Journal of Public Health in Africa最新文献

Background: Maternal anaemia contributes to high maternal morbidity and adverse birth outcomes in Nigeria. Oral iron supplementation is common but limited by poor adherence, side effects and systemic barriers. Ferric carboxymaltose (FCM), a single-dose intravenous iron formulation, offers a promising alternative, yet its routine use in Nigeria remains limited. Policymakers, providers and community leaders influence adoption of health services, making their perspectives key to successful integration.

Aim: To explore stakeholder perspectives on integrating FCM for maternal anaemia into routine maternal health services.

Setting: The study was conducted in Lagos State, Nigeria.

Methods: A qualitative descriptive study was conducted. Thirty-three purposively selected stakeholders participated, representing government agencies, healthcare providers, academic institutions, non-governmental organisations, professional associations and community leaders. Participants were grouped by affiliation and roles to encourage open dialogue. Discussions followed a semi-structured guide, were audio-recorded, transcribed verbatim and thematically analysed using an inductive approach.

Results: Three interrelated themes emerged: (1) health workers are not sufficiently prepared for intravenous iron delivery but could be through sensitisation, reorientation and resourcing; (2) sociocultural and religious influences, alongside misconceptions, require targeted community engagement and (3) affordability is a barrier but could be addressed through strategic policy levers.

Conclusion: Successful integration of FCM requires investment in health system capacity, sustained community engagement and alignment with financing and policy frameworks.

Contribution: The findings illustrate how stakeholder-informed analysis can reveal the practical, cultural and financial conditions necessary for sustainable uptake of FCM, advancing understanding of how maternal health innovations can be integrated within fragmented health systems.

Background: Rotaviruses are among the most common causal pathogens of severe dehydrating diarrhoea in children. Little is known about the burden of rotavirus diarrhoea in Gabon.

Aim: This study aimed to determine the proportion of rotavirus infection in children under 5 years with diarrhoea in Lambaréné and seen at the hospital and factors associated with rotavirus infection.

Setting: The data used in this study were collected between February 2020 and February 2021 in children presenting with acute diarrhoea in the Albert Schweitzer Hospital paediatric ward.

Methods: A cross-sectional study was carried out. Stool samples were tested for rotavirus antigens using the rotavirus Standard Diagnostic (SD) BIOLINE Rota and Adeno enzyme immunoassay detection kit.

Results: A total of 178 children were included in the study. The proportion of rotavirus infection was 22% (n = 39/178; 95% confidence interval [CI]: 16% - 29%). In the multivariate analysis, the rotavirus was independently associated with dehydration (adjusted odds ratio [aOR] = 2.65; 95% CI: 1.09-6.86), vomiting (aOR = 3.15; 95% CI: 1.29-8.25), lethargy (aOR = 3.12; 95% CI: 1.16-8.71) and hospitalisation (aOR = 4.63; 95% CI: 1.7-13.65).

Conclusion: Rotavirus infection was associated with severe diarrhoea and hospitalisation. This study shows the need to integrate and support free rotavirus vaccination into the expanded vaccination programme in Gabon.

Contribution: This study provides evidence that could guide public health strategies and inform vaccine policies that could ultimately reduce the burden of rotavirus-associated diarrhoea in children.

Background: In 2010, the Barekuma Collaborative Community Development Project demonstrated concerning evidence of unmet family planning needs in the Barkese sub-district in the Ashanti region of Ghana. In 2023, Ghana Health Services requested the study be repeated to understand how the prevalence of abortions, family planning perceptions and methods used by women in this region had changed since 2010.

Aim: The aim of this study is to understand how the region's attitudes and behaviours associated with contraception have changed since 2010.

Setting: Survey participants were from 10 communities in the Atwima Nwabiagya North District.

Methods: One hundred and ninety-eight women participated in a survey with questions adapted from the 2008 Ghana Demographic and Health Survey. Once responses were collected, descriptive analysis was performed to determine trends in the use of contraceptives and reasons against the use of family planning.

Results: Seventy-six point 5 per cent of women had used at least one family planning method. Emergency contraception was the most used method ever. One hundred and forty-seven had reproductive potential. Of these women, 47.6% were currently using a method to prevent pregnancy, most commonly the rhythm (calendar) method. When asked about their latest pregnancy, 65.7% were not trying to get pregnant at that time. Fear of side effects was a common reason for avoiding use of contraceptives.

Conclusion: Compared to the 2010 study, emergency contraception replaced oral contraceptives as the most ever used method. Fewer women were currently using a method to prevent pregnancy, and unintended pregnancies occurred more frequently. The fear of adverse side effects identified in the 2010 study continues to be a major barrier today.

Contribution: This study affirms the persistence of unplanned pregnancies and limited knowledge of contraceptive side effects, indicating the need for comprehensive family planning education.

Background: This study addressed the critical gap in teachers' preventive practices regarding hypertension and diabetes, highlighting the need for workplace health interventions to improve disease prevention.

Aim: This study aimed to examine the effect of an educational intervention on self-reported preventive practices of hypertension and diabetes among teachers in selected schools in Lagos State.

Setting: The research setting comprised Lagos Island and Yaba Local Government Areas (LGAs) in Lagos State, Nigeria, both of which are historically significant and serve as key centres for education and commerce.

Methods: A quasi-experimental research design was adopted, involving an experimental group that received the intervention and a control group that did not. The study population comprised public secondary school teachers, with a total of 176 participants, selected using a multistage sampling procedure. Data were collected using a structured questionnaire adapted from the Health-Promoting Lifestyle Profile II. Descriptive and inferential statistical analyses were conducted.

Results: There was no significant difference in self-reported preventive practices between the experimental and control groups before the intervention (Cohen's d = -0.0072, p = 0.953). However, post-intervention results showed a significant improvement in the experimental group compared to the control group (Cohen's d = 12.41, p < 0.001).

Conclusion: The educational intervention implemented in this study significantly enhanced teachers' preventive practices regarding hypertension and diabetes. It recommends that schools should collaborate with health agencies to conduct routine health screenings and awareness programmes.

Contribution: This study provided empirical evidence that the educational intervention significantly improved teachers' self-reported preventive practices for hypertension and diabetes, reinforcing the need for workplace-based health promotion.

Background: Global health emergencies consistently expose and exacerbate vaccine inequities, with high-income countries prioritising their populations and leaving low- and middle-income countries (LMICs) facing delays and shortages. Diseases primarily affecting LMICs receive limited attention from global vaccine developers because of perceived low market value and limited financial return, further entrenching these disparities. Africa's limited investment in vaccine manufacturing has heightened its vulnerability during outbreaks, including yellow fever, Ebola, meningococcal meningitis, mpox, and most recently, coronavirus disease 2019 (COVID-19).

Aim: This study examines the barriers to vaccine equity in Africa and critically analyses Nigeria's post-COVID-19 efforts to establish a viable, local vaccine manufacturing ecosystem.

Setting: The research focuses on Nigeria within the broader African vaccine manufacturing landscape, using it as a case study to explore both national and continental dynamics.

Methods: The study draws on document analysis of strategic plans, regulatory reports, and partnership announcements, complemented by qualitative insights from key informant interviews with stakeholders involved in vaccine policy, regulation, and production in Nigeria and across West Africa.

Results: Post-pandemic momentum has catalysed significant shifts: Nigeria has developed a national vaccine manufacturing strategy and secured international partnerships and financing commitments. The regulatory authority, National Agency for Food and Drug Administration and Control (NAFDAC), achieved the World Health Organization (WHO) Maturity Level 3 status, marking critical progress. Nonetheless, persistent gaps remain in research and development capacity, workforce development, regulatory agility, and infrastructure readiness.

Conclusion: While Nigeria has made notable progress since the COVID-19 pandemic, sustainable vaccine manufacturing requires long-term investment in research and development, policy reform, skills development, and regional cooperation. Failure to address these challenges systematically risks undermining current gains.

Contribution: This article provides insights to support ongoing and future investments in Nigeria's vaccine manufacturing sector, guiding government policy, international partnerships, and potential investors.

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.