Journal of Public Health in Africa最新文献

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).

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: Public health challenges in Africa stem from a complex interplay of individual, environmental, socio-cultural, and health-system factors, requiring integrated, interdisciplinary approaches to enhance healthcare systems.

Aim: This study synthesised evidence from interdisciplinary presentations at the 2025 African Voices for Research Virtual Conference to address public health challenges.

Setting: The study was based on abstracts presented in sessions of the 2025 African Voices for Research Virtual Conference.

Methods: An editorial narrative synthesis of all submitted abstracts was conducted. ChatGPT(OpenAI), supported the identification of patterns and themes, which were validated by the research team. Themes were grouped into broader categories reflecting major public health issues and potential solutions.

Results: The study showed how healthcare access, education, environmental justice, gender equity and innovation intersect in advancing Universal Health Coverage and the Sustainable Development Goals. Using Social Determinants of Health and One Health perspectives, the findings showed how infrastructural gaps, financial barriers and limited health literacy drive unequal health outcomes. Case studies on maternal health and environmental exposures highlighted the influence of socio-economic inequality and structural violence on population well-being. Gender disparities were prominent, especially among rural women facing political exclusion, violence and restricted access to care. Innovation in healthcare delivery, especially AI-enabled tools and diagnostic platforms such as GeneXpert, was recognised for its potential to strengthen health-system resilience.

Conclusion: This study offers an overview of emerging research themes from the conference and provides insight into future research priorities.

Contribution: This research highlights how healthcare access, environmental and gender inequities, and technological innovation shape population health across Africa.

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.