Birth In Africa Research Articles

Burden of infant mortality associated with flood in 37 African countries

Floods are becoming more frequent and severe in the context of climate change, with major impacts on human health. However, their effect on infant mortality remains unknown, particularly in low- and middle-income countries. We conducted a sibling-matched case-control study using individual-level data from Demographic and Health Surveys in Africa during 1990–2020. Individual flood experience was determined by matching the residential coordinates with flood events from the Dartmouth Flood Observatory database. Using data from 514,760 newborns, we found increased risks of infant mortality associated with flood exposure across multiple periods, with the risks remaining elevated for up to four years after the flood event. Overall, flood exposure was associated with 3.42 infant deaths per 1000 births in Africa from 2000 to 2020, approximately 1.7 times the burden associated with life-period exposure. This multi-country study in Africa provides novel evidence that flood events may increase infant mortality risk and burden, even over years after exposure.

Is Oral Iron and Folate Supplementation during Pregnancy Protective against Low Birth Weight and Preterm Birth in Africa? A Systematic Review and Meta-Analysis.

Despite recent evidence demonstrating iron and folate supplementation reduces the risk of low birth weight and preterm births, synthesis of the evidence is not sufficient to understand their impacts in Africa. MEDLINE, PsycINFO, Embase, Scopus, CHINAL, Web of Science, Cochrane databases, and Google Scholar were searched for the published and grey literature. Either iron-only, folate-only, or iron-folic acid (IFA) oral supplementation during pregnancy was the primary exposure/intervention. The focus of this review was low birth weight and preterm births in the African region. Qualitative synthesis, meta-analysis, and subgroup analysis were employed. In the qualitative synthesis (n = 4), IFA supplementation showed a positive impact on reducing preterm birth. Additionally, the meta-analysis showed that IFA and iron-only supplementation reduced the odds of low birth weight by 63% (OR 0.37; 95% CI: 0.29, 0.48) and 68% (OR 0.32; 95% CI: 0.21 to 0.50), respectively. Both iron-only and IFA supplementation are effective in reducing the risk of low birth weight in Africa. There is also promising evidence suggesting a potential reduction in preterm births. Consequently, further research is needed, particularly targeting high-risk groups such as women residing in rural areas with limited support and low levels of literacy.

The effect of maternal age on still birth in Africa: A systematic review and meta-analysis.

Stillbirth is a public health as well as a development problem in low and middle-income countries. The studies that found out maternal age as a factor for the risk of stillbirth reported different findings. This systematic review and meta-analysis is believed to fill the inconclusiveness of these findings. Hence, the aim of this systematic review and meta-analysis is to estimate the pooled effect of advanced maternal age on stillbirth in Africa. PubMed & HINARY databases and Google Scholar search engine were searched to access the primary studies. The extracted data using Microsoft excel was exported to Stata 15 software for analysis. The presence of heterogeneity was checked using Cochran's Q statistic and the I 2 test. Publication bias was examined by using funnel plot and Egger's test. The pooled effect measure with DerSimonian and Laird method of random-effect model was reported using odds ratio (OR) with respective 95% confidence interval. Totally, 14 articles are included for the systematic review and meta-analysis. The stillbirth reported by the studies ranges from 15 to 146.7 per 1000 births. The overall OR of advanced maternal age (≥35 years) on stillbirth is 1.42 (1.18, 1.71) when compared with the age group of 20-35 years. The cumulative effect of getting pregnant at advanced age on stillbirth was slightly increasing from year to year. Advanced maternal age is a risk factor for stillbirth. Health Information Communication on the risk of getting pregnant at the advanced ages on stillbirth should be well addressed to all women of reproductive age group.

Birth Outcomes of Twin’s Pregnancy and Associated Factors in Selected Public Hospitals of Addis Ababa, Ethiopia, 2022

Background: Twin birth is a type of multiple births when the mother gives birth to two offspring from the same pregnancy. The prevalence rates range from less than 8 twin pregnancies per 1,000 births in the East and Southern Asia, India, and Oceania to 17 or more per 1,000 births in Africa. There are factors to increase the negative birth outcome of twin delivery; from these, some of them are associated with increased maternal age, prim parity, low birth weight, chronic disease, low ANC follow-up, and PROM. Adverse birth outcome for twin delivery is a critical health issue in developing countries such as Ethiopia. It resulted in many bad consequences, neonatal and infant morbidity and mortality. Objective: The objective of this study was to assess birth out come and associated factors of twin’s pregnancy in selected public Hospitals, Addis Ababa, Ethiopia. Methods: Facility based cross sectional study was conducted on 246 maternal records of twin delivery in selected public hospitals of Addis Ababa to assess birth out come and associated factors of twin’s pregnancy from December, 2020-June, 2021.A pretested questionnaire which will be analyzed by SPSS and result will be reported in tables, bivariate and multivariate regression will be done to show correlations by Crude and adjusted odds ratio. A confidence limit of 95% and p- value less than 0.05 will be used as cut of point to see presence of statistical significance. Result: The prevalence of adverse birth outcome (Both maternal and fetal) among twin delivery in the three selected public hospitals of Addis Ababa is 234 (95%). majority, 156(63.4%) were in the age group 18-28 years, with the mean age of 29.78 and Standard deviation of±6.53.Most of the mothers 227(92%) were married. Mothers who had Pregnancy induced hypertension (AOR= 10.465, 95% CI (2.922-37.474)), Mothers who had ruptured membrane before the onset of Labor (AOR= 3.577, 95% CI (1.198-10.682)) and Mothers who labor for more than 12 hours were (AOR= 3.324, 95% CI (1.101-10.034)) were significantly associated with adverse maternal birth outcome. While mothers who had ANC follow up at private clinic (AOR= 0.252, 95% CI (0.098-0.649)) and Mothers who live outside Addis Ababa were unlikely to have adverse fetal outcome (AOR= 0.343, 95% CI (0.143-0.826)). Conclusion: Adverse birth outcome of Twins pregnancy is relatively higher when compared to similar studies conducted in Ethiopia. The Health facilities should have effective risk assessment in Antenatal care unit and labor ward. It is also recommended to have guidelines and protocols for the management of twin’s pregnancy. Since the Prevalence of Adverse twin’s Birth outcome is higher greater attention should be given on both Antepartum and Intrapartum care.

Temperature variability and birthweight: Epidemiological evidence from Africa

BackgroundMounting evidence supports an association between nonoptimal ambient temperatures (i.e., heat or cold) and risk of low birthweight (LBW) (<2500 g), while the effect of temperature variability (TV) is largely unknown. We aimed to quantify the association between TV and risk of LBW in Africa. MethodsData on birthweight in 37 countries during 1990–2020 were collected from the Demographic and Health Surveys program. We calculated overall, intraday, and interday TV during the entire pregnancy and each trimester using hourly temperatures at ∼ 9 km resolution from ERA5-Land. We employed generalized linear mixed logistic regression, with random effects for country and survey cluster, to quantify the association between LBW and three separate TV metrics. ResultsIn total there were 33,863 (10.2%) LBW births out of 333,618 records. We found a J-shaped association between TV and LBW. Compared to the reference TV where the lowest risk was observed, extremely high (97.5th percentile) overall, intraday, and interday TV during the entire pregnancy increased the odds of LBW birth by 37.3% (26.7–48.8%), 24.1% (16.4–32.3%), and 15.1% (6.9–24.0%), respectively. In total, 7.3% of all LBW births in Africa were attributable to elevated overall TV. These associations were observed in dry climate zones, but not in tropical or temperate zones. ConclusionsOur study suggests an adverse impact of TV on the risk of LBW in Africa, according to three different TV definitions, underlining the significance of climate-health risk assessment in those most vulnerable to climate change.

Safe recovery after cesarean in rural Africa: Technical consensus guidelines for post-discharge care.

Despite increasing cesarean rates in Africa, there remain extensive gaps in the standard provision of care after cesarean birth. We present recommendations for discharge instructions to be provided to women following cesarean delivery in Rwanda, particularly rural Rwanda, and with consideration of adaptable guidelines for sub-Saharan Africa, to support recovery during the postpartum period. These guidelines were developed by a Technical Advisory Group comprised of clinical, program, policy, and research experts with extensive knowledge of cesarean care in Africa. The final instructions delineate between normal and abnormal recovery symptoms and advise when to seek care. The instructions align with global postpartum care guidelines, with additional emphasis on care practices more common in the region and address barriers that women delivering via cesarean may encounter in Africa. The recommended timeline of postpartum visits and visit activities reflect the World Health Organization protocols and provide additional activities to support women who give birth via cesarean. These guidelines aim to standardize communication with women at the time of discharge after cesarean birth in Africa, with the goal of improved confidence and clinical outcomes among these individuals.

Knowledge, Attitude and Willingness to Screen Younger Infants for Sickle Cell Disease among Mothers attending Immunization Clinic in an Urban Community in Lagos, Nigeria

Background: Over 300,000 babies are born worldwide with sickle cell disease, mostly in low- and middle-income countries with the majority of these births in Africa. Nigeria has the largest population of people with sickle cell disease with about 150,000 children born with the disease every year. This study assessed the knowledge, attitude and willingness to screen younger infants for sickle cell disease among mothers attending immunization clinic in an urban community in Lagos, Nigeria.Methods: A cross-sectional descriptive study was carried out at primary health care centres in Somolu Local Government Area in Lagos, Nigeria. Two hundred and ninety-one mother-infant pairs were consecutively recruited from August 2019 to January 2020. Data were collected with a pre-tested, interviewer-administered questionnaire. The analysis was done using SPSS version 22 software. Univariate and bivariate analysis were conducted with the level of significance set at p&lt;0.05.Results: The mean age of respondents was 29.9 ± 5.4 years. Most 212 (72.9%) were aware of sickle cell disease. One hundred and fifty-one (71.2%) of those who were aware of sickle cell disease had good knowledge while 148 (69.8%) had a positive attitude towards SCD prevention. Majority of the respondents 180 (84.9%) were willing to screen their infants for sickle cell disease. A statistically significant association was found between good knowledge and positive attitude towards SCD (p&lt;0.001).Conclusion: There is the need for increased education of mothers of younger infants attending routine immunization clinic about SCD for better knowledge, attitude and willingness for early infants screening of SCD.

SOCIO-ETHICAL ISSUES SURROUNDING CAESAREAN SECTION BIRTHS IN AFRICA

In the last decade, a number of studies have questioned the practice of caesarean section birth in obstetrical practices in Africa. Medical sociologists and anthropologists have considered caesarean section as a medicalization of social events. We are not assuming that it is true of false. The transformation of social events into medical indications rises ethical issues in the provision of healthcare in Africa. In this paper, we especially used the case of caesarean section birth to explore the transformation of social events into medical indications in Africa. Caesarean sections by choice interrogates the obstetrical practices. This paper examines the socio-ethical issues in caesarean section in Africa. We considered some underlying factors: medicalization of the society, informed consent, biotechnology, demand inducement, consumer-inducement demand and the health market-driven economy. This was desk-based study. A review of secondary data and literatures relative to caesarean section births in Africa were used for discussion. Findings from literatures revealed that a number of considerations have to be taken such as: demand inducement and information asymmetry, defensive and corporate medicine, medical power, consumer induced demand and health market driven economy. The findings informed health regulators on demand and supply sides of caesarean sections.

Trends in Gender Inequalities in Life Expectancies at Birth in Africa, 1950-2015

In this paper, life expectancies by gender are presented for countries and regions in Africa. The gender gaps in life expectancy are calculated. Data on life expectancies by sex for African countries are available from the UNDESA and the latest estimates of 2015 are used. Four patterns of gender gap in life expectancy at birth trends are observed in Africa. The first group have high life expectancies and large gender gaps and comprises of mainly small islands (Seychelles, Mauritius and Mayotte) and those in North Africa whole life expectancy at birth has exceeded 70 years. The second group are those countries where the gap has been stable but narrowed during the peak of the AIDS epidemic but has started widening in recent times and comprising countries mainly in Southern Africa. Group 3 are those countries where the gender gaps has been low over the period and have narrowed or remained consistently low in recent times, mainly in West Africa. The last group comprises of countries where life expectancy at birth for males exceeds that of females. Currently, Swaziland and Mali are the only countries exhibiting this pattern. Thus, some few countries in Africa have followed trends that have been experienced by developed countries and many have followed a different pattern

Impact of country of birth on age at the time of diagnosis of hepatocellular carcinoma in the United States.

There is global variation in the onset of hepatocellular carcinoma (HCC). The objective of the current study was to investigate the impact of country of birth on age at the time of HCC diagnosis in the United States. Incident HCC cases diagnosed between 2000 and 2012 in the Surveillance, Epidemiology, and End Results program 18 registry were included. Factors associated with very early onset (age at diagnosis < 40 years) and early onset (age at diagnosis < 50 years) were identified by logistic regression. A total of 59,907 patients were included. The median age at the time of diagnosis of HCC was 62 years and 76% of the patients were male. Of the 75% of patients for whom information regarding birth country was available, 29% were foreign born. In multivariate logistic regression, birth in West Africa (adjusted odds ratio [AOR], 16.3; 95% confidence interval [95% CI], 9.2-27.9 [P<.01]), Central/South/other Africa (AOR, 11.0; 95% CI, 4.5-23.7 [P<.01]), Oceania (AOR, 4.9; 95% CI, 2.9-8.0 [P<.01]), and East Africa (AOR, 3.5; 95% CI, 1.5-6.8 [P<.01]) was found to have the strongest association with very early-onset HCC after adjusting for sex and race/ethnicity. Birth in West Africa, Central/South/other Africa, Oceania, or East Africa also was found to be strongly associated with early-onset HCC. Birth country was found to be independently associated with age at the time of HCC diagnosis in the United States. Birth in Africa (except for North Africa) and Oceania was strongly associated with very early-onset HCC. These findings have implications for the design of comprehensive HCC surveillance programs in the United States. Cancer 2016. © 2016 American Cancer Society. Cancer 2017;81-89. © 2016 American Cancer Society.

Using Seroprevalence and Immunisation Coverage Data to Estimate the Global Burden of Congenital Rubella Syndrome, 1996-2010: A Systematic Review.

BackgroundThe burden of Congenital Rubella Syndrome (CRS) is typically underestimated in routine surveillance. Updated estimates are needed following the recent WHO position paper on rubella and recent GAVI initiatives, funding rubella vaccination in eligible countries. Previous estimates considered the year 1996 and only 78 (developing) countries.MethodsWe reviewed the literature to identify rubella seroprevalence studies conducted before countries introduced rubella-containing vaccination (RCV). These data and the estimated vaccination coverage in the routine schedule and mass campaigns were incorporated in mathematical models to estimate the CRS incidence in 1996 and 2000–2010 for each country, region and globally.ResultsThe estimated CRS decreased in the three regions (Americas, Europe and Eastern Mediterranean) which had introduced widespread RCV by 2010, reaching <2 per 100,000 live births (the Americas and Europe) and 25 (95% CI 4–61) per 100,000 live births (the Eastern Mediterranean). The estimated incidence in 2010 ranged from 90 (95% CI: 46–195) in the Western Pacific, excluding China, to 116 (95% CI: 56–235) and 121 (95% CI: 31–238) per 100,000 live births in Africa and SE Asia respectively. Highest numbers of cases were predicted in Africa (39,000, 95% CI: 18,000–80,000) and SE Asia (49,000, 95% CI: 11,000–97,000). In 2010, 105,000 (95% CI: 54,000–158,000) CRS cases were estimated globally, compared to 119,000 (95% CI: 72,000–169,000) in 1996.ConclusionsWhilst falling dramatically in the Americas, Europe and the Eastern Mediterranean after vaccination, the estimated CRS incidence remains high elsewhere. Well-conducted seroprevalence studies can help to improve the reliability of these estimates and monitor the impact of rubella vaccination.

Prevalence of hepatitis E virus antibodies, Israel, 2009-2010.

We investigated prevalence of hepatitis E virus in a sample of the population of Israel. The overall seroprevalence of antibodies to the virus was 10.6% (95% CI 8.4%–13.0%); age-adjusted prevalence was 7.6%. Seropositivity was associated with age, Arab ethnicity, low socioeconomic status, and birth in Africa, Asia, or the former Soviet Union.

UNICEF report Generation 2030 Africa calls upon investing in and empowering girls and young women.

UNICEF’s Generation 2030 Africa report released in August 2014, focusing exclusively on Africa, provides an in-depth analysis of child demographic trends. The report highlights the marked increase that Africa population has experienced in the last few decades and the rapid population expansion that is set to continue, with its inhabitants doubling from 1.2 billion to 2.4 billion between 2015 and 2050. A factor driving Africa’s population increase is that the number of women of reproductive age has risen fivefold from 54 million in 1950 to 280 million in 2015 and is set to further increase to 407 million in 2030 and 607 million by 2050. The increasing number of women of reproductive age in Africa will lead to an increasing number of births in Africa even under the assumption of large declines in fertility levels. Adolescent fertility remains high in many African countries and it is estimated that almost one fifth of women in Africa have an unmet need for family planning. The report calls upon investing in and empowering girls and young women and on improving reproductive health of African adolescents.

Factors Associated with Preterm, Early Preterm and Late Preterm Birth in Malawi

BackgroundAssessment of risk factors for preterm birth in a population with high incidence of preterm birth and HIV infection.MethodsSecondary analysis of data for 2,149 women included in a community based randomized placebo controlled trial for the prevention of preterm birth (APPLe trial (ISRCTN84023116) with gestational age at birth determined through ultrasound measurement in early pregnancy. Multivariate Logistic Regression analyses to obtain models for three outcome variables: all preterm, early preterm, and late preterm birth.FindingsNo statistical differences were noted for the prevalence of HIV infection (p = 0.30) or syphilis (p = 0.12) between women who delivered preterm versus term. BMI (Adjusted OR 0.91 (0.85–0.97); p = 0.005) and weight gain (Adjusted OR 0.89 (0.82–0.97); p = 0.006) had an independent, protective effect. Previous preterm birth doubled the odds of preterm birth (Adjusted OR 2.13 (1.198–3.80); p = 0.01). Persistent malaria (despite malaria prophylaxis) increased the risk of late preterm birth (Adjusted OR 1.99 (1.05–3.79); p = 0.04). Age <20 (Adjusted OR 1.73 (1.03–2.90); p = 0.04) and anemia (Adjusted OR 1.95 (1.08–3.52); p = 0.03) were associated with early preterm birth (<34 weeks).ConclusionsDespite claims that HIV infection is an important cause of preterm birth in Africa, we found no evidence of an association in this population (unexposed to anti-retroviral treatment). Persistent malaria was associated with late preterm birth. Maternal undernourishment and anemia were independently associated with early preterm birth. The study did not assess whether the link was direct or whether a common precursor such as chronic infection was responsible for both maternal effects and early labour.

The practice of traditional rituals and customs in newborns by mothers in selected villages in southwest Uganda

Between 1990 and 2011, neonatal mortality dropped from 32 to 22 per 1000 live births globally, but has remained above 30 per 1000 live births in Africa. Many neonatal deaths are preventable with support for healthy pregnancies, deliveries and newborn care. Continuation of traditional pregnancy/birth rituals may be placing some mothers/neonates at risk. The Ankole region of Uganda has a population of approximately eight million, and approximately 10,000 live referral hospital births annually. However, most babies are born at home in their villages because women avoid going to the hospital unless complications occur. The purpose of the present study was to determine what potentially harmful traditional pregnancy/birth rituals were practiced in the Ankole region, and to develop Village Health Team (VHT; volunteer community workers with limited health training) mitigation strategies.

Caesarean section: in good surgical skills we trust

No fewer than 18·5 million caesarean sections are undertaken annually worldwide,1 making up 9–33% of all births in Africa, Latin America, and Asia.2–4 In The Lancet, the CORONIS Collaborative Group5 present a well thought out randomised controlled trial that included 15 935 women from 19 sites in Argentina, Chile, Ghana, India, Kenya, Pakistan, and Sudan, and that assessed the effects of five elements of the caesarean section surgical procedure on short-term outcomes. The comparisons undertaken in the CORONIS trial were as follows: (1) blunt versus sharp abdominal entry; (2) exterior versus intra-abdominal repair of the uterus; (3) single-layer versus double-layer closure of the uterus; (4) closure versus non-closure of the pelvic and parietal peritoneum; and (5) chromic catgut versus polyglactin-910 for uterine repair.

Chromosome painting in silico in a bacterial species reveals fine population structure.

Identifying population structure forms an important basis for genetic and evolutionary studies. Most current methods to identify population structure have limitations in analyzing haplotypes and recombination across the genome. Recently, a method of chromosome painting in silico has been developed to overcome these shortcomings and has been applied to multiple human genome sequences. This method detects the genome-wide transfer of DNA sequence chunks through homologous recombination. Here, we apply it to the frequently recombining bacterial species Helicobacter pylori that has infected Homo sapiens since their birth in Africa and shows wide phylogeographic divergence. Multiple complete genome sequences were analyzed including sequences from Okinawa, Japan, that we recently sequenced. The newer method revealed a finer population structure than revealed by a previous method that examines only MLST housekeeping genes or a phylogenetic network analysis of the core genome. Novel subgroups were found in Europe, Amerind, and East Asia groups. Examination of genetic flux showed some singleton strains to be hybrids of subgroups and revealed evident signs of population admixture in Africa, Europe, and parts of Asia. We expect this approach to further our understanding of intraspecific bacterial evolution by revealing population structure at a finer scale.

Knowledge, attitudes and usage of cancer screening among West African migrant women

To explore West African migrant women's knowledge, attitude and usage of cancer screening in Australia. Despite strong evidence that cancer screening saves lives through early detection and treatment, there is lack of empirical studies on West African migrant women's knowledge, attitude and usage of cancer screening in Australia. Qualitative naturalistic inquiry. Twenty-one West African migrant women who consented to participate in the study were recruited through a snowballing technique. These women were engaged in face-to-face audiotaped in-depth interviews which lasted for about 90 minutes. Interviews were transcribed verbatim and thematically analysed. The following three themes emerged from the data: knowledge of cancer screening, attitude towards cancer screening and usage of cancer screening Irrespective of the women's place of birth in Africa, twenty of the participants had no knowledge of cancer screening prior to migration, and most had a negative attitude towards screening. Women who had given birth after migrating to Australia were more likely to have had cervical cancer screening. Women who had passed their child-bearing years or had not presented to healthcare facilities for medical issues were more likely to be unaware of cancer screening. Improved health promotion strategies that provide accessible information and education to West African migrant women regarding cancer screening are required to enhance the uptake of such screening in this migrant group. Nurses who encounter West African migrant women in their day-to-day practice have the opportunity to provide this group with education related to the importance of cancer screening.

Implementing a birth dose of hepatitis B vaccine for home deliveries in Africa—Too soon?

Despite the recommendation of the World Health Organization (WHO) to provide the first hepatitis B vaccine dose at birth (within 24 h), there are epidemiological, economic and logistical reasons why this may not be the best approach for home births in Africa. The WHO policy presupposes that the epidemiology of hepatitis B infection in Africa is similar to the rest of the world and that the organizational, infrastructural and financial support is adequate. While babies born in health facilities may be relatively easy to immunize at birth, health systems and infrastructures in many resource-poor countries in Africa would be severely challenged, if required to reach home deliveries within 24 h of birth.

Kaposi sarcoma incidence in the Swiss HIV cohort study before and after highly active antiretroviral therapy

Between 1984 and 2006, 12 959 people with HIV/AIDS (PWHA) in the Swiss HIV Cohort Study contributed a total of 73 412 person-years (py) of follow-up, 35 551 of which derived from PWHA treated with highly active antiretroviral therapy (HAART). Five hundred and ninety-seven incident Kaposi sarcoma (KS) cases were identified of whom 52 were among HAART users. Cox regression was used to estimate hazard ratios (HR) and corresponding 95% confidence intervals (CI). Kaposi sarcoma incidence fell abruptly in 1996-1998 to reach a plateau at 1.4 per 1000 py afterwards. Men having sex with men and birth in Africa or the Middle East were associated with KS in both non-users and users of HAART but the risk pattern by CD4 cell count differed. Only very low CD4 cell count (>50 cells microl(-1)) at enrollment or at HAART initiation were significantly associated with KS among HAART users. The HR for KS declined steeply in the first months after HAART initiation and continued to be low 7-10 years afterwards (HR, 0.06; 95% CI, 0.02-0.17). Thirty-three out of 52 (63.5%) KS cases among HAART users arose among PWHA who had stopped treatment or used HAART for less than 6 months.