Journal of Public Health in Africa最新文献

Background: COVID-19 and tuberculosis (TB) were the top two leading causes of death from a single infectious agent in 2022.

Aim: This study aimed at assessing COVID-19 knowledge, attitude, and practices (KAP) and their associated factors among pulmonary TB patients and healthy individuals in Yaoundé, Cameroon.

Setting: The study was conducted at the Jamot Hospital in Yaoundé, a main referral hospital for TB management in Cameroon.

Methods: A cross-sectional design was used to recruit a consecutive sample of TB patients and healthy participants at Jamot Hospital and communities in Yaoundé, Cameroon, from April 2022 to March 2023. Data on socio-demographic characteristics and COVID-19 KAP were collected and analysed using logistic regression with significance considered at p < 0.05.

Results: Out of 409 participants, 67.5% had good knowledge, 54% had a favourable attitude, and 22.5% had good practices towards COVID-19. Multivariate analysis identified TB status, age, sex, and marital status as significant factors influencing KAP scores. Good knowledge and good practices were associated with being healthy, young, and single (p < 0.05). In addition, the female gender, good knowledge, and favourable attitudes were associated with good practices (p < 0.05).

Conclusion: Gaps in COVID-19 KAP among TB patients highlight the need for targeted public health interventions, with a focus on TB patients, males, the elderly, and married individuals for better control.

Contribution: Tuberculosis patients are not adopting positive prevention practices as required, thus increasing their risk of getting COVID-19 and transmitting TB, necessitating urgent action.

Background: Pneumonia is the primary infectious cause of mortality in children under five, with approximately 800 000 deaths annually in low-income settings. In Kenya, pneumonia accounted for 16% of child deaths in 2022. Good treatment outcome relies on efficient referral system and timely hospital access. However, monitoring referral completion remained challenging in Endebess hospitals.

Aim: To assess determinants and key barriers to utilisation of community referral system.

Setting: Seven public hospitals in Endebess sub-County in Kenya.

Methods: This mixed-methods study involved 273 caregivers, 24 health personnel, 40 Community Health Volunteers (CHV's) and 4 Community Health Assistants. Data were collected using questionnaires and interviews. Quantitative analysis used Statistical Package for Social Sciences Version 22 (Chi-square, logistic regression; p < 0.05). Qualitative data were analysed using thematic analyses.

Results: Overall, 112 caregivers (41%) were referred. However, only 19 referral forms (17%) were filed at hospitals and 10 children (52.6%) recorded in service delivery logbook. Referral completion was significantly associated with distance to the hospital (p = 0.021), whether a CHV had accompanied the patient (p = 0.002) and household income (p= 0.040). Caregivers with self-help group savings were more likely to visit the hospital within 24 h of referral (p = 0.002, OR [odds ratio] = 3.8, 95% CI [confidence interval] = 1.639-8.813) than those without savings.

Conclusion: Utilising CHV diaries and household registers improves referral completion, highlighting the need for digital integration to strengthen data concordance.

Contribution: This study informed policymakers on strengthening community referrals by emphasising CHV report verification, mentorship on documentation and ensuring referral completion.

Background: Non-communicable diseases (NCDs) among people living with human immunodeficient virus (HIV) are emerging and a leading cause of death in this population.

Aim: To identify disease trends, prevalence and outcomes of NCDs among PLHIV.

Setting: The study was conducted in Manicaland province.

Methods: We reviewed secondary data from October 2013 to September 2023. Data on five priority NCDs were analysed: hypertension (HPT), diabetes mellitus (DM), chronic kidney injury (CKD), cancers and chronic respiratory conditions (CRC). Kaplan-Meier analysis and Cox proportional hazard analysis were performed, risk and hazard ratios reported at the 95% confidence level.

Results: A total of 974 patient files were reviewed. The median age was 43 (Q1 = 35; Q3 = 51) years. A total of 409 (42.0%) were males and 565 (58.0%) were females. A total of 94 (9.7%) patients had HPT, 76 (7.8%) had DM, 6 (0.6%) had CKD, 9 (0.9%) had cancer and 3 (0.3%) had CRC. Controlling for age, gender and medication use, being on ART for more than 5 years and ageing were hazards to DM and HPT. Protease inhibitor-based regimen was a hazard to DM (hazard ratio [HR] = 4.66, 95% CI: 2.54-8.54, p < 0.001). Efavirenz-based regimen was protective in development of HPT (HR = 0.47, 95% CI: 0.26-0.83), p = 0.01.

Conclusion: Hypertension and DM are the most common NCDs among people living with HIV. Prevalence of HPT and DM increased with age and duration on ART. To minimise complications related to NCD and HIV comorbidities, we recommend regular screening of NCDs at least monthly, and personalising treatment for hypertensive patients to efavirenz based regimens. We educated people living with HIV about the risks of NCDs and importance of healthy eating and regular exercise.

Contribution: Integrated NCD and HIV care models.

Background: Women continue to be underrepresented in science, technology, engineering, mathematics and medicine (STEMM), globally including in Africa and, indeed in Zimbabwe. The gender gap, absence of formal research mentorship and the male-dominated academic culture common among low- and middle-income countries makes scientific growth dire for Africa- and Zimbabwe-based female science researchers.

Aim: To address some of these challenges, a group of researchers (90% female) created the African Excellence in Research Initiative (AFRIESEARCHI) Zimbabwe Gender in STEMM Mentorship Programme.

Setting: Public universities and research institutions in Zimbabwe.

Methods: The team crafted a research mentorship curriculum, informed by stakeholder engagement and needs assessment, and piloted it from October 2021 to December 2022.

Results: The inaugural 12-month programme capacitated 30 members (80% female) with skills for research. The participants' mean age was 42.5 (6.9) years, with minimum qualifications of Master's degrees. Specifically, 5 (17%) members either registered for or graduated with doctoral degrees, 14 (50%) members completed visiting fellowships. Five individual projects were awarded grants all totalling over $300 000.00, while this mentorship project was shortlisted for the Free STEM Fund award (€50 000.00) for the 2022-2023 cycle. Half of shortlisted team members were selected for the competitive Zimbabwean Emerging Faculty Development Program. Almost 90% of participants were satisfied with their mentorship experience, although resources and time were needed.

Conclusion: Despite challenges, the team resolved the need to prioritise formalised research mentorship, within the Zimbabwe setting.

Contribution: Such efforts will enhance scientific growth for women (and indeed all academic researchers) in the sciences.

Background: School-based hearing screening programmes play an important role in identifying and providing appropriate intervention services to children with progressive, late-onset, or acquired hearing loss.

Aim: To describe the knowledge and perspectives of government stakeholders within the Ministry of Health and the Ministry of Education and Skills Development on the implementation of school entry hearing screening programmes in Botswana.

Setting: The study was conducted in two administrative districts: Gaborone and the South-East District, Botswana.

Methods: A qualitative descriptive design was used. Fifteen key government stakeholders, including policymakers and service providers (audiologists, nurses, Grade 1 teachers), were purposefully sampled. Semi-structured interviews were conducted with each stakeholder. All audio recordings were transcribed verbatim. Reflexive thematic analysis was performed with the assistance of NVivo 12 software.

Results: There was variable knowledge of policy with most of the service providers not being aware of the existing current national school health policy. All stakeholders interviewed demonstrated universal support for implementation of the policy in relation to school-based hearing screening. Some service providers suggested that hearing screening services could be integrated into existing school health programmes. Barriers and facilitators for policy implementation were also identified.

Conclusion: Stakeholders' knowledge and support of the school health policy suggest that there is potential for the implementation of school-based hearing screening programmes.

Contribution: This study created awareness of a provision for school hearing screening in an existing policy that had not been implemented. The findings present an opportunity for advocating for the implementation of school hearing screening programmes.

Background: Adolescents in Zambia face interrelated health challenges, including human immunodeficiency virus (HIV), substance abuse and mental health disorders (MHDs). These issues have significant public health implications, as substance abuse and MHDs are known to increase the risk of HIV incidence.

Aim: This study aimed to analyse trends in HIV incidence, substance abuse and MHDs among Zambian adolescents aged 10-19 years from 2021 to 2023.

Setting: Data were retrieved from the Health Management Information System under Zambia's Ministry of Health, covering all 10 provinces.

Methods: A retrospective analysis of secondary data was conducted using District Health Information Software 2 (DHIS2), the Ministry of Health's primary data system. Microsoft Excel and Stata were used for descriptive statistics and regression analysis to examine potential associations.

Results: Findings indicate an increase in national HIV incidence rates from 1.89 in 2021 to 1.99 in 2022, before a decrease to 1.73 in 2023. Substance abuse also showed an upward trend, rising from 0.35 to 0.68 per 1000 adolescents. Incidence of MHDs more than doubled from 0.7 in 2021 to 1.54 in 2023, with Lusaka and Northwestern provinces showing the most significant increases. Our linear correlational analysis showed a positive relationship among the key variables.

Conclusion: The results underscore the interconnectedness of HIV, substance abuse and mental health issues among adolescents in Zambia, emphasising the need for integrated interventions.

Contribution: This study contributes valuable insights for policy and programme development, highlighting the need for targeted, holistic approaches in adolescent health services to address these interconnected issues effectively.

Background: South Africa accounts for 19% of the global population living with human immunodeficiency virus (HIV), limited knowledge exists on adherence to guidelines when managing complications.

Aim: This study assesses regimen adjustment for HIV-positive patients with renal and hepatic dysfunction resulting from antiretroviral therapy (ART) according to the South African Treatment Guidelines and examines the re-initiation of ART in patients who have defaulted.

Setting: The study was conducted at Tshepang HIV Clinic, Ga-Rankuwa, Pretoria, South Africa.

Methods: A retrospective review was conducted between November 2020 and December 2020. Patients who had been on ART for over 18 months and presented with hepatic, renal and/or virological failure were included in the study. The data collection tool included demographics and medical records. Statistical Package for Social Sciences version 25 for Windows was used for data analysis.

Results: A total of 181 files were reviewed, and only 37 were eligible for participation. The study found that treatment received by 25% of hepatic failure patients and 41.3% of renal impairment patients complied with South African ART guidelines. Furthermore, 40% of patients with virological failure were re-initiated according to guidelines.

Conclusion: This study found practices that were contrary to the prescribed guidelines with non-compliance accounting for more than 40%.

Contribution: This study demonstrates a high incidence of adherence failure to South African ART guidelines. Defaulted patients are placed risk of antiretroviral resistance. Adherence to guidelines is important to prevent complications resulting from ART.

Background: The consensus view that heterosexual transmission dominates human immunodeficiency viruses (HIV) epidemics in sub-Saharan Africa survives side-by-side with surveys and studies reporting infections in children with HIV-negative mothers, in virgins, and in adolescents and adults who claim no possible sexual exposure to HIV.

Aim: In this scoping review, we aim to show what phylogenetic analyses of HIV sequences say about the possible contribution of blood-borne transmission to HIV epidemics.

Setting: The focus was on sub-Saharan Africa.

Method: The authors conducted a search on PubMed and other platforms for studies reporting phylogenetic analyses of HIV in blood samples collected from at least 100 infected adults through community-based surveys in sub-Saharan Africa. They focussed on identifying information pertinent to assessing blood-borne transmission.

Results: Sixteen reports met the search criteria and provided information to assess blood-borne transmission. In five studies, similar HIV sequences from (reported or assumed) household couples identified a likely heterosexual source for 0.3% - 7.5% of community adults with sequenced HIV. In 10 studies, a median of 43% of sequence pairs linked two people of the same sex. Two studies report clusters of recent infections too large to be easily explained by sexual transmission.

Conclusion: Evidence from sequencing agrees with much other evidence that blood-borne HIV transmission is not rare in sub-Saharan Africa. Evidence also allows that blood-borne transmission could be making a major contribution to Africa's HIV epidemics.

Contribution: Evidence of harm is sufficient to stimulate discussions about what more could be done to address this continuing problem.

Background: Vaccine hesitancy among healthcare workers (HCWs) hinders coronavirus disease 2019 (COVID-19) control efforts.

Aim: The aim of the study was to assess enhancers and barriers to the uptake of COVID-19 vaccine among HCWs in Ibadan, Nigeria.

Setting: Health facility-based cross-sectional study in Ibadan, a metropolitan city in Oyo state, Nigeria.

Methods: A questionnaire administered using REDCap assessed HCW vaccination status, attitudes and access using the Behavioural and Social drivers (BeSD) framework. Data analysis performed using STATA version 17 included descriptive statistics and modified Poisson regression.

Results: Of the 1227 HCWs recruited, 82.8% received at least one dose. Vaccine uptake was higher among older HCWs compared to those below 25 years (45-54 years: prevalence ratio [PR] = 1.20, 95% confidence interval [CI]: 1.09, 1.33 and ≥ 55 years: PR = 1.17, 95% CI: 1.05, 1.30) and HCWs in private health centres (PR = 1.15, 95% CI: 1.08, 1.22). Most HCWs (83.5%) believed in vaccination for infectious diseases, but only 61.9% felt the same about COVID-19 vaccines. The major reasons for vaccine hesitancy among unvaccinated HCWs included the beliefs that vaccine development and authorisation were rushed (47 [26.1%]) and concerns about serious side effects (32 [17.8%]).

Conclusion: This study found that the uncertainty about COVID-19 vaccine safety is a key barrier to its uptake. Therefore, targeted education and communication strategies to improve vaccine confidence are crucial.

Contribution: This study identifies why HCWs in Nigeria are hesitant about getting vaccinated. This information can help to improve vaccination rates in this group. It fits with the journal's focus on making African public health responses stronger.

Background: Diagnostic tests for severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) may be performed based on symptomatic presentation or for screening of asymptomatic persons. Testing can limit spread by enabling rapid identification of cases leading to containment measures. However, views regarding diagnostic test as a containment intervention vary across different settings.

Aim: To synthesise the findings of qualitative studies on the perceptions and factors influencing the uptake of diagnostic test interventions for SARS-CoV-2.

Setting: Healthcare facilities, care homes, communities including households.

Method: We searched MEDLINE database and the (WHO) SARS-CoV-2 Research database from 01 January 2020 to 06 September 2022. Qualitative data were synthesised thematically while data for barriers and facilitators were synthesised using the SURE framework. The GRADE-CERQual approach was used to assess the confidence in each review finding, while the ENTREQ checklist was used to report the QES. The quality of included studies was assessed with the CASP tool.

Results: Twenty two studies were included for QES. Two were conducted in the health facility setting, 2 in care homes, and 18 in the community. Twenty of the studies came from high-income countries, 2 from low- and middle-income countries. In all, 13 analytical and 31 descriptive themes of low to moderate quality evidence emerged; mainly around fear of contracting COVID-19, test procedure and socio-economic implications of a positive test result.

Conclusion: Low to moderate quality evidence of barriers to uptake of diagnostic test were largely due to misconceptions about the interventions.

Contribution: Sensitising and engaging communities and stakeholders in the healthcare system, will help mitigate the fear barrier and enhance policy coordination.