Factors In sub-Saharan Africa Research Articles

Childhood hearing impairment and its associated factors in sub-Saharan Africa in the 21st century: A systematic review and meta-analysis.

Background:Childhood hearing impairment is still a significant cause of disability in the 21st century in developing countries. Particularly, the burden is more severe in sub-Saharan Africa, where the majority of children with hearing problems is living. Thre are great variations and inconsistencies of available findings conducted in sub-Saharan Africa. Hence, the aim of this review was to determine the pooled prevalence of childhood hearing impairment and its associated factors in sub-Saharan Africa.Methods:Studies were searched from main databases (PubMed, CINAHL, and African Journals Online), Google Scholar, and other relevant sources using electronic and manual techniques. All observational studies, written in English and conducted among participants (aged less than 18 years) from 2000 to 2018, were eligible. Heterogeneity between included studies was assessed using I2, and publication bias was explored using visual inspection of the funnel plot. Statistical analysis was carried out to determine pooled prevalence using Stata version 14. In addition, subgroup analysis was carried out for the normality criteria of hearing thresholds and characteristics of the study populations.Results:The pooled prevalence of hearing impairment was 10% (95% confidence interval (CI): 9%–11%). The magnitude of hearing impairment varies with the normality criterion used. The most commonly used threshold was 25 and 30 dB hearing level. The prevalence of hearing impairment based on normality criterion (>20 dB, >25 dB, >30 dB, and >35 dB) were 17%, 19%, 2%, and 1%, respectively. While in the questionnaire-based evaluation, the prevalence was 6% (95% CI: 3%–9%). In addition, based on population characteristics, the prevalence of hearing impairment for school or community-based children was 6% (95% CI: 5%–7%) while the prevalence for children with comorbidities was 23% (95% CI: 15%–31%). Chronic suppurative otitis media, impacted cerumen, advanced stage of human immunodeficiency virus, tuberculosis infection, and age of the children were associated with hearing impairment in sub-Saharan Africa.Conclusion:Hearing impairment in children and adolescents in sub-Saharan Africa was high, and associated with preventable and treatable risk factors.

Excess Mortality in Active Convulsive Epilepsy and Associated Risk Factors in Sub-Saharan Africa

Background: In sub-Saharan Africa, there is a paucity of evidence on the magnitude of excess mortality in epilepsy relative to the general population and risk factors associated to this excess. This study estimated excess mortality in people with active convulsive epilepsy (ACE) using data from the Studies of Epidemiology of Epilepsy in Demographic Surveillance Sites in three sub-Saharan African (SSA) countries. Methods: We followed those with and without epilepsy and documented deaths in Agincourt (South Africa), Ifakara (Tanzania) and Kilifi (Kenya) for duration of seven, six and eight years, respectively. Findings: A total of 199 deaths in ACE and 16,801 in general population were observed from the time of diagnosis to the most recent household survey. Mortality rates in ACE were estimated at 31.5 deaths per 1,000 person-years (95%CI: 19.4-43.6) in Agincourt, 23.9 (95%CI: 11.7-36.1) in Ifakara and 24.6 (95%CI: 19.5-29.6) in Kilifi. Pooled estimates of excess mortality (Standardized mortality ratio (SMR)), was 4.8 (95% CI: 4.2-5.6) times higher in PWE than those without epilepsy. Adjusting for age, SMRs were 3.20 (95%CI: 2.41-4.27) in Agincourt, 4.66 (95%CI: 3.46-6.29) in Ifakara and 6.22 (95%CI: 5.15-7.50) in Kilifi. Interpretation: This study demonstrates evidence of excess mortality in PWE in SSA countries. Mortality burden may be reduced by managing seizures with improved access to antiepileptic drugs, preventive measures against accidents, reducing perinatal adverse events at birth, preventing parasite infections with proper management of domesticated animals and hygiene, empowering PWE with education and decent low-risk jobs and managing co-morbidities. Funding Statement: This work was supported by grants from The Wellcome Trust [Grant No. 083744] to C.R.N.; Ifakara Health Institute under Training Unit and Basel Canton. The Agincourt HDSS is funded by the Wellcome Trust, UK (grants 058893/Z/99/A; 069683/Z/02/Z; 085477/Z/08/Z), with important contributions from the University of the Witwatersrand, the South African Medical Research Council, and the William and Flora Hewlett Foundation, National Institute on Aging (NIA) of the NIH, and Andrew W Mellon Foundation, USA. Declaration of Interests: Authors declare no conflict of Interest. Ethics Approval Statement: The study protocol was approved by Ifakara Health Institution Internal Review Board (IHI/IRB/No. A 70-2009) and National Institute of Health Research and Commission of Science and Technology with reference NIMR/HQ/R.8a/Vol. IX/1256. All participants were enrolled through verbal consent.

Under five mortality patterns and associated maternal risk factors in sub-Saharan Africa: A multi-country analysis.

BackgroundUnder-5 mortality rate in the sub-Saharan region has remained unabated. Worse still, information on the regional trend and associated determinants are not readily available. Knowledge of the trend and determinants of under-5 mortality are essential for effective design of intervention programmes that will enhance their survival. We aimed to examine the mortality patterns in under-5 children and maternal factors associated with under-5 deaths.MethodsDemographic and Health Survey (DHS) data from five sub-Sahara Africa countries; Chad, Democratic Republic of Congo, Mali, Niger and Zimbabwe were used in this study. The sample size consisted of 68,085 women aged 15–49 years with at least one history of childbirth. The outcome variable was under-five mortality rate. Relevant information on maternal factors were extracted for analysis. Multivariable Cox proportional hazards regression was used to model maternal factors associated with under-five mortality.ResultsThe current under-5 mortality rate (per 1,000 live births) was; 133 in Republic of Chad, 104 in Democratic Republic of Congo, 95 in Mali, 127 in Niger, and 69 in Zimbabwe. Several maternal and child level factors were found to be significantly associated with under-five mortality. Lack of spousal support (not currently married) resulted to increase in under-five mortality (Chad- Hazard Ratio [HR] = 1.11, 95%CI = 0.97–1.25; DR Congo- HR = 1.24, 95%CI = 1.11–1.40; Mali- HR = 2.43, 95%CI = 1.63–3.64; Niger- HR = 1.59, 95%CI = 1.24–2.03; Zimbabwe- HR = 1.33, 95%CI = 1.06–1.67). Delivery by caesarean section was significantly associated with under-five mortality (Chad- HR = 1.32, 95%CI = 1.00–1.77; DR Congo- HR = 1.20, 95%CI = 1.01–1.43; Mali- HR = 1.42, 95%CI = 1.08–1.85; Niger- HR = 1.43, 95%CI = 1.06–1.92; Zimbabwe- HR = 1.49, 95%CI = 1.03–2.15).ConclusionDespite concerted effort by government and several stakeholders in health to improve childhood survival, the rate of under-5 mortality is still high. Our findings provided evidence on the contribution of maternal age, place of residence, household wealth index, level of education, employment, marital status, religious background, birth type, birth order and interval, sex and size of child, place and mode of delivery, to Under-5 mortality rate in SSA. The position of prominent risk factors for under-five mortality should be addressed through effective design of timely and efficient intervention aimed at reducing childhood mortality.

The association between antiretroviral therapy and selected cardiovascular disease risk factors in sub-Saharan Africa: A systematic review and meta-analysis.

BackgroundWith increasing adverse cardiovascular disease (CVD) outcomes in HIV/AIDS patients, the possible contribution of antiretroviral therapy (ART) to the prevailing CVD epidemic in sub-Saharan Africa (SSA) through its effect on CVD risk factors has rather been under investigated. This study aimed to assess the extent to which ART is associated with hypertension, diabetes mellitus (DM) and dyslipidemia in SSA.MethodsThis is a systematic review and meta-analysis of studies from SSA, published between January 1946 and December 2017, from Medline, Embase, Africa-wide Information, the Cochrane library, African Index and Medicus databases. Both observational and interventional studies with comparable ART-treated and ART-naïve populations were selected and data was extracted from eligible studies. Pooled estimates of the effect of ART on the outcomes of interest (hypertension, diabetes and abnormal lipid profiles) were obtained using random effects meta-analysis, and meta-regression analysis was used to explore between-study heterogeneity.ResultsTwenty cross-sectional studies were included involving 5386 participants. There was no association between ART use and hypertension (OR: 1.9, 95%CI: 0.96–3.76, n = 8, I2 = 73.8%) and DM (OR: 2.53, 95%CI: 0.87–7.35, n = 8, I2 = 73.8%). ART use was associated with high total cholesterol (OR: 3.85, 95%CI: 2.45–6.07, n = 8, I2 = 67.0%), high triglycerides (OR: 1.46, 95%CI: 1.21–1.75, n = 14, I2 = 10.0%) and high LDL-cholesterol (OR: 2.38, 95%CI: 1.43–3.95, n = 11, I2 = 87.6%). ART was associated with rather lower odds of having low HDL-cholesterol (OR: 0.53, 95%CI: 0.32–0.87, n = 8, I2 = 78.2%). There was evidence of between-study heterogeneity for all outcomes except high triglycerides.ConclusionsART appears to be associated with CVD risk in HIV/AIDS patients in SSA only through dyslipidemia but not through hypertension and DM, however, high quality and robust research in SSA is mandated to accurately ascertain the actual contribution of ART to the CVD burden in this part of the world. Nevertheless, HIV/AIDS patients should still benefit from systematic CVD screening alongside their regular care services.Trial registrationProspero Registration - CRD42016042306.

Incidence of postpartum infection, outcomes and associated risk factors at Mbarara regional referral hospital in Uganda

BackgroundThere is a paucity of recent prospective data on the incidence of postpartum infections and associated risk factors in sub-Saharan Africa. Retrospective studies estimate that puerperal sepsis causes approximately 10% of maternal deaths in Africa.MethodsWe enrolled 4231 women presenting to a Ugandan regional referral hospital for delivery or postpartum care into a prospective cohort and measured vital signs postpartum. Women developing fever (> 38.0 °C) or hypothermia (< 36.0 °C) underwent symptom questionnaire, structured physical exam, malaria testing, blood, and urine cultures. Demographic, treatment, and post-discharge outcomes data were collected from febrile/hypothermic women and a random sample of 1708 normothermic women. The primary outcome was in-hospital postpartum infection. Multivariable logistic regression was used to determine factors independently associated with postpartum fever/hypothermia and with confirmed infection.ResultsOverall, 4176/4231 (99%) had ≥1 temperature measured and 205/4231 (5%) were febrile or hypothermic. An additional 1708 normothermic women were randomly selected for additional data collection, for a total sample size of 1913 participants, 1730 (90%) of whom had complete data. The mean age was 25 years, 214 (12%) were HIV-infected, 874 (51%) delivered by cesarean and 662 (38%) were primigravidae. Among febrile/hypothermic participants, 174/205 (85%) underwent full clinical and microbiological evaluation for infection, and an additional 24 (12%) had a partial evaluation. Overall, 84/4231 (2%) of participants met criteria for one or more in-hospital postpartum infections. Endometritis was the most common, identified in 76/193 (39%) of women evaluated clinically. Twenty-five of 175 (14%) participants with urinalysis and urine culture results met criteria for urinary tract infection. Bloodstream infection was diagnosed in 5/185 (3%) participants with blood culture results. Another 5/186 (3%) tested positive for malaria. Cesarean delivery was independently associated with incident, in-hospital postpartum infection (aOR 3.9, 95% CI 1.5–10.3, P = 0.006), while antenatal clinic attendance was associated with reduced odds (aOR 0.4, 95% CI 0.2–0.9, P = 0.02). There was no difference in in-hospital maternal deaths between the febrile/hypothermic (1, 0.5%) and normothermic groups (0, P = 0.11).ConclusionsAmong rural Ugandan women, postpartum infection incidence was low overall, and cesarean delivery was independently associated with postpartum infection while antenatal clinic attendance was protective.

Population risk factors for late-stage presentation of cervical cancer in sub-Saharan Africa

BackgroundCervical cancer is the most prevalent malignancy in sub-Saharan Africa (SSA) with many women only seeking professional help when they are experiencing symptoms, implying late-stage malignancy and higher mortality rates. This ecological study assesses population-level exposures of SSA women to the numerous risk factors for HPV infection and cervical cancer, against late-stage presentation of cervical cancer. Materials and methodA literature review revealed the relevant risk factors in SSA. Open-access databases were mined for variables closely representing each risk factor. A proxy for late-stage presentation was used (ratio of incidence-to-mortality, IMR), and gathered from IARC’s GLOBOCAN 2012 database. Variables showing significant correlation to the IMR were used in stepwise multiple regression to quantify their effect on the IMR. ResultsCountries with high cervical cancer mortality rates relative to their incidence have an IMR nearer one, suggesting a larger proportion of late-stage presentation. Western Africa had the lowest median IMR (1.463), followed by Eastern Africa (IMR = 1.595) and Central Africa (IMR = 1.675), whereas Southern Africa had the highest median IMR (1.761). Variables selected for the final model explain 65.2% of changes seen in the IMR. Significant predictors of IMR were GDP (coefficient = 2.189 × 10−6, p = 0.064), HIV infection (−1.936 × 10−3, p = 0.095), not using a condom (−1.347 × 10−3, p = 0.013), high parity (−1.744 × 10−2, p = 0.008), and no formal education (−1.311 × 10−3, p < 0.001). ConclusionUsing an IMR enables identification of factors predicting late-stage cervical cancer in SSA including: GDP, HIV infection, not using a condom, high parity and no formal education.

Can At-Scale Drug Provision Improve the Health of the Targeted in Sub-Saharan Africa?

The single largest item in the US foreign aid health budget is antiretroviral therapy (ART) for the treatment of HIV/AIDS. Many supply- and demand-side factors in sub-Saharan Africa could cause sma...

How seasonality and weather affect perinatal health: Comparing the experiences of indigenous and non-indigenous mothers in Kanungu District, Uganda

Maternal and newborn health disparities and the health impacts of climate change present grand challenges for global health equity, and there remain knowledge gaps in our understanding of how these challenges intersect. This study examines the pathways through which mothers are affected by seasonal and meteorological factors in sub-Saharan Africa in general, and Kanungu District (Uganda), in particular. We conducted a community-based study consisting of focus group discussions with mothers and interviews with health care workers in Kanungu District. Using a priori and a posteriori coding, we found a diversity of perspectives on the impacts of seasonal and weather exposures, with reporting of more food available in the rainy season. The rainy season was also identified as the period in which women performed physical labour for longer time periods, while work conditions in the dry season were reported to be more difficult due to heat. The causal pathways through which weather and seasonality may be affecting size at birth as reported by Kanungu mothers were consistent with those most frequently reported in the literature elsewhere, including maternal energy balance (nutritional intake and physical exertion output) and seasonal illness. While both Indigenous and non-Indigenous mothers described similar pathways, however, the severity of these experiences differed. Non-Indigenous mothers frequently relied on livestock assets or opportunities for less taxing physical work than Indigenous women, who had fewer options when facing food shortages or transport costs. Findings point to specific entry points for intervention including increased nutritional support in dry season periods of food scarcity, increased diversification of wage labour opportunities, and increased access to contraception. Interventions should be particularly targeted towards Indigenous mothers as they face greater food insecurity, may have fewer sources of income, and face greater overall deprivation than non-Indigenous mothers.

Association between highly active antiretroviral therapy and selected cardiovascular disease risk factors in sub-Saharan Africa: a systematic review and meta-analysis protocol

IntroductionThe increasing highly active antiretroviral therapy (HAART) coverage in sub-Saharan Africa (SSA) has been associated with increasing cardiovascular disease (CVD) incidence. However, the epidemiology of the association between HAART and...

On-farm rice yield and its association with biophysical factors in sub-Saharan Africa

Abstract Although increase in rice (Oryza spp.) production is a common objective for rice-producing countries in sub-Saharan Africa (SSA), basic information on yield and its variation at farm level is lacking. Field surveys were conducted in irrigated lowland (IL), rainfed lowland (RL), and rainfed upland (RU) rice production systems in 19 SSA countries in the 2012–2014 wet seasons. Mean yield varied widely across sites: 2.2–5.8 t/ha, 1.1–5.2 t/ha, and 1.0–2.5 t/ha in IL, RL, and RU, respectively. Rice yield levels differed between the agro-ecological zones (AEZs) with the highest yield in the semi-arid zone in IL, and in the highlands zone for RL and RU. Cluster analysis identified four groups using mean yields, coefficient of variation, and skewness of yield distribution of 42 site–production system combinations. Grouping was related to production system, AEZ, and field water condition. A high-yielding group with 5.3 t/ha mean yield and negative skewness had only four site–production system combinations. Other groups had mean yields from 1.6 to 3.5 t/ha with positive skewness. In these groups, research and development priority for lifting rice yield could be given to low-yielding IL and RL sites with large yield gaps. Raising rice yield in the humid zone irrespective of the production systems and RU across AEZs remain major challenges. Further assessment of the impact of farmers’ agricultural practices on yield variation is warranted to identify potential interventions to realize further yield enhancement.

Challenges of the Management of Stroke in Sub Saharan Africa: Evaluating Awareness, Access and Action

Background: Stroke is one of the major public health problems in the world today. It is the third leading cause of death worldwide after ischaemic heart disease and cancer. Stroke mortality is especially high in sub Saharan Africa (SSA) which accounts for as much as 87% of all the stroke deaths. Stroke however has become a treatable disease. Methods: We reviewed the literature on Stroke in SSA. We searched the PubMed database for studies on stroke in SSA, and included those that were community based, conducted in any SSA country and reported on awareness, mortality, risk factors and care. Results: We found few community-based studies. Most of the studies were hospital based. There were more studies on stroke mortality and risk factors in SSA. Few studies dealt with issues of access to stroke care. Most of the studies on stroke care showed that care is still mostly supportive. South Africa however had more stroke units and state of the art stroke care than other countries in SSA. Conclusion: There have not been many studies on optimal stroke care in SSA. The few studies seen showed that care has been majorly supportive.

Psychological correlates of suicidality in HIV/AIDS in semi-urban south-western Uganda.

There is a paucity of data on the prevalence of suicidality in HIV/AIDS, and associated psychological factors in sub-Saharan Africa, shown to be high in Uganda. Yet, the region accounts for over 70% of the world HIV burden. Our study used a cross-sectional survey of 226 HIV-positive (HIV+) adults and adolescents (aged 15-17 years) in Mbarara, Uganda. The relationship between suicidality and depressed mood, anxiety symptoms, state anger, self-esteem, trait anger and hopelessness was examined; anger was the predominant factor in suicidality, suggesting that anger management could potentially lower the prevalence of suicidality.

Young adolescent girls are at high risk for adverse pregnancy outcomes in sub-Saharan Africa: an observational multicountry study

ObjectivesOne of Africa's most important challenges is to improve maternal and neonatal health. The identification of groups at highest risk for adverse pregnancy outcomes is important for developing and implementing...

Women's Education, Infant and Child Mortality, and Fertility Decline in Sub-Saharan Africa: A Quantitative Assessment

Sub-Saharan Africa (SSA) was the last major world region to experience the fertility decline that all industrialized countries have gone through and that much of the developing world has experienced in large part. It has uniquely high fertility: at present, the United Nations estimates the total fertility rate at 5.1 for SSA, compared to 2.2 for both Asia and Latin America and the Caribbean. The ongoing fertility transition in the region has been comparatively slow and subject to stalling. At the same time, women’s educational attainment and infant and child mortality have been shown in the demography literature to be important determinants of fertility and fertility decline. Since the 1980s, fertility in sub-Saharan Africa has been falling in many countries while women’s school enrollment and educational attainment have been increasing and infant and child mortality for the most part has been declining. Previous research using aggregated data has shown the importance of growth in women’s schooling and reduction in infant and child mortality as major factors contributing to fertility decline in the region. This research uses individual-level micro data and a well-known decomposition technique for analyzing differences or changes to quantify the importance of increased women’s education and declining infant and child mortality in contributing to the observed declines in fertility in numerous countries. More specifically, this paper examines the quantitative impact of these two factors in sub-Saharan Africa in contributing to the ongoing decline in fertility that has been taking place in the region. Data come from 31 countries, and are from the Demographic and Health Surveys (DHS). The methodology is to decompose observed changes in fertility to changes attributable to different factors, including the two key variables of interest – women’s education and infant and child mortality – and two control variables, urbanization and age.

Chronic Airflow Obstruction in a Black African Population: Results of BOLD Study, Ile-Ife, Nigeria

Global estimates suggest that Chronic Obstructive Pulmonary Disease (COPD) is emerging as a leading cause of death in developing countries but there are few spirometry-based general population data on its prevalence and risk factors in sub-Saharan Africa. We used the Burden of Obstructive Lung Disease (BOLD) protocol to select a representative sample of adults aged 40 years and above in Ile-Ife, Nigeria. All the participants underwent spirometry and provided information on smoking history, biomass and occupational exposures as well as diagnosed respiratory diseases and symptoms. Chronic Airflow Obstruction (CAO) was defined as the ratio of post-bronchodilator (BD) one second Forced Expiratory Volume (FEV1) to Forced Vital Capacity (FVC) below the lower limit of normal (LLN) of the population distribution for FEV1/FVC.The overall prevalence of obstruction (post-BD FEV1/FVC < LLN) was 7.7% (2.7% above LLN) using Global Lung Function Initiative (GLI) equations. It was associated with few respiratory symptoms; 0.3% reported a previous doctor-diagnosed chronic bronchitis, emphysema or COPD. Independent predictors included a lack of education (OR 2·5, 95% CI: 1.0, 6.4) and a diagnosis of either TB (OR 23.4, 95% CI: 2.0, 278.6) or asthma (OR 35.4, 95%CI: 4.9, 255.8). There was no association with the use of firewood or coal for cooking or heating. The vast majority of this population (89%) are never smokers. We conclude that the prevalence of CAO is low in Ile-Ife, Nigeria and unrelated to biomass exposure. The key independent predictors are poor education, and previous diagnosis of tuberculosis or asthma.

Cardiovascular risk factors in sub-Saharan Africa: a review

Ischemic heart disease is increasing dramatically in the Sub-Saharan Africa (SSA), despite an increasing prevalence of risk factors, and some characteristics of the African people that make the African population subject to the effects of major cardiovascular risk factors. The pace and direction of economic development, rates of urbanization, the changes in life expectancy, associated with different pathophysiological factors are causing an increased rate of atherosclerotic disease in these countries. The prevalence of ischemic heart disease in SSA has shown a significant rise in the next two following decades due to the rising prevalence of risk factors, especially hypertension, diabetes, overweight and obesity, physical inactivity, tobacco use and the dyslipidemia, mainly due to an increase in urbanization. Moreover, thanks to new knowledge, it has been pointed out the difference of individual risk factors in the African population and other populations due to genetic differences. It is estimated that age-standardized approach for ischemic heart disease mortality rates will rise by 27% in African men and 25% in women by 2015 and by 70 and 74%, respectively by 2030. More research is needed in Africa to provide evidence for cardiovascular prevention and treatment to mitigate the oncoming epidemic. Health interventions are needed for preventing or reducing the morbidity/ mortality and should be addressed to both children and adults, including score of the risk stratification modified, starting early and aggressive therapy, if necessary.

Stroke-Risk Factors Differ between Rural and Urban Communities: Population Survey in Central Uganda

Background: Socioeconomic transition is changing stroke risk factors in Sub-Saharan Africa. This study assessed stroke-risk factors and their associated characteristics in urban and rural Uganda. Methods: We surveyed 5,420 urban and rural participants and assessed the stroke-risk factor prevalence and socio-behavioural characteristics associated with risk factors. Results: Rural participants were older with higher proportions of men and fewer poor compared to urban areas. The most prevalent modifiable stroke-risk factors in all areas were hypertension (27.1% rural and 22.4% urban, p = 0.004), overweight and obesity (22.0% rural and 42% urban, p < 0.0001), and elevated waist hip ratio (25.8% rural and 24.1% urban, p = 0.045). Diabetes, smoking, physical inactivity, harmful alcohol consumption were found in ≤5%. Age, family history of hypertension, and waist hip ratio were associated with hypertension in all, while BMI, HIV were associated with hypertension only in urban dwellers. Sex and family history of hypertension were associated with BMI in all, while age, socio-economic status and diabetes were associated with BMI only in urban dwellers. Conclusions: The prevalence of stroke-risk factors of diabetes, smoking, inactivity and harmful alcohol consumption was rare in Uganda. Rural dwellers belonging to a higher age group tended to be with hypertension and elevated waist hip ratio. Unlike high-income countries, higher socioeconomic status was associated with overweight and obesity.

Variation and risk factors of drug resistant tuberculosis in sub-Saharan Africa: a systematic review and meta-analysis.

BackgroundPrevalence of multidrug resistant tuberculosis (MDR-TB), defined as in vitro resistance to both rifampicin and isoniazid with or without resistance to other TB drugs, in sub-Saharan Africa (SSA) is reportedly low compared to other regions. These estimates are based on data reported to the World Health Organization (WHO) on drug resistance surveys, which may suffer from a reporting bias. We set out to evaluate the variation in prevalence of drug resistant tuberculosis (DR-TB) and its determinants across SSA countries among new and previously treated TB patients.MethodsThe aim was to perform a systematic review and meta-analysis of DR-TB prevalence and associated risk factors in SSA. PubMed, EMBASE, Cochrane and bibliographies of DR-TB studies were searched. Surveys at national or sub-national level, with reported DR-TB prevalence (or sufficient data to calculate a prevalence) to isoniazid (INH), rifampicin (RMP), ethambutol (EMB), and streptomycin (SM) conducted in SSA excluding the Republic of South Africa, published between 2003 and 2013 with no language restriction were considered. Two authors searched and reviewed the studies for eligibility and extracted the data in pre-defined forms. Forest plots of all prevalence estimates by resistance outcome were performed. Summary estimates were calculated using random effects models, when appropriate. Associations between any DR-TB and MDR-TB with potential risk factors were examined through subgroup analyses stratified by new and previously treated patients.ResultsA total of 726 studies were identified, of which 27 articles fulfilled the inclusion criteria. Studies reported drug susceptibility testing (DST) results for a total of 13,465 new and 1,776 previously treated TB patients. Pooled estimate of any DR-TB prevalence among the new cases was 12.6% (95% CI 10.6-15.0) while for MDR-TB this was 1.5% (95% CI 1.0-2.3). Among previously treated patients, these were 27.2% (95% CI 21.4-33.8) and 10.3% (95% CI 5.8-17.4%), respectively. DR-TB (any and MDR-TB) did not vary significantly with respect to study characteristics.ConclusionsThe reported prevalence of DR-TB in SSA is low compared to WHO estimates. MDR-TB in this region does not seem to be driven by the high HIV prevalence rates.

HRM Strategies and Macro Factors in Sub-Saharan Africa: A Conceptual and Contextual Analysis of Access Bank PLC

Abundant information in the literature suggests that the constant and effective implementation of formulated human resource management (HRM) policies and strategies affects how employees’ appreciate the alignment of their personal goals and fit with the organization, and the extent to which the organization regard or respects the agreed terms of employment whether expressly stated or implied. (Mayer et al., 1995; Ross and La Croix, 1996; Dietz and Den Hartog, 2006; Searle et al., 2011b; Whitener, 2001). This objective of this paper is to appraise the training/ development strategies, recruitment strategies, performance appraisal and rewards strategies of Access Bank Plc. The game plan is to access the impact of these strategies on productivity (among other objectives), and to see if there are alternative approach to any of these. The role of internal and external factors (globalization, political-economic and organizational structure dimension) on the above mentioned strategies will also be appraised. Conclusions and recommendations on alternative approaches, solutions or strategies to follow (if any) will be thoroughly discussed and a clearer image of the “cause-and-effect” relationship of these strategies (approaches) and increased productivity will be drawn.

Cardiovascular risk factors among the inhabitants of an urban Congolese community: results of the VITARAA Study

ObjectiveThe objective is to assess cardiovascular risk profile in an urban Congolese population. Design and MethodsFrom July 2007 to March 2008, we investigated 1824 inhabitants (≥10year old) randomly recruited from the Adoula quarter (Kinshasa, Congo). Measurements included: anthropometry, medical history and lifestyle habits via questionnaire, blood pressure and pulse rate (Omron M6, HEM 7001E), blood glucose, plasma lipids, and semi-quantitative proteinuria tests. We used stepwise logistic regression to model the odds for hypertension and diabetes. ResultsIn 1292 adult participants ≥20years (56.6% women, mean age 37±15years), the prevalence of hypertension and known diabetes was 30.9% and 4.2%, respectively. Among participants with hypertension respectively 46.6%, 29.3% and 18.3% were aware, on treatment and controlled. Control was better among women and subjects below age 55, but lower in overweight/obese subjects. The odds for hypertension independently increased with age (P<0.0001), overweight/obesity (P<0.0001), pulse rate (P=0.0249) and high legumes consumption (P=0.0453). The odds for diabetes increased with age (P=0.0009) and overweight/obesity (P=0.0016). The prevalence of other risk factors was 5.5%, 42.2%, 42.8% and 30.9%, for smoking, overweight/obesity, abdominal adiposity and hypercholesterolemia; 4.6% of participants had proteinuria. Smoking predominated in men (10.8% vs. 1.4%), obesity (8.6% vs. 21.5%) and hypercholesterolemia (23.2% vs. 37.4%) in women. Hypertension clustered with three or more risk factors including diabetes or proteinuria in 68.7%. ConclusionOur findings highlight the staggering rates of cardiovascular risk factors in sub-Saharan Africa and underscore the pressing need to move their prevention and control higher on the political agenda.