Objectives: The aim of this study is to analyse the process of successful ageing in older persons who state their belonging to a native Chilean ethnic group. There has recently been a notable increase in interest regarding analysis of the cultural processes and variables associated with successful ageing. However, there is a lack of studies analysing successful ageing in native ethnic groups; that is, ethnic communities living in their natural environmental surroundings.Methods: A cross-sectional research design was used. The sample was composed by 232 indigenous Aymara persons aged over 60 years who live in the far north of Chile. Data were collected using a questionnaire made up of validated measurement scales for successful ageing, community support, quality of life, religiousness/spirituality, and health.Results: The results suggest that indigenous persons age successfully, particularly in the context of physical functionality. Successful ageing is positively related with community integration, social support from informal systems , quality of life, and religiousness (forgiveness). In contrast, successful ageing is negatively related with depression.Conclusions: Cultural practices and an active lifestyle are ethnic cultural resources enabling persons to successfully cope with ageing. The results suggest that interventions would benefit from incorporating actions within a context of community integration. Particular attention to preventing deterioration in mental health would help to foster a successful ageing process. The concept of successful ageing  during ageing, studies conducted in Chile show that the variables or dimensions related with QoL among older Chilean persons are having social support networks, enjoying good health , having the capacity for self-acceptance and belonging to a protected physical environment. In this regard, the role played by social support networks  is recurrent in the evaluation of QoL of older Chilean persons. Health, frequently in the form of capacity for self-efficacy or independence , is also of particular importance, with an emphasis on the positive influence of physical activity for this dimension. Along these lines, adults experience various ailments and illnesses, but ‘adaptive capacity’ is key, in terms of new conditions or even limitations on dealing with the problems experienced in everyday life. Finally, belonging to a protected physical environment is positively related with QoL, with an emphasis on the perception of housing and/or the neighbourhood as spaces that are removed from problems such as violence, drug addiction and alcoholism . Those residents in the foothills mainly cultivate garlic and oregano. In the geographical areas closer to the sea, the norm is agricultural work such as the cultivation, irrigation and harvesting of fruit in particular  took place from the final decade of the nineteenth century, which contributed to a significant erosion of certain features of social interaction in the indigenous cultural context . In fact, the Aymara use Spanish as their working language, reserving the use of the Aymara language for private or indigenous community spaces.Interactions between older adults and members of their close and extended family tend to occur at religious festivals or other Aymara rites that are still celebrated in the villages, in which space older people play a leading role in cultural transmission. The significance of the role of older persons in maintaining indigenous cultural practices is shown in their participation in the social tasks  that represent an essential part of the routine of highland families  and successful ageing among indigenous older persons.The study was quantitative and cross-sectional, involving the participation of 232 indigenous older persons living in the far north of Chile. The design of the sample was non-probabilistic, given the difficulties found for it working with the indigenous population under study. In order to obtain an appropriate level of structural representativeness, a quota sample by sex, age, ethnicity and place of residence was designed. The fundamental aims were ensuring (1) that the sample reflected the characteristics of the population and (2) that the sample was sufficient to carry out the statistical analysis. Along these lines, the participants characteristics described in the results section adequately reflect the main social features of the population. The inclusion criteria were being aged 60 or over, belonging to the indigenous Aymara ethnicity and not suffering from serious cognitive deterioration. Some members of the research team  had enjoyed previous access to some communities from which participants were recruited, which enabled the technical team to obtain access without difficulty. These agents carried out an initial selection of participants based on the inclusion criteria. The experience and knowledge of the community of social workers contributed to a recruitment process that enabled the identification of persons with dementia (excluded from eligibility). Only participants without missing information on any of the variables considered were included in the study. The questionnaire was applied via personal (face-to-face) interview, having first obtained the informed consent of participants.The main source of bias in the present study was the administration of the questionnaire and the understanding of the measurement scales by the participants. It was essential to ensure that all members of the sample clearly and consistently understood the content of the different measurement instruments. To that end, a pilot measure was taken from a group of 33 people, none of which were part of the final sample. The pilot study allowed the questionnaire to be refined such that the interviewers were provided with clear instructions and definitions for the application of the measurement instruments. Qualified professionals administered it between June and August 2015. To reduce the interviewer variability effect on information gathering, all interviewers underwent a training programme in order to ensure that the interviewers had the skills and knowledge to correctly carry out interviews. This involved specific training on the research questionnaire. Similarly, particular attention was paid to the design of the questionnaire with the aim of reducing misinterpretation of information by interviewers.The Ethics Committee of the University of Tarapacá and the National Council for Science and Technology of Chile approved and monitored the ethical aspects of the study. All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.Seven measurement scales were used to adequately measure the psychosocial dimensions included as part of the study aim. All data were self-reported.The Successful Ageing Inventory (SAI) devised by Troutman, Nies, Small, and Bates  was usedThe Perceived Social Community Support Questionnaire devised by Gracia, Herrero, and Musitu  was applThe WHOQOL-BREF scale, from the quality of life group of the World Health Organization , was useThe Brief Multidimensional Measure of Religiousness/Spirituality (BMMRS) from the Fetzer Institute  was applThis study evaluated health in terms of mental health (depression), main health problems (most recurrent illnesses) and dependency in daily activities. The following instruments were applied to assess health in these contexts:The existence of depressive symptoms was evaluated via the Geriatric Depression Scale (GDS) developed by Brink et al. . The oriThe Health Problems Questionnaire produced by Herrera, Barros, and Fernández  was usedThe Barthel Activities of Daily Living (ADL) Index, developed by Mahoney and Barthel , was appTwo stages of data analysis were implemented in order to address the aims of the study. First, the descriptive statistics corresponding to the scores for the successful ageing questionnaire and the other study variables. Second, a hierarchical regression analysis was carried out for the ‘successful ageing among indigenous older persons’ variable, which entailed the creation of four models. Included in all of these were the following control variables: sex , age and marital status . In model 1, the dimensions of community social support  were included. Model 2 integrated the quality of life variable. Model 3 added together the scores for the various dimensions of religiousness/spirituality . Finally, model 4 included mental and physical health . Version 23 of the IBM-SPSS programme was used to carry out the analyses.The main socioeconomic characteristics were: 65% women and 35% men. In terms of age, 58% were between 60 and 69 years old, 32% between 70 and 79, and 10% over 80 years old . With respect to marital status, 47% had a partner (whether married or cohabiting), 23% were widows/widowers, 17% divorced or separated, and 13% single. Concerning the level of education, 24% had not attended school, 38% had completed primary education, 30% secondary education, and 8% had completed higher education. In terms of place of residence, 66% lived in an urban area (Arica), 23% in highland areas , and 11% in foothills (Codpa and its surrounding area). Concerning financial background, 66% were still working for financial remuneration and 55% contributed the highest amount to their household (head of household).β = −.252; p < 0.01) and community integration are the main predictive variables  along with social support from informal systems . In model 2 , age again remains  as does community integration , and quality of life is added . Model 3  retains age , community integration , social support from informal systems , and quality of life , with forgiveness being added . Finally, in model 4 , social support from informal systems  and forgiveness  remain, with depression added . In sum, successful ageing is positively related with community integration, social support from informal systems, quality of life and forgiveness. In contrast, successful ageing is negatively related with age and depression.The results obtained suggest that a process of successful ageing characterises older Aymara persons who participated therein. In this regard, the average score (67.7) was located in the successful ageing interval according to the evaluation criteria of the questionnaire used (scores from 54 to 80 indicate successful ageing). Though this statement is applicable to the various dimensions used of the SAI, the average scores for the ‘functional performance’ (7.20 with a range of 0–8) and ‘life purpose/satisfaction’ (10.72 with range 0–12) categories are of particular note. In general terms, and particularly in these two cases, it is possible to link successful ageing with various cultural elements characteristic of this native ethnicity, which could be positively influencing both the definition and the successful unfolding of ageing.The older Aymara people have an active lifestyle, to a large extent due to the Aymara organisation of productive and reproductive activities. This circumstance – maintaining labour activity and the specific features of that activity – may contribute to explaining the positive results found for the dimension of ‘physical functionality’ in the SAI. Insofar as older Aymara persons integrate and participate in maintaining indigenous cultural practices , only deterioration in mental health showed a significant association. The Geriatric Depression Scale, which considers symptoms such as loneliness, lack of meaning in life, abandonment of interests, feelings of boredom, experiencing fear, and feeling useless, was used to measure depressive feelings in our study. On this point it is necessary to emphasise that indigenous Aymara people, especially those living in highland zones, have witnessed the depopulation of their regions. Likewise, they have seen their key social networks affected by the migration of younger people to urban areas  population in the region of Arica and Parinacota, the results cannot be generalised for the entire indigenous population of Chile. Fourth, the average score for the dependence measure (Barthel ADL index) suggests the possible existence of a ceiling effect in the data analysis, and specifically in the estimation of its association with the outcome variable. It is possible that the measure used is not entirely appropriate for research using a community-based population. Fifth, empirical evidence is not available with regard to the development of successful ageing in the case of indigenous older persons belonging to In the contexts of these limitations, present peace of research identify deterioration in mental health  as one of the main threats to successful adaptation to ageing. It is worth emphasising that in terms of health, the role of this variable stands out from others such as physical health in the case of the Aymara people who participated in our study. Previous studies suggest that the psychological deterioration of older persons belonging to native ethnicities is strongly related with situations of social isolation (Gallardo-Peralta et al., being Aymara (Gundermann et al., Our results suggest the existence of indicators of successful ageing for indigenous older persons from the north of Chile. Certain Aymara cultural characteristics appear to define and foster a process of successful adaptation to old age. Indigenous persons aged over 60 years have constructed their individual, family and group identity based on the notion of As a consequence, this research opens up a space for reflection in the field of intercultural interventions.More specifically, our results support the usefulness of and need for an ethnically sensitive approach based on an anti-racist, anti-oppressive and anti-discriminatory perspective of social intervention. This is rooted in the idea that a recognition of the cultural values, cultural needs and differences of local ethnic groups includes a practice focused on developing positive minority identities, taking affirmative action and empowering indigenous communities Urh, . In otheThe design of psychosocial interventions with an ethnic perspective should take into account the debate revolving around the cultural construction of the SA concept. In this sense, it is worth emphasising that the dimensions defining and comprising this concept are not necessarily equivalent for all ethnic groups and in all cultural contexts. Some of its dimensions may be more relevant in designing the social intervention than others, bearing in mind the specific cultural and ethnic context for which the intervention is designed and constructed (Afshar, Franks, Maynard, & Wray, Finally, our results also identify depression as one of the main threats to successful adaptation to ageing. It is worth emphasising that in terms of health, the role of this variable stands out from others such as physical health in the case of the Aymara people who participated in our study. Previous studies suggest that the psychological well-being of older persons belonging to native ethnicities is strongly related with situations of social isolation (Gallardo-Peralta et al.,


Background: Intimate partner violence (IPV) continues to be a serious problem worldwide. South Africa has a high prevalence of women experiencing IPV. Although much research reports on the prevalence rates, risk factors, and consequences of IPV, fewer studies report on how women deal with the experiences of IPV.Objective: This systematic review of the empirical literature aimed to identify and synthesize the best available evidence on women's experiences of coping with IPV in South Africa.Methods: A four-level search and retrieval strategy using PRISMA and JBI guidelines was conducted, which included critical appraisal, study selection, data extraction, and data synthesis. Ten studies met the eligibility criteria and were included in the review. They were assessed to meet a set threshold (7/10) based on the JBI Critical Appraisal Checklist for Qualitative Research. All studies were conducted between 2010 and 2020, conducted in South Africa, and used qualitative methodologies to accomplish the overall aim of investigating IPV experiences of women and their responses to it.Results: The total number of women included in the studies was 159. The data extraction yielded 49 findings of which 47 were aggregated into 14 categories and three themes: (1) help- and support-seeking coping, (2) emotional regulation coping, and (3) problem avoidance and distraction coping. Help- and support-seeking coping refers to women's responses when they seek instrumental aid, advice, comfort, and/or understanding from others. Emotional regulation includes responses of women in which their emotions were expressed or regulated. Problem avoidance and distraction coping represent responses of women in which they take efforts to avoid thinking about the problem situation and rather reshift their focus.Conclusion: Overall, this review found that a variety of coping responses are used by South African women experiencing IPV. The findings point to the need for understanding IPV and responses to it within a broader social context rather than just at the personal level. Approaching IPV at many levels may lead to a change in societal norms, better access to and delivery of services to IPV survivors, more functional family affairs, and personal well-being and improved quality of life. Violence against women is historical, threatens the lives of women, and violates women's human rights. It cuts across nations, cultures, religion, and class and continues to this day. Although the majority of countries in the world have made violence against women a criminal act with societies at large condemning it, it continues to be a critical global problem. Most of this violence is intimate partner violence (IPV), defined as the experience of sexual, physical, or psychological harm by a current or former partner . WorldwiSouth Africa is one of the highest-ranking countries in IPV prevalence with studies recording rates from 20% to 50% in which women report having experienced IPV at some point in their lives –9. IPV cTogether with the importance of learning about IPV prevalence, consequences, and risk factors lies the significance of understanding how women respond to the violence they experience. Women may experience the same kind of violence, but the consequences in terms of mental and physical well-being may be different. One way to argue for such differences may be the way individuals cope with the incident(s), i.e., their coping strategies/mechanisms. Coping mechanisms have the potential to alter the impact of IPV on survivor's well-being . The strOne of the most prominent conceptualizations of coping is presented by Lazarus and Folkman . They deGlobally, many researchers have addressed the coping responses of women experiencing IPV. Findings of these studies suggest that women use many coping strategies to manage substantial stress , escape It is furthermore noteworthy to mention that factors such as age, ethnicity, employment, geographical location, and culture should not be disregarded in the discussion about coping. They all may play a role in the resources available to a woman and the coping responses she uses. Indeed, research regarding the socioeconomic status (SES) of IPV survivors has shown, for example, that IPV and poverty create parallel effects and constrain coping mechanisms . Both poThe aim of the present study is to provide a comprehensive systematic review and synthesis of the available literature on women's experiences of coping with IPV in South Africa. We focus on both adaptive and maladaptive coping in this review. The feminist theory and the social-ecological framework serve as theoretical frameworks to understand IPV and its causes, risk factors, and coping responses. Whereas, a growing body of research has examined the prevalence rates that different forms of IPV have and risk factors associated with them, rather little research has examined the strategies survivors have used to cope with the violence, especially in the South African context. Much of our understanding of coping is based mainly on Western cultures . HoweverThe study utilizes a systematic review methodology. Systematic reviews are defined by collecting all possible studies related to a given topic and design and reviewing and analyzing their results . They aiA search strategy was designed using the population, exposure, and outcome (PEO) framework. The population of interest were South African women experiencing IPV. Hence, the exposure constitutes experiencing IPV. Last, the outcome refers to coping with IPV. The PEO framework, thus, yielded the following research question: What are the coping strategies used by South African Women experiencing IPV?The following electronic databases were searched to identify potential studies: Web of Science (WoS), PubMed, EBSCOhost, and Google Scholar. Although the first three databases were searched on the same date , the fourth was searched 4 days later . The databases yielded 735 hits in total of which 334 were generated by WoS, 247 by PubMed, 13 by EBSCOhost, and 141 by Google Scholar using the following key terms and Boolean strings: intimate partner violence OR domestic violence OR partner abuse AND coping OR coping strategy OR responses OR coping mechanism OR experience AND South Africa. The specific search strings matching the database are displayed in To identify and select the studies most relevant to the present review, inclusion and exclusion criteria were established. Inclusion criteria were (i) the paper focused on qualitative data, including but not restrictive to designs, such as phenomenology, feminist research, and discourse analysis; (ii) the paper explicitly included or discussed women above the age of 18 who had personally experienced IPV; and (iii) papers were conducted between 2010 and 2020. Exclusion criteria were (i) the paper was in a non-English language, (ii) the study was not conducted in South Africa, and (iii) papers were not conducted in the designated time frame.Out of the 735 hits yielded by the databases, potential titles were screened in each database, resulting in 20 studies . Additional studies were identified from the reference list of all articles considered. The title search of the reference lists yielded five potential studies. Abstracts of 25 studies were screened for further inclusion by means of meeting the abovementioned inclusion as well as exclusion criteria of the study. This led to 12 articles being excluded after evaluation of the abstract. The remaining 13 records were retrieved for a full text review also with regards to the inclusion and exclusion criteria. Three articles were excluded in this step due to one article having the wrong study design, another having an ineligible population, and one for not focusing on the phenomena of interest. This process led to a final selection of 10 included studies to be assessed for methodological quality. The PRISMA flow chart in The methodological quality of the studies was assessed using the JBI Critical Appraisal Checklist for Qualitative Research , and ratAccording to the abovementioned methodological assessment, a total of 10 studies were recognized as appropriate for the purpose of the current study and were included in the final review to address the objectives and research question of the present study. For the data extraction, each of the 10 identified studies were coded in a preformulated data extraction sheet according to the following characteristics: first author name, year conducted, methodology, methods, setting, phenomena of interest, data analysis, and the authors' conclusion. Next, findings of each included study were described in a consistent manner to synthesize and interpret them at a later stage. A level of “credibility” was given to each finding based on the amount of support presented by each illustration of the finding. As described by the standardized JBI qualitative extraction tool the below presented levels were given. A full list of findings along with illustrations and levels of credibility are presented in Unequivocal (U): the findings' accompanied illustration is not open for challenge.Credible (C): the findings' accompanied illustration is open for challenge.Unsupported (US): the finding is not supported by data.The ConQual approach, also called “summary of findings” is a systematic method to consider what increases or decreases confidence in the results of the qualitative studies . This deDependability is measured by asking questions regarding the appropriateness of the conduct of the research. Questions two, three, four, six, and seven of the abovementioned JBI Critical Appraisal Checklist are asked see . If fourAll included studies were of qualitative design and, therefore, received an initial ranking of “high.” For all three synthesized findings, the majority of the included studies received two to three “yes” responses on the ConQual identified criteria for dependability; therefore, the ranking moved down to one and yielding a “moderate” level of confidence. Credibility levels of the second and third synthesized findings were downgraded one level due to a mix of unequivocal and credible ratings, and the first synthesized finding remained unchanged due to only unequivocal ratings. The so-called summary of findings can be seen in The research findings were pooled by means of the meta-aggregation approach described by the JBI Manual of Systematic Reviews of Qualitative Evidence . It invoFindings extraction from all included papers with an accompanying illustration and assigned credibility level for each finding.Categorization of findings based on similarity in meaning and concepts.Development of a comprehensive set of aggregated findings (of at least two categories) that could be used as a basis for evidence-based practice.The synthesized findings were evaluated with the abovementioned ConQual approach as presented in JBI's Manual to establish a level of confidence in each synthesized finding .For each included study, findings were extracted using the extraction sheet of the abovementioned JBI-QARI. The findings were extracted with an illustration from the original data and assigned a level of credibility. A finding is defined as a literal extract of the authors analytic interpretation, which is supplemented by either a participant's voice or other data . AccordiAlcohol as a Coping Mechanism. This was supported by two illustrations from the study as follows: “I take a doppie. That's how I cope.” (participant X) or “You take a doppie and dance just to try to get through life and to forget the pain.” (participant Y)  . Both ilipant Y)  of the fipant Y) . In thisAll 10 studies included in the present review were conducted between 2010 and 2020, conducted in South Africa, and used a qualitative design. Six studies were conducted in the Western Cape Province (Cape Town), three studies in the Gauteng Province (Johannesburg and Tshwane), and one study in the North West Province (Mafikeng). The total number of participants included in the studies was 159. informal support, refers to the people to whom women reach out to find support for their difficult situation. These include family members, friends, and neighbors. Participants found these people to be very supportive as shown with this statement: “My mother is my biggest support. If it was not for her, I would not cope”   , 35. Theficulty” . All thrlove. Several women in the studies described how, on the one hand, loving their partner had helped them deal with the abuse, and on the other hand, loving behaviors from their abusers helped them get through. Love seemed to be a powerful concept that enforced women to survive their relationship as one woman clearly stated: “He tells me he loves me (.) he was my reason for living (.).”  or for choosing the wrong partner    .” . The secveness”) , 42. The go on.” . The nexlls me”) . The laso away”) .harmful substance use, refers to women coping with the help of alcohol. Women describe how the use of alcohol made them forget the pain as one participant stated: “You take a doppie and dance just to try to get through life and to forget the pain” ”  (Children formed the fifth category. Here women expressed how their children helped them get through as their love for them inspired them (“It's just my children. I love them very much. They are the reason I am going on”)  I have managed to reach grade 12, there are many chances that I can get so that I become better,” or as another woman said: “I will get to the top (…) I am a fighter (.)” (Six categories comprising 16 findings were integrated into the last theme of problem avoidance and distraction coping and can be seen in he pain” . The secren (…)” . Also, sren (…)” . The fouso bad”) , 42. Chiing on”) . The laster (.)” , 37. AllThe synthesized findings show that women who experience IPV use a wide variety of coping mechanisms to deal with the violence. Consistent with the prominent conceptualization of Lazarus and Folkmann , which rMany women in the present study responded to the violence they experienced by seeking help and support from others. Such responses have been linked to problem-focused coping strategies in previous research as they have the potential to alter the problem , 45. PreTogether, these findings show that women are not passive survivors but rather active in that they adopt active strategies to ensure their safety and comfort through the help of others. Research often reports that women suffer in silence . HoweverThe current review further found that many coping responses of women experiencing IPV involved focusing, expressing, or shifting their emotions. For example, women identified love as a powerful survival strategy. They reported that the love they felt for their partner kept them going (reason to survive), which also influenced their commitment to stay in the abusive relationship. This is not uncommon as the concept of love has been linked to a woman's decision and process of leaving an abusive partner in previous research. In a study conducted by Copp et al. , they foThe reported findings of the current review highlight that women use a range of emotional coping responses. They express their emotions, keep them under control, and/or reconstruct the way they emotionally understand the problem situation. However, many of the responses, as previous research also shows, are not necessarily effective as they can negatively impact decision making. Yet, it is important to acknowledge the presence of emotions in survivors' situations and recognize their influence on decision making. This is especially important for organizations providing services to survivors of IPV who rely on the decision-making processes of women.Many coping responses of women in the present study were characterized by avoidance and distraction, which confirms previous research suggesting that women deal with the violence they experience by avoiding it or distracting themselves , 54, 55.Although this review has systematically evaluated the included studies and comprehensively examined the coping strategies used by women experiencing IPV in South Africa, limitations concerning the search strategies, number of studies, effectiveness of coping responses, and generalizability need to be considered. Further, limitations of the included studies need to be considered. The researcher of this review strived to conduct a systematic search strategy supporting the aims of the review as well as was possible. Even though an electronic search of databases is effective, it may only identify some of the eligible studies. To increase the likelihood of identifying more eligible studies, reference mining was added to the search method. Nonetheless, it cannot be ruled out that eligible studies were not identified and, thus, missed, which forms the first limitation. The second limitation is the small number of only 10 included studies, which concludes that the findings cannot be overgeneralized. This limitation also goes for the included studies as they were all conducted only in South Africa and only with women survivors. Further, this systematic review did not exclusively focus on the effectiveness of each of the coping responses in terms of well-being and helpfulness, which forms another limitation. Although the present review has cited literature that evaluates the mentioned coping responses in terms of their helpfulness, a closer look at coping strategies' effectiveness and their comparison is needed. This should be integrated into future research to see, which coping strategies, in fact, have the potential to mitigate the impact of IPV. Last, readers should note that this study focused solely on experiences of cis-gender women whose relationships were characterized as heterosexual. Thus, experiences of male or LGBTQ survivors of IPV were not included, making generalizability of results not possible, at least for males, non-cis-gender women, and non-heterosexual relationships.Based on the findings of the present study, the following three recommendations are made. First, agency at a collective level (community and society) needs to be facilitated. Our study has shown that IPV is a complex, multifaceted phenomenon, which occurs within a social context influenced by many levels. Although it is important for women experiencing IPV to be empowered to facilitate agency at an individual level, the multilevel influence on a woman's experience of IPV demand facilitation at the collective level as well. Facilitators should, for example, address structural barriers encountered by women, which hinder effective responses. The following examples may help in breaking those barriers: (1) Having regular visits and events from different organizations aimed at supporting IPV survivors in different places , (2) a police workshop at which experts in the field of IPV and its consequences sit down with different police departments to discuss the issue and how women can more easily reach and talk to the police. Such workshops could be made mandatory. (3) Doctors use a fitted-out van to provide free medical checkups and care in different cities and villages. And, by that, survivors of IPV may be identified and referred for further assistance. Second, beliefs and norms of the society need to be challenged. The findings of the present study have shown that many women had internalized harmful gender roles putting them in subservient positions. They emphasized their duties as a wife and mother as well as their responsibility to keep the family together. Also, they normalized and minimized their experience with abuse. It, thus, seems imperative to start shifting the power balance within the relationship as well as the community, which contributes to those beliefs. The following are some ideas on how to do that: (1) advertisement, for example, portraying strong, self-confident and admirable single mothers in TV, billboards etc. to challenge the current view of a women being dependent on a man; (2) financial support for IPV survivors to also challenge the view of a women being dependent on financial support from a man; (3) fines/punishments for abusers, which are higher than the current ones to target the ineffectual handling of abusers in society today; (4) billboards highlighting the terrible facts about IPV. This may lead to more frequent public talks about the issue and eventually lead to a society that more openly addresses this issue. Last, women's emotions need be integrated in IPV services. Organizations providing services to survivors of IPV should recognize the influence of women's emotions in their decision making. Findings of the present study show that, for example, many women still love the man who is abusing them and feel attached to the life they have together. These factors need to be considered to properly assist women and help them to find their full independence.Based on the findings of this systematic review, future research should address the following. First is the effectiveness of coping responses in terms of well-being. As mentioned above, one limitation of the present review was the in-detail analysis of the effectiveness of each reported coping strategy. However, this may be valuable information as it could inform organizations aimed at supporting survivors of IPV about the coping strategies that are actually helpful and effective. Second, the effectiveness of coping responses in terms of leaving the abuser. Further research may be used to not only examine how particular coping responses enable survivors to cope but also how they facilitate the process of leaving an abusive partner. Last, male and LGBTQ survivors' perspectives of coping experiences should be investigated as their lives and experiences are relevant as well.This qualitative systematic review was undertaken to better understand the coping experiences of women survivors of IPV. Ten studies were included in this review after a rigorous search and inclusion process. All included studies were of high quality based on the JBI Critical Appraisal Checklist for Qualitative Research .This review identified and provided an understanding of the different kinds of coping mechanisms used by South African women who experience IPV and compared them to available literature. Coping strategies in this study involved help- and support-seeking from others, emotional regulation efforts, and avoidance and distraction. Exploring these coping strategies pointed out the need for understanding IPV and responses to it within a broader context, which involves interpersonal, relationship, and communal as well as societal aspects. Hence, IPV constitutes a complex phenomenon, which is influenced by multiple factors. Although some coping responses are considered by previous literature as effective, others are not. The findings in this review confirm this as each theme had both effective and ineffective strategies. Nevertheless, the authors agree with previous research stating that seeking help and support from others (first theme) is an effective strategy. This also supports the abovementioned notion that IPV should be understood within an ecological system with the different levels involved in not only the emergence and perpetuation of IPV, but also in the resolution. Approaching IPV accordingly can lead to a change in societal norms, better access to and delivery of services to IPV survivors, and more functional family affairs as well as personal well-being and higher quality of life.The original contributions presented in the study are included in the article/YS, NR, and RR contributed to the conception, design of the review, writing of the paper, and drafting the manuscript. YS and NR contributed to the literature search and analysis as well as the result interpretation. All authors contributed to the article and approved the submitted version.The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.


Increasing attention is being directed at the environmental, social, and economic sustainability of the global food system. However, a key aspect of a sustainable food system should be its ability to deliver nutrition to the global population. Quantifying nutrient adequacy with current tools is challenging.To produce a computational model illustrating the nutrient adequacy of current and proposed global food systems.The DELTA Model was constructed using global food commodity balance sheet data, alongside demographic and nutrient requirement data from UN and European Food Safety Authority sources. It also includes nutrient bioavailability considerations for protein, the indispensable amino acids, iron, and zinc, sourced from scientific literature.The DELTA Model calculates global per capita nutrient availability under conditions of equal distribution and identifies areas of nutrient deficiency for various food system scenarios. Modeling the 2018 global food system showed that it supplied insufficient calcium  and vitamin E (69%), despite supplying sufficient macronutrients. Several future scenarios were modeled, including variations in waste; scaling up current food production for the 2030 global population; plant-based food production systems; and removing sugar crops from the global food system. Each of these scenarios fell short of meeting requirements for multiple nutrients. These results emphasize the need for a balanced approach in the design of future food systems.Nutrient adequacy must be at the forefront of the sustainable food system debate. The DELTA Model was designed for both experts and nonexperts to inform this debate as to what may be possible, practical, and optimal for our food system. The model results strongly suggest that both plant and animal foods are necessary to achieve global nutrition. The model is freely available for public use so that anyone can explore current and simulated global food systems. Supplemental Figure 1). Understanding it and identifying opportunities for improvement requires a comprehensive view of the whole system, which is not easily achieved. However, increasing calls for greater environmental sustainability and nutrition security in the global food system have motivated attempts to rigorously analyze and model subsets of its dynamics  between modeled scenarios, including those changes required to move from insufficient nutrient supply to a food system that can deliver global nutrient adequacy.Using this framework, the DELTA Model allows for comparison between different future global food system scenarios in terms of nutrition, to be used in combination with investigations into the other aspects of sustainability. The DELTA Model is so named as it enables side by side comparisons of the mathematical difference , from a combination of publicly available databases and in-house modeling. The general structure of the model is displayed in d online .The DELTA Model was designed to allow visual comparison of the nutritional performance of global food system scenarios. The user defines a scenario by entering values for several variables, including primary production of 121 food commodities, a scenario year that defines the global population, and food waste (in the supply chain and in-home). For accessibility, the 121 food commodities are aggregated into 15 major food groups, 6 animal-sourced  and 9 plant-sourced . The nutritional performance of this scenario can then be compared with alternatives.The DELTA Model takes the user inputs for global annual food production and distributes these into individual food items according to their distribution in the 1998–2017 FAO food balance sheets (FBS) . The 201The model next deducts feed uses from those food items that are used for animal feed, as well as supply chain waste and nonfood use of food items, in accordance with the proportion found in the FBS.This yields a value for the total amount of each food item available to consumers per year. From this is deducted the inedible portion of relevant food items ,The composition of each modeled food item was taken from the USDA database . CombiniSupplemental file 1.For iron and zinc, insufficient data was available for the bioavailability or digestibility of these nutrients in foods to allow the same structure to be applied. Instead, the DELTA Model contains higher target intakes for these nutrients, sourced from WHO recommendations , to be uIn order to compare the nutrition values of the modeled scenario to dietary reference value (DRV) data, DRVs for 29 nutrients were obtained from the EFSA and the FAO , 41. TheDemographic information for 21 age groups of both genders in 5 global regions was obtained from the FAO databases for past and future forecast populations . The DRVThe DELTA Model was designed to be used by both experts and nonexperts to explore current and future scenarios for the global food system. The role of the DELTA Model is to identify areas of the global food system in need of improvement, to inform the sustainable nutrition debate, and as an educational tool for users. It is not an optimization tool to identify prescriptive changes that should be implemented in the future. Instead, a number of example uses and results are presented here to illustrate the capacity of the DELTA Model.Supplemental file 4 for derivation and model inputs in each scenario). From this data set, it was possible to examine how the 2018 food system would have met the nutrient requirements of the population under conditions of equal food availability. The baseline data set for the DELTA Model is the 2018 global population and food production, extrapolated from the 1998–2017 FBS  scaled to the larger population.The main difference between the two scenarios was in the nutrient gaps. The nutrient gaps show the deficiency between the per capita global availability of a nutrient and the target daily intake value. Only gaps greater than 5% of the target value are displayed; smaller gaps were not considered to be material from the degree of accuracy of the model. In the 2018 scenario, global food production delivered insufficient calcium and vitamin E. Thus, even with the equal distribution of food assumed by the model, the 2018 global food system would have left its population deficient in these nutrients.Clearly, these nutrient gaps would grow if the same amount of food were distributed over a larger population, as shown in the 2030 scenario. The nutrient gaps for calcium and vitamin E grew, while iron, potassium, riboflavin, vitamin A, and vitamin B-12 were added to the list of deficient nutrients.The globally averaged target daily intake values differed between the two scenarios . This waThe reduction of food waste forms part of the UN Sustainable Development Goals . The DERegardless of waste and loss reduction, there were no instances in which the 2018 food system could deliver nutrient adequacy for the global population. At zero waste and losses, the nutrient gaps for calcium and vitamin E were ≥20%. Increasing waste and losses led to increasing degrees of nutrient deficiency. In the 2018 data set, milk and oil crop foods were the major sources of calcium and vitamin E, respectively. Depending on the global region, the DELTA Model assumes that 0.1–15% of milk is wasted in-home, and 1–4% of oil crop foods .The DELTA Model also allows users to investigate the nutrients wasted. In the 2018 baseline scenario, for all nutrients except vitamin B-12, plant foods were responsible for most nutrient waste and losses . Sugar products fill the top 3 places for carbohydrate density in this data set and make a negligible contribution to intake of other nutrients. Due to the low positive impact of sugar products on global nutrition, the scale-up scenario was modified by removing sugar and allocating the 2.3 billion tons of biomass proportionally across the remaining plant groups.The no sugar scenario resulted in almost identical total biomass and feed compared with the scale-up scenario. However, the total food supply was increased by 1.63 billion tons, due to the lower mass yield of available food from sugar crops after processing and other uses (<10%) compared with other plant food groups. Moreover, the nutrient gaps in this scenario were reduced compared with the scale-up scenario. However, due to increased availability of plant foods, there were excesses for carbohydrates and energy.The half waste scenario utilizes 2018 food production, with food waste halved for both supply chain and in-home losses. It applies this global food system to the 2050 population. The purpose of this scenario is to demonstrate that the current global food system can provide sufficient macronutrients to nourish a 2050 population; energy, protein, and fat targets are all met in this scenario, as are those for the IAA. However, gaps exist for several micronutrients. Reducing supply chain and in-home losses to zero in this scenario , a population reference intake , and an upper limit  for calcium . ContrasThe utility of the DELTA Model will grow over time through extension and development; the current version has several limitations. Foremost among these is omission of the other aspects of sustainability: environmental, economic, and social. Modeling studies are best suited to the environmental and economic aspects, and numerous models exist for these dimensions of the food system , 49, 50.It should also be noted that the FAO FBS do not provide complete coverage of global food production. A total of 19 countries, mostly developing nations or low-volume food producers, are not currently included in the FBS. This likely results in a small underestimation bias for nutrient delivery, as the populations of these countries  are included in the model, but not their food production.Moreover, the FBS only give information on food supply and not consumption. We have addressed this issue by subdividing the FBS food items into more specific food types using detailed supply data for these. Finally, the FBS do not capture subnational food availability. We have not attempted to address regional nutrient availability, instead taking a global average approach, which masks the inequitable distribution of food in many parts of the world. Considering these limitations of the data, the model predictions are an estimate of global nutrient availability to the average global citizen. Despite these limitations, the FBS were chosen for use in the model as an international standardized data set, with annual updates to allow for continued relevance of the DELTA Model. It is hoped that the omitted countries and a greater resolution will be included in future FBS, allowing future versions of the model to provide increasing levels of accuracy.There also exist limitations to the resolution of the model. Currently, food items are grouped into 15 food groups for ease of use by a broad audience. This means that any increase in the total production of a food group causes a proportional increase in the production of each food item within it, following the distribution in the baseline data set. This increase is carried through all model calculations: waste, other uses, and the available nutrients. Future versions of the model will allow for user input at a higher resolution.The DELTA Model differs from much of the sustainable nutrition literature by not considering individual diets. The inputs and outputs of the model are for the global food system, considering the ways in which the world can feed the world. Much research exists on the environmental, economic, and health sustainability of food from an individual dietary perspective , 60–62. An advantage of the DELTA Model over other similar models is its consideration of amino acids in addition to protein, as well as the digestibility of these nutrients. Foods cannot be assumed to deliver equal nutritional value purely because they have similar nutritional content . DiffereThere is increasing awareness of the need for the global food system to change in order to sustainably nourish the entire global population. Much of the narrative centers around significant shifts towards predominantly or entirely plant-based individual diets to achieve health and environmental goals , 5, 53. Many models have been created for different aspects of the food system and have begun to explore ideas for how it might be transformed. The DELTA Model provides an important contribution towards understanding the current problems of the food system and the implications of proposed changes on global nutrient availability. Nutrition must be a priority in the design of future food systems and the DELTA Model facilitates this consideration.nxab199_Supplemental_FilesClick here for additional data file.


Biomedical research plays an important role in improving health. There seems to exist a negative correlation between the amount of biomedical research funding and disease burden from all Sub-Saharan African countries. In this study, we describe funding patterns for biomedical research, explore the correlation between funding and burden of diseases, and quantify inequalities in funds distribution across diseases in Gabon over the period 2005–2015.Data on medical research funds from 2005 to 2015 were retrieved through a structured questionnaire distributed to Gabonese biomedical research institutions and by consulting online databases. Data on the burden of diseases were gathered from the World Health Organization and the Institute for Health Metrics and Evaluation. We used Kendall rank correlation coefficient to explore the correlation between cumulative funds over time and the burden of disease. The inequality distribution of funding across diseases was assessed through Gini coefficient and Lorenz curve.Biomedical research funding was characterized by a remarkable growth from 2005 to 2010 and a decline from 2010 to 2014. Funds were mostly from external sources and from partnerships. There was inequality in research funds allocation across diseases and malaria was far the most funded disease. There was a significant negative correlation between cumulative funding and the burden of HIV, tuberculosis, and of Helminthiasis (from 2006 to 2010) suggesting that research may be contributing to the management of such diseases. A positive, although not significant, correlation was found between cumulative funds and malaria burden.The negative correlation between HIV and tuberculosis cumulative funding and burden suggests that research may be contributing to the management of such diseases but further research is needed to assess the causal direction of such as relationship. As the burden of non-communicable diseases is increasing, more research funds should be focused on those. While research partnerships have been and will remain fundamental, Gabon should increase the amount of national funds to overcome periods of reduced research funding flows from abroad.The online version contains supplementary material available at 10.1186/s12889-021-12201-w. Since independence, countries of sub-Saharan Africa (SSA) have made significant progress on the healthcare front allowing universal health coverage (UHC) to be set as a goal in the national health strategies , 2. AlthDespite such encouraging improvement, the all-cause morbidity and mortality burden in SSA is still unacceptably high while at halfway toward completion of the epidemiological transition, characterized by (a) the double presence of infectious and non-communicable diseases , and (b)In the past decade, concerns about the disproportionate burden of disease and mortality in SSA have arisen. The health-gap in SSA could be improved with investments in healthcare delivery but also by boosting research . There iChanneling funding to support biomedical and basic research may be seen not as a priority . In factHealth research is likely to play an important role in freeing resources for the health system. In a recent study, Jaffar et al.  concludeIn such a complexity, several factors need to be considered by agencies seeking to fund biomedical research. Fixing research priorities should take into account among other factors, the disease burden in order for research investments to impact the health of populations . ResearcInequities also exist across pathologies with many diseases receiving little funding, including those that are particularly problematic in Africa, such as the NTDs  , 23. On In terms of sources, research funds for SSA countries come mainly from foreign donors. In their study, Head et al.  found thTo summarize, most funding for scientific research, training and infrastructure upgrade in Africa comes from high-income countries, which build, in some cases, on already existing infrastructure , 29. As Our study is linked to the literature on health research funding decisions, which aims to set an ethical and moral framework for the allocation of research funds . AccordiSituated in Central Africa, Gabon is an upper/middle-income country with a population estimated in 2018 by the World Bank to be about 2,200,000 inhabitants, and a large geographic area relatively to its small population .In comparison with the remainder Central Africa countries, Gabon has experienced a remarkable biomedical research expansion. This is likely to be due to the leadership of the few research institutions present in the country and the capacities of their actors to attract funding. The political stability, the ease of carrying out research due to the acceptance of research activities by the political community, the commitment of stakeholders to medical research activities, and the existence of a minimum of infrastructure could be further reasons. The funds mobilized by the few Gabonese research institutions increase their capacities, which, in turn, increase the attractiveness of the country for conducting research, forming a virtuous circle.While medical research centers based in Gabon sometimes conduct single-center research projects, most projects are conducted in partnerships with other institutions based in other countries, both from the South and the North. Partnerships are established through consortia that involve several research institutions for the conduct of collaborative research projects, memoranda of understanding for long-term partnerships, and the development of research networks for the exchange and sharing of knowledge and skills. A network that includes research institutions based in Gabon is the Central Africa Network on Tuberculosis, HIV/AIDS, and Malaria (CANTAM) which is funded by EDCTP, a partnership of which Gabon is also a member.In a study describing the patterns of biomedical science production in a sub-Saharan research center conducted in Lambaréné, Gabon, Agnandji et al.  found thIn the World Report, Collins et al.  found thThe Gabonese health system is organized into three sectors namely the public sector which includes the civil and military sectors, the para-public sector and the private sector. The civil public sector has three levels, namely the peripheral level which is that of the operationalization of primary care, the intermediate level which plays a role of technical support to regional and departmental structures, and the central level which plays a role of strategic orientation, normative and regulator of the whole system. The epidemiological situation of Gabon is characterized by transmissible infectious and parasitic diseases, non-communicable diseases, emerging and re-emerging diseases, injuries from road accidents, alcoholism, smoking, drug addiction, occupational diseases and those food-related, sexually transmitted infections including HIV / AIDS, and sickle cell disease. Health research is poorly structured in Gabon. The country does not have a structured medical research agenda and research is carried out by very few institutions including public medical schools, para-public institutions and private institutions.Biomedical research is funded and conducted with the aim of generating new knowledge, studying the causes and potential treatments and prevention of diseases in order to contribute to the improvement of population health. It is therefore important to analyze the link between the funding allocated to biomedical research and the population health through the burden of disease.This study took place in Gabon from 2016 to 2018. The study was organized from Centre de Recherches Médicales de Lambaréné (CERMEL), an independent research institution in Lambaréné, Gabon, focusing on research on malaria, multidrug-resistant tuberculosis, and worm infections. Initially a Research Laboratory as part of the Albert Schweitzer Foundation, the center has successively changed its name first to Medical Research Unit (MRU) in 2001 with a financial and administrative independence from the Albert Schweitzer Hospital, then to CERMEL in 2011, its current name, with a new legal status. But the research center still shares the same physical address with the hospital. CERMEL is now a leading research center in the Central African sub-region which has established partnerships with several research institutions and academics around the world.To collect data for this study, we used a structured questionnaire to gather financial data from all health research institutions in Gabon that provided information from their project administration offices. We searched data for the longest possible period, and could obtain them for the period from 2005 to 2015. The questionnaire included questions on the characteristics of the institution, funding amounts and funding sources during the studied period , funding by disease , funding by activity type , funding by research type , and funding by funder type . The questionnaire is included in supplementary material  and the Institute for Health Metrics and Evaluation (IHME) web sites.www1.oanda.com).We have combined the data collected from research institutions and those extracted from databases, and eliminated duplicates. We did not consider in-kind resources. Only funding resulting in transfer of money from the donor to the beneficiary was taken into account. Each extracted award from the web was linked to the disease it focused on and put in the following categories: treatment, prevention, basic research, and applied research. When the funding was common to two or more diseases, the funding amount was split into the number of diseases and equally attributed to each disease. Research funds that were specific to ethics or social science were classified as “cross-cutting” and diseases that were funded only within one project were classified as “other”. Where applicable, the grant funds were converted to Euro using the average exchange rate in the year of the award. We performed the conversion using the “Historical Currency Converter” tool available on the website of OANDA (We used Disability-Adjusted Life Years (DALYs) for Gabon from the IHME’s global burden of diseases results tool as a measure of disease burden. We considered the DALYs caused by the diseases for which we have funding data, that is, for the diseases that resulted having a positive level of associated funds. We used DALYs as a measure for disease burden as research funding should help with the improvement of at least one of the DALYs component, that is, morbidity or mortality.In order to establish whether there are possible links between funding and disease burden, and to measure the strength of this connection if applicable, the correlation between the cumulative funding amounts and the burden (DALYs) of the main diseases present in Gabon, over time was explored through the Kendall’s test. The correlation was quantified through the Kendall rank correlation coefficient. To measure the inequality in the allocation of research funding across diseases, we plotted the Lorenz curve of the cumulative funding amount for biomedical research relatively to the disease burden where diseases were ordered from highest burden to lowest, and calculated the Gini coefficient.We used the statistical software R version 3.5.1 to analyze the data .A total of 74 biomedical research funded projects were gathered from 5 research institutions in Gabon. The 74 biomedical research projects were funded for a total of 20,6 million euros over the period 2005–2015, with a median yearly funding amount of 2165 thousand euros (range: 112 to 2960 thousand euros). By far, most of the funds came from external sources and were granted by international funders, with 58% of the total funding amount coming from the public sector, 37% from the philanthropic sector, and 5% from the private sector. The annual funding for biomedical research in Gabon for the period 2005–2015 contains two main phases: a phase of growth which extends from 2005 to 2010 and a decline phase running from 2010 to 2014. During the phase of decline, the funding amounts for biomedical research in Gabon decreased successively from year to year before slightly recovering in 2015  for 12 projects (16%) while treatment was funded 5,2 million euros  for 14 projects (19%). Other activity types (‘descriptive’) which are neither prevention nor treatment and corresponding to research areas such as social science, ethics, immunology, or epidemiology was funded 5,0 million euros  through 48 (65%) projects.By research type, clinical trials were allocated 15,6 million euros (76%) for 26 (35%) funded projects; capacity building was funded with 1,7 million euros (8%) for 13 (18%) funded projects, epidemiology was allocated 1,6 million euros (8%) for 22 (30%) projects, and immunology received a total funding amount of 1,5 million euros (7%) for 7 (9%) projects. Altogether, the top four research types together received 99% of the total funding amount through 92% of the number of funded biomedical research projects. The remaining research types  received 1% of the total funding amount. By cross-cutting research, ethics and social science have equally shared the number of funded projects, 3 (50%) each. In terms of funding amount, ethics has been funded a total amount of 143,8 thousand euros , and the social science has been funded a total amount of 119,6 thousand euros .p < 0.01), between cumulative funding amount for tuberculosis and relative burden of disease , and between cumulative funding amount for helminthiasis and relative disease burden for the period from 2006 to 2010 . A strong positive but not significant correlation was found between cumulative funding amount for malaria research and relative burden of disease , and a strong positive and significant correlation was found between cumulative funding amount for helminthiasis and relative disease burden for the period from 2010 to 2015 .The Kendall rank coefficient (tau) highlighted a strong negative correlation between cumulative funding amount for HIV and relative burden of disease , followed by malaria , tuberculosis , helminthiasis , and viral diseases .The cumulative funding amounts for biomedical research on malaria in Gabon grew over the studied period while the DALYs caused by malaria decreased between 2005 and 2007, increased from 2007 to 2012, and decreased between 2012 and 2015  is devoted to malaria: funds are mainly awarded by public international donors; are mainly for clinical trials and for prevention.Importantly, the association between the cumulative amount of funds and burden of disease has been found negative and significant for tuberculosis, HIV, and also for helminthiasis for the period from 2006 to 2010. Although this is only an association, it may be interpreted in the sense that the accumulation of funds for tuberculosis, HIV, and helminthiasis is contributing to a reduction of disease burden. Interestingly, Head et al.  found a HIV has the highest associated DALYs during the studied period. As HIV prevalence is not particularly high in Gabon , this might be explained by the fact that HIV is a chronic and life-long disease and that increases disability in comparison with the remaining diseases. Notably, in our analysis we undertook only a bivariate analysis between funding and disease burden; we are aware that a diverse set of factors can be explanatory of the disease burden  in addition to health research. However, in our analysis, we wanted to focus the attention on disease burden and funding only, over time, while assuming everything else constant.The sharp funds increase over the period 2005–2010, the decrease from 2010 to 2014 before increasing again between 2014 and 2015 may be explained by the ensuing reasons. Beginning of the years 2000 were characterized by an increase in research funding for Global Health and the increasing pattern in Gabon from 2005, from a negligible amount recorded in the same year 2005, mirrors such a global pattern . As biomA remarkable feature of the research funds Gabon has been receiving is that almost all of the projects are the result of North / South collaborations and the funds come from the North only. Thus, the lack of South / South partnerships and of locally led projects arises . SoutherThe top 3 funders were respectively Bill & Melinda Gates Foundation, European and Developing Countries Clinical Trial Partnership (EDCTP), and the European Commission (EC). They together provided almost 75% of total biomedical research funding, and malaria alone received about 70% of the total funding. This shows the interest the funders place on malaria research, which remains one of the leading causes of mortality and morbidity in developing countries although not the main one in many contexts, including Gabon , 39.Our findings are different from the ones of Head et al.  where itGlobally, according to data from G-Finder, most of the funding for biomedical research comes from the public sector, and this has been confirmed in this study.Currently, most of funding for biomedical research in Gabon is directed at communicable diseases. There is a total lack of research on non-communicable disease while they are becoming very prevalent  .It seems there is a lack of disease burden arbitration for funds allocation which goes more to communicable diseases where researchers in Gabon have more capacity. Such allocation of funds is understandable given that diseases, such as malaria, are endemic in SSA, including Gabon, and not in high-income countries, where most of research on non-communicable diseases is carried out.For the welfare of the SSA population, it would be important that the disease burden is taken into account in the funding allocation for biomedical research . To achiBiomedical research could impact health care and contribute to the improvement of population health. To achieve this, it is key for research findings to be implemented and for the population to have access to research outputs, such as vaccines or new treatments; however, this is difficult without implementation research and health system research. The research in Gabon appears to be very vertical, i.e., focused on the disease rather than on the health system. Therefore, in order for biomedical research to contribute fully to improving the population health in Gabon, it is essential that health systems and implementation research are conducted at a larger scale .For example, biomedical research studies could be designed in a way to include a component of implementation research. An example of implementation research embedded in biomedical studies is the recent Ebola vaccine study where the clinical trial was designed in order to take into account the implementation of a fast response in the case of a new outbreak .In Gabon, a concrete example where biomedical research has contributed to improving the health of the population is the study of the combination of artesunate/amodiaquine which has been conducted in Gabon and in other countries. Indeed, following the initial registration for the manufacture of the drug, Gabon is one of the first endemic countries to have granted authorization for its local marketing, and on the recommendation of WHO to use the combination in malaria control programs and for first-line treatment for African children with uncomplicated malaria, Gabon has made it a national policy and artesunate/amodiaquine is thus the first-line treatment for uncomplicated malaria , 45.The lack of a national policy, of a research agenda, and of a funding plan for medical research in Gabon did not allow us to analyze the current funding in relation to forecasted needs, and this leads us to formulate the following recommendations: a) a national biomedical research agenda should be put in place with an adequate funding plan, in accordance with the priorities of the health system, to establish rules that ease and strengthen medical research, and increase and diversify the capacity of researchers in the biomedical field; b) the establishment of a dialogue between research funders, researchers and decision-makers to help better allocate resources; c) more research on the causal impact of health research on health outcomes as well as on equity and on equality issues should be fostered; d).more effort, from all the stakeholders, should be placed on health data collection and gathering as national routine surveillance for all the diseases and health concerns. Our recommendations are theoretical and do not consider issues of resources constraints; however, we believe that these are necessary steps to take to enhance the effectiveness of health research towards improving health.Our study is not without limitations. One of these is the validity of the data used for disease burden. In fact, we used DALYs data for Gabon published by the IHME which are generally estimates derived from models; these estimates may contain missing data and may be slightly different from DALYs calculated with actual data.Another limitation is that in addition to online consultation of funders databases, we asked research institutions for their financial information to extract what would not be available in the funders databases. The failure of research institutions to provide us with the exhaustiveness of their financial information constitutes missing data which could change the results of the study.This study shows that biomedical research in Gabon is mainly funded by external resources. Inequality exists in the allocation of funding across diseases and malaria, a major disease in Africa, including Gabon, accounts for most of the funding for biomedical research activities for the period 2005–2015, while it is not the disease that causes the highest disease burden. While the negative correlation between tuberculosis, HIV, and helminthiasis cumulative funding and burden of diseases are apparent, suggesting that research may be contributing to the management of such diseases, further research would be needed to establish causality. As the burden of non-communicable diseases is increasing in Gabon, as for all SSA, more research funds should be focused on those. Gabon should also increase the amount of national funds towards research for overcoming periods of reduced funding flows from abroad.Additional file 1. Questionnaire on data related to biomedical research funding in Gabon. This is the questionnaire used to collect data on medical research funds from Gabonese biomedical research institutions.