Journal of Public Health in Africa最新文献

Background: Mortality data are critical for understanding changes in population health, detecting and monitoring diseases, guiding public health responses and evaluating interventions like human immunodeficiency viruses (HIV) prevention and treatment programmes. However, in low- and middle-income countries (LMICs), comprehensive mortality data are often hindered by a high incidence of deaths occurring outside healthcare facilities and the lack of robust data systems, creating a significant knowledge gap.

Aim: This article presents methodologies for collecting mortality data, particularly in LMICs, to provide accurate and reliable information on overall and cause-specific mortality, including HIV-related deaths.

Setting: This study explore methods that may be useful in LMICs, where mortality data systems are often ad-hoc, sub-national and incomplete.

Method: Available methods were examined for collecting mortality data and report on the strengths, weaknesses and resource considerations for each method.

Results: The analysis shows that while Civil Registration and Vital Statistics is the gold standard for mortality data collection, its implementation is challenging because of differing priorities of stakeholders, infrastructural and legal barriers. Alternative methods may provide valuable data but may have limitations in coverage and resource allocation. Integrating these methods can enhance understanding of mortality data, including for HIV-related deaths.

Conclusion: Implementing a combination of mortality data-collection methods could address gaps in mortality data in LMICs. Tailoring interventions based on these data may improve health outcomes and support HIV epidemic control efforts.

Contribution: This study could be used as a resource to ministries of health, national and international public health organisations, researchers and funding bodies as it can assist countries in selecting the mortality surveillance strategy that best fits their HIV epidemic, and available infrastructure and financial resources.

Respiratory syncytial virus (RSV) is a leading cause of severe lower respiratory tract infections (LRTIs) in young children, accounting for an estimated 94 600 to 149 400 deaths annually and over 33 million cases of LRTI. The burden is particularly acute in Africa, where limited healthcare access, malnutrition, and co-infections exacerbate outcomes. Despite the introduction of maternal vaccines, such as RSVpreF (respiratory syncytial virus prefusion F protein vaccine), and monoclonal antibodies (mAbs), such as nirsevimab, barriers including high costs, infrastructure limitations, and vaccine hesitancy hinder implementation in African settings. This article examines the challenges of RSV prophylaxis in Africa, including the economic burden of interventions, cold chain requirements, and the scarcity of robust epidemiological and surveillance data. It highlights the need for expanded molecular surveillance and localised clinical trials to ensure the safety and efficacy of these interventions. Vaccine hesitancy, rooted in historical failures such as the formalin-inactivated RSV vaccine, underscores the importance of culturally sensitive community engagement. Opportunities for advancing RSV prevention in Africa include integrating maternal vaccines into antenatal care systems, aligning vaccination schedules with RSV seasonality, and leveraging private sector partnerships. Advocacy for WHO prequalification is essential to enable global procurement and secure international funding. A dual approach combining maternal vaccines with mAbs offers comprehensive protection, particularly for high-risk infants. By addressing these challenges and leveraging available opportunities, Africa can lead efforts to reduce RSV-associated morbidity and mortality, improving outcomes for its most vulnerable populations.

Background: During health emergencies, continuity of care for non-communicable diseases (NCDs) and mental health (MH), informed by robust surveillance, is required. The COVID-19 pandemic revealed that many countries were ill-prepared in this respect.

Aim: This study assesses the effect of COVID-19 on the continuity of care and surveillance of NCDs and MH in 10 African Union (AU) member states (MS) from the onset of the COVID-19 pandemic.

Setting: The study was conducted in 10 AU MS, with two MS from each AU region.

Methods: An online cross-sectional survey was developed. Member states were selected using stratified random sampling, and individual participants were selected from the ministries of health as national NCD and MH focal persons. Responses were analysed using descriptive statistics and thematic analysis.

Results: All 10 MS responded. In two-thirds and half of participating MS, routine surveillance for NCDs and MH took place, respectively. During the COVID-19 pandemic, where data were available, several MS observed increases in NCD and MH risk factors and NCD mortality and MH morbidity. Half of the MS integrated NCDs and MH into emergency preparedness and response plans and activities.

Conclusion: The MS had varied levels of national NCD and MH surveillance practices. Where data were available, most observed negative effects on NCDs and MH during the COVID-19 pandemic. Though the integration of NCDs and MH in emergency preparedness and response planning was limited, some countries responded with innovative measures to ensure continuity of care.

Contribution: The study provides insights for improving public health surveillance and emergency response systems.

Background: Most children from low- and middle-income countries (LMICs) are at risk of poor development. Poor developmental outcomes are associated with later poor schooling and labour outcomes. Previous literature has documented a range of factors that influence children's development. However, these factors are not well established in rural settings.

Aim: The current study aims at assessing the determinants of developmental outcomes among children under 3 years.

Setting: Siaya County, Kenya.

Methods: A cross-sectional study of children under 3 years and their caregivers, attending Child Welfare Clinic (CWC) at tier 3 health facilities in a rural setting in Kenya, was conducted. A total of 149 children were randomly selected to participate in the study and had their development assessed using the third version of the Ages and Stages Questionnaire (ASQ-3). We assessed the association between ASQ-3 scores and environmental, cultural and individual-level factors in crude and adjusted linear regression models.

Results: Being married and being employed showed the strongest positive associations with child development while earning less than $100.00 per month has a negative association with children's development for individual-level factors. In addition, exposing children to opportunities for early learning had a greater effect on the child's outcomes. Also, responsive caregiving showed higher scores for children's developmental outcomes.

Conclusion: The study suggests a positive association between child development outcomes and caregivers' socio-demographic characteristics. There is also an association between responsive caregiver-child interactions and child development outcomes. Programmes that create an enabling environment for caregivers to provide a stimulating environment for their children may help children to thrive, improving their development outcomes.

Contribution: This study contributes to the body of knowledge on the important roles of caregivers in enhancing their children's optimal development.

Background: Neonatal mortality is still a significant global public health issue and most of these deaths occur in sub-Saharan Africa. Despite extensive government and nongovernment campaigns, the neonatal fatality rate in this region remains unacceptable.

Aim: This review evaluates the efficacy of educational resuscitation interventions on the knowledge and skills of nurses and midwives about newborns resuscitation.

Setting: Knowledge and skills of nurses and midwives about newborns resuscitation in sub-Saharan Africa.

Method: The review followed Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) standards and used the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) system to evaluate the quality of evidence from the included studies. A search was conducted across seven databases from 2000 to 2024. A cumulative number of 912 studies were retrieved. The review protocol was registered in PROSPERO (CRD42022332734).

Result: The final selection comprised 16 articles. An average grading score of 2.4, suggesting low to moderate evidence. The programmes included the Basic Emergency Obstetrics and Newborn Care training, the Helping Babies Breathe (HBB), the UK Resuscitation Guidelines, the American Heart Council Guidelines, the American Neonatal Resuscitation Program and the Safe Delivery Application. The intervention resulted in considerable improvements in resuscitation knowledge and skills.Conclusion: This review has demonstrated the importance of providing nurses and midwives with training in neonatal resuscitations, as well as the substantial impact it has on the reduction of neonatal mortality rates.

Contribution: This study highlights the need for high-quality data and prioritise locally and culturally acceptable interventions to reduce neonatal mortality in sub-Saharan Africa.

Background: COVID-19 and tuberculosis (TB) were the top two leading causes of death from a single infectious agent in 2022.

Aim: This study aimed at assessing COVID-19 knowledge, attitude, and practices (KAP) and their associated factors among pulmonary TB patients and healthy individuals in Yaoundé, Cameroon.

Setting: The study was conducted at the Jamot Hospital in Yaoundé, a main referral hospital for TB management in Cameroon.

Methods: A cross-sectional design was used to recruit a consecutive sample of TB patients and healthy participants at Jamot Hospital and communities in Yaoundé, Cameroon, from April 2022 to March 2023. Data on socio-demographic characteristics and COVID-19 KAP were collected and analysed using logistic regression with significance considered at p < 0.05.

Results: Out of 409 participants, 67.5% had good knowledge, 54% had a favourable attitude, and 22.5% had good practices towards COVID-19. Multivariate analysis identified TB status, age, sex, and marital status as significant factors influencing KAP scores. Good knowledge and good practices were associated with being healthy, young, and single (p < 0.05). In addition, the female gender, good knowledge, and favourable attitudes were associated with good practices (p < 0.05).

Conclusion: Gaps in COVID-19 KAP among TB patients highlight the need for targeted public health interventions, with a focus on TB patients, males, the elderly, and married individuals for better control.

Contribution: Tuberculosis patients are not adopting positive prevention practices as required, thus increasing their risk of getting COVID-19 and transmitting TB, necessitating urgent action.

Background: Pneumonia is the primary infectious cause of mortality in children under five, with approximately 800 000 deaths annually in low-income settings. In Kenya, pneumonia accounted for 16% of child deaths in 2022. Good treatment outcome relies on efficient referral system and timely hospital access. However, monitoring referral completion remained challenging in Endebess hospitals.

Aim: To assess determinants and key barriers to utilisation of community referral system.

Setting: Seven public hospitals in Endebess sub-County in Kenya.

Methods: This mixed-methods study involved 273 caregivers, 24 health personnel, 40 Community Health Volunteers (CHV's) and 4 Community Health Assistants. Data were collected using questionnaires and interviews. Quantitative analysis used Statistical Package for Social Sciences Version 22 (Chi-square, logistic regression; p < 0.05). Qualitative data were analysed using thematic analyses.

Results: Overall, 112 caregivers (41%) were referred. However, only 19 referral forms (17%) were filed at hospitals and 10 children (52.6%) recorded in service delivery logbook. Referral completion was significantly associated with distance to the hospital (p = 0.021), whether a CHV had accompanied the patient (p = 0.002) and household income (p= 0.040). Caregivers with self-help group savings were more likely to visit the hospital within 24 h of referral (p = 0.002, OR [odds ratio] = 3.8, 95% CI [confidence interval] = 1.639-8.813) than those without savings.

Conclusion: Utilising CHV diaries and household registers improves referral completion, highlighting the need for digital integration to strengthen data concordance.

Contribution: This study informed policymakers on strengthening community referrals by emphasising CHV report verification, mentorship on documentation and ensuring referral completion.

Background: Non-communicable diseases (NCDs) among people living with human immunodeficient virus (HIV) are emerging and a leading cause of death in this population.

Aim: To identify disease trends, prevalence and outcomes of NCDs among PLHIV.

Setting: The study was conducted in Manicaland province.

Methods: We reviewed secondary data from October 2013 to September 2023. Data on five priority NCDs were analysed: hypertension (HPT), diabetes mellitus (DM), chronic kidney injury (CKD), cancers and chronic respiratory conditions (CRC). Kaplan-Meier analysis and Cox proportional hazard analysis were performed, risk and hazard ratios reported at the 95% confidence level.

Results: A total of 974 patient files were reviewed. The median age was 43 (Q1 = 35; Q3 = 51) years. A total of 409 (42.0%) were males and 565 (58.0%) were females. A total of 94 (9.7%) patients had HPT, 76 (7.8%) had DM, 6 (0.6%) had CKD, 9 (0.9%) had cancer and 3 (0.3%) had CRC. Controlling for age, gender and medication use, being on ART for more than 5 years and ageing were hazards to DM and HPT. Protease inhibitor-based regimen was a hazard to DM (hazard ratio [HR] = 4.66, 95% CI: 2.54-8.54, p < 0.001). Efavirenz-based regimen was protective in development of HPT (HR = 0.47, 95% CI: 0.26-0.83), p = 0.01.

Conclusion: Hypertension and DM are the most common NCDs among people living with HIV. Prevalence of HPT and DM increased with age and duration on ART. To minimise complications related to NCD and HIV comorbidities, we recommend regular screening of NCDs at least monthly, and personalising treatment for hypertensive patients to efavirenz based regimens. We educated people living with HIV about the risks of NCDs and importance of healthy eating and regular exercise.

Contribution: Integrated NCD and HIV care models.

Background: Women continue to be underrepresented in science, technology, engineering, mathematics and medicine (STEMM), globally including in Africa and, indeed in Zimbabwe. The gender gap, absence of formal research mentorship and the male-dominated academic culture common among low- and middle-income countries makes scientific growth dire for Africa- and Zimbabwe-based female science researchers.

Aim: To address some of these challenges, a group of researchers (90% female) created the African Excellence in Research Initiative (AFRIESEARCHI) Zimbabwe Gender in STEMM Mentorship Programme.

Setting: Public universities and research institutions in Zimbabwe.

Methods: The team crafted a research mentorship curriculum, informed by stakeholder engagement and needs assessment, and piloted it from October 2021 to December 2022.

Results: The inaugural 12-month programme capacitated 30 members (80% female) with skills for research. The participants' mean age was 42.5 (6.9) years, with minimum qualifications of Master's degrees. Specifically, 5 (17%) members either registered for or graduated with doctoral degrees, 14 (50%) members completed visiting fellowships. Five individual projects were awarded grants all totalling over $300 000.00, while this mentorship project was shortlisted for the Free STEM Fund award (€50 000.00) for the 2022-2023 cycle. Half of shortlisted team members were selected for the competitive Zimbabwean Emerging Faculty Development Program. Almost 90% of participants were satisfied with their mentorship experience, although resources and time were needed.

Conclusion: Despite challenges, the team resolved the need to prioritise formalised research mentorship, within the Zimbabwe setting.

Contribution: Such efforts will enhance scientific growth for women (and indeed all academic researchers) in the sciences.