The prevalence of stunting,overweight and obesity,and metabolic disease risk in rural South African children

Background  

Low- to middle-income countries are undergoing a health transition with non-communicable diseases contributing substantially to disease burden, despite persistence of undernutrition and infectious diseases. This study aimed to investigate the prevalence and patterns of stunting and overweight/obesity, and hence risk for metabolic disease, in a group of children and adolescents in rural South Africa.     

Determinants of health insurance ownership among South African women

Background  

Studies conducted in developed countries using economic models show that individual- and household- level variables are important determinants of health insurance ownership. There is however a dearth of such studies in sub-Saharan Africa. The objective of this study was to examine the relationship between health insurance ownership and the demographic, economic and educational characteristics of South African women.     

Prevalence and risk factors for HIV-1 infection in rural Kilimanjaro region of Tanzania: Implications for prevention and treatment

Background  

Variability in stages of the HIV-1 epidemic and hence HIV-1 prevalence exists in different areas in sub-Saharan Africa. The purpose of this study was to investigate the magnitude of HIV-1 infection and identify HIV-1 risk factors that may help to develop preventive strategies in rural Kilimanjaro, Tanzania.     

Heavy burden of non-communicable diseases at early age and gender disparities in an adult population of Burkina Faso: world health survey

Background  

WHO estimates suggest that age-specific death rates from non-communicable diseases are higher in sub-Saharan Africa than in high-income countries. The objectives of this study were to examine, in Burkina Faso, the prevalence of non-communicable disease symptoms by age, gender, socioeconomic group and setting (rural/urban), and to assess gender and socioeconomic inequalities in the prevalence of these symptoms.     

Wealth and sexual behaviour among men in Cameroon

Background  

The 2004 Demographic and Health Survey (DHS) in Cameroon revealed a higher prevalence of HIV in richest and most educated people than their poorest and least educated compatriots. It is not certain whether the higher prevalence results partly or wholly from wealthier people adopting more unsafe sexual behaviours, surviving longer due to greater access to treatment and care, or being exposed to unsafe injections or other HIV risk factors. As unsafe sex is currently believed to be the main driver of the HIV epidemic in sub-Saharan Africa, we designed this study to examine the association between wealth and sexual behaviour in Cameroon.     

Wastage in the health workforce: some perspectives from African countries

Background  

Sub-Saharan Africa faces a human resources crisis in the health sector. Over the past two decades its population has increased substantially, with a significant rise in the disease burden due to HIV/AIDS and recurrent communicable diseases and an increased incidence of noncommunicable diseases. This increased demand for health services is met with a rather low supply of health workers, but this notwithstanding, sub-Saharan African countries also experience significant wastage of their human resources stock.     

The migration of physicians from sub-Saharan Africa to the United States of America: measures of the African brain drain

Background  

The objective of this paper is to describe the numbers, characteristics, and trends in the migration to the United States of physicians trained in sub-Saharan Africa.     

Oil for health in sub-Saharan Africa: health systems in a 'resource curse' environment

Background  

In a restricted sense, the resource curse is a theory that explains the inverse relationship classically seen between dependence on natural resources and economic growth. It defines a peculiar economic and political environment, epitomised by oil extraction in sub-Saharan Africa.     

A qualitative investigation into knowledge,beliefs, and practices surrounding mastitis in sub-Saharan Africa: what implications for vertical transmission of HIV?

Background  

Mastitis constitutes an important risk factor in HIV vertical transmission. Very little, however, is known on how women in sub-Saharan Africa conceptualise health problems related to breastfeeding, such as mastitis, and how they act when sick. We aimed at filling this gap in knowledge, by documenting the indigenous nosography of mastitis, health seeking behaviour, and remedies for prophylaxis and treatment in rural sub-Saharan Africa.     

Understanding the correlations between wealth, poverty and human immunodeficiency virus infection in African countries

Objective

To investigate the relationships between the prevalence of human immunodeficiency virus (HIV) infection and underlying structural factors of poverty and wealth in several African countries.

Methods

A retrospective ecological comparison and trend analysis was conducted by reviewing data from demographic and health surveys, acquired immunodeficiency syndrome (AIDS) indicator surveys and national sero-behavioural surveys in 12 sub-Saharan African countries with different estimated national incomes. Published survey reports were included in the analysis if they contained HIV testing data and wealth quintile rankings. Trends in the relation between gender-specific HIV prevalence and household wealth quintile were determined with the χ² test and compared across the 12 countries, and also within one country (the United Republic of Tanzania) at two points in time.

Findings

The relationship between the prevalence of HIV infection and household wealth quintile did not show consistent trends in all countries. In particular, rates of HIV infection in higher-income countries did not increase with wealth. Tanzanian data further illustrate that the relationship between wealth and HIV infection can change over time in a given setting, with declining prevalence in wealthy groups occurring simultaneously with increasing prevalence in poorer women.

Conclusion

Both wealth and poverty can lead to potentially risky or protective behaviours. To develop better-targeted HIV prevention interventions, the HIV community must recognize the multiple ways in which underlying structural factors can manifest themselves as risk in different settings and at different times. Context-specific risks should be the targets of HIV prevention initiatives tailored to local factors.     

HIV/AIDS mitigation strategies and the State in sub-Saharan Africa – the missing link?

Background  

The HIV/AIDS pandemic in sub-Saharan Africa is widely recognised as a development disaster threatening poverty reduction, economic growth and not merely a health issue. Its mitigation includes the societal-wide adoption and implementation of specific health technologies, many of which depend on functional institutions and State.     

HIV infection in older adults in sub-Saharan Africa: extrapolating prevalence from existing data

Objective

To quantify the number of cases and prevalence of human immunodeficiency virus (HIV) infection among older adults in sub-Saharan Africa.

Methods

We reviewed data from Demographic and Health Surveys (DHS). Although in these surveys all female respondents are < 50 years of age, 18 of the surveys contained data on HIV infection among men aged ≥ 50 years. To estimate the percentage of older adults (i.e. people ≥ 50 years of age) who were positive for HIV (HIV+), we extrapolated from data from the Joint United Nations Programme on HIV/AIDS on the estimated number of people living with HIV and on HIV infection prevalence among adults aged 15–49 years.

Findings

In 2007, approximately 3 million people aged ≥ 50 years were living with HIV in sub-Saharan Africa. The prevalence of HIV infection in this group was 4.0%, compared with 5.0% among those aged 15–49 years. Of the approximately 21 million people in sub-Saharan Africa aged ≥ 15 years that were HIV+, 14.3% were ≥ 50 years old.

Conclusion

To better reflect the longer survival of people living with HIV and the ageing of the HIV+ population, indicators of the prevalence of HIV infection should be expanded to include people > 49 years of age. Little is known about comorbidity and sexual behaviour among HIV+ older adults or about the biological and cultural factors that increase the risk of transmission. HIV services need to be better targeted to respond to the growing needs of older adults living with HIV.     

Chronic disease risk factors,healthy days and medical claims in South African employees presenting for health risk screening

Background  

Non-communicable diseases (NCD) accounts for more than a third (37%) of all deaths in South Africa. However, this burden of disease can be reduced by addressing risk factors. The aim of this study was to determine the health and risk profile of South African employees presenting for health risk assessments and to measure their readiness to change and improve lifestyle behaviour.     

Poor mental health and sexual risk behaviours in Uganda: A cross-sectional population-based study

Background  

Poor mental health predicts sexual risk behaviours in high-income countries, but little is known about this association in low-income settings in sub-Saharan Africa where HIV is prevalent. This study investigated whether depression, psychological distress and alcohol use are associated with sexual risk behaviours in young Ugandan adults.     

Albuminuria,cardiovascular risk factors and disease management in subjects with type 2 diabetes: a cross sectional study

Background  

Epidemiological studies have shown that microalbuminuria is an important risk factor for arteriosclerosis, coronary heart disease and other vascular diseases in persons with type 2 diabetes. In the present study we examined the prevalence and risk factors for micro- and macroalbuminuria and examined glycemic control as well as treatment of modifiable cardiovascular risk factors in persons with known type 2 diabetes in Germany.     

Alcohol use and extramarital sex among men in Cameroon

Background  

The spread of HIV in sub-Saharan Africa is believed to be driven by unsafe sex, and identification of modifiable risk factors of the latter is needed for comprehensive HIV prevention programming in the region. Some previous studies suggest an association between alcohol abuse and unsafe sexual behaviour, such as multiple concurrent sexual partnerships and inconsistent condom use in sex with non-spousal non-cohabiting partners. However, most of these studies were conducted in developed countries and the few studies in Africa were conducted among well-defined social groups such as men attending beer halls or sexually transmitted infection clinics. We therefore examined the association between alcohol and extramarital sex (a sign of multiple concurrent sexual partnerships) among men in a population-based survey in Cameroon; a low-income country in sub-Saharan Africa with a high rate of alcohol abuse and a generalised HIV epidemic.     

Childhood vaccination in informal urban settlements in Nairobi,Kenya: Who gets vaccinated?

Background  

Recent trends in global vaccination coverage have shown increases with most countries reaching 90% DTP3 coverage in 2008, although pockets of undervaccination continue to persist in parts of sub-Saharan Africa particularly in the urban slums. The objectives of this study were to determine the vaccination status of children aged between 12-23 months living in two slums of Nairobi and to identify the risk factors associated with incomplete vaccination.     

Delayed presentation and diagnosis of breast cancer in African women: a systematic review

PurposeAfrica has low breast cancer incidence rates but high mortality rates from this disease due to poor survival. Delays in presentation and diagnosis are major determinants of breast cancer survival, but these have not been comprehensively investigated in Africa.MethodsMEDLINE, Embase, and Global Health were searched to identify studies reporting on delays in presentation and/or diagnosis of breast cancer published between January 1, 2000 and May 31, 2016. Data were synthesized in narrative, tabular, and graphical forms. Meta-analyses were not possible due to between-study differences in the way delays were reported.ResultsTwenty-one studies were included in the review. Study-specific average times between symptom recognition and presentation to a health care provider ranged from less than 1 to 4 months in North Africa and from less than 3 to greater than 6 months in sub-Saharan Africa. Study-specific average times from presentation to diagnosis were less than 1 month in North Africa but ranged from less than 3 to greater than 6 months in sub-Saharan Africa. Reported reasons for these delays included patient-mediated (e.g., socioeconomic factors) and health system–mediated factors (e.g., referral pathways).ConclusionsThis systematic review revealed marked delays in presentation and diagnosis of breast cancer in Africa. Identification of their drivers is crucial to the development of appropriate control strategies in the continent.     

Illness-related behaviour and utilization of oral health services among adult city-dwellers in Burkina Faso: evidence from a household survey

Background  

In sub-Saharan Africa, the availability and accessibility of oral health services are seriously constrained and the provision of essential oral care is limited. Reports from the region show a very low utilization of oral health care services, and visits to dental-care facilities are mostly undertaken for symptomatic reasons. The objectives of the present study were to describe the prevalence of oral symptoms among adults in Ouagadougou, capital city of Burkina Faso and the use of oral health services and self-medication in response to these symptoms and to measure the associations between predisposing, enabling and needs factors and decisions to seek oral health care.     

Spatial heterogeneity of haemoglobin concentration in preschool-age children in sub-Saharan Africa

Objective

To determine whether blood haemoglobin concentration in preschool-age children (< 5 years of age) is geographically heterogeneous in sub-Saharan Africa and describe its association with environmental variables that drive anaemia of different etiologies.

Methods

Data were obtained on 24 277 preschool-age children in western Africa (2862 cluster sites) and 25 343 in eastern Africa (2999 cluster sites) from the 2001–2007 Demographic and Health Surveys (DHS) for sub-Saharan Africa. Cluster sites were linked to environmental information on distance to perennial water body, elevation, land surface temperature and normalized difference vegetation index (NDVI; a proxy for rainfall) in a geographical information system. Statistical associations with environmental variables were determined using multivariate regression models, and the spatial dependence of haemoglobin concentration unexplained by these factors was quantified using semivariograms.

Findings

In eastern Africa, the lowest haemoglobin concentrations (< 70 g/l) occurred in small clusters throughout the region; in western Africa, they occurred in a large cluster straddling the border between Burkina Faso and Mali. Our results show significant continent-wide associations between haemoglobin concentration and environmental variables, particularly in western Africa for land surface temperature and NDVI, and in eastern Africa for elevation. Residual spatial dependence was significant, and the magnitude was greater in western than in eastern Africa.

Conclusion

The distribution of anaemia is driven by large-scale environmental factors, and the epidemiological drivers differ in western and eastern Africa. Strategies for anaemia control in preschool-age children in sub-Saharan Africa should be tailored to local conditions, taking into account the specific etiology and prevalence of anaemia.