Strong association between higher-risk sex and HIV prevalence at the regional level: an ecological study of 27 sub-Saharan African countries

Background: It is unclear why HIV prevalence varies by nearly two orders of magnitude between regions within countries in sub-Saharan Africa. In this ecological study, we assess if HIV prevalence by region is associated with any of four markers of higher risk sexual behavior: lifetime number of partners, multiple partners in past year, higher risk sex (defined as sex with non-cohabiting, non-marital partners) and age at debut. Methods: We performed Pearson’s correlation between the 4 behavioral risk factors and HIV prevalence by region in 47 nationally representative surveys from 27 sub-Saharan African countries, separately by gender. In addition, principal components analysis was used to reduce the eight risk factors (four for each gender) to two principal components (PCs). Mixed effects linear regression was used to assess the relationship between the resulting two PCs and HIV prevalence after controlling for the prevalence of male circumcision. Results: HIV prevalence varied by a median 3.7 fold (IQR 2.9-7.9) between regions within countries. HIV prevalence was strongly associated with higher risk sex and, to a lesser extent, the other risk factors evaluated. Both PCs were strongly associated with HIV prevalence when assessed via linear regression. Conclusions: Differences in sexual behavior may underpin the large differences in HIV-prevalence between subpopulation within sub-Saharan African countries.

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Estimating the burden of cardiovascular risk in community dwellers over 40 years old in South Africa, Kenya, Burkina Faso and Ghana

BMJ Global Health ◽

10.1136/bmjgh-2020-003499 ◽

2021 ◽

Vol 6 (1) ◽

pp. e003499

Author(s):

Ryan G Wagner ◽

Nigel J Crowther ◽

Lisa K Micklesfield ◽

Palwende Romauld Boua ◽

Engelbert A Nonterah ◽

...

Keyword(s):

Risk Factors ◽

Risk Factor ◽

South African ◽

Sub Saharan Africa ◽

African Countries ◽

Cvd Risk ◽

Genomic Studies ◽

Sub Saharan ◽

Context Specific ◽

The Impact

IntroductionCardiovascular disease (CVD) risk factors are increasing in sub-Saharan Africa. The impact of these risk factors on future CVD outcomes and burden is poorly understood. We examined the magnitude of modifiable risk factors, estimated future CVD risk and compared results between three commonly used 10-year CVD risk factor algorithms and their variants in four African countries.MethodsIn the Africa-Wits-INDEPTH partnership for Genomic studies (the AWI-Gen Study), 10 349 randomly sampled individuals aged 40–60 years from six sites participated in a survey, with blood pressure, blood glucose and lipid levels measured. Using these data, 10-year CVD risk estimates using Framingham, Globorisk and WHO-CVD and their office-based variants were generated. Differences in future CVD risk and results by algorithm are described using kappa and coefficients to examine agreement and correlations, respectively.ResultsThe 10-year CVD risk across all participants in all sites varied from 2.6% (95% CI: 1.6% to 4.1%) using the WHO-CVD lab algorithm to 6.5% (95% CI: 3.7% to 11.4%) using the Framingham office algorithm, with substantial differences in risk between sites. The highest risk was in South African settings (in urban Soweto: 8.9% (IQR: 5.3–15.3)). Agreement between algorithms was low to moderate (kappa from 0.03 to 0.55) and correlations ranged between 0.28 and 0.70. Depending on the algorithm used, those at high risk (defined as risk of 10-year CVD event >20%) who were under treatment for a modifiable risk factor ranged from 19.2% to 33.9%, with substantial variation by both sex and site.ConclusionThe African sites in this study are at different stages of an ongoing epidemiological transition as evidenced by both risk factor levels and estimated 10-year CVD risk. There is low correlation and disparate levels of population risk, predicted by different risk algorithms, within sites. Validating existing risk algorithms or designing context-specific 10-year CVD risk algorithms is essential for accurately defining population risk and targeting national policies and individual CVD treatment on the African continent.

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HIV Prevalence Trends and Disparities by Gender and Urban-rural Residence Among Adolescents in Sub-saharan Africa

10.21203/rs.3.rs-52929/v1 ◽

2020 ◽

Author(s):

Reka Maulide Cane ◽

Dessalegn Melesse ◽

Nkomba Kayeyi ◽

Abubakar Manu ◽

Yohannes Dibaba Wado ◽

...

Keyword(s):

Hiv Testing ◽

Hiv Transmission ◽

Hiv Prevalence ◽

Sub Saharan Africa ◽

Annual Rate ◽

Lower Prevalence ◽

Average Annual Rate ◽

African Countries ◽

Urban Rural ◽

Sub Saharan

Abstract Background In sub-Saharan Africa HIV transmission is a major challenge in adolescents, especially among girls and those living in urban settings. Major international efforts have aimed at reducing sexual transmission. This analysis aims to assess the trends in HIV prevalence by gender in adolescents, as well as urban-rural disparities. Methods HIV prevalence data were obtained for 30 countries with a national survey since 2010 and for 23 countries with one survey circa 2005 and a recent survey circa 2015. Countries were grouped into 2% or higher and lower than 2% HIV prevalence among girls 15–19 years in the first survey. Country medians and average annual rates of changes were used to summarize the trends. Data on HIV incidence at ages 15–24 and prevalence at 5–9 and 10–14 years were reviewed from 11 recent national surveys. Trends in urban-rural disparities in HIV prevalence and selected indicators of sexual and HIV testing behaviours were assessed for females and males 15–24 years, using the same surveys. Results HIV prevalence among girls 15–19 years declined in the higher HIV prevalence group from 5.7–2.6% during 2005–2015, corresponding with an average annual rate of reduction of 6.5% per year. Among boys, the median HIV prevalence declined from 2.1–1.2% in the higher prevalence group. Smaller changes were observed in the lower prevalence country group where median HIV prevalence among girls decreased from 0.7–0.4% (average annual rate of reduction 5.9%). Girl – boy differences at 10–14 years were small with a country median HIV of 1.0% and 1.3%, respectively. Urban females and males 15–24 had at least 1.5 times higher HIV prevalence than their rural counterparts, and all experienced similar declines during 2005–2015. Condom use and HIV testing increased among adolescents in both higher and lower prevalence countries, but indicators of sexual activity showed little change over time. Conclusions HIV prevalence declined in almost all countries during the last decade, in both urban and rural settings, for both sexes. The urban-rural gap persisted and HIV transmission to girls, but not boys, is still a major challenge in eastern and southern African countries.

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Economic Perception to Political Performance Evaluation: Establishing Precursors to Economic Voting in Africa

Political Research Quarterly ◽

10.1177/1065912919888017 ◽

2019 ◽

pp. 106591291988801

Author(s):

Inbok Rhee

Keyword(s):

Performance Evaluation ◽

Strong Association ◽

Empirical Support ◽

Economic Voting ◽

Sub Saharan Africa ◽

African Countries ◽

Developing Democracies ◽

Individual Level ◽

Sub Saharan ◽

Instrumental Variables Approach

Empirical support for economic voting is well documented in advanced democracies. We know less, however, about the extent and dynamics of economic voting in the developing democracies of sub-Saharan Africa. The relationship between economic perceptions and incumbent performance evaluations is a critical precursor to vote choice. I evaluate this link using more than fifty-five thousand individual-level observations across sixteen sub-Saharan African countries. I find that there exists a strong association between economic perception and performance evaluation while controlling for a host of covariates, including ethnicity, partisanship, information, and public goods provision. Contrary to previous findings, however, I show that the influence of economic perception is stronger than many other factors considered in the models such as coethnicity with the incumbent. Moreover, my findings indicate that coethnicity—but not copartisanship—conditions the influence of economic perception on performance evaluation. I use an instrumental variables approach to further validate the findings.

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

The Journal of Infection in Developing Countries ◽

10.3855/jidc.1308 ◽

2011 ◽

Vol 5 (03) ◽

pp. 182-198 ◽

Cited By ~ 8

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.

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Risk Factors for Infectious Diseases in Urban Environments of Sub-Saharan Africa: A Systematic Review and Critical Appraisal of Evidence

Tropical Medicine and Infectious Disease ◽

10.3390/tropicalmed4040123 ◽

2019 ◽

Vol 4 (4) ◽

pp. 123 ◽

Cited By ~ 5

Author(s):

Matthew R. Boyce ◽

Rebecca Katz ◽

Claire J. Standley

Keyword(s):

Infectious Disease ◽

Risk Factors ◽

Infectious Diseases ◽

Disease Risk ◽

Urban Environments ◽

Health Systems Strengthening ◽

Sub Saharan Africa ◽

Original Research ◽

African Countries ◽

Sub Saharan

Our world is rapidly urbanizing. According to the United Nations, between 1990 and 2015, the percent of the world’s population living in urban areas grew from 43% to 54%. Estimates suggest that this trend will continue and that over 68% of the world’s population will call cities home by 2050, with the majority of urbanization occurring in African countries. This urbanization is already having a profound effect on global health and could significantly impact the epidemiology of infectious diseases. A better understanding of infectious disease risk factors specific to urban settings is needed to plan for and mitigate against future urban outbreaks. We conducted a systematic literature review of the Web of Science and PubMed databases to assess the risk factors for infectious diseases in the urban environments of sub-Saharan Africa. A search combining keywords associated with cities, migration, African countries, infectious disease, and risk were used to identify relevant studies. Original research and meta-analyses published between 2004 and 2019 investigating geographical and behavioral risk factors, changing disease distributions, or control programs were included in the study. The search yielded 3610 papers, and 106 met the criteria for inclusion in the analysis. Papers were categorized according to risk factors, geographic area, and study type. The papers covered 31 countries in sub-Saharan Africa with East Africa being the most represented sub-region. Malaria and HIV were the most frequent disease focuses of the studies. The results of this work can inform public health policy as it relates to capacity building and health systems strengthening in rapidly urbanizing areas, as well as highlight knowledge gaps that warrant additional research.

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Risk Factors Associated with Neonatal Sepsis: A Case Study at a Specialist Hospital in Ghana

The Scientific World JOURNAL ◽

10.1155/2019/9369051 ◽

2019 ◽

Vol 2019 ◽

pp. 1-8 ◽

Cited By ~ 10

Author(s):

Peter Adatara ◽

Agani Afaya ◽

Solomon Mohammed Salia ◽

Richard Adongo Afaya ◽

Kennedy Diema Konlan ◽

...

Keyword(s):

Risk Factors ◽

Neonatal Sepsis ◽

Strong Association ◽

Mode Of Delivery ◽

Mortality Rates ◽

Sub Saharan Africa ◽

Care Utilization ◽

Neonatal Deaths ◽

Antenatal Care Utilization ◽

Sub Saharan

Worldwide, neonatal sepsis accounts for an estimated 26% of under-five deaths, with sub-Saharan Africa having the highest mortality rates. Though worldwide neonatal deaths have decreased by over 3.6 million per year since 2000, neonatal sepsis remains a notable hindrance to the progress in the decline of cause-specific mortality rates especially in sub-Saharan Africa. This study aimed at examining the risk factors of neonatal sepsis at the Trauma and Specialist Hospital, Winneba. The study was an unmatched case control retrospective study. Cases were neonates who had sepsis with their index mothers and controls were neonates who did not have sepsis with their index mothers. Neonatal and maternal medical records were retrieved from January to December 2017. Data abstraction lasted for one month and 2650 folders for the neonates and their index mothers were retrieved. Nine hundred (900) neonatal folders were considered valid for the study and likewise for the maternal folders. One hundred and three (103) folders were considered cases while 797 were considered as controls. Data were entered using the Statistical Package for Social Sciences Version 22. Logistic regression was used to determine the risk of neonatal sepsis. Maternal factors that predicted the occurrence of sepsis among neonates were parity (p<0.027), mode of delivery (p<0.001), bleeding disorder (p<0.001), and PROM (p<0.001). Neonatal risk factors which predicted the occurrence of sepsis were APGAR score in the first and fifth minute (p<0.001), resuscitation at birth (p<0.004), duration of stay in the facility (p<0.001), and neonatal age on admission (p<0.001). The study found both maternal and neonatal factors to have a strong association with the risk of developing neonatal sepsis. Encouraging maternal antenatal care utilization would help identify the risk factors during prenatal and postnatal care and appropriate interventions implemented to reduce the likelihood of the neonate developing sepsis.

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AN ASSOCIATION BETWEEN ETHNIC DIVERSITY AND HIV PREVALENCE IN SUB-SAHARAN AFRICA

Journal of Biosocial Science ◽

10.1017/s002193201200082x ◽

2013 ◽

Vol 45 (6) ◽

pp. 853-862 ◽

Cited By ~ 4

Author(s):

PAUL HENRY BRODISH

Keyword(s):

Ethnic Diversity ◽

Predictor Variable ◽

Hiv Prevalence ◽

Sub Saharan Africa ◽

Demographic And Health Surveys ◽

African Countries ◽

The Past ◽

Hiv Serostatus ◽

Sub Saharan ◽

Cluster Level

SummaryThis paper investigates whether ethnic diversity at the Demographic and Health Surveys (DHS) cluster level predicts HIV serostatus in three sub-Saharan African countries (Kenya, Malawi and Zambia), using DHS household survey and HIV biomarker data for men and women aged 15–59 collected since 2006. The analysis relates a binary dependent variable (HIV positive serostatus) and a weighted aggregate predictor variable representing the number of different ethnic groups within a DHS Statistical Enumeration Area (SEA) or cluster, which roughly corresponds to a neighbourhood. Multilevel logistic regression is used to predict HIV prevalence within each SEA, controlling for known demographic, social and behavioural predictors of HIV serostatus. The key finding was that the cluster-level ethnic diversity measure was a significant predictor of HIV serostatus in Malawi and Zambia but not in Kenya. Additional results reflected the heterogeneity of the epidemics: male gender, marriage (Kenya), number of extramarital partners in the past year (Kenya and Malawi, but probably confounded with younger age) and Muslim religion (Zambia) were associated with lower odds of positive HIV serostatus. Condom use at last intercourse (a spurious result probably reflecting endogeneity), STD in the past year, number of lifetime sexual partners, age (Malawi and Zambia), education (Zambia), urban residence (Malawi and Zambia) and employment (Kenya and Malawi) were associated with higher odds of positive serostatus. Future studies might continue to employ multilevel models and incorporate additional, more robust, controls for individual behavioural risk factors and for higher-level social and economic factors, in order to verify and further clarify the association between neighbourhood ethnic diversity and HIV serostatus.

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Strong Association Between In-Migration and HIV Prevalence in Urban Sub-Saharan Africa

Sexually Transmitted Diseases ◽

10.1097/olq.0b013e3181c3f2d0 ◽

2009 ◽

pp. 1 ◽

Cited By ~ 10

Author(s):

Hélène A. C. M. Voeten ◽

Debby C. J. Vissers ◽

Simon Gregson ◽

Basia Zaba ◽

Richard G. White ◽

...

Keyword(s):

Strong Association ◽

Hiv Prevalence ◽

Sub Saharan Africa ◽

Sub Saharan

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Determinants of Higher-Risk Sexual Behavior in Some Selected African Countries

Scientifica ◽

10.1155/2021/8089293 ◽

2021 ◽

Vol 2021 ◽

pp. 1-13

Author(s):

Adikwor Ewoenam Puplampu ◽

Seth Afagbedzi ◽

Samuel Dery ◽

Dzifa Adimle Puplampu ◽

Chris Guure

Keyword(s):

Sexual Behavior ◽

Cox Regression ◽

Religious Affiliation ◽

Economic Status ◽

Sub Saharan Africa ◽

African Region ◽

African Countries ◽

Sub Saharan ◽

Risk Sexual Behavior ◽

Ssa Countries

Background. Although higher-risk sexual behavior (H-RSB) is a major contributor to the rapid rising rate of new HIV infections, there exists paucity of comprehensive evidence across the sub-Saharan African region. The purpose of this study was to determine the prevalence of H-RSB and its determinants across sub-Saharan Africa to inform policy. Method. Data were obtained from the Demographic and Health Survey (DHS) of ten sub-Saharan African (SSA) countries with their three most current DHS surveys from 2000 to 2016. Only participants who ever had sexual encounters in their lifetime were included in the study. Weighted adjusted Cox regression with robust variance and constant time was used to investigate disparities of H-RSB among the ten SSA countries. Relationships between sociodemographic, socioeconomic, knowledge, mass media, and H-RSB were investigated. Results. The trend and prevalence of higher-risk sexual behavior show that Lesotho experienced a decreasing trend of the prevalence of H-RSB from 8.92 in period one to 6.42 in period three. Ghana experienced a marginal increase from 6.22 in period one to 6.76 in period two and then to 6.43 in the third period. However, Malawi, Zambia, and Zimbabwe obtained a marginal increasing trend in the prevalence of H-RSB from period one to three: 2.75 to 3.74, 4.33 to 6.24, and 6.11 to 7.99, respectively. Meanwhile, the prevalence of H-RSB in Namibia and Uganda decreased in period two to 1.84 and 5.76 but increased in period three to 2.01 and 6.83, respectively. Generally, determinants of H-RSB among the countries include age, sex, religious affiliation, marital status, educational level, employment status, economic status, age at first sex, and status of circumcision. Conclusion. Trend of relatively high prevalence of H-RSB has been found across majority of the countries with key sociodemographic factors influencing H-RSB. Therefore, different targeted interventional approaches are needed in all the countries to help reduce H-RSB and the overall HIV incidence. If issues regarding sexual behavior and sexual health are not addressed adequately, H-RSB can negate all the appreciable efforts aimed at ending the HIV pandemic by 2030.

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P3459Research Network in Africa (RNA): gender differences in cardiovascular risk factors and complications in 12 African countries

European Heart Journal ◽

10.1093/eurheartj/ehz745.0332 ◽

2019 ◽

Vol 40 (Supplement_1) ◽

Author(s):

I B Diop ◽

M Antignac ◽

C Nhavoto ◽

A Sidy Ali ◽

D Balde ◽

...

Keyword(s):

Risk Factors ◽

Gender Differences ◽

Cardiovascular Risk ◽

Cardiovascular Risk Factors ◽

Random Effect ◽

Sub Saharan Africa ◽

African Countries ◽

Cross Sectional Survey ◽

Hypertensive Patients ◽

Sub Saharan

Abstract Background Cardiovascular diseases are rapidly growing epidemic in Sub-Saharan Africa. Unlike other regions of the world, death rates due to hypertension are greater for women than men in Africa. Scarce data were available on factors associated with gender in cardiovascular risk factors and complications in Sub-Saharan Africa. Purpose To assess gender differences in cardiovascular risk factors pattern in patients with hypertension in 12 Sub-Saharan countries. Methods We conducted a cross-sectional survey in urban clinics of twelve countries in Africa. Data were collected on demographics, treatment and standardized BP measures were made among the hypertensive patients attending the clinics. BP control was defined as BP<140/90 mmHg and hypertension grades were defined according to European Society of Cardiology guidelines. The separate association between women factors and BP control was investigated using Generalized Linear Mixed-Effects Models adjusted on age; A random effect on the country was added (generalized estimated equation models) to account for inter-country variability. Results The EIGHT study enrolled 2198 patients with hypertension in 12 sub-Saharan countries between January 2014 and November 2015. The proportion of women (60,2%) was higher than men and varied significantly according to countries (p<0.001), ranged from 33.7% (Guinea) to 71.9% (Gabon). Mean age was 57.7±12.0 years for women and 59.2±11.4 years for men (p<0.001). Compared to men, women had a higher rate of family cardiovascular background (79% vs 70%, for women and men respectively) (p<0.0001), cardiovascular risk factors (74.3% vs 68.1) (p=0.008), such as obesity (25.8% vs 12.1%) (p<0.0001), sedentary behavior (42.1% vs 35.0%) (p=0,006). BP control didn't differ according to gender, the repartition of grades of hypertension was similar between women and men and proportion of uncontrolled BP was 77.2% in women and 77.8% in men (p=0.4), with same proportion of women and men receiving antihypertensive treatment (96 vs 97.5%) (NS). However, African women had less cardiovascular complications than men (39% vs 52.4%) (p<0.0001) (OR: 0.50 [CI 95% 0.41–0.61]). Conclusions Our study highlighted gender differences in cardiovascular risk factors pattern in Sub-Saharan hypertensive patients. Tailoring medical (public health) programs to improve cardiovascular disease prevention that take into women characteristics may enhance their effectiveness.

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