scholarly journals Risk factors of anemia among selected countries experiencing higher rate of under-5 mortality in sub-Saharan Africa: a three-way interaction model

Author(s):  
Olanrewaju D. Eniade ◽  
Abayomi T. Olarinmoye ◽  
Tongdiyen L. Jasper ◽  
Yusuff A. Olasunkanmi ◽  
Musibau A. Alabi ◽  
...  

Background: Over 1.8 million under-five mortality could be avoided each year if anemia is dealt with. No adequate information on the determinants of anemia among the sub-Saharan countries experiencing a higher after prevalence under-5 mortality. This study identified the risk factors of anemia among three sub-Saharan countries (Benin, Guinea and Nigeria).Methods: A total of 24137 records from the 2018 demographic and health survey. The outcome variable was anemia status (Anemic=1, not anemic=0). Measures of effects (AOR) were assessed using binary logistic regression and random-effect generalized linear model. Stata MP 16 was used for the data analysis.Results: Anemia was found to be common among children in Nigeria (ENREF 59.4%), Benin (58.2%), and Guinea (46.0%). Children (<6 months) had higher risk of anemia (AOR: 1.20, 95% CI: 1.05-1.37). Intake of drugs for the treatment of intestinal parasites during pregnancy was found to be protective against anemia in Nigeria (AOR: 0.85, 95% CI: 0.89-0.97) and Guinea (AOR: 0.76, 95% CI: 0.63-0.91). Main cooking fuel: Kerosene (AOR: 1.32, 95% CI: 1.05-1.65) and firewood (AOR: 1.46, 95% CI: 1.17-1.81) were associated with a higher risk of anemia.Conclusions: Children of younger age (<6 months) deserve priority attention in the battle against anemia. Intake of drugs for intestinal parasites during pregnancy presents a potentially impactful strategy for anemia prevention among under-5 children in addition to routine deworming and treatments. Also, rural residents, users of kerosene and firewood as main cooking fuel, and users of unprotected well as main source of drinking water needs attention in the awareness and campaigns against under-5 anemia.

2021 ◽  
Author(s):  
Katherine M. Jia ◽  
Hallie Eilerts ◽  
Olanrewaju Edun ◽  
Kevin Lam ◽  
Adam Howes ◽  
...  

AbstractIntroductionSeveral HIV ‘risk scores’ have been developed to identify individuals for prioritised HIV prevention in sub-Saharan Africa. We systematically reviewed HIV risk scores to: (i) identify factors that consistently predicted incident HIV infection, (ii) review inclusion of community-level HIV risk in predictive models, and (iii) examine predictive performance.MethodsWe systematically searched nine databases for studies developing and/or validating HIV risk scores among the general population in sub-Saharan Africa from database inception until February 15, 2021. Studies not prospectively observing seroconversion or recruiting only key populations were excluded. Record screening, data extraction, and critical appraisal were conducted in duplicate. We used random-effect meta-analysis to summarise hazard ratios and the area under the receiver-operating characteristic curve (AUC-ROC).ResultsFrom 1563 initial search records, we identified 14 risk scores in 13 studies. Seven studies were among sexually active women using contraception enrolled in randomised-controlled trials, three among adolescent girls and young women (AGYW), and three among cohorts enrolling both men and women. Consistently identified HIV prognostic factors among women were younger age (pooled adjusted hazard ratio: 1.62 [95% Confidence Interval: 1.17, 2.23], compared to above-25), single/not cohabiting with primary partners (2.33 [1.73, 3.13]) and having sexually transmitted infections (STIs) at baseline (HSV-2: 1.67 [1.34, 2.09]; curable STIs: 1.45 [1.17; 1.79]). Among AGYW only STIs were consistently associated with higher incidence, but studies were limited (n=3). Community-level HIV prevalence or unsuppressed viral load strongly predicted incidence but were only considered in three of 11 multi-site studies. The AUC-ROC ranged from 0.56 to 0.79 on the model development sets. Only the VOICE score was externally validated by multiple studies, with pooled AUC-ROC 0.626 [0.588, 0.663] (I2: 64.02%).ConclusionsYounger age, non-cohabiting, and recent STIs were consistently identified as predicting future HIV infection. Both community HIV burden and individual factors should be considered to quantify HIV risk. However, HIV risk scores had only low-to-moderate discriminatory ability and uncertain generalizability outside of the study populations. Further evidence on the relative value of specific factors and data outside high-risk populations will help inform optimal implementation of risk scoring algorithms in HIV programmes.PROSPERO NumberCRD42021236367


2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
I B Diop ◽  
M Antignac ◽  
C Nhavoto ◽  
A Sidy Ali ◽  
D Balde ◽  
...  

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.


2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Abdul-Aziz Seidu ◽  
Ebenezer Agbaglo ◽  
Louis Kobina Dadzie ◽  
Justice Kanor Tetteh ◽  
Bright Opoku Ahinkorah

Abstract Background In sub-Saharan Africa, sexually transmitted infections (STIs) other than HIV are major public health problems. This study, therefore, sought to assess the prevalence and factors associated with self-reported STIsamong sexually active men in Ghana. Methods Data from the 2014 Ghana demographic and health survey wereused to conduct the study. This research included a total of 3051 sexually active men aged 15–59 years. Self-reported STI was the outcome variable. The data were analyzed using both descriptive (frequencies and percentages) and inferential (binary logistic regression) analysis. Results The prevalence of self-reported STIs in the past 12 months preceding the survey was 6.0% (CI:4.7–6.8). Compared to men aged 45-59 years, those aged 25–34 (aOR = 2.96, CI: 1.64–5.35), 15–24 (aOR = 2.19, CI: 1.13–4.26), and 35–44 (aOR = 2.29, CI: 1.23–4.24) were more likely to report an STI. Men who had 2 or more sexual partners apart from their spouse were more likely to report an STI compared to those with no other partner apart from spouse (aOR = 4.24, CI: 2.52–7.14). However, those who had their first sex when they were 20 years and above (AOR = 0.66, CI: 0.47–0.93) and men who read newspaper/magazine had lower odds (aOR = 0.53, CI: 0.37–0.77) of reporting STIs compared to those who had sex below 20 and those who did not read newspaper/magazine respectively. Conclusion The study has revealed a relatively low prevalence of self-reported STI among sexually active men in Ghana. Sexually active men aged 25–34 years, those whose age at first sex is below 20 years and those with two or more sexual partners apart from their spouse had higher odds of reporting STIs. However, reading a newspaper was found to be positive in reducing the odds of reporting STIs. To reduce STIs among sexually active men in Ghana, it is important for health systems and stakeholders to consider these factors and put in place measures to mitigate those that put men at risk of STIs and encourage the adoption of the protective factors. Mass media can be used as a useful avenue for encouraging men to report STIs in order to avoid transmitting them to their partners. 


BMJ Open ◽  
2021 ◽  
Vol 11 (5) ◽  
pp. e045992
Author(s):  
Eugene Budu ◽  
Bright Opoku Ahinkorah ◽  
Richard Gyan Aboagye ◽  
Ebenezer Kwesi Armah-Ansah ◽  
Abdul-Aziz Seidu ◽  
...  

ObjectiveThe objective of the study was to examine the association between maternal healthcare utilisation and complete childhood vaccination in sub-Saharan Africa.DesignOur study was a cross-sectional study that used pooled data from 29 countries in sub-Saharan Africa.ParticipantsA total of 60 964 mothers of children aged 11–23 months were included in the study.Outcome variablesThe main outcome variable was complete childhood vaccination. The explanatory variables were number of antenatal care (ANC) visits, assistance during delivery and postnatal care (PNC).ResultsThe average prevalence of complete childhood vaccination was 85.6%, ranging from 67.0% in Ethiopia to 98.5% in Namibia. Our adjusted model, children whose mothers had a maximum of three ANC visits were 56% less likely to have complete vaccination, compared with those who had at least four ANC visits (adjusted OR (aOR)=0.44, 95% CI 0.42 to 0.46). Children whose mothers were assisted by traditional birth attendant/other (aOR=0.43, 95% CI 0.41 to 0.56) had lower odds of complete vaccination. The odds of complete vaccination were lower among children whose mothers did not attend PNC clinics (aOR=0.26, 95% CI 0.24 to 0.29) as against those whose mothers attended.ConclusionThe study found significant variations in complete childhood vaccination across countries in sub-Saharan Africa. Maternal healthcare utilisation (ANC visits, skilled birth delivery, PNC attendance) had significant association with complete childhood vaccination. These findings suggest that programmes, interventions and strategies aimed at improving vaccination should incorporate interventions that can enhance maternal healthcare utilisation. Such interventions can include education and sensitisation, reducing cost of maternal healthcare and encouraging male involvement in maternal healthcare service utilisation.


2021 ◽  
Vol 10 (1) ◽  
Author(s):  
Hafte Kahsay Kebede ◽  
Lillian Mwanri ◽  
Paul Ward ◽  
Hailay Abrha Gesesew

Abstract Background It is known that ‘drop out’ from human immunodeficiency virus (HIV) treatment, the so called lost-to-follow-up (LTFU) occurs to persons enrolled in HIV care services. However, in sub-Saharan Africa (SSA), the risk factors for the LTFU are not well understood. Methods We performed a systematic review and meta-analysis of risk factors for LTFU among adults living with HIV in SSA. A systematic search of literature using identified keywords and index terms was conducted across five databases: MEDLINE, PubMed, CINAHL, Scopus, and Web of Science. We included quantitative studies published in English from 2002 to 2019. The Joanna Briggs Institute Meta-Analysis of Statistics Assessment and Review Instrument (JBI-MAStARI) was used for methodological validity assessment and data extraction. Mantel Haenszel method using Revman-5 software was used for meta-analysis. We demonstrated the meta-analytic measure of association using pooled odds ratio (OR), 95% confidence interval (CI) and heterogeneity using I2 tests. Results Thirty studies met the search criteria and were included in the meta-analysis. Predictors of LTFU were: demographic factors including being: (i) a male (OR = 1.2, 95% CI 1.1–1.3, I2 = 59%), (ii) between 15 and 35 years old (OR = 1.3, 95% CI 1.1–1.3, I2 = 0%), (iii) unmarried (OR = 1.2, 95% CI 1.2–1.3, I2 = 21%), (iv) a rural dweller (OR = 2.01, 95% CI 1.5–2.7, I2 = 40%), (v) unemployed (OR = 1.2, 95% CI 1.04–1.4, I2 = 58%); (vi) diagnosed with behavioral factors including illegal drug use(OR = 13.5, 95% CI 7.2–25.5, I2 = 60%), alcohol drinking (OR = 2.9, 95% CI 1.9–4.4, I2 = 39%), and tobacco smoking (OR = 2.6, 95% CI 1.6–4.3, I2 = 74%); and clinical diagnosis of mental illness (OR = 3.4, 95% CI 2.2–5.2, I2 = 1%), bed ridden or ambulatory functional status (OR = 2.2, 95% CI 1.5–3.1, I2 = 74%), low CD4 count in the last visit (OR = 1.4, 95% CI 1.1–1.9, I2 = 75%), tuberculosis co-infection (OR = 1.2, 95% CI 1.02–1.4, I2 = 66%) and a history of opportunistic infections (OR = 2.5, 95% CI 1.7–2.8, I2 = 75%). Conclusions The current review identifies demographic, behavioral and clinical factors to be determinants of LTFU. We recommend strengthening of HIV care services in SSA targeting the aforementioned group of patients. Trial registration Protocol: the PROSPERO Registration Number is CRD42018114418


BMJ Open ◽  
2020 ◽  
Vol 10 (12) ◽  
pp. e039456
Author(s):  
Leolin Katsidzira ◽  
Wisdom F Mudombi ◽  
Rudo Makunike-Mutasa ◽  
Bahtiyar Yilmaz ◽  
Annika Blank ◽  
...  

IntroductionThe epidemiology of inflammatory bowel disease (IBD) in sub-Saharan Africa is poorly documented. We have started a registry to determine the burden, phenotype, risk factors, disease course and outcomes of IBD in Zimbabwe.Methods and analysisA prospective observational registry with a nested case–control study has been established at a tertiary hospital in Harare, Zimbabwe. The registry is recruiting confirmed IBD cases from the hospital, and other facilities throughout Zimbabwe. Demographic and clinical data are obtained at baseline, 6 months and annually. Two age and sex-matched non-IBD controls per case are recruited—a sibling or second-degree relative, and a randomly selected individual from the same neighbourhood. Cases and controls are interviewed for potential risk factors of IBD, and dietary intake using a food frequency questionnaire. Stool is collected for 16S rRNA-based microbiota profiling, and along with germline DNA from peripheral blood, is being biobanked. The estimated sample size is 86 cases and 172 controls, and the overall registry is anticipated to run for at least 5 years. Descriptive statistics will be used to describe the demographic and phenotypic characteristics of IBD, and incidence and prevalence will be estimated for Harare. Risk factors for IBD will be analysed using conditional logistic regression. For microbial analysis, alpha diversity and beta diversity will be compared between cases and controls, and between IBD phenotypes. Mann-Whitney U tests for alpha diversity and Adonis (Permutational Multivariate Analysis of Variance) for beta diversity will be computed.Ethics and disseminationEthical approval has been obtained from the Parirenyatwa Hospital’s and University of Zimbabwe’s research ethics committee and the Medical Research Council of Zimbabwe. Findings will be discussed with patients, and the Zimbabwean Ministry of Health. Results will be presented at scientific meetings, published in peer reviewed journals, and on social media.Trial registration numberNCT04178408.


2021 ◽  
Vol 6 (1) ◽  
pp. e003499
Author(s):  
Ryan G Wagner ◽  
Nigel J Crowther ◽  
Lisa K Micklesfield ◽  
Palwende Romauld Boua ◽  
Engelbert A Nonterah ◽  
...  

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.


2020 ◽  
Vol 151 (2) ◽  
pp. 547-574 ◽  
Author(s):  
Lukas Salecker ◽  
Anar K. Ahmadov ◽  
Leyla Karimli

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.


2014 ◽  
Vol 2014 ◽  
pp. 1-6 ◽  
Author(s):  
R. S. Houmsou ◽  
B. E. Wama ◽  
S. O. Elkanah ◽  
L. C. Garba ◽  
T. D. Hile ◽  
...  

Malaria still remains a challenging infection affecting the lives of several HIV infected pregnant women in sub-Saharan Africa. This study was undertaken to determine malarial infection in HIV infected pregnant women in relation to sociodemographic and obstetrical factors. The study also assessed relationship between malarial infection and haemoglobin level, CD4+ counts, and ART regimen, as well as predisposing risk factors that influenced occurrence of malarial infection in the women. Thick and thin blood smears were prepared and stained with Giemsa. Haemoglobin level was determined using a hematology analyzer, while the flow cytometry was used to measure CD4+ counts. Sociodemographic and obstetrical parameters were obtained through the administration of questionnaires. Of the 159 HIV infected pregnant women examined, 33.3% (59/159) had malarial infection. Malarial infection was significantly higher in pregnant women who were divorced, 40.24% (33/82) (χ2=5.72; P=0.05), were at their first trimester (4–12 weeks), 54.8% (17/31) (χ2=14.85; P=0.01), had CD4+ = [201–500 cells/μL], 42.42% (42/99) (χ2=10.13; P=0.00), and those that had severe anaemia (<8 dg/L), 100.00% (χ2= 45.75; P=0.00). However, risk factors that influenced the occurrence of malarial infection in the pregnant women were occupation (farming) (AOR=0.226; P=0.03), marital status (divorced) (AOR=2.80; P=0.02), gestation (first trimester) (AOR=0.33; P=0.00), haemoglobin level (Hb < 8 dg/L) (AOR=0.02; P=0.00), and CD4+ counts (low CD4+) (OR=0.40; P=0.05). The study reported endemicity of malaria in HIV infected pregnant women living in rural areas of Benue State, Nigeria. Malarial infection was higher in women that were divorced, and at their first trimester, had low CD4+ count, and had severe anaemia. Farming, divorce, gestation, severe anaemia, and low CD4+ counts were predisposing risk factors that influenced malaria occurrence in the HIV infected pregnant women. It is advocated that HIV infected pregnant women should be properly and thoroughly educated on malaria preventive measures in rural areas so as to avoid unpleasant effect of malaria during their pregnancies.


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