Mortality In Africa Research Articles

High seroprevalence of SARS-CoV-2 but low infection fatality ratio eight months after introduction in Nairobi, Kenya

BackgroundThe lower than expected COVID-19 morbidity and mortality in Africa has been attributed to multiple factors, including weak surveillance. This study estimated the burden of SARS-CoV-2 infections eight months into the epidemic in Nairobi, Kenya.MethodsA population-based, cross-sectional survey was conducted using multi-stage random sampling to select households within Nairobi in November 2020. Sera from consenting household members were tested for antibodies to SARS-CoV-2. Seroprevalence was estimated after adjusting for population structure and test performance. Infection fatality ratios (IFRs) were calculated by comparing study estimates with reported cases and deaths.ResultsAmong 1,164 individuals, the adjusted seroprevalence was 34.7% (95% CI 31.8-37.6). Half of the enrolled households had at least one positive participant. Seropositivity increased in more densely populated areas (spearman's r=0.63; p=0.009). Individuals aged 20-59 years had at least two-fold higher seropositivity than those aged 0-9 years. The IFR was 40 per 100,000 infections, with individuals ≥60 years old having higher IFRs.ConclusionOver one-third of Nairobi residents had been exposed to SARS-CoV-2 by November 2020, indicating extensive transmission. However, the IFR was >10-fold lower than that reported in Europe and the USA, supporting the perceived lower morbidity and mortality in sub-Saharan Africa.

Healthcare professionals' knowledge of modifiable stroke risk factors: A cross-sectional questionnaire survey in greater Gaborone, Botswana.

BackgroundStroke remains the second leading cause of deaths and disability globally, with highest mortality in Africa (low- and middle-income countries). It is crucial for healthcare professionals to have sufficient stroke risk factors' knowledge in order to reduce the stroke burden.AimsWe investigated healthcare professionals' knowledge of modifiable stroke risk factors, and identified demographic factors influencing this knowledge.MethodsIn this cross-sectional survey study from Botswana (upper middle-income country), structured questionnaires reflecting recent stroke guidelines were administered to a representative selection of healthcare workers in greater Gaborone. The response rate was 61.4%, comprising 84 doctors, 227 nurses and 33 paramedics. Categorical data were described using percentages and Chi-square tests. Associations between stroke risk factors' knowledge and demographic factors were analyzed with one-way ANOVA using SPSS 25 statistical software.ResultsAwareness rate of individual stroke risk factors was highest for hypertension (96.5%), followed by obesity (93.3%), smoking (91.9%), elevated total cholesterol (91.0%), physical inactivity (83.4%), elevated low-density lipoprotein (LDL) cholesterol (81.1%), excessive alcohol drinking (77.0%), and lowest for diabetes (73.3%). For all-8 risk factors, doctors had the highest knowledge, followed by nurses and paramedics lowest (7.11 vs 6.85 vs 6.06, P < 0.05).ConclusionIn Botswana, specific healthcare professionals' subgroups need to be targeted for continuing education on stroke risk factors for improving stroke prevention and reducing stroke-related disability and mortality.

Understanding the performance of a pan-African intervention to reduce postoperative mortality: a mixed-methods process evaluation of the ASOS-2 trial

BackgroundThe African Surgical OutcomeS-2 (ASOS-2) trial tested an enhanced postoperative surveillance intervention to reduce postoperative mortality in Africa. We undertook a concurrent evaluation to understand the process of intervention delivery. MethodsMixed-methods process evaluation, including field notes, interviews, and post-trial questionnaire responses. Qualitative analysis used the framework method with subsequent creation of comparative case studies, grouping hospitals by intervention fidelity. A post-trial questionnaire was developed using initial qualitative analyses. Categorical variables were summarised as count (%) and continuous variables as median (inter-quartile range [IQR]). Odds ratios (OR) were used to rank influences by impact on fidelity. ResultsThe dataset included eight in-depth case studies, and 96 questionnaire responses (response rate 67%) plus intervention fidelity data for each trial site. Overall, 57% (n=55/96) of hospitals achieved intervention delivery using an inclusive definition of fidelity. Delivery of the ASOS-2 interventions and data collection presented a significant burden to the investigators, outstripping limited resources. The influences most associated with fidelity were: surgical staff enthusiasm for the trial (OR=3.0; 95% confidence interval [CI], 1.3–7.0); nursing management support of the trial (OR=2.6; 95% CI, 1.1–6.5); performance of a dummy run (OR=2.6; 95% CI, 1.1–6.1); nursing colleagues seeing the value of the intervention(s) (OR=2.1; 95% CI, 0.9–5.7); and site investigators' belief in the effectiveness of the intervention (OR=3.2; 95% CI, 1.2–9.4). ConclusionsASOS-2 has proved that coordinated interventional research across Africa is possible, but delivering the ASOS-2 interventions was a major challenge for many investigators. Future improvement science efforts must include better planning for intervention delivery, additional support to investigators, and promotion of strong inter-professional teamwork. Clinical trial registrationClinicalTrials gov NCT03853824.

Qualitative Evaluation of the Africa Malaria Task Force Symposia Effectiveness on African Partner Nations' Malaria Vector Management Capacity.

Creating health alliances to build meaningful networks is critical to combating regional and global burdens of disease. These alliances work by uniting support for elimination efforts through cooperative engagement at the national and international levels. The reduction in malaria-related morbidity and mortality in Africa since 2001 is in part because of investments of international organizations and governments in national level malaria control and prevention-related programs and research. Investment in malaria reduction networks has contributed to this success by strengthening support to overcome the conditions that restrict or prevent change through local laboratory and epidemiological capacity building, thereby resulting in a decrease in burden of disease, increase in economic prosperity, and improvements in stability worldwide.The reformation of local military efforts to combat disease through incorporation into health security alliance networks by the provision of training and financial support is key to reinforcing this success at the national level. One such example of this is the U.S. Africa Command (USAFRICOM) established and partner nation (PN) led Africa Malaria Task Force (AMTF) program. USAFRICOM's mission for AMTF as a health security alliance was to develop sustainable African-led malaria diagnostic, vector surveillance and control capabilities, and to increase collaborations among AMTF military PNs by enabling national and international-level network capacity. The overall objective of this evaluation of the AMTF program was to assess the implementation effectiveness of two AMTF supported symposia in improving the individual, organizational, and institutional diagnostic capacity of the Ghanaian, Ivorian, and Senegalese armed forces. The specific aims of this process evaluation were to identify procedural, contextual, and capacity-related factors that influence the effect of the symposia events on laboratory capabilities at the individual, organizational, and institutional levels through a two-phased formative evaluation approach utilizing qualitative methodologies. Findings indicate that the AMTF program symposia positively encouraged malaria prevention and control efforts in all three countries included in the evaluation. Conclusions suggest that learning about the different types of malaria prevention and control efforts underway in other countries helped to contextualize the burden of malaria-related morbidity and mortality not only within their respective countries, but also across the African continent. Participation in the AMTF Symposia and Key Leader Events helped military leadership clarify the purpose and intention of their military objectives related to systemic malaria prevention and control while purposefully contributing to national land international-level malaria reduction capacity.

Enhanced postoperative surveillance versus standard of care to reduce mortality among adult surgical patients in Africa (ASOS-2): a cluster-randomised controlled trial

SummaryBackgroundRisk of mortality following surgery in patients across Africa is twice as high as the global average. Most of these deaths occur on hospital wards after the surgery itself. We aimed to assess whether enhanced postoperative surveillance of adult surgical patients at high risk of postoperative morbidity or mortality in Africa could reduce 30-day in-hospital mortality.MethodsWe did a two-arm, open-label, cluster-randomised trial of hospitals (clusters) across Africa. Hospitals were eligible if they provided surgery with an overnight postoperative admission. Hospitals were randomly assigned through minimisation in recruitment blocks (1:1) to provide patients with either a package of enhanced postoperative surveillance interventions (admitting the patient to higher care ward, increasing the frequency of postoperative nursing observations, assigning the patient to a bed in view of the nursing station, allowing family members to stay in the ward, and placing a postoperative surveillance guide at the bedside) for those at high risk (ie, with African Surgical Outcomes Study Surgical Risk Calculator scores ≥10) and usual care for those at low risk (intervention group), or for all patients to receive usual postoperative care (control group). Health-care providers and participants were not masked, but data assessors were. The primary outcome was 30-day in-hospital mortality of patients at low and high risk, measured at the participant level. All analyses were done as allocated (by cluster) in all patients with available data. This trial is registered with ClinicalTrials.gov, NCT03853824.FindingsBetween May 3, 2019, and July 27, 2020, 594 eligible hospitals indicated a desire to participate across 33 African countries; 332 (56%) were able to recruit participants and were included in analyses. We allocated 160 hospitals (13 275 patients) to provide enhanced postoperative surveillance and 172 hospitals (15 617 patients) to provide standard care. The mean age of participants was 37·1 years (SD 15·5) and 20 039 (69·4%) of 28 892 patients were women. 30-day in-hospital mortality occurred in 169 (1·3%) of 12 970 patients with mortality data in the intervention group and in 193 (1·3%) of 15 242 patients with mortality data in the control group (relative risk 0·96, 95% CI 0·69–1·33; p=0·79). 45 (0·2%) of 22 031 patients at low risk and 309 (5·6%) of 5500 patients at high risk died. No harms associated with either intervention were reported.InterpretationThis intervention package did not decrease 30-day in-hospital mortality among surgical patients in Africa at high risk of postoperative morbidity or mortality. Further research is needed to develop interventions that prevent death from surgical complications in resource-limited hospitals across Africa.FundingBill & Melinda Gates Foundation and the World Federation of Societies of Anaesthesiologists.TranslationsFor the Arabic, French and Portuguese translations of the abstract see Supplementary Materials section.

Determinants of Utilization of Early Infant HIV Diagnosis Services at Kericho County Referral Hospital, Kericho County, Kenya

HIV and AIDS has become a health challenge globally. It is a major cause of infant and childhood morbidity and mortality in Africa. This research was a cross sectional analytical survey to assess the determinants of utilization of Early Infant Diagnosis (EID) at Kericho County Referral Hospital (KCRH). Data was collected using pretested questionnaires, administered to the postnatal HIV positive mothers and or caretakers of HIV exposed children. Data was analysed using SPSS software version 18.0. Data was analysed using Chi-square and Logistic Regression analysis. Of the 254 respondents, 201 (79.1%) were biological mothers to the children, the rest were caretakers. The children were aged between 1 and 18 months with a mean age of 9.62 months. Majority of the respondents had adequate knowledge of adult HIV infection with regard to what HIV is, routes of transmission, diagnosis and treatment. Knowledge of paediatric HIV infection was however inadequate with only 132 (52%) respondents who knew the approximate rate of HIV transmission from mother to child and 130 (51.2%) who knew about the availability of paediatric Antiretroviral (ARV) drugs. Both adult and paediatric HIV knowledge was better with increasing level of education. The younger respondents were also more knowledgeable than the older ones. The children who had utilized EID were only 75 (29.5%). The significant determinants of EID utilization included: the level of education (p=0.002), the place of delivery (p&lt;0.01), the age of the respondent (p=0.008), the distance to the nearest healthcare facility that offered EID (p=0.004) among others. The most significant determinants of EID utilization were the level of education, accessibility and the age of the respondents. In conclusion, EID utilization is still low in Kericho County. This study recommends that improving maternal education would improve EID uptake.

Screening and characterization of hypothetical proteins of Plasmodium falciparum as novel vaccine candidates in the fight against malaria using reverse vaccinology

BackgroundPlasmodium falciparum is the most deadly and leading cause of morbidity and mortality in Africa. About 90% of all malaria deaths in the world today occur in Sub-Saharan Africa especially in children aged < 5 years. In 2018, it was reported that there were 228 million malaria cases that resulted in 405,000 deaths from 91 countries. Currently, a fully effective and long-lasting preventive malaria vaccine is still elusive therefore more effort is needed to identify better effective vaccine candidates. The aim of this study was to identify and characterize hypothetical proteins as vaccine candidates derived from Plasmodium falciparum 3D7 genome by reverse vaccinology. ResultsOf the 23 selected hypothetical proteins, 5 were predicted on the extracellular localization by WoLFPSORTv.2.0 program and all the 5 had less than 2 transmembrane regions that were predicted by TMHMMv2.0 and HMMTOP programs at default settings. Two out of the five proteins lacked secretory signal peptides as predicted by SignalP program. Among the 5 extracellular proteins, 3 were predicted to be antigenic by VaxiJen (score ≥ 0.5) and had negative GRAVY values ranging from − 1.156 to − 0.440. B cell epitope prediction by ABCpred and BCpred programs revealed a total of 15 antigenic epitopes. A total of 13 cytotoxic T cells were predicted from the 3 proteins using CTLPred online server. Only 2 out of the 13 CTL were antigenic, immunogenic, non-allergenic, and non-toxic using VaxiJen, IEDB, AllergenFp, and Toxinpred servers respectively in that order. Five HTL peptides from XP_001351030.1 protein are predicted inducers of all the three cytokines. STRING protein–protein network analysis of HPs revealed XP_001350955.1 closely interacts with nucleoside diphosphate kinase (PF13-0349) at 0.704, XP_001351030.1 interacts with male development protein1 (Mdv-1) at 0.645, and XP_001351047.1 with an uncharacterized protein (MAL8P1.53) at 0.400. ConclusionReverse vaccinology is a promising strategy for the screening and identification of antigenic antigens with potential capacity to elicit cellular and humoral immune responses against P. falciparum infection. In this study, potential vaccine candidates of Plasmodium falciparum were identified and screened using standard bioinformatics tools. The vaccine candidates contained antigenic and immunogenic epitopes which could be considered for novel and effective vaccine targets. However, we strongly recommend in vivo and in vitro experiments to validate their immunogenicity and protective efficacy to completely decipher the vaccine targets against malaria.

Abstract 46: Clinical Outcomes and Quality Metrics of Cervical Cancer Treatment in Rwanda

Abstract Purpose: Cervical cancer is a leading cause of cancer-related mortality in Africa. As treatment capacity expands, it is critical to evaluate outcomes and identify targets for quality improvement. We describe a cohort of cervical cancer patients at Butaro Cancer Center (BCCOE) in rural Rwanda, many co-managed by gynecologic specialists at the national referral hospital and a subset referred for definitive chemoradiotherapy plus brachytherapy (CRT) in Nairobi based on available funds and estimated curability. Methosd: We conducted a retrospective cohort study of all patients with cervical cancer seen at BCCOE between 6/2016 and 6/2018. Data were extracted from clinical charts and analyzed using descriptive statistics and Kaplan Meier method. Results: 377 patients were included; median age 54 years, 21% HIV positive. Most patients (85%) had squamous cell carcinoma. A majority (67%) had stage III or IV disease at presentation. Several early stage patients underwent radical hysterectomy (n=34). 114 (30%) received CRT, representing 45% of eligible candidates. Of these, 30 (26%) received upfront CRT after a median 126 days from diagnosis, and 83 (73%) received “temporizing” carboplatin/paclitaxel while awaiting CRT, with a median 56 days from diagnosis to chemotherapy. Patients sent for upfront CRT were younger (p &amp;lt;0.001) and more likely stage II (p &amp;lt;0.001). Nevertheless, there was no survival difference between upfront CRT versus temporizing chemotherapy before CRT. Most chemotherapy recipients (77%) reported improvement in symptoms. Estimated 3-year overall survival was 94% with radical hysterectomy (95% CI 63-99%), 66% with CRT (95% CI 54-75%), 11% with chemotherapy only (95% CI 5-19%), and 7% with no treatment (95% CI 2-17%) (p&amp;lt;0.001). Conclusion: Multi-modality treatment of cervical cancer is effective in low resource settings through coordinated care and pragmatic approaches. Our data support a role for temporizing chemotherapy if delays to CRT are anticipated. Expanded and timely access to radiation is urgently needed. Citation Format: Victoria Umutoni, Cyprien Shyirambere, Ethan Katznelson, Cam Nguyen, Jean Bosco Bigirimana, Aline Umwizerwa, Alan Paciorek, Lisa Bazzett-Matabele, Diomede Ntasumbumuyange, Scott Triedman, Lawrence Shulman, Tharcisse Mpunga, Rebecca DeBoer. Clinical Outcomes and Quality Metrics of Cervical Cancer Treatment in Rwanda [abstract]. In: Proceedings of the 9th Annual Symposium on Global Cancer Research; Global Cancer Research and Control: Looking Back and Charting a Path Forward; 2021 Mar 10-11. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2021;30(7 Suppl):Abstract nr 46.

Abstract 11: Neglected Elements of Cancer Control During The COVID-19 Pandemic in Africa: Call for Action from 2019-2020 African Cancer Research and Control ECHO Programme

Abstract Purpose: As the world is learning to live with the coronavirus (COVID-19) pandemic, there is a shift in cancer control priorities and focus, with innovations to ensure continuity of cancer treatment and patient support during the COVID-19 pandemic. However, cancer control requires a comprehensive approach to minimize cancer incidence, mortality and improve the quality of life of those living with cancer. Hence, this analysis aimed to identify areas of cancer control affected by the COVID-19 pandemic that would equally affect cancer incidence, morbidity and mortality in Africa. Methods: The Africa Cancer Research and Control ECHO® Programme (Africa Cancer ECHO) is a community of practice that meets in an online platform to discuss cancer control challenges and solutions in the Africa region. The Africa Cancer ECHO conducted eleven sessions from April to August 2020 about the emerging COVID-19 pandemic, its impact on cancer control in Africa, and country-level practices as presented through case and didactic presentations. Sessions were analysed thematically to identify elements of cancer control that are adversely affected as a result of the COVID-19 pandemic and how they have been addressed. Results: HPV vaccination, cancer screening and early detection services, palliative care (PC) services, and cancer registration were particularly adversely affected, and in many cases have not yet resumed in some African countries. Recommendations included: use of affordable point of care HPV tests with immediate results; introducing COVID-19 testing along with HPV-testing; transitioning PC services from hospice to home care; and embracing Information Technology to enhance cancer registration. Conclusion: Cancer prevention, screening, supportive care, and surveillance services need to be urgently revitalised in Africa. The Africa Cancer ECHO platform highlights the need for generation of locally-relevant, evidence-based strategies that will safeguard past gains and continue to maximize the reduction of cancer incidence, morbidity and mortality during the COVID-19 pandemic. Citation Format: Annet Nakaganda, Nwamaka Lasebikan, Elise M. Garton, Benda Kithaka, Mishka K. Cira. Neglected Elements of Cancer Control During The COVID-19 Pandemic in Africa: Call for Action from 2019-2020 African Cancer Research and Control ECHO Programme [abstract]. In: Proceedings of the 9th Annual Symposium on Global Cancer Research; Global Cancer Research and Control: Looking Back and Charting a Path Forward; 2021 Mar 10-11. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2021;30(7 Suppl):Abstract nr 11.

Report of the Premier African Organisation for Research and Training in Cancer Virtual Genomics Conference held from 18-20 February 2021.

The rapidly rising cancer burden and mortality rate in Africa are in contrast to the increase in cancer survivorship in Europe and North America. Genomic medicine has contributed to the rise in survival and has facilitated precision cancer control. However, there is a shortage of African representation in genomic databases, even for cancers that disproportionately affect Africans. To improve this outlook and address research in genomics and genetics relevant to Africa and people of African descent, the African Organisation for Research and Training in Cancer (AORTIC), under the Research Committee’s auspices, organised the Cancer Genomic Conference. The conference aimed to develop a roadmap for cancer genomics research to control the continent’s increasing cancer burden. Presentations at the conference revealed that: (1) Africa is made up of a highly heterogeneous group of people with diverse ethnic groups, (2) Very few African countries have been the focus of cancer genomics research, (3) Cancer exacts a heavy burden on global populations across the African diaspora with obvious genetic variants and cancer disparities and (4) There are differences in the contribution of genetics by race or ancestry and these differences are likely due to evolutionary genetics, contextual factors and genomic architecture. The importance of data security, ethics and integrity of the African genomics data was emphasised. The implementation of the conference highlights will provide the bedrock for pharmacogenomics to guide treatment decisions for cancer in Africa. The conference concluded with the formation of an AORTIC Special Interest Group on cancer genomics. It is the goal of this group to drive the implementation of this Conference’s outcomes.

Excess COVID-19 mortality among critically ill patients in Africa

Excess COVID-19 mortality among critically ill patients in Africa

Bridging the Radiotherapy Education Gap in Africa: Lessons Learnt from the Cape Town Access to Care Training Programme Over the Past 5 Years (2015-2019).

The role of radiotherapy (RT) in cancer care is well described, with a clear correlation between access to radiotherapy and overall survival. Cancer mortality rates in Africa are substantially higher than those of the rest of the world, which may be partly attributed to lack of RT access and insufficient human resources. The Access to Care (A2C) Cape Town RT training programme was created in 2014 with the aim of supplementing practical RT training in the region, focusing on clinics moving from 2 to 3D conformal radiotherapy (3DCRT). The programme makes use of hybrid teaching methods, including pre-course e-learning followed by 17 on-site days of free-thinking design exercises, didactic learning, hands-on treatment planning computer sessions (39% of total teaching time), virtual simulation training and departmental demonstration sessions. Email support is offered to all teams for 3 months after each course to develop clinical protocols. Thirteen teams (radiation oncologist, medical physicist and radiation therapy technologist) from Africa attended the course between 2015 and 2019, with additional participants from seven South African and four international centres. E-learning done on the LäraNära training platform was only successful once formal progress tracking was introduced in 2019 (34% vs. 76% test completion rate). Delays between course attendance and initial clinical use of equipment proved to be detrimental to knowledge retention, with some centres having to send a second team for training. The course will be modified for remote teaching in 2021, to make provision for the global changes in travel due to Covid-19.

Bordetella pertussis in School-Age Children, Adolescents, and Adults: A Systematic Review of Epidemiology, Burden, and Mortality in Africa.

The Global Pertussis Initiative recommends diphtheria–tetanus–pertussis (DTP3) vaccination of infants aged < 1 year for all African countries, and recommends the vaccination of pregnant women as a primary prevention strategy. However, the role of older children and adults in the transmission of pertussis in Africa is not clear. A systematic search of MEDLINE, EMBASE, and BIOSIS was undertaken to identify studies published between 1 January 1990 and 17 June 2019, with information on pertussis epidemiology, burden of illness, and mortality in school-aged children, adolescents, and adults in Africa. Studies identified for inclusion were reviewed narratively because a statistical comparison was not possible because of the mix of methodologies used.Studies from North Africa (Morocco, Tunisia, and Algeria) reported that although DTP4 vaccine coverage is high, severe pertussis-related complications persist in young children, vaccine-acquired immunity wanes in adolescents, and household contacts are important transmitters of infection. A serosurvey in Gambia showed that 6% of the general population had pertussis antibody levels suggesting recent infection, and studies from Senegal showed that pertussis infection was endemic despite high DTP3 coverage. During a pertussis outbreak in Ethiopia, the case fatality rate was 3.7% overall, and 6.3% among children aged 5–9 years. In a case-surveillance study in South Africa, the incidence of pertussis among hospitalized children was 526/100,000, and infection rates were higher in HIV-exposed and -infected children compared with uninfected children. In conclusion, the highest burden of pertussis in Africa is among infants, and surveillance is lacking in many African countries meaning that the burden of pertussis among infants and infection rates among older children and adults are not well reported, and likely underestimated.Electronic supplementary materialThe online version of this article (doi:10.1007/s40121-021-00442-6) contains supplementary material, which is available to authorized users.

Cancer in Africa: The Untold Story.

BackgroundDespite rising incidence and mortality rates in Africa, cancer has been given low priority in the research field and in healthcare services. Indeed, 57% of all new cancer cases around the world occur in low income countries exacerbated by lack of awareness, lack of preventive strategies, and increased life expectancies. Despite recent efforts devoted to cancer epidemiology, statistics on cancer rates in Africa are often dispersed across different registries. In this study our goal included identifying the most promising prevention and treatment approaches available in Africa. To do this, we collated and analyzed the incidence and fatality rates for the 10 most common and fatal cancers in 56 African countries grouped into 5 different regions (North, West, East, Central and South) over 16-years (2002–2018). We examined temporal and regional trends by investigating the most important risk factors associated to each cancer type. Data were analyzed by cancer type, African region, gender, measures of socioeconomic status and the availability of medical devices.ResultsWe observed that Northern and Southern Africa were most similar in their cancer incidences and fatality rates compared to other African regions. The most prevalent cancers are breast, bladder and liver cancers in Northern Africa; prostate, lung and colorectal cancers in Southern Africa; and esophageal and cervical cancer in East Africa. In Southern Africa, fatality rates from prostate cancer and cervical cancer have increased. In addition, these three cancers are less fatal in Northern and Southern Africa compared to other regions, which correlates with the Human Development Index and the availability of medical devices. With the exception of thyroid cancer, all other cancers have higher incidences in males than females.ConclusionOur results show that the African continent suffers from a shortage of medical equipment, research resources and epidemiological expertise. While recognizing that risk factors are interconnected, we focused on risk factors more or less specific to each cancer type. This helps identify specific preventive and therapeutic options in Africa. We see a need for implementing more accurate preventive strategies to tackle this disease as many cases are likely preventable. Opportunities exist for vaccination programs for cervical and liver cancer, genetic testing and use of new targeted therapies for breast and prostate cancer, and positive changes in lifestyle for lung, colorectal and bladder cancers. Such recommendations should be tailored for the different African regions depending on their disease profiles and specific needs.

The African tragedy: the effect of democracy on economic growth

We estimate the effect of democracy on economic growth for the countries in Sub-Saharan Africa in comparison with other countries. We find that in contrast to other countries, democracy in Africa benefits neither GDP per capita nor total GDP. We explain the former by changes in the size of the population and the latter by changes in the age structure of the population. Both demographic changes relate to the finding that unlike in other countries, democracy does not reduce child mortality in Africa. The evidence suggests that without improvements in health, democracy puts Africa on a path toward a Malthusian trap.

Fine Particulate Matter Constituents and Infant Mortality in Africa: A Multi-Country Study

Background: Few studies have investigated the association between exposure to fine particulate matter (PM2.5) and infant mortality in developing countries, especially for the health effects of specific PM2.5 constituents. We aimed to examine the association of long-term exposure to specific PM2.5 constituents with infant mortality in 15 African countries from 2005 to 2015. Methods: Based on the Demographic and Health Surveys (DHS) dataset, we included birth history records from 15 countries in Africa and conducted a multi-country cross-sectional study to examine the associations between specific PM2.5 constituents and infant mortality. We used satellite-based models to predict annual residential exposure to PM2.5 and its six constituents, including organic carbon (OC), black carbon (BC), sulfate (SO>sub>42−) , nitrate (NO3−), ammonium (NH4+), and soil dust (DUST). Multivariable logistic regression analysis was employed by fitting single-constituent models, the constituent-PM2.5 models, and the constituent-residual models. We also conducted stratified analyses by potential effect modifiers and examined the specific associations for each country. Findings: We found positive and significant associations between PM2.5 total mass and most of its constituents with infant mortality. In the single-constituent model, for an IQR increase in pollutant concentrations, the odds ratio (OR) of infant mortality was 1·03 (95%CI; 1·01, 1·06) for PM2.5 total mass, and was 1·04 (95%CI: 1·02, 1·06), 1·04 (95%CI: 1·02, 1·05), 1·02 (95%CI: 1·00, 1·03), 1·04 (1·01, 1·06) for BC, OC, SO42-, and DUST, respectively. The associations of BC, OC, and SO42- remained significant in the other two models. We observed larger estimates in subgroups with older maternal age, living in urban areas, using unclean cooking energy, and with access to piped water. The associations varied among countries, and by different constituents. Interpretation: The carbonaceous fractions and sulfate play a major important role among PM2.5 constituents on infant mortality, suggesting the need for a targeted controlling strategy on corresponding sources of emissions. Funding: HK was supported by the National Natural Science Foundation of China (92043301 and 82030103). CL was supported by the China Postdoctoral Science Foundation (2020M681185) and China National Postdoctoral Program for Innovative Talents (BX20200088). Declaration of Interests: The authors have declared that no competing interests exist.

Assessing sub-regional-specific strengths of healthcare systems associated with COVID-19 prevalence, deaths and recoveries in Africa.

IntroductionThe coronavirus 2019 (COVID-19) has overwhelmed the health systems of several countries, particularly those within the African region. Notwithstanding, the relationship between health systems and the magnitude of COVID-19 in African countries have not received research attention. In this study, we investigated the relationship between the pervasiveness of the pandemic across African countries and their Global Health Security Index (GHSI) scores.Materials and methodsThe study included 54 countries in five regions viz Western (16); Eastern (18); Middle (8); Northern (7); and Southern (5) Africa. The outcome variables in this study were the total confirmed COVID-19 cases (per million); total recoveries (per million); and the total deaths (per million). The data were subjected to Spearman’s rank-order (Spearman’s rho) correlation to determine the monotonic relationship between each of the predictor variables and the outcome variables. The predictor variables that showed a monotonic relationship with the outcome were used to predict respective outcome variables using multiple regressions. The statistical analysis was conducted at a significance level of 0.05.ResultsOur results indicate that total number of COVID-19 cases (per million) has strong correlations (rs >0.5) with the median age; aged 65 older; aged 70 older; GDP per capita; number of hospital beds per thousand; Human Development Index (HDI); recoveries (per million); and the overall risk environment of a country. All these factors including the country’s commitments to improving national capacity were related to the total number of deaths (per million). Also, strong correlations existed between the total recoveries (per million) and the total number of positive cases; total deaths (per million); median age; aged 70 older; GDP per capita; the number of hospital beds (per thousand); and HDI. The fitted regression models showed strong predictive powers (R-squared>99%) of the variances in the total number of COVID-19 cases (per million); total number of deaths (per million); and the total recoveries (per million).ConclusionsThe findings from this study suggest that patient-level characteristics such as ageing population (i.e., 65+), poverty, underlying co-morbidities–cardiovascular disease (e.g., hypertension), and diabetes through unhealthy behaviours like smoking as well as hospital care (i.e., beds per thousand) can help explain COVID-19 confirmed cases and mortality rates in Africa. Aside from these, other determinants (e.g., population density, the ability of detection, prevention and control) also affect COVID-19 prevalence, deaths and recoveries within African countries and sub-regions.

Needs assessment of community health workers to enhance efficient delivery of their services for community case management of malaria in Kenya

BackgroundMalaria continues to be the leading cause of morbidity and mortality in Africa. Community Case Management of malaria (CCMm) which is undertaken by engaging Community Health Workers (CHWs) to effectively address management of malaria cases in some endemic communities was explored in this study. The aim was to assess the needs of CHWs that would help sustain and retain their services to enhance the efficient delivery of CCMm.MethodsUsing semi-structured questionnaires, data on the needs of CHWs was gathered through a qualitative study consisting of in-depth interviews and focus group discussions (FGDs) conducted among study participants in five districts in western Kenya. The study participants comprised of 100 CHWs, 100 mothers of children under five years and 25 key informants made up of public health officers and clinicians involved in the CCMm. The interviews were conducted in English and Swahili or Dholuo, the local language. The recorded audio interviews were transcribed later. The analysis was done using NVivo version 7 software and transcripts were coded after which themes related to the objectives of the study were identified.ResultsAll the study participants recognized the need to train and update CHWs on their work as well as remunerating them for their services to enhance efficient delivery of services. The CHWs on their part perceived the provision of gloves, rapid diagnostic test kits (RDTs), lancets, cotton wool and ethanol, bins (to dispose of RDTs and lancets), together with drugs for treating clients as the essential needs to undertake CCMm in the communities. Other logistical needs and incentives mentioned by CHWs and key informants for the successful delivery of CCMm included: gumboots, raincoats, torch lights, mobile phones, means of transportation (bicycles and motorbikes), uniforms and ID cards for identification.ConclusionsCHWs would perform tasks better and their services retained for a sustainable CCMm if: properly incentivized; offered refresher trainings (and updates) on malaria; and equipped with the requisite tools identified in this study.

A Review of Cancer Genetics and Genomics Studies in Africa.

Cancer is the second leading cause of death globally and is projected to overtake infectious disease as the leading cause of mortality in Africa within the next two decades. Cancer is a group of genomic diseases that presents with intra- and inter-population unique phenotypes, with Black populations having the burden of morbidity and mortality for most types. At large, the prevention and treatment of cancers have been propelled by the understanding of the genetic make-up of the disease of mostly non-African populations. By the same token, there is a wide knowledge gap in understanding the underlying genetic causes of, and genomic alterations associated with, cancer among black Africans. Accordingly, we performed a review of the literature to survey existing studies on cancer genetics/genomics and curated findings pertaining to publications across multiple cancer types conducted on African populations. We used PubMed MeSH terms to retrieve the relevant publications from 1990 to December 2019. The metadata of these publications were extracted using R text mining packages: RISmed and Pubmed.mineR. The data showed that only 0.329% of cancer publications globally were on Africa, and only 0.016% were on cancer genetics/genomics from Africa. Although the most prevalent cancers in Africa are cancers of the breast, cervix, uterus, and prostate, publications representing breast, colorectal, liver, and blood cancers were the most frequent in our review. The most frequently reported cancer genes were BRCA1, BRCA2, and TP53. Next, the genes reported in the reviewed publications’ abstracts were extracted and annotated into three gene ontology classes. Genes in the cellular component class were mostly associated with cell part and organelle part, while those in biological process and molecular function classes were mainly associated with cell process, biological regulation, and binding, and catalytic activity, respectively. Overall, this review highlights the paucity of research on cancer genomics on African populations, identified gaps, and discussed the need for concerted efforts to encourage more research on cancer genomics in Africa.

High‐skilled emigration and child health in Africa

Africa is estimated to lose a very significant number of high‐skilled individuals through emigration. This has resulted in a number of studies investigating the effect of high‐skilled emigration on socio‐economic indicators in Africa. Notwithstanding, the majority of these studies have examined the effect of high‐skilled emigration on economic growth, with less attention paid to health outcomes. Meanwhile, health outcomes, especially child health outcomes, have major implications for future human capital and overall economic development. With sub‐Saharan Africa (SSA) having the highest child mortality rate in the world, this study, therefore, investigates the effect of the emigration of high‐skilled individuals on child health in 48 African countries for the period, 1985–2010. Neonatal mortality and infant mortality rates are used to proxy child health. The panel fixed effects and the dynamic panel system Generalised Methods of Moments (GMM) regressions are employed as estimation techniques. Using the panel fixed effects, we find that, while the emigration of high‐skilled individuals is detrimental to neonatal mortality, in the case of infant mortality, it is insignificant. However, after controlling for endogeneity using the dynamic panel system GMM, the emigration of high‐skilled individuals is found to be detrimental to both neonatal mortality and infant mortality. The results suggest that, in order to enhance child mortality in Africa, attention should be paid towards decreasing high‐skilled emigration on the continent.