Conceptualization and practices in digital health voices from Africa

This paper presents voices from Africa on digital health in Africa. These voices were gleaned during interviews and an online, focus group session in May 2020, during which 30 experts across Africa, among others from the South, were asked about their experiences and observations on the conceptualization of, and practices in, digital health in their respective communities and countries. Extensive input was provided, both orally and textually. The quotes gathered and presented in this paper indicate that there is a distinct need for the respectful co-development of digital health interventions in Africa. In addition, the quotes show how a one-size-fits-all solution approach does not exist, it is not a solution to Africa. Further, the community-focus, fit, and fragmentation of existing activities digital health interventions is questioned. The narratives provide a rich resource indicating capable and local agency and the need to address power-differences in international health development

Prevalence of physical activity and dietary patterns as risk factors for cardiovascular diseases among semi-urban dwellers in Ibadan, Nigeria

Background: Physical inactivity and unhealthy diet are leading risk factors for cardiovascular diseases globally. Limited studies have assessed the prevalence of these risk factors in community-based settings in Nigeria. Objectives: This study assessed the prevalence of physical activity and the dietary pattern of residents in selected semi-urban communities in Ibadan, Nigeria. Methods: This was a cross-sectional study carried out among 500 randomly selected residents from two semi-urban communities. Multi-stage random sampling technique was used to select households and participants. Data were collected using a pretested modified version of the WHO STEPS instrument. Descriptive and inferential statistical analyses were determined at 5% level of significance. Results: The mean age was 35.36 ± 12.24 and a mean household size of 4.07 ± 1.85. Majority (87.2%) of the respondents engaged in low physical activity (< 150-300 min/wk). Consumption of fruits and vegetables was low among respondents at 33% and 36.4% respectively. The employment status of respondents was significantly related to expected workplace physical activity level (χ2=11.27; P=0.024). Conclusions: This study highlights the need for the development and implementation of community-driven, multi-layered public health promotion initiatives across different settings

Socio-cultural factors influencing teenage pregnancy in the East Mamprusi Municipality, Ghana

Teenage pregnancy puts a heavy cost on the mother and newborn child, family and the wider society. Despite measures taken by the Ghana Health Service to tackle the issue of teenage pregnancy, the phenomenon remains a public health concern that is widespread throughout the country. The study investigated the socio-cultural factors influencing teenage pregnancy in the East Mamprusi Municipality using an exploratory descriptive design. The study was conducted in rural communities in the East Mamprusi Municipality, in the North East Region of Ghana. Eighteen (18) participants were purposively sampled. Data collection was done by face to face interviews using an interview guide. The study found that polygamous families, parents' desire for grandchildren, multiple sexual partners and poverty were reportedly influencing teenage pregnancy in the rural community. The bid to establish close family ties also accounted for early marriages. There is a culture of silence on matters of sexuality in the community. Teenage pregnancy is an observed phenomenon admitted by the participants and teenage girls are at risk of serious health complications. This phenomenon paints a gloomy picture of the girl child education in the municipality. (Afr J Reprod Health 2022; 26[5]: 120-130).

The first year of the COVID-19 pandemic in the ECOWAS region

Objective: to analyse the pandemic after one year in terms of the evolution of morbidity and mortality and factors that may contribute to this evolution Design: This is a secondary analysis of data gathered to respond to the COVID-19 pandemic. The number of cases, incidence rate, cumulative incidence rate, number of deaths, case fatality rate and their trends were analysed during the first year of the pandemic. Testing and other public health measures were also described according to the information available. Settings: The 15 States members of the Economic Community of West African States (ECOWAS) were considered. Results: As of 31st March 2021, the ECOWAS region reported 429,760 COVID-19 cases and 5,620 deaths. In the first year, 1,110.75 persons were infected per million, while 1.31% of the confirmed patients died. The ECOWAS region represents 30% of the African population. One year after the start of COVID-19 in ECOWAS, this region reported 10% of the cases and 10% of the deaths in the continent. Cumulatively, the region has had two major epidemic waves; however, countries show different patterns. The case fatality rate presented a fast growth in the first months and then decreased to a plateau. Conclusion: We learn that the context of COVID-19 is specific to each country. This analysis shows the importance of better understanding each country's response. During this first year of the pandemic, the problem of variants of concern and the vaccination were not posed.

A Bioética global e os direitos humanos para o desenvolvimento sustentável / Global Bioethics and human rights for sustainable development

Tomar decisões criticamente fundamentadas entre o que podemos fazer e o que devemos evitar, ou o que é melhor fazer quando surgem alguns dilemas,é crucial para o discernimento ético e político. A legitimidade das decisões humanas sobre as aplicações da ciência e da tecnologia para promover a vida, a saúde e o bem-estar dos povos é possível graças à cooperação internacional e à protecção do direitocomo instrumento de protecção e garantia do bem comum, da dignidade e bens fundamentais da pessoa, isto é, o que chamamos de direitos humanos. A Bioética Global propõe uma articulação adequada entre as questões bioéticas e os direitos humanos como paradigma ético universal que deve ser levado em consideração nas decisões, públicas e privadas, no campo das ciências da vida e da saúde. O desafio ético e político é saber como equilibrar ointeresse legítimo da indústria por lucros e o desenvolvimento econômico com inovação científica e tecnológica prudente e para o bem das pessoas e comunidades. O reconhecimento mútuo está na base da relaçãoque nos permite dar a cada um o que é seu e promover a convivência pacífica na nossa casa comum. Se realizada de acordo com os imperativos morais de solidariedade e justiça, atentando para a minimização das distâncias entre pobres e ricos e entre as regiões Norte e Sul Global, a ciência e a tecnologia contribuirão para o desenvolvimento humano de forma eficaz e eticamentesustentável.

Making critically informed decisions between what we can do and what we should avoid, or what is best to do when some dilemmas arise, is crucial for ethical and political discernment. The legitimacy of human decisions on the applications of science and technology to promote life, health and people's well-being is possible thanks to international cooperation and the protection of law as an instrument toprotect and guarantee the common good, dignity and fundamental goods of the person, that is, what we call human rights. Global Bioethics proposes an appropriate articulation between bioethical issues and humanrights as a universal ethical paradigm that should be taken into consideration in decisions, public and private, in the field of life and health sciences. The ethical and political challenge is how to balance the legitimate interest of industry for profits and economic development with prudent scientific and technological innovation for the good of people and communities. Mutual recognition is at the basis of the relationship that allows us to give each his due and to promote peaceful coexistence in our common home. If carried out in accordance with the moral imperatives of solidarity and justice, paying attention to minimizing the gaps between the poor and the rich and between the Global North and South, science and technology will contribute to human development in an effective and ethically sustainable manner

Gender-based violence during COVID-19 lockdown: case study of a community in Lagos, Nigeria

Background: Gender-based violence (GBV) has been identified to be one of the ripple effects of the global pandemic. In countries like Nigeria, the situation is hypothesized to be worse because of widespread poverty and gender inequalities. Objective: To examine the exposure of females to GBV during the first 3 months of the COVID-19 lockdown. Method: This cross-sectional study was conducted in a low-income community in Lagos. Semi-structured questionnaires were administered to 130 respondents selected via systematic random sampling. Results: The mean age of the respondents was 26.89 ± 8.67 years. Majority worked informal jobs, while only 50% had attained beyond primary education. Within the period, the respondents had been subjected to sexual (54.6%), physical (52.3%), verbal assault (41.5%), and online sexual harassment (45.4%); of which only 30% reported to the police. Furthermore, respondents subjected to sexual (p=0.004) and physical assault (p=0.032) during the period earned significantly less money than other respondents. Conclusion: The fact that over 1 out of every 2 females was subjected to at least one form of GBV within the short timeframe shows how unsafe girls and women in low-income communities are. This calls for proactive community-level interventions to curb the GBV menace.

Family members' experiences of caring for a relative with substance-induced psychosis disorder

Background: When there is a lack of resources in the community to support deinstitutionalisation,family members of a relative diagnosed with substance-induced psychosis disorder (SIPD) are the most affected and vulnerable. Nevertheless, family members' care is still largely unacknowledged in the mental health sector in low- and middle-income countries. Furthermore, no prior research could be found on family members' experiences caring for a relative with SIPD in Giyani, Limpopo province, South Africa. Objectives: To explore and describe family members' experiences caring for a relative with SIPD. Method: The study employed a qualitative research design using interpretative phenomenological analysis as the research method. Telephonic interviews were conducted and analysed. Eight family members were selected to participate in the study using a purposive sampling technique. Results: The analysis of data led to the emergence of the following themes: family members experienced caring for a relative with SIPD as a destabilising responsibility; they experienced acceptance and support from significant others and the community and solace in prayer. Participants also expressed they experienced a need for support from government structures in order to care for a relative with SIPD. Conclusion: The study's findings highlighted the family members' experiences of caring for a relative with SIPD and the role of the family, community and government structures in caring for an individual with SIPD. It is evident from the challenges experienced that the family members need external interventions to develop healthy coping strategies. Contribution: This study adds knowledge to nursing practice, nursing education and nursing research by promoting effective coping amongst family members caring for a relative with SIPD.

Contextualizing migration and mental health in the post-COVID era

Background: The population of migrants all over the world is progressively rising. The major reasons for migration include the desire for self-actualization, moving to a place with more opportunities, tourism, and education, and escaping hardship and political unrest in the home country. In recent times climate change, insecurity, and economic hardship are top of the list. The global economy has suffered a major blow from the multiple waves of the lingering COVID-19 pandemic. To lessen the scourge of inflation and to restore economic stability, several countries are being forced to liberalize their immigration policies and therefore immigrants are welcomed in these nations. This review attempts to investigate how migration in the post-pandemic era affects migrants' mental health. Main Text: Migration and the COVID-19 epidemic both have beneficial and durable effects on the mental health of migrants and immigration laws have a direct impact on several health-related issues. Mental health disorders may develop at any point from the pre-migration phase to the post-migration settlement in the host nations. Factors such as host community, racism, marginalization, political climate, poor support, loss of social status, language barriers, undocumented status, climate change, mode of dressing in the host country, and several others may lead to mental health disorders among migrants. Unfortunately, there is limited access to care, and the services provided may not be culturally sensitive. Conclusion: Despite the benefits gotten from migration like financial benefits and economic development of the native country and the left behind family members, migration has enormous psychological complications which have to be attended to. Access to specialists who are trained to provide culturally sensitive interventions and implement outreach programs to introduce the services to the migrants' community should be encouraged.

Oral Health-Related Knowledge, Attitude and Practices Among Trainee Community Health Officers in A Nigerian Tertiary Health Institution

To evaluate the oral health-related knowledge and practices of trainee Community Health Officers. A cross-sectional descriptive study conducted using total population purposive sampling method with a self-administered questionnaire on 70 community health officer's trainees at the centre for training community health officers. Sixty-two trainees (response rate of 88.6%) participated made up of year one (45.2%) and year two 54.8%. %). Mean age of 33.5 years (SD=8.65). By gender, females 90.3% were more than males 9.7% while privately sponsored (53.2%) were more than government-sponsored 38.7% A majority had knowledge of Caries (98.4%), Periodontal disease (93.5%) and Oral cancer (96.8%). Year two trainees had more knowledge about periodontal diseases 54.8% compared to year one 38.5% (p<0.05). Most respondents (91.1%) reported dental visit to be important with 87.1% of the opinion that the visit should not be for pain only; 38.7% felt that dental treatment was expensive. More privately sponsored (51.5%) compared to government-sponsored (20.8%) felt that dental treatment was expensive (p<0.05). only 11.3% had visited the dentist in the past six months with dental experience gum bleeding (8.1%), dental caries (8.1%), and tooth sensitivity (21%). A majority (85.5%) rated their oral health to be good. The study showed that community health officer trainees have a good knowledge of oral diseases with the year two trainees demonstrating a better knowledge of caries, periodontal disease and oral cancer and self-rated oral health. Their role in oral health promotion programs at the Primary Health Care level should be encouraged to reduce the burden of oral health diseases in the community.

Oral Health-Related Knowledge, Attitude and Practices Among Trainee Community Health Officers in A Nigerian Tertiary Health Institution

To evaluate the oral health-related knowledge and practices of trainee Community Health Officers. A cross-sectional descriptive study conducted using total population purposive sampling method with a self-administered questionnaire on 70 community health officer's trainees at the centre for training community health officers. Sixty-two trainees (response rate of 88.6%) participated made up of year one (45.2%) and year two 54.8%. %). Mean age of 33.5 years (SD=8.65). By gender, females 90.3% were more than males 9.7% while privately sponsored (53.2%) were more than government-sponsored 38.7% A majority had knowledge of Caries (98.4%), Periodontal disease (93.5%) and Oral cancer (96.8%). Year two trainees had more knowledge about periodontal diseases 54.8% compared to year one 38.5% (p<0.05). Most respondents (91.1%) reported dental visit to be important with 87.1% of the opinion that the visit should not be for pain only; 38.7% felt that dental treatment was expensive. More privately sponsored (51.5%) compared to government-sponsored (20.8%) felt that dental treatment was expensive (p<0.05). only 11.3% had visited the dentist in the past six months with dental experience gum bleeding (8.1%), dental caries (8.1%), and tooth sensitivity (21%). A majority (85.5%) rated their oral health to be good. The study showed that community health officer trainees have a good knowledge of oral diseases with the year two trainees demonstrating a better knowledge of caries, periodontal disease and oral cancer and self-rated oral health. Their role in oral health promotion programs at the Primary Health Care level should be encouraged to reduce the burden of oral health diseases in the community.

Comparative yield of different active TB case finding interventions in a large urban TB project in central Uganda: a descriptive study

Introduction: Systematic screening for TB among patients presenting to care and among high risk populations is recom- mended to improve TB case finding. We aimed to describe the comparative yield of three TB screening approaches imple- mented by a large urban TB project in central Uganda. Methods: We abstracted data on the screening cascade from 65 health facilities and their surrounding communities (num- bers screened, with presumptive TB, receiving a diagnostic test and diagnosed with TB) from the different clinic and com- munity TB registers. Results: From January 2018 to December 2019, 93,378 (24%) of all patients screened at health facilities had presumptive TB; 77,381 (82.9%) received a diagnostic test and 14,305 (18.5%) were diagnosed with TB. The screening yield (the number of patients diagnosed with TB out of all patients screened) was 0.3% and was three times higher among men than women (0.6% vs 0.2% p<0.01). During targeted community screening interventions, 9874 (21.1%) of all patients screened had presumptive TB; 7034 (71.2%) of these received a diagnostic test and 1699 (24.2%) were diagnosed with TB. The screening yield was higher among men, (3.7% vs 3.3% p<0.01) and highest among children 0-14 (4.8% vs 3.2% p<0.01). Conclusion: Targeted community TB screening interventions improve access to TB diagnosis for men and children 0-14 years

Simulation as an educational strategy to deliver interprofessional education

Background. Various educational methods are available to deliver interprofessional education (IPE) to prepare healthcare students for collaborative practice. One such method is simulation-based health education.Objectives. To identify current IPE methods used in undergraduate programmes in the Faculty of Health Sciences at the University of the Free State, Bloemfontein, South Africa, and to determine the opinions of module leaders on using simulation as a particular IPE teaching strategy.Methods. A quantitative, cross-sectional descriptive study design was employed. Structured interviews were conducted with 47 module leaders of the undergraduate programmes in the Faculty of Health Sciences. These programmes cover 66 modules in the Schools for Allied Health Professions (nutrition and dietetics, occupational therapy, physiotherapy and optometry), nursing and medicine.Results. At the time of the study, IPE activities were used in 29 (43.9%) of the modules, of which 17 (58.6%) were coincidental. Respondents' opinions on the potential use of simulation to address formalised IPE activities included the challenge of 'scheduling' (73.9%) and 'logistical and high cost issues' (19.6%). The most prominent advantage that was foreseen (41.3%) was better clarification of roles among the different professions.Conclusions. The module leaders had a positive attitude towards simulation and its potential use for IPE, with their major concern being logistical challenges. To improve role clarification, a scenario should be developed to engage students from all the relevant professions. The proposed type of simulation was to use standardised patients in a role-play scenario. The outcomes of these activities should be aligned with the principles of IPE

The incidence of Mycoplasma pneumoniae in community acquired pneumonia among children: one centre study

Background: Mycoplasma pneumoniae (M. pneumoniae) is an important cause of pediatric community acquired pneumonia (CAP). Aim: The aim of this study was to determine the incidence of M. pneumoniae in pediatric community acquired pneumonia and to determine the most frequent clinical findings of M. pneumoniae CAP. Methods: A total of 83 pediatric CAP patients were subjected to history taking, clinical examination, chest X-ray, CBC, CRP and serum antimycoplasma pneumonia IgM and IgA by ELISA. Results: Twenty-nine (34.9%) out of 83 patients were positive for M. pneumoniae Ig M while 2 (3.4%) patients were positive for M. pneumoniae Ig A. There were more infection (54%) in age group (5-9 years; p value = <0.001). M. pneumoniae pneumonia infected patients were presented with cough (29/29; 100%), fever (29/29; 100%), malaise (18/29; 43.8%), headache (16/29; 33.8%), wheeze (21/29; 52.5%), chest discomfort (13/29; 44.8%), sore throat (13/29; 46.4%), rhinitis (8/29; 27.5%) and pharyngitis (6/29; 24%). The most frequent X ray findings in M. pneumoniae pneumonia was air space pneumonia (71%); segmental more than lobar form (p-value = < 0.0001). Conclusion: The findings of this study highlight the clinical significance of M pneumoniae in pediatric community acquired pneumonia

Living arrangements in sub-Saharan Africa between modernization and ethnicity

Context/Background: Sub-Saharan Africa is characterized by an extraordinary diversification of living arrangements. It is a debatable question whether these features are evolving alongside the deep economic and social changes observed in the past few decades. Despite numerous studies on family changes and their effects, very few analyses consider different ethnic and geographical contexts. Data Source and Methods: The paper observe the interaction between modernization and cultural heritage in shaping living arrangements in 10 sub-Saharan countries and in 38 ethnic groups. A temporal perspective has been adopted, comparing two successive DHS carried out between 1990 and 2013. Stratifying by ethnic groups and rural/urban contexts, factor analysis and hierarchical classification analysis investigate how living arrangements combine with fertility levels and socio-economic characteristics. Findings: The results support the large heterogeneity of living arrangements and the increase of new family forms, rather than the existence of a convergence process on a single nuclear family pattern. Ethnic background is confirmed a valid interpretative key, necessary to understand the cultural substrate in which the modernization factors brought by globalization act. Conclusion: National governments should develop and implement family policies that can raise the wellbeing of the emerging family models. In particular, family policies should support households in providing care and economic, material, psychological and affective support for their members

The Metabolic Syndrome in an Elite African Community

Metabolic syndrome is a combination of metabolic disorders which increase the risk of developing cardiovascular disease and type 2 diabetes; two common causes of morbidity and mortality all over the world; with increasing incidence in sub-Saharan Africa. This study was carried out to determine the prevalence of metabolic syndrome in an elite Nigerian community and determine independent predictors of the condition. A cross-sectional study was designed involving 200 members of the community. They responded to a structured questionnaire on their demographic parameters as well as medical and drug histories. Fasting blood glucose; triglycerides; LDL-cholesterol; HDL-cholesterol and Total cholesterol were measured. Blood pressure; BMI and waist circumference were also measured. Using the IDF definition i.e presence of central adiposity and two of raised TG (?1.7 mm/L); reduced HDL (1.03 mm/L in men and 1.29 mm/L in women); raised blood pressure (130 mmHg systolic or 85 mmHg diastolic; or an antihypertensive drugs); and raised fasting blood glucose (5.6mm/L or previously diagnosed type 2 diabetes); a total of 35 persons were found to have metabolic syndrome. The commonest lipid abnormality found was reduced HDL levels. Raised BMI was a strong predictor (18). The study shows that while the prevalence of metabolic syndrome is low in the community; a large number of people have central obesity and high BMI. It is important for stakeholders to create awareness on the need to keep fit. There is also a need to carry out more studies on independent determinants of metabolic syndrome and seek to understand the pathways by which it develops; so as to be able to address it's far reaching implications

Teething Myths among Nursing Mothers in a Nigerian Community

"Many symptoms had been associated with teething in children with the possibility of overlooking potentially fatal condition. Symptoms that had been associated with teething include diarrhoea; fever; vomiting and cough. The possibility that any of these symptoms could have been due to other causes call for thorough investigation of the child before concluding that it is only ""teething"". Objectives: The study was carried out to assess the beliefs of nursing mothers concerning symptoms that are associated with teething among children and to identify those that would seek medical treatments in case of their children having such symptoms during teething. Materials and Methods: Two hundred and ninety nursing mothers whose children had erupted at least a tooth were interviewed in the immunisation clinics of the University College Hospital and Adeoyo Maternity Teaching Hospital; both in Ibadan; Nigeria; on their beliefs and practice concerning teething in children. Results: One hundred and eighty-eight (64.8) of the mothers associated symptoms such as fever; cough; catarrh and diarrhoea with eruption of teeth in their children. Over half of the women agreed that a child having either fever (51.0); ear infection (57.6) or cough (50.3) should be promptly taken for medical consultation and not be tagged ""teething""; while for other symptoms such as gum pain (74.5); sleepless night (56.6); vomiting (51.4) and diarrhoea (51.7); over half of the mothers believed that the symptoms will resolve following the eruption of the teeth. Conclusion: The study demonstrated that mothers in the study attributes several symptoms to teething; which could be detrimental to the survival of their children as the symptom could have been due to other causes. There is; therefore; need for public enlightenment to create awareness on the possible effect of presumptuous belief that childhood diseases are due to teething process."

Practice of Asthma Management among Doctors in South-East Nigeria

The major role of airway inflammation in childhood asthma has been recognised for more than a decade; and anti-inflammatory drugs now form the mainstay of treatment. In order to optimise treatment and achieve a better outcome; different guidelines have been introduced for asthma management. Examining the practice of the medical practitioners who manage asthma will help establish the gaps and provide informed advice on the current national and international guidelines. Our objective was to investigate the appropriate treatment of acute bronchial asthma by medical practitioners in south-east Nigeria. Two hundred and eighty-five doctors were interviewed using a structured questionnaire. Evaluation for differences in asthma management by doctors with different years of practice and heath facilities was carried out. Results were analysed with Epi info version 3.5. We concluded that management based on newer trends in childhood asthma management and adherence to management guidelines is less common among doctors that work in non-tertiary health facilities and among doctors that graduated more than 15 years ago or less than 5 years ago. This needs to be improved for optimal management of these patients. The need for regular continuing medical education for all doctors cannot be over emphasised

Determinants of Extramarital Sex by Men in Tanzania: A Case Study of Mbeya Region

This paper attempts to identify some factors associated with extramarital sex by men in the Mbeya region of Tanzania using data from a survey conducted in 2003/2004. The choice of Mbeya region was prompted by the fact that it has been found by previous studies to be one of the regions with the highest HIV prevalence rate in Tanzania. Correlates of extramarital sex that were considered include current age; education; residence; age at first sexual intercourse; age at first marriage and sex before marriage. A bivariate analysis of the survey data; which comprised a sample size of 568 married men aged between 15 and 62 years revealed statistically significant association between extramarital sex with current age; education; age at first intercourse and sex before marriage. The effect of these variables was tested through a multivariate logistic regression analysis and all the four independent variables were found to be statistically significant predictors of extramarital sex in Mbeya region