ABSTRACT
As agricultural land use and climate change continue to pose increasing threats to biodiversity in sub-Saharan Africa, efforts are being made to identify areas where trade-offs between future agricultural development and terrestrial biodiversity conservation are expected to be greatest. However, little research so far has focused on freshwater biodiversity conservation in the context of agricultural development in sub-Saharan Africa. We aimed to identify lakes and lake areas where freshwater biodiversity is most likely to be affected by eutrophication and Harmful Algal Blooms (i.e., when algae multiply to the extent that they have toxic effects on people and freshwater fauna), some of the most important emerging threats to freshwater ecosystems worldwide, especially with the onset of climate change. Using novel remote-sensing techniques, we identified lakes that demonstrated high biodiversity and algal bloom levels. We calculated the richness of freshwater species and the normalized difference chlorophyll index (NDCI) to prioritize lakes in Ghana, Ethiopia, Zambia, and bordering countries, of high priority for conservation. We identified 169 priority lakes and lake areas for conservation, based on high levels of biodiversity exposed to potentially harmful algal blooms. Zambia had the most lakes identified as conservation priorities (76% of its small lakes and five 100-km2 areas in large lakes). Many of the conservation priority lakes and lake areas identified in this study were in transboundary watersheds; thus, collaborative water resource management and conservation at the watershed scale is needed. The use of remote-sensing tools to prioritize freshwater systems for conservation according to algal-bloom risk is vital in remote, undersampled world regions, especially given the increasing threat posed to freshwater biodiversity by rapidly expanding agriculture and climate change.
Priorización de la Conservación en los Lagos Sub-Saharianos con base en Medidas de Biodiversidad de Aguas Dulces y Floración de Algas Resumen Conforme el cambio climático y el uso de suelo para cultivos siguen representando amenazas crecientes para la biodiversidad en la región sub-sahariana de África, se están realizando esfuerzos para identificar las áreas en donde se espera que sucedan las mayores compensaciones entre el desarrollo agrícola venidero y la conservación de la biodiversidad terrestre. Sin embargo, pocas investigaciones se han centrado en la conservación de la biodiversidad de aguas dulces dentro del contexto del desarrollo agrícola en esta región de África. Nos enfocamos en localizar las áreas en donde sea más probable que la biodiversidad de aguas dulces se vea afectada por la eutrofización y las floraciones de algas (es decir, cuando las algas se multiplican a tal grado que tienen efectos tóxicos sobre las personas y la fauna de agua dulce), dos de las amenazas emergentes más importantes para los ecosistemas de agua dulce en todo el mundo debido al cambio climático. Mediante técnicas novedosas de teledetección identificamos los lagos que se traslapaban con áreas de gran biodiversidad y floraciones de algas. Calculamos la riqueza de especies de agua dulce y el índice de diferencia normalizada de clorofila (IDNC) para identificar los lagos de suma importancia para la conservación en Ghana, Etiopía, Zambia y sus países fronterizos. Identificamos 169 áreas prioritarias para la conservación con base en los niveles elevados de biodiversidad expuestos a las floraciones de algas potencialmente dañinas. Zambia tuvo la mayor cantidad de lagos identificados como prioridades de conservación (76% de sus lagos pequeños y cinco áreas de 100 km2 en los grandes lagos). Las amenazas para la biodiversidad de agua dulce estuvieron presentes a nivel de cuenca, con frecuencia con una extensión más allá de las fronteras políticas de un país; por lo tanto, se requiere que el manejo de recursos hídricos y la conservación sean esfuerzos colaborativos a nivel de cuenca. El uso de herramientas de teledetección para priorizar la conservación de los sistemas de agua dulce de acuerdo con el riesgo de floración de algas es vital en las regiones remotas y poco muestreadas del mundo, especialmente debido a la amenaza creciente que representan el cambio climático y la expansión agrícola para la biodiversidad de agua dulce.
Subject(s)
Conservation of Natural Resources , Ecosystem , Benchmarking , Biodiversity , Chlorophyll , Conservation of Natural Resources/methods , Eutrophication , Humans , LakesABSTRACT
Introduction: The aim was to examine the health status and infectious diseases in a cohort of unaccompanied immigrant minors (UIMs) from Africa in Spain, and to detect if there are differences according to the geographical area of origin. Methods: Cross-sectional study in 622 African male UIMs at the time of admission to residential care in Aragon (Spain) during 2005-2019. A physical, nutritional and laboratory examination was performed following sanitary guidelines. Results: The mean age of the African UIMs was 16.1 years (SD 1.7; range 13-17). 88.9% were from Maghreb (mean age 15.9 years; SD 1.5) and 14.1% from Western Sub-Saharan (mean age 16.8 years; SD 1). We found that the prevalence of caries, iron deficiency and dermatological problems was significantly higher (p<.05) among Maghrebian, and the prevalence of past and present hepatitis B virus (HBV) infection, intestinal parasitosis, eosinophilia (p<.00001) and latent tuberculosis (p=.0034) was significantly higher in those of Sub-Saharan origin. Conclusion: The most relevant finding was the high prevalence of present HBV infection (14.8%) among Sub-Saharan adolescents. This finding highlights the importance of recommending targeted screening, preventive vaccination programs, and integration into local health care systems that allow for long-term treatment and follow-up as a way to prevent the transmission of HBV infection.(AU)
Introducción: El objetivo fue estudiar el estado de salud y las enfermedades infecciosas de una cohorte de menores inmigrantes no acompañados (MENA) procedentes de África en España, y detectar si existen diferencias según la zona geográfica de origen. Métodos: Estudio transversal en 622 MENA varones africanos en el momento de su admisión en la atención residencial en Aragón (España) entre 2005 y 2019. Se realizó un examen físico, nutricional y analítico de laboratorio siguiendo las directrices sanitarias. Resultados: La edad media de los MENA africanos era de 16,1 años (DE 1,7, intervalo 13-17). El 88,9 % procedía del Magreb (edad media 15,9 años; DE 1,5) y el 14,1 % de la zona subsahariana occidental (edad media 16,8 años; DE 1). Se constató que la prevalencia de caries, ferropenia y problemas dermatológicos era significativamente mayor (p < 0,05) entre los magrebíes, y que la prevalencia de infección pasada y presente por el virus de la hepatitis B (VHB), parasitosis intestinal, eosinofilia (p < 0,00001) y tuberculosis latente (p = 0,0034) era significativamente mayor entre los sujetos de origen subsahariano. Conclusión: El dato más relevante fue la alta prevalencia de infección actual por el VHB (14,8 %) entre los adolescentes subsaharianos. Este hallazgo pone de relieve la importancia de recomendar cribados selectivos, programas de vacunación preventiva e integración en los sistemas locales de atención sanitaria que permitan un tratamiento y seguimiento a largo plazo como manera de prevenir la transmisión de la infección por el VHB.(AU)
Subject(s)
Humans , Male , Adolescent , Young Adult , Health Status , Communicable Diseases , Emigrants and Immigrants , Physical Examination , Nutrition Assessment , Hepatitis B virus , Microbiology , Spain , Africa , Cohort Studies , Cross-Sectional Studies , Africa South of the SaharaABSTRACT
INTRODUCTION: The aim was to examine the health status and infectious diseases in a cohort of unaccompanied immigrant minors (UIMs) from Africa in Spain, and to detect if there are differences according to the geographical area of origin. METHODS: Cross-sectional study in 622 African male UIMs at the time of admission to residential care in Aragon (Spain) during 2005-2019. A physical, nutritional and laboratory examination was performed following sanitary guidelines. RESULTS: The mean age of the African UIMs was 16.1 years (SD 1.7; range 13-17). 88.9% were from Maghreb (mean age 15.9 years; SD 1.5) and 14.1% from Western Sub-Saharan (mean age 16.8 years; SD 1). We found that the prevalence of caries, iron deficiency and dermatological problems was significantly higher (p<.05) among Maghrebian, and the prevalence of past and present hepatitis B virus (HBV) infection, intestinal parasitosis, eosinophilia (p<.00001) and latent tuberculosis (p=.0034) was significantly higher in those of Sub-Saharan origin. CONCLUSION: The most relevant finding was the high prevalence of present HBV infection (14.8%) among Sub-Saharan adolescents. This finding highlights the importance of recommending targeted screening, preventive vaccination programs, and integration into local health care systems that allow for long-term treatment and follow-up as a way to prevent the transmission of HBV infection.
Subject(s)
Communicable Diseases , Emigrants and Immigrants , Adolescent , Africa/epidemiology , Cross-Sectional Studies , Health Status , Humans , Male , Minors , Spain/epidemiologyABSTRACT
Recent molecular phylogenetic work has found that Breviceps Merrem, 1820 comprises two major clades, one of which, the B. mossambicus group, is widely distributed across southern sub-Saharan Africa. This group is notable for harboring abundant cryptic diversity. Of the four most recently described Breviceps species, three are members of this group, and at least five additional lineages await formal description. Although Breviceps has long been known to occur in Angola, no contemporary material has been collected until recently. The three most widespread taxa, B. adspersus, B. mossambicus, and B. poweri, may all occur in Angola, but accurate species assignment remains challenging given the rampant morphological similarity between these taxa, and, until recently, the lack of genetic resources. Phylogenetic, morphological, and acoustic analyses of recently collected samples from disparate localities within Angola provide evidence for an undescribed species that is sister to B. poweri. The new species can be diagnosed from its sister taxon by lacking pale spots along the flanks, a pale patch above the vent, and a short, dark band below the nares (all present in B. poweri). Additionally, the male advertisement call differs from the three other Breviceps that might occur in Angola in having both a longer interval between consecutive calls and a higher average dominant frequency. We here describe this lineage as a distinct species, currently only known from Angola, and discuss the presence of other Breviceps taxa within Angola.
ResumoInvestigações moleculares recentes revelaram que o género Breviceps Merrem, 1820, é composto por duas linhagens principais, uma das quais, o grupo B. mossambicus, é amplamente distribuído na região sul da África subsaariana. Este grupo é notável por albergar uma abundante diversidade críptica. Das quatro espécies de Breviceps recentemente descritas, três pertencem a este grupo, e pelo menos outras cinco linhagens adicionais aguardam a sua descrição formal. Apesar de o género ser conhecido de Angola desde há muito tempo, só muito recentemente foram colhidos novos espécimes. Os três taxa mais amplamente distribuídos, B. adspersus, B. mossambicus e B. poweri podem todos, porventura, ocorrer em Angola, no entanto a correta identificação destas espécies têm sido problemática devido às semelhanças morfológicas extremas entre este taxa, e, até muito recente, a completa ausência de material genético. Análises filogenéticas, morfológicas e acústicas dos espécimes recentemente colhidos em diferentes locais de Angola apontam para a existência de uma espécie nova para a ciência, irmã de B. poweri. A nova espécie pode ser diferenciada do seu táxon irmão pela falta de marcas pálidas nos flancos, mancha pálida acima do ventre e pequena banda negra abaixo do nariz (presentes em B. poweri). Para além destas características, o chamamento dos machos difere das outras três espécies de Breviceps que podem ocorrer em Angola por ter um maior intervalo entre chamamentos consecutivos e uma maior frequência média dominante. Descrevemos aqui esta linhagem como uma espécie distinta, atualmente apenas conhecida de Angola, e discutimos a presença de outras espécies de Breviceps em Angola.
ABSTRACT
In Uganda, one in five children presents mental health challenges, including disruptive behavior disorders (DBDs). DBDs can persist through adulthood and result in negative outcomes. Effective interventions for DBDs have been developed and tested in high-poverty communities in developed countries. Yet, most African countries, such as Uganda, lack such interventions. This paper describes the adaptation process of an evidence-based intervention of U.S. origin to optimize fit to context with intervention fidelity, as part of a randomized trial conducted with youth that exhibit behavioral challenges and their caregivers in 30 schools in Uganda. The process involved: initial meetings with headteachers and teachers to introduce the study and the main concepts of the intervention; initial manual review focusing on 4Rs and 2Ss content by the Uganda team; engagement of community stakeholders for additional feedback on content and cultural relevance; final revision of the manual; and collection of children's drawings for the illustration of the manual. This paper describes both similarities and differences between the original and adapted intervention content and methods of delivery. The findings also highlight the importance of involving community stakeholders in the adaptation process.
En Uganda, uno de cada cinco niños presenta problemas de salud mental, incluidos los trastornos del comportamiento disruptivo (TCD). Los TCD pueden continuar hasta la adultez y tener consecuencias negativas. Se han desarrollado intervenciones eficaces para los TCD, las cuales se han evaluado en comunidades con altos índices de pobreza en países desarrollados. Sin embargo, la mayoría de los países africanos, como Uganda, carecen de dichas intervenciones. Este artículo describe el proceso de adaptación de una intervención factual de origen estadounidense para optimizar su adaptación al contexto con la fidelidad de la intervención como parte de un ensayo aleatorizado realizado con jóvenes que presentan problemas conductuales y sus cuidadores en 30 escuelas de Uganda. El proceso consistió en reuniones iniciales con directores y maestros para presentar el estudio y los conceptos principales de la intervención; una revisión inicial del manual centrada en el contenido de la intervención "4Rs and 2 Ss" por parte del equipo de Uganda; la participación de partes interesadas de la comunidad para obtener comentarios adicionales sobre el contenido y la relevancia cultural; la revisión final del manual; y la recopilación de dibujos de los niños para la ilustración del manual. Este artículo describe tanto las similitudes como las diferencias entre el contenido de la intervención original y la adaptada y los métodos de implementación. Los resultados también destacan la importancia de hacer participar a las partes interesadas en el proceso de adaptación.
Subject(s)
Attention Deficit and Disruptive Behavior Disorders/therapy , Culturally Competent Care/methods , Evidence-Based Medicine/methods , Family Therapy/methods , Mental Health Services , Adolescent , Adult , Attention Deficit and Disruptive Behavior Disorders/ethnology , Child , Child Health Services , Culturally Competent Care/ethnology , Female , Happiness , Humans , Longitudinal Studies , Male , UgandaABSTRACT
OBJECTIVE: The incidence of HIV and sexually transmitted infections is disproportionately high among sex workers (SW). We aimed to update the evidence on the effectiveness of SW interventions in sub-Saharan Africa and to provide more insights into combination prevention. METHODS: The Systematic review followed PRISMA guidelines in a search of PUBMED and POPLINE for peer-reviewed literature published between 1 January 2000 and 22 July 2016 (registration number on PROSPERO: CRD42016042529). We considered cohort interventions, randomised controlled trials and cross-sectional surveys of SW programmes. A framework was used in the description and mapping of intervention to desired outcomes. RESULTS: Twenty-six papers(reporting on 25 studies) were included. A strategy that empowered peer educator leaders to steer community activities showed a twofold increase in coverage of behaviour change communication and utilisation of health facility among SW. Brief alcohol harm reduction effort demonstrated a significant effect on sexual violence and engagement in sex trading. A risk reduction counselling intervention among drug-injecting SW showed an effect on alcohol, substance use and engagement in sex work. No study on a promising intervention like PrEP among SWs was found. We observed that interventions that combined some structural components, biomedical and behavioural strategies tend to accumulate more desired outcomes. CONCLUSION: The evidence base that can be considered in intervention designs to prevent HIV in SW in SSA is vast. The health sector should consider interventions to reduce binge alcohol intake and intravenous drug use among sex workers. Programmes should staunchly consider multicomponent approaches that explore community-based structural approaches.
Subject(s)
HIV Infections/prevention & control , Sex Work , Sex Workers , Sexually Transmitted Diseases/prevention & control , Africa South of the Sahara , Anti-HIV Agents/therapeutic use , Counseling , Female , Health Education , Humans , Risk Reduction BehaviorABSTRACT
OBJECTIVE: To compare administrative coverage data with results from household coverage surveys for vitamin A supplementation (VAS) and deworming campaigns conducted during 2010-2015 in 12 African countries. METHODS: Paired t-tests examined differences between administrative and survey coverage for 52 VAS and 34 deworming dyads. Independent t-tests measured VAS and deworming coverage differences between data sources for door-to-door and fixed-site delivery strategies and VAS coverage differences between 6- to 11-month and 12- to 59-month age group. RESULTS: For VAS, administrative coverage was higher than survey estimates in 47 of 52 (90%) campaign rounds, with a mean difference of 16.1% (95% CI: 9.5-22.7; P < 0.001). For deworming, administrative coverage exceeded survey estimates in 31 of 34 (91%) comparisons, with a mean difference of 29.8% (95% CI: 16.9-42.6; P < 0.001). Mean ± SD differences in coverage between administrative and survey data were 12.2% ± 22.5% for the door-to-door delivery strategy and 25.9% ± 24.7% for the fixed-site model (P = 0.06). For deworming, mean ± SD differences in coverage between data sources were 28.1% ± 43.5% and 33.1% ± 17.9% for door-to-door and fixed-site distribution, respectively (P = 0.64). VAS administrative coverage was higher than survey estimates in 37 of 49 (76%) comparisons for the 6- to 11-month age group and 45 of 48 (94%) comparisons for the 12- to 59-month age group. CONCLUSION: Reliance on health facility data alone for calculating VAS and deworming coverage may mask low coverage and prevent measures to improve programmes. Countries should periodically validate administrative coverage estimates with population-based methods.
Subject(s)
Anthelmintics/therapeutic use , Dietary Supplements/statistics & numerical data , Health Care Surveys/statistics & numerical data , Helminthiasis/drug therapy , Vitamin A Deficiency/therapy , Vitamin A/therapeutic use , Africa South of the Sahara , Child, Preschool , Female , Health Care Surveys/methods , Humans , Infant , Male , VitaminsABSTRACT
OBJECTIVES: Improved life expectancy and reduced transmission probabilities due to ART may result in behavioural disinhibition - that is an increase in sexual risk behaviour in response to a perceived lower risk of HIV. We examined trends in sexual risk behaviour in the general population of sub-Saharan African countries 1999-2015. METHODS: We systematically reviewed scientific literature of sexual behaviour and reviewed trends in Demographic and Health Surveys. A meta-analysis on four indicators of sexual risk behaviour was performed: unprotected sex, multiple sexual partners, commercial sex and prevalence of sexually transmitted infections. RESULTS: Only two peer-reviewed studies met our inclusion criteria, while our review of DHS data spanned 18 countries and 16 years (1999-2015). We found conflicting trends in sexual risk behaviour. Reported unprotected sex decreased consistently across the 18 countries, for both sexes. In contrast, reporting multiple partners was decreasing over the period 1999 to the mid-2000s, yet has been consistently increasing thereafter. Similar trends were found for reported sexually transmitted infections and commercial sex (men only). CONCLUSIONS: In conclusion, we found no clear evidence of behavioural disinhibition due to expanded access to ART in sub-Saharan Africa. Substantial increases in condom use coincided with increases in reported multiple partners, commercial sex and sexually transmitted infections, especially during the period of ART scale-up. Further research is needed into how these changes might affect HIV transmission.
Subject(s)
Anti-Retroviral Agents/therapeutic use , Attitude to Health , HIV Infections/prevention & control , HIV Infections/psychology , Sexual Behavior/psychology , Sexual Behavior/statistics & numerical data , Africa South of the Sahara , Humans , Risk-Taking , Unsafe Sex/psychology , Unsafe Sex/statistics & numerical dataABSTRACT
OBJECTIVE: To compare the cost-utility of microscopic observation drug-susceptibility assay (MODS) and Xpert® MTB/RIF implementation for tuberculosis (TB) diagnosis in rural northern Mozambique. METHODS: Stochastic transmission compartmental TB model from the healthcare provider perspective with parameter input from direct measurements, systematic literature reviews and expert opinion. MODS and Xpert® MTB/RIF were evaluated as replacement test of smear microscopy (SM) or as an add-on test after a negative SM. Costs were calculated in 2013 USD, effects in disability-adjusted life years (DALY). Willingness to pay threshold (WPT) was established at once the per capita Gross National Income of Mozambique. RESULTS: MODS as an add-on test to negative SM produced an incremental cost-effectiveness ratio (ICER) of 5647.89USD/DALY averted. MODS as a substitute for SM yielded an ICER of 5374.58USD/DALY averted. Xpert® MTB/RIF as an add-on test to negative SM yielded ICER of 345.71USD/DALY averted. Xpert® MTB/RIF as a substitute for SM obtained an ICER of 122.13USD/DALY averted. TB prevalence and risk of infection were the main factors impacting MODS and Xpert® MTB/RIF ICER in the one-way sensitivity analysis. In the probabilistic sensitivity analysis, Xpert® MTB/RIF was most likely to have an ICER below the WPT, whereas MODS was not. CONCLUSION: Our cost-utility analysis favours the implementation of Xpert® MTB/RIF as a replacement of SM for all TB suspects in this rural high TB/HIV prevalence African setting.
Subject(s)
Cost-Benefit Analysis , Drug Resistance, Bacterial , Microscopy , Molecular Diagnostic Techniques , Mycobacterium tuberculosis , Rifampin/pharmacology , Tuberculosis, Pulmonary/diagnosis , Antibiotics, Antitubercular/pharmacology , Costs and Cost Analysis , DNA, Bacterial/analysis , Humans , Microbial Sensitivity Tests/economics , Molecular Diagnostic Techniques/economics , Mozambique , Mycobacterium tuberculosis/drug effects , Mycobacterium tuberculosis/genetics , Mycobacterium tuberculosis/growth & development , Prevalence , Quality-Adjusted Life Years , Rural Population , Sensitivity and Specificity , Sputum , Tuberculosis, Multidrug-Resistant/diagnosis , Tuberculosis, Multidrug-Resistant/drug therapy , Tuberculosis, Multidrug-Resistant/microbiology , Tuberculosis, Pulmonary/drug therapy , Tuberculosis, Pulmonary/microbiologyABSTRACT
Various forms of body modification may be observed in sub-Saharan Africa. Hypotheses and theories of scarification and tribal marking in sub-Saharan Africa are described, plus the procedure of scarification, examples from several African countries, assumed effects in prevention and treatment of diseases, and the medical risks resulting from unsterile manipulation.
Subject(s)
Body Modification, Non-Therapeutic , Culture , Medicine , Africa South of the Sahara , Female , Humans , Male , RiskABSTRACT
OBJECTIVES: To investigate and determine the factors that enhanced or constituted barriers to the acceptance of an mHealth system which was piloted in Asante-Akim North District of Ghana to support healthcare of children. METHODS: Four semi-structured focus group discussions were conducted with a total of 37 mothers. Participants were selected from a study population of mothers who subscribed to a pilot mHealth system which used an interactive voice response (IVR) for its operations. Data were evaluated using qualitative content analysis methods. In addition, a short quantitative questionnaire assessed system's usability (SUS). RESULTS: Results revealed 10 categories of factors that facilitated user acceptance of the IVR system including quality-of-care experience, health education and empowerment of women. The eight categories of factors identified as barriers to user acceptance included the lack of human interaction, lack of update and training on the electronic advices provided and lack of social integration of the system into the community. The usability (SUS median: 79.3; range: 65-97.5) of the system was rated acceptable. CONCLUSIONS: The principles of the tested mHealth system could be of interest during infectious disease outbreaks, such as Ebola or Lassa fever, when there might be a special need for disease-specific health information within populations.
Subject(s)
Cell Phone , Health Services Accessibility , Patient Acceptance of Health Care , Telemedicine/statistics & numerical data , Adult , Child , Child, Preschool , Female , Ghana , Health Education , Humans , Infant , Male , Power, Psychological , Quality of Health Care , Telemedicine/methods , Voice , WomenABSTRACT
OBJECTIVES: As neonatal care is being scaled up in economically poor settings, there is a need to know more on post-hospital discharge and longer-term outcomes. Of particular interest are mortality, prevalence of developmental impairments and malnutrition, all known to be worse in low-birthweight neonates (LBW, <2500 g). Getting a better handle on these parameters might justify and guide support interventions. Two years after hospital discharge, we thus assessed: mortality, developmental impairments and nutritional status of LBW children. METHODS: Household survey of LBW neonates discharged from a neonatal special care unit in Rural Burundi between January and December 2012. RESULTS: Of 146 LBW neonates, 23% could not be traced and 4% had died. Of the remaining 107 children (median age = 27 months), at least one developmental impairment was found in 27%, with 8% having at least five impairments. Main impairments included delays in motor development (17%) and in learning and speech (12%). Compared to LBW children (n = 100), very-low-birthweight (VLBW, <1500 g, n = 7) children had a significantly higher risk of impairments (intellectual - P = 0.001), needing constant supervision and creating a household burden (P = 0.009). Of all children (n-107), 18% were acutely malnourished, with a 3½ times higher risk in VLBWs (P = 0.02). CONCLUSIONS: Reassuringly, most children were thriving 2 years after discharge. However, malnutrition was prevalent and one in three manifested developmental impairments (particularly VLBWs) echoing the need for support programmes. A considerable proportion of children could not be traced, and this emphasises the need for follow-up systems post-discharge.
Subject(s)
Infant Mortality , Infant, Low Birth Weight , Malnutrition/epidemiology , Neurodevelopmental Disorders/epidemiology , Nutritional Status , Patient Discharge , Burundi/epidemiology , Child Health Services , Female , Follow-Up Studies , Hospitals, District , Humans , Infant , Infant, Newborn , Intensive Care Units, Neonatal , Male , Malnutrition/complications , Prevalence , Rural Health Services , Rural PopulationABSTRACT
OBJECTIVE: To estimate the prevalence and causes of hearing impairment in Fundong Health District, North-West Cameroon. METHODS: We selected 51 clusters of 80 people (all ages) through probability proportionate to size sampling. Initial hearing screening was undertaken through an otoacoustic emission (OAE) test. Participants aged 4+ years who failed this test in both ears or for whom an OAE reading could not be taken underwent a manual pure-tone audiometry (PTA) screening. Cases of hearing impairment were defined as those with pure-tone average ≥41 dBHL in adults and ≥35 dBHL in children in the better ear, or children under age 4 who failed the OAE test in both ears. Each case with hearing loss was examined by an ear, nose and throat nurse who indicated the main likely cause. RESULTS: We examined 3567 (86.9%) of 4104 eligible people. The overall prevalence of hearing impairment was 3.6% (95% confidence interval [CI]: 2.8-4.6). The prevalence was low in people aged 0-17 (1.1%, 0.7-1.8%) and 18-49 (1.1%, 0.5-2.6%) and then rose sharply in people aged 50+ (14.8%, 11.7-19.1%). Among cases, the majority were classified as moderate (76%), followed by severe (15%) and profound (9%). More than one-third of cases of hearing impairment were classified as unknown (37%) or conductive (37%) causes, while sensorineural causes were less common (26%). CONCLUSIONS: Prevalence of hearing impairment in North-West Cameroon is in line with the WHO estimate for sub-Saharan Africa. The majority of cases with known causes are treatable, with impacted wax playing a major role.
Subject(s)
Hearing Loss/epidemiology , Hearing Loss/etiology , Adolescent , Adult , Age Factors , Aged , Aged, 80 and over , Cameroon/epidemiology , Catchment Area, Health , Cerumen , Child , Child, Preschool , Female , Humans , Infant , Infant, Newborn , Male , Middle Aged , Prevalence , Severity of Illness Index , Young AdultABSTRACT
OBJECTIVE: The retention of patients on antiretroviral therapy (ART) is key to achieving global targets in response to the HIV epidemic. Loss to follow-up (LTFU) can be substantial, with unknown outcomes for patients lost to ART programmes. We examined changes in outcomes of patients LTFU over calendar time, assessed associations with other study and programme characteristics and investigated the relative success of different tracing methods. METHODS: We performed a systematic review and logistic random-effects meta-regression analysis of studies that traced adults or children who started ART and were LTFU in sub-Saharan African treatment programmes. The primary outcome was mortality, and secondary outcomes were undocumented transfer to another programme, treatment interruption and the success of tracing attempts. RESULTS: We included 32 eligible studies from 12 countries in sub-Saharan Africa: 20 365 patients LTFU were traced, and 15 708 patients (77.1%) were found. Compared to telephone calls, tracing that included home visits increased the probability of success: the adjusted odds ratio (aOR) was 9.35 (95% confidence interval [CI] 1.85-47.31). The risk of death declined over calendar time (aOR per 1-year increase 0.86, 95% CI 0.78-0.95), whereas undocumented transfers (aOR 1.13, 95% CI 0.96-1.34) and treatment interruptions (aOR 1.31, 95% CI 1.18-1.45) tended to increase. Mortality was lower in urban than in rural areas (aOR 0.59, 95% CI 0.36-0.98), but there was no difference in mortality between adults and children. The CD4 cell count at the start of ART increased over time. CONCLUSIONS: Mortality among HIV-positive patients who started ART in sub-Saharan Africa, were lost to programmes and were successfully traced has declined substantially during the scale-up of ART, probably driven by less severe immunodeficiency at the start of therapy.
Subject(s)
Anti-HIV Agents/therapeutic use , Delivery of Health Care , HIV Infections/drug therapy , Lost to Follow-Up , Adult , Africa South of the Sahara , Child , HIV Infections/mortality , HumansABSTRACT
OBJECTIVE: HIV diagnosis and linkage to care are the main barriers in Africa to achieving the UNAIDS 90-90-90 targets. We assessed HIV-positive status awareness and linkage to care among survey participants in Chiradzulu District, Malawi. METHOD: Nested cohort study within a population-based survey of persons aged 15-59 years between February and May 2013. Participants were interviewed and tested for HIV (and CD4 if found HIV-positive) in their homes. Multivariable regression was used to determine factors associated with HIV-positive status awareness prior to the survey and subsequent linkage to care. RESULTS: Of 8277 individuals eligible for the survey, 7270 (87.8%) participated and were tested for HIV. The overall HIV prevalence was 17.0%. Among HIV-positive participants, 77.0% knew their status and 72.8% were in care. Women (adjusted odds ratio [aOR] 6.5, 95% CI 3.2-13.1) and older participants (40-59 vs. 15-29 years, aOR 10.1, 95% CI 4.0-25.9) were more likely to be aware of their positive status. Of those newly diagnosed, 47.5% were linked to care within 3 months. Linkage to care was higher among older participants (40-59 vs. 15-29, adjusted hazard ratio [aHR] 3.39, 95% CI 1.83-6.26), women (aHR 1.73, 95% CI 1.12-2.67) and those eligible for ART (aHR 1.61, 95% CI 1.03-2.52). CONCLUSIONS: In settings with high levels of HIV awareness, home-based testing remains an efficient strategy to diagnose and link to care. Men were less likely to be diagnosed, and when diagnosed to link to care, underscoring the need for a gender focus in order to achieve the 90-90-90 targets.
Subject(s)
Awareness , HIV Infections/diagnosis , HIV Infections/epidemiology , Health Services Accessibility , Home Care Services , Adolescent , Adult , Cross-Sectional Studies , Enzyme-Linked Immunosorbent Assay , Female , HIV Infections/therapy , Humans , Incidence , Malawi/epidemiology , Male , Middle Aged , Prevalence , Surveys and Questionnaires , Viral LoadABSTRACT
OBJECTIVE: To estimate the independent and combined risks of infant and child mortality associated with maternal smoking and use of solid fuel in sub-Saharan Africa. METHODS: Pooled weighted data on 143 602 under-five children in the most recent demographic and health surveys for 15 sub-Saharan African countries were analysed. The synthetic cohort life table technique and Cox proportional hazard models were employed to investigate the effect of maternal smoking and solid cooking fuel on infant (age 0-11 months) and child (age 12-59 months) mortality. Socio-economic and other confounding variables were included as controls. RESULTS: The distribution of the main explanatory variable in households was as follows: smoking + solid fuel - 4.6%; smoking + non-solid fuel - 0.22%; no smoking + solid fuel - 86.9%; and no smoking + non-solid fuel - 8.2%. The highest infant mortality rate was recorded among children exposed to maternal smoking + solid fuel (72 per 1000 live births); the child mortality rate was estimated to be 54 per 1000 for this group. In full multivariate models, the risk of infant death was 71% higher among those exposed to maternal smoking + solid fuel (HR = 1.71, CI: 1.29-2.28). For ages 12 to 59 months, the risk of death was 99% higher (HR = 1.99, CI: 1.28-3.08). CONCLUSIONS: Combined exposures to cigarette smoke and solid fuel increase the risks of infant and child mortality. Mothers of under-five children need to be educated about the danger of smoking while innovative approaches are needed to reduce the mortality risks associated with solid cooking fuel.
Subject(s)
Air Pollution/adverse effects , Child Mortality , Cooking/methods , Environmental Exposure/adverse effects , Infant Mortality , Mothers , Smoking/adverse effects , Adult , Africa South of the Sahara/epidemiology , Child, Preschool , Demography , Family Characteristics , Health Surveys , Humans , Infant , Infant Death/etiology , Infant, Newborn , Proportional Hazards Models , Tobacco Smoke Pollution/adverse effectsABSTRACT
OBJECTIVE: To synthesise the evidence on pregnancy and childbirth after repair of obstetric fistula in sub-Saharan Africa and to identify the existing knowledge gaps. METHODS: A scoping review of studies reporting on pregnancy and childbirth in women who underwent repair for obstetric fistula in sub-Saharan Africa was conducted. We searched relevant articles published between 1 January 1970 and 31 March 2016, without methodological or language restrictions, in electronic databases, general Internet sources and grey literature. RESULTS: A total of 16 studies were included in the narrative synthesis. The findings indicate that many women in sub-Saharan Africa still desire to become pregnant after the repair of their obstetric fistula. The overall proportion of pregnancies after repair estimated in 11 studies was 17.4% (ranging from 2.5% to 40%). Among the 459 deliveries for which the mode of delivery was reported, 208 women (45.3%) delivered by elective caesarean section (CS), 176 women (38.4%) by emergency CS and 75 women (16.3%) by vaginal delivery. Recurrence of fistula was a common maternal complication in included studies while abortions/miscarriage, stillbirths and neonatal deaths were frequent foetal consequences. Vaginal delivery and emergency C-section were associated with increased risk of stillbirth, recurrence of the fistula or even maternal death. CONCLUSION: Women who get pregnant after repair of obstetric fistula carry a high risk for pregnancy complications. However, the current evidence does not provide precise estimates of the incidence of pregnancy and pregnancy outcomes post-repair. Therefore, studies clearly assessing these outcomes with the appropriate study designs are needed.
Subject(s)
Delivery, Obstetric/methods , Obstetric Labor Complications/epidemiology , Obstetric Labor Complications/surgery , Pregnancy Outcome , Pregnancy Rate , Vaginal Fistula/epidemiology , Vaginal Fistula/surgery , Adult , Africa South of the Sahara/epidemiology , Female , Humans , Maternal Mortality , Obstetric Labor Complications/mortality , Pregnancy , Recurrence , Vaginal Fistula/mortalityABSTRACT
OBJECTIVE: To identify gaps in the use of HIV prevention and care services and commodities for female sex workers, we conducted a baseline cross-sectional survey in four cities, in the context of an implementation research project aiming to improve use of sexual and reproductive health services. METHODS: Using respondent-driven sampling, 400 sex workers were recruited in Durban, 308 in Tete, 400 in Mombasa and 458 in Mysore and interviewed face-to-face. RDS-adjusted proportions were estimated by nonparametric bootstrapping and compared across cities using post hoc pairwise comparison. RESULTS: Condom use with last client ranged from 88.3% to 96.8%, ever female condom use from 1.6% to 37.9%, HIV testing within the past 6 months from 40.5% to 70.9%, receiving HIV treatment and care from 35.5% to 92.7%, care seeking for last STI from 74.4% to 87.6% and having had at least 10 contacts with a peer educator in the past year from 5.7% to 98.1%. Many of the differences between cities remained statistically significant (P < 0.05) after adjusting for differences in FSWs' socio-demographic characteristics. CONCLUSION: The use of HIV prevention and care by FSWs is often insufficient and differed greatly between cities. Differences could not be explained by variations in socio-demographic sex worker characteristics. Models to improve use of condoms and HIV prevention and care services should be tailored to the specific context of each site. Programmes at each site must focus on improving availability and uptake of those services that are currently least used.
Subject(s)
HIV Infections/prevention & control , Health Behavior , Patient Acceptance of Health Care , Sex Workers/psychology , Adolescent , Adult , Cities , Cross-Sectional Studies , Female , Humans , India/epidemiology , Kenya/epidemiology , Mozambique/epidemiology , South Africa/epidemiologyABSTRACT
OBJECTIVE: In resource-limited settings, where genotypic drug resistance testing is rarely performed and poor adherence is the most common reason for treatment failure, programmatic approaches to handling treatment failure are essential. This study was performed to describe one such approach to adherence optimisation. METHODS: This was a single-arm study of patients on second-line protease inhibitor (PI)-based antiretroviral therapy (ART) with a HIV-1 RNA ≥400 copies/ml in Johannesburg, South Africa, between 1 March 2012 and 1 December 2013. Patients underwent enhanced adherence counselling. Those with improved adherence and a repeat viral load of >1000 copies/ml underwent HIV-1 drug resistance testing. We describe results using simple proportions and 95% confidence intervals. RESULTS: Of the 400 patients who underwent targeted adherence counselling after an elevated viral load on second-line ART, 388 (97%) underwent repeat viral load testing. Most of these (n = 249; 64%, 95% CI 59-69) resuppressed (<400 copies/ml) on second line. By the end of follow-up (1 March 2014), among the 139 (36%, 95% CI: 31-41%), who did not initially resuppress after being targeted, 106 had a viral load >400 copies/ml, 11 switched to third line, 5 were awaiting third line, 4 had died and 13 were lost to follow-up. Among the unsuppressed, 48 successfully underwent resistance testing with some resistance detected in most (41/48). CONCLUSIONS: Most (64%) second-line treatment failure in this clinic is related to adherence and can be overcome with careful adherence support. Controlled interventions are needed to determine what the optimal approach is to improving second-line outcomes and reducing the need for third-line ART.
Subject(s)
Anti-HIV Agents/therapeutic use , Antiretroviral Therapy, Highly Active , Counseling , Drug Resistance, Viral , HIV Infections/drug therapy , Patient Compliance , Adult , CD4 Lymphocyte Count , Female , HIV Infections/virology , HIV-1 , Humans , Male , Middle Aged , Prospective Studies , South Africa , Treatment Failure , Viral LoadABSTRACT
OBJECTIVE: Understanding the fertility of HIV-positive women is critical to estimating HIV epidemic trends from surveillance data and to planning resource needs and coverage of prevention of mother-to-child transmission services in sub-Saharan Africa. In the light of the considerable scale-up in antiretroviral therapy (ART) coverage over the last decade, we conducted a systematic review of the impact of ART on the fertility outcomes of HIV-positive women. METHODS: We searched Medline, Embase, Popline, PubMed and African Index Medicus. Studies were included if they were conducted in sub-Saharan Africa and provided estimates of fertility outcomes (live births or pregnancies) among women on ART relative to a comparison group. RESULTS: Of 2070 unique references, 18 published papers met all eligibility criteria. Comparisons fell into four categories: fertility of HIV-positive women relative to HIV-negative women; fertility of HIV-positive women on ART compared to those not yet on ART; fertility differences by duration on ART; and temporal trends in fertility among HIV-positive women. Evidence indicates that fertility increases after approximately the first year on ART and that while the fertility deficit of HIV-positive women is shrinking, their fertility remains below that of HIV-negative women. These findings, however, were based on limited data mostly during the period 2005-2010 when ART scaled up. CONCLUSIONS: Existing data are insufficient to characterise how ART has affected the fertility of HIV-positive women in sub-Saharan Africa. Improving evidence about fertility among women on ART is an urgent priority for planning HIV resource needs and understanding HIV epidemic trends. Alternative data sources such as antenatal clinic data, general population cohorts and population-based surveys can be harnessed to understand the issue.