Journal of Public Health in Africa最新文献

Background: The COVID-19 pandemic placed pressure on health systems, exposing workforce shortages and prompting innovative strategies to manage patients with mild to moderate symptoms. Home-based care emerged as a practical approach to reduce facility burden while maintaining quality care.

Aim: To assess the implementation and acceptability of the COVID-19 home management model in Zambia.

Setting: The study was conducted in 11 purposively selected districts with high levels of home-based management.

Methods: A comparative cross-sectional study was conducted. Data were collected in June 2023 and September 2023 from 566 individuals with confirmed COVID-19 eligible for home management, sampled systematically from health facility line lists. Descriptive statistics summarised participant characteristics, and multivariable logistic regression identified factors associated with accepting home-based care.

Results: Sixty per cent participants were female, with a median age of 28 years. Awareness of the home management model (adjusted odds ratio [AOR] = 5.11; 95% confidence interval [CI]: 2.61-10.0), income between 600 and 1000 kwacha (AOR = 2.64; 95% CI: 1.10-6.85), and perceiving the model as effective (AOR = 7.88; 95% CI: 3.56-18.3) increased odds of acceptance, while formal employment reduced it (AOR = 0.38; 95% CI: 0.18-0.78).

Conclusion: Home-based care is a strategy for easing health system pressure. Strengthening awareness and addressing socio-economic barriers could increase uptake in Zambia.

Contribution: This study contributes new evidence on the determinants of home-based care uptake within a low-resource context. The study provides actionable insights for policymakers and programme implementers seeking to strengthen community-based models of care.

Background: This study aimed to identify the clinical signs and symptoms most associated with fatal outcomes in Ebola virus disease (EVD) using a Bayesian framework.

Aim: The goal was to develop a prognostic model capable of predicting mortality in EVD patients treated in Ebola Treatment Centres (ETCs) based on observed clinical indicators.

Setting: A retrospective expert-based study of the 10th Ebola outbreak was conducted to identify key mortality factors using hypothetical cases in the Democratic Republic of the Congo.

Methods: Clinical experts assessed mortality predictors in Ebola cases using Bayesian methods to estimate likelihood ratios and post-test probabilities, with analyses conducted in Excel and SPSS.

Results: Eight clinical factors were identified as potential predictors of poor outcomes in Ebola virus disease. Five showed strong associations with mortality: deterioration in general condition and comorbidity, hemorrhagic syndrome, neurological disorders, biological deterioration with dehydration, and high viral load at diagnosis. Internal validation using 42 hypothetical cases demonstrated excellent performance (sensitivity [Se] = 97.4%, specificity [Sp] = 100.0%, positive predictive value [PPV] = 100.0%, negative predictive value [NPV] = 75.0%, accuracy = 97.6%) and strong expert agreement (κ = 0.84).

Conclusion: The model demonstrated strong internal validity in predicting mortality from Ebola virus disease. Among five key predictors, bleeding syndrome, neurological disorders, and biological alteration with dehydration were the most accurate, each correctly predicting fatal outcomes in 83% of cases.

Contribution: This Bayesian model offers a useful decision-support tool for managing Ebola outbreaks.

Background: Early initiation of breastfeeding is crucial for the survival of newborns, as it significantly reduces infant mortality rates. However, in Guinea, this practice remains below the targets set by the World Health Organization, which stated that each member country should achieve a rate of early initiation of breastfeeding of 70% by 2030.

Aim: This study aims to identify the factors associated with the early initiation of breastfeeding in Guinea.

Setting: This study was conducted in Guinea.

Methods: Multilevel logistic regression was carried out to identify the determinants of early initiation of breastfeeding. Three two-level statistical models were adjusted and the final model was obtained using a stepwise backwards approach.

Results: Only 42.8% (95% confidence interval [CI]: 39.7-46.0) of mothers reported having breastfed their newborn babies within the first hour of life. Factors associated with early initiation of breastfeeding included caesarean delivery (adjusted odds ratio [aOR] = 0.29; 95% CI: 0.16-0.53, p < 0.001), assistance at delivery (aOR = 1.62; 95% CI: 1.26-2.07, p < 0.001), the woman's employment (aOR = 1.38; 95% CI: 1.11-1.73, p < 0.003), small birth size (aOR = 0.67; 95% CI: 0.48-0.94, p < 0.023) and belonging to rich and very rich households (aOR = 1.60; 95% CI: 1.11-2.31, p < 0.011 and aOR = 2.05; 95% CI: 1.33-3.17, p < 0.001).

Conclusion: Less than half of women in Guinea initiate breastfeeding early.

Contribution: These results underline the importance of strengthening prenatal care and awareness-raising interventions to improve breastfeeding practices in Guinea.

Background: There is an increase in non-communicable diseases (NCDs) in Africa, amid a high health worker shortage, necessitating task-sharing with community health workers (CHWs). However, task sharing with CHWs may not have positive patient outcomes, as they face several challenges.

Aim: To describe the task-sharing challenges faced by CHWs in NCDs mitigation.

Setting: Studies conducted in Africa were selected.

Method: The Arksey and O' Marley Framework was used. Included articles were published in English from 2015 to 2025. PubMed, ScienceDirect, and Google Scholar were searched from 26 March 2025. Two reviewers used Covidence to select studies, and conflicts were resolved through discussions. The researchers developed the data extraction tool and used content analysis to analyse data.

Results: Articles screened by title were 189, with a final selection of 14 articles. The review found that an individual-level challenge was a lack of skills and inadequate knowledge. Organization-level challenges included a lack of supervision, a lack of equipment and infrastructure, and a poor referral system. Community-level challenges included safety concerns, poverty among community members, lack of transport, and mistrust of community health workers.

Conclusion: It is essential to capacitate CHWs through continued supervision and training, and with policies that address broader socio-economic challenges like poverty and crime in Africa.

Contribution: The study contributes to increasing the efficiency of the African CHWs by providing insights into the challenges they experience so that these challenges may be addressed.

Background: Inflammatory rheumatic diseases (IRDs) have been considered potential risk factors for COVID-19, but evidence from Africa remains limited.

Aim: To investigate the association between IRDs and COVID-19 among general patients after hospital discharge in Nairobi, Kenya.

Setting: The prospective cohort study was conducted at Mbagathi County Hospital, a major public hospital in Nairobi, Kenya.

Methods: Patients were classified as IRD and non-IRD cases based on admission diagnosis. After discharge, 348 IRD and 2951 non-IRD patients were followed up for 2 years or until death. Cox proportional hazard models adjusted for baseline characteristics were executed to predict COVID-19 hazard in patients with versus without IRDs.

Results: The cohort included 46.2% women. IRD patients were older (mean 64 years vs. 62 years; p < 0.001), more frequently alcohol drinkers (17.0% vs. 9.5%; p < 0.001), less often vaccinated against COVID-19 (74.0% vs. 78.0%; p = 0.031) and had higher body mass index (BMI) (mean 26.3 kg/m² vs. 25.3 kg/m²; p < 0.001). The 2-year COVID-19 incidence rate per 100 person-years was 4.5 (95% confidence interval [CI]: 3-7) in IRD patients and 5.0 (95% CI: 4-6) in non-IRD patients. The age- and sex-adjusted hazard of COVID-19 among IRD versus non-IRD patients was 0.9 (95% CI: 0.6-1.4; p = 0.667).

Conclusion: Inflammatory rheumatic diseases did not increase COVID-19 risk in this Kenyan cohort.

Contribution: This study provides valuable African data on IRDs and COVID-19 risk, reflecting potential regional features in clinical practice and public health strategies.

Background: Pertussis remains a public health concern worldwide, particularly in infants and young children. Despite effective vaccines, challenges persist in addressing pertussis because of barriers such as limited healthcare access, inadequate vaccination coverage and weak surveillance systems, especially in low- and middle-income countries.

Aim: To describe the demographic, geographic and seasonal distribution of pertussis cases reported in Tshwane District, Gauteng province, South Africa, from 2015 to 2019.

Setting: The study was conducted in Gauteng's Tshwane District, which has seven sub-districts with diverse demographics ranging from highly urbanised to peri-urban and rural areas.

Methods: A retrospective cross-sectional analysis of surveillance data was conducted for all pertussis cases notified in Tshwane between 1 January 2015 and 31 December 2019. Data were obtained from the district Pertussis Monitoring Database and validated against the District Health Information System. Descriptive statistics, chi-square tests and time-series analyses were applied.

Results: A total of 272 cases were reported; 46.7% occurred in infants under 1 year, with those younger than 6 months comprising 39.7%. One-third were hospitalised, mostly infants. Most notifications originated from private facilities (73.5%), and spring-summer peaks were observed. Three infant deaths were recorded.

Conclusion: Pertussis contributes substantially to the disease burden in Tshwane, particularly in early infancy. Strengthened immunisation programme, improved surveillance and equitable diagnostic access are essential to reduce morbidity and mortality.

Contribution: This study provides district-level analysis of pertussis in Tshwane, highlighting inequities in vaccination reporting and diagnostic access and informing strategies to strengthen pertussis immunisation and surveillance.

Background: The integration of services for human immunodeficiency virus (HIV) and non-communicable diseases (NCDs) has gained increasing attention in recent years because of the overlapping prevalence and shared risk factors between these health conditions. However, successful integration requires more than just the alignment of clinical practices. The role of institutional support and organisational culture in promoting effective integration remains an underexplored area.

Aim: This study aims to fill this gap by examining how institutional structures and organisational values influence the integration of HIV and NCD care.

Setting: The study setting was Nakuru County in Kenya.

Methods: This study employed a qualitative research design to capture the nuanced experiences and perceptions of healthcare providers involved in HIV and NCD care integration. A total of 99 key informant interviews were conducted with healthcare providers in levels 2 to 5 facilities in Nakuru County. The interviews lasting 45 min - 60 min were conducted sequentially. This study adopted a thematic analysis using NVivo 12.

Results: Institutional support, including an improved provider efficiency, support from top management, capacity building, availability of essential commodities, maximum use of facility space, and monitoring of outcomes, has been shown to enhance integration efforts. Additionally, a supportive organisational culture characterised by adaptivity, embracing innovative or new culture, staff empowerment to propose new strategies, teamwork and performance monitoring contributes to successful integration outcomes. These factors improve patient workflow, ensure continuity of care, reduce patient wait times and reduce stigma.

Conclusion: The findings highlight the importance of leadership commitment, resource allocation, communication, collaboration, stigma reduction and patient-centredness in achieving successful integration outcomes.

Contribution: This study contributes to the body of knowledge surrounding the integration of HIV and NCD services, providing valuable insights that can be applied in other contexts and settings aiming to enhance healthcare delivery and outcomes for individuals living with these conditions.

Background: During the COVID-19 pandemic, medical laboratory workers had a higher risk of contracting COVID-19 compared to the general population.

Aim: To assess the COVID-19 vaccine acceptance and hesitancy among medical laboratory workers in South Africa in 2022.

Setting: In South Africa among the healthcare worker population at the National Health Laboratory Service (NHLS) in 2022.

Methods: Descriptive statistics was used to identify the reasons for COVID-19 acceptance. We examined the association between COVID-19 acceptance and other socio-demographic factors using logistic regression analyses to calculate the odds ratio (OR) and 95% confidence interval (CI).

Results: The prevalence of COVID-19 vaccine acceptance among NHLS workers was 82.8%. Most of the participants reported that their reason for COVID-19 vaccine acceptance was mainly to protect their family (62.6%) and to protect themselves (50.2%), and they perceived the vaccine to be safe (40.7%). COVID-19 vaccine hesitancy was mainly because the participants reported that there was very little research done on the vaccine (41.4%) and some were worried about the vaccine side effects (31.4%). Increased COVID-19 vaccine acceptance was associated with age, 40-49 years (OR: 5.35 [95% CI: 1.42-20.10]) and 50-59 years (OR: 11.0 [95% CI: 1.63-74.92]). Decreased COVID-19 vaccine acceptance was associated with black people (OR: 0.15 [95% CI: 0.03-0.89]).

Conclusion: The prevalence of COVID-19 vaccine acceptance among medical laboratory workers was notably high.

Contribution: This study contributes to the body of knowledge on vaccine acceptance and hesitancy.

Background: Invasive fungal diseases (IFDs) are a public health issue causing morbidity and mortality in millions annually, yet they remain under-recognised.

Aim: To determine the awareness and perception of IFDs among Nigerians.

Setting: Three states in Nigeria: Lagos, Oyo and Cross River.

Methods: This was a cross-sectional study utilising multistage sampling to recruit participants who responded to an interviewer-administered questionnaire. Logistic regression was used to determine factors associated with awareness and perception of IFDs, and a p-value of < 0.05 was taken for statistical significance.

Results: One thousand two hundred and forty one participants were recruited with a mean age of 37.1 ± 16.1 years. The highest percentage had tertiary education as the highest educational attainment 538 (43.4%) and monthly household income within the lowest range of less than 30 000.00 naira ($40.00) 320 (25.8%). Awareness of IFDs was low 240 (19.3%) among the participants. Most participants 820 (66.1%) also had poor perception of fungal diseases. Tertiary education level showed higher IFD awareness (p < 0.001) than lower educational levels. Higher educational level was also associated with better perception, with secondary (p = 0.049), tertiary (p < 0.001) and postgraduate (p < 0.001) participants showing significantly better perception compared to those without formal education.

Conclusion: Awareness and perception of invasive fungal infections among the Nigerian populace were low. There is a need for public health awareness and education on IFDs in Nigeria.

Contribution: This study provides baseline data and crucially highlights a need for increased public health campaigns to improve awareness of IFDs in Nigeria.

Background: Reproductive health service maintains optimal health and reduces missed opportunities for seropositive women. But it is reported that the service uptake is not adequately recognised.

Aim: This study helped to explore healthcare providers' perceived challenges of reproductive health service utilisation by seropositive women.

Setting: This study was conducted in Addis Ababa, June 2021.

Methods: Qualitative-exploratory research design was carried out. Human immunodeficiency virus (HIV) programme representative health professionals (n = 22) were recruited through the snowball sampling method from different levels of facility and health offices. They participated in three researcher-led focused group discussion (FGD) using semi-structured guiding questions. Prior to actual FGD sessions, a pilot test was done. ATLAS.ti version 7.0 software was used for data analysis. Data visualisation, coding and thematic analysis were done consecutively.

Result: Participants' mean age was 30.14 years; 12 (54.5%) of them were nurses, and 11 (50%) of them worked for 2-4 years. Low reproductive healthcare utilisation was related to the vertical care delivery approach to HIV, lack of clear guidance for providing multidimensional care, technical skill gaps and the low caring attitude of health professionals. Another factor that lessens reproductive health use was seropositive women's fear of status disclosure, interest for only HIV care or demanding additional incentives for newly introduced care.

Conclusion: Reproductive health service is inadequately utilised by seropositive women due to several reasons and causes inefficient opportunities to care.

Contribution: This study helps for task-shifting and to design reproductive health components integration with HIV care that ensures comprehensive service to these target population.