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Blackstone, Sarah R., Ucheoma Nwaozuru, and Juliet Iwelunmor. "Factors Influencing Contraceptive Use in Sub-Saharan Africa: A Systematic Review." International Quarterly of Community Health Education 37, no. 2 (January 2017): 79–91. http://dx.doi.org/10.1177/0272684x16685254.
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The purpose of this study was to systematically review the literature regarding factors influencing contraceptive use in sub-Saharan Africa between 2005 and 2015. A total of 58 studies from twelve Sub-Saharan African countries were reviewed. Keywords were grouped using the PEN-3 cultural model. Negative factors prohibiting or reducing contraceptive use were women’s misconceptions of contraceptive side–effects, male partner disapproval, and social/cultural norms surrounding fertility. Positive factors included education, employment, and communication with male partner. Increasing modern contraceptive use in Sub-Saharan Africa is a multi-faceted problem that will require community and systems wide interventions that aim to counteract negative perceptions and misinformation.
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Popoola, Timothy Oladayo. "Health Outcomes in Sub-Saharan Africa Countries: An Analysis of Key Determinants." Modern Health Science 1, no. 1 (May 21, 2018): p8. http://dx.doi.org/10.30560/mhs.v1n1p8.
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The poor health outcomes (low longevity and high mortalities) in developing countries has been great concern for citizens and policy makers alike. Although, numerous studies have focus on socio-economic drivers (like education, age of mothers, income levels, and poverty) of health outcomes in developing nations; however, the same is not true for important exogenous determinants. Therefore, this study investigated the effects of access to clean drinkable water, sanitation, fertility rate, prevalence of HIV/AIDS, health financing, and child immunization on health outcomes in sub-Sahara African (SSA) region. To achieve this, the study explored Pooled OLS, Fixed and Random Effects covering 46 countries in the region from 2000 to 2015. The findings reveal that population health outcomes - as measured by infant and under-five mortalities rates are related negatively with increase public health financing, timely children immunization, quality drinkable water supply, but directly associated with higher fertility rate, and HIV prevalence. For life expectancy at birth, increase government health spending, timely children immunization, and quality drinkable water supply are positively predicted, while relate inversely with higher fertility rate, and HIV prevalence. The findings therefore suggest that for SSA countries to achieve the United Nations’ Sustainable Development Goal three of ensuring healthy lives before 2030; emphasis should on increasing public health financing, and provision of infrastructural facilities like clean water supply and sanitation. Again, greater attention should be on enhancing child immunization, reducing fertility rates and HIV prevalence in the region.
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Armstrong-Mensah, Elizabeth, Krystal Ruiz, Aminata Fofana, and Victoria Hawley. "Perinatal HIV Transmission Prevention: Challenges among Women Living with HIV in sub-Saharan Africa." International Journal of Maternal and Child Health and AIDS (IJMA) 9, no. 3 (August 9, 2020): 354–59. http://dx.doi.org/10.21106/ijma.404.
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About 86 percent of the estimated 160,000 children newly-infected with the human immunodeficiency virus (HIV) live in sub-Saharan Africa. Despite global efforts to reduce perinatal HIV transmission, this phenomenon continues to be a public health problem in sub-Saharan Africa. This paper discusses challenges associated with perinatal HIV transmission prevention in sub-Saharan Africa and offers strategies for the way forward. These strategies include safe sex education and behavioral change, increased access to integrated antenatal care, training of unskilled traditional birth attendants into formal delivery systems, access to antiretroviral therapy, and investing in virologic testing.
Key words: • HIV • Perinatal • Antiretroviral Therapy • Mother to Child HIV Transmission • HIV Prevention • Sub-Saharan Africa
Copyright © 2020 Armstrong-Mensah, et al. Published by Global Health and Education Projects, Inc. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY 4.0) which permits unrestricted use, distribution, and reproduction in any medium, provided the original work, first published in this journal, is properly cited.
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Melesse, Dessalegn Y., Martin K. Mutua, Allysha Choudhury, Yohannes D. Wado, Cheikh M. Faye, Sarah Neal, and Ties Boerma. "Adolescent sexual and reproductive health in sub-Saharan Africa: who is left behind?" BMJ Global Health 5, no. 1 (January 2020): e002231. http://dx.doi.org/10.1136/bmjgh-2019-002231.
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Adolescent sexual and reproductive health (ASRH) continues to be a major public health challenge in sub-Saharan Africa where child marriage, adolescent childbearing, HIV transmission and low coverage of modern contraceptives are common in many countries. The evidence is still limited on inequalities in ASRH by gender, education, urban–rural residence and household wealth for many critical areas of sexual initiation, fertility, marriage, HIV, condom use and use of modern contraceptives for family planning. We conducted a review of published literature, a synthesis of national representative Demographic and Health Surveys data for 33 countries in sub-Saharan Africa, and analyses of recent trends of 10 countries with surveys in around 2004, 2010 and 2015. Our analysis demonstrates major inequalities and uneven progress in many key ASRH indicators within sub-Saharan Africa. Gender gaps are large with little evidence of change in gaps in age at sexual debut and first marriage, resulting in adolescent girls remaining particularly vulnerable to poor sexual health outcomes. There are also major and persistent inequalities in ASRH indicators by education, urban–rural residence and economic status of the household which need to be addressed to make progress towards the goal of equity as part of the sustainable development goals and universal health coverage. These persistent inequalities suggest the need for multisectoral approaches, which address the structural issues underlying poor ASRH, such as education, poverty, gender-based violence and lack of economic opportunity.
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McClintock, Heather F., Julia M. Alber, Sarah J. Schrauben, Carmella M. Mazzola, and Douglas J. Wiebe. "Constructing a measure of health literacy in Sub-Saharan African countries." Health Promotion International 35, no. 5 (August 22, 2019): 907–15. http://dx.doi.org/10.1093/heapro/daz078.
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Abstract We sought to develop and evaluate a health literacy measure in a multi-national study and to examine demographic characteristics associated with health literacy. Data were obtained from Demographic Health Surveys conducted between 2006–15 in 14 countries in Sub-Saharan Africa. Surveys were the same in all countries but translated to local languages as appropriate. We identified eight questions that corresponded to the National Academy of Medicine (NAM) definition of health literacy. Factor analysis was used to extract one measure of health literacy. Logistic regression was employed to examine the relationship between demographic characteristics and health literacy. A total of 224 751 individuals between the ages of 15 and 49 years were included. The derived health literacy measure demonstrated good internal consistency (Cronbach’s α = 0.72) and good content validity. The prevalence of high health literacy overall was 35.77%; females 34.08% and males 39.17%; less than or equal to primary education 8.93%, some secondary education 69.40% and ≥complete secondary 84.35%. High health literacy varied across nations, from 8.51% in Niger to 63.89% in Namibia. This is the first known study to evaluate a measure of health literacy relying on the NAM definition utilizing a large sample from 14 countries in Sub-Saharan Africa. Our study derived a robust indicator of NAM-defined health literacy. This indicator could be used to examine determinants and outcomes of health literacy in additional countries.
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Ssewanyana, Derrick, and Byron Kiiza Yafesi Bitanihirwe. "Menstrual hygiene management among adolescent girls in sub-Saharan Africa." Global Health Promotion 26, no. 1 (May 9, 2017): 105–8. http://dx.doi.org/10.1177/1757975917694597.
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Menstruation is a delicate physiological process through which a shedding of uterine lining occurs each month in females of reproductive age. Often considered a taboo subject, menstruation is seldom openly discussed in developing parts of the world. This article explores menstrual hygiene management (MHM) in sub-Saharan Africa and emphasizes the urgent and neglected need for feasible solutions, especially among adolescent girls. Optimizing menstrual hygiene interventions will require an integration of both knowledge and skill training gained through education on MHM alongside an improvement of access to girl-friendly water, sanitation and hygiene facilities in addition to access to low-cost hygienic sanitary products. To facilitate the identification and implementation of feasible and cultural relevant programs we recommend the utilization of public health intervention research.
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Nwagbara, Ugochinyere Ijeoma, Emmanuella Chinonso Osual, Rumbidzai Chireshe, Obasanjo Afolabi Bolarinwa, Balsam Qubais Saeed, Nelisiwe Khuzwayo, and Khumbulani W. Hlongwana. "Knowledge, attitude, perception, and preventative practices towards COVID-19 in sub-Saharan Africa: A scoping review." PLOS ONE 16, no. 4 (April 19, 2021): e0249853. http://dx.doi.org/10.1371/journal.pone.0249853.
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Background Knowledge, attitudes, perception, and preventative practices regarding coronavirus- 2019 (COVID-19) are crucial in its prevention and control. Several studies have noted that the majority of people in sub-Saharan African are noncompliant with proposed health and safety measures recommended by the World Health Organization (WHO) and respective country health departments. In most sub-Saharan African countries, noncompliance is attributable to ignorance and misinformation, thereby raising questions about people’s knowledge, attitudes, perception, and practices towards COVID-19 in these settings. This situation is particularly of concern for governments and public health experts. Thus, this scoping review is aimed at mapping evidence on the knowledge, attitudes, perceptions, and preventive practices (KAP) towards COVID-19 in sub-Saharan Africa (SSA). Methods Systematic searches of relevant articles were performed using databases such as the EBSCOhost, PubMed, Science Direct, Google Scholar, the WHO library and grey literature. Arksey and O’Malley’s framework guided the study. The risk of bias for included primary studies was assessed using the Mixed Method Appraisal Tool (MMAT). NVIVO version 10 was used to analyse the data and a thematic content analysis was used to present the review’s narrative account. Results A total of 3037 eligible studies were identified after the database search. Only 28 studies met the inclusion criteria after full article screening and were included for data extraction. Studies included populations from the following SSA countries: Ethiopia, Nigeria, Cameroon, Uganda, Rwanda, Ghana, Democratic Republic of Congo, Sudan, and Sierra Leone. All the included studies showed evidence of knowledge related to COVID-19. Eleven studies showed that participants had a positive attitude towards COVID-19, and fifteen studies showed that participants had good practices towards COVID-19. Conclusions Most of the participants had adequate knowledge related to COVID-19. Despite adequate knowledge, the attitude was not always positive, thereby necessitating further education to convey the importance of forming a positive attitude and continuous preventive practice towards reducing contraction and transmission of COVID‐19.
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Gyasi, Razak M., and David R. Phillips. "Aging and the Rising Burden of Noncommunicable Diseases in Sub-Saharan Africa and other Low- and Middle-Income Countries: A Call for Holistic Action." Gerontologist 60, no. 5 (July 19, 2019): 806–11. http://dx.doi.org/10.1093/geront/gnz102.
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Abstract Noncommunicable diseases (NCDs) are a prevalent and growing burden among older cohorts in sub-Saharan Africa and other low- and middle-income countries (LMICs) as in many wealthier parts of the world. This stems from the combined effects of factors such as demographic aging, behavioral transitions, and developmental origins of health and disease. A crucial characteristic of many NCDs is that their personal and family impacts and costs are not accurately reflected in mortality data. Their effects are often chronic and long-term and can cause morbidity, loss of work ability, and impaired quality of life over a prolonged period. Unless addressed seriously, the continuing increase of NCDs and their burden in sub-Saharan African countries and other LMICs will almost certainly undermine progress toward achieving the target of reducing by 25% premature mortality from NCDs in these countries by 2025 and also one-third reduction of NCDs target by 2030. To have any chance of meeting or even getting near to these targets, this article calls for action by national and regional governments to strengthen universal health coverage (UHC), economic empowerment of vulnerable groups, public–private partnerships, effective fiscal regulation, and public education on NCDs, their risk factors and impacts in sub-Saharan Africa in particular and most LMICs globally.
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Dominic, Azuh, Adeyemi Ogundipe, and Oluwatomisin Ogundipe. "Determinants of Women Access to Healthcare Services in Sub-Saharan Africa." Open Public Health Journal 12, no. 1 (December 31, 2019): 504–14. http://dx.doi.org/10.2174/1874944501912010504.
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Background: The study examined the socio-economic determinants of women access to healthcare services in Sub-Saharan Africa for the period 1995-2015. Methods: The study adopted the dynamic panel model and estimated it using the System Generalized Method of Moments in a bid to overcome the endogeneity problem inherent in the model of study. Result: The study harmonized the theoretical strands in the literature by describing the measure of access determinants as three main components; i. Health service availability, ii. Health service utilization and iii. Health service decision. Conclusion: The indicators of health service availability such as community health workers, physicians, nurses and midwives and hospital beds improve women's access to healthcare facilities in Africa. Also, health service utilization indicators such as population density worsen the quality of healthcare services available to women while electricity access and private health expenditure enhance women’s access to quality healthcare delivery. Health service decision indicators such as female bank account ownership, female labour force participation, attainment of basic education and female household headship were important in enhancing women's access to healthcare facilities. Generally, women's health outcomes were more responsive to health service utilization; implying that service utilization is an important proof of healthcare access in Africa.
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Rutter-Locher, Z., J. Galloway, and H. Lempp. "SAT0640-HPR RHEUMATOLOGY CARE OF MIGRANTS FROM SUB-SAHARAN AFRICA; A QUALITATIVE PILOT STUDY OF PATIENTS’ PERSPECTIVES." Annals of the Rheumatic Diseases 79, Suppl 1 (June 2020): 1279.1–1279. http://dx.doi.org/10.1136/annrheumdis-2020-eular.2789.
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Background:Rheumatological diseases are common in Sub-Saharan Africa [1] but specialist healthcare is limited and there are less than 150 rheumatologists currently serving 1 billion people in Sub-Saharan Africa [2]. Rheumatologists practising in the UK NHS are likely to be exposed to migrant patients. There is therefore, an unmet need for health care providers to understand the differences in rheumatology healthcare provision between Sub-Saharan Africa and the UK and the barriers which migrants face in their transition of rheumatology care.Objectives:To gain an understanding of the experiences of patients with rheumatological conditions, about their past healthcare in Sub-Saharan Africa and their transition of care to the UK.Methods:A qualitative study using semi-structured interviews was conducted. Participants were recruited from two rheumatology outpatient clinics in London. Thematic analysis was applied to identify key themes.Results:Seven participants were recruited. Five had rheumatoid arthritis, one had ankylosing spondylitis and one had undifferentiated inflammatory arthritis. Participants described the significant impact their rheumatological conditions had on their physical and emotional wellbeing, including their social and financial implications. Compared to the UK, rheumatology healthcare in Sub-Saharan Africa was characterised by higher costs, limited access to specialists, lack of investigations and treatments, the use of traditional medicines and poor communication by clinicians. Barriers to transition of rheumatology care to the UK were: poor understanding of rheumatological conditions by the public and primary care providers, lack of understanding of NHS entitlements by migrants, fear of data sharing with immigration services and delayed referral to specialist care. Patient, doctor and public education were identified by participants as important ways to improve access to healthcare.Conclusion:This study has described, for the first time, patients’ perspectives of rheumatology health care in Sub-Saharan Africa and the transition of their care to the UK. These initial findings allow healthcare providers in the UK to tailor management for this migrant population and suggests that migrants need more information about their NHS entitlements and specific explanations on what non-clinical data will be shared with immigration services. To increase access to appropriate care, a concerted effort by clinicians and public health authorities is necessary to raise awareness and provide better education to patients and migrant populations about rheumatological conditions.References:[1]G. Mody, “Rheumatology in Africa-challenges and opportunities,” Arthritis Res. Ther., vol. 19, no. 1, p. 49, 2017.[2]M. A. M. Elagib et al., “Sudan and Sweden Active Rheumatoid Arthritis in Central Africa: A Comparative Study Between,” J. Rheumatol. J. Rheumatol. January, vol. 43, no. 10, pp. 1777–1786, 2016.Acknowledgments:We are grateful to the patients involved in this study for their time and involvement.Disclosure of Interests:None declared
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Diamond, Megan B., Shona Dalal, Clement Adebamowo, David Guwatudde, Carien Laurence, Ikeoluwapo O. Ajayi, Francis Bajunirwe, et al. "Prevalence and risk factor for injury in sub-Saharan Africa: a multicountry study." Injury Prevention 24, no. 4 (November 8, 2017): 272–78. http://dx.doi.org/10.1136/injuryprev-2016-042254.
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IntroductionInjury-related morbidity is a neglected health concern in many low-income and middle-income countries. Most injury data in Africa have been collected from hospital-based studies, and few studies have occurred across multiple countries. Using data from a novel cohort, we examined the prevalence and incidence of serious injuries and associated risk factors across five sites in sub-Saharan Africa (SSA).MethodsA common baseline and follow-up survey was administered to participants. The study population included 1316 persons at baseline and 904 persons at follow-up. Frequencies were calculated, and logistic regression models were used to assess risk factors for injury.ResultsA total of 233 (17.7%) persons reported a serious injury at baseline and 60 (6.6%) reported a serious injury 6 months later at follow-up. Sixty-nine per cent of participants responded to the follow-up questionnaire. At baseline and follow-up, the most common cause of serious injury at urban sites was transport related, followed by poison/overdose. In rural Uganda, sharp instruments injuries were most common, followed by transport-related injuries. Living at an urban site was associated with an increased odds for serious injury compared with those at the rural site (OR: 1.83, 95% CI 1.15 to 2.90). Participants who consumed above a moderate amount of alcohol were at a higher risk of serious injury compared with those who did not consume alcohol (OR: 1.86, 95% CI 1.02 to 3.41). High level of education was an important risk factor for injury.ConclusionAt baseline and follow-up, common causes of serious injury were transport related, sharp instrument and poison/overdose. Alcohol consumption, urban location and education are important risk factors for injury. It is feasible to collect longitudinal injury data using a standardised questionnaire across multiples sites in SSA. Longitudinal data collection should be leveraged to obtain robust data on risk factors for injury in SSA.
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Tesema, Getayeneh Antehunegn, Misganaw Gebrie Worku, Zemenu Tadesse Tessema, Achamyeleh Birhanu Teshale, Adugnaw Zeleke Alem, Yigizie Yeshaw, Tesfa Sewunet Alamneh, and Alemneh Mekuriaw Liyew. "Prevalence and determinants of severity levels of anemia among children aged 6–59 months in sub-Saharan Africa: A multilevel ordinal logistic regression analysis." PLOS ONE 16, no. 4 (April 23, 2021): e0249978. http://dx.doi.org/10.1371/journal.pone.0249978.
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Background Anemia is a major public health problem affecting more than half of children under the age of five globally. It has serious short- and long-term consequences including growth retardation, impaired motor and cognitive development, and increased morbidity and mortality. Despite anemia is the leading cause of child mortality in sub-Saharan Africa, there is limited evidence on the prevalence and determinants of anemia among under-five children in sub-Saharan Africa. Therefore, this study aimed to investigate the prevalence and determinants of severity levels of anemia among children aged 6–59 months in sub-Saharan Africa. Methods This study was based on the most recent Demographic and Health Survey (DHS) data of 32 sub-Saharan African countries. A total weighted sample of 135,619 children aged 6–59 months was included in the study. Considering the hierarchical nature of DHS data and the ordinal nature of anemia, a multilevel ordinal logistic regression model was applied. Proportional odds assumption was tested by Brant test and it was satisfied (p-value = 0.091). Besides, deviance was used for model comparison. Variables with a p-value ≤0.2 in the bivariable analysis were considered for the multivariable analysis. In the multivariable multilevel proportional odds model, the Adjusted Odds Ratio (AOR) with 95% Confidence Interval (CI) were reported for potential determinant factors of severity levels of anemia. Results The overall prevalence of anemia among children aged 6–59 months in sub-Saharan Africa was 64.1% [95% CI: 63.9%, 64.4%]. Of which, 26.2% were mildly anemic, 34.9% moderately anemic and 3% severely anemic. Poor maternal education, lower household wealth status, large family size, being male child, multiple births, having fever in the last two weeks, having diarrhea in the last two weeks, higher-order birth, maternal anemia, underweight, wasted, and stunted were significantly associated with increased odds of higher levels of anemia. Whereas, being 24–59 months age, taking drugs for an intestinal parasite, and born from mothers aged ≥ 20 years were significantly associated with lower odds of higher levels of anemia. Conclusion Severity levels of anemia among children aged 6–59 months in sub-Saharan Africa was a major public health problem. Enhancing maternal education, providing drugs for an intestinal parasite, designing interventions that address maternal anemia, febrile illness, and diarrheal disease, and strengthening the economic status of the family are recommended to reduce childhood anemia. Furthermore, it is better to strengthen the strategies of early detection and management of stunted, wasted, and underweight children to decrease childhood anemia.
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Workneh, Firehiwot, Dongqing Wang, Ourohiré Millogo, Alemayehu Worku, Angela Chukwu, Bruno Lankoande, Nega Assefa, et al. "Knowledge and Practice Related to COVID-19 and Mental Health among Adults in Sub-Saharan Africa." American Journal of Tropical Medicine and Hygiene 105, no. 2 (August 11, 2021): 351–62. http://dx.doi.org/10.4269/ajtmh.21-0219.
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ABSTRACT. Coronavirus disease 2019 (COVID-19) is a public health emergency affecting the lives of millions of people globally. Different measures and extraordinary steps are being taken to contain the transmission of the virus. The levels of knowledge and implementation of preventive practices related to COVID-19 in sub-Saharan African countries are unclear. Additionally, there is a lack of evidence regarding the impacts of the pandemic on mental health. This study aimed to describe knowledge and practices related to COVID-19 and to assess mental health status among adults in three sub-Saharan African countries: Burkina Faso, Ethiopia, and Nigeria. A total of 1,797 adults were included in the survey, and data were collected using computer-assisted telephone interviews. The proportions of adults who identified more than 80% of COVID-19 symptoms, transmission methods, and prevention mechanisms were 69.9%, 79.2%, and 90.7%, respectively. The practice of preventive measures was relatively lower for avoiding social gatherings and disinfecting contaminated surfaces. Better education, urban residence, and believing the pandemic is real were factors associated with good knowledge on COVID-19 symptoms, transmission methods, and preventive actions. Additionally, being male was associated with good knowledge on symptoms and transmission methods, whereas being in an older age group was associated with knowledge of transmission methods. Mild, moderate, and severe psychological distress was reported by 20.6%, 5.9%, and 1.1% of the participants, respectively. Although this study found high levels of knowledge regarding COVID-19, interventions are needed to increase the uptake of recommended preventive practices among adults in sub-Saharan Africa.
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Moses, S., and F. A. Plummer. "Health education, counselling and the underlying causes of the HIV epidemic in sub-saharan africa." AIDS Care 6, no. 2 (March 1994): 123–26. http://dx.doi.org/10.1080/09540129408258623.
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Chopra, Mickey, and Ian Darnton-Hill. "Responding to the crisis in sub-Saharan Africa: the role of nutrition." Public Health Nutrition 9, no. 5 (August 2006): 544–50. http://dx.doi.org/10.1079/phn2006948.
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AbstractIn the chapter dealing with education and health, the report of the influential Commission for Africa prioritises basic health systems, HIV/AIDS, malaria and tuberculosis. In contrast, nutrition is given less than half a page and is reduced to parasite control and micronutrient support. Such neglect of nutrition is hard to understand in the context of increasing hunger and malnutrition across the continent. Sub-Saharan Africa is the only region in the world where the proportion of underweight children has stagnated and the absolute numbers have actually increased in the last decade. It has been pointed out that if current trends continue sub-Saharan Africa will achieve the Millennium Development Goal for child mortality around 2115 – one century after the target date. Quite clearly those concerned with nutrition need to more powerfully advocate the role of nutrition in lifting Africa out of the spiral of poverty. The present paper argues that to achieve this requires an understanding not just of the critical role of nutrition for health and development (both individual and national), but also of how recent global changes are interacting with changes in food production and supply, other determinants of maternal and child health, and the role and capacity of the state to tackle malnutrition in Africa. It concludes by suggesting some responses that nutritionists could now be making.
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Glik, Deborah, Andrew Gordon, William Ward, Kale Kouame, and Mahbi Guessan. "Focus Group Methods for Formative Research in Child Survival: An Ivoirian Example." International Quarterly of Community Health Education 8, no. 4 (January 1988): 297–316. http://dx.doi.org/10.2190/pn0p-rujr-juxb-xxqa.
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The study reported here represents the ongoing development of focus group interview methods in support of health education planning for child survival programs in the CCCD project in Sub-Saharan Africa. Using illustrative examples from a field experience in Cote d'Ivoire, methods that enhance the usefulness and validity of focus group interviews for health program planning are discussed.
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Brewer, Devon D. "Knowledge of blood-borne transmission risk is inversely associated with HIV infection in sub-Saharan Africa." Journal of Infection in Developing Countries 5, no. 03 (March 21, 2011): 182–98. http://dx.doi.org/10.3855/jidc.1308.
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Introduction: Accurate, comprehensive knowledge of an infectious pathogen's modes of transmission helps people to avoid infection. Growing evidence suggests that blood-borne HIV transmission is widespread in sub-Saharan Africa. Methodology: I examined the association between knowledge of blood-borne HIV risk and prevalent HIV infection in Demographic and Health Survey data from 16 sub-Saharan African countries. I also searched three online databases for evidence of public education campaigns focused on blood-borne HIV risks in these countries. Results: Knowledge was moderately to strongly inversely related to HIV prevalence at the national level (i.e., countries in which many respondents were aware of blood-borne risk had lower HIV prevalence than countries in which few respondents were aware of such risk). At the individual level, respondents who knew about blood-borne HIV risks were modestly less likely to be infected than those who did not show awareness of this risk, independent of demographic and sexual behavior variables. This relationship was stronger in southern Africa than in west, central, and east Africa. In parallel analyses, knowledge of condom use as a way to prevent HIV was positively associated with prevalent HIV infection at both the national and individual levels. West, central, and east African countries with low to moderate HIV prevalence had implemented public education campaigns that included a focus on blood-borne transmission risks. Such campaigns were absent from high prevalence countries in southern Africa. Conclusion: These findings suggest that knowledge of blood-borne HIV risk protects against HIV infection and that public education campaigns are important for spreading that knowledge.
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Niaz, Qamar, Brian Godman, Stephen Campbell, and Dan Kibuule. "Compliance to prescribing guidelines among public health care facilities in Namibia; findings and implications." International Journal of Clinical Pharmacy 42, no. 4 (May 26, 2020): 1227–36. http://dx.doi.org/10.1007/s11096-020-01056-7.
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Abstract Background The World Health Organization estimates that over 50% medicines are prescribed inappropriately and the main driver of antimicrobial resistance globally. There have only been a limited number of studies evaluating prescribing patterns against national standard treatment guidelines (STGs) in sub-Saharan African countries including Namibia. This is important given the high prevalence of both infectious and non-infectious diseases in sub-Saharan Africa alongside limited resources. Objective Our aim was to assess prescribing practices and drivers of compliance to National guidelines among public health care facilities in Namibia to provide future guidance. Setting Three levels of public healthcare in Namibia. Method A mixed method approach including patient exit and prescriber interviews at three levels of health care in Namibia, i.e. hospital, health centre and clinic. Main outcome measures Medicine prescribing indicators, compliance to and attitudes towards National guidelines. Results Of the 1243 prescriptions analysed, 73% complied with the STGs and 69% had an antibiotic. Of the 3759 medicines (i.e. mean of 3.0 ± 1.1) prescribed, 64% were prescribed generically. The vast majority of prescribers were aware of, and had access to, the Namibian STGs (94.6%), with the majority reporting that the guidelines are easy to use and they regularly refer to them. The main drivers of compliance to guidelines were programmatic, that is access to up-to date objective guidelines, support systems for continued education on their use, and ease of referencing. Lack of systems to regulate noncompliance impacted on their use. Conclusion Whilst the findings were encouraging, ongoing concerns included limited prescribing of generic medicines and high use of antibiotics. A prescribing performance management system should be introduced to improve and monitor compliance to prescribing guidelines in public healthcare.
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Khumalo, Gugulethu Eve, Elizabeth E. Lutge, Praba Naidoo, and Tivani Phosa Mashamba-Thompson. "Barriers and facilitators of rendering HIV services by community health workers in sub-Saharan Africa: a meta-synthesis." Family Medicine and Community Health 9, no. 4 (September 2021): e000958. http://dx.doi.org/10.1136/fmch-2021-000958.
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ObjectivesTo synthesise qualitative studies that address the barriers to and facilitators of providing HIV services by community health workers (CHWs) in sub-Saharan Africa (SSA).DesignThis meta-synthesis was guided by Preferred Reporting Items for Systematic Reviews and Meta-Analyses. We included studies that were published between 2009 and 2019. The Ritchie and Spencer framework and the Supporting the Use of Research Evidence framework were used for thematic analysis and framework analysis, respectively. The Qualitative Assessment and Review Instrument was used to assess the quality of selected studies.Eligibility criteriaQualitative studies published between 2009 and 2019, that included CHWs linked directly or indirectly to the Ministry of Health and providing HIV services in the communities.Information sourcesAn extensive search was conducted on the following databases: EBSCOhost- (ERIC; Health Source-Nursing/Academic Edition; MEDLINE Full Text), Google Scholar and PubMed.ResultsBarriers to rendering of HIV services by CHWs were community HIV stigma; lack of CHW respect, CHWs’ poor education and training; poor stakeholders’ involvement; poor access to the communities; shortage of CHWs; unsatisfactory incentives; lack of CHW support and supervision, lack of equipment and supplies and social barriers due to culture, language and political structures. The altruistic behaviour of CHWs and the availability of job facilitated the provision of HIV services.ConclusionThe delivery of HIV services by CHWs in SSA is faced by more lingering barriers than facilitators. Planners and policymakers can minimise the barriers by investing in both CHW and community training regarding HIV services. Furthermore, sufficient funding should be allocated to the programme to ensure its efficiency.PROSPERO registration numberCRD42020160012.
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Nyamuranga, Chamunorwa, and Jaeun Shin. "Public health expenditure and child mortality in Southern Africa." International Journal of Social Economics 46, no. 9 (August 12, 2019): 1137–54. http://dx.doi.org/10.1108/ijse-12-2018-0643.
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Purpose The purpose of this paper is to empirically assess the effect of public health expenditure on child mortality in the Southern African Development Community (SADC) region in comparison to the developing world as a whole and the region of Sub-Saharan Africa (SSA). Design/methodology/approach This study used panel data extracted from the World Development Indicators database for the period 2000–2013 for 98 developing countries including 15 SADC countries. A dynamic panel data model of child mortality was estimated using the system generalized method of moments technique. Findings Results indicate that public health expenditure has a statistically significant effect on reducing infant and under-five mortality rates in the developing world, and that this effect is strongest in the SADC. Immunization and female literacy contributed significantly to the prevention of deaths of infants and children under five in developing countries. In the region of SSA, improved water sources and the reduction in the prevalence of HIV were found to be effective in reducing childhood mortality. There was little evidence for the benefit of higher GDP per capita. Practical implications The findings of this study suggest four policy areas which should be prioritized in public health spending to achieve better health among children: ensuring that females have better access to education, providing immunizations, intensifying interventions against the spread of HIV/AIDS, and improving water and sanitation infrastructure. Originality/value This study, which shows that the benefits of public health expenditure may be augmented by regional collaborations like the SADC, is one of the first to explore regional heterogeneity in the effectiveness of public health expenditure for the improvement of children’s health across the developing world.
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Kyere, Paul, J. Lennert Veerman, Patricia Lee, and Donald E. Stewart. "Effectiveness of school-based nutrition interventions in sub-Saharan Africa: a systematic review." Public Health Nutrition 23, no. 14 (July 10, 2020): 2626–36. http://dx.doi.org/10.1017/s1368980020000506.
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AbstractObjective:To evaluate the effect of school-based nutrition interventions (SBNI) involving schoolchildren and adolescents in sub-Saharan Africa (SSA) on child nutrition status and nutrition-related knowledge, attitudes and behaviour.Design:A systematic review on published school nutrition intervention studies of randomised controlled trials, controlled clinical trials, controlled before-and-after studies or quasi-experimental designs with control. Nine electronic bibliographic databases were searched. To be included, interventions had to involve changes to the school’s physical and social environments, to the school’s nutrition policies, to teaching curriculum to incorporate nutrition education and/or to partnership with parents/community.Setting:Schools in SSA.Participants:School-aged children and adolescents, aged 5–19 years.Results:Fourteen studies met our inclusion criteria. While there are few existing studies of SBNI in SSA, the evidence shows that food supplementation/fortification is very effective in reducing micronutrient deficiencies and can improve nutrition status. Secondly, school nutrition education can improve nutrition knowledge, but this may not necessarily translate into healthy nutrition behaviour, indicating that nutrition knowledge may have little impact without a facilitating environment. Results regarding anthropometry were inconclusive; however, there is evidence for the effectiveness of SBNI in improving cognitive abilities.Conclusions:There is enough evidence to warrant further trials of SBNI in SSA. Future research should consider investigating the impact of SBNI on anthropometry and nutrition behaviour, focusing on the role of programme intensity and/or duration. To address the high incidence of micronutrient deficiencies in low- and middle-income countries, food supplementation strategies currently available to schoolchildren should be expanded.
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Moon, T. D., J. R. Burlison, M. Blevins, B. E. Shepherd, A. Baptista, M. Sidat, A. E. Vergara, and S. H. Vermund. "Enrolment and programmatic trends and predictors of antiretroviral therapy initiation from President's Emergency Plan for AIDS Relief (PEPFAR)-supported public HIV care and treatment sites in rural Mozambique." International Journal of STD & AIDS 22, no. 11 (November 2011): 621–27. http://dx.doi.org/10.1258/ijsa.2011.010442.
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Summary Many countries in sub-Saharan Africa have made antiretroviral therapy (ART) available in urban settings, but the progress of treatment expansion into rural Africa has been slower. We analysed routine data for patients enrolled in a rural HIV treatment programme in Zambézia Province, Mozambique (1 June 2006 through 30 March 2009). There were 12,218 patients who were ≥15 years old enrolled (69% women). Median age was 25 years for women and 31 years for men. Older age and higher level of education were strongly predictive of ART initiation (P < 0.001). Patients with a CD4+ count of 350 cells/μL versus 50 cells/μL were less likely to begin ART (odds ratio [OR]: 0.19, 95% confidence interval [CI]: 0.16-0.23). In rural sub-Saharan Africa, HIV testing, linkage to care, logistics for ART initiation and fears among some patients to take ART require specialized planning to maximize successes. Sustainability will require improved health manpower, infrastructure, stable funding, continuous drug supplies, patient record systems and, most importantly, community engagement.
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Aula, Oyime Poise, Donald P. McManus, Malcolm K. Jones, and Catherine A. Gordon. "Schistosomiasis with a Focus on Africa." Tropical Medicine and Infectious Disease 6, no. 3 (June 22, 2021): 109. http://dx.doi.org/10.3390/tropicalmed6030109.
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Schistosomiasis is a common neglected tropical disease of impoverished people and livestock in many developing countries in tropical Africa, the Middle East, Asia, and Latin America. Substantial progress has been made in controlling schistosomiasis in some African countries, but the disease still prevails in most parts of sub-Saharan Africa with an estimated 800 million people at risk of infection. Current control strategies rely primarily on treatment with praziquantel, as no vaccine is available; however, treatment alone does not prevent reinfection. There has been emphasis on the use of integrated approaches in the control and elimination of the disease in recent years with the development of health infrastructure and health education. However, there is a need to evaluate the present status of African schistosomiasis, primarily caused by Schistosoma mansoni and S. haematobium, and the factors affecting the disease as the basis for developing more effective control and elimination strategies in the future. This review provides an historical perspective of schistosomiasis in Africa and discusses the current status of control efforts in those countries where the disease is endemic.
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Ofori-Asenso, Richard, Akosua Adom Agyeman, and Amos Laar. "Metabolic Syndrome in Apparently “Healthy” Ghanaian Adults: A Systematic Review and Meta-Analysis." International Journal of Chronic Diseases 2017 (2017): 1–9. http://dx.doi.org/10.1155/2017/2562374.
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Background. Metabolic syndrome (MetS) is a major public health problem in Sub-Saharan Africa. We systematically reviewed the literature towards estimating the prevalence of MetS among apparently “healthy” Ghanaian adults. Methods. We searched PubMed, Web of Science, Scopus, Africa Journals Online, African Index Medicus, and Google scholar as well as the websites of the Ministry of Health and Ghana Health service through September 2016. Only studies conducted among apparently “healthy” (no established disease, e.g., diabetes and hypertension) adults aged ≥ 18 years were considered. Only studies that utilised the National Cholesterol Education Program Adult Treatment Panel (NCEP-ATP), World Health Organization (WHO), or International Diabetes Federation (IDF) classifications for MetS were included. Results. Data from nine studies involving 1,559 individuals were pooled. The prevalence of MetS based on NCEP-ATP, WHO, and IDF classifications was 12.4% (95% confidence interval [CI] = 8.3–17.4%), 6.0% (95% CI = 1.4–13.1%), and 21.2% (95% CI = 12.4–30.9), respectively. Prevalence of MetS was higher among women than men. Conclusion. Among a population of adult Ghanaians deemed “healthy,” there is a high prevalence of MetS. Preventive measures are required to address the risk components of MetS such as obesity and hypertension which are rapidly rising in Ghana.
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Good, Kenneth. "At the Ends of the Ladder: Radical Inequalities in Botswana." Journal of Modern African Studies 31, no. 2 (June 1993): 203–30. http://dx.doi.org/10.1017/s0022278x00011903.
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Botswana ranks very high in sub-Saharan Africa in income per capita, and in such indicators of human development as public expenditure on health and education. Nevertheless, inequalities of wealth and income are particularly severe, in both international and domestic comparisons. Although wealth and poverty are mediated and expressed in complex ways, the disparities between the very rich and the very poor are established, structured, and growing.
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Dunin De Skrzynno, Sophie CJ, and Francesco Di Maggio. "Surgical consent in sub-Saharan Africa: a modern challenge for the humanitarian surgeon." Tropical Doctor 48, no. 3 (June 12, 2018): 217–20. http://dx.doi.org/10.1177/0049475518780531.
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Surgical consent is one of the pillars of ethical conduct in Western world surgical practice. Recent studies have described the consenting processes for clinical trials in low- and middle-income countries (LMICs), but only a few have explored its practice before surgical procedures. The recent World Medical Association (WMA) Declaration of Lisbon recommends autonomy and independent decision-making. However, informed consent is influenced by cultural background, family structure, socioeconomic status, religion and education. The authors of the paper support the WMA recommendations, but agree the process for obtaining informed consent should be reviewed and developed to integrate in a culturally appropriate manner. This commentary reports the author’s personal experience of surgical consent in Burundi and reviews the literature describing its practice and the specific challenges faced in Sub-Saharan Africa. Its aim is to encourage a debate among surgeons as to how surgical consent can be undertaken in different scenarios of LMICs.
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Berlacher, Michelle, Timothy Mercer, Edith O. Apondi, Winfred Mwangi, Edwin Were, and Megan S. McHenry. "Integrating Prevention of Mother-to-Child Transmission of HIV Care into General Maternal Child Health Care in Western Kenya." International Journal of Maternal and Child Health and AIDS (IJMA) 10, no. 1 (December 30, 2020): 19–28. http://dx.doi.org/10.21106/ijma.429.
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Background: Health systems integration is becoming increasingly important as the global health community transitions from acute, disease-specific health programming to models of care built for chronic diseases, primarily designed to strengthen public-sector health systems. In many countries across sub-Saharan Africa, including Kenya, prevention of mother-to-child transmission of HIV (pMTCT) services are being integrated into the general maternal child health (MCH) clinics. The objective of this study was to evaluate the benefits and challenges for integration of care within a developing health system, through the lens of an evaluative framework. Methods: A framework adapted from the World Health Organization’s six critical health systems functions was used to evaluate the integration of pMTCT services with general MCH clinics in western Kenya. Perspectives were collected from key stakeholders, including pMTCT and MCH program leadership and local health providers. The benefits and challenges of integration across each of the health system functions were evaluated to better understand this approach. Results: Key informants in leadership positions and MCH staff shared similar perspectives regarding benefits and challenges of integration. Benefits of integration included convenience for families through streamlining of services and reduced HIV stigma. Concerns and challenges included confidentiality issues related to HIV status, particularly in the context of high-volume, crowded clinical spaces. Conclusion and Global Health Implications: The results from this study highlight areas that need to be addressed to maximize the effectiveness and clinical flow of the pMTCT-MCH integration model. The lessons learned from this integration may be applied to other settings in sub-Saharan Africa attempting to integrate HIV care into the broader public-sector health system. Key words: • HIV prevention • Maternal-child health • Prevention of maternal-to-child transmission • Health services • Integration • Kenya • Sub-Saharan Africa Copyright © 2020 Berlacher et al. Published by Global Health and Education Projects, Inc. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY 4.0) which permits unrestricted use, distribution, and reproduction in any medium, provided the original work, first published in this journal, is properly cited.
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Beattie, Pauline, and Moses Bockarie. "THE NINTH FORUM OF THE EUROPEAN & DEVELOPING COUNTRIES CLINICAL TRIALS PARTNERSHIP." BMJ Global Health 4, Suppl 3 (April 2019): A1. http://dx.doi.org/10.1136/bmjgh-2019-edc.1.
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The EDCTP community meets biennially to share research findings, plan new partnerships and collaborations, and discuss maximising impact from EDCTP-funded research. In 2018, the Ninth EDCTP Forum took place in Lisbon, Portugal, from 17–21 September 2018. The Lisbon meeting was the largest international conference focusing on clinical research on poverty-related infectious diseases in sub-Saharan Africa. It started with a strong commitment, from European and African EDCTP member countries, for a successor programme to EDCTP2 (2014–2024). It provided a platform for the presentation of project results and discussion of progress in clinical research and capacity strengthening in sub-Saharan Africa.The theme of the Ninth Forum was ‘Clinical research and sustainable development in sub-Saharan Africa: the impact of North-South partnerships’. This reflected not only the broader scope of a larger EDCTP research programme but also the growing awareness of the need for global cooperation to prepare for public health emergencies and strengthen health systems. The theme highlighted the impact of Europe-Africa partnerships supporting clinical research and the clinical research environment, towards achieving the sustainable development goals in sub-Saharan Africa.A central topic of the Forum was the discussion of the character and scope of an EDCTP successor programme, which should start in 2021 under the next European Framework Programme for Research and Innovation, Horizon Europe. On 17 September, a high-level meeting on this topic took place immediately before the opening of the Forum1. On 19 September, the plenary session continued this discussion through a panel of representatives of strategic partners. There was consensus on the added value of the programme for Europe and the countries in sub-Saharan Africa and political commitment to a successor programme. Poverty-related infectious diseases and a partnership approach will remain central to the programme. There was also a general awareness that all participating countries would need to engage more strongly with a successor programme, both in its governance and in their financial contributions to its objectives.The Forum hosted 550 participants from more than 50countries. The programme consisted of keynote addresses by policy makers, research leaders, and prominent speakers from Europe and Africa in 5 plenary presentations. There were 9 symposia, 45 oral presentations in parallel sessions, and 74 electronic poster presentations. Abstracts of the plenary, oral and poster presentations are published in this supplement to BMJ Global Health.EDCTP is proud of its contribution to strengthening clinical research capacity in Africa, with more than 400 postgraduate students and 56 EDCTP fellows supported under the first EDCTP programme. The second programme developed a comprehensive fellowship scheme. More than 100 EDCTP fellows (former and current) participated in a one-day pre-conference to discuss the further development of our Alumni Network launched in 2017. The Forum also offered scholarships to many early and mid-career researchers from sub-Saharan Africa and Europe. With the support of the European Union, EDCTP member countries and sponsors, they were able to present results of their studies and meet colleagues from Africa and Europe.The Forum also provided the appropriate platform for recognising individual and team achievements through the four EDCTP 2018 Prizes. With the support of the European Union, EDCTP recognised outstanding individuals and research teams from Africa and Europe. In addition to their scientific excellence, the awardees made major contributions to the EDCTP objectives of clinical research capacity development in Africa and establishing research networks between North and South as well as within sub-Saharan Africa.Dr Pascoal Mocumbi Prize Professor Souleyman Mboup (Professor of Microbiology, University of Cheikh Anta Diop, Dakar; Head of the Bacteriology-Virology Laboratory of CHU Le Dantec, Dakar; and President of IRESSEF, Senegal) was recognised for his outstanding achievements in advancing health research and capacity development in Africa.Outstanding Research Team Prize The prize was awarded to the team of the CHAPAS (Children with HIV in Africa – Pharmacokinetics and acceptability of simple antiretroviral regimens) studies, led by Professor Diana Gibb (MRC Clinical Trials Unit, United Kingdom).Outstanding Female Scientist Prize The prize was awarded to Professor Gita Ramjee (Chief Specialist Scientist and Director of the HIV Prevention Research Unit of the South African Medical Research Council, Durban, South Africa) for her outstanding contributions to her field.Scientific Leadership Prize The prize was awarded to Professor Keertan Dheda (Head of the Centre for Lung Infection and Immunity and Head of the Division of Pulmonology at Groote Schuur Hospital and the University of Cape Town, South Africa) for his research contributions and leadership.Partnership is at the core of the EDCTP mission. In the year before the Forum, Nigeria and Ethiopia were welcomed as the newest member countries of the EDCTP Association, while Angola became an aspirant member. Partnership was also demonstrated by the many stakeholders who enriched the programme by organising scientific symposia, collaborative sessions and workshops. We thank our sponsors Novartis, Merck, the European Union, the Federal Ministry of Education and Research (Germany), the Institute of Health Carlos III (Spain), the National Alliance for Life Sciences and Health (France), the Medical Research Council (United Kingdom), the Swedish International Development Agency (Sweden), ClinaPharm (African CRO), the Deutsche Stiftung Weltbevölkerung (Germany), The Global Health Network (United Kingdom), PATH, and ScreenTB. We gratefully acknowledge the support of our partners and hosts of the Forum, the Portuguese Foundation for Science and Technology and the Calouste Gulbenkian Foundation.The tenth EDCTP Forum will take place in sub-Saharan Africa in 2020.
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Budu, Eugene, Bright Opoku Ahinkorah, Abdul-Aziz Seidu, John Elvis Hagan, Wonder Agbemavi, James Boadu Frimpong, Collins Adu, Kwamena Sekyi Dickson, and Sanni Yaya. "Child Marriage and Sexual Autonomy among Women in Sub-Saharan Africa: Evidence from 31 Demographic and Health Surveys." International Journal of Environmental Research and Public Health 18, no. 7 (April 3, 2021): 3754. http://dx.doi.org/10.3390/ijerph18073754.
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Child marriage has a variety of undesirable consequences at the peril of women’s health and autonomy. In this study, we examined the association between child marriage and sexual autonomy among women in sub-Saharan Africa. We utilised data from the most recent Demographic and Health Surveys conducted in 31 countries in sub-Saharan Africa between 2010 and 2019. A total of 218,578 women aged 20–49 were included in this study. Multivariable binary logistic regression models were used to show the association between child marriage and sexual autonomy. Crude odds ratio (cOR) and adjusted odds ratio (aOR) were used in presenting the results. The prevalence of child marriage and sexual autonomy was 44.51% and 83.35%, respectively. Compared to women who married at 18 years or above, those who married at less than 18 were less likely to have sexual autonomy, and this persisted after controlling for important covariates. In terms of the country-specific results, women who experienced child marriage were less likely to have sexual autonomy in Burundi, Congo DR, Nigeria, and Niger. With the covariates, lower odds of sexual autonomy were found among women with no formal education, those whose partners had no formal education, those who were not exposed to media, and non-working women. Child marriage was found to be associated with sexual autonomy. There is a need to strengthen policies and programmes such as compulsory basic education, poverty alleviation, and an increase in access to media that aim at reducing child marriage. These interventions will help to improve sexual autonomy among women, especially in this 21st century where individuals and organisations incessantly advocate for gender equality.
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Wang, Yiting, Xuhui Wang, Lu Ji, and Rui Huang. "Sociodemographic Inequalities in Health Insurance Ownership among Women in Selected Francophone Countries in Sub-Saharan Africa." BioMed Research International 2021 (August 17, 2021): 1–8. http://dx.doi.org/10.1155/2021/6516202.
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In sub-Saharan Africa, improving equitable access to healthcare remains a major challenge for public health systems. Health policymakers encourage the adoption of health insurance schemes to promote universal healthcare. Nonetheless, progress towards this goal remains suboptimal due to inequalities health insurance ownership especially among women. In this study, we aimed to explore the sociodemographic factors contributing to health insurance ownership among women in selected francophone countries in sub-Saharan Africa. Methods. This study is based on cross-sectional data obtained from Demographic and Health Surveys on five countries including Benin ( n = 13,407 ), Madagascar ( n = 12,448 ), Mali ( n = 10,326 ), Niger ( n = 12,558 ), and Togo ( n = 6,979 ). The explanatory factors included participant age, marital status, type of residency, education, household wealth quantile, employment stats, and access to electronic media. Associations between health insurance ownership and the explanatory factors were analyzed using multivariate regression analysis, and effect sizes were reported in terms in average marginal effects (AMEs). Results. The highest percentage of insurance ownership was observed for Togo (3.31%), followed by Madagascar (2.23%) and Mali (2.2%). After stratifying by place of residency, the percentages were found to be significantly lower in the rural areas for all countries, with the most noticeable difference observed for Niger (7.73% in urban vs. 0.54% in rural women). Higher levels of education and wealth quantile were positively associated with insurance ownership in all five countries. In the pooled sample, women in the higher education category had higher likelihood of having an insurance: Benin ( AME = 1.18 ; 95% CI = 1.10 , 1.27), Madagascar ( AME = 1.10 ; 95% CI = 1.05 , 1.15), Mali ( AME = 1.14 ; 95% CI = 1.04 , 1.24), Niger ( AME = 1.13 ; 95% CI = 1.07 , 1.21), and Togo ( AME = 1.17 ; 95% CI = 1.09 , 1.26). Regarding wealth status, women from the households in the highest wealth quantile had 4% higher likelihood of having insurance in Benin and Mali and 6% higher likelihood in Madagascar and Togo. Conclusions. Percentage of women who reported having health insurance was noticeably low in all five countries. As indicated by the multivariate analyses, the actual situation is likely to be even worse due to significant socioeconomic inequalities in the distribution of women having an insurance plan. Increasing women’s access to healthcare is an urgent priority for population health promotion in these countries, and therefore, addressing the entrenched sociodemographic disparities should be given urgent policy attention in an effort to strengthen universal healthcare-related goals.
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Blackstone, Sarah R., Ucheoma Nwaozuru, and Juliet Iwelunmor. "Antenatal HIV Testing in Sub-Saharan Africa During the Implementation of the Millennium Development Goals: A Systematic Review Using the PEN-3 Cultural Model." International Quarterly of Community Health Education 38, no. 2 (December 22, 2017): 115–28. http://dx.doi.org/10.1177/0272684x17749576.
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This study systematically explored the barriers and facilitators to routine antenatal HIV testing from the perspective of pregnant women in sub-Saharan Africa during the implementation period of the Millennium Development Goals. Articles published between 2000 and 2015 were selected after reviewing the title, abstract, and references. Twenty-seven studies published in 11 African countries were eligible for the current study and reviewed. The most common barriers identified include communication with male partners, patient convenience and accessibility, health system and health-care provider issues, fear of disclosure, HIV-related stigma, the burden of other responsibilities at home, and the perception of antenatal care as a “woman's job.” Routine testing among pregnant women is crucial for the eradication of infant and child HIV infections. Further understanding the interplay of social and cultural factors, particularly the role of women in intimate relationships and the influence of men on antenatal care seeking behaviors, is necessary to continue the work of the Millennium Development Goals.
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Houeto, David, and Alain Deccache. "Child Malaria in Sub-Saharan Africa: Effective Control and Prevention Require a Health Promotion Approach." International Quarterly of Community Health Education 28, no. 1 (April 2008): 51–62. http://dx.doi.org/10.2190/iq.28.1.e.
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Kelcey, Ben, and Zuchao Shen. "Planning community-based assessments of HIV educational intervention programs in sub-Saharan Africa." Health Education Research 32, no. 4 (August 1, 2017): 353–63. http://dx.doi.org/10.1093/her/cyx046.
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Adu-Gyamfi, Samuel, Mariama Marciana Kuusaana, Benjamin Dompreh Darkwa, and Lucky Tomdi. "The Changing Landscape of Mission Medicine and Hospitals in Sub-Saharan Africa." Christian Journal for Global Health 7, no. 5 (December 21, 2020): 65–81. http://dx.doi.org/10.15566/cjgh.v7i5.417.
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Missions have played numerous developmental roles towards the achievement of economic and social advancement including the provision of healthcare. From their entry into Africa, they have employed numerous methods in order to introduce their Christian faith. The construction of schools and hospitals, engagement in public health campaigns, provision of relevant services for the poor, and spearheading the provision of formal education, among others, have been the most effective mechanisms. The activities of missionaries have taken different dimensions as their scope continues to change over time. Nevertheless, existing literature shows little data on the changing landscape of mission medicine and hospitals in Africa. Using a systematic literature review approach, the current study discusses the changing landscape of mission medicine and hospitals in Sub-Saharan Africa. This contribution dwells partly on the missionary theory of medical practice to define most of the services of these faith-based organization (FBOs) in Africa. Findings from the study have revealed that mission hospitals have established schools and training schemes that allow them to train medical personnel to complement the limited number of health personnel on the continent. In the twenty-first century, they have contributed to achieving the targets of the Millennium Development Goals (MDGs) and the Sustainable Development Goals (SDGs), especially aspects that focus on health. It is evident that while the focus, methods, and partnerships have changed, missions in healthcare have not diverted their attention from sharing the gospel of Jesus Christ.
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Meher, Rajkishor, and Rajendra Prasad Patro. "Interstate Level Comparison of People’s Health Status and the State of Public Health Care Services in India." Journal of Health Management 16, no. 4 (November 26, 2014): 489–507. http://dx.doi.org/10.1177/0972063414548558.
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Health is an essential component of economic development and there is a strong correlation between health of human population and societal well-being. We cannot just think of the development of the human capital without the development of health and education of the people. However, it is found that although India has made large gains on the health front of its population, there exist wide variations between and within states. While states such as Kerala, Punjab and Tamil Nadu have a very developed health sector and the health indicators of these states are comparable to those of developed middle-income countries, states such as Bihar, Jharkhand, Madhya Pradesh, Chhattisgarh, Uttar Pradesh, Odisha, etc., are almost at the level of Sub-Saharan Africa. By using a few of the key health indicators the present article makes a critical analysis of the health status of people in the 17 major states of India, the ongoing health development programmes and the present state of public health care services in different parts of the country. The article further delves into an arena of specific policy intervention measures that are required to be undertaken in order to increase the health status of people.
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Hall, Andrew, Emily Bobrow, Simon Brooker, Matthew Jukes, Kate Nokes, Jane Lambo, Helen Guyatt, et al. "Anaemia in schoolchildren in eight countries in Africa and Asia." Public Health Nutrition 4, no. 3 (June 2001): 749–56. http://dx.doi.org/10.1079/phn2000111.
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AbstractObjectiveTo report on the haemoglobin concentrations and prevalence of anaemia in schoolchildren in eight countries in Africa and Asia.DesignBlood samples were collected during surveys of the health of schoolchildren as a part of programmes to develop school-based health services.SettingRural schools in Ghana, Indonesia, Kenya, Malawi, Mali, Mozambique, Tanzania and Vietnam.SubjectsNearly 14 000 children enrolled in basic education in three age ranges (7–11 years, 12–14 years and Ä15 years) which reflect the new UNICEF/WHO thresholds to define anaemia.ResultsAnaemia was found to be a severe public health problem (defined as >40% anaemic) in five African countries for children aged 7–11 years and in four of the same countries for children aged 12–14 years. Anaemia was not a public health problem in the children studied in the two Asian countries. More boys than girls were anaemic, and children who enrolled late in school were more likely to be anaemic than children who enrolled closer to the correct age. The implications of the four new thresholds defining anaemia for school-age children are examined.ConclusionsAnaemia is a significant problem in schoolchildren in sub-Saharan Africa. School-based health services which provide treatments for simple conditions that cause blood loss, such as worms, followed by multiple micronutrient supplements including iron, have the potential to provide relief from a large burden of anaemia.
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Barasa, Edwine, Jacob Kazungu, Peter Nguhiu, and Nirmala Ravishankar. "Examining the level and inequality in health insurance coverage in 36 sub-Saharan African countries." BMJ Global Health 6, no. 4 (April 2021): e004712. http://dx.doi.org/10.1136/bmjgh-2020-004712.
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IntroductionLow/middle-income countries (LMICs) in sub-Saharan Africa (SSA) are increasingly turning to public contributory health insurance as a mechanism for removing financial barriers to access and extending financial risk protection to the population. Against this backdrop, we assessed the level and inequality of population coverage of existing health insurance schemes in 36 SSA countries.MethodsUsing secondary data from the most recent Demographic and Health Surveys, we computed mean population coverage for any type of health insurance, and for specific forms of health insurance schemes, by country. We developed concentration curves, computed concentration indices, and rich–poor differences and ratios to examine inequality in health insurance coverage. We decomposed the concentration index using a generalised linear model to examine the contribution of household and individual-level factors to the inequality in health insurance coverage.ResultsOnly four countries had coverage levels with any type of health insurance of above 20% (Rwanda—78.7% (95% CI 77.5% to 79.9%), Ghana—58.2% (95% CI 56.2% to 60.1%), Gabon—40.8% (95% CI 38.2% to 43.5%), and Burundi 22.0% (95% CI 20.7% to 23.2%)). Overall, health insurance coverage was low (7.9% (95% CI 7.8% to 7.9%)) and pro-rich; concentration index=0.4 (95% CI 0.3 to 0.4, p<0.001). Exposure to media made the greatest contribution to the pro-rich distribution of health insurance coverage (50.3%), followed by socioeconomic status (44.3%) and the level of education (41.6%).ConclusionCoverage of health insurance in SSA is low and pro-rich. The four countries that had health insurance coverage levels greater than 20% were all characterised by substantial funding from tax revenues. The other study countries featured predominantly voluntary mechanisms. In a context of high informality of labour markets, SSA and other LMICs should rethink the role of voluntary contributory health insurance and instead embrace tax funding as a sustainable and feasible mechanism for mobilising resources for the health sector.
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Obasohan, Phillips Edomwonyi, Stephen J. Walters, Richard Jacques, and Khaled Khatab. "A Scoping Review of the Risk Factors Associated with Anaemia among Children Under Five Years in Sub-Saharan African Countries." International Journal of Environmental Research and Public Health 17, no. 23 (November 27, 2020): 8829. http://dx.doi.org/10.3390/ijerph17238829.
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Background/Purpose: Globally, anaemia is a severe public health condition affecting over 24% of the world’s population. Children under five years old and pregnant women are the most vulnerable to this disease. This scoping review aimed to evaluate studies that used classical statistical regression methods on nationally representative health survey data to identify the individual socioeconomic, demographic and contextual risk factors associated with developing anaemia among children under five years of age in sub-Saharan Africa (SSA). Methods/Design: The reporting pattern followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) guidelines. The following databases were searched: MEDLINE, EMBASE (OVID platform), Web of Science, PUBMED, Cumulative Index to Nursing and Allied Health Literature (CINAHL), PsycINFO, Scopus, Cochrane library, African Journal of online (AJOL), Google Scholar and Measure DHS. Results: The review identified 20 relevant studies and the risk factors for anaemia were classified as child-related, parental/household-related and community- or area-related factors. The risk factors for anaemia identified included age, birth order, sex, comorbidities (such as fever, diarrhoea and acute respiratory infection), malnutrition or stunting, maternal education, maternal age, mother’s anaemia status, household wealth and place of residence. Conclusion: The outcome of this review is of significant value for health policy and planners to enable them to make informed decision that will correct any imbalances in anaemia across socioeconomic, demographic and contextual characteristics, with the view of making efficient distributions of health interventions.
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Miles, Steven H. "HIV in insurgency forces in sub-Saharan Africa — a personal view of policies." International Journal of STD & AIDS 14, no. 3 (March 1, 2003): 174–78. http://dx.doi.org/10.1258/095646203762869179.
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The special requirements for HIV-prevention programmes by armed forces or insurgency groups in very poor countries that are in active conflict have not been well described. Customary military programme components include: education on sexually transmitted diseases, condom distribution, and HIV testing. Programmes for these armed forces must address: a command structure that may not prioritize this activity, severe resource and logistical constraints, weak health systems for treating sexually transmitted illness, beliefs in traditional medicines for symptoms of sexually transmitted illness, illiteracy that diminishes the utility of educational pamphlets, rape and sexual bartering by soldiers, battlefield transfusions, tattooing and the co-epidemic of tuberculosis.
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Fabian, June, Jaya A. George, Harriet R. Etheredge, Manuel van Deventer, Robert Kalyesubula, Alisha N. Wade, Laurie A. Tomlinson, Stephen Tollman, and Saraladevi Naicker. "Methods and reporting of kidney function: a systematic review of studies from sub-Saharan Africa." Clinical Kidney Journal 12, no. 6 (August 19, 2019): 778–87. http://dx.doi.org/10.1093/ckj/sfz089.
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Abstract Globally, chronic kidney disease (CKD) is an emerging public health challenge but accurate data on its true prevalence are scarce, particularly in poorly resourced regions such as sub-Saharan Africa (SSA). Limited funding for population-based studies, poor laboratory infrastructure and the absence of a validated estimating equation for kidney function in Africans are contributing factors. Consequently, most available studies used to estimate population prevalence are hospital-based, with small samples of participants who are at high risk for kidney disease. While serum creatinine is most commonly used to estimate glomerular filtration, there is considerable potential bias in the measurement of creatinine that might lead to inaccurate estimates of kidney disease at individual and population level. To address this, the Laboratory Working Group of the National Kidney Disease Education Program published recommendations in 2006 to standardize the laboratory measurement of creatinine. The primary objective of this review was to appraise implementation of these recommendations in studies conducted in SSA after 2006. Secondary objectives were to assess bias relating to choice of estimating equations for assessing glomerular function in Africans and to evaluate use of recommended diagnostic criteria for CKD. This study was registered with Prospero (CRD42017068151), and using PubMed, African Journals Online and Web of Science, 5845 abstracts were reviewed and 252 full-text articles included for narrative analysis. Overall, two-thirds of studies did not report laboratory methods for creatinine measurement and just over 80% did not report whether their creatinine measurement was isotope dilution mass spectroscopy (IDMS) traceable. For those reporting a method, Jaffe was the most common (93%). The four-variable Modification of Diet in Renal Disease (4-v MDRD) equation was most frequently used (42%), followed by the CKD Epidemiology Collaboration (CKD-EPI) equation for creatinine (26%). For the 4-v MDRD equation and CKD-EPI equations, respectively, one-third to one half of studies clarified use of the coefficient for African-American (AA) ethnicity. When reporting CKD prevalence, <15% of studies fulfilled Kidney Disease: Improving Global Outcomes criteria and even fewer used a population-based sample. Six studies compared performance of estimating equations to measured glomerular filtration rate (GFR) demonstrating that coefficients for AA ethnicity used in the 4-v MDRD and the CKD-EPI equations overestimated GFR in Africans. To improve on reporting in future studies, we propose an ‘easy to use’ checklist that will standardize reporting of kidney function and improve the quality of studies in the region. This research contributes some understanding of the factors requiring attention to ensure accurate assessment of the burden of kidney disease in SSA. Many of these factors are difficult to address and extend beyond individual researchers to health systems and governmental policy, but understanding the burden of kidney disease is a critical first step to informing an integrated public health response that would provide appropriate screening, prevention and management of kidney disease in countries from SSA. This is particularly relevant as CKD is a common pathway in both infectious and non-communicable diseases, and multimorbidity is now commonplace, and even more so when those living with severe kidney disease have limited or no access to renal replacement therapy.
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Wang, Dongqing, Angela Chukwu, Ourohiré Millogo, Nega Assefa, Christabel James, Tara Young, Bruno Lankoande, et al. "The COVID-19 Pandemic and Adolescents’ Experience in Sub-Saharan Africa: A Cross-Country Study Using a Telephone Survey." American Journal of Tropical Medicine and Hygiene 105, no. 2 (August 11, 2021): 331–41. http://dx.doi.org/10.4269/ajtmh.20-1620.
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ABSTRACT. The public health measures instituted by governments to combat the coronavirus disease 2019 (COVID-19) may cause developmental and educational losses to adolescents. The impacts of the COVID-19 pandemic and its mitigation strategies on adolescents in sub-Saharan Africa are unclear. This study aimed to examine adolescents’ knowledge, perceptions, and practices related to COVID-19 and the impacts of the pandemic on the daily lives of adolescents in sub-Saharan Africa. The survey was conducted in Burkina Faso, Ethiopia, and Nigeria using computer-assisted telephone interviews to enable rapid and remote data collection. Two sites were included in each country, with approximately 300 adolescents per site and 1,795 adolescents in total. Variations across the six sites were noted for the proportions of the adolescents who could correctly identify all key COVID-19 symptoms (4–25%), transmission methods (16–59%), and prevention approaches (33–79%). Most (> 72%) of the adolescents were no longer going to school due to school closures. Many adolescents (23–81%) were not receiving any education during the pandemic. A considerable proportion of the adolescents (44–83%) self-assessed as having less ability to learn during the pandemic; many expected it to be very difficult to catch up on education after the pandemic. Decreases in the consumption of major food groups were common across sites. Urgent actions are needed in sub-Saharan Africa to address the inadequate knowledge of COVID-19 among adolescents and the impacts of the pandemic on adolescent education and nutrition.
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Ayeni, A. "Extension education strategy for minimizing aflatoxin impact on sub-Saharan African agriculture and food systems." World Mycotoxin Journal 8, no. 2 (January 1, 2015): 253–57. http://dx.doi.org/10.3920/wmj2014.1716.
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Sub-Saharan Africa (SSA) is the most vulnerable region of the world to all aflatoxin-related problems including food insecurity, ill health and reduced foreign exchange earnings. Aflatoxin-contaminated maize, groundnuts (peanuts), sorghum and other crops reduce human access to adequate calories from these staples; consumption of aflatoxin-contaminated foods results in severe health conditions, including liver cancer, that deny the region a significant amount of otherwise productive man-hours; while the reduction of grain quality below the international standards due to aflatoxin contamination drastically reduces income in foreign exchange earnings. Scientific knowledge of the causes of aflatoxins in agricultural systems and their mitigation abounds in research institutions in SSA and internationally, but most of this knowledge is unavailable to farmers, food consumers and policy makers in useful form due to poor extension education and ineffective extension services. A paradigm shift in the approach to extension in SSA is proposed, one driven by a sustainable mechanism that is sensitive to the needs of the people and proactive (rather than reactive) in providing solutions to aflatoxin-related problems the local community and policy makers have to deal with. This paper argues that such sustainable mechanism may only be found in a University-based and University-run ‘land grant’ type extension services adapted appropriately to SSA conditions.
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Sowa, Stephen, Ian Warwick, and Elaine Chase. "Producing and using community health education films in low- and middle-income countries." Health Education Journal 77, no. 7 (April 20, 2018): 803–14. http://dx.doi.org/10.1177/0017896918769693.
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Objective: To analyse the production and use of health education films in Kenya, Tanzania and Zambia. Design: Review of community health education films and their use by three partner organisations. Methods: A focused content analysis of 18 community health education films was conducted, and three exemplar films were selected for more detailed review. Interviews were carried out with four film production personnel and seven project workers using the films in health education projects in Kenya, Tanzania and Zambia. Concepts drawn from the Ottawa Charter for Health Promotion and Anchored Instruction informed the study. Findings: The films, produced primarily for use across sub-Saharan Africa, mostly conveyed biological information and addressed behavioural issues related to maternal and child health topics. The predominantly low-literacy audiences reached by the projects may further benefit from localised content highlighting the social determinants of health through engaging narrative formats. While the health education projects provided some opportunities to discuss the films after screening, linked problem-solving activities could raise awareness of the multiple factors influencing health and help community members formulate holistic action plans. Conclusion: The film production company responded to emerging findings, noting that more context-specific films should be produced, with community members being more fully involved in planning, production and evaluation. Such an approach could generate more relevant content and engage audiences more effectively in problem-solving related to health and wellbeing.
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Bankole, Akinrinola, Susheela Singh, Rubina Hussain, and Gabrielle Oestreicher. "Condom Use for Preventing STI/HIV and Unintended Pregnancy Among Young Men in Sub-Saharan Africa." American Journal of Men's Health 3, no. 1 (September 9, 2008): 60–78. http://dx.doi.org/10.1177/1557988308322394.
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The condom is the only known method that provides simultaneous protection against unplanned pregnancy and some sexually transmitted infections (STIs), including HIV, among sexually active people. Using data from the Demographic and Health Surveys from 18 Sub-Saharan African countries, this study examined condom use and reasons for using the method at last intercourse among sexually active young men aged 15 to 29. Most young men were aware of the condom (73%-98%), but its use at last intercourse was quite variable, ranging from 6% in Madagascar to 74% in Namibia. In 10 countries, more young men reportedly used condoms for preventing STIs alone than they did for preventing pregnancy alone. In 6 countries, at least one third of the users used the method for both purposes. Use of the condom at last intercourse was associated with union status, education, residence, and exposure to television in at least two thirds of the countries.
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Skrip, Laura A., Veronique Dermauw, Pierre Dorny, Rasmané Ganaba, Athanase Millogo, Zékiba Tarnagda, and Hélène Carabin. "Data-driven analyses of behavioral strategies to eliminate cysticercosis in sub-Saharan Africa." PLOS Neglected Tropical Diseases 15, no. 3 (March 23, 2021): e0009234. http://dx.doi.org/10.1371/journal.pntd.0009234.
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Background The multi-host taeniosis/cysticercosis disease system is associated with significant neurological morbidity, as well as economic burden, globally. We investigated whether lower cost behavioral interventions are sufficient for local elimination of human cysticercosis in Boulkiemdé, Sanguié, and Nayala provinces of Burkina Faso. Methodology/Principal findings Province-specific data on human behaviors (i.e., latrine use and pork consumption) and serological prevalence of human and pig disease were used to inform a deterministic, compartmental model of the taeniosis/cysticercosis disease system. Parameters estimated via Bayesian melding provided posterior distributions for comparing transmission rates associated with human ingestion of Taenia solium cysticerci due to undercooking and human exposure to T. solium eggs in the environment. Reductions in transmission via these pathways were modeled to determine required effectiveness of a market-focused cooking behavior intervention and a community-led sanitation and hygiene program, independently and in combination, for eliminating human cysticercosis as a public health problem (<1 case per 1000 population). Transmission of cysticerci due to consumption of undercooked pork was found to vary significantly across transmission settings. In Sanguié, the rate of transmission due to undercooking was 6% higher than that in Boulkiemdé (95% CI: 1.03, 1.09; p-value < 0.001) and 35% lower than that in Nayala (95% CI: 0.64, 0.66; p-value < 0.001). We found that 67% and 62% reductions in undercooking of pork consumed in markets were associated with elimination of cysticercosis in Nayala and Sanguié, respectively. Elimination of active cysticercosis in Boulkiemdé required a 73% reduction. Less aggressive reductions of 25% to 30% in human exposure to Taenia solium eggs through sanitation and hygiene programs were associated with elimination in the provinces. Conclusions/Significance Despite heterogeneity in effectiveness due to local transmission dynamics and behaviors, education on the importance of proper cooking, in combination with community-led sanitation and hygiene efforts, has implications for reducing morbidity due to cysticercosis and neurocysticercosis.
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Cai, Yutong, Harry Gibson, Rema Ramakrishnan, Mohammad Mamouei, and Kazem Rahimi. "Ambient Air Pollution and Respiratory Health in Sub-Saharan African Children: A Cross-Sectional Analysis." International Journal of Environmental Research and Public Health 18, no. 18 (September 15, 2021): 9729. http://dx.doi.org/10.3390/ijerph18189729.
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Ambient air pollution is projected to become a major environmental risk in sub-Saharan Africa (SSA). Research into its health impacts is hindered by limited data. We aimed to investigate the cross-sectional relationship between particulate matter with a diameter ≤ 2.5 μm (PM2.5) and prevalence of cough or acute lower respiratory infection (ALRI) among children under five in SSA. Data were collected from 31 Demographic and Health Surveys (DHS) in 21 SSA countries between 2005–2018. Prior-month average PM2.5 preceding the survey date was assessed based on satellite measurements and a chemical transport model. Cough and ALRI in the past two weeks were derived from questionnaires. Associations were analysed using conditional logistic regression within each survey cluster, adjusting for child’s age, sex, birth size, household wealth, maternal education, maternal age and month of the interview. Survey-specific odds ratios (ORs) were pooled using random-effect meta-analysis. Included were 368,366 and 109,664 children for the analysis of cough and ALRI, respectively. On average, 20.5% children had reported a cough, 6.4% reported ALRI, and 32% of children lived in urban areas. Prior-month average PM2.5 ranged from 8.9 to 64.6 μg/m3. Pooling all surveys, no associations were observed with either outcome in the overall populations. Among countries with medium-to-high Human Development Index, positive associations were observed with both cough (pooled OR: 1.022, 95%CI: 0.982–1.064) and ALRI (pooled OR: 1.018, 95%CI: 0.975–1.064) for 1 μg/m3 higher of PM2.5. This explorative study found no associations between short-term ambient PM2.5 and respiratory health among young SSA children, necessitating future analyses using better-defined exposure and health metrics to study this important link.
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Cau, Boaventura M. "Area-Level Normative Social Context and Intimate Partner Physical Violence in Mozambique." Journal of Interpersonal Violence 35, no. 15-16 (April 21, 2017): 2754–79. http://dx.doi.org/10.1177/0886260517704960.
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Violence against women is considered a serious public health problem. It is estimated that about 30% of women who have been in a relationship in the world have experienced some form of physical or sexual violence from their intimate partners. In sub-Saharan Africa, one of the regions in the world with the highest prevalence of intimate partner violence, there have been studies of factors associated with intimate partner violence. However, few studies have explicitly examined the influence of the normative social context on women’s accepting attitudes toward spousal abuse and their risk of experiencing intimate partner violence in the region. Using data from the 2011 Demographic and Health Survey in Mozambique, we employ multilevel logistic regression to examine the influence of area-level normative social context factors on 4,864 women’s accepting attitudes toward spousal abuse and their likelihood of experiencing intimate partner physical violence in Mozambique. Our findings revealed the importance of religious norms in geographic areas as key predictors of women’s acceptance of intimate partner violence. Specifically, area-level normative religious predictors were negatively associated with women’s acceptance of spousal abuse. The prevalence of early marriages in a given geographic area was positively associated with both acceptance of spousal abuse and experiencing intimate partner physical violence. The level of female education in a geographic area was negatively associated with accepting spousal abuse and having experienced intimate partner physical violence. As intimate partner physical violence in sub-Saharan Africa continues unabated, programs and interventions to address the problem will need to consider the normative context of geographic areas.
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Yah, Clarence S., Sithembiso Ndlovu, Alison Kutywayo, Nicolette Naidoo, Tshepo Mahuma, and Saiqa Mullick. "The prevalence of pregnancy among adolescent girls and young women across the Southern African development community economic hub: A systematic review and meta-analysis." Health Promotion Perspectives 10, no. 4 (November 7, 2020): 325–37. http://dx.doi.org/10.34172/hpp.2020.51.
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Background: Despite the high rate of HIV infections, there is still high rate of early unprotected sex, unintended pregnancy, and unsafe abortions especially among unmarried adolescent girls and young women (AGYW) 10-24 years of age in sub Saharan Africa. AGYW face challenges in accessing health care, contraception needs, and power to negotiate safer sex. This study aimed to estimate the rate of pregnancy among AGYW aged 10-24, 10-19 and 15-19 years in the Southern African Development Community (SADC) economic region. Methods: A systematic review and meta-analysis was used to describe the prevalence of pregnancy among AGYW in 15 SADC member countries between January 2007 and December2017. The articles were extracted from PubMed/MEDLINE, African Index Medicus, and other reports. They were screened and reviewed according to PRISMA methodology to fulfil study eligibility criteria. Results: The overall regional weighted pregnancy prevalence among AGYW 10-24 years of age was 25% (95% CI: 21% to 29%). Furthermore, sub-population 10-19 years was 22% (95% CI:19% to 26%) while 15-19 years was 24% (18% to 30%). There was a significant heterogeneity detected between the studies (I=99.78%, P < 0.001), even within individual countries. Conclusion: The findings revealed a high pregnancy rate among AGYW in the SADC region. This prompts the need to explore innovative research and programs expanding and improving sexual and reproductive health communication to reduce risk and exposure of adolescents to early planned, unplanned and unwanted pregnancies, SRHR challenges, access to care, HIV/STIs, as well as other risk strategies.
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Odonkor, Stephen T., Hugues Mitsotsou-Makanga, and Emmanuel Nene Dei. "Road Safety Challenges in Sub-Saharan Africa: The Case of Ghana." Journal of Advanced Transportation 2020 (September 10, 2020): 1–9. http://dx.doi.org/10.1155/2020/7047189.
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The importance of road safety in the developmental agenda of a country cannot be overemphasized. It is essential for effective socioeconomic development. However, several countries in the developing world are confronted by several challenges relating to road safety, which are inadequately investigated. These challenges further aggravate the already heavily burdened health-care systems. The aim of this study is, therefore, to determine and analyse road safety issues in Ghana aimed at contributing to national policy development, stakeholder engagements, and public safety education campaigns on road traffic collision. A qualitative study by one-on-one interviews with individuals (n = 97) in road safety leadership positions was performed from November 2018 to February 2019. The interviews were audio-recorded and transcribed. Data analysis was conducted using a constant comparative methodology approach facilitated by Atlas.ti 8.0 software. Important road safety challenges that were identified by the respondents were categorized into six thematic areas, namely, institutional, executional, managerial and operational, attitudinal and behavioural, research, and financial and investment challenges. We recommend that the government and stakeholders alike should tackle these challenges by building a collaborative environment where everyone is involved in the process of developing and implementing strategies aimed at overcoming these challenges as they arise. There is also the need to address the epidemic carnage of road traffic injuries, many of which are preventable since they arise from human actions and inactions.
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Audain, Keiron, Louis Levy, and Basma Ellahi. "Sugar-sweetened beverage consumption in the early years and implications for type-2 diabetes: a sub-Saharan Africa context." Proceedings of the Nutrition Society 78, no. 4 (February 28, 2019): 547–53. http://dx.doi.org/10.1017/s0029665118002860.
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This review aims to explore trends of early consumption of sugar-sweetened beverages (SSB) in sub-Saharan Africa (SSA), within the context of growing child and adolescent obesity and escalating type-2 diabetes prevalence. We explore efforts to mitigate these, drawing on examples from Africa and elsewhere. SSB, including carbonated drinks and fruit juices, play a contributory role in the development of obesity and associated non-communicable diseases (NCD). SSA is an attractive market for beverage companies owing to its rapid economic growth, growing middle class and youthful populations. SSB already contribute significantly to total sugar and energy consumption in SSA where a plethora of marketing techniques targeted at younger people are utilised to ensure brand recognition and influence purchasing and brand loyalty. Coupled with a general lack of nutrition knowledge or engagement with preventative health, this can lead to frequent consumption of sugary drinks at a young age. Public health efforts in many high income and some middle-income countries address increasing prevalence of obesity and type-2 diabetes by focusing on strategies to encourage reduction in sugar consumption via health policy and public education campaigns. However, similar efforts are not as developed or forthcoming in low-income countries. Health care systems across SSA are ill-prepared to cope with epidemic proportions of NCD, particularly when contextualised with the ongoing battle with infectious diseases. We conclude that greater efforts by governments and the nutrition community to educate the public on the health effects of increased and excessive consumption of SSB are necessary to help address this issue.