Journal of Public Health in Africa最新文献

Background: Little is known about attitudes towards COVID-19 vaccination in sub-Saharan Africa, where immunisation coverage is the lowest in the world.

Aim: The study aimed to identify factors associated with COVID-19 vaccine hesitancy and uptake in Cameroon, and assess changes in these factors over a period of time.

Setting: The study was conducted in the ten regions of Cameroon.

Methods: The authors conducted a two-phase cross-sectional survey in the 10 regions of Cameroon, from July 2021 to August 2021 (Phase one) and from August 2022 to September 2022 (Phase two). We analysed reasons for vaccine hesitancy descriptively and used logistic regression to assess factors associated with hesitancy.

Results: Overall, we enrolled 12 109 participants: 6567 (54.23%) in Phase one and 5542 (45.77%) in Phase two. Of these, 8009 (66.14%) were not interested in receiving the COVID-19 vaccine (n = 4176 in Phase one, n = 3833 in Phase two). The refusal rate increased significantly in the northern region from 27.00% in Phase 1 to 60.00% in Phase two. The leading contributor to COVID-19 vaccine hesitancy was fear that the vaccine was dangerous, which was significantly associated (95% confidence interval [CI], p < 0.05%) with vaccine refusal in both phases. Overall, 32.90% of participants (n = 2578) perceived the COVID-19 vaccine to be dangerous. Advanced age, male gender, Muslim religion and low level of education were associated with vaccine acceptance. Participants reported that healthcare workers were the most trusted source of information about the COVID-19 vaccine by 5005 (42.84%) participants.

Conclusion: Despite the investment of the Ministry of Health and its partners in community engagement, focussing on communication about the vaccine efficacy, tolerance and potential adverse events, fear of the vaccine remains high, likely leading to vaccine hesitancy in Cameroon between 2021 and 2022.

Contribution: The study highlight regional variations in COVID-19 vaccine acceptance in Cameroon, with factors age, gender, religion and education influencing willingness to vaccine. Trust in health workers was high, indicating that, tailored, community-led vaccination strategies are key for improving vaccine uptake, not only for COVID-19 but also for future epidemics.

Background: In 205 health facilities, mother-to-child transmission (MTCT) of human immunodeficiency virus (HIV) rates were reduced from 7.4% to 2.1% between 2017 and 2020, respectively.

Aim: To determine characteristics that potentially correlate to the change in MTCT rates between two time points.

Setting: Study was conducted in Kenya, semi-urban and rural areas.

Methods: A retrospective, cross-sectional, exploratory analysis of programme implementation at two points in time (2017 and 2020). Between 2017 and 2020, we compared over 170 mother-infant pairs where MTCT occurred to over 6000 mother-infant pairs where MTCT did not occur through the following factors: (1) location of health facilities, (2) mother and infant characteristics, (3) access to antiretroviral therapy (ART), and (4) viral load suppression. Bivariate and multivariable logistic regression models were used to identify factors associated with MTCT.

Results: Factors significantly associated with reduced MTCT rates were time points, mother's age, infant age at first test, proportions of mothers receiving ART, and maternal viral load. When restricting the analysis to the sub-counties contributing data at both time points, the results were similar; however, counties' location became significant in the updated model, as did the interaction term for mother and infant receipt of antiretrovirals (odds ratio [OR]: 0.228; p = 0.04).

Conclusion: What changed between 2017 and 2020 is a higher proportion of pregnant women living with HIV received ART. Also, unlike in 2017, in 2020, tenofovir disoproxil fumarate was the backbone of the ART regimen for the prevention of MTCT.

Contribution: The findings can potentially inform efforts on elimination of mother-to-child transmission of HIV.

Background: Studies have focused on smoking and alcohol as risk factors for colorectal cancer (CRC). Caucasians and other populations have been studied worldwide, and both smoking and alcohol have been validated as causes of CRC. However, there are limited data on the black population; studies that have been performed in Africa have not specifically focused on these two risk factors but rather in combination with other risks.

Aim: To determine how smoking and alcohol affect the incidence of CRC in the African black population.

Setting: Steve Biko Academic Hospital's gastrointestinal clinic.

Methods: Subjects used for the study included black African patients above 18 years who had undergone a colonoscopy for suspected CRC between 2016 and 2018. Cases used were confirmed CRC on histology; controls were negative on histology. A minimum of 68 cases and 136 controls were needed for this study according to sample calculation. Hundred and ten cases and 220 controls were obtained in the final analysis. Data were collected between June 2019 and March 2020.

Results: Smoking (odds ratio [OR] = 1.795, p = 0.049) was a significant risk factor for CRC among black patients who presented at the gastrointestinal clinic. Age > 50 years (OR = 3.742, p < 0.001), family history (OR = 12.457, p < 0.001), and the combination of smoking and alcohol (OR = 5.927, p = 0.008) were significant risk factors. Interestingly, alcohol alone was protective (OR = 0.205, p < 0.001).

Conclusion: Both smoking and a combination of alcohol and smoking are significant risk factors in the development of CRC in the black African population.

Contribution: Smoking, as in most population groups, is a risk factor for CRC. The observed protective role of alcohol needs to be confirmed in larger studies representing the African population.

Background: Community screening could be an effective strategy for identifying people with undiagnosed type 2 diabetes mellitus (T2DM) in low-income countries.

Aim: This study aimed to estimate the prevalence of undiagnosed T2DM and its risk factors.

Setting: This study was conducted in Ouagadougou, the capital of Burkina Faso.

Methods: This was a cross-sectional study, including consenting population (≥ 18 years). Data were collected from 11 November 2020 to 16 November 2020, in five fix sites after a 10-day information campaign on T2DM. The SD CodeFreeTM glucose analyser was used to diagnose T2DM. Multivariable logistic regression was used to identify the associate factors.

Results: A total of 1200 (95%) volunteered out of 1330 people were enrolled, which included 667 (52.27%) women. The mean age was 34.16 years (standard deviation: 12.42). Overall, 40.28% were abdominally obese and 31.43% hypertensive. The prevalence of T2DM was 10.74% (95% confidence interval [95% CI]: 9.15; 12.56). In multivariate analysis, being aged or greater than 35 years (adjusted odds ratio [ORa]: 2.30; 95% CI: 1.42; 3.72), having a family history of diabetes (ORa = 1.55; 95% CI: 1.006; 2.40), being overweight (ORa = 1.69; 95% CI: 1.09; 2.62), being obese (ORa = 1.80; 95% CI: 1.08; 3.00), being a known hypertensive (ORa = 2.92 95% CI: 1.64; 5.19) and having high blood pressure on the day of the survey (ORa = 1.86; 95% CI: 1.22; 2.85) increased significantly the probability to present T2DM.

Conclusion: Community screening is useful to identify T2DM. A national programme to control diabetes mellitus and its associated risk factors is urgently needed in Burkina Faso.

Contribution: This study will enable early detection of diabetes mellitus and its management in order to prevent or delay the onset of complications.

Background: Following the implementation of the Movement Control Order (MCO) during the coronavirus disease 2019 (COVID-19) pandemic, academicians from the universities in Malaysia needed to ensure that the quality-of-service delivery to the stakeholders is undisturbed by adopting new challenging norms. This compromises the work-life balance (WLB), causes more stress and potentially affects their quality of life (QoL).

Aim: This study investigates how perceived stress (PS) impacts the QoL of Malaysian academicians during the COVID-19 pandemic, focusing on the mediating role of WLB.

Setting: Academics working in Malaysia during COVID-19 pandemic.

Methods: A cross-sectional study, using a voluntary response sampling method, was conducted among 417 academicians from universities in Malaysia in September 2021. A self-reported online questionnaire, measuring PS, WLB and QoL, was distributed.

Results: The QoL scored a mean of 50 (standard deviation [s.d.] = 9.84), PS scored a mean of 24.26 (s.d. = 8.19) and WLB had a mean score of 51.12 (s.d. = 18.73). Work-life balance was a significant mediator of PS and QoL (β = -0.43, 95% confidence interval [CI] = -0.52 to -0.35, p = 0.0001). Perceived stress was a significant predictor of WLB (β = 1.62, p = 0.0001).

Conclusion: Institutions should consider implementing flexible working arrangements, and providing workshops on crisis management, time management, and resilience. Stress coping methods are recommended for enhancing WLB among academicians.

Contribution: This study contributes to the pool of evidence to support intervention strategies and policy recommendations aimed to enhance well-being.

Background: The Collaboration for Evidence-based Healthcare and Public Health in Africa (CEBHA+) developed and offered a course on evidence-based public health (EBPH) in five sub-Saharan African (SSA) countries to enhance individual and institutional capacity.

Aim: This study aims to assess, compare and learn from implementing the CEBHA+ EBPH course using the Reach, Effectiveness, Adoption, Implementation, Maintenance (RE-AIM) framework and Practical, Robust, Implementation and Sustainability Model (PRISM).

Setting: This study involved CEHBA+ partner universities in five countries in SSA.

Methods: We developed a framework that draws on signalling questions for RE-AIM and PRISM dimensions. Country teams reflected on, discussed and mapped unique experiences. Using this framework, we then elicited common themes across countries and distilled country-specific experiences through virtual discussions.

Results: Across countries, 130 public health practitioners, researchers and students completed the course (Reach). The course increased EBPH knowledge and skills and the capacity to teach EBPH and resulted in immediate opportunities for applying skills (Effectiveness). Hybrid offering in two countries presented challenges regarding Internet connectivity and hybrid discussions. Facilitators had previous training in teaching EBPH. While learning material was the same across countries, the content was adapted to represent local public health priorities (Implementation, Adoption). Course materials have informed other related training leading to spin-offs (Maintenance). Institutionalisation is dependent on external funding.

Conclusion: Strengthening EBPH capacity across contexts is feasible. Curricula containing both core and contextualised elements create an authentic learning environment. Formal evaluations should be embedded within capacity-strengthening initiatives.

Contribution: This is the first study evaluating EBPH training in SSA using an implementation science lens, offering learning about context-relevant adaptations that assist with plans for sustainability and scale.