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Khalid Khattala, Youssef Bouabdallah
Moussa Seck, Maureen Adéniké Dabo, Elimane Seydi Bousso, Mohamed Keita, Sokhna Aïssatou Touré, Sérigne Mourtalla Guèye, Blaise Félix Faye, Fatma Dieng, Saliou Diop
Objectives The aim of this study was to describe the morbidity and mortality of homozygous sickle cell disease after the age of 40. Methods This was a cohort study of 209 patients followed from 1994 to 2022. All hemoglobin electrophoresis-confirmed SS sickle cell patients over 40 years were included. A descriptive study of epidemiological, diagnostic, therapeutic, and evolutionary data was used to assess morbidity and mortality. Results Sex ratio (M/F) was 0.6. Median age was 47 (41–75). According to morbidity, 95.1% had less than 3 vaso-occlusive crises/year. Acute anemia was the most frequent complication (52.63%). Chronic complications were noted in 32.5%. At diagnosis, mean hemoglobin was 8.1 g/dl ± 1.9, HbS was 86.5 ± 10, and HbF was 9.4 ± 7.6. Number of patients transfused was 66%. We noted that 8.1% of patients died, 29.2% were lost to follow-up, and 62.7% were still being followed up. The risk factors identified for death were geographical origin, comorbidity, high HbS, low HbF, and thrombocytosis. Conclusion This study shows that homozygous SCD is increasingly becoming an adult disease and that it can be carried into old age in Africa. Advanced age over 40 is marked by an upsurge in chronic complications, making it essential to set up a screening program and to organize multidisciplinary follow-up.
Margaux Gaury
Chez les bovins lait, la longévité fonctionnelle est un caractère d’intérêt majeur sur les plans économique, environnemental et du bien-être animal mais elle n’est mesurable que tardivement dans la vie des individus. L’objectif de ce stage était d’évaluer si l’âge épigénétique, prédit à partir de la méthylation de l’ADN pouvait constituer un biomarqueur précoce du vieillissement et de la longévité fonctionnelle. Le méthylome sanguin de 4 751 vaches Holstein a été analysé à l’aide de la puce RUMIGEN EpiChip, ciblant 44 053 sites CpGs. Plusieurs modèles de prédiction ont été comparés afin de construire une horloge épigénétique. Le meilleur modèle a prédit l’âge épigénétique des animaux avec une précision de 129 jours. L’écart entre l’âge épigénétique et l’âge réel a été calculé pour chaque animal. Dans les modèles analysés, cet écart présentait une héritabilité modérée et était associé à plusieurs régions génomiques où plusieurs gènes candidats ont été identifiés (dont DNMT3B et RCAN2). De plus, cet écart a permis d’observer que l’accélération du vieillissement épigénétique était associée à une réforme précoce des animaux. Ces résultats montrent qu’une horloge épigénétique peut être construite chez la vache laitière et que l’âge épigénétique pourrait constituer un éventuel biomarqueur précoce de la longévité fonctionnelle. Ces approches sont très prometteuses pour être appliquées à d’autres contextes et à différentes échelles d’étude.
Alfred B. Tiono, Amadou T. Konaté, Désiré Kargougou, Amidou Diarra, Issa Nébié Ouedraogo, Amidou Ouedraogo, Franco Pagnoni, David Modiano, Sodiomon B. Sirima
BackgroundIn the current context of tailoring interventions to maximize impact, it is important that current data of clinical epidemiology guide public health programmes and health workers in the management of severe disease. This study aimed at describing the burden of severe malaria at hospital level in two areas with distinct malaria transmission intensity.MethodsA hospital-based surveillance was established in two regional hospitals located in two areas exposed to different malaria transmission. Data on paediatric severe malaria admissions were recorded using standardized methods from August 2017 to August 2018 with an interruption during the dry season from April to June 2018.ResultsIn total, 921 children with severe malaria cases were enrolled in the study. The mean age was 33.9 (± 1.3) and 36.8 (± 1.6) months in lower malaria transmission (LMT) and higher malaria transmission (HMT) areas (p = 0.15), respectively. The geometric mean of asexual P. falciparum density was significantly higher in the LMT area compared to the HMT area: 22,861 trophozoites/µL (95% CI 17,009.2–30,726.8) vs 11,291.9 trophozoites/µL (95% CI 8577.9–14,864.5). Among enrolled cases, coma was present in 70 (9.2%) participants. 196 patients (21.8%) presented with two or more convulsions episodes prior to admission. Severe anaemia was present in 448 children (49.2%). Other clinical features recorded included 184 (19.9%) cases of lethargy, 99 (10.7%) children with incoercible vomiting, 80 (8.9%) patients with haemoglobinuria, 43 (4.8%) children with severe hypoglycaemia, 37 (4.0%) cases where child was unable to drink/suck, 11 (1.2%) cases of patients with circulatory collapse/shock, and 8 cases (0.9%) of abnormal bleeding (epistaxis). The adjusted odds of presenting with coma, respiratory distress, haemoglobinuria, circulatory collapse/shock and hypoglycaemia were significantly higher (respectively 6.5 (95%CI 3.4–12.1); 1.8 (95%CI 1.0–3.2); 2.7 (95%CI 1.6–4.3); 5.9 (95%CI 1.3–27.9); 1.9 (95%
Angeline Boula, Madikay Senghore, Rose Ngoh, Flaubert Tassadjo, Marie-Christine Fonkoua, Ariane Nzouankeu, Mina Kenkela Njiki, Jeanne Musi, Sandrine Bebey, Madeline Ngo Baleba, Angeline Nkembe, Sidonie Médjina, Peter S Ndow, Archibald Worwui, Marie Kobela, Marceline Nimpa, Jason M Mwenda, Aboubacar N’diaye, Brenda A Kwambana-Adams, Martin Antonio
AbstractBackgroundMeningitis is endemic to regions of Cameroon outside the meningitis belt including the capital city, Yaoundé. Through surveillance, we studied the etiology and molecular epidemiology of pediatric bacterial meningitis in Yaoundé from 2010 to 2016.MethodsLumbar puncture was performed on 5958 suspected meningitis cases; 765 specimens were further tested by culture, latex agglutination, and/or polymerase chain reaction (PCR). Serotyping/grouping, antimicrobial susceptibility testing, and/or whole genome sequencing were performed where applicable.ResultsThe leading pathogens detected among the 126 confirmed cases were Streptococcus pneumoniae (93 [73.8%]), Haemophilus influenzae (18 [14.3%]), and Neisseria meningitidis (15 [11.9%]). We identified more vaccine serotypes (19 [61%]) than nonvaccine serotypes (12 [39%]); however, in the latter years non–pneumococcal conjugate vaccine serotypes were more common. Whole genome data on 29 S. pneumoniae isolates identified related strains (<30 single-nucleotide polymorphism difference). All but 1 of the genomes harbored a resistance genotype to at least 1 antibiotic, and vaccine serotypes harbored more resistance genes than nonvaccine serotypes (P < .05). Of 9 cases of H. influenzae, 8 were type b (Hib) and 1 was type f. However, the cases of Hib were either in unvaccinated individuals or children who had not yet received all 3 doses. We were unable to serogroup the N. meningitidis cases by PCR.Conclusions Streptococcus pneumoniae remains a leading cause of pediatric bacterial meningitis, and nonvaccine serotypes may play a bigger role in disease etiology in the postvaccine era. There is evidence of Hib disease among children in Cameroon, which warrants further investigation. We studied the etiology of pediatric bacterial meningitis in Cameroon, in the postvaccine era, associated with Streptococcus pneumoniae, Haemophilus influenzae, and Neisseria meningitidis. Our findings emphasize the need for increased effor
Norovirus (NoV) constitutes the second most common viral pathogen causing pediatric diarrhea after rotavirus. In Africa, diarrhea is a major health problem in children, and yet few studies have been performed regarding NoV. The association of histo-blood group antigens (HBGA) and susceptibility to NoV infection is well established in Caucasian populations with non-secretors being resistant to many common NoV strains. No study regarding HBGA and NoV susceptibility has yet been performed in Africa. We collected 309 stool and 208 saliva samples from diarrheal children in Ouagadougou, Burkina Faso; May 2009 to March 2010. NoV was detected using real-time PCR, and genotyped by sequencing. Saliva samples were ABO, Lewis and secretor phenotyped using in house ELISA assays. NoV was detected in 12% (n = 37) of the samples. The genotype diversity was unusually large; overall the 37 positive samples belonged to 14 genotypes. Only children <2 years of age were NoV positive and the GII.4 NoVs were more frequent in the late dry season (Jan-May). NoV infections were observed less in children with the secretor-negative phenotype or blood group A (OR 0.18; p = 0.012 and OR 0.31; p = 0.054; respectively), with two non-secretors infected with genotypes GII.7 and GII.4 respectively. Lewis-negative (Lea−b−) children, representing 32% of the study population, were susceptible to GII, but were not infected with any NoV GI. GII.4 strains preferentially infected children with blood group B whereas secretor-positive children with blood group O were infected with the largest variety of genotypes. This is the first study identifying host genetic factors associated with susceptibility to NoV in an African population, and suggests that while the non-secretor phenotype provides protection; the Lewis b antigen is not necessary for GII infection.
Gregory MacMullin, Ronald Mackenzie, Rachel Lau, Julie Khang, Haibo Zhang, Nimerta Rajwans, W Conrad Liles, Dylan R Pillai
BackgroundClinical observations suggest that Canadian-born (CB) travellers are prone to more severe malaria, characterized by higher parasite density in the blood, and severe symptoms, such as cerebral malaria and renal failure, than foreign-born travellers (FB) from areas of malaria endemicity. It was hypothesized that host cytokine and chemokine responses differ significantly in CB versus FB patients returning with malaria, contributing to the courses of severity. A more detailed understanding of the profiles of cytokines, chemokines, and endothelial activation may be useful in developing biomarkers and novel therapeutic approaches for malaria.Materials and methodsThe patient population for the study (n = 186) was comprised of travellers returning to Toronto, Canada between 2007 and 2011. The patient blood samples’ cytokine, chemokine and angiopoietin concentrations were determined using cytokine multiplex assays, and ELISA assays.ResultsSignificantly higher plasma cytokine levels of IL-12 (p40) were observed in CB compared to FB travellers, while epidermal growth factor (EGF) was observed to be higher in FB than CB travellers. Older travellers (55 years old or greater) with Plasmodium vivax infections had significantly higher mean cytokine levels for IL-6 and macrophage colony-stimulating factor (M-CSF) than other adults with P. vivax (ages 18–55). Patients with P. vivax infections had significantly higher mean cytokine levels for monocyte chemotactic protein-1 (MCP-1), and M-CSF than patients with Plasmodium falciparum. Angiopoietin 2 (Ang-2) was higher for patients infected with P. falciparum than P. vivax, especially when comparing just the FB groups. IL-12 (p40) was higher in FB patients with P. vivax compared to P. falciparum. Il-12 (p40) was also higher in patients infected with P. vivax than those infected with Plasmodium ovale. For patients travelling to West Africa, IFN-γ and IL-6 was lower than for patients who were in other regions of Africa.Conclusion
Kristine Belesova, Antonio Gasparrini, Ali Sié, Rainer Sauerborn, Paul Wilkinson
BackgroundReduction of child undernutrition is one of the Sustainable Development Goals for 2030. Achievement of this goal may be made more difficult in some settings by climate change through adverse impact on agricultural productivity. However, there is only limited quantitative evidence on the link between household crop harvests and child nutrition. We examined this link in a largely subsistence farming population in rural Burkina Faso.MethodsData on the middle-upper arm circumference (MUAC) of 975 children ≤5 years of age, household crop yields, and other parameters were obtained from the Nouna Health and Demographic Surveillance System. Multilevel modelling was used to assess the relationship between MUAC and the household crop harvest in the year 2009 estimated in terms of kilocalories per adult equivalent per day (kcal/ae/d).ResultsFourteen percent of children had a MUAC <125 mm (a value indicative of acute undernutrition). The relationship between MUAC and annual household food energy production adjusted for age, sex, month of MUAC measurement, household wealth, whether a household member had a non-agricultural occupation, garden produce, village infrastructure and market presence, suggested a decline in MUAC below around 3000 kcal/ae/d. The mean MUAC was 2.49 (95% CI 0.45, 4.52) mm less at 1000 than at 3000 kcal/ae/d.ConclusionsLow per capita household crop production is associated with poorer nutritional status of children in a rural farming population in Burkina Faso. This and similar populations may thus be vulnerable to the adverse effects of weather on agricultural harvest, especially in the context of climate change.Electronic supplementary materialThe online version of this article (doi:10.1186/s12940-017-0258-9) contains supplementary material, which is available to authorized users.
Joëlle Castellani, Borislava Mihaylova, Mohamadou Siribié, Zakaria Gansane, Amidou Z. Ouedraogo, Florence Fouque, Sodiomon B. Sirima, Silvia M. A. A. Evers, Aggie T. G. Paulus, Melba Gomes
BackgroundCommunity health workers (CHWs) were trained to identify children with malaria who could not take oral medication, treat them with rectal artesunate (RA) and refer them to the closest healthcare facility to complete management. However, many children with such symptoms did not seek CHWs’ care. The hypothesis was that the cost of referral to a health facility was a deterrent. The goal of this study was to compare the out-of-pocket costs and time to seek treatment for children who sought CHW care (and received RA) versus those who did not.MethodsChildren with symptoms of severe malaria receiving RA at CHWs and children with comparable disease symptoms who did not go to a CHW were identified and their parents were interviewed. Household out-of-pocket costs per illness episode and speed of treatment were evaluated and compared between RA-treated children vs. non-RA treated children and by central nervous symptoms (CNS: repeated convulsions, altered consciousness or coma).ResultsAmong children with CNS symptoms, costs of RA-treated children were similar to those of non-RA treated children ($5.83 vs. $4.65; p = 0.52), despite higher transport costs ($2.74 vs. $0.91; p < 0.0001). However, among children without CNS symptoms, costs of RA-treated children were higher than the costs of non-RA treated children with similar symptoms ($5.62 vs. $2.59; p = 0.0001), and the main driver of the cost difference was transport. After illness onset, CNS children reached CHWs for RA an average of 9.0 h vs. 16.1 h for non-RA treated children reaching first treatment [difference 7.1 h (95% CI − 1.8 to 16.1), p = 0.11]. For non-CNS patients the average time to CHW-delivered RA treatment was 12.2 h vs. 20.1 h for those reaching first treatment [difference 7.9 h (95% CI 0.2–15.6), p = 0.04]. More non-RA treated children developed CNS symptoms before arrival at the health centre but the difference was not statistically significant (6% vs. 4%; p = 0.58).ConclusionsCommunity health wor
Laetitia Duval, Elisa Sicuri, Susana Scott, Maminata Traoré, Bunja Daabo, Halidou Tinto, Koen Peeters Grietens, Umberto d’Alessando, Henk Schallig, Petra Mens, Lesong Conteh
BackgroundMalaria in pregnancy remains a major health threat in sub-Saharan Africa to both expectant mothers and their unborn children. To date, there have been very few studies focused on the out of pocket costs associated with seeking treatment for malaria during pregnancy.MethodsA cross-sectional survey was undertaken in Burkina Faso and The Gambia to estimate the direct and indirect costs associated with outpatient consultations (OP) and inpatient admissions (IP). Direct costs were broken down into medical (admission fees, drug charges, and laboratory fees), and non-medical (transportation and food). Indirect costs reflected time lost due to illness. In total, 220 pregnant women in Burkina Faso and 263 in The Gambia were interviewed about their treatment seeking decisions, expenditure, time use and financial support associated with each malaria episode.ResultsIn Burkina Faso 6.7% sought treatment elsewhere before their OP visits, and 27.1% before their IP visits. This compares to 1.3% for OP and 25.92% for IP in The Gambia. Once at the facility, the average direct costs (out of pocket) were 3.91US$ for an OP visit and 15.38US$ of an IP visit in Burkina Faso, and 0.80US$ for an OP visit and 9.19US$ for an IP visit in The Gambia. Inpatient direct costs were driven by drug costs (9.27US$) and transportation costs (2.72US$) in Burkina Faso and drug costs (3.44 US$) and food costs (3.44 US$) in The Gambia. Indirect costs of IP visits, valued as the opportunity cost of time lost due to the illness, were estimated at 11.85US$ in Burkina Faso and 4.07US$ in The Gambia. The difference across the two countries was mainly due to the longer time of hospitalization in Burkina Faso compared to The Gambia. In The Gambia, the vast majority of pregnant women reported receiving financial support from family members living abroad, most commonly siblings (65%).ConclusionsHigh malaria treatment costs are incurred by pregnant women in Burkina Faso and The Gambia. Beyond the medical c
ObjectivesTo describe the variation in household crowding and social mixing patterns in the African meningitis belt and to assess any association with self-reported recent respiratory symptoms.MethodsIn 2010, the African Meningococcal Carriage Consortium (MenAfriCar) conducted cross-sectional surveys in urban and rural areas of seven countries. The number of household members, rooms per household, attendance at social gatherings and meeting places were recorded. Associations with self-reported recent respiratory symptoms were analysed by univariate and multivariate regression models.ResultsThe geometric mean people per room ranged from 1.9 to 2.8 between Ghana and Ethiopia respectively. Attendance at different types of social gatherings was variable by country, ranging from 0.5 to 1.5 per week. Those who attended 3 or more different types of social gatherings a week (frequent mixers) were more likely to be older, male (OR 1.27, p<0.001) and live in urban areas (OR 1.45, p<0.001). Frequent mixing and young age, but not increased household crowding, were associated with higher odds of self-reported respiratory symptoms (aOR 2.2, p<0.001 and OR 2.8, p<0.001 respectively). A limitation is that we did not measure school and workplace attendance.ConclusionThere are substantial variations in household crowding and social mixing patterns across the African meningitis belt. This study finds a clear association between age, increased social mixing and respiratory symptoms. It lays the foundation for designing and implementing more detailed studies of social contact patterns in this region.
Travis J. Lybbert, Stephen A. Vosti, Katherine P. Adams, Rosemonde Guissou
Addressing early-life micronutrient deficiencies can improve short- and long-term outcomes. In most contexts, private supply chains will be key to effective and efficient preventative supplementation. With established vendors, we conducted a 60-week market trial for a food-based micronutrient supplement in rural Burkina Faso with randomized price and non-price treatments. Repeat purchases – critical for effective supplementation – are extremely price sensitive. Loyalty cards boost demand more than price discounts, particularly in non-poor households where the father is the cardholder. A small minority of households achieved sufficient supplementation for their children through purely retail distribution, suggesting the need for more creative public-private delivery platforms informed by insights into household demand persistence and heterogeneity.
Food insecurity and achieving adequate nutrition is a major global challenge, especially in vulnerable groups such as refugee communities. In West Africa, thousands of Burkina Faso refugees have crossed the border into northern Ghana due to conflict and instability in their home country. We conducted a one-off cross-sectional survey to assess household food insecurity, living conditions, and sense of security among Burkina Faso refugees currently residing in the Upper East region of Ghana. Study data was collected over 14–21 October 2022 from 498 refugee households, via registered refugee households who were contacted with the help of the community refugee focal persons. We used the validated USAID household food insecurity questionnaire, analysed using Rasch modelling, with descriptive statistics, and linear regression analyses (with significance at p < 0.05) to assess food insecurity. Results revealed that 100% of households experienced food insecurity, with 95.2% defined as moderate or severe, and 70.4% as experiencing severe food insecurity. Refugees from rural areas were less insecure compared to urban refugees (β = -4.25 [CI: -5.79 –-2.71], p < .001). Refugees residing in host communities experienced lower food insecurity than those in designated refugee camps (β = -1.56 [CI: -2.74 –-0.39,] p = .009). Further, refugees who were dissatisfied with their accommodation size were more likely to experience food insecurity (β = 2.96 [CI: -0.06–2.47], p = .060). Most refugees (73.5%) felt safe and welcomed by host communities. Our results highlight the extremely high prevalence of moderate and severe food insecurity in this vulnerable refugee population. We provide evidence to support the need to improve food distribution logistics, prioritising suitable accommodation, and facilitating access to healthcare. Follow-up research, such as repeated community surveys, can track this evolving situation to continuously inform decision-making for refugee support.
Mouhamadou Lamine Daffe, Salimata Thiam, Fatoumata Bah, Awa Ndong, Mathilde Cabral, Cheikh Diop, Aminata Toure, Absa Lam, Mamadou Fall
BackgroundOne out of ten deaths of children under five are attributable to indoor air pollution. And Acute Respiratory Illness (ARI) is among the direct causes.ObjectiveThis study showed the possibilities of characterizing indoor air pollution in West African Economic and Monetary Union (WAEMU) area and it also made it possible to estimate its impact on the occurrence of ARI in children under five.MethodsIt has been a secondary analysis based on Demographic and Health Surveys (DHSs) from WAEMU countries’ data.. “Household level of air pollution” is the created composite variable, from questions on the degradation factors of indoor air quality (domestic combustion processes) which served to characterize indoor air pollution and to measure its impact by a logistic regression.ResultsBurkina Faso stands out with a greater number of households with a high level of pollution (63.7%) followed by Benin (43.7%) then Togo (43.0%). The main exposure factor "Household level of air pollution" was associated with ARI symptoms (Togo: prevalence = 51.3%; chi-squared test’s p-value < 0.001). Exposure to high level of pollution constitutes a risk (AOR [95 CI]), even though it is not significant ( Ivory Coast: 1.29 [0.72–2.30], Senegal: 1.39 [0.94–2.05] and Togo: 1.15 [0.67–1.95]) and this could be explained by the high infectious etiology of the ARI.
Sarah A Meyer, Paul A Kristiansen
Kanyiva Muindi, Samuel Iddi, Hellen Gitau, Blessing Mberu
BackgroundThe connection between healthy housing status and health is well established. The quality of housing plays a significant role in infectious and non-communicable as well as vector-borne diseases. The global burden of disease attributable to housing is considerable with millions of deaths arising from diarrheal and respiratory diseases annually. In sub-Saharan Africa (SSA), the quality of housing remains poor although improvements have been documented. There is a general dearth of comparative analysis across several countries in the sub-region. We assess in this study, the association between healthy housing and child morbidity across six countries in SSA.MethodsWe use the Demographic and Health Survey (DHS) data for six countries where the most recent survey collected health outcome data on child diarrhoea, acute respiratory illness, and fever. The total sample size of 91,096 is used in the analysis (representing 15, 044 for Burkina Faso, 11, 732 for Cameroon, 5, 884 for Ghana, 20, 964 for Kenya, 33, 924 for Nigeria, and 3,548 for South Africa). The key exposure variable is healthy housing status. We control for various factors associated with the three childhood health outcomes. These include quality housing status, residency (rural/urban), age of the head of the household, mother’s education, mother’s BMI status, marital status, mother’s age, and religious status. Others include the child’s gender, age, whether the child is from multiple or single births, and breastfeeding status. Inferential analysis using survey-weighted logistic regression is employed.ResultsOur findings indicate that housing is an important determinant of the three outcomes investigated. Compared to unhealthier housing, healthy housing status was found to be associated with reduced odds of diarrhoea in Cameroon [Healthiest: aOR = 0.48, 95% CI, (0.32,0.71), healthier: aOR = 0.50, 95% CI,(0.35,0.70), Healthy: aOR = 0.60, 95% CI, (0.44,0.83), Unhealthy: aOR = 0.60, 95% CI, (0.44,0.81)],
Yazoumé Yé, Moshe Hoshen, Valérie Louis, Simboro Séraphin, Issouf Traoré, Rainer Sauerborn
BackgroundIdentification and better understanding of potential risk factors for malaria are important for targeted and cost-effective health interventions. Housing conditions have been suggested as one of the potential risk factors. This study aims to further investigate this risk factor, and is focused on the effect of the type of roof on Plasmodium falciparum infection among children below five years in the North West of Burkina Faso.MethodsIn a cross-sectional study design, 661 children aged six to 60 months were randomly selected from three rural and one semi-urban site at the end of the rainy season (November 2003). The children were screened for fever and tested for Plasmodium falciparum infection. In addition, data on bed net use and house characteristics was collected from the household were each child lived. Using adjusted odds ratios, children living in house roofed with iron-sheet were compared with those in house with mud or grass roof.ResultsOverall P. falciparum infection prevalence was 22.8 % with a significant variation between (Chi-square, p < 0.0001). The prevalence in Cissé (33.3 %) and Goni (30.6 %) were twice times more than in Nouna (15.2 %) and Kodougou (13.2 %). After adjusting for age, sex, use of bed net and housing conditions, children living in houses with mud roofs had significantly higher risk of getting P. falciparum infection compared to those living in iron-sheet roofed houses (Odds Ratio 2.6; 95% Confidence Interval, 1.4–4.7).ConclusionThese results suggest that house characteristics should be taken into consideration when designing health intervention against P. falciparum infection and particular attention should be paid to children living in houses with mud roofs.
BackgroundImprovements to housing may contribute to malaria control and elimination by reducing house entry by malaria vectors and thus exposure to biting. We tested the hypothesis that the odds of malaria infection are lower in modern, improved housing compared to traditional housing in sub-Saharan Africa (SSA).Methods and FindingsWe analysed 15 Demographic and Health Surveys (DHS) and 14 Malaria Indicator Surveys (MIS) conducted in 21 countries in SSA between 2008 and 2015 that measured malaria infection by microscopy or rapid diagnostic test (RDT). DHS/MIS surveys record whether houses are built with finished materials (e.g., metal) or rudimentary materials (e.g., thatch). This information was used to develop a binary housing quality variable where houses built using finished wall, roof, and floor materials were classified as “modern”, and all other houses were classified as “traditional”. Conditional logistic regression was used to determine the association between housing quality and prevalence of malaria infection in children aged 0–5 y, adjusting for age, gender, insecticide-treated net (ITN) use, indoor residual spraying, household wealth, and geographic cluster. Individual survey odds ratios (ORs) were combined to determine a summary OR using a random effects meta-analysis.Of 284,532 total children surveyed, 139,318 were tested for malaria infection using microscopy (n = 131,652) or RDT (n = 138,540). Within individual surveys, malaria prevalence measured by microscopy ranged from 0.4% (Madagascar 2011) to 45.5% (Burkina Faso 2010) among children living in modern houses and from 0.4% (The Gambia 2013) to 70.6% (Burkina Faso 2010) in traditional houses, and malaria prevalence measured by RDT ranged from 0.3% (Senegal 2013–2014) to 61.2% (Burkina Faso 2010) in modern houses and from 1.5% (The Gambia 2013) to 79.8% (Burkina Faso 2010) in traditional houses. Across all surveys, modern housing was associated with a 9% to 14% reduction in the odds of malaria infe
Amanda VanSteelandt, Raahyma Ahmad, Aganeta Enns, Beth Jackson, Tanya Kakkar, Fiona Kouyoumdjian
AbstractIntroduction:There is a complex relationship between housing status and substance use, where substance use reduces housing opportunities and being unhoused increases reasons to use substances, and the associated risks and stigma.Methods:In this descriptive analysis of people without housing who died of accidental substance-related acute toxicity in Canada, we used death investigation data from a national chart review study of substance-related acute toxicity deaths in 2016 and 2017 to compare sociodemographic factors, health histories, circumstances of death and substances contributing to death of people who were unhoused and people not identified as unhoused, using Pearson chi-square test. The demographic distribution of people who died of acute toxicity was compared with the 2016 Nationally Coordinated Point-In-Time Count of Homelessness in Canadian Communities and the 2016 Census.Results:People without housing were substantially overrepresented among those who died of acute toxicity in 2016 and 2017 (8.9% versus <1% of the overall population). The acute toxicity event leading to death of people without housing occurred more often in an outdoor setting (24%); an opioid and/or stimulant was identified as contributing to their death more frequently (68%–82%; both contributed in 59% of their deaths); and they were more frequently discharged from an institution in the month before their death (7%).Conclusion: We identified several potential opportunities to reduce acute toxicity deaths among people who are unhoused, including during contacts with health care and other institutions, through harm reduction supports for opioid and stimulant use, and by creating safer environments for people without housing.
Marion Ravit, Julia Lohmann, Alexandre Dumont, Charles Kabore, Jean‐Louis Koulidiati, Manuela De Allegri
AbstractObjectivesIn Burkina Faso, only 2.1% of women give birth by caesarean section (CS). To improve the use of maternal health services during pregnancy and childbirth, many interventions were implemented during the 2010s including performance‐based financing (PBF) and a free maternal health care policy (the gratuité). The objective of this study is to evaluate the impact of a supply‐side intervention (PBF) combined with a demand‐side intervention (gratuité) on institutional CS rates in Burkina Faso.MethodsWe used routine health data from all the public health facilities in 21 districts (10 that implemented PBF and 11 that did not) from January 2013 to September 2017. We analysed CS rates as the proportion of CS performed out of all facility‐based deliveries (FBD) that occurred in the district. We performed an interrupted time series (ITS) analysis to evaluate the impact of PBF alone and then in conjunction with the gratuité on institutional CS rates.ResultsCS rates in Burkina Faso increased slightly between January 2013 and September 2017 in all districts. After the introduction of PBF, the increase of CS rates was higher in intervention than in non‐intervention districts. However, after the introduction of the gratuité, CS rates decreased in all districts, independently of the PBF intervention.ConclusionIn 2017, despite high FBD rates in Burkina Faso as well as the PBF intervention and the gratuité, less than 3% of women who gave birth in a health facility did so by CS. Our study shows that the positive PBF effects were not sustained in a context of user fee exemption.
Françoise Jenniskens, Georges Tiendrebeogo, Anne Coolen, Lucie Blok, Seni Kouanda, Fuseini Sataru, Andriamampianina Ralisimalala, Victor Mwapasa, Mbela Kiyombo, David Plummer
BackgroundHealth systems have experienced unprecedented stress in recent years, and as yet no consensus has emerged as to how to deal with the multiple burden of disease in the context of HIV and AIDS and other competing health priorities. Priority setting is essential, yet this is a complex, multifaceted process. Drawing on a study conducted in five African countries, this paper explores different stakeholders′ perceptions of health priorities, how priorities are defined in practice, the process of resource allocation for HIV and Health and how different stakeholders perceive this.MethodsA sub-analysis was conducted of selected data from a wider qualitative study that explored the interactions between health systems and HIV and AIDS responses in five sub-Saharan countries (Burkina Faso, the Democratic Republic of Congo, Ghana, Madagascar and Malawi). Key background documents were analysed and semi-structured interviews (n = 258) and focus group discussions (n = 45) were held with representatives of communities, health personnel, decision makers, civil society representatives and development partners at both national and district level.ResultsHealth priorities were expressed either in terms of specific health problems and diseases or gaps in service delivery requiring a strengthening of the overall health system. In all five countries study respondents (with the exception of community members in Ghana) identified malaria and HIV as the two top health priorities. Community representatives were more likely to report concerns about accessibility of services and quality of care. National level respondents often referred to wider systemic challenges in relation to achieving the Millennium Development Goals (MDGs). Indeed, actual priority setting was heavily influenced by international agendas (e.g. MDGs) and by the ways in which development partners were supporting national strategic planning processes. At the same time, multi-stakeholder processes were increasingly used
Donmozoun Télesphore Somé, Issiaka Sombié, Nicolas Meda
BackgroundDelay in decision-making to use skilled care during pregnancy and childbirth is an important factor for maternal death in many developing countries. This paper examines how decisions for maternal care are made in two rural communities in Burkina Faso.MethodsFocus group discussions (FGDs) and individual interviews (IDIs)) were used to collect information with 30 women in Ouargaye and Diapaga medical districts. All interviews were tape recorded and analyzed using QSR Nvivo 2.0.ResultsDecision-making for use of obstetric care in the family follows the logic of the family’s management. Husbands, brothers-in-law and parents-in-law make the decision about whether to use a health facility for antenatal care or for delivery. In general, decision-makers are those who can pay, including the woman herself. Payment of care is the responsibility of men, according to women interviewed, because of their social role and status.ConclusionsTo increase use of health facilities in Ouargaye and Diapaga, the empowerment of women could be helpful as well as exemption of fees or cost sharing for care.
Laurie Werner, Chilunga Puta, Taonga Chilalika, Sara Walker Hyde, Hannah Cooper, Hallie Goertz, Maya Rivera Hildebrand, Christina Bernadotte, Veronica Kapnick
IntroductionWe are in an era of rapid technological advance and digitalization. Countries around the world want to leverage technology to improve health outcomes by accelerating data use and increasing evidence-based decision-making to inform action in the health sector. Yet, there is no “one size fits all” approach to achieving this. To understand more, PATH and Cooper/Smith conducted a study documenting and analyzing the experiences of five African countries (Burkina Faso, Ethiopia, Malawi, South Africa, and Tanzania) that are on this digitalization journey. The goal was to examine their different approaches and develop a holistic model of digital transformation for data use that identifies what the essential components for digitalization success are and how they interact with each other.MethodsOur research had two phases: first, we analyzed documentation from the five countries to identify core components and enabling factors for successful digital transformation, as well as barriers encountered; and second, we held interviews with key informants and focus groups within the countries to fill gaps and validate findings.FindingsOur findings show that the core components of digital transformation success are highly interrelated. We found that the more successful digitalization efforts address issues that cut across components—such as stakeholder engagement, health workforce capacity, and governance structures—and consider more than just systems and tools. Specifically, we found two critical components of digital transformation that have not been addressed in previous models like the eHealth strategy building blocks developed by the World Health Organization and the International Telecommunication Union: (a) cultivating a culture of data use throughout the health sector and (b) managing the process of system-wide behavior change required to move from manual or paper-based to digital systems.ConclusionThe resulting model is based on the study's findings and is intende
Molly Cliff, Kanny Diallo, Richard B. Yapi, Axelle B. D. Tano, Sally Jahn, Caroline M. Wainwright, Caroline Trotter
AbstractGlobally, the highest incidence of meningococcal meningitis occurs within the African meningitis belt, spanning 26 countries across sub‐Saharan Africa. Meningococcal meningitis incidence is highly seasonal in this region specifically, with outbreaks mostly occurring during the dry season, characterized by low rainfall and atmospheric humidity, high temperature, and increased dust and wind speed. The strong seasonality of meningococcal outbreaks coincides with seasonal variation in climatic factors. This multicollinearity can make it difficult to identify environmental drivers of disease and the mechanisms by which they operate. This review aims to collate existing evidence to better clarify the mechanisms by which climatic variables influence meningococcal meningitis incidence. We examined the impact of dust, wind speed, temperature, rainfall, and land cover on meningococcal meningitis outbreaks. Within the literature, atmospheric dust and wind speed had the strongest statistical association with meningococcal outbreaks and demonstrated greater predictive probability than other climatic variables. However, several climatic factors have demonstrable influences on one another, reflected in the seasonality of meningococcal meningitis. Atmospheric dust can reduce precipitation levels in part through its radiative properties. Decreased rainfall and increasing temperatures can dry out soil, increasing its availability to be uplifted as dust. Alongside, this lower atmospheric humidity increases evaporative demand, leading to faster soil moisture loss and enhanced surface drying. We argue that rainfall, temperature, and land cover variability may act as part of a broader climatic mechanism, increasing atmospheric dust. This increases the incidence and risk of meningococcal meningitis. Plain Language SummaryThe African meningitis belt, spanning 26 countries across sub‐Saharan Africa from Senegal to Ethiopia, has a high burden of meningococcal meningitis. Outbreaks of