
What it is: Walking on uneven terrain, such as trails or hills.

How to do it: Wear sturdy shoes (think hiking boots, or shoes with proper grip and stability) and maintain a steady pace.

Benefits: Engages more muscle groups, improves balance and coordination, increases strength and allows you to connect with nature, which can reduce stress levels.

Nordic walking
What it is: A full-body walking workout, using poles to engage the upper body.

How to do it: Hold the poles at a slight angle, and push off with each step, to involve your arms and shoulders while walking.

By Olayinka Oyegbile

Finally, Taiwan’s President Lai Ching-te was able to make his scheduled trip to Eswatini, the only African country with which Taiwan has diplomatic relations. According to reports, the visit which should have been from April 22-26, 2026, was aborted because three Indian Ocean countries – Seychelles, Mauritius and Madagascar- revoked the flight permits earlier granted the president’s flight after what a Taiwanese official alleged was as a result of “intense pressure” and economic coercion from China.

The president’s trip was to coincide with the 40th anniversary of Eswatini’s King Mswati III’s accession and birthday and was meant for bilateral talks as well as the signing of an agreement on customs.

However, a Chinese official while praising the three countries for denying the president of the flight permits denied that the step was taken as a result of coercion from Beijing. But observers say this was not true pointing out that China must have used what has been described in diplomatic circuits as its usual “Dollar Diplomacy”, a system in which it makes countries support it actions through granting of loans and credit facilities.

For instance, Zambia on May 2, 2026, abruptly cancelled an international conference on digital media and human rights scheduled to begin in the country from May 5-8. The permanent secretary for the Ministry of Information & Media, Thabo Kawana, said the conference could no longer hold because the government wanted to ensure the gathering “aligns with Zambia’s national values, policy priorities, and broader public interest considerations.”

This was a conference which the organisers said had taken them months to plan and finetune with government officials. However, observers said the conference was abruptly cancelled because there are many civil rights activists billed to participate at the conference coming from Taiwan.

Taipei was the host of the conference in 2025 while the venue in Lusaka was said to have been built and donated by China which protested at the attendance of Taiwanese delegates! Beijing has continuously claimed that Taiwan, a democracy is a province of China.
When the President Lai’s visit was cancelled, the Taiwanese government had described the action as “unexpected and without prior notice”.

But in a surprising move on Saturday, May 2, 2026, it was widely reported that President Lai had landed in Eswatini. The trip was a diplomatic victory for a country that has been under intense pressure from Beijing by trying to muscle it out of existence and from any engagement with the wider world.

In quick reaction to the visit, China immediately resorted to its fabled “Dollar Diplomacy” by scrapping tariffs for all African countries, except Eswatini! The Chinese government has always frowned at President Lai’s actions to engage with the world and Africa. It had previously described him and his party Democratic Progressive Party (DPP) as a “troublemaker” and a “destroyer of cross-strait peace”.

But President Lai, in a statement on his X handle, faulted what he described as China’s “coercive actions.” According to him, the action has “exposed the risks authoritarian regimes pose to the international order. No number of threats or coercion will shake Taiwan’s resolve to engage with the world.”

In another posting on the social media, President Lai wrote: “Taiwan will never be deterred by external pressures. Our resolve and commitment are underpinned by the understanding that Taiwan will continue to engage with the world – no matter the challenges faced.”

He thanked Eswatini for “standing firm against various diplomatic and economic pressure, speaking out for Taiwan’s international place through concrete actions. I hope this trip will contribute to even deeper friendship between Taiwan and Eswatini, thanks to closer economic, agricultural, cultural and educational links, as well as promote Taiwan’s international co-operation.”

In the meantime, the House Foreign Affairs Committee of the United States in a post on X said they “stood with Taiwan against this blatant coercion,” while Senator Ted Cruz also criticised the action of the three countries, saying they seemed “determined to ally with the Chinese Communist Party.”

The implications of the visit for Africa
While the controversy rages, analysts pondering on the implications of the visit to Eswatini on other countries in Africa. Prof Sabella Abidde of the Alabama State University, Montogomery, United States of America is of the opinion that, “President Lai’s visit to Eswatini is significant on many fronts, the least of which is his strong commitment, respect, and appreciation for His Majesty King Mswati III and the great people of Eswatini. As was the case with former President Tsai Ing-wen, President Lai is committed to the well-being and prosperity of her diplomatic allies. The visit is also an indication that – not minding China’s undue interference and high-handed diplomatic tactics – much of the world sees Taiwan as a reliable partner and a force for good.”

According to the University don, who has written extensively on Asia, Taiwan and African relations, the attempt by China to stop the trip by prevailing on the three countries to cancel the over flight permission was an attempt to “curtail the autonomy of countries.” He said, “Indeed, there are many lessons to be learned.

First, China should stop taking Africa for granted; it should stop acting as though it owns the continent. Second, China should stop dictating to African governments on how to conduct their internal and external affairs.”

He warned that Beijing’s assistance to states and societies on the continent does not mean it should curtail the autonomy of countries like Seychelles, Mauritius, and Madagascar.

He averred that “No one should assume that Taiwan is powerless and can therefore be shoved around. Taiwan is not a political and diplomatic orphan; Taipei has a widening and deepening global support that will become more evident within a decade or so.”

In the meantime, Nigeria and Taiwan may be working toward strengthening ties even though they have no diplomatic relations yet. Receiving the Taiwan Head of Mission to Nigeria, Andy Yih-Pin Liu at the Aso Villa, Abuja on August 1, 2025, the First Lady Senator Oluremi Tinubu praised the enthusiasm of both countries to scale up trade and cultural relations.

*Senator Remi Tinubu with Andy Yin-Ping Liu at Aso Villa, August 1, 2025

A statement by Busola Kukoyi, Senior Special Assistant Media to the First Lady, said Senator Tinubu invited members of the diplomatic community to enjoy the richness of Nigeria’s culture, fashion, cuisine and tradition. The visit to the First Lady is viewed as a tacit move to learn more from the small island nation and one of the big Asian Tigers. Mrs Tinubu emphasized that Nigeria’s rich culture and fashion have remained unrivaled as the nation possesses a rich and diverse scope of these.

The statement added that, “Welcoming the Chief of Mission back to Nigeria after his first stint in 1993, Senator Oluremi Tinubu praised the enthusiasm of both countries to scale up trade and cultural relations.

“The Chief of Taiwan’s Mission to Nigeria, Andy Yin-Ping Liu explained that Taiwan has renewed its willingness to collaborate with President Bola Tinubu, in achieving his desire to turn the nation’s Southeast into a technological and industrial hub, dubbed ‘Taiwan of Africa’.

“He said even without formal diplomatic relations between Nigeria and Taiwan, the two countries have leveraged a Memorandum of Understanding, signed in 1990 to facilitate trade exchange, which stood at about 400 million dollars at the end of the first quarter of year 2024.”

President Tinubu as the candidate of the All Progressives Congress (APC) had in his campaign in November 2022, promised to turn the South East to Taiwan of Africa. According to him, “I will engage the leaders of the South-east in a heart-to-heart discussion on all issues agitating their minds. If elected, I will address all issues and policies that tend to hinder their commerce and enterprise. I will work with businessmen and women and encourage them to make the South-east the Taiwan of Africa.”

Also, Governor Chukwuma Soludo of Anambra State had in March 2026, during his swearing in for a second term toed the line of President Tinubu by promising to turn to reality the dream of turning the Southeast to the Taiwan of Africa.

The Taiwanese envoy Andy during the visit to the First Lady perhaps with these at the back of his mind, told her that his country is eager to expand the trade volume between the two countries especially in health, education and technology. He added that Taiwan with no natural resources, intends to leverage its advantage in modern technology and education to acquire deeper partnerships with Nigeria.

But why is Africa dilly- dallying with having full diplomatic relations with Taiwan? Prof Abidde is of the view that “Many African governments are illiberal, and their presidents are politically illegitimate and are afraid of taking on China (the new global hegemon). Many are heavily dependent on handouts from China, forgetting that Taiwan can better help them develop their economies, institutions, and infrastructure. No one is asking African governments to expel China. No, oh no! But the fact is that Africa is large enough for a ‘Two China’ policy — large enough for both Chinas and all those wishing to engage Africa meaningfully.” He is of the strong opinion that both countries should engage with African countries as they deem fit and proper without any of them breathing down the neck of the other.

On a way out for African countries to escape from the yoke of China taking into cognizance the fact that Taiwan has its expertise in technology and the world’s biggest manufacturer of semiconductor, Prof Abidde counselled, “First, African governments and much of the international community must admit that they misread the 1971 UN General Assembly Resolution 2758, which recognized the People’s Republic of China (PRC) as the sole representative of China to the UN. This misreading partly led to the adoption of the ‘One China’ policy. Second, African governments must accept that Taiwan has long ago met all the requirements for Statehood and should therefore accord Taiwan full diplomatic recognition. For the last two or more decades, Taiwan has been a strong supporter of many African governments, providing various forms of development assistance – especially in education and international trade. They benefit greatly from Taiwan, but do not want to codify the relationship?”

However, it is viewed, President Lai as Maya Angelou wrote in one of her poems has flown to Eswatini and back to Taiwan like “A free bird leaps on the back of the wind and floats downstream till the current ends.” Africa must be free to choose her friends and work for closer economic, agricultural, cultural and educational links as Taiwan seeks to deepen its friendship and promote international cooperation without been hindered.

*Dr Oyegbile an award-winning journalist, and media scholar is a Fellow of the Taiwan Foundation for Democracy

By Tony Irawo

In Lagos, land is more than an asset. It is power, identity, and increasingly a trigger for violence. Yet beyond the brazen invasions, demolitions, and the growing body count lies a more troubling reality: a justice system many believe has become either too weak or too compromised to hold perpetrators to account.

The latest controversy surrounding the sudden withdrawal of a land dispute case file involving Nasco Town Limited and property developer Abiodun Ariori, has once again exposed deep cracks in the system.

Without prior notice to the claimants or their lawyers, the Chief Judge of Lagos State reportedly ordered the case file to be retrieved from the Ikeja High Court, halting proceedings indefinitely. No reasons were given. For observers, it was not just unusual; it was ominous.

For a case already plagued by delays since 2020, the move has heightened fears that justice may once again be derailed in a state where land disputes too often follow a familiar script of intimidation, violence, and ultimately, legal ambiguity.

However in another twist, the case came up before another judge, Justice Yakub Oshoala today Wednesday, April 29, 2026, without notice to the claimants, Nasco Town Limited. Apparently, the Chief Judge has reassigned the case to the new judge. The defendants were the only party in court and one of them notified the claimant’s lawyer by asking why they were not in court.

At the centre of the storm is Abiodun Ariori, a controversial figure whose name has surfaced repeatedly in high-stakes land disputes across Lagos.

In the Nasco case, the company claims decades-long possession of the disputed land, dating back to 1978, backed by federal lease, development activity, and documented registry records.

Yet in 2018, that possession was violently challenged when Ariori and associates allegedly stormed the land with armed security operatives, invoking a 1997 Consent Judgment between the late Chief Michael Mojisola Cole and some other persons.

Nasco insists they were not a party to the consent judgement and that it does not apply to their property. Nasco further argued that documents obtained from the case file during their investigation show that the said consent judgement had already been executed at a different location by the late Chief Cole , the original benefactor of the consent judgement before his demise.

This pattern, asserting legal authority while deploying force, appears consistent across multiple allegations against Ariori. In Owode-Onirin, the stakes turned deadly. What began as a land enforcement operation spiralled into a massacre in August 2025, leaving at least six traders dead.

The police initially appeared resolute. Officers linked to the killings were arrested, dismissed, and evidence, including autopsy and ballistic reports, was reportedly assembled.
Then came yet another twist.

The Lagos State Directorate of Public Prosecutions (DPP), Babajide Martins, issued a legal advice declaring that there was no prima facie case against the officers. The killings, it concluded, occurred in self-defence. Charges were withdrawn.

The decision stunned many, not least the police themselves. In a rare institutional clash, senior investigators, including the erstwhile Commissioner of Police, Moshood Jimoh and the officer in charge of the State Criminal Investigation Department, DCP Dayo Akinbisehin pushed back, insisting that sufficient evidence existed to prosecute. Their protest was ignored.

The result was that there was no trial, no convictions and no closure for the victims’ families.

The DPP’s position, that evidence was insufficient, reflects a core principle of criminal law: prosecution must be based on proof, not suspicion.

The Lagos Ministry of Justice, through the Attorney General, Lawal Pedro SAN, has defended its decision, citing gaps in forensic submissions and delays by the police. Yet critics argue that the issue is not merely legal; it is systemic.

How does a case involving multiple deaths, dismissed officers, and forensic reports collapse at the prosecutorial stage? Why does the burden of investigative failure consistently fall in ways that favour the powerful?

These questions are not new. Nearly three decades ago, a similar controversy unfolded in the infamous Abiola Farms case. After the brutal killing of a farm manager during a land dispute, suspects were arrested and charged. But in a stunning reversal, the DPP at the time issued legal advice that the killing was justified as a defence of property. Charges were dropped.

Today, the parallels are difficult to ignore.

Then, as now, land disputes turned violent. Then, as now, the legal system appeared to tilt in favour of those asserting ownership through force. Then, as now, justice dissolved into technical reasoning that left victims without redress.

Legal practitioner Monday Ubani has also sounded the alarm over what he describes as the weaponisation of state institutions in land disputes. In a case involving his client, Idahosa Osa, Ubani alleged that land grabbers, led by the same Ariori, and backed by security personnel and state officials, invaded a property under the guise of enforcing a court judgment that did not apply to the disputed parcel of land in the Ikeja area.

Despite obtaining a court injunction, he claims enforcement agencies ignored it, demolishing structures and seizing control of the land. More troubling were allegations that officials openly boasted of acting “on instructions from higher quarters.”

Whether proven or not, such claims reinforce a growing perception that in Lagos, access to power can shape not just outcomes but the entire process of justice.

Ariori himself has consistently denied all allegations of wrongdoing. He insists he is a legitimate developer acting on valid court judgments and land titles. In the Owode-Onirin case, he maintains he was not present at the scene and has accused the police of bias and media trial.

This dual narrative, of victim and accused, captures the complexity of land disputes in Lagos. Competing claims, overlapping titles, and historical ambiguities often create legal grey zones.

But what is harder to justify is the recurring descent into violence, and the apparent inability of the justice system to decisively resolve disputes.

Lagos State does have a law against land grabbing—the Property Protection Law of 2016—designed to curb precisely these abuses. It criminalises forceful land takeover and prescribes penalties for offenders.

Yet enforcement has been inconsistent. Cases drag on for years. Defendants evade service. Court orders are flouted. And when violence occurs, prosecutions falter.

The withdrawal, and reassignment, of the Nasco case file without explanation only deepens concerns about transparency. If judicial processes can be interrupted without accountability, what confidence can litigants have?

The consequences extend far beyond individual disputes. Land grabbing undermines property rights, the foundation of economic stability. It deters investment, fuels urban chaos, and erodes trust in institutions. More dangerously, it normalises violence as a tool of negotiation.

In Owode-Onirin, that violence claimed lives. In other cases, it has displaced families, destroyed livelihoods, and left communities in fear.
When justice fails, people seek alternatives, often through self-help, retaliation, or vigilantism. This is how disputes escalate into cycles of violence.

At its core, the crisis raises a fundamental question: Is the Lagos justice system unable or unwilling to confront powerful interests?
The answer may lie somewhere in between.

Under-resourced investigations, bureaucratic delays, and legal technicalities all play a role. But so too do allegations of influence, connections, and selective enforcement.

The irony is obvious. In a state that prides itself as Nigeria’s commercial nerve centre, the rule of law, especially in land matters, remains fragile. The same system that should protect property rights is often accused of enabling its violation.

Restoring confidence will require more than rhetoric. Transparent judicial processes, timely case management, and independent prosecutorial decisions are essential. So too is accountability, both for perpetrators of land grabbing and for institutions that fail to act.

The Nasco case, the Owode-Onirin killings, the Ubani allegations, and the historical shadow of Abiola Farms all point to one conclusion: this is not an isolated problem. It is a pattern. And patterns, left unchecked, become norms.

Perhaps the greatest tragedy is not just the violence, but the message it sends that in Lagos, land can be taken by force. That justice can be delayed or denied. And that, for the powerful, the system may bend just enough to protect them.

For the victims, traders, landowners, and families, the question is painfully simple: if the law cannot protect them, who will?

Until that question is answered, the cycle will continue, of land, of blood, and of broken justice.

The proposal, attributed to a group identified as “Concerned Akoko APC Stakeholders,” emphasizes the need to consolidate local support while presenting candidates considered credible, loyal, and capable across key political positions in the constituency.

Objective and Strategic Focus

At the core of the document is a plan to strengthen the party’s electoral base by aligning community interests with candidate selection. The stakeholders stressed that success would depend on disciplined coordination, inclusive engagement, and effective mobilization across all wards in Akoko North.

Senatorial Position: Akoko North West

For the Ondo North Senatorial seat, the stakeholders identified Engr. Michael Abayomi Adeyanju a.k.a. Imole as a leading aspirant. They described him as possessing the capacity, loyalty, and grassroots appeal necessary to galvanize support across the senatorial district.

According to the report, his candidacy is seen as reflective of the aspirations of Akoko North West and capable of fostering unity among party stakeholders in the region.

House of Representatives: Akoko North East

On the House of Representatives seat, the stakeholders advocated zoning the position to Akoko North East, citing ongoing calls for equitable power rotation within the constituency.

They highlighted Azeez Richardos Momoh as a potential candidate, noting his background, including ties to the Olukare royal lineage, as well as his perceived credibility and ability to connect with constituents. The report described his emergence as a “balanced and acceptable option” that could enhance cohesion.

State Assembly: Constituency I

For Akoko North West Constituency I in the Ondo State House of Assembly, the stakeholders pointed to the Okeagbe axis as a strategic stronghold for candidate selection.

Businessman Olumide Aliu was identified as a viable contender, with the report citing his loyalty to the current administration and the presence of an established political structure capable of supporting a successful campaign.

State Assembly: Constituency II

In Akoko North West Constituency II, the stakeholders expressed support for Hon. Bode Awe, describing him as an experienced and consistent aspirant with strong grassroots connections.

They noted that his previous participation in elections, combined with his resilience and local popularity, positions him as a formidable candidate for the seat.

Electoral Significance of Ogbagi Akoko

The report placed particular emphasis on Ogbagi Akoko, describing it as the most populous voting bloc in the local government area. Stakeholders argued that effective mobilization in Ogbagi, complemented by support from other wards, could provide a decisive advantage in elections.

Strategic Advantages

The proposed alignment, according to the stakeholders, offers several benefits:

*Deployment of candidates with strong grassroots appeal and established loyalty

*Strategic focus on high voter-density areas such as Ogbagi

*Balanced representation across different parts of Akoko North

*Capacity for sustained campaign mobilization and funding

Conclusion

The stakeholders concluded that the outlined structure presents a clear pathway to electoral success for the APC in Akoko North. They emphasized that unity, coordination, and inclusive political engagement would be critical not only for winning elections but also for ensuring long-term political stability in the constituency.

Every minute your kidneys are hard at work, filtering around 200 litres of blood, removing waste, balancing salts and fluids, and regulating blood pressure. This happens without any conscious effort on your part.

But when your kidneys begin to fail, the consequences are devastating, including fatigue, fluid buildup and heart complications. Some people eventually need dialysis or a transplant to stay alive.

Kidney disease is one of the fastest-growing causes of death across the world. Around 850 million people are living with some form of it, more than the combined number of people affected by diabetes and cancer. Chronic kidney disease – when your kidneys slowly lose the ability to do their job – causes approximately 1.5 million deaths each year globally and that toll is rising.

But kidney disease develops silently, with few symptoms until it is already severe.

And the burden is not shared equally. People of African ancestry are four times more likely to develop the most severe form of kidney failure than people of European ancestry. In sub-Saharan Africa, rates of high blood pressure and type 2 diabetes are rising too. Both are leading drivers of kidney damage. Around 30% of adults in sub-Saharan Africa have high blood pressure, and 25 million (one in 20 adults) have diabetes) – mostly undiagnosed and untreated.

Sub-Saharan Africa has lower numbers of kidney specialists, dialysis facilities and transplant services per capita than the rest of the world. Africa as a whole has fewer than one nephrologist per million people. In some African countries there are no kidney specialists at all. The global median is around 10 per million. In high-income countries the figure reaches 23 per million. For most Africans who reach kidney failure, there is simply no treatment available.

Identifying who is at risk before their kidneys fail is therefore vital.

Our recently published research fills a big gap here. We are members of the KidneyGenAfrica consortium, a pan-African partnership that aims to deliver research and training excellence in genomics of kidney disease.

We found new genetic variants that point to kidney disease risk in African populations. And we uncovered differences between the genetic risks faced by people living in Africa, on one hand, and people of African descent living in the North America and Europe, on the other.

This shows how important it is for medicine to be based on relevant research.

Understanding kidney disease

Kidney disease does not appear suddenly. It often develops gradually, shaped by a combination of factors. Some people carry genetic variants, small differences in their DNA, that make their kidneys more susceptible to damage.

Others face environmental risks such as high-salt diets, uncontrolled high blood pressure or diabetes infections. The use of herbal medicines, contaminated water and environmental toxins are risks too.

In most cases, it is the combinations of these factors that determine who gets sick and how quickly. But until recently, African populations had barely featured in the scientific conversation about this. Africa, home to the most genetically diverse human populations on Earth, have been represented in only a small fraction of the world’s genomic research.

That is beginning to change.

Large genetic study of Africans

We analysed genomic data from about 26,000 individuals across eastern, western and southern Africa, and around 81,000 individuals of African ancestry living elsewhere. It’s the largest genetic study of kidney function in continental Africans ever conducted.

Our study sheds new light on the genetics of chronic kidney disease across diverse African populations. It will also support future work aimed at improving prevention, diagnosis and treatment of kidney disease among these populations and worldwide.

The team used a method called a genome-wide association study, which scans the entire human genetic code to find variants linked to a particular trait or disease. Here, the trait of interest was estimated glomerular filtration rate, a standard blood test result that measures how efficiently the kidneys are filtering waste. A lower score signals poorer kidney function and higher risk of disease.

Analysing continental African populations alone, the study identified four relevant locations on genes, including two that hadn’t been reported before.

Adding African-ancestry populations across the diaspora, the number rose to 19 locations, three of them new. Four of these genetic locations were pinpointed with high precision. This means the team was able to identify the specific genetic variant most likely driving the effect, rather than simply flagging a region of the genome where something relevant was happening.

Each newly discovered location is now a potential target for future drugs or diagnostic tools.

The study also examined polygenic scores, which are tools that estimate a person’s overall risk of developing a disease. A key finding here was that scores built using data from genetically similar African populations performed better than scores derived from larger but genetically distant datasets.

This matters enormously for medicine in Africa: the science only works if the reference data matches the population it is meant to serve.

A gene that behaves differently on either side of the Atlantic

An important finding from the study concerns a gene called APOL1. Two variants of the APOL1 gene, known as G1 and G2, increase the risk of several serious forms of kidney disease in African Americans. It was widely assumed that the same risk would apply equally to people living on the African continent.

However, the data suggests otherwise. In continental Africa, these high-risk APOL1 variants occur at lower frequencies (and vary across regions of Africa). Their association with reduced kidney function is markedly weaker than in the African diaspora.

The same gene appears to behave differently depending on where a person lives and what population they descend from.

The finding matters for drug development. Clinical trials for kidney disease treatments must include people living in Africa and not just people of African descent living elsewhere.

What must happen now

Several things must follow from this research if it is to benefit people’s health:

• African health systems must invest in early kidney disease detection. Simple, affordable blood and urine tests can identify kidney damage when lifestyle changes and medication can still make a difference. Genetic risk tools can help identify who needs screening most urgently.
• Pharmaceutical companies must include continental African populations in their clinical trials.
• The global research community must continue investing in African genomic infrastructure – research cohorts and large groups of consenting participants whose genetic and health data are collected and stored for analysis.

This research is evidence that African scientists, working with African communities, can generate knowledge that shifts the global picture. The world’s understanding of one of its most urgent health challenges will be sharper for it.

*Segun Fatumo is Professor and Chair of Genomic Diversity, Queen Mary University of London

Nigeria faces one of the world’s highest maternal mortality rates. Around 1,047 women die for every 100,000 live births, far above the African regional average of about 531 deaths per 100,000. This highlights the fact that not all women are getting maternal healthcare.

Reasons include:

• differences in access to healthcare between geographical regions
• socio-demographic factors such as education, poverty, age and limited decision-making power within households
• religious affiliation, which in some communities shapes health-seeking behaviour
• limited exposure to health information
• poverty and unemployment
• a lack of health insurance.

Nigeria has implemented several maternal health programmes over the past two decades. The National Integrated Maternal, Newborn and Child Strategy, Midwives Service Scheme and Free Maternal and Child Health Programmes were designed to increase skilled birth attendance, improve access to antenatal and postnatal care, and reduce financial barriers to maternal health services.

But progress in reducing maternal deaths has been uneven across Nigeria. Maternal mortality in the north-east and north-west exceeds 1,000 deaths per 100,000 live births, far higher than rates in southern regions of the country. Many women still do not receive essential maternal health services. For example, only 47.8% of women reported delivering with a skilled birth attendant, and millions of women have limited access to regular antenatal care.

The challenge is no longer about identifying the problem. It is about removing the real barriers Nigerian women face.

We are global public health researchers with a focus on maternal health systems in low- and middle-income countries.

Our recent published policy brief highlighted why many women in Nigeria aren’t using maternity services. Our findings suggest that there are four practical shifts that the Nigerian government could make to improve the use of maternity services across Nigeria. These are:

• region-specific interventions
• increasing the coverage of services so that they’re closer to where women live
• removing financial barriers to care
• using digital capabilities to overcome gaps in services.

Four interventions that can make a difference

1. Target regions differently

Maternal health policies often take a national approach, but Nigeria is not uniform. Northern and some southern regions face different cultural, religious and geographic barriers. Government policies therefore need to target specific barriers in different regions. For example, improving transport and health facility access in rural areas, expanding community-based maternal services, and strengthening culturally appropriate health education programmes.

Such policies would typically be developed by Nigeria’s Federal Ministry of Health in collaboration with state governments, local health authorities and community organisations. Regional inequalities in maternal death have shown why a uniform policy approach is ineffective. For example, skilled birth attendance is far lower in the north-west than in southern regions.

The Federal Ministry of Health should empower the state governments to:

• work with the religious and traditional leaders to promote skilled birth attendance
• engage community influencers to counter harmful norms
• train health workers in culturally sensitive care
• strengthen primary healthcare services in underserved districts.

When communities trust the system, they use it.

2. Take services closer to women

Distance remains a barrier, especially in rural areas. Many women cannot travel long distances while pregnant. In many parts of Nigeria, a health facility may be more than 5-10 kilometres away, and poor roads, limited transport and travel costs make it difficult to reach care.

Mobile health clinics can bridge this gap. They bring antenatal care, family planning and basic obstetric services directly to remote communities. These clinics can be established and operated by state ministries of health and local government health authorities. Though there are mobile clinics in Nigeria currently, there ought to be more.

Outreach teams dedicated to maternal health specifically and including trained midwives, nurses, community health extension workers, volunteer community health workers, supported by local primary healthcare staff should:

• provide health education in local languages
• offer on-the-spot referrals
• use community health workers to track pregnancies early.

Care that comes closer to women increases uptake, as seen in western Kenya.

3. Remove financial barriers

Out-of-pocket payments still prevent many Nigerian women from seeking care. Health insurance coverage remains low. Fewer than 10% of Nigerians are currently covered by any form of health insurance, leaving the majority of households to pay directly for services. This is despite the fact that it was made mandatory for all Nigerians and legal residents in 2022.

Maternal health is meant to be free. But the policy isn’t implemented consistently.

Three reforms are critical:

• expand health insurance coverage for maternity service
• enforce policies that prevent informal or hidden charges
• introduce targeted financial incentives such as vouchers or conditional cash transfers for poor women.

These reforms would require coordinated action across Nigeria’s federal, state and local health systems, which jointly oversee healthcare financing and service delivery.

Evidence from other low- and middle-income countries shows that financial incentives increase service use. When cost is removed, utilisation rises.

Long-term economic empowerment of women is equally important. Women with stable incomes are more likely to seek care.

4. Use digital health to widen access

Nigeria’s digital penetration is growing rapidly. More than 100 million Nigerians use the internet, representing about 45% of the population. Mobile phone penetration exceeds 80% of the population. This creates an opportunity to create digital platforms that:

• send appointment reminders
• provide pregnancy education
• support teleconsultations
• use artificial intelligence tools to improve risk screening.

Way forward

Nigeria does not need more policy documents. It needs targeted implementation.

First, federal and state governments must align efforts. Nigeria already has national institutions coordinating maternal health policy, including the Federal Ministry of Health and Social Welfare and the National Primary Health Care Development Agency. But because health services are delivered largely by state and local governments, implementation varies widely. Maternal health policies should be state-specific but nationally coordinated and adapted to state-specific realities.

Second, funding must prioritise primary healthcare and community engagement. Investments should focus on where utilisation is lowest.

Third, monitoring systems must improve. Data should guide decisions at local levels. Programmes that work should be scaled. Those that fail should be redesigned.

Finally, women themselves must be part of policy design. Solutions imposed from above rarely succeed. Improving maternity service use is not only a health goal. It strengthens families, communities and the economy.

The next step is clear: implement smarter, targeted policies that remove barriers and bring care closer to every woman.

*Obasanjo Bolarinwa and Rebecca Tadokera are with York St John University