scholarly journals Estimating the Fraction of Severe Malaria among Malaria-Positive Children: Analysis of Household Surveys in 19 Malaria-Endemic Countries in Africa

2021 ◽  
Author(s):  
Cameron Taylor ◽  
Sorrel M. L. Namaste ◽  
Joanna Lowell ◽  
Johanna Useem ◽  
Yazoumé Yé
Keyword(s):  
Severe Malaria ◽  
Population Level ◽  
Population Based ◽  
Sub Saharan Africa ◽  
Severe Illness ◽  
Demographic And Health Surveys ◽  
Country Level ◽  
Alternative Approach ◽  
Sub Saharan ◽  
Level Analysis

To date, the only robust estimates of severe malaria cases include children who present to the formal healthcare system. It is a challenge to use these data because of varying age ranges of reporting, different diagnosis techniques, surveillance methods, and healthcare utilization. This analysis examined data from 37 Demographic and Health Surveys and Malaria Indicator Surveys across 19 countries in sub-Saharan Africa collected between 2011 and 2018. The outcome of interest is a proxy indicator for severe malaria, defined as a proportion of children aged 6–59 months with at least one self-reported symptom of severe illness including loss of consciousness, rapid breathing, seizures, or severe anemia (hemoglobin < 5 g/dL) among those who were positive for malaria. The study includes a weighted descriptive, country-level analysis and a multilevel mixed-effects logistic regression model to assess the determinants of severe malaria. Among children positive for malaria across all surveys, 4.5% (95% CI: 4.1–4.8) had at least one sign or symptom of severe malaria, which was significantly associated with age, residence, wealth, and year of survey fieldwork at a P-value less than 0.05. This analysis presents a novel and an alternative approach of estimating the fraction of severe malaria cases among malaria-positive children younger than 5 years in malaria-endemic countries. Estimating severe malaria cases through population-based surveys allows countries to estimate severe malaria across time and to compare with other countries. Having a population-level estimate of severe malaria cases helps further our understanding of the burden and epidemiology of severe malaria.

scholarly journals Estimating cases of severe malaria: Analysis of household surveys in 19 malaria endemic countries in Africa

2020 ◽  
Author(s):  
Cameron Taylor ◽  
Sorrel ML NAMASTE ◽  
Joanna LOWELL ◽  
Johanna USEEM ◽  
Yazoumé YÉ
Keyword(s):  
Severe Malaria ◽  
Population Level ◽  
Healthcare Facility ◽  
Population Based ◽  
Sub Saharan Africa ◽  
Severe Illness ◽  
P Value ◽  
Demographic And Health Surveys ◽  
Transmission Zone ◽  
The Impact

Abstract Background The burden of severe malaria is uncertain at the population level because existing estimates rely heavily on data from the formal healthcare system. Using data from population-based surveys, this analysis examines severe malaria cases at the population level, which captures malaria positive children whose caregivers 1) have taken the child to a healthcare facility but the child’s illness did not resolve, or 2) have not sought care for the child’s illness. Direct inclusion of these children in severe malaria estimates has been an underlying data gap. Methods This analysis examined data from 37 Demographic and Health Surveys and Malaria Indicator Surveys across 19 countries in sub-Saharan Africa collected between 2011 and 2018. The outcome of interest is a proxy indicator for severe malaria, defined as children age 6-59 months who were positive for malaria with at least one self-reported symptom of severe illness including loss of consciousness, rapid breathing, seizures, or severe anemia (hemoglobin <5 g/dl). The study includes a weighted descriptive, country-level analysis and a multilevel mixed-effects logistic regression model to assess the determinants of severe malaria. Results Among children positive for malaria across all surveys, 4.5% (95% CI 4.1–4.8) had at least one sign or symptom of severe malaria, which was significantly associated with age, residence, wealth, and fieldwork year at a p-value less than 0.05. Malaria positive children in the higher malaria transmission zone were more likely to have signs or symptoms of severe malaria compared to those in the lowest transmission zone; however, these results were not statistically significant. Conclusion Having an accurate estimate of severe malaria cases among malaria positive children is essential to assessing the impact of malaria interventions and to guiding future malaria investments. This analysis presents a novel approach of estimating severe malaria cases among malaria positive children under age five in malaria endemic countries. Estimating severe malaria cases through household-based surveys allows countries to estimate severe malaria across time and to compare with other countries. Having a population level estimate of severe malaria cases helps further our understanding of the burden and epidemiology of severe malaria.

scholarly journals Estimating cases of severe malaria at the population-level: Analysis of household surveys from 19 malaria endemic countries in Africa

2020 ◽  
Author(s):  
Cameron Taylor ◽  
Sorrel ML NAMASTE ◽  
Joanna LOWELL ◽  
Johanna USEEM ◽  
Yazoumé YÉ
Keyword(s):  
Severe Malaria ◽  
Population Level ◽  
Healthcare Facility ◽  
Population Based ◽  
Sub Saharan Africa ◽  
P Value ◽  
Demographic And Health Surveys ◽  
Transmission Zone ◽  
The Impact ◽  
Level Analysis

Abstract Background The burden of severe malaria is uncertain at the population level because existing estimates rely exclusively on data from the formal healthcare system. Using data from population-based surveys this analysis examines severe malaria cases at the population level, which captures children whose caregivers 1) have taken the child to a healthcare facility but the child’s illness did not resolve, or 2) have not sought care for the child’s illness. Direct inclusion of these children in severe malaria estimates has been an underlying data gap. Methods This analysis examined data from 37 Demographic and Health Surveys and Malaria Indicator Surveys across 19 countries in sub-Saharan Africa collected between 2011 and 2018. The outcome of interest is severe malaria, defined as children age 6–59 months who were positive for malaria with at least one self-reported symptom for severe malaria, including loss of consciousness, rapid breathing, seizures, or severe anemia. The study includes a weighted descriptive, country-level analysis and a multilevel mixed-effects logistic regression model to assess the determinants of severe malaria. Results Among children positive for malaria across all surveys, 4.5% (95% CI 4.1–4.8) had at least one symptom of severe malaria, which was significantly associated with age, residence, wealth, and survey timing at a p-value less than 0.05. Children in the higher malaria transmission zone were more likely to have symptoms compared to those in the lowest transmission zone; however, these results were not statistically significant. Conclusion An accurate estimate of the burden of severe malaria is essential to assessing the impact of malaria interventions and to guiding future malaria investments. This analysis presents a novel approach of estimating the burden of severe malaria in children under age five in malaria endemic countries. Estimating severe malaria through household-based surveys allows countries to estimate severe malaria across time and to compare with other countries. Having a population level estimate of severe malaria helps further our understanding of the burden and epidemiology of severe malaria.

Migration as a Risk Factor for HIV Infection among Youths in Sub-Saharan Africa

2013 ◽  
Vol 648 (1) ◽  
pp. 136-158 ◽  
Author(s):  
Monica A. Magadi
Keyword(s):  
Risk Factor ◽  
Hiv Infection ◽  
Urban Areas ◽  
Young Female ◽  
Sub Saharan Africa ◽  
Demographic And Health Surveys ◽  
Country Level ◽  
Female Migrants ◽  
Sub Saharan ◽  
Living With Hiv

Of the estimated 10 million youths living with HIV worldwide, 63 percent live in sub-Saharan Africa. This article focuses on migration as a risk factor of HIV infection among the youths in sub-Saharan Africa. The study is based on multilevel modeling, applied to the youth sample of the Demographic and Health Surveys (DHS), conducted from 2003 to 2008 in nineteen countries. The analysis takes into account country-level and regional-level variations. The results suggest that across countries in sub-Saharan Africa, migrants have on average about 50 percent higher odds of HIV infection than nonmigrants. The higher risk among migrants is to a large extent explained by differences in demographic and socioeconomic factors. In particular, migrants are more likely to be older, to have been married, or to live in urban areas, all of which are associated with higher risks of HIV infection. The higher risk among youths who have been married is particularly pronounced among young female migrants.

scholarly journals Adherence to Iron Supplementation in 22 Sub-Saharan African Countries and Associated Factors among Pregnant Women: A Large Population-Based Study

2019 ◽  
Vol 3 (12) ◽  
Author(s):  
Djibril M Ba ◽  
Paddy Ssentongo ◽  
Kristen H Kjerulff ◽  
Muzi Na ◽  
Guodong Liu ◽  
...  
Keyword(s):  
Pregnant Women ◽  
Iron Supplementation ◽  
Population Based ◽  
Sub Saharan Africa ◽  
Deficiency Anemia ◽  
Demographic And Health Surveys ◽  
Factors Associated ◽  
Sub Saharan ◽  
Ssa Countries ◽  
Antenatal Visits

ABSTRACT Background Iron deficiency anemia during pregnancy is a significant public health problem in sub-Saharan Africa (SSA) and is associated with serious adverse health outcomes. Although it is recommended that all women receive iron supplementation during pregnancy, little research has been conducted to measure overall compliance with this recommendation or variation across SSA countries. Objectives To assess prevalence and sociodemographic-economic factors associated with adherence to iron supplementation among pregnant women in SSA. Methods This was a weighted population-based cross-sectional study of 148,528 pregnant women aged 15–49 y in 22 SSA countries that participated in the Demographic and Health Surveys (DHS) in 2013–2018 and measured iron supplementation during pregnancy. Adherence to iron supplementation was defined as using iron supplementation for ≥90 d during pregnancy of the most recent birth. Results The overall prevalence of adherence to ≥90 d of iron supplementation during pregnancy was 28.7%, ranging from 1.4% in Burundi to 73.0% in Senegal. Factors associated with adherence included receiving ≥4 antenatal care visits [adjusted Prevalence Ratio (aPR): 25.73; 95% CI: 22.36, 29.60] compared with no antenatal visits; secondary or higher education (aPR: 1.17; 95% CI: 1.14, 1.19) compared with no education; wealthy (aPR: 1.13; 95% CI: 1.10, 1.16) compared with poor; and older women aged 35–49 y (aPR: 1.07; 95% CI: 1.05, 1.10) compared with younger women aged 15–24 y. Conclusions Adherence to iron supplementation during pregnancy in SSA is low and varies substantially across countries and in relation to factors such as number of antenatal visits, education, and level of family wealth. These results underscore the need for increased efforts to improve the uptake of iron supplementation for pregnant women in SSA.

Estimating HIV Prevalence and Incidence in Africa from Mortality Data

2010 ◽  
Vol 10 (1) ◽  
Author(s):  
Emily Oster
Keyword(s):  
Population Based ◽  
Hiv Prevalence ◽  
Early Years ◽  
Sub Saharan Africa ◽  
Mortality Data ◽  
Country Level ◽  
Hiv Virus ◽  
Current Prevalence ◽  
Prevalence Estimates ◽  
Sub Saharan

Abstract An estimated 33 million people are infected with the HIV virus, with 67% of them in Sub-Saharan Africa. Despite this, knowledge about HIV prevalence in Africa is limited and imperfect. Although population-based testing in recent years has provided reliable information about current prevalence in the general population, we have little reliable data on prevalence in early years of the epidemic. This paper suggests a new methodology for estimating HIV prevalence and incidence using inference from mortality data. This methodology can be used to generate prevalence estimates from early in the epidemic. This information is valuable for understanding how the epidemic has evolved over time and is also likely to be helpful in analyses that explore how policy affects the epidemic or how HIV affects other country-level outcomes.

scholarly journals How education mitigates the realisation of fertility intentions: Is sub-Saharan Africa different?

2018 ◽  
Author(s):  
Melanie Channon ◽  
SARAH HARPER
Keyword(s):  
Educational Achievement ◽  
Fertility Transition ◽  
Population Level ◽  
Fertility Intentions ◽  
Sub Saharan Africa ◽  
Demographic And Health Surveys ◽  
Individual Level ◽  
Highly Educated ◽  
Sub Saharan ◽  
The Individual

The gap between achieved fertility and fertility ideals is notably higher in sub-Saharan Africa (SSA) than elsewhere, relating to both under- and overachievement of fertility ideals. We consider the extent to which the relationship between fertility ideals and achieved fertility is mitigated by educational achievement. Further, we consider if the effect of education acts differently in SSA, and thereby hypothesise how increasing levels of education in SSA may decrease fertility.We use 227 Demographic and Health Surveys from 57 countries worldwide to look at population- and individual-level measures of achieving fertility ideals. Population level measures are used to assess whether the correspondence between fertility intentions and achievements differ by level of education. We then look at the individual-level determinants of both under- and overachieving fertility intentions. An average of 40% of women in SSA underachieve their stated fertility intentions compared to 26% in non-SSA countries. Furthermore, the educational gradient of underachievement is different in SSA where higher levels of education are not related to better correspondence between fertility intentions and achievements. We argue that the phenomenon of underachieving fertility ideals (or unrealized fertility) may be of particular importance for the ongoing fertility transition throughout SSA, especially for highly educated groups.

scholarly journals Husbands' Dominance in Decision-Making About Women's Health: A Spatial Diffusion Perspective in Sub-Saharan Africa

Demography ◽  
2021 ◽  
Author(s):  
Liliana Andriano ◽  
Julia Behrman ◽  
Christiaan Monden
Keyword(s):  
Decision Making ◽  
Fixed Effects ◽  
Spatial Regression ◽  
Sub Saharan Africa ◽  
Spatial And Temporal Variation ◽  
Demographic And Health Surveys ◽  
Country Level ◽  
Sub Saharan ◽  
And Gender ◽  
Panel Fixed Effects

Abstract This article maps spatial and temporal variation in husbands' dominance in decision-making about their wives' health using pooled Demographic and Health Surveys from 28 countries in sub-Saharan Africa in an earlier (i.e., 2001–2005) and later (i.e., 2010–2014) period. First, we use adaptive bandwidth kernel density estimation to show how aggregate country-level estimates of husbands' decision-making dominance mask enormous spatial heterogeneity within countries. Our maps also reveal a geographic clustering of cells with similar levels of husband's decision-making dominance both within and between countries. Next, we use panel fixed-effects spatial regression methods to show that decreases in husbands' decision-making dominance in neighboring cells are associated with decreases in husbands' decision-making dominance in the reference cell. These findings support a diffusion explanation for declines in husbands' decision-making dominance over time. Our analyses also indicate that schooling and urbanization may be important channels through which diffusion occurs, which we speculate is because these are places where people are exposed to new ideas and gender norms.

scholarly journals Breast Cancer Diagnostics, Therapy, and Outcomes in Sub-Saharan Africa: A Population-Based Registry Study

2021 ◽  
pp. 1-11
Author(s):  
Walburga Yvonne Joko-Fru ◽  
Mirko Griesel ◽  
Nikolaus Christian Simon Mezger ◽  
Lucia Hämmerl ◽  
Tobias Paul Seraphin ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Hormone Receptor ◽  
Relative Survival ◽  
Population Level ◽  
Population Based ◽  
Hormone Receptor Status ◽  
Sub Saharan Africa ◽  
Receptor Status ◽  
Sub Saharan ◽  
The Impact

Background: Breast cancer (BC) is the most common cancer in sub-Saharan Africa (SSA). However, little is known about the actual therapy received by women with BC and their survival outcome at the population level in SSA. This study aims to describe the cancer-directed therapy received by patients with BC at the population level in SSA, compare these results with the NCCN Harmonized Guidelines for SSA (NCCN Harmonized Guidelines), and evaluate the impact on survival. Methods: Random samples of patients with BC (≥40 patients per registry), diagnosed from 2009 through 2015, were drawn from 11 urban population–based cancer registries from 10 countries (Benin, Congo, Cote d’Ivoire, Ethiopia, Kenya, Mali, Mozambique, Namibia, Uganda, and Zimbabwe). Active methods were used to update the therapy and outcome data of diagnosed patients (“traced patients”). Excess hazards of death by therapy use were modeled in a relative survival context. Results: A total of 809 patients were included. Additional information was traced for 517 patients (63.8%), and this proportion varied by registry. One in 5 traced patients met the minimum diagnostic criteria (cancer stage and hormone receptor status known) for use of the NCCN Harmonized Guidelines. The hormone receptor status was unknown for 72.5% of patients. Of the traced patients with stage I–III BC (n=320), 50.9% received inadequate or no cancer-directed therapy. Access to therapy differed by registry area. Initiation of adequate therapy and early-stage diagnosis were the most important determinants of survival. Conclusions: Downstaging BC and improving access to diagnostics and care are necessary steps to increase guideline adherence and improve survival for women in SSA. It will also be important to strengthen health systems and facilities for data management in SSA to facilitate patient follow-up and disease surveillance.

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