Journal of Public Health in Africa最新文献

Background: In Western Africa, the causal relationship between hydropower project implementation and malaria transmission, remains understudied.

Aim: This study assesses whether a causal correlation exists between hydropower development and malaria transmission outcomes across locally affected communities, using malaria incidence and prevalence as key indicators. Malaria incidence is measured as the number of clinical Plasmodium falciparum cases per person, while prevalence is the parasite rate of P. falciparum in children aged 2-10 years. The analysis focuses on P. falciparum given its severity across West Africa, along with the availability of consistent geospatial data.

Setting: The study was conducted in Ghana, Côte d'Ivoire, and Gabon.

Methods: Utilising multivariate Difference-in-Differences (DiD) regression models and geospatial analysis across pre- and post-dam periods, this study evaluates malaria outcomes within 15 km of hydropower sites.

Results: The DiD estimator (Treatment_Post variable) suggests no statistically significant increase in malaria transmission following hydropower project implementation. Estimated effects are insignificant in Côte d'Ivoire (incidence: p = 0.210, prevalence: p = 0.200), Gabon (incidence: p = 0.990, prevalence: p = 0.990), and Ghana (incidence: p = 0.089, prevalence: p = 0.102), indicating no strong causal link at the 5% level. By contrast, environmental and socio-economic variables such as urbanisation, elevation, and climate factors consistently showed strong associations with malaria transmission (p < 0.01).

Conclusion: Hydropower presence alone is not a primary driver of malaria dynamics.

Contribution: This study provides the first large-scale geospatial analysis of malaria trends across hydropower projects in Western Africa, challenging traditional assumptions of a direct causal link and highlighting the need for interventions shaped by environmental and socio-economic factors.

Background: Internet addiction (IA) is prevalent among Nigerian undergraduates. This study seeks to explore the broader mental health consequences of IA among diverse groups of students in Nigerian universities.

Aim: This study aims to assess the prevalence of IA among undergraduates in Lagos State and examine its relationship with health conditions such as depression, anxiety and stress.

Setting: The research was conducted in three public tertiary institutions in Lagos State, involving 830 undergraduates aged 18-24 years.

Methods: This cross-sectional study used a structured questionnaire, incorporating the Internet Addiction Test (IAT) and the Depression, Anxiety and Stress Scale (DASS-21). Chi-square tests determined associations and logistic regression identified predictors of IA. Data analyses were performed using IBM^® SPSS 25.0.

Results: The prevalence of IA was 73.3%. Certain critical predictors of IA emphasised the role of institutional affiliation, living arrangements, purpose and timing of use and duration of daily internet engagement. There were positive correlations between IA and depression (r _s = 0.368), anxiety (r _s = 0.359) and stress (r _s = 0.401).

Conclusion: The study found a high prevalence of IA among undergraduates, with significant associations with depression, anxiety and stress.

Contribution: The findings underscore the need to raise awareness about IA and also highlight the need for context-sensitive, evidence-based interventions and for universities and policymakers to implement strategies that aim at promoting healthier internet usage, improving mental health services and raising awareness of the risks associated with excessive online activities.

Rabies is a fatal neglected tropical zoonotic disease caused by neurotropic viruses of the genus Lyssavirus in the family Rhabdoviridae. We report the disease progression in a 30-year-old woman, in her eighth pregnancy, living with human immunodeficiency virus (HIV) on antiretroviral therapy (ART), who presented with neurological symptoms including aggression, restlessness, fever and vomiting 20 days following rabies exposure through multiple dog bites on the face and upper limbs. She had received a 4-dose regimen of rabies post-exposure prophylaxis (PEP), starting 2 days after exposure, with subsequent doses given 3 and 7 days later, while the 4th dose was administered 20 days after exposure. Wound washing was not performed, and rabies immunoglobulin was not administered as recommended by the World Health Organization for category 3 exposures. The disease rapidly progressed to rabies encephalitis, leading to death within 6 days of admission. Reverse transcriptase polymerase chain reaction (RT-PCR) performed on cerebral spinal fluid (n = 3) and nasopharyngeal swabs (n = 2) confirmed the diagnosis of rabies infection. Although the incubation period and symptomatology did not significantly deviate from documented classical cases, a compromised immunity evidenced by a low cluster of differentiation 4 (CD4) T-cell count of 382, coupled with non-adherence to recommended best practices for wound management and PEP administration, may have influenced the rapid disease progression. This case reveals the need for capacity building in health workers and the community to improve knowledge of rabies post-exposure response in Africa.

Background: Excess body weight was associated with a higher chance for hypertension detection.

Aim: To compare the anthropometric characteristics and blood pressure levels between Burkinabè adults who had ever been screened for hypertension and those who had never been screened, and to assess the associated factors with the uptake of hypertension screening.

Setting: Urban and rural Burkina Faso.

Methods: This was a secondary analysis using the Burkina Faso 2013 WHO Stepwise approach to Surveillance cross-sectional survey. Data from 3831 adult men and women were analysed. Descriptive and analytical analyses were performed using Student's t, ANOVA, ^{χ 2}, Fisher's exact tests and logistic regression.

Results: Among participants, 41.6% (95% CI: 40.0-43.1) had never been screened for hypertension, and compared to those who had ever been screened, they had significantly lower mean weight, waist circumference and body mass index, and lower prevalence of overweight or obesity and abdominal obesity. The prevalence of prehypertension was similar between the two groups (around 40%) and the prevalence of hypertension was lower in those who had never been screened (17.3% vs 20.8%; p = 0.007). Overweight or obesity (adjusted odds ratio [aOR] = 1.3; p = 0.03) and abdominal obesity (aOR = 1.3; p = 0.002) were associated with screening uptake.

Conclusion: The Burkinabè adults who had never been screened for hypertension were apparently thin, but pre-hypertension or hypertension was also common among them. Increasing body size (excess weight or abdominal obesity) may be the reason for screening uptake.

Contribution: Specific awareness-raising messages to motivate slim people to undergo screening need to be developed.

Background: South Africa has the world's largest human immunodeficiency virus (HIV) pandemic. Most service gaps for cluster of differentiation 4 (CD4) testing were previously addressed.

Aim: This study aimed to assess the impact of a tiered service on interlaboratory referral distances.

Setting: Data are reported for CD4 testing that are referred from a national network of laboratories.

Methods: Test volumes were extracted for source and testing laboratories from 2012 to 2021. The Euclidean distances (EDs) were calculated, with the annual and provincial medians reported and categorised (50 km, 51 km - 99 km, 100 km - 199 km, 200 km - 299 km and ≥ 300 km). The relationship between ED, referrals and turnaround time (TAT) was analysed. The change in the provincial median ED between 2012 and 2021 was calculated.

Results: Data included 14 487 006 referrals. The median ED ranged from 55 km to 60 km. An ED category of 51 km - 99 km, 100 km - 199 km, 200 km - 299 km and ≥ 300 km was reported for 35.1%, 13.2%, 3.5% and 0.3% of the specimens. A negative linear correlation was reported for ED with referral volumes (-0.1540) and TAT (-0.2305). The provincial median ED ranged from 16 km (Gauteng) to 186 km (Northern Cape). Excluding the Northern Cape, a provincial ED of ≤ 100 km was reported. The percentage change in median ED between 2012 and 2021 ranged from -55.7% (Free State) to 0.8% (Mpumalanga). Two source laboratories reported a median ED > 300 km in 2021 (Springbok and Beaufort West).

Conclusion: The study's findings indicate that the decentralisation of services reduced the national median ED to below 60 km.

Contribution: The tiered implementation improved accessibility, however, some coverage gaps still remain.

Background: The use of psychoactive substances is a growing global public health concern because of its high prevalence and associated risks of morbidity and mortality. In the Eastern Mediterranean Region (EMRO), this issue is particularly pressing among medical students, as it can impact their academic performance, mental health and future professional behaviour.

Aim: This systematic review and meta-analysis aim to determine the prevalence and patterns of psychoactive substance use among medical students in the EMRO region.

Setting: Studies conducted in the EMRO region were included in the analysis.

Method: A systematic search was conducted in PubMed, Scopus and Web of Science, identifying eligible studies. A random-effects model was used to estimate pooled prevalence rates, and meta-regression was performed to assess factors influencing prevalence variation.

Results: Ten studies were included in the study. The pooled prevalence of alcohol consumption among medical students was 9.52% (95% confidence interval [CI]: [4.82-17.93]), which decreased to 5.92% (95% CI: [4.59-7.60]) after removing outliers (I ² = 81.3%). Meta-regression indicated that studies with sample sizes above 500 reported lower prevalence than smaller studies (β = -1.55, 95% CI: [-2.89; -0.21]). The pooled prevalence of illicit drug use was 9.89% (95% CI: [4.67-19.75]) and 7.78% (95% CI: [3.71-15.58]) after outlier removal.

Conclusion: Substance use among medical students in the EMRO region remains a significant concern.

Contribution: This study highlights the urgent need for preventive strategies to raise awareness and promote healthier behaviours among medical students.

Background: Sub-Saharan Africa has a high prevalence of sexual violence in young women, with less data on young men.

Aim: We investigated the prevalence of forced sex among adolescents and young people and described factors putting them at risk of sexual violence.

Setting: The study was conducted in South Africa, Uganda and Zimbabwe.

Methods: We conducted a cross-sectional, structured survey among 1330 13-24-year-old male and female participants. Logistic regression models were used to estimate odds ratios for associations with forced sex, adjusting for site, sex and age. Sixty in-depth interviews and 24 group discussions were also conducted. Data were transcribed, translated and analysed using thematic framework analysis.

Results: Seventy-six out of 1326 participants (6%) reported forced sex in the last 6 months. Forced sex was most commonly reported in Entebbe versus other sites, female than male participants, and 18-24 years than 13-18 years. Associations were seen with younger sexual debut (adjusted odds ratio [aOR]: 0.89; 95% confidence interval [CI]: 0.81, 0.98), ever having transactional sex (aOR: 2.18; 95% CI: 1.19, 4.02), risk-taking (aOR: 3.51; 95% CI: 1.99, 6.19), depression (aOR: 3.20; 95% CI: 1.69, 6.06), anxiety (aOR: 2.07; 95% CI: 1.08, 3.96) and binge drinking (aOR: 2.66; 95% CI: 1.33, 5.36), and strong association with forcing someone to have sex (aOR: 7.54; 95% CI: 3.68, 15.46). Qualitative data support these results.

Conclusion: Our findings identify risks similar to those for sexual violence.

Contribution: We suggest protection strategies to police times and places of risk are developed, and addressed in economic and legal country specific guidance.

Background: In 2024, type 2 diabetes mellitus (T2DM) - a public health challenge - affected 589 million adults worldwide. In South Africa, the prevalence is estimated at 15%, contributing to approximately 3.4 million deaths. Achieving optimal glycaemic control in patients is challenging, resulting in preventable complications and deaths. Systemic reforms and targeted interventions are urgently required.

Aim: To identify barriers faced by healthcare professionals (HCPs) to effectively manage patients with T2DM.

Setting: A survey was conducted in the Tshwane Metropolitan Municipality, Gauteng province, South Africa.

Methods: The study involved 205 HCPs across 22 clinics and 6 community health centres from May 2022 to June 2022. Data were analysed descriptively. Categorical variables were compared using Fisher's exact test and a p-value of < 0.05 was considered significant.

Results: Most participants were nurses (84%), < 50 years (65%), female (87%), black people (64.7%), and > 10 years experience (65%) and had academic and in-house training on T2DM (38.5%). Key barriers faced by HCPs in managing patients with T2DM included workload making it difficult monitor patients (53%) and screen for complications (57%), time pressures to deliver quality care (59%) and educate patients (69%), inadequate insulin initiation knowledge (68%) and lack of continuity of care (62%).

Conclusion: Excessive workloads, insufficient staffing, time pressures, insulin inertia, and knowledge gaps - impede the delivery of personalised care, patient education and monitoring.

Contribution: Addressing these challenges will require collaborative care models, workforce optimisation, targeted training, better resource allocation and health technology and can significantly improve patient outcomes and alleviate burden among HCPs.

Background: In Cameroon, the prevalence of hepatitis B in the general population is 10%, and the vaccination coverage is less than 15% among adults. Although 80% have heard about the disease, only 50% know the modes of transmission and prevention of hepatitis B virus (HBV).

Aim: To assess the knowledge, attitude and practice (KAP), sensitise the population and identify new cases of hepatitis B.

Setting: Rural and urban areas of the Centre and South West Regions in Cameroon.

Methods: An observational cross-sectional study was carried out from 2021 to 2023 on the general population to determine the HBV, seroprevalence and assess awareness of hepatitis B. We used modified Bloom's cutoff to define KAP categories.

Results: Seven hundred and fifty-nine and 456 persons gave consent to participate in the KAP and sero-surveys, respectively. About 20.4% (n = 155/759) of participants had never heard of hepatitis B. Among the 604 participants who had heard, 52.2% (n = 315/604) did not know at least one transmission route. However, 56.8% (n = 343/604) knew the hepatitis B vaccine, yet the vaccination coverage was 5.1% (n = 39/759). Furthermore, 69.5% (n = 420/604) had been tested at least once, 71.0% (n = 429/604) had inadequate knowledge and 68.7% (n = 415/604) had unfavourable practices. An association was observed between knowledge and practice, with an odds ratio of 4.1. HBV seroprevalence was 8.3%.

Conclusion: Poor knowledge and lack of access to reliable information enhance the spread of hepatitis B. This propagation could be mitigated through sensitisation, voluntary counselling and testing (VCT) to identify new cases.

Contribution: Highlights community-engaging initiatives to sensitise, test, prevent and treat hepatitis B.

The nomenclature of monkeypox disease has been changed to mpox, and the clades of the causative virus have also been changed in keeping with international best practices. We commend the World Health Organization for its efforts in this regard while drawing attention to the need for a change in the name of the monkeypox virus. The continual use of the viral nomenclature can be considered stigmatising, discriminatory and inaccurate.