Journal of Public Health in Africa最新文献

Background: Overweight and obesity are rising health concerns in South Africa, increasingly affecting young adults in rural communities, and are influenced by distinct demographic, socio-economic and behavioural factors.

Aim: This study aimed to determine the prevalence of body mass index (BMI)-defined overweight and obesity among young adults aged 18-29 years.

Setting: The study was conducted in Lephalale, a predominantly rural-industrial area located within the Waterberg District Municipality of Limpopo province, South Africa.

Methods: A community-based cross-sectional survey of 1063 adults aged 18-29 years from 42 rural settlements collected data on socio-demographic characteristics, employment, income, government grant receipt, physical activity (International Physical Activity Questionnaire - IPAQ), dietary practices (processed and fast food intake, fruit and vegetable consumption), smoking and alcohol use. BMI was calculated as weight divided by height squared (kg/m²) and classified using WHO criteria. Univariate and multivariable logistic regression analyses identified the predictors of combined overweight and obesity compared with normal or underweight participants.

Results: The combined prevalence of overweight and obesity was 35%. Significant independent predictors included age 25-29 years (adjusted odds ratio [AOR]: 2.05; 95% confidence interval [CI]: 1.40-3.00), government grant receipt (AOR: 1.55; 95% CI: 1.05-2.28), daily processed food intake (AOR: 1.85; 95% CI: 1.25-2.73), weekly fast food intake (AOR: 1.70; 95% CI: 1.18-2.45), smoking (AOR: 1.25; 95% CI: 1.00-1.72) and daily alcohol use (AOR: 2.10; 95% CI: 1.35-3.15). Overweight and obesity were prevalent among rural young adults and were associated with socio-economic vulnerability and modifiable lifestyle behaviours.

Conclusion: Overweight and obesity were highly prevalent among young adults living in a rural-industrial setting in Limpopo province.

Contribution: The findings highlight priority behavioural and social determinants that can inform targeted public health interventions and obesity-prevention policies in transitioning rural communities.

Background: Cervical cancer (CC) remains a leading cause of cancer-related deaths among women in sub-Saharan Africa. In rural Kenya, screening uptake is particularly low, partly because of limited access to reliable health information and other structural barriers such as the unavailability of screening equipment and the cost of screening.

Aim: To examine the relationship between access to CC information and screening uptake, and to identify information needs, preferences and dissemination strategies among women with low educational attainment in resource-limited rural settings.

Setting: Rural communities in Bomet and Kericho Counties, Kenya.

Methods: We conducted a mixed methods study among 174 women recruited through purposive convenience sampling. Data collection involved interviewer-administered cross-sectional surveys and semi-structured interviews (n = 21). Quantitative data were analysed using logistic regression, and qualitative data using thematic analysis. Findings were integrated during interpretation.

Results: Participants had a mean age of 45 years; 88.5% were from low-income households. Although 82.2% had heard of CC - primarily via news media (36.8%), health workers (24.1%) and social networks (21.3%) - only 6.3% had been screened. Health workers and the radio were the most trusted information sources. Access to each additional information source was associated with 4.66 times higher odds of screening (95% confidence interval: 1.19-18.25). Despite this, 92% felt inadequately informed. Integrated findings underscored the need for culturally relevant, literacy-sensitive approaches.

Conclusion: Screening uptake remains low but improves with exposure to diverse, trusted information sources.

Contribution: This study highlights the importance of tailored, community-based strategies to enhance CC screening in underserved rural populations.

Background: Recent dengue outbreaks in Burkina Faso have caused substantial morbidity and mortality among semi-urban and urban populations.

Aim: To assess the knowledge, attitudes, and practices (KAP) among the population of Tougan, a semi-urban city, towards dengue.

Setting: Between April 2024 and July 2024, a cross-sectional study was performed among residents and internally displaced populations (IDPs) in Tougan.

Methods: Participants aged 18 years and older, recruited through an adapted three-stage random sampling were eligible. Sociodemographic data as well as information on knowledge, attitudes, and practices (KAP) were collected using a questionnaire. Factors associated with good knowledge of dengue (i.e. knowledge score ≥ 11) were identified using logistic regression models.

Results: A total of 419 participants, including 130 (31.1%) IDPs, were enrolled in the study. The majority were male (53.9%), with a mean age of 38.5 years (standard deviation [s.d.] 12.9). The mean scores of KAP regarding dengue were 10.1 (s.d. 1.2), 13.5 (s.d. 1.9), and 9.4 (s.d. 2.2), respectively. Internally displaced populations had significantly lower levels of knowledge of dengue (adjusted odds ratio [aOR]: 0.49, 95% confidence interval [CI]: 0.29-0.81, p = 0.006) compared to residents. Moreover, participants with stagnant water at their home (aOR: 3.03, 95% CI: 1.84-4.96, p < 0.001) and those with good practices towards dengue (aOR: 3.39, 95% CI: 1.37-8.38, p = 0.008) had better knowledge.

Conclusion: Context-specific prevention messages on dengue and targeted interventions should be developed for IDPs and residents from semi-urban areas in Burkina Faso.

Contribution: This study provides findings to enhance dengue awareness among vulnerable populations and preparedness for future epidemics.

The West African Ebola virus disease (EVD) epidemic of 2013-2016 was the largest on record, severely affecting Guinea, Liberia, and Sierra Leone, and overwhelming public health systems. Following Nigeria's successful containment of its domestic EVD outbreak in 2014, the African Union Support to Ebola Outbreak in West Africa (ASEOWA) mission deployed 196 Nigerian public health professionals, the largest single-nation contingent, to Liberia and Sierra Leone. This commentary reflects on that deployment, highlighting operational contributions, innovations, and the enduring impact of the mission on Africa's public health security landscape. The Nigerian team strengthened Ebola Treatment Units (ETUs), surveillance, epidemiological investigations, laboratory testing, infection prevention and control (IPC), community mobilisation, and restoration of essential health services. Significantly, no responder infections occurred under Nigeria's deployment. The mission reinforced African-led outbreak response and contributed to the evolution of regional security structures, including the Africa Centres for Disease Control and Prevention (Africa CDC) and the African Union Volunteer Health Corps (AVOHC). A decade later, the deployment remains instrumental in shaping sustained public health workforce investments and integrated emergency preparedness systems across Africa.

Artemisinin partial resistance (ART-R) has now emerged in the Horn, Eastern and Southern Africa. Mutations in the Plasmodium falciparum kelch13 gene, strongly associated with ART-R, are increasingly reported in several Central and West Africa countries. Here, we opine that the emergence and spread of ART-R in Central and West Africa should not be overlooked given public health, clinical and economic consequences. Again, in addition to the recent funding cuts from the United States (US) government, some regions in these countries are affected by armed conflicts that undoubtedly will disrupt malaria control measures. Thus, measures should be proactively taken to prevent the emergence of ART-R or mitigate its spread in these two regions. We also propose strategies that could be valuable in implementing a near real-time surveillance and information system, will produce high-quality analysis, allow to draw malaria reality-reflecting conclusions, optimally enhance data use and define tailored control and elimination strategies.

Background: The World Health Organization (WHO) recommends integrating hypertension and human immunodeficiency virus (HIV) care; however, evidence for implementing integrated care in primary healthcare (PHC) HIV clinics remains limited.

Aim: To assess the feasibility and acceptability of a pilot model for integrating hypertension care into HIV services and to describe the hypertension care cascade among people living with HIV (PLHIV) and hypertension.

Setting: Two PHC HIV clinics in Wakiso district, Uganda.

Methods: We conducted a parallel convergent mixed methods study. The pilot intervention included providing blood pressure (BP) cuffs, antihypertensive medications, a treatment algorithm and training healthcare provider (HCP) on hypertension care. Quantitative data were collected from February 2022 to December 2022. Using the consolidated framework for implementation research, we conducted interviews with HCPs (n = 12) and PLHIV with hypertension (n = 8) to explore implementation determinants. We performed descriptive analysis for hypertension care cascades. Qualitative data identified barriers and facilitators to integrating HIV and hypertension care.

Results: Of 3802 PLHIV in care, 3502 (92%) were screened for hypertension. Among these, 290 (8.3%) had a chart diagnosis of hypertension, 282 (97.2%) were treated and 128 (50.2%) achieved BP control. Key facilitators included access to medications, BP monitors and improved provider knowledge on management of BP among PLHIV. Barriers included unsynchronised clinic visits and increased provider workload.

Conclusion: Integrating hypertension and HIV services in Ugandan HIV clinics is feasible and acceptable. Availability of resources (BP medications and monitors) and trained personnel facilitates integration of these services.

Contribution: This pilot study provides evidence that integrating hypertension care into existing PHC HIV in Uganda and other similar settings is both feasible and acceptable but may necessitate additional human resources for health.

Background: Postpartum depression (PPD) is a form of major depression that occurs after childbirth and may begin during pregnancy. It affects 10% - 20% of new mothers globally and has a relatively high prevalence in developing countries. Postpartum depression can negatively impact maternal health, child development and family well-being. In Ethiopia, there is limited evidence from the Oromia Region despite its large population.

Aim: This study aimed to assess the magnitude and associated factors of PPD among mothers attending the Batu Health Center.

Setting: The study was conducted from 11 July 2022 until 11 August 2022 in Batu, East Shewa Zone, Oromia, a regional state of Ethiopia.

Methods: A facility-based cross-sectional study was conducted among postnatal mothers who gave birth within the past 12 months. A total of 195 mothers were selected via simple random sampling. The data were analysed via Statistical Package for Social Sciences (SPSS) version 20. Bivariable and multivariable logistic regressions were conducted to identify factors associated with PPD at a significance level of p < 0.05.

Results: The prevalence of postpartum depression among the participants was 24.6%. Among those with PPD, 18.75% had thoughts of self-harm. The factors significantly associated with PPD included a history of abortion (adjusted odds ratio [AOR] = 2.574; 95% confidence interval [CI]: 1.320-5.022), a history of mental illness of the mother (AOR = 7.836; 95% CI: 3.077-12.648) and low social support (AOR = 9.325; 95% CI: 5.849-12.801).

Conclusion: This study revealed a high prevalence of postpartum depression among mothers in Batu.

Contribution: Routine screening, health professional training and public awareness efforts are essential to improve early detection and support for affected mothers in Ethiopia.

Background: Increased access to antiretroviral therapy (ART) for key populations who bear a disproportionate burden of human immunodeficiency virus (HIV) and acquired immunodeficiency syndrome (AIDS), including female sex workers (FSWs), reduces onwards transmission. This is, however, dependent on achieving high levels of adherence to ART.

Aim: To determine the level of adherence to ART and associated factors among FSWs.

Setting: An urban HIV clinic in Kampala, Uganda.

Methods: This cross-sectional study enrolled 226 FSWs accessing HIV care between May 2017 and June 2017. We assessed self-reported adherence using interviewer-administered questionnaires and reviewing medical records. We defined high-level adherence as those who scored ≥ 95% at assessment. Using multivariable logistic regression, we identified factors independently associated with adherence.

Results: Overall, 59.2% of participants were adherent to ART. Major reasons for non-adherence were being away from home (40.8%) and forgetfulness (26.7%). In the multivariable model, owning a phone (adjusted odds ratios [AOR]: 2.90; 95% confidence intervals [CI]: 1.07, 7.88), a 10-year increase in age (AOR: 1.60; 95% CI: 1.00, 2.60) and being a widow (AOR: 0.22; 95% CI: 0.05, 0.87) were independently associated with adherence.

Conclusion: This baseline assessment builds a case for the development and scale-up of targeted intervention strategies to increase ART adherence among FSWs. Incorporating information and communication technology in routine adherence counselling could be scaled up among FSWs.

Contribution: Our study highlights the possibility of integrating mobile phone-based adherence support in routine HIV care and informs the design of targeted interventions to curtail HIV transmission.

Background: Sickle cell anaemia, a major genetic blood disorder, is associated with serious complications, including oral health problems, which significantly impact daily living and health-related quality of life (QoL) (HRQoL).

Aim: To assess the impact of untreated dental caries on the QoL of children with sickle cell anaemia (SCA).

Setting: The study was carried out at the Obafemi Awolowo University Teaching Hospitals' Complex (OAUTHC), Ile-Ife.

Methods: A quasi-experimental study that included SCA children aged 8 to 16 years old with dental caries from the Paediatrics Outpatient Clinics of OAUTHC. The impact of dental caries on the oral health-related quality of life (OHRQoL) of each child was assessed pre-treatment using the Child-Oral Impact on Daily Performance (Child-OIDP) and 4 weeks post-treatment. The mean Child-OIDP scores were calculated pre- and post-treatment for the 8 different domains. A paired t-test was used to compare the difference in the mean Child-OIDP scores pre- and post-treatment. Statistical significance was inferred at p < 0.05.

Results: There were 27 children with a relatively low overall pre-treatment mean Child-OIDP score of 1.63 (standard deviation [s.d. = 3.71]), which decreased to 0.37 (s.d. = 1.21) post-treatment (p = 0.10). The mean Child-OIDP score for the eating domain was significantly reduced from 0.30 (s.d. = 0.54) pre-treatment to 0.11 (s.d. = 0.42) post-treatment (p = 0.02).

Conclusion: The overall mean Child-OIDP score was low pre-treatment, with a decline post-treatment. There was a significant reduction in the eating domain post-treatment.

Contribution: Treatment of dental caries in children with SCA will significantly improve their oral health-related QoL (OHRQoL).