Providing nutritious and environmentally sustainable food to all people at all times is one of the greatest challenges currently facing society. This problem is particularly acute in Africa where an estimated one in four people still lack adequate food to sustain an active and healthy life. In this study, we consider the potential impact of future population growth and climate change on food security in Africa, looking ahead to 2050. A modelling framework termed FEEDME (Food Estimation and Export for Diet and Malnutrition Evaluation) was used which was characterised to model the impacts of future climate changes (utilising the IPCC Special Report on Emissions Scenarios projections) and projected population growth on food availability and subsequent undernourishment prevalence in 44 African countries. Our results indicate that projected rapid population growth will be the leading cause of food insecurity and widespread undernourishment across Africa. Very little to no difference in undernourishment projections were found when we examined future scenarios with and without the effects of climate change, suggesting population growth is the dominant driver of change. Various adaptation options are discussed, such as closing the yield gap via sustainable intensification and increasing imports through trade and aid agreements. These strategies are likely to be critical in preventing catastrophic future food insecurity.

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Significance Two billion people across the planet suffer from nutrient deficiencies. Dietary diversification is key to solving this problem, yet many food and nutrition security policies, especially in low- and middle-income countries, still focus on increasing agricultural production and access to sufficient calories as the main solution. But calories are not all equal. Here, we show how deforestation in Tanzania caused a reduction in fruit and vegetable consumption (of 14 g per person per day) and thus vitamin A adequacy of diets. Using a combination of regression and weighting analyses to generate quasi-experimental quantitative estimates of the impacts of deforestation on people’s food intake, our study establishes a causal link between deforestation and people’s dietary quality.

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Surgical site infection (SSI) is a common postoperative complication which leads to significant morbidity and mortality. The aim of antibiotic prophylaxis is to reduce the incidence of SSI by preventing the development of infection due to colonizing or contaminating organisms at the operative site. It is used as an adjunct to, rather than a replacement for, other evidence-based interventions to prevent wound infection, such as the use of skin antiseptics. The choice of antimicrobial agent(s) used is dependent on how clean the operation is, the operative site (which determines the likely organisms), and a variety of patient factors including the presence of allergies and colonization with resistant organisms such as meticillin-resistant Staphylococcus aureus (MRSA). The practicalities of antibiotic prophylaxis administration are discussed. Not all operations require antibiotic prophylaxis; use of antibiotics in any context, including as prophylaxis, can be associated with adverse effects, specifically an increased risk of Clostridium difficile infection (CDI) and resistance development. Prophylaxis should therefore be used responsibly. This article will address some of the common misconceptions about its use and special patient circumstances requiring deviation from the usual guidance.

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