Journal of Public Health in Africa最新文献

Background: Significant strides have been made globally and in South Africa (SA) in the policy and biomedical management of multidrug-resistant tuberculosis (MDR-TB). However, MDR-TB remains a significant public health threat.

Aim: This policy content analysis aims to explore the key milestones in MDR-TB management in SA and globally over the last decade, 2013-2023, to identify gaps and opportunities for improvement.

Setting: This review focussed on global and South African national MDR-TB policies since SA is on all three World Health Organization (WHO) watch lists for TB, TB/HIV and MDR-TB, despite its significant contributions to policy.

Method: A policy review and content analysis were conducted of all publicly available SA and WHO drug-resistant TB policies developed between 2013 and 2023.

Results: Key changes identified were in the areas of new drug development and regimens, care delivery settings, task shifting and, terminology used in the field of drug-resistant TB. Changes in the biomedical sphere predominated in both SA and WHO policies.

Conclusion: Important biomedical interventions have offered renewed hope for the SA MDR-TB programme. This review highlights that policy translation and implementation in non-biomedical interventions have been slow, sometimes lagging up to 10 years behind an intervention being recommended. This article recommends equal weight be placed on non-biomedical interventions and that these policy translations occur at a more rapid speed to positively impact the dire public health consequences of MDR-TB.

Contribution: Insights offered through this policy review may contribute to policy development, translation and implementation towards improving MDR-TB outcomes in SA.

Background: Many low- and middle-income countries (LMICs) face the daunting task of digitising, maturing and deciding where to invest in digital health systems.

Aim: Describing the facilitators and barriers to conducting digital health maturity assessments and how health leaders can prioritise the assessments.

Setting: eHealth leaders from 10 African countries, working or supporting Ministries of Health's digital health and participating in the eHealth Leaders' Forum from July 2023 to September 2023.

Methods: This qualitative, descriptive study utilised key informant interviews conducted via Zoom with 14 conveniently selected leaders. We used Dedoose Version 9.0 to develop themes based on the health system's building blocks.

Results: Participants identified maturity assessments as a critical first step to digital health strengthening, showing the system's performance and building a baseline response to systematic data quality challenges. Barriers to conducting digital health maturity assessment include lacking collaborators' buy-in, fragmented vision, overdependence on donor priorities, non-supportive policies and an inadequately skilled workforce. Facilitators include multi-stakeholder engagement, understanding the country's digital health ecosystem and appropriately integrating maturity assessment objectives. Recommendations include capacity building in data use and conducting maturity assessments at all health system levels to grow the demand and value of digital health strengthening.

Conclusion: Promoting digital health maturity assessments can help leaders to make appropriate decisions to prioritise areas of improvement and steward maturity advancement as a pathway to strengthening the health system.

Contribution: We spotlight the perspectives of African eHealth leaders, centering voices on the barriers, facilitators to planning and recommendations for implementing digital health systems maturity assessments.

Background: International vertical health financing programmes risk functioning in parallel with existing domestic funding in low- and middle-income countries (LMICs), leading to inefficient service delivery and concomitant poor health outcomes.

Aim: We assessed the opportunities offered by digitalised diagnostics (ConnDx) to target and monitor health funds to those in need objectively and transparently.

Setting: ConnDx was rolled out in five private health facilities in Kisumu, Kenya.

Methods: The ConnDx process was codeveloped with the local Department of Health of Kisumu. We used the quantitative data generated by ConnDx. We also calculated the costs for ConnDx and standard care to assess potential cost reductions.

Results: In total, 2199 malaria cases were detected among 11 689 patients with fever. ConnDx allowed for the identification of malaria hotspots, semi-real-time assessment of patient health seeking behaviour across facilities and insights in doctor's prescription behaviours. Based on these insights, we estimated a 25% reduction in costs can be realised, while simultaneously better quality indicators can be monitored.

Conclusion: The concept of ConnDx can be used for any medical condition that can be diagnosed in a digital manner and linked to mobile payment systems. The generated data can contribute to better quality services for individual patients while at the same time support local health policy makers and managers for more targeted interventions.

Contribution: The ConnDx approach can help decision makers in LMICs to channel disease-specific funds to the right patients for the right disease at the right time, which can potentially accelerate the way to universal health coverage.

Background: Kenya has recorded at least 38 678 cases and 695 deaths over the last decade, and costing on average $2.2 million annually. From 2014 to 2016, the country experienced one of the deadliest and largest outbreak. However, between 2017 and 2020, there was a decline in the number of reported cases and deaths.

Aim: This study seeks to reveal the investments made post the 2014-2016 outbreak and highlight existing gaps that need to be addressed to stop the resurgence of cholera outbreaks in Kenya.

Setting: The study was conducted in two counties: Homabay and Nairobi.

Methods: We used an observational study. Data were collected from 20 health facilities (involved in cholera control, during the study), 9 key informant interviews (KII) and 6 focus group discussions (FGDs).

Results: We found improvement such as: dissemination of standard operating procedures, aligned reporting system, field epidemiology programme, establishment of a public health emergency operating centre and improved partner coordination. On the other hand, 12 of the selected 20 (60%) facilities had no prior training before government financing and laboratory capacity was sub-optimal: 13 (65%) facilities had no prior training, 16 (20%) had no operational laboratory plan and 10 (50%) had inadequate laboratory test kits and reagents.

Conclusion: This study highlights that Kenya has experienced an improvement in specific core capacities.

Contribution: For Kenya to completely flatten the curve, there is need for more sustainable investment and government's commitment in health system strengthening.

Background: Little is known about the evolution of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) immunity in African communities.

Aim: We evaluated changes in anti-SARS-CoV-2 antibodies, mortality and vaccination status in Cameroon between August 2021 and September 2022 to begin describing the evolution of the pandemic in Africa.

Setting: The study was conducted across Cameroon's 10 regional capitals, between 2021 and 2022 as the country hosted a mass gathering.

Methods: We conducted a cross-sectional population-based survey in 2022, including SARS-CoV-2 seroprevalence testing and retrospective mortality estimation using two-stage cluster sampling. We estimated and compared seroprevalence and crude mortality rates (CMR) to a survey conducted in 2021 using the same methodology.

Results: We performed serologic testing on 8400 individuals and collected mortality data from 22 314 individuals. Approximately 5% in each survey reported SARS-CoV-2-vaccination. Rapid diagnostic test-based seroprevalence increased from 11.2% (95% confidence interval [CI]: 10-12.5) to 59.8% (95% CI: 58.3-61.2) between 2021 and 2022, despite no increase in the proportion vaccinated. The CMR decreased from 0.17 to 0.06 deaths per 10 000 persons per day between 2021 and 2022. In 2022, no deaths were reportedly attributable to COVID-19 as compared to 17 deaths in 2021.

Conclusion: Over a 12-month period encompassing two waves of omicron variant SARS-CoV-2 and a mass gathering, SARS-CoV-2 seropositivity in Cameroon approached 60%, and deaths declined despite low vaccination coverage.

Contribution: This study challenges the assumption that high immunisation coverage is the sole determinant of epidemic control in the African context and encourages policymakers to increasingly rely on local research when designing response strategies for more effective outbreak management.

Background: Healthcare workers (HCWs) are a priority group targeted for vaccination because they are greatly exposed to infectious agents.

Aim: To determine the prevalence of coronavirus disease 2019 (COVID-19) vaccination and associated risk factors for vaccine hesitancy to recommend vaccine uptake strategies among student nurses.

Setting: The study was carried out at the University of Namibia, main campus in Windhoek.

Methods: A cross-sectional study was undertaken using a proportionate stratified sampling method. The total sample for the study was 509 students. Statistical Package for the Social Sciences (SPSS) 29 was used to analyse data. Frequencies and proportions were calculated. Bivariate analysis and multiple logistic regression were conducted to pronounce the predictors for vaccine hesitancy.

Results: Only 31.40% students were vaccinated against COVID-19. Out of the vaccinated, 41.80% (p < 0.001) were previously infected with COVID-19. Participants who were not HCWs before nursing school were most likely not to be vaccinated (p < 0.001). Most unvaccinated students were hesitant because of a lack of information about the COVID-19 vaccine's side effects (50.36%) and not knowing its effectiveness (38.13%). A total 60.80% of the participants believed a vaccine was needed to overcome the pandemic.

Conclusion: We recommend the creation of targeted awareness campaigns that shed more light on the benefits of vaccination and vaccine side effects.

Contribution: The study identifies key factors that can be targeted to change student nurses' behaviour towards vaccination and offers valuable data that can inform preparedness and response strategies for future pandemics in Namibia and similar regions.

Background: In Guinea, despite women's recourse to antenatal care (ANC), little remains known about the use of focused antenatal care (FANC), contained in the ANC package.

Aim: The aim of this study was to analyse the frequency and factors associated with FANC, using data from the Demographic and Health Survey (DHS) 2018.

Setting: This study was conducted in Guinea.

Methods: This was a secondary analysis of data from the DHS conducted in 2018 in Guinea. It included all women who achieved at least one ANC visit in the last 2 years prior to the survey. Multivariate logistic regression was received to identify factors associated with FANC. Stata 16 software was used for the analysis.

Results: This study shows that in Guinea, between 2016 and 2018 only 33% of women undergoing ANC received a FANC. The most commonly used service was blood pressure measurement (93%), while the least commonly used service was deworming (42%). Factors associated with FANC were living in the Kindia region (odds ratio = 1.7; 95% confidence interval: 1.04-2.97); not intending to become pregnant for this pregnancy; belonging to a poor household; and having made 3, 4 or more ANC visits.

Conclusion: This study reports a low proportion of women receiving the full package of ANC.

Contribution: In order to improve this indicator, greater efforts need to be made in certain regions of the country to target pregnant women who achieve fewer ANC visits, carry pregnancies that were not intentional or belong to poorer households.