SOCIOECONOMIC STATUS AS A RISK FACTOR FOR HIV INFECTION IN WOMEN IN EAST, CENTRAL AND SOUTHERN AFRICA: A SYSTEMATIC REVIEW

2004 ◽  
Vol 37 (1) ◽  
pp. 1-36 ◽  
Author(s):  
JANET MAIA WOJCICKI
Keyword(s):  
Systematic Review ◽  
Socioeconomic Status ◽  
Hiv Infection ◽  
Southern Africa ◽  
Case Control ◽  
Sub Saharan Africa ◽  
Eastern Africa ◽  
Low Ses ◽  
Causal Pathway ◽  
Sub Saharan

This is a critical, systematic review of the relationship between socioeconomic status (SES) and HIV infection in women in Southern, Central and Eastern Africa. In light of the interest in micro-credit programmes and other HIV prevention interventions structured to empower women through increasing women’s access to funds and education, this review examines the epidemiological and public health literature, which ascertains the association between low SES using different measurements of SES and risk of HIV infection in women. Also, given the focus on structural violence and poverty as factors driving the HIV epidemic at a structural/ecological level, as advocated by Paul Farmer and others, this study examines the extent to which differences in SES between individuals in areas with generalized poverty affect risk for SES. Out of 71 studies retrieved, 36 studies met the inclusion criteria including 30 cross-sectional, one case-control and five prospective cohort or nested case-control studies. Thirty-five studies used at least one measurement of female’s SES and fourteen also included a measurement of partner’s SES. Studies used variables measuring educational level, household income and occupation or employment status at the individual and neighbourhood level to ascertain SES. Of the 36 studies, fifteen found no association between SES and HIV infection, twelve found an association between high SES and HIV infection, eight found an association between low SES and HIV infection and one was mixed. In interpreting these results, this review examines the role of potential confounders and effect modifiers such as history of STDs, number of partners, living in urban or rural areas and time and location of study in sub-Saharan Africa. It is argued that STDs and number of partners are on the causal pathway under investigation between HIV and SES and should not be adjusted as confounders in any analysis. In conclusion, it is argued that in low-income sub-Saharan Africans countries, where poverty is widespread, increasing access to resources for women may initially increase risk of HIV or have no effect on risk-taking behaviours. In some parts of Southern Africa where per capita income is higher and within-country inequalities in wealth are greater, studies suggest that increasing SES may decrease risk. This review concludes that increased SES may have differential effects on married and unmarried women and further studies should use multiple measures of SES. Lastly, it is suggested that the partner’s SES (measured by education or income/employment) may be a stronger predictor of female HIV serostatus than measures of female SES.

scholarly journals Estimating the impact of pneumococcal conjugate vaccines on childhood pneumonia in sub-Saharan Africa: A systematic review

2019 ◽  
Author(s):  
Chukwuemeka Onwuchekwa ◽  
Edem Bassey ◽  
Victor Williams ◽  
Emmanuel Oga
Keyword(s):  
Systematic Review ◽  
Pneumococcal Pneumonia ◽  
Data Extraction ◽  
Case Control ◽  
Sub Saharan Africa ◽  
Case Control Studies ◽  
Childhood Pneumonia ◽  
Vaccine Impact ◽  
Sub Saharan ◽  
The Impact

AbstractBackgroundThe impact of pneumococcal conjugate vaccine introduction in reducing the incidence of childhood pneumonia has not been well documented in sub-Saharan Africa. Many studies evaluating vaccine impact have used invasive pneumococcal disease or pneumococcal pneumonia as an outcome.ObjectiveTo estimate the impact of routine administration of 10-valent and 13-valent PCV on the incidence of pneumonia in children under five years of age in sub-Saharan Africa.Data sourcesA systematic review was conducted between 16 and 31 July 2019. The review was registered on PROSPERO with registration number CRD42019142369. The literature search was conducted in indexed databases including Medline and Embase, grey literature databases and online libraries of two universities. Manual search of the references of included studies was performed to identify additional relevant studies. The search strategy combined pneumococcal conjugate vaccine, pneumonia and child as search concepts.Study selectionStudies investigating the impact of 10- or13-valent PCV on childhood pneumonia in a sub-Saharan African country were eligible for inclusion. Case-control, cohort, pre-post and time-series study designs were eligible for inclusion. Exclusion criteria were use of 7- or 9-valent PCV, systematic review studies, clinical trials and record publication prior to 2009.Data extractionIndependent data extraction was conducted. Key variables include year study conducted, type of study design, type of PCV used and year of introduction, reported PCV coverage, outcome measure evaluated and the effect measure.Data synthesisEight records were included in the final analysis, 6 records were pre-post or time-series studies, 1 was a case-control study and 1 report combined pre-post and case-control studies. Vaccine impact measured as percentage reduction in risk (%RR) of clinical pneumonia was mostly small and non-significant. The risk reduction was more significant and consistent on radiological and pneumococcal pneumonia. Vaccine effectiveness reported in case-control studies was mostly non-significant.ConclusionEvidence of the positive impact of routine infant pneumococcal vaccination on pneumonia in sub-Saharan Africa is weak. There is a need for more research in this area to evaluate the influence of pathogen or serotype replacement in pneumonia after PCV introduction. Ongoing surveillance is also required to establish the long term trend in pneumonia epidemiology after PCV introduction.

scholarly journals Social, Behavioral, and Cultural factors of HIV in Malawi: Semi-Automated Systematic Review

10.2196/18747 ◽  
2020 ◽  
Vol 22 (8) ◽  
pp. e18747
Author(s):  
Amaury Thiabaud ◽  
Isotta Triulzi ◽  
Erol Orel ◽  
Kali Tal ◽  
Olivia Keiser
Keyword(s):  
Systematic Review ◽  
Open Access ◽  
Hiv Infection ◽  
A Priori ◽  
Sub Saharan Africa ◽  
Topic Modelling ◽  
African Countries ◽  
Comprehensive Overview ◽  
Quantitative Analyses ◽  
Sub Saharan

Background Demographic and sociobehavioral factors are strong drivers of HIV infection rates in sub-Saharan Africa. These factors are often studied in qualitative research but ignored in quantitative analyses. However, they provide in-depth insight into the local behavior and may help to improve HIV prevention. Objective To obtain a comprehensive overview of the sociobehavioral factors influencing HIV prevalence and incidence in Malawi, we systematically reviewed the literature using a newly programmed tool for automatizing part of the systematic review process. Methods Due to the choice of broad search terms (“HIV AND Malawi”), our preliminary search revealed many thousands of articles. We, therefore, developed a Python tool to automatically extract, process, and categorize open-access articles published from January 1, 1987 to October 1, 2019 in the PubMed, PubMed Central, JSTOR, Paperity, and arXiV databases. We then used a topic modelling algorithm to classify and identify publications of interest. Results Our tool extracted 22,709 unique articles; 16,942 could be further processed. After topic modelling, 519 of these were clustered into relevant topics, of which 20 were kept after manual screening. We retrieved 7 more publications after examining the references so that 27 publications were finally included in the review. Reducing the 16,942 articles to 519 potentially relevant articles using the software took 5 days. Several factors contributing to the risk of HIV infection were identified, including religion, gender and relationship dynamics, beliefs, and sociobehavioral attitudes. Conclusions Our software does not replace traditional systematic reviews, but it returns useful results to broad queries of open-access literature in under a week, without a priori knowledge. This produces a “seed dataset” of relevance that could be further developed. It identified known factors and factors that may be specific to Malawi. In the future, we aim to expand the tool by adding more social science databases and applying it to other sub-Saharan African countries.

Prevalence of curable STIs and bacterial vaginosis during pregnancy in sub-Saharan Africa: a systematic review and meta-analysis

2021 ◽  
pp. sextrans-2021-055057
Author(s):  
Dorothy Chiwoniso Nyemba ◽  
Eposi C Haddison ◽  
Colin Wang ◽  
Leigh Francis Johnson ◽  
Landon Myer ◽  
...  
Keyword(s):  
Bacterial Vaginosis ◽  
Pregnant Women ◽  
Southern Africa ◽  
Diagnostic Errors ◽  
Public Health Problem ◽  
Sub Saharan Africa ◽  
Eastern Africa ◽  
Pooled Prevalence ◽  
Prevalence Estimates ◽  
Sub Saharan

ObjectiveSTIs remain a global public health problem with a high burden among pregnant women. STIs in pregnant women may lead to various adverse pregnancy outcomes. In most sub-Saharan African countries, syndromic management is used for screening and treatment of STIs. We aimed to update and summarise pooled prevalence of curable STIs and bacterial vaginosis (BV) among pregnant women in sub-Saharan Africa.MethodsElectronic databases and reference lists of relevant published and unpublished studies were searched from March 2015 to October 2020. Studies were included if they estimated prevalence of Chlamydia trachomatis (CT), Trichomonas vaginalis (TV), Neisseria gonorrhoeae (NG), Treponema pallidum (syphilis), Mycoplasma genitalium (MG) and BV among pregnant women in sub-Saharan Africa. Meta-analyses were performed with observed prevalences corrected for diagnostic errors to estimate the pooled prevalence of diagnosed infections by region.ResultsA total of 48 studies met the inclusion criteria, providing 85-point prevalence estimates for curable STIs and BV. Pooled prevalence estimates (with 95% CI and number of women tested) were as follows: MG: 13.5% (4.0–27.2, n=1076); CT: 10.8% (6.9–15.5, n=6700); TV: 13.8% (10.0–18.0, n=9264); NG: 3.3% (2.1–4.7, n=6019); syphilis: 2.9% (2.0–4.0, n=95 308) and BV: 36.6% (27.1–46.6, n=5042). By region, BV was the most prevalent and ranged from 28.5% (24.5–32.8, n=1030) in Eastern Africa to 52.4% (33.5–70.9, n=2305) in Southern Africa; NG had the lowest prevalence, ranging from 1.4% (95% CI 0.1 to 3.1, n=367) in Central Africa to 4.4% (95% CI 2.6 to 6.4, n=4042) in Southern Africa.ConclusionThe prevalence of curable STIs and BV in sub-Saharan Africa is substantial in pregnant women but most prevalent in Southern Africa where HIV prevalence is highest. It is crucial to integrate screening of curable STIs into antenatal care programmes that have previously focused on diagnosis and treatment of syphilis and HIV.

Male circumcision and risk of HIV infection in sub-Saharan Africa: a systematic review and meta-analysis

AIDS ◽  
2000 ◽  
Vol 14 (15) ◽  
pp. 2361-2370 ◽  
Author(s):  
Helen A. Weiss ◽  
Maria A. Quigley ◽  
Richard J. Hayes
Keyword(s):  
Systematic Review ◽  
Hiv Infection ◽  
Male Circumcision ◽  
Meta Analysis ◽  
Sub Saharan Africa ◽  
Sub Saharan

scholarly journals Knowledge of blood-borne transmission risk is inversely associated with HIV infection in sub-Saharan Africa

2011 ◽  
Vol 5 (03) ◽  
pp. 182-198 ◽  
Author(s):  
Devon D. Brewer
Keyword(s):  
Public Education ◽  
Hiv Infection ◽  
Hiv Risk ◽  
Southern Africa ◽  
Hiv Prevalence ◽  
Sub Saharan Africa ◽  
African Countries ◽  
Hiv Risks ◽  
Education Campaigns ◽  
Sub Saharan

Introduction: Accurate, comprehensive knowledge of an infectious pathogen's modes of transmission helps people to avoid infection. Growing evidence suggests that blood-borne HIV transmission is widespread in sub-Saharan Africa. Methodology: I examined the association between knowledge of blood-borne HIV risk and prevalent HIV infection in Demographic and Health Survey data from 16 sub-Saharan African countries. I also searched three online databases for evidence of public education campaigns focused on blood-borne HIV risks in these countries. Results: Knowledge was moderately to strongly inversely related to HIV prevalence at the national level (i.e., countries in which many respondents were aware of blood-borne risk had lower HIV prevalence than countries in which few respondents were aware of such risk). At the individual level, respondents who knew about blood-borne HIV risks were modestly less likely to be infected than those who did not show awareness of this risk, independent of demographic and sexual behavior variables. This relationship was stronger in southern Africa than in west, central, and east Africa. In parallel analyses, knowledge of condom use as a way to prevent HIV was positively associated with prevalent HIV infection at both the national and individual levels. West, central, and east African countries with low to moderate HIV prevalence had implemented public education campaigns that included a focus on blood-borne transmission risks. Such campaigns were absent from high prevalence countries in southern Africa. Conclusion: These findings suggest that knowledge of blood-borne HIV risk protects against HIV infection and that public education campaigns are important for spreading that knowledge. 

scholarly journals Barriers to Childhood Immunization in Sub-Saharan Africa: A Systematic Review

2020 ◽  
Author(s):  
Joseph Benjamin Bangura ◽  
Shui-yuan Xiao ◽  
Dan Qiu ◽  
Feiyun Ouyang ◽  
Lei Chen
Keyword(s):  
Systematic Review ◽  
Health Systems ◽  
Immunization Coverage ◽  
Case Control ◽  
Sub Saharan Africa ◽  
Immunization Programs ◽  
Childhood Immunization ◽  
Cross Sectional ◽  
National Immunization ◽  
Sub Saharan

Abstract Background Immunization to prevent infectious diseases is a core strategy to improve childhood health as well as survival. It remains a challenge for some African countries to attain the required childhood immunization coverage. We aim at identifying individual barriers confronting parents/caretakers, providers, and health systems that hinder childhood immunization coverage in Sub-Saharan Africa. Method This systematic review searched PubMed/MEDLINE, Web of Science and EMBASE. We restricted to published articles in English that focused on childhood immunization barriers in Sub-Saharan Africa from January 1988 to February 2019. We excluded studies if: focused on barriers to immunization for children in other regions of the world, studied adult immunization barriers; studies not available on the university library, they were editorial, reports, reviews, supplement, and bulletins. Study designs included were cross-sectional, second-hand data analysis; and case control. Results Of the 2,538 items identified, 40 met inclusion criteria. Parents/caretakers were the most common subjects. Eight articles were of moderate and 32 were of high methodological quality. Seven studies analyzed secondary data; 30 used cross-sectional designs and three employed case control method. Twenty-five studies reported national immunization coverage of key vaccines for children under one, fifteen did not. When reported, national immunization coverages of childhood vaccines were reported to be low. Parents/caretaker’s barriers included lack of knowledge of immunization, distance to access point, financial deprivation, lack of partners support, and distrust in vaccines and immunization programs. Other associated factors for low vaccine rates included the number of off-springs, life style, migration and occupation. Barriers at health system level cited by healthcare providers included limited human resources and inadequate infrastructures to maintain the cold chain and adequate supply of vaccines. Conclusion In this review we identified more thoroughly the parents/caretakers’ barriers than those of providers and health systems. Factors that influenced decisions to get children vaccinated were mainly their gender, beliefs, socio-economic and socio-culture factors in the communities in which they live. Thus it is vital that immunization programs consider these barriers and address the people and societies in their communities across Sub-Saharan Africa.

DO THE FACTORS ASSOCIATED WITH FEMALE HIV INFECTION VARY BY SOCIOECONOMIC STATUS IN CAMEROON?

2013 ◽  
Vol 46 (4) ◽  
pp. 431-448 ◽  
Author(s):  
JOYCE N. MUMAH ◽  
DOUGLAS JACKSON-SMITH
Keyword(s):  
Hiv Infection ◽  
Hiv Risk ◽  
Access To Health Care ◽  
Social Epidemiology ◽  
Sub Saharan Africa ◽  
Low Ses ◽  
Factors Associated ◽  
Increased Risk ◽  
Sub Saharan ◽  
Using Data

SummaryOne of the most consistent findings in social epidemiology is an inverse relationship between indicators of SES and most types of illness. However, a growing body of research on HIV in sub-Saharan Africa suggests an intriguing reversal of this pattern, particularly with respect to HIV among women. In Cameroon, specifically, high-SES women have higher rates of HIV infection compared with low-SES women. Using data from the 2004 Cameroon DHS, this study explored the relationships between SES and HIV and tested a multivariate model designed to highlight the distinctive factors associated with increased risk of HIV among women in different SES classes. The results revealed that high-SES women who reported engaging in riskier sexual behaviour had the highest levels of HIV infection. Surprisingly, among this group increased knowledge of HIV, more domestic decision-making authority and access to health care did not reduce vulnerability. Meanwhile, among low-SES women relative gender inequality was significantly related to HIV risk. Specifically, among this group of women, having a partner with higher education was strongly associated with greater HIV risk. The results suggest that different approaches targeting each sub-group are needed to effectively combat the disease.

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