scholarly journals Perception of Malaria Chemoprevention Interventions in Infants and Children in Eight Sub-Saharan African Countries: An End User Perspective Study

2021 ◽  
Vol 6 (2) ◽  
pp. 75
Author(s):  
Céline Audibert ◽  
André-Marie Tchouatieu
Keyword(s):  
Health Workers ◽  
Qualitative Interviews ◽  
Intermittent Preventive Treatment ◽  
Age Groups ◽  
Sub Saharan Africa ◽  
End User ◽  
African Countries ◽  
Preventive Chemotherapy ◽  
High Staff Turnover ◽  
Sub Saharan

Preventive chemotherapy interventions have been identified as key tools for malaria prevention and control. Although a large number of publications have reported on the efficacy and safety profile of these interventions, little literature exists on end-user experience. The objective of this study was to provide insights on the perceptions and attitudes towards seasonal malaria chemoprevention (SMC) and intermittent preventive treatment of infants (IPTi) to identify drivers of and barriers to acceptance. A total of 179 in-depth qualitative interviews were conducted with community health workers (CHWs), health center managers, parents of children receiving chemoprevention, and national decision makers across eight countries in sub-Saharan Africa. The transcribed verbatim responses were coded and analyzed using a thematic approach. Findings indicate that, although SMC is largely accepted by end users, coverage remained below 100%. The main causes mentioned were children’s absenteeism, children being sick, parents’ reluctance, and lack of staff. Regarding IPTi, results from participants based in Sierra Leone showed that the intervention was generally accepted and perceived as efficacious. The main challenges were access to water, crushing the tablets, and high staff turnover. SMC and IPTi are perceived as valuable interventions. Our study identified the key elements that need to be considered to facilitate the expansion of these two interventions to different geographies or age groups.

Perception of Malaria Chemoprevention Interventions in Infants and Children in Eight Sub-Saharan African Countries: an End-User Perspective Study

2020 ◽  
Author(s):  
Celine Audibert ◽  
Andre-Marie Tchouatieu
Keyword(s):  
Health Center ◽  
Sierra Leone ◽  
Safety Profile ◽  
Intermittent Preventive Treatment ◽  
Infant Mortality Rate ◽  
Sub Saharan Africa ◽  
Efficacy And Safety ◽  
End User ◽  
High Staff Turnover ◽  
Sub Saharan

Abstract Background: Preventive chemotherapy interventions have been identified as key tools for malaria prevention and control. Seasonal malaria chemoprevention (SMC) and intermittent preventive treatment of infants (IPTi) represent the two major chemoprevention measures recommended by the WHO since 2012. A large number of publications of clinical trials have reported on the efficacy and safety profile of these interventions. However, little literature exists on end-user experience. The objective of this study was to provide insights on the perceptions and attitudes towards SMC and IPTi to identify drivers of and barriers to acceptance.Methods: a total of 179 in-depth qualitative interviews were conducted with community health workers (CHWs), health center managers, parents of children receiving chemoprevention, and national decision-makers across eight countries in sub-Saharan Africa. Questionnaires were adapted to the malaria chemoprevention intervention in place in each country. The transcribed verbatim responses were coded and analyzed using a thematic approach.Results: Study data indicate that SMC is largely well perceived and accepted by end-users, mainly due to its generally favorable efficacy and safety profile. Despite this largely positive perception, coverage remained below 100%, with health-center managers and CHWs who participated in our survey estimating, respectively, that 88% and 92% of eligible children received the first dose each month. The main causes mentioned for missing doses were children’s absenteeism, children being sick, parents’ reluctance, and lack of staff. Regarding IPTi, results from participants based in Sierra Leone showed that the intervention was generally well accepted and integrated into the Expanded Programme on Immunization (EPI) program. High infant mortality rate due to malaria and supportive efficacy data led Sierra Leone to implement IPTi, although these arguments were not sufficient for respondents from other countries. At the field level, parents and CHWs from Sierra Leone recognized the efficacy of the intervention in protecting their infants from malaria. The main challenges encountered were access to water, crushing the tablets, and high staff turnover.Conclusions: SMC and IPTi are perceived as valuable interventions. Our study identified the key elements that need to be considered to facilitate the expansion of these two interventions to different geographies or age groups.

scholarly journals Competing interests, clashing ideas and institutionalizing influence: insights into the political economy of malaria control from seven African countries

2020 ◽  
Author(s):  
Justin Parkhurst ◽  
Ludovica Ghilardi ◽  
Jayne Webster ◽  
Robert W Snow ◽  
Caroline A Lynch
Keyword(s):  
Decision Making ◽  
Malaria Control ◽  
Qualitative Interviews ◽  
Sub Saharan Africa ◽  
African Countries ◽  
Health Community ◽  
Control Programmes ◽  
Control Decision ◽  
Sub Saharan ◽  
Economic Considerations

Abstract This article explores how malaria control in sub-Saharan Africa is shaped in important ways by political and economic considerations within the contexts of aid-recipient nations and the global health community. Malaria control is often assumed to be a technically driven exercise: the remit of public health experts and epidemiologists who utilize available data to select the most effective package of activities given available resources. Yet research conducted with national and international stakeholders shows how the realities of malaria control decision-making are often more nuanced. Hegemonic ideas and interests of global actors, as well as the national and global institutional arrangements through which malaria control is funded and implemented, can all influence how national actors respond to malaria. Results from qualitative interviews in seven malaria-endemic countries indicate that malaria decision-making is constrained or directed by multiple competing objectives, including a need to balance overarching global goals with local realities, as well as a need for National Malaria Control Programmes to manage and coordinate a range of non-state stakeholders who may divide up regions and tasks within countries. Finally, beyond the influence that political and economic concerns have over programmatic decisions and action, our analysis further finds that malaria control efforts have institutionalized systems, structures and processes that may have implications for local capacity development.

scholarly journals The toll of COVID-19 on African children: A descriptive analysis on the COVID-19-related morbidity and mortality among the pediatric population in Sub-Saharan Africa

2021 ◽  
Author(s):  
Sabina Rodriguez Velasquez ◽  
Lea Jacques ◽  
Jyoti Dalal ◽  
Paolo Sestito ◽  
Zahra Habibi ◽  
...  
Keyword(s):  
Cumulative Incidence ◽  
Pediatric Population ◽  
Adult Population ◽  
Age Groups ◽  
Sub Saharan Africa ◽  
Morbidity And Mortality ◽  
African Countries ◽  
Regional Office ◽  
Sub Saharan ◽  
Epidemiological Characteristics

Introduction: Since the beginning of the COVID-19 pandemic, very little data on the epidemiological characteristics among the pediatric population in Africa has been published. This paper examines the age and sex distribution of the morbidity and mortality rate in children with COVID-19 and compares it to the adult population within 15 Sub-Saharan African countries. Methods: A merge line listing dataset using a reverse engineering model shared by countries within the Regional Office for Africa was analyzed. Patients diagnosed within 1 March 2020 and 1 September 2020 with confirmed positive RT-PCR test for SARS-CoV-2 were analyzed. Children data were stratified into three age groups: 0-4 years, 5-11 years, and 12-17 years, while adults were combined. The cumulative incidence of cases including its medians and 95% confidence intervals were calculated. Results: 9% of the total confirmed cases and 2.4% of the reported deaths were pediatric cases. The 12-17 age group in all 15 countries showed the highest cumulative incidence proportion in children. COVID-19 cases in males and females under the age of 18 were evenly distributed. Among adults, a higher case incidence per 100,000 people was observed compared to children. Conclusion: The cases and deaths within the children population was smaller than the adult population. These differences can reflect biases in COVID-19 testing protocols and reporting implemented by countries, highlighting the need for more extensive investigation and focus on the effects of COVID-19 in children.

TRACKING CHANGES IN STATES OF CONTRACEPTIVE USE OVER TIME IN SUB-SAHARAN AFRICA THROUGH COHORT AND PERIOD ANALYSES

2014 ◽  
Vol 47 (3) ◽  
pp. 329-344 ◽  
Author(s):  
ELIZABETH LEAHY MADSEN ◽  
BERNICE KUANG ◽  
JOHN ROSS
Keyword(s):  
Contraceptive Use ◽  
Age Groups ◽  
Unmet Need ◽  
Sub Saharan Africa ◽  
African Countries ◽  
Younger Women ◽  
Health Survey Data ◽  
Sub Saharan ◽  
Representative Samples ◽  
Unmet Need For Contraception

SummaryIt is difficult to gauge the success of programmatic efforts to reduce unmet need for contraception without knowing whether individual women have had their need met and adopted contraception. However, the number of true longitudinal datasets tracking the transition of panels of individual women in and out of states of contraceptive use is limited. This study analyses changes in contraceptive use states using Demographic and Health Survey data for 22 sub-Saharan African countries. A cohort approach, tracking representative samples of five-year age groups longitudinally across surveys, as well as period-based techniques, are applied to indicate whether new users of contraception have been drawn from women who previously had no need and/or those who had unmet need for family planning. The results suggest that a greater proportion of increases in contraceptive use in recent years can be attributed to decreases in the percentage of women with no need, especially among younger women, than to decreases in the proportion with unmet need.

scholarly journals Cultural Adaptations of the Standard EMDR Protocol in Five African Countries

2021 ◽  
Vol 15 (1) ◽  
pp. 29-43
Author(s):  
Femke Bannink Mbazzi ◽  
Anne Dewailly ◽  
Kalkidan Admasu ◽  
Yvonne Duagani ◽  
Kizito Wamala ◽  
...  
Keyword(s):  
Health Workers ◽  
Group Discussion ◽  
Sub Saharan Africa ◽  
Mental Health Workers ◽  
Standard Protocol ◽  
African Countries ◽  
Cultural Adaptations ◽  
Study Results ◽  
Sub Saharan ◽  
Age Range

Since 2007, mental health workers in sub-Saharan Africa have been trained in eye movement desensitization and reprocessing (EMDR) therapy. This qualitative study used an Afrocentric design with thematic analysis to investigate adaptations to the EMDR standard protocol that make it culturally relevant for African clients. Participants were 25 EMDR therapists (three male, age range 32–60 years, x̄ = 44) from five African countries, who practiced EMDR for 1–11 years (x̄ = 7). All answered a survey questionnaire, eight participated in a focus group discussion, and two provided a supervision notes analysis. Participants found EMDR a useful and beneficial therapy and preferred it over other therapies because of its nonnarrative nature and quick results. We identified four areas in which African therapists consistently made adaptations to the standard protocol: wording of the protocol text, cultural expression of thoughts and emotions, stimulation choice, and simplification of quantitative scales. Based on the study results, we make numerous recommendations for cultural adaptions to the EMDR protocol. These include language changes to take into account the clients' “we oriented” communication; cultural interpretations of positive and negative thoughts and events; adding cultural activities such as dance, music, and religious practices as resourcing exercises; using hand gestures or the pictorial faces scale instead of ordinal scales; and using tapping for bilateral stimulation instead of eye movements, which were sometimes seen as “witchcraft.” The relevance of the findings for EMDR practice and training are discussed. We recommend that African researchers further study the acceptability, use, and effectiveness of EMDR in their countries.

scholarly journals Maternal cumulative prevalence measures of child mortality show heavy burden in sub-Saharan Africa

2020 ◽  
Vol 117 (8) ◽  
pp. 4027-4033 ◽  
Author(s):  
Emily Smith-Greenaway ◽  
Jenny Trinitapoli
Keyword(s):  
Mortality Rate ◽  
Infant Mortality ◽  
Age Groups ◽  
Infant Mortality Rate ◽  
Sub Saharan Africa ◽  
Demographic And Health Surveys ◽  
African Countries ◽  
Sub Saharan ◽  
Offspring Mortality ◽  
Cumulative Prevalence

We advance a set of population-level indicators that quantify the prevalence of mothers who have ever experienced an infant, under 5-y-old child, or any-age child die. The maternal cumulative prevalence of infant mortality (mIM), the maternal cumulative prevalence of under 5 mortality (mU5M), and the maternal cumulative prevalence of offspring mortality (mOM) bring theoretical and practical value to a variety of disciplines. Here we introduce maternal cumulative prevalence measures of mortality for multiple age groups of mothers in 20 sub-Saharan African countries with Demographic and Health Surveys data spanning more than two decades. The exercise demonstrates the persistently high prevalence of African mothers who have ever experienced a child die. In some African countries, more than one-half of 45- to 49-y-old mothers have experienced the death of a child under age 5, and nearly two-thirds have experienced the death of any child, irrespective of age. Fewer young mothers have experienced a child die, yet in many countries, up to one-third have. Our results show that the mIM and mU5M can follow distinct trajectories from the infant mortality rate (IMR) and under 5 mortality rate (U5MR), offering an experiential view of mortality decline that annualized measures conceal. These measures can be adapted to quantify the prevalence of recurrent offspring mortality (mROM) and calculated for subgroups to identify within-country inequality in the mortality burden. These indicators can be used to improve current understandings of mortality change, bereavement as a public health threat, and population dynamics.

scholarly journals Community-orientated primary care: a scoping review of different models, and their effectiveness and feasibility in sub-Saharan Africa

2019 ◽  
Vol 4 (Suppl 8) ◽  
pp. e001489 ◽  
Author(s):  
Bob Mash ◽  
Sunanda Ray ◽  
Akye Essuman ◽  
Edu Burgueño
Keyword(s):  
South Africa ◽  
Primary Care ◽  
Scoping Review ◽  
Health Workers ◽  
Historical Analysis ◽  
Sub Saharan Africa ◽  
African Countries ◽  
Scoping Reviews ◽  
Study Characteristics ◽  
Sub Saharan

IntroductionCommunity-orientated primary care (COPC) is an approach to primary healthcare (PHC) that originated in South Africa and contributed to the formulation of the Declaration of Alma-Ata 40 years ago. Despite this, PHC remains poorly developed in sub-Saharan African countries. There has been a resurgence of interest in strengthening PHC systems in the last few years and identifying key knowledge gaps. COPC has been an effective strategy elsewhere, most notably Brazil. This scoping review investigated COPC in the sub-Saharan African context and looked for evidence of different models, effectiveness and feasibility.MethodsDatabases were systematically searched using a comprehensive search strategy to identify studies from the last 10 years. A methodological guideline for conducting scoping reviews was followed. A standardised template was used to extract data and compare study characteristics and findings. Studies were grouped into five categories: historical analysis, models, implementation, educational studies and effectiveness.ResultsA total of 1997 publications were identified and 39 included in the review. Most publications were from the last 5 years (n = 32), research (n = 27), from South Africa (n = 27), focused on implementation (n = 25) and involving case studies (n = 9), programme evaluation (n = 6) or qualitative methods (n = 10). Nine principles of COPC were identified from different models. Factors related to the implementation of COPC were identified in terms of governance, finances, community health workers, primary care facilities, community participation, health information and training. There was very little evidence of effectiveness of COPC.ConclusionsThere is a need for further research to describe models of COPC in Africa, investigate the appropriate skills mix to integrate public health and primary care in these models, evaluate the effectiveness of COPC and whether it is included in training of healthcare workers and government policy.

scholarly journals Socio-economic differences in disability by age in sub-Saharan Africa: A cross-national study using the World Health Survey

2017 ◽  
Vol 44 (3-4) ◽  
pp. 134
Author(s):  
Yentéma Onadja ◽  
Simona Bignami ◽  
Maria-Victoria Zunzunegui
Keyword(s):  
Health Survey ◽  
Age Groups ◽  
Sub Saharan Africa ◽  
Functional Health ◽  
World Health ◽  
National Study ◽  
African Countries ◽  
Afrique Subsaharienne ◽  
World Health Survey ◽  
Sub Saharan

This study aims to examine the relationship between socio-economic status (as measured by education) and multiple disability measures among adults in eighteen sub-Saharan African countries, and to determine whether the strength of this relationship varies across age groups. The analysis uses data drawn from the 2002–04 World Health Survey. The findings indicate that low education is positively associated with poor functional health, and the functional health gap between educational levels remains stable across age. These findings suggest that in sub-Saharan African countries, the undereducated are less successful in postponing disability to later ages.Cette étude examine la relation entre le niveau d’éducation et les incapacités parmi les adultes dans 18 pays d’Afrique subsaharienne, et détermine si cette relation varie selon les groupes d’âge. L’analyse a utilisé les données de l’enquête mondiale de santé 2002–2004. Nos résultats indiquent que le manque d'éducation était positivement associé à des niveaux plus élevés d'incapacités, et le différentiel d’état de santé fonctionnelle entre les différents niveaux d'éducation augmentait entre les groupes d’âges. Ces résultats suggèrent qu’en Afrique subsaharienne, les individus faiblement éduqués ont moins de succès dans le report de l’incapacité dans la vieillesse.

scholarly journals Microbiology and Safety of Ogi Fermentation: A Review

2020 ◽  
pp. 90-100
Author(s):  
Abosede Margaret Adisa ◽  
Victor N. Enujiugha
Keyword(s):  
Age Groups ◽  
Food Poisoning ◽  
Fungal Species ◽  
West African ◽  
Sub Saharan Africa ◽  
Weaning Food ◽  
Breakfast Cereal ◽  
African Countries ◽  
Sub Saharan ◽  
Good Hygiene

Ogi a widely consumed breakfast cereal in Nigeria and other West African countries plays an important role in the nutrition and economy of many of the populace, especially among the under-privileged as its consumption cut across all age groups. It is significant for its application as a cheap and convenient weaning food for children, breakfast and soft meal for adult, convalescents, pregnant and nursing women. This paper is aimed at reviewing the production of ogi from different cereals, which maize (Zea mays), sorghum (Sorghum bicolor) and millet (Penisetum glaucum). The microflora of ogi is mainly dominated by lactic acid bacteria which are generally regarded as safe with Lactobacillus plantarum dominating and certain beneficial fungal species which belong to the genus Saccharomyces and Aspergillus niger. The safety of the potential microorganisms which are responsible for the fermentation of the product from the various substrates is also of vital importance.  The importance of good hygiene practice to reduce post production re- contamination of the product which could possibly lead to food poisoning especially at the grassroot level is also considered. The widespread use of ogi as a weaning food for children in sub-Saharan Africa makes this review very significant and relevant.

scholarly journals Analysis of clinical knowledge, absenteeism and availability of resources for maternal and child health: a cross-sectional quality of care study in 10 African countries

2020 ◽  
Vol 5 (12) ◽  
pp. e003377
Author(s):  
Laura Di Giorgio ◽  
David K Evans ◽  
Magnus Lindelow ◽  
Son Nam Nguyen ◽  
Jakob Svensson ◽  
...  
Keyword(s):  
Health Workers ◽  
Healthcare Providers ◽  
Sub Saharan Africa ◽  
Clinical Knowledge ◽  
Health Providers ◽  
African Countries ◽  
Cross Sectional ◽  
Drug Availability ◽  
Minimum Quality Standards ◽  
Sub Saharan

ObjectiveAssess the quality of healthcare across African countries based on health providers’ clinical knowledge, their clinic attendance and drug availability, with a focus on seven conditions accounting for a large share of child and maternal mortality in sub-Saharan Africa: malaria, tuberculosis, diarrhoea, pneumonia, diabetes, neonatal asphyxia and postpartum haemorrhage.MethodsWith nationally representative, cross-sectional data from ten countries in sub-Saharan Africa, collected using clinical vignettes (to assess provider knowledge), unannounced visits (to assess provider absenteeism) and visual inspections of facilities (to assess availability of drugs and equipment), we assess whether health providers are available and have sufficient knowledge and means to diagnose and treat patients suffering from common conditions amenable to primary healthcare. We draw on data from 8061 primary and secondary care facilities in Kenya, Madagascar, Mozambique, Nigeria, Niger, Senegal, Sierra Leone, Tanzania, Togo and Uganda, and 22 746 health workers including doctors, clinical officers, nurses and community health workers. Facilities were selected using a multistage cluster-sampling design to ensure data were representative of rural and urban areas, private and public facilities, and of different facility types. These data were gathered under the Service Delivery Indicators programme.ResultsAcross all conditions and countries, healthcare providers were able to correctly diagnose 64% (95% CI 62% to 65%) of the clinical vignette cases, and in 45% (95% CI 43% to 46%) of the cases, the treatment plan was aligned with the correct diagnosis. For diarrhoea and pneumonia, two common causes of under-5 deaths, 27% (95% CI 25% to 29%) of the providers correctly diagnosed and prescribed the appropriate treatment for both conditions. On average, 70% of health workers were present in the facilities to provide care during facility hours when those workers are scheduled to be on duty. Taken together, we estimate that the likelihood that a facility has at least one staff present with competency and key inputs required to provide child, neonatal and maternity care that meets minimum quality standards is 14%. On average, poor clinical knowledge is a greater constraint in care readiness than drug availability or health workers’ absenteeism in the 10 countries. However, we document substantial heterogeneity across countries in the extent to which drug availability and absenteeism matter quantitatively.ConclusionOur findings highlight the need to boost the knowledge of healthcare workers to achieve greater care readiness. Training programmes have shown mixed results, so systems may need to adopt a combination of competency-based preservice and in-service training for healthcare providers (with evaluation to ensure the effectiveness of the training), and hiring practices that ensure the most prepared workers enter the systems. We conclude that in settings where clinical knowledge is poor, improving drug availability or reducing health workers’ absenteeism would only modestly increase the average care readiness that meets minimum quality standards.

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