Baseline assessment of Pharmacovigilance activities in four sub-Saharan African countries: a perspective on tuberculosis

Abstract Background: New medicines have become available for the treatment of drug-resistant tuberculosis (DR-TB) and are introduced in sub-Saharan Africa (SSA) by the national TB programs (NTPs) through special access schemes. Pharmacovigilance is typically the task of national medicines regulatory agencies (NMRAs), but the active drug safety monitoring and management (aDSM) recommended for the new TB medicines and regimens was introduced through the NTPs.We assessed the strengths and challenges of pharmacovigilance systems in Eswatini, Ethiopia, Nigeria and Tanzania, focusing on their capacity to monitor safety of medicines registered and not registered by the NMRAs for the treatment of DR-TB. Methods: Assessment visits were conducted to all four countries by a multidisciplinary team. We used a pharmacovigilance indicator tool derived from existing tools, interviewed key stakeholders, and visited health facilities where DR-TB patients were treated with new medicines. Assessment results were verified with the local NMRAs and NTPs.Results: Most countries have enabling laws, regulations and guidelines for the conduct of pharmacovigilance by the NMRAs. The relative success of NTP-NMRA collaboration iss much influenced by interpersonal relationships between staff. Division of roles and responsibilities is not always clear and leads to duplication and unfulfilled tasks (e.g. causality assessment). The introduction of aDSM has increased awareness and adverse drug reaction (ADR) reporting to the NMRAs among DR-TB healthcare providers.Conclusion: aDSM has created awareness about the importance of pharmacovigilance among NTPs and has increased ADR reporting rates from the NTPs and/or TB healthcare providers to the NMRAs. In the future, a push for conducting pharmacovigilance through public health programs seems useful, but this needs to coincide with increased collaboration with between public health programs and NMRAs with clear formulation of roles and responsibilities.

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Baseline assessment of pharmacovigilance activities in four sub-Saharan African countries: a perspective on tuberculosis

BMC Health Services Research ◽

10.1186/s12913-021-07043-6 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Everdina W. Tiemersma ◽

Ibrahim Ali ◽

Asnakech Alemu ◽

Yohanna Kambai Avong ◽

Alemayehu Duga ◽

...

Keyword(s):

Public Health ◽

Interpersonal Relationships ◽

Healthcare Providers ◽

Sub Saharan Africa ◽

Health Programs ◽

African Countries ◽

Public Health Programs ◽

Roles And Responsibilities ◽

Drug Safety Monitoring ◽

Sub Saharan

Abstract Background New medicines have become available for the treatment of drug-resistant tuberculosis (DR-TB) and are introduced in sub-Saharan Africa (SSA) by the national TB programs (NTPs) through special access schemes. Pharmacovigilance is typically the task of national medicines regulatory agencies (NMRAs), but the active drug safety monitoring and management (aDSM) recommended for the new TB medicines and regimens was introduced through the NTPs. We assessed the strengths and challenges of pharmacovigilance systems in Eswatini, Ethiopia, Nigeria and Tanzania, focusing on their capacity to monitor safety of medicines registered and not registered by the NMRAs for the treatment of DR-TB. Methods Assessment visits were conducted to all four countries by a multidisciplinary team. We used a pharmacovigilance indicator tool derived from existing tools, interviewed key stakeholders, and visited health facilities where DR-TB patients were treated with new medicines. Assessment results were verified with the local NMRAs and NTPs. Results Most countries have enabling laws, regulations and guidelines for the conduct of pharmacovigilance by the NMRAs. The relative success of NTP-NMRA collaboration is much influenced by interpersonal relationships between staff. Division of roles and responsibilities is not always clear and leads to duplication and unfulfilled tasks (e.g. causality assessment). The introduction of aDSM has increased awareness among DR-TB healthcare providers. Conclusion aDSM has created awareness about the importance of pharmacovigilance among NTPs. In the future, a push for conducting pharmacovigilance through public health programs seems useful, but this needs to coincide with increased collaboration with between public health programs and NMRAs with clear formulation of roles and responsibilities.

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Development of a pharmacovigilance system in a resource-limited country: the experience of the Democratic Republic of Congo

Therapeutic Advances in Drug Safety ◽

10.1177/2042098619864853 ◽

2019 ◽

Vol 10 ◽

pp. 204209861986485 ◽

Cited By ~ 1

Author(s):

Didier Nzolo ◽

Andrea Kuemmerle ◽

Yves Lula ◽

Nsengi Ntamabyaliro ◽

Aline Engo ◽

...

Keyword(s):

Public Health ◽

Democratic Republic ◽

Health Programs ◽

African Countries ◽

Pv System ◽

Public Health Programs ◽

Pv Systems ◽

Resource Limited ◽

Sub Saharan ◽

Set Up

Implementation of pharmacovigilance (PV) systems in resource-limited countries is a real endeavor. Despite country- and continent-specific challenges, the Democratic Republic of the Congo (DRC) has been able to develop one of the most active PV systems in the sub-Saharan Africa. The World Health Organization (WHO) regional Office identified the DRC experience to set up a PV system for antimalarial drugs safety monitoring as a ‘best practice’ that needed to be documented in order to help DRC improve its PV system and to be scaled up in other African countries. In response to the WHO request, a best practices and bottlenecks analysis was conducted in 2015. This analysis was updated in 2018 in the light of the minimum requirements of the WHO to set up a PV system taking into account other guidance for PV systems. The following themes were retained for analysis: (1) creation of the national PV center; (2) implementation of PV in the health system; (3) data collection and analysis; (4) collaboration with public health programs; (5) collaboration with the National Regulatory Authority. Lessons learnt from the DRC experience show that it is possible to implement PV systems in order to promote patients’ safety in resource limited sub-Saharan African countries with no guaranteed funding. The ability of national PV centers to collaborate with Public health stakeholders, including public health authorities at all levels as well as public health programs, and to use existing health information systems are considered the main key to success and may substantially reduce the cost of PV activities.

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Crowdsourcing Covid-19 signals in sub-Saharan Africa: Leveraging digital contributor networks for participatory surveillance of Covid-19 symptoms and deaths (Preprint)

10.2196/preprints.26347 ◽

2020 ◽

Author(s):

Ngozi A Erondu ◽

Sagal A Ali ◽

Mohamed Ali ◽

Schadrac C Agbla

Keyword(s):

Public Health ◽

Sub Saharan Africa ◽

Specific Information ◽

Surveillance Systems ◽

Health Seeking ◽

African Countries ◽

Cross Sectional Survey ◽

Local Networks ◽

The World ◽

Sub Saharan

BACKGROUND In sub-Saharan Africa, underreporting of cases and deaths has been attributed to various factors including, weak disease surveillance, low health-seeking behaviour of flu like symptoms, and stigma of Covid-19. There is evidence that SARS-CoV-2 spread mimics transmission patterns of other countries across the world. Since the Covid-19 pandemic has changed the way research can be conducted and in light of restrictions on travel and risks to in-person data collection, innovative approaches to collecting data must be considered. Nearly 50% of Africa’s population is a unique mobile subscriber and it is one of the fastest growing smart-phone marketplaces in the world; hence, mobile phone platforms should be considered to monitor Covid-19 trends in the community. OBJECTIVE We demonstrate the use of digital contributor platforms to survey individuals about cases of flu-like symptoms and instances of unexplained deaths in Ethiopia, Kenya, Nigeria, Somalia, and Zimbabwe. METHODS Rapid cross-sectional survey of individuals with severe flu and pneumonia symptoms and unexplained deaths in Ethiopia, Kenya, Nigeria, Somalia and Zimbabwe RESULTS Using a non-health specific information platform, we found COVID-19 signals in five African countries, specifically: •Across countries, nearly half of the respondents (n=739) knew someone who had severe flu or pneumonia symptoms in recent months. •One in three respondents from Somalia and one in five from Zimbabwe respondents said they knew more than five people recently displaying flu and/or pneumonia symptoms. •In Somalia there were signals that a large number of people might be dying outside of health facilities, specifically in their homes or in IDP or refugee camps. CONCLUSIONS Existing digital contributor platforms with local networks are a non-traditional data source that can provide information from the community to supplement traditional government surveillance systems and academic surveys. We demonstrate that using these distributor networks to for community surveys can provide periodic information on rumours but could also be used to capture local sentiment to inform public health decision-making; for example, these insights could be useful to inform strategies to increase confidence in Covid19 vaccine. As Covid-19 continues to spread somewhat silently across sub-Saharan Africa, regional and national public health entities should consider expanding event-based surveillance sources to include these systems.

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Preventing Multimorbidity with Lifestyle Interventions in Sub-Saharan Africa: A New Challenge for Public Health in Low and Middle-Income Countries

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph182312449 ◽

2021 ◽

Vol 18 (23) ◽

pp. 12449

Author(s):

Ahmad Alkhatib ◽

Lawrence Achilles Nnyanzi ◽

Brian Mujuni ◽

Geofrey Amanya ◽

Charles Ibingira

Keyword(s):

Public Health ◽

Cardiovascular Disease ◽

Sub Saharan Africa ◽

Lifestyle Interventions ◽

African Countries ◽

Middle Income ◽

Non Communicable Diseases ◽

Economic Disparity ◽

Middle Income Countries ◽

Sub Saharan

Objectives: Low and Middle-Income Countries are experiencing a fast-paced epidemiological rise in clusters of non-communicable diseases such as diabetes and cardiovascular disease, forming an imminent rise in multimorbidity. However, preventing multimorbidity has received little attention in LMICs, especially in Sub-Saharan African Countries. Methods: Narrative review which scoped the most recent evidence in LMICs about multimorbidity determinants and appropriated them for potential multimorbidity prevention strategies. Results: MMD in LMICs is affected by several determinants including increased age, female sex, environment, lower socio-economic status, obesity, and lifestyle behaviours, especially poor nutrition, and physical inactivity. Multimorbidity public health interventions in LMICs, especially in Sub-Saharan Africa are currently impeded by local and regional economic disparity, underdeveloped healthcare systems, and concurrent prevalence of communicable and non-communicable diseases. However, lifestyle interventions that are targeted towards preventing highly prevalent multimorbidity clusters, especially hypertension, diabetes, and cardiovascular disease, can provide early prevention of multimorbidity, especially within Sub-Saharan African countries with emerging economies and socio-economic disparity. Conclusion: Future public health initiatives should consider targeted lifestyle interventions and appropriate policies and guidelines in preventing multimorbidity in LMICs.

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Willingness to Pay for Condoms among Men in Sub-Saharan Africa

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph16010034 ◽

2018 ◽

Vol 16 (1) ◽

pp. 34 ◽

Cited By ~ 2

Author(s):

William Evans ◽

Kuyosh Kadirov ◽

Ibou Thior ◽

Ramakrishnan Ganesan ◽

Alec Ulasevich ◽

...

Keyword(s):

Public Health ◽

Willingness To Pay ◽

Condom Use ◽

Sub Saharan Africa ◽

Linear Regression Models ◽

African Countries ◽

Donor Funding ◽

Sub Saharan ◽

Tool Building ◽

Hiv Aids

HIV/AIDS and other sexually transmitted infections (STIs) continue to be among the greatest public health threats worldwide, especially in sub-Saharan Africa (SSA). Condom use remains an essential intervention to eradicate AIDS, and condom use is now higher than ever. However, free and subsidized condom funding is declining. Research on how to create healthy markets based on willingness to pay for condoms is critically important. This research has three primary aims: (1) willingness of free condom users in five African countries to pay for socially marketed condoms; (2) the relationship between specific population variables and condom brand marketing efforts and willingness to pay; and (3) potential opportunities to improve condom uptake. Nationally representative samples of at least 1200 respondents were collected in Kenya, Nigeria, South Africa, Zambia, and Zimbabwe. We collected data on a range of demographic factors, including condom use, sexual behavior, awareness of condom brands, and willingness to pay. We estimated multivariate linear regression models and found that free condom users are overwhelmingly willing to pay for condoms overall (over 90% in Nigeria) with variability by country. Free users were consistently less willing to pay for condoms if they had a positive identification with their free brand in Kenya and Zimbabwe, suggesting that condom branding is a critical strategy. Ability to pay was negatively correlated with willingness, but users who could not obtain free condoms were willing to pay for them in Kenya and Zimbabwe. In a landscape of declining donor funding, this research suggests opportunities to use scarce funds for important efforts such as campaigns to increase demand, branding of condoms, and coordination with commercial condom manufacturers to build a healthy total market approach for the product. Free condoms remain an important HIV/AIDS prevention tool. Building a robust market for paid condoms in SSA is a public health priority.

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Sub-Saharan Africa preparedness and response to the COVID-19 pandemic: A perspective of early career African scientists

Wellcome Open Research ◽

10.12688/wellcomeopenres.16070.2 ◽

2020 ◽

Vol 5 ◽

pp. 163

Author(s):

Gisele Umviligihozo ◽

Lucy Mupfumi ◽

Nelson Sonela ◽

Delon Naicker ◽

Ekwaro A. Obuku ◽

...

Keyword(s):

Public Health ◽

Case Fatality ◽

Early Career ◽

Health Interventions ◽

Sub Saharan Africa ◽

Public Health Interventions ◽

African Countries ◽

Scientific Publications ◽

First Case ◽

Sub Saharan

Emerging highly transmissible viral infections such as SARS-CoV-2 pose a significant global threat to human health and the economy. Since its first appearance in December 2019 in the city of Wuhan, Hubei province, China, SARS-CoV-2 infection has quickly spread across the globe, with the first case reported on the African continent, in Egypt on February 14th, 2020. Although the global number of COVID-19 infections has increased exponentially since the beginning of the pandemic, the number of new infections and deaths recorded in African countries have been relatively modest, suggesting slower transmission dynamics of the virus on the continent, a lower case fatality rate, or simply a lack of testing or reliable data. Notably, there is no significant increase in unexplained pneumonias or deaths on the continent which could possibly indicate the effectiveness of interventions introduced by several African governments. However, there has not yet been a comprehensive assessment of sub-Saharan Africa’s (SSA) preparedness and response to the COVID-19 pandemic that may have contributed to prevent an uncontrolled outbreak so far. As a group of early career scientists and the next generation of African scientific leaders with experience of working in medical and diverse health research fields in both SSA and resource-rich countries, we present a unique perspective on the current public health interventions to fight COVID-19 in Africa. Our perspective is based on extensive review of the available scientific publications, official technical reports and announcements released by governmental and non-governmental health organizations as well as from our personal experiences as workers on the COVID-19 battlefield in SSA. We documented public health interventions implemented in seven SSA countries including Uganda, Kenya, Rwanda, Cameroon, Zambia, South Africa and Botswana, the existing gaps and the important components of disease control that may strengthen SSA response to future outbreaks.

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Challenges of healthcare delivery in the context of COVID-19 pandemic in Sub-Saharan Africa

Iberoamerican Journal of Medicine ◽

10.53986/ibjm.2020.0018 ◽

2020 ◽

Vol 2 (2) ◽

pp. 100-109

Author(s):

Bamidele Johnson Alegbeleye ◽

◽

Rana Kadhim Mohammed ◽

Keyword(s):

Public Health ◽

Health Systems ◽

Healthcare Delivery ◽

Sub Saharan Africa ◽

African Countries ◽

Health Security ◽

Public Health Systems ◽

Public Health Infrastructure ◽

Health Infrastructure ◽

Sub Saharan

Introduction: Public health security is concerned with infection prevention and control worldwide. These measures are the concern of all and sundry to ensure prevention of any outbreaks of diseases that has epidemic potential. Africa may be uniquely positioned to have the most severe and under-detected outcomes related to COVID-19 infection. This article seeks to highlight such challenges of healthcare delivery systems in the context of the COVID-19 pandemic in sub-Saharan Africa. The communique also suggests possible strategies for improvement in such settings. Method: We identified relevant articles to date using a manual library search, journal publications on the subject, and critically reviewed them. Results: We identified and exhaustively discussed the main limitations to public health security in sub-Saharan Africa as follows i) Continuing deterioration of the public health infrastructure for disease control, ii) The changing outlooks of contagious diseases, iii) Private sector reforms like the managed care, iv) Relatively weak health care systems, and v) Poor organizational structures. Conclusion: Most Africans are eager to see the desired transformation in our public health systems. Unfortunately, the political will to invest in public health infrastructure is lacking. Also, the system is characterized by human resources shortage and diverted resources, which significantly impacted the provision for emerging COVID-19 pandemic –related care. Interestingly the monumental breakthroughs in research development for bio-therapeutics and vaccines in African countries appear a mirage even with extensive past study experience with such products from China and the Western world. Finally, notwithstanding these challenges in our public health systems as elaborated, the facts are that enormous capacities exist that can be harnessed in African countries for the COVID-19 preparedness and response.

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COVID-19 Knowledge, Perception, Preventive Measures, Stigma, and Mental Health Among Healthcare Workers in Three Sub-Saharan African Countries: A Phone Survey

American Journal of Tropical Medicine and Hygiene ◽

10.4269/ajtmh.20-1621 ◽

2021 ◽

Author(s):

Nega Assefa ◽

Abdramane Soura ◽

Elena C. Hemler ◽

Michelle L. Korte ◽

Dongqing Wang ◽

...

Keyword(s):

Mental Health ◽

Social Stigma ◽

Healthcare Providers ◽

Sub Saharan Africa ◽

Prevention Measures ◽

African Countries ◽

Health Crisis ◽

Adjusted Risk ◽

Adequate Knowledge ◽

Sub Saharan

The coronavirus disease 2019 (COVID-19) pandemic is an unprecedented public health crisis globally. Understanding healthcare providers’ (HCPs’) knowledge and perceptions of COVID-19 is crucial to identifying effective strategies to improve their ability to respond to the pandemic in sub-Saharan Africa. A phone-based survey of 900 HCPs in Burkina Faso, Ethiopia, and Nigeria (300 per country) was conducted to assess knowledge, perceptions, COVID-19 prevention measures, stigma, and mental health of HCPs. Modified Poisson regression models were used to evaluate predictors of knowledge, perceptions, and prevention measures; adjusted risk ratios (ARRs) and 95% confidence intervals (CIs) were calculated. Three-fourths of the HCPs had adequate knowledge, and over half had correct perceptions of risk and high levels of self-reported prevention measures. The majority of the HCPs (73.7%) reported self-perceived social stigma. There was relatively low prevalence of depression (6.6%), anxiety (6.6%), or psychological distress (18%). Compared with doctors, being a nurse was associated with lower levels of knowledge (ARR: 0.83; 95% CI: 0.77–0.90) and was also negatively associated with having correct perceptions toward COVID-19 (AOR: 0.82; 95% CI: 0.73–0.92). HCPs treating COVID-19 patients had higher likelihood of having high levels of prevention measures (AOR: 1.37; 95% CI: 1.23–1.53). Despite high levels of knowledge among HCPs in sub-Saharan Africa, there is a need to improve COVID-19 perceptions and compliance with prevention measures as well as address social stigma toward HCPs to better ensure their safety and prepare them to deliver health services.

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Anaemia in schoolchildren in eight countries in Africa and Asia

Public Health Nutrition ◽

10.1079/phn2000111 ◽

2001 ◽

Vol 4 (3) ◽

pp. 749-756 ◽

Cited By ~ 44

Author(s):

◽

Andrew Hall ◽

Emily Bobrow ◽

Simon Brooker ◽

Matthew Jukes ◽

...

Keyword(s):

Public Health ◽

Health Services ◽

Health Problem ◽

Basic Education ◽

Public Health Problem ◽

Sub Saharan Africa ◽

School Age Children ◽

African Countries ◽

School Based ◽

Sub Saharan

AbstractObjectiveTo report on the haemoglobin concentrations and prevalence of anaemia in schoolchildren in eight countries in Africa and Asia.DesignBlood samples were collected during surveys of the health of schoolchildren as a part of programmes to develop school-based health services.SettingRural schools in Ghana, Indonesia, Kenya, Malawi, Mali, Mozambique, Tanzania and Vietnam.SubjectsNearly 14 000 children enrolled in basic education in three age ranges (7–11 years, 12–14 years and Ä15 years) which reflect the new UNICEF/WHO thresholds to define anaemia.ResultsAnaemia was found to be a severe public health problem (defined as >40% anaemic) in five African countries for children aged 7–11 years and in four of the same countries for children aged 12–14 years. Anaemia was not a public health problem in the children studied in the two Asian countries. More boys than girls were anaemic, and children who enrolled late in school were more likely to be anaemic than children who enrolled closer to the correct age. The implications of the four new thresholds defining anaemia for school-age children are examined.ConclusionsAnaemia is a significant problem in schoolchildren in sub-Saharan Africa. School-based health services which provide treatments for simple conditions that cause blood loss, such as worms, followed by multiple micronutrient supplements including iron, have the potential to provide relief from a large burden of anaemia.

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