Journal of Public Health in Africa最新文献

Background: Effective preparedness is essential to safeguard healthcare workers (HCWs) and strengthen outbreak response. The 2022-2023 Ebola virus disease (EVD) outbreak in Uganda exposed critical gaps in healthcare preparedness, with HCWs accounting for 13.4% cases and 12.7% deaths.

Aim: The study assessed preparedness of HCWs in public health facilities in Mubende and Kassanda districts, Uganda for EVD containment.

Setting: The study was conducted in 16 public health facilities in districts severely affected by the 2022-2023 EVD outbreak.

Methods: A cross-sectional study was conducted in May 2024 and June 2024 among 376 HCWs. Preparedness was assessed based on knowledge, infection prevention and control practices (IPC) practices and attitudes towards EVD containment. Data were collected using self-reported structured questionnaires. Preparedness was determined using median split. Logistic regression analysis was performed in STATA, and 95% confidence intervals (CIs) were calculated to assess statistical significance.

Results: One hundred and fifteen (30.6%) HCWs met preparedness criteria. A total of 295 HCWs (78.5%) could not correctly don personal protective equipment (PPE), while 258 (68.6%) could not correctly doff PPE. The HCWs with degree or higher had higher odds of being prepared (adjusted odds ratio [aOR]: 4.55, 95% CI: 1.26-16.45) compared to those with lower qualifications. Similarly, HCWs with 11-15 years of experience had higher odds of being prepared compared to those with fewer years (aOR: 3.47, 95% CI: 1.12-10.07).

Conclusion: Overall preparedness among HCWs was low. This highlights the need for continuous professional development and routine practical training on PPE use including donning and doffing procedures.

Contribution: Findings provide evidence to guide targeted interventions for improving HCW preparedness for future EVD outbreaks.

Background: Oral health often receives low priority in fragile countries like Sierra Leone (SL), which have constrained health systems and resources.

Aim: To explore both normative and perceived oral health needs of adults in SL to guide strategies for the development of future oral health programmes and services.

Setting: This study was conducted across all four regions of SL.

Methods: This study utilised a self-completion questionnaire exploring access to dental care, oral hygiene practices, diet, risk behaviours, general and dental health and oral health-related quality of life. Clinical examinations used the International Caries Detection and Assessment System (ICDAS) and the PUFA (pulp, ulcer, fistula, abscess) Index, among other tools. Descriptive statistics summarised key variables, while bivariate analyses explored associations using STATA and Statistical Package for Social Sciences (SPSS).

Results: One hundred and sixty one participants aged between 19 years and 70 years (mean = 35.6 years) completed the questionnaire survey. Two-thirds (75%, n = 121) reported having 'never been to a dentist', 40% (n = 62) experiencing toothache and 68% (n = 82) consuming one or more sugary items at least once a day, particularly males. Urban participants reported good dental health (63%), while 17% - 29% of rural participants reported significant impacts on daily life due to oral health issues. Of the 45 participants who underwent a clinical examination, 84% (n = 38) had cavitated dental caries into dentine with over five heavily diseased teeth on average (D_5-6MFT = 5.2).

Conclusion: This survey suggests a high level of perceived need and untreated dental disease among participating adults, limited dental care access, notable sugar consumption and significant impacts on quality of life.

Contribution: This study highlights the necessity for a national-level adult dental health survey to better inform the planning of oral health services in support of adults in SL.

Background: Climate change has significant health implications, disproportionately affecting Africa because of its limited adaptive capacity and socio-environmental vulnerabilities. Malaria, a climate-sensitive disease, is a major public health concern. Climate change influences malaria transmission by altering vector behaviour, parasite life cycles and environmental conditions.

Aim: To identify, map and analyse evidence on the relationship between malaria and climate change in Africa.

Setting: The study examined institutional and community-based studies conducted in the African region.

Method: A systematic review of studies published between January 2010 and December 2024 was conducted across PubMed, Scopus, African Index Medicus and Embase using keywords related to climate change and malaria. Thematic analysis was applied to synthesise patterns and trends.

Results: Ninety studies were included. Findings demonstrate that slight temperature increases significantly impact malaria transmission by accelerating mosquito vector and parasite development. Changes in rainfall patterns, whether excessive or diminished, affect mosquito breeding sites, leading to fluctuations in malaria incidence. Regional variations highlight the need for localised interventions.

Conclusion: Climate factors are crucial in malaria prevalence and distribution in Africa. As climate shifts alter mosquito populations, traditional interventions, such as chemical spraying, may become less effective. Integrating ecological data into malaria control strategies ensures interventions remain effective under changing climatic conditions. Strengthening climate-responsive policies will be pivotal in malaria reduction and elimination efforts.

Contribution: This review offers a comprehensive synthesis of climate-malaria interactions, providing insights for policymakers and researchers to develop climate-informed malaria control strategies tailored to Africa's diverse ecosystems landscapes.

Background: The re-emergence of the diphtheria outbreak in Nigeria raises concern about the surveillance system's capability to detect, prepare for and respond to outbreaks.

Aim: To evaluate the usefulness and attributes of the diphtheria surveillance system in Kaduna State, Nigeria.

Setting: Kaduna State, northwest Nigeria.

Methods: An observational study, using a mixed-method approach, was adopted. It comprised a survey, a record review of the 2023 outbreak and key informant interviews. A pre-tested semi-structured self-administered questionnaire and an interview guide, adapted from the Centres for Disease Control and Prevention (CDC) (2001) guidelines on surveillance evaluation, were utilised. Three stakeholders were interviewed, 21 surveillance officers were surveyed, and eight surveillance attributes were assessed.

Results: The outbreak data had 67% (n = 382/573) missing values. Eighty-two per cent (n = 432/525) of cases had an investigation initiated within 48 hours. All 21 (100%) respondents reported ease in filling in forms and a willingness to continue participating in the system, which could correctly identify cases. Twelve (57%) of the 21 respondents stated that private health facilities submitted their reports. Of the 12 respondents who reported modifications in the system, six (50%) stated < 1 month for implementation. Nineteen (90%) of the 21 respondents reported inadequate resources, while six (67%) of the nine respondents who reported receiving stipends indicated these were provided by partner organisations.

Conclusion: The system was acceptable to stakeholders, useful in detecting outbreaks, simple in data collection, flexible in accommodating changes and sensitive in identifying cases. However, resource constraints pose a threat to its stability. We recommend providing adequate resources, improving data quality and reporting from private health facilities.

Contribution: The study underscores areas for improvement in the diphtheria surveillance system, highlighting the potential for targeted interventions to overhaul the system.

Background: Gestational diabetes mellitus (GDM) represents a significant global public health challenge, posing substantial risks to both maternal and foetal health.

Aim: This study analysed risk factors, follow-up, management approaches and obstetric complications in pregnant women with GDM.

Setting: This study was conducted in Southern Morocco.

Methods: This multicentre retrospective cross-sectional study analysed 297 patient files (n = 120 with GDM) from four maternity hospitals (2019-2023). Data were collected via a standardised form. Statistical analysis included descriptive summaries, group comparisons (Chi-square, Fisher's t-test, Mann-Whitney U) and logistic regression to calculate odds ratios (ORs) using SPSS version 27.

Results: Gestational diabetes mellitus screening was inconsistent: only 17% (95% confidence interval [CI]: 11.5% - 25.6%) of women were screened before 24 weeks of amenorrhea, and 38% (95% CI: 29.8% - 47.5%) between 24 weeks and 28 weeks. The oral glucose tolerance test 75 g was not used. Gestational diabetes mellitus was significantly associated with caesarean delivery (OR = 2.52; 95% CI: 1.29-4.92; p = 0.007 and preeclampsia 5.95 (95% CI: 1.21-29.21; p = 0.028). Risk factors for GDM included maternal age over 35 years and obesity (body mass index [BMI]: ≥ 30). A history of prematurity showed a significant association with GDM, with adjuster OR (aOR) of 3.47 (95% CI: 1.36-8.79; p < 0.011).

Conclusion: Preventing maternal complications from GDM relies on raising women's awareness about the importance of screening and monitoring during pregnancy in Southern Morocco.

Contribution: This study highlights the necessity of strengthening GDM screening and targeted management strategies for at-risk pregnant women in Morocco, particularly in the southern region.

Background: Adolescent sexual intercourse in schools is a common phenomenon.

Aim: This study analysed the prevalence and contributing factors of sexual intercourse among adolescents attending school in Guinea.

Setting: This study was conducted in Guinea (Conakry).

Methods: This was an analysis of the secondary data from a survey of adolescents in secondary schools in Guinea. A sex-stratified logistic regression analysis was performed. Adjusted odds ratios (AORs) and its 95% confidence intervals (CIs) were reported. The significance level was set at 0.05.

Results: The overall prevalence of sexual intercourse among adolescents of school-age in Guinea was 35.2%. The sexual intercourse prevalence rate was 42.4% (95% CI: 40.4-44.4) among boys and 32.7% (95% CI: 31.6-33.9) among girls. High school (girls AOR: 1.64; 95% CI: 1.43-1.88 and boys AOR: 1.35; 95% CI: 1.07-1.69), Christian and other (boys AOR: 1.58; 95% CI: 1.22-2.06 and girls AOR: 1.49; 95% CI: 1.27-1.73), having a partner (boys AOR: 7.03; 95% CI: 5.61-6.80 and girls AOR: 6.29; 95% CI: 5.44-7.28), knowledge of family planning (boys AOR: 2.25; 95% CI: 1.83-2.75 and girls AOR: 1.67; 95% CI: 1.47-1.89) and age (boys AOR: 1.50; 95% CI: 1.38-1.63 and girls AOR: 1.74; 95% CI: 1.65-1.84) were the most important contributing factors of sexual intercourse.

Conclusion: Future programmes targeting adolescents should include public health interventions that address these factors related to sexual intercourse to reduce early sexuality in schools.

Contributions: This study will help policymakers make decisions about reducing sexual intercourse among school-attending adolescents.

Background: Despite measures, malaria in pregnancy is still reported. It results in maternal illness, anaemia, low birth weight, preterm delivery and both maternal and foetal death.

Aim: To determine the prevalence and density of malaria parasitaemia and identify the associated factors among pregnant women.

Setting: This was a hospital-based study in two health facilities in Dschang, Western Cameroon.

Methods: A cross-sectional study was conducted. A questionnaire was used to collect data on socio-demographics clinical manifestations, environmental factors and prevention measures used. Parasitological tests were carried out using thick and thin blood smears. Data were analysed using Statistical Package for Social Sciences (SPSS), version 22.0.

Results: Out of the 314 participants, 46 (14.6%) were positive for malaria parasitaemia, and the only species identified was Plasmodium falciparum. A multinomial regression model showed that the presence of bushes around houses (odds ratio [OR] = 2.40, p = 0.03) exposes individuals to malaria parasite infection, while the presence of a ceiling (OR = 0.20, p < 0.01), taking intermittent preventive treatment for pregnant women (IPTp) (OR = 0.23, p < 0.01) and having window screens (OR = 0.14, p = 0.01) were protective. Geometric mean parasite density (GMPD) was highest among pregnant women in the second trimester (2190/µL, F = 61.3, p = 0.016), those with more than three gravidities (1022/µL, F = 66.28, p = 0.009), those who presented with sweating (1946/µL, F = 272, p = 0.004) and, unexpectedly, those who were using long-lasting insecticide-treated bed nets (1536/µL; F = 3.32, p < 0.001), compared with their corresponding counterparts.

Conclusion: The prevalence and density of malaria parasite varied with demographics, pregnancy characteristics, clinical manifestations, quality of housing, environmental conditions and malaria prevention methods.

Contribution: An update on malaria among pregnant women. Continuous sensitisation on prevention methods is necessary.

Background: Viral rebound (VR), the resurgence of detectable human immunodeficiency virus (HIV) viral loads (> 50 copies/mL) after suppression, remains a challenge for individuals on antiretroviral therapy (ART) in South Africa, despite free access to treatment.

Aim: This systematic review aimed to determine the prevalence of HIV VR and its contributing factors among individuals on ART.

Setting: This is a systematic review study, it relies primarily on secondary data, and it does not have a physical setting.

Method: This study is conducted in line with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and the Cochrane methodology, and the study was registered with PROSPERO (ID: CRD42024524121). Data were sourced from PubMed, EBSCOhost and Scopus, yielding 89 684 articles. After screening in Rayyan, 23 articles met the inclusion criteria. The risk of bias was assessed using the Joanna Briggs Institute's (JBI's) appraisal tool.

Results: Viral rebound varies across different populations. Contributing factors included biological, genetic, demographic, socio-economic and structural elements, as well as incarceration, missed appointments, lifestyle behaviours, travel, multiple sexual partners, ART regimen, age and clinical management. Poor ART adherence emerged as a key driver.

Conclusion: Human immunodeficiency virus viral rebound results from a combination of biological, social and treatment-related factors, with non-adherence to ART being a major contributor. The study highlights the need for improved adherence strategies to reduce VR.

Contribution: This review enhances the understanding of HIV VR prevalence and its contributing factors, while also providing recommendations to mitigate these factors.

Background: Female genital mutilation (FGM), especially infibulation, is a significant public health issue that poses numerous health risks for young girls. Despite its severity, this phenomenon remains under-documented.

Aim: This study aims to identify the factors associated with infibulation among girls who underwent FGM in Guinea.

Setting: This study was conducted in Guinea.

Method: A secondary analysis of data from the 2018 Demographic and Health Survey (DHS) in Guinea included 3950 women whose daughters had undergone female genital mutilation or excision (FGM/E). A multivariate logistic regression was performed to identify factors associated with infibulation using the Stata software version 17.

Results: The overall prevalence of infibulation among girls who underwent female genital mutilation or cutting (FGM/C) in Guinea was 16%. This prevalence was higher at 17% (95% confidence interval [CI]: [0.1-0.2]) among girls aged 0 years to 4 years. Statistically significant individual and contextual factors included: maternal age (odds ratio [OR] = 1.4, 95% CI: [1.1-2.6]), maternal employment status (OR = 1.7, 95% CI: [1.3-2.2]), maternal religion (OR = 2.7, 95% CI: [1.2-5.8]), maternal infibulation status (OR = 22.1, 95% CI: [16.6-29.4]) and region of residence (OR = 2.8, 95% CI: [1.6-4.8]).

Conclusion: This study highlights the need for educational, socio-economic and public health strategies to eradicate infibulation in Guinea and promote sustainable change.

Contribution: This research revealed the influence of individual and contextual factors on infibulation and highlighted the emergency of targeted strategies, such as awareness raising, community dialogue and education about its risks.