Journal of Public Health in Africa最新文献

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.

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.