Journal of Public Health in Africa最新文献

The intersection of mpox and mental health is a critical concern, particularly for individuals with pre-existing mental disorders, who face heightened psychological stress and exacerbation of symptoms. This study explores the potential of genetic testing, such as Polygenic Risk Scores and pharmacogenetics, in enhancing mental disorders and mpox management. By tailoring treatment and prevention strategies to an individual's genetic profile, clinicians can provide more personalised care, reducing adverse effects and improving outcomes. Furthermore, genetic insights can inform the development of safer vaccines and early interventions, particularly for vulnerable populations. The study underscores the importance of integrating mental and public health strategies, advocating for targeted research and fostering interdisciplinary collaboration to effectively address these complex health challenges.

Background: Prostate cancer is the third most common cancer in men and fourth in causing cancer-related deaths in both men and women in Africa.

Aim: The aim of this study was to assess knowledge and attitudes about prostate cancer screening among men over 50 years.

Setting: The study setting is Intermediate Hospital Oshakati.

Methods: A quantitative cross-sectional design was adopted. Census sampling was employed, and the data were collected through the use of a structured, self-administered questionnaire. Data were analysed with the aid of the Statistical Package for the Social Sciences (SPSS) version 26.0 using frequencies and percentages, and Chi-square test of association.

Results: Majority of the respondents were knowledgeable about prostate cancer except in questionnaire items 3, 12 and 13 in which they (71.8%, 82.4% and 94.7%, respectively) were not knowledgeable. In all the items of the questionnaire, majority of the respondents had positive attitudes towards prostate cancer screening. The percentages of the positive attitude range from 80% to 95% across all the items. There is no significant association between the respondents' prostate cancer screening knowledge and all the respondents' characteristics (age, level of education, marital status and religion), p > 0.05, respectively. There is no significant association between respondents' prostate cancer screening attitude and all the respondents' characteristics, p > 0.05, respectively.

Conclusion: The survey respondents were knowledgeable about prostate cancer screening, except when it comes to the different methods of diagnosing prostate cancer, what happens to the prostate gland in prostate cancer and who should be screened for prostate cancer.

Contribution: The results from this study can be used by the Ministry of Health and Social Services and its stakeholders to create a baseline data which help to develop appropriate preventative measures and awareness programmes. Furthermore, this study can be used to identify possible reasons for the late reporting of men for PCa screening and aid to inform the public on the need for early-seeking behaviour through screening.

Background: There is a substantial risk of indirect transmission of SARS-CoV-2 from contaminated surfaces and objects in healthcare settings.

Aim: To evaluate the effectiveness of enhanced cleaning protocols for high-touch surfaces during COVID-19, focusing on cleaning products, concentrations, contact time, and recommended frequency.

Setting: We focused on research conducted in healthcare settings or where samples were obtained from healthcare environments.

Method: We assessed studies that compared different cleaning, disinfection, sterilisation, or decontamination procedures and cleaning frequency with standard or routine procedures. We prioritised randomised trials, non-randomised controlled trials, controlled before-and-after studies, and interrupted time series analyses carried out between 01 January 2020 and 31 August 2022.

Results: Three studies met our criteria from 2139 references searched. These studies, which took place in Iran, China and the United States, found that routine terminal cleaning and enhanced terminal cleaning with different cleaning enhancements significantly reduced SARS-CoV-2 surface contamination. One of the studies tested residual SARS-CoV-2 levels after routine and terminal cleaning with varying strengths of disinfectant and evaluated the efficacy of two common types of disinfectants in inactivating SARS-CoV-2 on inanimate surfaces in different hospital wards.

Conclusion: Limited evidence supports cleaning strategies that can reduce the transmission of SARS-CoV-2 from surfaces in healthcare settings. Combining various cleaning methods and using multiple disinfectants can effectively reduce surface contamination.

Contribution: Randomised controlled trials are crucial for evaluating cleaning effectiveness. They must outline cleaning protocols, detailing frequency, product concentration and volume, application methods, soil and surface types, and environmental conditions, to provide strong evidence.

Background: In Guinea, the 2013-2015 Ebola epidemic profoundly affected maternal health service use. The frequency of births attended by skilled health professionals in the post-Ebola context remains under-documented.

Aim: The aim of this study was to analyze the trend and factors associated with skilled births among women aged 15-49 between 2016 and 2018 in Guinea.

Setting: The Republic of Guinea was the setting for this study.

Methods: Data from 3018 women aged 15-49 years who had at least one live birth over the period 2016-2018 were analysed. The simple binary logistic regression model was used to analyse factors associated with skilled births using Stata software version 16.1. The significance level was set at 5%.

Results: Our study found that 57.3% of deliveries were skilled births. This proportion showed a remarkable variation with a trend in assisted deliveries from 61% in 2016 to 59% in 2017 and then to 50% (p = 0.003) in 2018. Factors associated with skilled birth attendance in post-Ebola were: having no level of education (odds ratio [OR] = 0.39; confidence interval [CI]: 0.31-0.77), performing four or more antenatal care (ANC) (OR = 12.10; CI: 8.24-17.77), residing in a rural area (OR = 0.25 [0.17-0.37]), having a spouse who was a trader or manual worker, belonging to a household with an intermediate or poor wealth index and residing in the Labé region.

Conclusion: This study showed that the proportion of assisted births showed a downward trend between 2016-2018.

Contribution: The interventions undertaken to strengthen the maternal health system in the aftermath of the Ebola epidemic should be reinforced and maintained, in particular the retention of health providers deployed in rural areas and capacity building (training, equipment) for community health workers would help to improve this indicator.

Background: In South Africa, screening for diabetic retinopathy (DR) is non-existent at the primary healthcare (PHC) level because of the absence of a screening programme. This leads to preventable vision loss.

Aim: To describe the clinical characteristics and outcomes of eye screenings and subsequent referrals.

Setting: Laudium Community Health Centre (CHC), a PHC facility in Tshwane.

Methods: We conducted a cross-sectional study from February 2022 to August 2022. Individuals with diabetes were screened for eye complications using visual acuity testing, intraocular pressure measurement, and fundoscopy with a non-mydriatic digital fundus camera. Fundus images were analysed by an optometrist and an artificial intelligence (AI) programme. Demographic and clinical data were collected.

Results: A total of 120 participants were included, with the majority (60.7%) from Laudium CHC. Most participants (64.2%) were on oral agents, and 66.7% were women. The mean haemoglobin A1c (HbA1c) was 8.3%, with a median diabetes duration of 8 years. Artificial intelligence detected more glaucoma cases (17.5% vs 9.2%) and DR (23.3% vs 15.8%) compared to the optometrist. In contrast, the optometrist identified more cases of macula pathology (29.2% vs 19.2%). Participants (n = 79) were referred to an ophthalmologist for diagnosis confirmation and management.

Conclusion: The study revealed that while DR was not highly prevalent among PHC patients with diabetes, there was a significant referral rate for other ocular complications. Artificial intelligence can enhance early detection and improve efficiency.

Contribution: The findings underscore the need to integrate diabetes eye screening programmes into PHC services for people living with diabetes.

Background: Asymptomatic testing involves the process whereby individuals who do not show symptoms of COVID-19 are tested for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection using any of the available laboratory test techniques.

Aim: To evaluate the effectiveness of testing asymptomatic individuals visiting, living or working in healthcare facilities in reducing SARS-CoV-2 viral infections.

Setting: Healthcare databases.

Method: Electronic databases were searched and limited to English language and studies published 2020 to 02 September 2022. Following the methods for rapid systematic reviews, data were analysed using a fixed effect model, and results of the effect estimate were reported as odds ratios (OR) with their confidence intervals (CI) (95% CI).

Results: Databases' searches yielded 3065 articles after deduplication and 3 studies by searching reference lists of included articles. After screening abstracts and full text articles, 3 cohort studies were included, each with serious risk of bias. Very low certainty evidence shows a decrease in occurrence of SARS-CoV-2 infections in the asymptomatic testing group among patients going for index surgery (OR: 0.05, 95 % CI: 0.00-0.82; 501 participants; 1 study) and among long term care facility staff (OR: 0.31, 95 % CI: 0.18-0.52; 3457 participants; 2 studies, I ² = 89%) than the 'no asymptomatic testing' group. However, its effect on their residents was contradictory.

Conclusion: There is limited quality evidence to support asymptomatic testing of individuals for SARS-CoV-2 in the prevention of virus transmission in health care settings.

Contribution: In the event of a future pandemic, this review offers current evidence on the potential effects of asymptomatic testing.

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.