METHODS: Experimental and observational studies conducted in sub-Saharan Africa between 2000 and 2021 which had quantitatively evaluated the impact of health education interventions on malaria knowledge and ITN usage were included in the review.
RESULTS: A total of 11 studies (20,523 participants) were included. Four studies used educational interventions to teach appropriate ITN strategies and promote ITN usage. Two others focused on improving knowledge of malaria transmission, prevention, treatment, and its signs and symptoms. The remaining five studies assessed both ITN use and malaria knowledge. Of these, 10 were eligible for meta-analysis. On average, the odds of a person in the intervention group reporting better malaria knowledge (odds ratio 1.30, 95% CI: 1.00 to 1.70, p = 0.05) and higher ITN usage (odds ratio 1.53, 95% CI: 1.02 to 2.29, p = 0.004) increased significantly after receiving health education interventions compared to those in the control group. The odds of ITN usage also substantially increased when the interventions were based on a theory or model (odds ratio 5.27, 95% CI: 3.24 to 8.58, p = 0.05).
DISCUSSION: Our review highlights sub-Saharan Africa's various health education strategies to curb malaria over the past two decades. Meta-analysis findings show that health education interventions are moderately effective in improving malaria knowledge and ITN usage and have contributed to the effort of global malaria strategy.
DESIGN: We included data on children initiating ART between 2004 and 2016 at less than 16 years old at 16 International Epidemiologic Databases to Evaluate AIDS Southern Africa cohorts. Children were classified as loss to follow up (LTFU) if they had not attended clinic for more than 180 days. Children had a care interruption if they were classified as LTFU, and subsequently returned to care. Children who died within 180 days of ART start were excluded.
METHODS: The main outcome was all cause mortality. Two exposed groups were considered: those with a first care interruption within the first 6 months on ART, and those with a first care interruption after 6 months on ART. Adjusted hazard ratios were determined using a Cox regression model.
RESULTS: Among 53 674 children included, 23 437 (44%) had a care interruption, of which 10 629 (20%) had a first care interruption within 6 months on ART and 12 808 (24%) had a first care interruption after 6 months on ART. Increased mortality was associated with a care interruption within 6 months on ART [adjusted hazard ratio (AHR) = 1.52, 95% CI 1.12-2.04] but not with a care interruption after 6 months on ART (AHR = 1.05, 95% CI 0.77-1.44).
CONCLUSION: The findings suggest that strengthening retention of children in care in the early period after ART initiation is critical to improving paediatric ART outcomes.
METHODS: We carried out a systematic review of the scientific literature published between 2006 and 2018, supplemented by mortality data from WHO. We extracted data from 157 publications and the WHO cause-of-death database, then performed country-wise synopses, and arrived at annual numbers of national UAPP. World-wide UAPP was estimated based on national figures and population data for regions defined by the Food and Agriculture Organization (FAO).
RESULTS: In total 141 countries were covered, including 58 by the 157 articles and an additional 83 by data from the WHO Mortality Database. Approximately 740,000 annual cases of UAPP were reported by the extracted publications resulting from 7446 fatalities and 733,921 non-fatal cases. On this basis, we estimate that about 385 million cases of UAPP occur annually world-wide including around 11,000 fatalities. Based on a worldwide farming population of approximately 860 million this means that about 44% of farmers are poisoned by pesticides every year. The greatest estimated number of UAPP cases is in southern Asia, followed by south-eastern Asia and east Africa with regards to non-fatal UAPP.
CONCLUSIONS: Our study updates outdated figures on world-wide UAPP. Along with other estimates, robust evidence is presented that acute pesticide poisoning is an ongoing major global public health challenge. There is a need to recognize the high burden of non-fatal UAPP, particularly on farmers and farmworkers, and that the current focus solely on fatalities hampers international efforts in risk assessment and prevention of poisoning. Implementation of the international recommendations to phase out highly hazardous pesticides by the FAO Council could significantly reduce the burden of UAPP.
AREAS COVERED: Published and unpublished studies from January 1981 to June 2020 were systematically reviewed on PubMed, Web of Science and Scopus. Additionally, the reference list of all studies was hand-searched for additional studies. This effort identified a total of 104614 registered patients and suggests identification of at least 10590 additional PID patients, mainly from countries located in Asia and Africa. Molecular defects in genes known to cause PID were identified and reported in 13852 (13.2% of all registered) patients.
EXPERT OPINION: Although these data suggest some progress in the identification and documentation of PID patients worldwide, achieving the basic requirement for the global PID burden estimation and registration of undiagnosed patients will require more reinforcement of the progress, involving both improved diagnostic facilities and neonatal screening.
METHODS: A total of 1028 confirmed cases of COVID-19 from Africa with definite survival outcomes were identified retrospectively from an open-access individual-level worldwide COVID-19 database. The live version of the dataset is available at https://github.com/beoutbreakprepared/nCoV2019 . Multivariable logistic regression was conducted to determine the risk factors that independently predict mortality among patients with COVID-19 in Africa.
RESULTS: Of the 1028 cases included in study, 432 (42.0%) were females with a median (interquartile range, IQR) age of 50 (24) years. Older age (adjusted odds ratio {aOR} 1.06; [95% confidence intervals {95% CI}, 1.04-1.08]), presence of chronic disease (aOR 9.63; [95% CI, 3.84-24.15]), travel history (aOR 2.44; [95% CI, 1.26-4.72]), as well as locations of Central Africa (aOR 0.14; [95% CI, 0.03-0.72]) and West Africa (aOR 0.12; [95% CI, 0.04-0.32]) were identified as the independent risk factors significantly associated with increased mortality among the patients with COVID-19.
CONCLUSIONS: The COVID-19 pandemic is evolving gradually in Africa. Among patients with COVID-19 in Africa, older age, presence of chronic disease, travel history, and the locations of Central Africa and West Africa were associated with increased mortality. A regional response should prioritize strategies that will protect these populations. Also, conducting a further in-depth study could provide more insights into additional factors predictive of mortality in COVID-19 patients.
METHODS: In the course of retrieval of data following MOOSE guidelines and PRISMA checklist, we found a total of fourteen studies that have been conducted during that period on altering sperm concentration in the African male.
RESULTS: Following analysis of the data, a time-dependent decline of sperm concentration (r = -0.597, p = 0.02) and an overall 72.6% decrease in mean sperm concentration was noted in the past 50 years. The major matter of concern is the present mean concentration (20.38×106/ml) is very near to WHO cut-off value of 2010 of 15×106/ml. Several epidemic diseases, genital tract infection, pesticides and heavy metal toxicity, regular consumption of tobacco and alcohol are reported as predominant causative factors.
CONCLUSION: This comprehensive, evidence-based meta-analysis and systematic review concisely presents the evidence of decreased sperm concentration in the African male over past 50 years with possible causative factors to serve the scientific research zone related to male reproductive health.
METHODS: This approach included the use of the Alcohol Use Disorders Identification Test-Consumption (AUDIT-C) as a means of screening to identify individuals at moderate (score of 5-7) to high risk (score of 8 +) alcohol use, raising awareness, and investigating the potential utility of brief advice and referrals as a means of reducing risk.
RESULTS: Of the 54,187 participants, 43.0% reported engaging in moderate-risk alcohol consumption, with 22.1% reporting high-risk alcohol consumption. Resistance to brief advice was observed to increase with higher AUDIT-C scores. Similarly, participants engaging in high-risk alcohol consumption were resistant to accepting treatment referrals, with fewer than 10% open to receiving a referral.
CONCLUSIONS: While men were most likely to report patterns of high-risk alcohol consumption, they were more resistant to accepting referrals. Additionally, participants who were willing to receive brief advice were often resistant to taking active steps to alter their alcohol use. This study highlights the need to consider how to prevent harmful patterns of alcohol use effectively and holistically, especially in low socioeconomic settings through primary health care and community services.
METHODS: We analyzed data from 91 seroprevalence surveys and sentinel surveillance among antenatal care clinic (ANC) attendees using model-based geostatistical methods to produce estimates of HIV prevalence across 43 countries in SSA, from years 2000 to 2018, at a 5 × 5-km resolution and presented among second administrative level (typically districts or counties) units.
RESULTS: We found substantial variation in HIV prevalence across localities, ages, and sexes that have been masked in earlier analyses. Within-country variation in prevalence in 2018 was a median 3.5 times greater across ages and sexes, compared to for all adults combined. We note large within-district prevalence differences between age groups: for men, 50% of districts displayed at least a 14-fold difference between age groups with the highest and lowest prevalence, and at least a 9-fold difference for women. Prevalence trends also varied over time; between 2000 and 2018, 70% of all districts saw a reduction in prevalence greater than five percentage points in at least one sex and age group. Meanwhile, over 30% of all districts saw at least a five percentage point prevalence increase in one or more sex and age group.
CONCLUSIONS: As the HIV epidemic persists and evolves in SSA, geographic and demographic shifts in prevention and treatment efforts are necessary. These estimates offer epidemiologically informative detail to better guide more targeted interventions, vital for combating HIV in SSA.
METHODS: Data were from population-based studies of aging and their Harmonized Cognitive Assessment Protocols (HCAPs) in the US, South Africa, India, and Mexico (N = 10,037; Age range: 50 to 105 years; 2016 to 2020). Main lifetime occupational skill was classified according to the International Standard Classification of Occupations. Weighted, adjusted regression models estimated pooled and country-specific associations between main lifetime occupational skill and later-life general cognitive function in men and women.
RESULTS: We observed positive gradients between occupational skill and later-life cognitive function for men and women in the US and Mexico, a positive gradient for women but not men in India, and no association for men or women in South Africa.
DISCUSSION: Main lifetime occupations may be a source of later-life cognitive reserve, with cross-national heterogeneity in this association.
HIGHLIGHTS: No studies have examined cross-national differences in the association of occupational skill with cognition. We used data from Harmonized Cognitive Assessment Protocols in the US, Mexico, India, and South Africa. The association of occupational skill with cognitive function varies by country and gender.