Investigating persistent measles dynamics in Niger and associations with rainfall

Measles is a major cause of child mortality in sub-Saharan Africa. Current immunization strategies achieve low coverage in areas where transmission drivers differ substantially from those in high-income countries. A better understanding of measles transmission in areas with measles persistence will increase vaccination coverage and reduce ongoing transmission. We analysed weekly reported measles cases at the district level in Niger from 1995 to 2004 to identify underlying transmission mechanisms. We identified dominant periodicities and the associated spatial clustering patterns. We also investigated associations between reported measles cases and environmental drivers associated with human activities, particularly rainfall. The annual and 2–3-year periodicities dominated the reporting data spectrum. The annual periodicity was strong with contiguous spatial clustering, consistent with the latitudinal gradient of population density, and stable over time. The 2–3-year periodicities were weaker, unstable over time and had spatially fragmented clustering. The rainy season was associated with a lower risk of measles case reporting. The annual periodicity likely reflects seasonal agricultural labour migration, whereas the 2–3-year periodicity potentially results from multiple mechanisms such as reintroductions and vaccine coverage heterogeneity. Our findings suggest that improving vaccine coverage in seasonally mobile populations could reduce strong measles seasonality in Niger and across similar settings.

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Wealth-related inequalities in demand for family planning satisfied among married and unmarried adolescent girls and young women in sub-Saharan Africa

Reproductive Health ◽

10.1186/s12978-021-01076-0 ◽

2021 ◽

Vol 18 (S1) ◽

Author(s):

Martin K. Mutua ◽

Yohannes D. Wado ◽

Monica Malata ◽

Caroline W. Kabiru ◽

Elsie Akwara ◽

...

Keyword(s):

Family Planning ◽

West Africa ◽

Adolescent Girls ◽

Young Women ◽

Rate Of Change ◽

Sub Saharan Africa ◽

Demographic And Health Surveys ◽

Sexually Active ◽

Sub Saharan ◽

Over Time

Abstract Background The use of modern contraception has increased in much of sub-Saharan Africa (SSA). However, the extent to which changes have occurred across the wealth spectrum among adolescents is not well known. We examine poor-rich gaps in demand for family planning satisfied by modern methods (DFPSm) among sexually active adolescent girls and young women (AGYW) using data from national household surveys. Methods We used recent Demographic and Health Surveys and Multiple Indicator Cluster Surveys to describe levels of wealth-related inequalities in DFPSm among sexually active AGYW using an asset index as an indicator of wealth. Further, we used data from countries with more than one survey conducted from 2000 to assess DFPSm trends. We fitted linear models to estimate annual average rate of change (AARC) by country. We fitted random effects regression models to estimate regional AARC in DFPSm. All analysis were stratified by marital status. Results Overall, there was significant wealth-related disparities in DFPSm in West Africa only (17.8 percentage points (pp)) among married AGYW. The disparities were significant in 5 out of 10 countries in Eastern, 2 out of 6 in Central, and 7 out of 12 in West among married AGYW and in 2 out of 6 in Central and 2 out of 9 in West Africa among unmarried AGYW. Overall, DFPSm among married AGYW increased over time in both poorest (AARC = 1.6%, p < 0.001) and richest (AARC = 1.4%, p < 0.001) households and among unmarried AGYW from poorest households (AARC = 0.8%, p = 0.045). DPFSm increased over time among married and unmarried AGYW from poorest households in Eastern (AARC = 2.4%, p < 0.001) and Southern sub-regions (AARC = 2.1%, p = 0.030) respectively. Rwanda and Liberia had the largest increases in DPFSm among married AGYW from poorest (AARC = 5.2%, p < 0.001) and richest (AARC = 5.3%, p < 0.001) households respectively. There were decreasing DFPSm trends among both married (AARC = − 1.7%, p < 0.001) and unmarried (AARC = − 4.7%, p < 0.001) AGYW from poorest households in Mozambique. Conclusion Despite rapid improvements in DFPSm among married AGYW from the poorest households in many SSA countries there have been only modest reductions in wealth-related inequalities. Significant inequalities remain, especially among married AGYW. DFPSm stalled in most sub-regions among unmarried AGYW.

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Contrasting Monetary and Multidimensional Poverty Measures in a Low-Income Sub-Saharan African Country

Social Indicators Research ◽

10.1007/s11205-020-02382-z ◽

2020 ◽

Vol 151 (2) ◽

pp. 547-574 ◽

Cited By ~ 1

Author(s):

Lukas Salecker ◽

Anar K. Ahmadov ◽

Leyla Karimli

Keyword(s):

Risk Factors ◽

Low Income ◽

Multidimensional Poverty ◽

Poverty Measurement ◽

Sub Saharan Africa ◽

Analytical Strategy ◽

Poverty Risk ◽

Two Measures ◽

Sub Saharan ◽

Over Time

AbstractDespite significant progress in poverty measurement, few studies have undertaken an in-depth comparison of monetary and multidimensional measures in the context of low-income countries and fewer still in Sub-Saharan Africa. Yet the differences can be particularly consequential in these settings. We address this gap by applying a distinct analytical strategy to the case of Rwanda. Using data from two waves of the Rwandan Integrated Household Living Conditions Survey, we combine comparing poverty rates cross-sectionally and over time, examining the overlaps and differences in the two measures, investigating poverty rates within population sub-groups, and estimating several statistical models to assess the differences between the two measures in identifying poverty risk factors. We find that using a monetary measure alone does not capture high incidence of multidimensional poverty in both waves, that it is possible to be multidimensional poor without being monetary poor, and that using a monetary measure alone overlooks significant change in multidimensional poverty over time. The two measures also differ in which poverty risk factors they put emphasis on. Relying only on monetary measures in low-income sub-Saharan Africa can send inaccurate signals to policymakers regarding the optimal design of social policies as well as monitoring their effectiveness.

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The relative importance and stability of disease burden causes over time: summarizing regional trends on disease burden for 290 causes over 28 years

Population Health Metrics ◽

10.1186/s12963-021-00257-0 ◽

2021 ◽

Vol 19 (1) ◽

Author(s):

Henry Dyson ◽

Raf Van Gestel ◽

Eddy van Doorslaer

Keyword(s):

Disease Burden ◽

Respiratory Infections ◽

Sub Saharan Africa ◽

Regional Trends ◽

Disability Adjusted Life ◽

Life Years ◽

Causes Of Disease ◽

Sub Saharan ◽

Disease Study ◽

Over Time

Abstract Background Since the Global Burden of Disease study (GBD) has become more comprehensive, data for hundreds of causes of disease burden, measured using Disability Adjusted Life Years (DALYs), have become increasingly available for almost every part of the world. However, undergoing any systematic comparative analysis of the trends can be challenging given the quantity of data that must be presented. Methods We use the GBD data to describe trends in cause-specific DALY rates for eight regions. We quantify the extent to which the importance of ‘major’ DALY causes changes relative to ‘minor’ DALY causes over time by decomposing changes in the Gini coefficient into ‘proportionality’ and ‘reranking’ indices. Results The fall in regional DALY rates since 1990 has been accompanied by generally positive proportionality indices and reranking indices of negligible magnitude. However, the rate at which DALY rates have been falling has slowed and, at the same time, proportionality indices have tended towards zero. These findings are clearest where the focus is exclusively upon non-communicable diseases. Notably, large and positive proportionality indices are recorded for sub-Saharan Africa over the last decade. Conclusion The positive proportionality indices show that disease burden has become less concentrated around the leading causes over time, and this trend has become less prominent as the DALY rate decline has slowed. The recent decline in disease burden in sub-Saharan Africa is disproportionally driven by improvements in DALY rates for HIV/AIDS, as well as for malaria, diarrheal diseases, and lower respiratory infections.

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The acceptance of covid-19 vaccines in Sub-Saharan Africa: Evidence from 6 national phone surveys

10.1101/2021.06.28.21259320 ◽

2021 ◽

Author(s):

Shelton Kanyanda ◽

Yannick Markhof ◽

Philip Wollburg ◽

Alberto Zezza

Keyword(s):

Side Effects ◽

Low Income ◽

Urban Areas ◽

Vaccine Coverage ◽

Sub Saharan Africa ◽

Low Income Countries ◽

Vaccine Hesitancy ◽

African Countries ◽

Representative Sampling ◽

Sub Saharan

Introduction Recent debates surrounding the lagging covid-19 vaccination campaigns in low-income countries center around vaccine supply and financing. Yet, relatively little is known about attitudes towards covid-19 vaccines in these countries and in Africa in particular. In this paper, we provide cross-country comparable estimates of the willingness to accept a covid-19 vaccine in six Sub-Saharan African countries. Methods We use data from six national high-frequency phone surveys from countries representing 38% of the Sub-Saharan African population (Burkina Faso, Ethiopia, Malawi, Mali, Nigeria, and Uganda). Samples are drawn from large, nationally representative sampling frames providing a rich set of demographic and socio-economic characteristics by which we disaggregate our analysis. Using a set of re-calibrated survey weights, our analysis adjusts for the selection biases common in remote surveys. Results Acceptance rates in the six Sub-Saharan African countries studied are generally high, with at least four in five people willing to be vaccinated in all but one country. Vaccine acceptance ranges from nearly universal in Ethiopia (97.9%, 97.2% to 98.6%) to below what would likely be required for herd immunity in Mali (64.5%, 61.3% to 67.8%). We find little evidence for systematic differences in vaccine hesitancy by sex or age but some clusters of hesitancy in urban areas, among the better educated, and in richer households. Safety concerns about the vaccine in general and its side effects emerge as the primary reservations toward a covid-19 vaccine across countries. Conclusions Our findings suggest that limited supply, not inadequate demand, likely presents the key bottleneck to reaching high covid-19 vaccine coverage in Sub-Saharan Africa. To turn intent into effective demand, targeted communication campaigns bolstering confidence in the safety of approved vaccines and reducing concerns about side effects will be crucial to safeguard the swift progression of vaccine rollout in one of the world's poorest regions.

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Recurrent Cholera Outbreaks in Sub-Saharan Africa: Moving beyond Epidemiology to Understand the Environmental Reservoirs and Drivers

Challenges ◽

10.3390/challe10010001 ◽

2019 ◽

Vol 10 (1) ◽

pp. 1 ◽

Cited By ~ 7

Author(s):

Willis Gwenzi ◽

Edmond Sanganyado

Keyword(s):

Epidemiological Studies ◽

Sub Saharan Africa ◽

Environmental Drivers ◽

Future Research ◽

Research Directions ◽

Complex Interactions ◽

Future Research Directions ◽

Sub Saharan ◽

And Control ◽

Water Borne

Recurrent cholera outbreaks in sub-Saharan Africa (SSA) attracted a lot of research interest, raising questions about the effectiveness of current prevention and control methods. However, research on cholera and other water-borne diseases in Africa is dominated by epidemiological studies, while investigations on the environmental drivers and reservoirs of cholera remain scarce. The current discourse relating cholera to the environment in SSA is often limited to the rudimentary statement that, “cholera is caused by the consumption of contaminated water and food”. Yet, beyond this simplistic view, literature elsewhere shows that cholera outbreaks are controlled by its complex interactions with environmental drivers and reservoirs. This brings to question whether cholera can be eradicated in SSA without understanding these complex interactions. The current review seeks to (1) highlight the nature and dynamics of recent cholera outbreaks in SSA, (2) discuss the importance of environmental reservoirs of Vibrio cholerae, and anthropogenic and hydroclimatic drivers in controlling the dynamics of cholera outbreaks, and (3) highlight key knowledge gaps and future research directions, and the need to harness emerging research tools such as modeling, machine learning, data mining, and genomics techniques to better understand the cholera dynamics. By bringing to fore these often-overlooked issues in cholera research, we seek to stimulate discussion, and promote a shift toward cross-disciplinary research on cholera and other water-borne diseases in SSA and beyond.

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Countering Violent Extremism in Sub-Saharan Africa: What Policy Makers Need to Know

World Affairs ◽

10.1177/0043820019862270 ◽

2019 ◽

Vol 182 (3) ◽

pp. 256-272 ◽

Cited By ~ 1

Author(s):

Robin A. Hardy

Keyword(s):

Financial Support ◽

Muslim World ◽

Sub Saharan Africa ◽

Risk Assessments ◽

Boko Haram ◽

Policy Makers ◽

Counter Terrorism ◽

Violent Extremism ◽

Sub Saharan ◽

Over Time

This essay addresses recurring and growing inaccurate reports from political officials as well as counter-terrorism analysts and journalists that the Sahara-Sahel group Boko Haram is a defeated entity. Notwithstanding concerted efforts to rout the movement, Boko Haram and its network of jihadists have expanded. Crucial misunderstandings surrounding what fostered and sustains the phenomenon—as well as a general naivety regarding the organization’s flexibility to adapt to attract combatants, financial support, and weaponry beyond Nigeria’s borders—have made performing basic adequate risk assessments overwhelmingly challenging. Policy makers and CVE (Countering Violent Extremism) practitioners would be wise to recognize that not only has Boko Haram morphed but its growing affiliates also terrorize increased territory. The threat of militant Islam in the Sahara-Sahel, therefore, has not been contained as some would have us believe. Rather, Muslim extremism has become entangled and more complex not only in Africa but across the Muslim world. When jihadists in one territory have taken a beating, surviving fighters have simply relocated to other geographies accompanied by connections for capital and munitions. In this way, Boko Haram—the fulcrum of violent Islam in the Sahara-Sahel—has become, over time, an international jihadist actor.

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Sex Differences in HIV Prevalence Persist over Time: Evidence from 18 Countries in Sub-Saharan Africa

PLoS ONE ◽

10.1371/journal.pone.0148502 ◽

2016 ◽

Vol 11 (2) ◽

pp. e0148502 ◽

Cited By ~ 27

Author(s):

Hanne K. Hegdahl ◽

Knut M. Fylkesnes ◽

Ingvild F. Sandøy

Keyword(s):

Sex Differences ◽

Hiv Prevalence ◽

Sub Saharan Africa ◽

Sub Saharan ◽

Over Time

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The paradox of water accessibility: understanding the temporal and spatial dimensions of access to improved water sources in Rwanda

Journal of Water Sanitation and Hygiene for Development ◽

10.2166/washdev.2015.029 ◽

2015 ◽

Vol 5 (4) ◽

pp. 553-564 ◽

Cited By ~ 4

Author(s):

Lydia Osei ◽

Jonathan Amoyaw ◽

Godfred Odei Boateng ◽

Sheila Boamah ◽

Isaac Luginaah

Keyword(s):

Drinking Water ◽

Water Sources ◽

Regional Disparities ◽

Sub Saharan Africa ◽

Demographic And Health Surveys ◽

Logistic Regression Models ◽

The People ◽

Spatial Dimensions ◽

Sub Saharan ◽

Over Time

According to the United Nations, the world has met the Millennium Development Goal target of halving the proportion of people without access to safe drinking water. However, global figures mask massive disparities between regions and countries, and within countries. For instance, only 64% of the people in sub-Saharan Africa have access to improved water sources. Over 40% of all people globally who lack access to drinking water live in sub-Saharan Africa. Rwanda is used as a case in point in this study. Despite the abundance of water resources in the country, access to improved water sources is limited. Using the Rwandan Demographic and Health Surveys (2000–2010), we examined regional disparities in access to improved water sources. Results from logistic regression models show that overall, access to improved water has declined between 2000 and 2010; except in the western region, where access to water marginally improved. Educated individuals, wealthier and urban dwellers were more likely to have access to improved water sources over time compared to their uneducated, poor and rural counterparts. The persistence of regional disparities in access to improved water over time suggests the need for policy to address insufficient investments in water infrastructure in Rwanda.

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Leadership and Personal Danger in African Politics

The Journal of Modern African Studies ◽

10.1017/s0022278x00012295 ◽

1993 ◽

Vol 31 (4) ◽

pp. 657-660 ◽

Cited By ~ 4

Author(s):

John A. Wiseman

Keyword(s):

Sub Saharan Africa ◽

Political Leader ◽

African Politics ◽

The Past ◽

The World ◽

Acute Form ◽

Sub Saharan ◽

Over Time

To be a political leader in many parts of the world is to follow an extremely hazardous and insecure occupation. In addition, in sub-Saharan Africa, but elsewhere as well, the element of personal danger exists in a particularly acute form. Althought the extent to which this is true varies considerably not only from place to place but also over time, the evidence of the past 30 years clearly suggests that there are remarkably few states in which an individual could contemplate embarking on a career in politics free from the dauger of incurring severe personal penalties at some stage.

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Aid and growth in Sub-Saharan Africa: accounting for transmission mechanisms

Journal of International Development ◽

10.1002/jid.1259 ◽

2005 ◽

Vol 17 (8) ◽

pp. 1055-1075 ◽

Cited By ~ 85

Author(s):

Karuna Gomanee ◽

Sourafel Girma ◽

Oliver Morrissey

Keyword(s):

Sub Saharan Africa ◽

Transmission Mechanisms ◽

Sub Saharan

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