Journal of Public Health in Africa最新文献

Background: Advances in science and technology have significantly improved global living conditions, enhancing overall quality of life. However, these changes have also contributed to lifestyle shifts marked by reduced physical activity, increased sedentary behaviour, and altered dietary patterns fueling overnutrition and related non-communicable diseases (NCDs). Among these, type 2 diabetes mellitus (T2DM) has increased sharply over the past three decades, placing a burden on healthcare systems.

Aim: This meta-analysis investigates the effectiveness of dietary interventions in managing T2DM and identifies nutritional strategies associated with improved glycaemic outcomes.

Setting: The review includes studies conducted globally in community and health facility settings.

Method: Peer-reviewed articles published between January 2010 and December 2024 were retrieved from PubMed, Scopus, and Web of Science. Eligible studies focused on dietary interventions for T2DM management. A random-effects model was used for meta-analysis, with effect sizes computed using R Studio. Heterogeneity was assessed using the I ² statistic.

Results: Eighteen studies met the inclusion criteria. Dietary interventions significantly improved glycaemic control (mean difference: -0.30%; 95% CI: -0.45 to -0.15), despite high heterogeneity (I ² = 93.4%). Interventions focused solely on diet showed a modest effect (MD: -0.17%; 95% CI: -0.33 to -0.00), while intensive lifestyle interventions demonstrated a significantly higher impact (MD: -0.25%; 95% CI: -0.41 to -0.09).

Conclusion: This study reinforces the critical role of lifestyle modifications particularly dietary changes and increased physical activity in managing T2DM. Comprehensive lifestyle interventions are more likely to yield meaningful improvements in glycaemic control.

Contribution: This study highlights the importance of developing and scaling up multifaceted, sustainable strategies to support long-term lifestyle change in individuals living with T2DM.

Background: Programmed death-1 (PD-1) is an immune checkpoint receptor that regulates T-cell function by modulating and terminating immune responses.

Aim: This study investigates the functional and structural impact of missense single nucleotide polymorphisms in the human Programmed Cell Death 1 (PDCD1) gene.

Setting: The data related to PDCD1 gene single nucleotide polymorphisms [SNPs] were collected from dbSNP.

Methods: PredictSNP1.0, integrating eight tools (sorting intolerant from tolerant [SIFT], PolyPhen-1/2, multivariate analysis of protein polymorphism [MAPP], predictor of human deleterious [PhD] SNP, screening for non-acceptable polymorphisms [SNAP], PANTHER, nsSNPAnalyzer), was used for variant predictions. Conservation was assessed with ConSurf, stability with MUPro and I-Mutant 2.0 and pathogenicity with MutPred2. Molecular dynamics (MD) simulations analysed native and mutant PD-1 variants over 100 nanosecond (ns), assessing root-mean-square deviation (RMSD), root-mean-square fluctuation (RMSF), radius of gyration (R _g), solvent-accessible surface area (SASA) and hydrogen bonding.

Results: D117V and W286G were identified as the most deleterious variants. However, W286G was located in an unfavourable structural region, rendering its model unreliable and excluding it from further analysis. Molecular dynamic simulations on the native and D117V models showed no significant differences in RMSD, RMSF, R _g, SASA or hydrogen bonding, suggesting D117V (rs772130993) has minimal impact on PD-1 stability or flexibility.

Conclusion: Bioinformatics tools predicted the D117V variant as deleterious, but molecular dynamics simulations suggest it may have limited functional impact.

Contribution: These findings underscore the importance of integrating computational predictions with experimental validation to guide therapeutic exploration of genetic variants.

Background: Adherence to COVID-19 prevention and control measures is related to people's knowledge, attitudes and practices.

Setting: In Thabo Mofutsanyana District, the proportion of reported community COVID-19-related deaths was higher than in-facility reported deaths.

Aim: To assess knowledge, attitudes and practices of the community towards COVID-19.

Methods: A survey was conducted among consenting adults from 28 February 2022 to 4 March 2022. An interviewer-administered questionnaire was used for data collection. Descriptive statistics was used to describe the responses and logistic regression used to assess factors associated with poor knowledge towards COVID-19.

Results: A total of 551 participants' data were analysed, most of whom were < 40 years (63%) and female (68%). Despite 43.4% having education levels below high school, 89% knew that anyone could contract COVID-19, mainly through television and/or radio (74%) and social media (53%). The majority practiced mask-wearing (84%) and social distancing (80%), while 65% indicated they will use home remedies if there was severe COVID-19 infection. Older age group (OR = 2.40; 95% CI 1.17-4.89; p = 0.015), higher education level (OR = 0.59; 95% CI 0.39-0.87; p = 0.009) and higher monthly income were each associated with poor knowledge towards COVID-19 but the significance did not remain in multivariate model.

Conclusion: Participants had good knowledge of COVID-19; however, a high proportion supported the use of home remedies in severe COVID-19 infections. This underscores the need to enhance the health-seeking behaviour of communities through health education and community engagement, using television and/or radio and social media.

Contribution: Study findings are useful to inform preparedness and response strategies in communities.

Background: Integrating digital technologies into mental healthcare offers a transformative shift in the provision of online-based mental health services to Nigerians. This is crucial for Nigeria in order to minimise and curb the developing health emergency because of COVID-19.

Aim: This study seeks to explore the perception of healthcare workers (HCWs) towards the use of digital technologies in improving mental services in Nigeria.

Setting: This study was carried out in four neuropsychiatric hospitals in South-West Nigeria.

Methods: Mixed-method convergent design was used. Purpose sampling utilising snowball method was utilised in selecting qualitative participants, while proportional stratified sampling method was adopted for quantitative participants. Quantitative data collection tools were administered to 317 participants at the selected neuropsychiatric hospitals while interview was conducted on 16 qualitative participants. Thematic analysis was employed on qualitative data and descriptive statistical analysis (mean, standard deviation, frequencies, percentages, crosstabs, Chi-square) was conducted on quantitative data.

Results: Findings showed that 58% of psychiatric nurses, 17% of clinical psychologists, 16% of psychiatrists and 6% of occupational therapists view digital technologies as effective in combination with face-to-face therapy. Additionally, qualitative findings showed that HCWs view digital tools as helpful tools for both patients and HCWs and offer the opportunity to immensely advance mental services.

Conclusion: Incorporating digital technologies into mental health service delivery enhances mental health services, increases prompt access to healthcare and reduces the effect and impact of any future health emergencies.

Contribution: This study raised awareness on the need to improve mental health services in public mental health facilities and advocate for the integration of digital technologies to improve mental health service delivery.

Background: Two COVID-19 oral antivirals (COAVs), Molnupiravir and Paxlovid, have been shown to be cost-effective in high-income countries.

Aim: This study assesses the cost-effectiveness of Paxlovid and Molnupiravir, compared to usual care in three African countries.

Setting: The study was conducted using data from Ghana, Rwanda and Zambia.

Methods: We modelled costs (2022 United States dollars) and health outcomes in the acute phase of COVID-19 from a public payer's perspective in three unvaccinated target populations: (1) all adult patients, (2) patients aged 65 years and above (elderly), and (3) adult patients with other underlying risk factors for disease severity. We conducted pairwise and full incremental analyses.

Results: In the pairwise analysis, Paxlovid was less costly and more effective than usual care (i.e. dominated) in all three study countries for elderly patients, while in adults with other underlying risk factors, Paxlovid dominated in Rwanda and Zambia, and Molnupiravir dominated usual care in Rwanda. Neither Paxlovid nor Molnupiravir were cost-effective in the all-adult group in any country context. In the full incremental analysis, Paxlovid dominated both Molnupiravir and usual care in elderly patients (in all three countries) and in adults with other risk factors (in Rwanda and Zambia). Key determinants of cost-effectiveness were COAV price, likelihood of early treatment initiation, hospitalisation rates and vaccination status.

Conclusion: In African settings like Zambia, Ghana or Rwanda, Paxlovid could be cost-effective in unvaccinated populations and those at high risk of progression to severe COVID-19.

Contribution: This study broadly supports African governments decisions not to procure substantial quantities of COAV.

Background: Childhood malnutrition, including both undernutrition and overnutrition, remains a significant public health concern in many low- and middle-income countries, including South Africa. Understanding the anthropometric characteristics and obesity predictors among rural South African adolescents is crucial for informing targeted public health interventions.

Aim: This study aimed to assess the nutritional status of children in rural Ellisras, South Africa, aged 11-17 years, and to identify predictors of obesity.

Setting: The study was conducted in Ellisras, a rural area in South Africa, between January 2021 and December 2021.

Methods: A total of 1217 adolescents (612 boys, 605 girls) participated in the study. Anthropometric measurements, including height, weight and body mass index (BMI), were collected. Multivariate regression analysis was used to identify factors associated with obesity.

Results: The findings indicated that 43.10% of children were classified as underweight, with a higher prevalence among boys (64.57%) than girls (35.43%). The overall prevalence of overweight and obesity was low (0.41%), with girls (80%) being more affected than boys (20%). Boys had a slightly higher average height (154.79 cm) than girls (154.60 cm), while girls had a higher average BMI (16.41 kg/m²) compared to boys (15.81 kg/m²). Multivariate regression analysis revealed that adolescents aged 15-16 years had significantly higher odds of obesity (adjusted odds ratio [AOR] = 2.10, p < 0.001) compared to 11-12-year-olds. Additionally, girls had significantly higher odds of obesity than boys (AOR = 2.80, p < 0.001).

Conclusion: The study highlights the dual burden of malnutrition among rural South African adolescents, with a high prevalence of underweight and emerging obesity, particularly among girls.

Contribution: These findings emphasise the need for targeted nutritional interventions, with special attention to adolescents aged 15-16 years and girls, who are at a higher risk of obesity.

The Abuja Declaration, which was endorsed in 2001, was a hallmark of African leadership's decision to prevent and control human immunodeficiency virus (HIV) and acquired immunodeficiency syndrome (AIDS) in Africa. Since this declaration, there have been several achievements recorded in the fight against HIV and AIDS. This includes increased domestic and international financing, ground-breaking innovations and discoveries for effective screening, diagnosis, and treatment of HIV and AIDS, targeted interventions to address mother-to-child transmission, and tailored and innovative approaches to prevent new HIV infections, particularly among the key and vulnerable populations. However, unaddressed challenges still require urgent and accelerated interventions to attain and sustain the set 95-95-95 Joint United Nations Programme on HIV and AIDS (UNAIDS) target. As we are near the 2030 landmark, revitalisation of the commitments made in the Abuja Declaration is essential. African countries must increase their domestic resources to address the inequities and improve access to essential HIV and AIDS prevention and response interventions, particularly for adolescent girls and young women, children, and vulnerable populations. Revitalisation of sex education, social protection, and revisiting in-country laws that negatively impact the HIV prevention and response efforts are more essential than ever before. There is a clear need for rededication of political and leadership will and commitment as we envision epidemic control of HIV and AIDS by 2030. Countries need to develop an action-oriented, targeted, and all-inclusive roadmap for HIV and AIDS epidemic control by 2030.

Oral health remains a critical yet often overlooked aspect of overall health in Africa, where a significant burden of oral diseases is evident. The integration of community health workers (CHWs) into oral health promotion strategies presents a unique opportunity to address both human resource and educational challenges, particularly in underserved communities. This study explores the pivotal role CHWs can play in enhancing oral health outcomes across various African contexts. By providing basic dental care, education and facilitating access to professional services, CHWs contribute to the prevention and early detection of oral diseases. The research draws on case studies, programme evaluations and field reports to highlight the effectiveness of CHW-led initiatives. The findings underscored the need for increased investment in CHW training and support as a sustainable approach to improving oral health in Africa. It highlights the role of the Africa Centres for Disease Control and Prevention in promoting oral health in the mandate of CHWs, identifies the challenges it may face in playing this role and proffers solutions including promoting the development of oral health policies and plans by the Africa Union Member States as a critical first and feasible step. The study concludes by identifying the need for a comprehensive assessment of the status of integration of oral health into CHW programmes in Africa to help the Africa Centres for Disease Control and Prevention identify gaps for strategic actions. This article offers the first comprehensive exploration of the potential for formally integrating CHWs into oral health promotion strategies across Africa. By mapping existing interventions, evaluating their effectiveness, and identifying policy and structural challenges, the study provides critical insights into how CHWs can bridge gaps in access to oral healthcare, particularly in underserved populations. It highlights the strategic role of the Africa CDC in advancing oral health through CHW-led initiatives and calls for standardised training, policy support, and system integration. The article aligns with the Journal of Public Health in Africa's scope by addressing health systems strengthening and universal health coverage in the African context through an underutilised yet scalable workforce.

Background: Landfills are globally recognised as significant environmental and public health risks. Their emissions contribute to air and water contamination. However, research in the South African context remains limited.

Aim: To assess community perceptions of air quality and health impacts of living near a landfill site.

Setting: The study was conducted in Durban, South Africa.

Methods: The study employed a cross-sectional survey design. A structured survey questionnaire was used to collect data from a sample of residents (n = 154). Survey interviews were administered in English and isiZulu. Survey data were captured on Microsoft^® Excel for descriptive statistical analysis.

Results: The analysis revealed that 72% of respondents rated air quality as poor or very poor, with the landfill site identified as the primary contributor (77%). Seasonal variations were evident, with summer perceived as the season of worst air quality (45%). Awareness of environmental rights and engagement in formal environmental activities were low, with 93% of respondents not participating in any environmental group. Common behavioural responses included shutting windows (60%) and limiting outdoor activities (17%), while 75% of respondents advocated relocation of either the landfill site or the community to address these concerns.

Conclusion: The findings underscore the urgent need for stronger community engagement, targeted awareness campaigns and interventions to address environmental and health challenges near landfill sites.

Contribution: This study advances public health in Africa by highlighting the environmental and health risks of landfill sites and highlighting the need for targeted interventions in affected communities.