Journal of Public Health in Africa最新文献

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.

[This corrects the article DOI: 10.4102/jphia.v16i4.1348.].

Background: Tuberculosis (TB) is one of the leading causes of death globally because of a single infectious pathogen. The rise in prevalence of multi-drug-resistant tuberculosis (MDR-TB) puts an increased burden on the health system in terms of cost and longer treatment duration. People living in correctional facilities are more likely to develop TB and have poor TB treatment outcomes than the general population, making them a vulnerable group to develop MDR-TB. However, the burden of MDR-TB and associated treatment outcomes among prisoners in sub-Saharan Africa (SSA) is poorly documented.

Aim: The study aims to investigate the burden and associated factors of MDR-TB treatment among prisoners in SSA.

Setting: The review will include studies of MDR-TB done in prisons and detention centers involving prisoners and inmates in sub Saharan Africa.

Methods: Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PROSPERO), we will conduct a systematic review and meta-analysis. We will review studies examining MDR-TB patient treatment outcomes among prisoners reported in published literature in SSA from 2000 to 31 December 2024. A search on studies reporting MDR-TB treatment outcomes from the databases such as 'Medline, Embase, CINAHL (EBSCOhost), Scopus and Web of Science' will be conducted. We will analyse continuous outcomes as mean differences for studies using the same scales with standard deviation reported and binary outcome data as odds ratios or risk ratios, all presented with their 95% confidence intervals. Additionally, the pooled proportions will be used to determine the prevalence or incidence of specific MDR-TB treatment outcomes. Heterogeneity will be assessed using the I ² statistic, and where significant heterogeneity is detected, a random-effects model meta-analysis will be performed; otherwise, a fixed-effect model meta-analysis will be carried out. Risk factors will be determined using the meta-regression analysis technique.

Results: After analysis of pooled data, prevalence of MDT-TB in prisons will be presented as proportions. Meta-analysis outcome will be presented as forest plots, showing odd ratios and co-responding 95% confidence intervals. Narrative synthesis of included studies will be presented in a table format.

Conclusion: This proposed systematic review and meta-analysis will help consolidate evidence to support the development of public health guidelines to enhance the reduction of MDT-TB factors among prisoners in the SSA region.

Contribution: This review will provide evidence to support guideline development on screening, diagnosis, and clinical management of MDR-TB patients in prisons.

Background: Schistosimiasis affects over 250 million people globally. It is considered a moderately endemic condition in South Africa, with 36 people per 100 000 infected annually between 2011 and 2018. Despite its ability to cause long-term complications, it remains under-studied in Gauteng Province, and its epidemiological patterns are poorly understood.

Aim: To describe the prevalence and trends of human schistosomiasis from 2017 to 2022.

Setting: Gauteng Province, South Africa.

Methods: A descriptive cross-sectional study was conducted using all clinical and laboratory human schistosomiasis cases in Gauteng Province from 2017 to 2022. Descriptive statistics summarised cases. Annual trends, seasonal patterns, and geographic distribution were assessed. Yearly incidence rates and overall provincial prevalence were estimated per 100 000 population.

Results: There were 2526 human schistosomiasis cases recorded. The median age was 28 years (interquartile range [IQR]: 19-42), and men aged 10-19 years were most affected (15%). Cases declined by 37 per year over the study period, with seasonal peaks in February-March and August-September. The highest incidence occurred in 2019 (3.83 cases per 100 000). City of Tshwane Metropolitan and Mogale City had region-specific prevalence of > 25 cases per 100 000; overall provincial prevalence was 15 cases per 100 000.

Conclusion: Enhanced surveillance, strengthened reporting, targeted awareness and preventative measures in vulnerable communities are recommended to reduce transmission. Ongoing research is crucial to inform evidence-based interventions in Gauteng Province and South Africa.

Contribution: The study identified key demographic patterns, geographic hotspots, and temporal trends of human schistosomiasis cases in Gauteng Province.