Adults In sub-Saharan Africa Research Articles

Knowledge and Practice Related to COVID-19 and Mental Health among Adults in Sub-Saharan Africa.

ABSTRACT.Coronavirus disease 2019 (COVID-19) is a public health emergency affecting the lives of millions of people globally. Different measures and extraordinary steps are being taken to contain the transmission of the virus. The levels of knowledge and implementation of preventive practices related to COVID-19 in sub-Saharan African countries are unclear. Additionally, there is a lack of evidence regarding the impacts of the pandemic on mental health. This study aimed to describe knowledge and practices related to COVID-19 and to assess mental health status among adults in three sub-Saharan African countries: Burkina Faso, Ethiopia, and Nigeria. A total of 1,797 adults were included in the survey, and data were collected using computer-assisted telephone interviews. The proportions of adults who identified more than 80% of COVID-19 symptoms, transmission methods, and prevention mechanisms were 69.9%, 79.2%, and 90.7%, respectively. The practice of preventive measures was relatively lower for avoiding social gatherings and disinfecting contaminated surfaces. Better education, urban residence, and believing the pandemic is real were factors associated with good knowledge on COVID-19 symptoms, transmission methods, and preventive actions. Additionally, being male was associated with good knowledge on symptoms and transmission methods, whereas being in an older age group was associated with knowledge of transmission methods. Mild, moderate, and severe psychological distress was reported by 20.6%, 5.9%, and 1.1% of the participants, respectively. Although this study found high levels of knowledge regarding COVID-19, interventions are needed to increase the uptake of recommended preventive practices among adults in sub-Saharan Africa.

Community-based care models for arterial hypertension management in non-pregnant adults in sub-Saharan Africa: A scoping review protocol

Introduction: Arterial hypertension (aHT) is the most important cardiovascular risk factor (CVRF) in adults living in sub-Saharan Africa (SSA), leading to an excess of cardiovascular disease (CVD) morbidity and mortality. Life-long aHT service delivery models in the region remain mostly anchored to health facilities and are provided by physicians or nurses, thus limiting access to care. Over the past years, decentralized community-based aHT care models have been piloted, aiming to improve access to prevention, diagnosis, and treatment. Although individual studies suggest that community-based care is well-received and potentially efficacious, a synthesized overview of such care models is missing. Hence, the aim of this scoping review is to map out and summarize existing interventions for community-based aHT diagnosis and care in non-pregnant adults in SSA. Additionally, we will describe outcomes in terms of acceptability, blood pressure control, patient engagement in care, and occurrence of aHT caused end-organ damage. Methods and analysis: We will apply the Arksey and O’Malley scoping review methodology and best practice, as outlined by Levac and the Joanna Briggs Institute scoping review guidelines. The research questions have been identified through a literature review and expert consultation. A systematic literature search will be conducted in four databases using a tailored search strategy, including a supplemental search through backward and forward citation. Abstracts and full text screening as well as the extraction of data will be conducted by two independent reviewers. Discrepancies will be resolved by a third reviewer. Information will be presented in both tabular and narrative form. Ethics and dissemination: This scoping review will summarize findings from existing publications, rather than primary data, and as such, does not require ethics review. Findings will be disseminated through stakeholder meetings, conference presentations, websites, and a peer-reviewed publication.

Intergenerational ethics in Africa: Duties to older adults in skipped generation households.

This paper examines individual and societal duties to older adults in sub-Saharan Africa who reside in skipped generation households, which are households in which a young and old generation live together with the middle generation absent. As they age, older adults in skipped generation households may lack the prospect of social and economic support from offspring, making their situation precarious. If ill health results in an older adult's inability to work, who will support them? If they need assistance with basic activities of daily living, who will provide it? This paper addresses these questions through the lens of African ethics. Section I appeals to the African ethic of ubuntu ('humanness') to identify normative conceptions of persons and moral character relevant to skipped generation ethics. Section II elaborates this focus by means of the virtues of gratitude and reciprocity, discussing their conditions, requirements, and limits and comparing surrogate parent-child to parent-child cases. Section III explores the application of an ubuntu ethic to society as a whole and defines societal duties toward older adults by appealing to African conceptions of dignity and justice.

Oxygen delivery systems for adults in Sub-Saharan Africa: A scoping review.

BackgroundRespiratory diseases are the leading cause of death and disability worldwide. Oxygen is an essential medicine used to treat hypoxemia from respiratory diseases. However, the availability and utilization of oxygen delivery systems for adults in sub-Saharan Africa is not well-described. We aim to identify and describe existing data around oxygen availability and provision for adults in sub-Saharan Africa, determine knowledge or research gaps, and make recommendations for future research and capacity building.MethodsWe systematically searched four databases for articles on April 22, 2020, for variations of keywords related to oxygen with a focus on countries in sub-Saharan Africa. Inclusion criteria were studies that included adults and addressed hypoxemia assessment or outcome, oxygen delivery mechanisms, oxygen availability, oxygen provision infrastructure, and oxygen therapy and outcomes.Results35 studies representing 22 countries met inclusion criteria. Availability of oxygen delivery systems ranged from 42%-94% between facilities, with wide variability in the consistency of availability. There was also wide reported prevalence of hypoxemia, with most studies focusing on specific populations. In facilities where oxygen is available, health care workers are ill-equipped to identify adult patients with hypoxemia, provide oxygen to those who need it, and titrate or discontinue oxygen appropriately. Oxygen concentrators were shown to be the most cost-effective delivery system in areas where power is readily available.ConclusionsThere is a substantial need for building capacity for oxygen delivery throughout sub-Saharan Africa. Addressing this critical issue will require innovation and a multi-faceted approach of developing infrastructure, better equipping facilities, and health care worker training.

\u2018Too old to test?\u2019: A life course approach to HIV-related risk and self-testing among midlife-older adults in Malawi

BackgroundDespite the aging HIV epidemic, increasing age can be associated with hesitancy to test. Addressing this gap is a critical policy concern and highlights the urgent need to identify the underlying factors, to improve knowledge of HIV-related risks as well as uptake of HIV testing and prevention services, in midlife-older adults.MethodsWe conducted five focus group discussions and 12 in-depth interviews between April 2013 and November 2016 among rural and urban Malawian midlife-older (≥30 years) men and women. Using a life-course theoretical framework we explored how age is enacted socially and its implications on HIV testing and sexual risk behaviours. We also explore the potential for HIV self-testing (HIVST) to be part of a broader strategy for engaging midlife-older adults in HIV testing, prevention and care. Thematic analysis was used to identify recurrent themes and variations.ResultsMidlife-older adults (30–74 years of age) associated their age with respectability and identified HIV as “a disease of youth” that would not affect them, with age protecting them against infidelity and sexual risk-taking. HIV testing was felt to be stigmatizing, challenging age norms, threatening social status, and implying “lack of wisdom”. These norms drove self-testing preferences at home or other locations deemed age and gender appropriate. Awareness of the potential for long-standing undiagnosed HIV to be carried forward from past relationships was minimal, as was understanding of treatment-as-prevention. These norms led to HIV testing being perceived as a threat to status by older adults, contributing to low levels of recent HIV testing compared to younger adults.ConclusionsCharacteristics associated with age-gender norms and social position encourage self-testing but drive poor HIV-risk perception and unacceptability of conventional HIV testing in midlife-older adults. There is an urgent need to provide targeted messages and services more appropriate to midlife-older adults in sub-Saharan Africa. HIVST which has often been highlighted as a tool for reaching young people, may be a valuable tool for engaging midlife-older age groups who may not otherwise test.

Immune response to the hepatitis B vaccine among HIV-infected adults in Uganda

BackgroundCo-infection with hepatitis B virus (HBV) and human immunodeficiency virus (HIV) is common in sub-Saharan Africa (SSA) and can rapidly progress to cirrhosis and hepatocellular carcinoma. Recent data demonstrate ongoing HBV transmission among HIV-infected adults in SSA, suggesting that complications of HIV/HBV co-infection could be prevented with HBV vaccination. Because HBV vaccine efficacy is poorly understood among HIV-infected persons in SSA, we sought to characterize the humoral response to the HBV vaccine in HIV-seropositive Ugandan adults. MethodsWe enrolled HIV-infected adults in Kampala, Uganda without serologic evidence of prior HBV infection. Three HBV vaccine doses were administered at 0, 1 and 6 months. Anti-HBs levels were measured 4 weeks after the third vaccine dose. “Response” to vaccination was defined as anti-HBs levels ≥ 10 IU/L and “high response” as ≥ 100 IU/L. Regression analysis was used to determine predictors of response. ResultsOf 251 HIV-positive adults screened, 132 (53%) had no prior HBV infection or immunity and were enrolled. Most participants were women [89 (67%)]; median (IQR) age was 32 years (27–41), and 68 (52%) had received antiretroviral therapy (ART) for > 3 months. Median (IQR) CD4 count was 426 (261–583), and 64 (94%) of the 68 receiving ART had undetectable plasma HIV RNA. Overall, 117 (92%) participants seroconverted to the vaccine (anti-HBs ≥ 10 IU/L), with 109 (86%) participants having high-level response (anti-HBs ≥ 100 IU/L). In multivariate analysis, only baseline CD4 > 200 cells/mm3 was associated with response [OR = 6.97 (1.34–34.71), p = 0.02] and high-level response [OR = 4.25 (1.15–15.69)], p = 0.03]. ConclusionHBV vaccination was effective in eliciting a protective humoral response, particularly among those with higher CD4 counts. Half of the screened patients did not have immunity to HBV infection, suggesting a large at-risk population for HBV infection among HIV-positive adults in Uganda. Our findings support including HBV vaccination as part of routine care among HIV-positive adults.

Development of a brief screening method for identification of depression in older adults in Sub-Saharan Africa

Objectives To develop a brief, culturally appropriate screening tool for identifying late life depression (LLD), for use by non-specialist clinicians in primary and out-patient care settings in sub-Saharan Africa (SSA). Background Depressive disorders are a leading contributor to the global health burden. LLD is common and cases will increase as populations’ age, particularly in low- and middle-income countries (LMICs), such as those in SSA. A chronic mental health workforce shortage and the absence of culturally adapted LLD screening tools to aid non-specialist clinicians have contributed to a significant diagnostic gap. Design A systematic random sample of older people attending general medical clinics were interviewed using a 30-item LLD questionnaire, developed utilizing a Delphi consensus analysis of items from the Geriatric Depression Scale, Patient Health Questionnaire-2 and questions developed from a study of lay conceptualisations of depression in Tanzania. The items were assessed for validity against blinded DSM 5 diagnosis of depression by a research doctor. Factor and item analysis were then used to refine the questionnaire. Results The 12-item Maddison Old-age Scale for Identifying Depression (MOSHI-D) was developed. It has good internal consistency (Cronbach’s α = 0.820) and construct and criterion validity (AUROC = 0.880). Conclusions On initial evaluation, the MOSHI-D showed good internal validity. It should be easy for non-specialists to administer. External validation and further refinement will be conducted. A culturally-appropriate LLD screen may improve mental health care integration into existing healthcare settings within SSA and facilitate greater patient access to care, in accordance with current WHO strategy.

Population normative data for three cognitive screening tools for older adults in sub-Saharan Africa.

ABSTRACTIn sub-Saharan Africa (SSA),cognitive screening is complicated by both cultural and educational factors, and the existing normative values may not be applicable. The Identification of Dementia in Elderly Africans (IDEA) cognitive screen is a low-literacy measure with good diagnostic accuracy for dementia.Objective: The aim of this study is to report normative values for IDEA and other simple measures [i.e., categorical verbal fluency, the Consortium to Establish a Registry for Alzheimer’s Disease (CERAD) 10-word list] in representative community-dwelling older adults in SSA.Methods: Individuals aged ≥60 years resident in 12 representative villages in Kilimanjaro, Tanzania and individuals aged ≥65 years resident within three communities in Akinyele Local Government Area, Oyo State, Nigeria underwent cognitive screening. The normative data were generated by the categories of age, sex, and education.Results: A total of 3,011 people in Tanzania (i.e., 57.3% females and 26.4% uneducated) and 1,117 in Nigeria (i.e., 60.3% females and 64.5% uneducated) were screened. Individuals with higher age, lower education, and female gender obtained lower scores. The 50th decile values for IDEA were 13 (60–64 years) vs. 8/9 (above 85 years), 10–11 uneducated vs. 13 primary educated, and 11/12 in females vs. 13 in males. The normative values for 10-word list delayed recall and categorical verbal fluency varied with education [i.e., delayed recall mean 2.8 [standard deviation (SD) 1.7] uneducated vs. 4.2 (SD 1.2) secondary educated; verbal fluency mean 9.2 (SD 4.8) uneducated vs. 12.2 (SD 4.3) secondary educated], substantially lower than published high-income country values.Conclusions: The cut-off values for commonly used cognitive screening items should be adjusted to suit local normative values, particularly where there are lower levels of education.

Frequency and Associated Factors with QT Interval Prolongation in Adults with Chronic Heart Failure in Yaoundandeacute

Background: Heart failure is a chronic cardiovascular disease that has an increasing incidence and a poor prognosis in adults in Sub-Saharan Africa due to the rhythm disorders frequently associated to it. Although QT interval prolongation increases cardiovascular mortality in chronic heart failure, there is poor knowledge and it remains undiagnosed... in Sub-Saharan Africa. We therefore deemed it appropriate to determine the frequency and identify the factors associated with QT interval prolongation in adult patients with chronic heart failure in Yaounde. Our main objective was to study the frequency and factors associated with QT interval prolongation in adult patients with chronic heart failure in Yaounde-Cameroon. Objective: The objective of our study was to study the frequency and factors associated with QT interval prolongation in adults with chronic heart failure in Yaounde. Methods: We conducted a descriptive cross-sectional study from January to May 2020 (05 months) at the Central Hospital and General Hospital of Yaounde. Adults with chronic heart failure presenting in these two hospitals without signs of decompensation were recruited on an outpatient basis. A 12-lead electrocardiogram was performed to all these patients to determine the type of heart rhythm, measure the QT interval, look for rhythm disturbances and hypertrophy indices (ventricular and atrial). For heart rates between 60 and 100 beats per minute, Bazett's formula was used for the calculation of the corrected QT; for heart rates outside this range, Framingham's formula was used. Patients' left ventricular systolic and diastolic functions were assessed by transthoracic echocardiography (TTE). Blood measurements of creatinine, urea, potassium, sodium and total calcium were performed. The significance level was set at 5%. Results: Out Of 104 patients, 19 (18.27%) had a prolonged QT interval and 01 (0.09%) had an abnormally high QTc interval (>500 ms). Secondary repolarization disorders (p=0.035), hypocalcaemia (p=0.015), hypokalemia (p=0.0016), left ventricular hypertrophy (p=0.005), and plasma creatinine level>13mg/l (p=0.010) were associated with QT interval prolongation. QT prolongation was not significantly associated with advanced age or sex. No association was found between QT prolongation and heart failure drugs. Conclusion: QT interval prolongation was present in 1/5 of our patients. The associated factors found were: hypokalemia, hypocalcaemia, a plasma creatinine concentration higher than 13mg/l, left ventricular hypertrophy and secondary repolarization disorders.

The Impact of Community Health Workers on HIV Therapy Outcome in Sub-Saharan Africa

In sub-Saharan Africa, the burden on HIV care givers is high. This resulted in renewed interest in community health worker (CHW) programs. We conducted a review of the literature to summarize CHWs' effects on HIV therapy outcome. We also investigated which CHW tasks might favorably impact treatment outcome.<br/> We conducted a comprehensive literature search in PubMed, Web of Science and Embase for papers published up to October 2018. The studies included were conducted on HIV-positive adults in sub-Saharan Africa and reported biological HIV outcomes. We systematically collected data on HIV therapy outcome and CHW tasks. We used Bayesian network modelling for the analysis of CHW tasks.<br/> We included 19 studies in total: 4 randomized controlled trials, 8 comparative cohort studies and 7 single arm interventions. In all studies, CHW interventions were beneficial or not inferior to standard of care (SOC). The more common tasks of CHWs involved an important human support component, with home visits being the most common task. Upon analysis we found indications that ART delivery, individual adherence support and frequent home visits were predictive of a successful CHW intervention, defined as improved therapy outcome compared to SOC or reaching 90% of treated patients being virally suppressed.<br/> We found that CHW interventions are not inferior to SOC and might even be beneficial. We hypothesize that ART delivery, individual adherence support and frequent home visits are predictive of a successful CHW intervention. Further research is needed to be able to judge whether any single task or a particular combination of tasks is significantly correlated with a successful CHW intervention, or whether such tasks are context specific.

HIV‐associated neurocognitive disorders (HAND) in a cART‐treated cohort of adults aged 50 and over in Kilimanjaro, Tanzania: The first longitudinal follow‐up study of HAND in an older population in sub‐Saharan Africa

AbstractBackgroundHIV‐associated neurocognitive disorders (HAND) are highly prevalent in Sub‐Saharan Africa (SSA), due to increasing life expectancy and availability of combination antiretroviral therapy (cART). These preliminary data represent the first longitudinal study of HAND in older cART‐treated adults in SSA with the aim of reporting prevalence and persistence of cognitive impairment, and neurocognitive profile.MethodWe investigated prevalence and incidence of HAND diagnosis and subtypes (asymptomatic neurocognitive impairment (ANI), minor neurocognitive disorder (MND) and HIV‐associated dementia (HAD), alongside neuropsychological profile and neurological symptom burden over 40 months in 253 HIV positive adults aged ≥50 attending a government clinic (2016‐2019). HAND diagnoses were reviewed annually by a consensus panel using Frascati criteria, based on detailed clinical assessment.ResultAt baseline (2016), 253 individuals underwent full assessment, of these, 185 were re‐evaluated in 2017, 181 in 2018 and 128 in 2019. 139 individuals had complete data 2016 ‐2018. The majority (68%) were female, median age at diagnosis was 51, and time since diagnosis 7.6 years. Almost all were receiving cART and were well‐managed (mn CD4 532.76. HAND prevalence was 47% in 2016 (n=253, 95.5% cART‐treated) and 49% in 2017 (one‐year incidence from those at risk 37%). Provisional follow‐up data indicates HAND prevalence of 62% in 2018 (n=172) and 54% in 2019 (n=128). Milder forms of HAND predominated, with evidence of reversibility. The predominant cognitive domains affected were both cortical and subcortical (executive function, motor speed, working memory, verbal memory (word list learning) and orientation) with visuoconstruction and language comprehension relatively spared. Both depression and neurological impairments were highly prevalent.ConclusionThis is the first longitudinal study of neurocognitive impairment in older adults living with HIV in SSA. Findings suggest cART and regular follow‐up are insufficient to prevent occurrence or progression of HAND, though the aetiology remains unclear. Both cortical and subcortical cognitive domains are affected suggesting the possibility of non‐HIV‐related neurodegenerative cognitive decline. If replicated in other SSA settings, HAND is likely to be a major cause of cognitive impairment in older people in SSA, despite cART treatment.

Predictors of three-month mortality among hospitalized older adults in Togo

BackgroundAssessing hospital mortality and its predictors is important as some of these can be prevented through appropriate interventions. Few studies have reported hospital mortality data among older adults in sub-Saharan Africa. The objective of this study was to assess the mortality and associated factors among hospitalized older adults in Togo.MethodsWe conducted a prospective cohort study from February 2018 to September 2019 among patients ≥50 years admitted in medical and surgical services of six hospitals in Togo. Data were recorded during hospitalization and through telephone follow-up survey within 90 days after admission. The main outcome was all-cause mortality at 3 months. Survival curves were estimated using the Kaplan-Meier method and Cox regression analyses were performed to assess predictors of mortality.ResultsThe median age of the 650 older adults included in the study period was 61 years, IQR: [55–70] and at least one comorbidity was identified in 59.7% of them. The all-cause mortality rate of 17.2% (95%CI: 14.4–20.4) and the majority of death (93.7%) occurred in hospital. Overall survival rate was 85.5 and 82.8% after 30 and 90 days of follow-up, respectively. Factors associated with 3-month mortality were the hospital level in the health pyramid, hospitalization service, length of stay, functional impairment, depression and malignant diseases.ConclusionTogolese health system needs to adjust its response to an aging population in order to provide the most effective care.

HIV retesting and risk behaviors among high-risk, HIV-uninfected adults in Uganda

ABSTRACT There are limited data characterizing HIV retesting among high-risk adults in sub-Saharan Africa. From October-December 2018, we distributed recruitment cards offering health evaluations with HIV testing at venues frequented by individuals at-risk of HIV infection in Southwest Uganda. Those who attended were asked about their HIV testing history and risk factors: having >1 sexual partner, an HIV+ partner, STIs, and/or transactional sex. We defined “highest risk” as ≥3 risk factors and “frequent testing” as ≥3 tests within the past year. Of 1,777 cards distributed, 1,482 (83%) adults came to clinic: median age was 26(IQR: 22-31), 598 (40%) were men, and 334 (23%) were HIV+. Of 1,148 HIV-negative adults, 338 (29%) were highest risk and 205 (18%) were frequent testers. Frequent testing was similar in women (19%) and men (16%, p = 0.22). Among women, those at highest risk were more likely to report any testing (90% vs. 81%, p = 0.01) and frequent testing (25% vs. 18%, p = 0.06) than those at lower risk. Among men, any testing and frequent testing were similar between risk levels. Among adults recruited from high-risk venues in peri-urban Uganda, HIV risk behaviors were commonly reported, yet frequent retesting remained low. Interventions to promote retesting are needed, particularly among men.

Mapping physical access to health care for older adults in sub-Saharan Africa and implications for the COVID-19 response: a cross-sectional analysis

BackgroundSevere acute respiratory syndrome coronavirus 2, the virus causing COVID-19, is rapidly spreading across sub-Saharan Africa. Hospital-based care for COVID-19 is often needed, particularly among older adults. However, a key barrier to accessing hospital care in sub-Saharan Africa is travel time to the nearest health-care facility. To inform the geographical targeting of additional health-care resources, we aimed to estimate travel time at a 1 km × 1 km resolution to the nearest hospital and to the nearest health-care facility of any type for adults aged 60 years and older in sub-Saharan Africa.MethodsWe assembled a dataset on the geolocation of health-care facilities, separately for hospitals and any type of health-care facility and including both private-sector and public-sector facilities, using data from the OpenStreetMap project and the Kenya Medical Research Institute–Wellcome Trust Programme. Population data at a 1 km × 1 km resolution were obtained from WorldPop. We estimated travel time to the nearest health-care facility for each 1 km × 1 km grid using a cost–distance algorithm.Findings9·6% (95% CI 5·2–16·9) of adults aged 60 years or older across sub-Saharan Africa had an estimated travel time to the nearest hospital of 6 h or longer, varying from 0·0% (0·0–3·7) in Burundi and The Gambia to 40·9% (31·8–50·7) in Sudan. For the nearest health-care facility of any type (whether primary, secondary, or tertiary care), 15·9% (95% CI 10·1–24·4) of adults aged 60 years or older across sub-Saharan Africa had an estimated travel time of 2 h or longer, ranging from 0·4% (0·0–4·4) in Burundi to 59·4% (50·1–69·0) in Sudan. Most countries in sub-Saharan Africa contained populated areas in which adults aged 60 years and older had a travel time to the nearest hospital of 12 h or longer and to the nearest health-care facility of any type of 6 h or longer. The median travel time to the nearest hospital for the fifth of adults aged 60 years or older with the longest travel times was 348 min (IQR 240–576; equal to 5·8 h) for the entire population of sub-Saharan Africa, ranging from 41 min (34–54) in Burundi to 1655 min (1065–2440; equal to 27·6 h) in Gabon.InterpretationOur high-resolution maps of estimated travel times to both hospitals and health-care facilities of any type can be used by policy makers and non-governmental organisations to help target additional health-care resources, such as makeshift hospitals or transport programmes to existing health-care facilities, to older adults with the least physical access to care. In addition, this analysis shows the locations of population groups most likely to under-report COVID-19 symptoms because of low physical access to health-care facilities. Beyond the COVID-19 response, this study can inform the efforts of countries to improve physical access to care for conditions that are common among older adults in the region, such as chronic non-communicable diseases.FundingBill & Melinda Gates Foundation.

Integrating Online Autodidacticism in Lifelong Learning for Adults in Sub-Saharan Africa

Education is a lifelong journey that should be continuous even in adulthood. Lifelong learning has the potential to spur innovation, creativity, and problem-solving in society for an improved life. To achieve this, there is a need to integrate the concept of self-directed learning into lifelong learning and adult education curriculum at all levels. Many researchers have proved the important place of autodidacticism in the realization of the objectives of adult education and lifelong learning. This concept has been variously spoken and practiced in most parts of the developed world, but unfortunately seldom talked about and applied in the adult education system of Sub-Saharan Africa. Adult education in this region is still heavily lean to conventional education and pedagogy systems. The main objective of this paper is to present a holistic view of autodidacticism and its relevance in lifelong learning and adult education in this global and knowledge economy. The exploratory study examined the influence of online autodidacticism on lifelong learning among adults in Sub-Saharan Africa. Interviews were conducted using WhatsApp to elicit answers from adult respondents. The paper provides insight into the possibility of applying online autodidacticism delivery for originating a new instructional paradigm that makes a shift possible from the traditional practice of teaching in adult education in Sub-Saharan Africa and success stories of interviewees who acquired new skills through autodidacticism.

Treatment Outcomes in Adult Tuberculous Meningitis: A Systematic Review and Meta-analysis.

BackgroundThere is substantial variation in the reported treatment outcomes for adult tuberculous meningitis (TBM). Data on survival and neurological disability by continent and HIV serostatus are scarce.MethodsWe performed a systematic review and meta-analysis to characterize treatment outcomes for adult TBM. Following a systematic literature search (MEDLINE and EMBASE), studies underwent duplicate screening by independent reviewers in 2 stages to assess eligibility for inclusion. Two independent reviewers extracted data from included studies. We employed a random effects model for all meta-analyses. We evaluated heterogeneity by the I2 statistic.ResultsWe assessed 2197 records for eligibility; 39 primary research articles met our inclusion criteria, reporting on treatment outcomes for 5752 adults with TBM. The commonest reported outcome measure was 6-month mortality. Pooled 6-month mortality was 24% and showed significant heterogeneity (I2 > 95%; P < .01). Mortality ranged from 2% to 67% in Asian studies and from 23% to 80% in Sub-Saharan African studies. Mortality was significantly worse in HIV-positive adults at 57% (95% CI, 48%–67%), compared with 16% (95% CI, 10%–24%) in HIV-negative adults (P < .01). Physical disability was reported in 32% (95% CI, 22%–43%) of adult TBM survivors. There was considerable heterogeneity between studies in all meta-analyses, with I2 statistics consistently >50%.ConclusionsMortality in adult TBM is high and varies considerably by continent and HIV status. The highest mortality is among HIV-positive adults in Sub-Saharan Africa. Standardized reporting of treatment outcomes will be essential to improve future data quality and increase potential for data sharing, meta-analyses, and facilitating multicenter tuberculosis research to improve outcomes.

Genomic characterization of Salmonella Uzaramo for human invasive infection.

Salmonella is composed of a wide variety of serovars, causing human self-limited gastrointestinal illnesses or invasive infections. Invasive non-typhoidal Salmonella (iNTS) is well documented, with high mortality for children and immunocompromised adults in sub-Saharan Africa and has recently been reported in Southeast Asia. However, iNTS in China remains unknown. In May 2019, a case of invasive infection caused by Salmonella enterica serovar Uzaramo (S. Uzaramo) was reported for the first time in China. Phylogenomic analysis was performed by genomic sequencing the available contextualized isolates, which separated the two Chinese strains into different sublineages. Both phenotypic and genomic characterization demonstrated that the S. Uzaramo isolates showed in general low antimicrobial resistance potential, except one isolated from lake-water in China. Additional comparative genomic analysis and Caenorhabditis elegans killing assays suggested a unique combination of virulence factors, including typhoid toxin and tcf fimbrial adhesin, which might play a role in the invasive infection. This study highlights that the transparency of global surveillance genomic data could accelerate understanding of virulence and antimicrobial resistance makeup of a previously unknown threat.

Human Immunodeficiency Virus-Associated Myocardial Diastolic Dysfunction and Soluble ST2 Concentration in Tanzanian Adults: A Cross-Sectional Study.

The aims of this study were (1) to compare the prevalence of myocardial diastolic dysfunction (DD) in antiretroviral therapy (ART)-naive people living with human immunodeficiency virus (PLWH) to human immunodeficiency virus (HIV)-uninfected adults in East Africa and (2) to determine the association between serum concentration of the cardiac biomarkers ST2 and DD. In this cross-sectional study, we enrolled PLWH and uninfected adults at a referral HIV clinic in Mwanza, Tanzania. Standardized history, echocardiography, and serum were obtained. Regression models were used to quantify associations. We enrolled 388 ART-naive PLWH and 461 HIV-uninfected adults with an average age of 36.0 ± 10.2 years. Of PLWH in the third, fourth, and fifth decades of life, 5.0%, 12.5%, and 32.7%, respectively, had DD. PLWH had a higher prevalence of DD (adjusted odds ratio, 2.71 [95% confidence interval, 1.62-4.55]; P < .0001). PLWH also had a higher probability of dysfunction with one or fewer traditional risk factors present. Serum ST2 concentration was associated with dysfunction in PLWH but not uninfected participants (P = .04 and P = .90, respectively). In a large population of young adults in sub-Saharan Africa, DD prevalence increased starting in the third decade of life. HIV was independently associated with dysfunction. Serum ST2 concentration was associated with DD in PLWH but not HIV-uninfected participants. This pathway may provide insight into the mechanisms of HIV-associated dysfunction.

4086 HIV-Associated Myocardial Diastolic Dysfunction and Soluble ST2 Concentration in Tanzanian Adults: A Cross-Sectional Study

OBJECTIVES/GOALS: To determine the prevalence of myocardial diastolic dysfunction (DD) and association of serum concentration of the cardiac biomarker serum soluble ST2 in HIV-infected as compared to uninfected Tanzanian adults at the time of HIV diagnosis. METHODS/STUDY POPULATION: In this cross-sectional study we consecutively enrolled HIV-infected participants and uninfected controls at a large, referral HIV clinic in Mwanza, Tanzania. Standardized history, physical examination, echocardiography and serum samples were obtained. The primary outcome was prevalence of myocardial diastolic dysfunction in HIV-infected as compared to uninfected adults. The secondary outcome was the association of baseline serum sST2 concentration with diastolic dysfunction prevalence. Regression models were used to quantify the associations. RESULTS/ANTICIPATED RESULTS: We enrolled 388 HIV-infected, ART naïve and 461 HIV-uninfected controls. Participants with HIV had a higher prevalence of DD (OR = 2.44, p = 0.001, controlled for age, sex, hypertension and BMI) and more severe dysfunction (66.7% vs 42.5%, p = 0.056) at an earlier age. Baseline serum sST2 concentration was significantly associated with DD in HIV-infected but not uninfected participants (p = 0.04 and 0.90, respectively). More HIV-infected adults with concurrent DD exceeded the threshold of 35ng/mL as compared to controls (15.7% vs 5.3%, p&lt;0.0001). Additionally, a significant population level shift to higher sST2 concentration was observed in HIV-infected adults with dysfunction as compared to both HIV-infected without and HIV-uninfected adults with dysfunction (Kolmogrov-Smirnov test: p = 0.02 and 0.04). DISCUSSION/SIGNIFICANCE OF IMPACT: In a large population of HIV-infected adults in sub-Saharan Africa, HIV infection is associated with myocardial diastolic dysfunction. This dysfunction is associated with higher sST2 concentrations. Therefore, we conclude that the sST2 pathway may provide insight into the pathophysiologic mechanisms of dysfunction in HIV-infected adults.

Mapping evidence on the prevalence, incidence, risk factors and cost associated with chronic low back pain among adults in Sub-Saharan Africa: a systematic scoping review protocol

BackgroundGlobally, low back pain (LBP) is a major public health problem affecting mainly adults of the working class and is the leading cause of disability. The estimated lifetime prevalence of LBP is 50 to 80%. From 1990 to 2015, the years lived with disability caused by LBP have scaled up by 54% with the greatest increase observed in low-middle-income countries (LMICs). LBP poses a significant socio-economic burden to the society regardless of all the technological advancement in diagnosis and intervention approaches in recent years. Despite an increase in the literature of LBP in LMICs, chronic low back pain (CLBP) is poorly investigated yet it is responsible for the largest amount of burden. The purpose of this scoping review is to map the existing evidence on the prevalence, incidence, mortality, risk factors, and cost associated with CLBP among adults in Sub-Saharan Africa (SSA).MethodsWe will conduct a scoping review to explore, describe, and map literature on the prevalence, incidence, mortality, risk factors, and costs associated with CLBP among adults in SSA. The search will be performed using the EBSCOhost platform by searching the following databases within the platform: Academic search complete, health source: nursing/academic edition, CINAHL with full text, Embase, PubMed, MEDLINE, Science Direct databases, Google Scholar, and the World Health Organization library databases. The search will include peer-reviewed, review articles, and gray literature. The first (title and abstract) and the second (full text) screening phases will be performed by two independent reviewers, with the third reviewer employed to adjudicate discrepancies. The reference list of all included articles will also be searched for eligible articles. This scoping review will be reported in accordance to the MOOSE and PRISMA-ScR guidelines. The NVivo 12 data analysis software will be used to generate themes, and a thematic content analysis will be used to give the narrative account of the review.DiscussionThe study anticipates finding relevant literature on the prevalence, incidence, risk factors, mortality, and cost associated with CLBP among adults in SSA. The study outcomes will aid in identifying research gaps, planning, informing policy, commissioning of future research, and funding prioritization.