Mortality In sub-Saharan Africa Research Articles

Risk Factors of Standalone and Coexisting Forms of Undernutrition Among Children in Sub-Saharan Africa: A Study Using Data from 26 Country-Based Demographic and Health Surveys

Introduction: Undernutrition in low- and middle-income countries (LMICs) remains a leading public health challenge. It accounts for one-third of the under-five mortality rate in sub-Saharan Africa (SSA). This study applied the composite index of anthropometric failure (CIAF) to assess the prevalence of various standalone and coexisting forms of undernutrition and identify associated risk factors. Methods: Nationally representative demographic health survey (DHS) data from 26 SSA countries were used. A multilevel multinomial logistic regression analysis was conducted considering the hierarchical nature of DHS data and more than two categories of outcome variable. Four models were fitted and the model with the highest log-likelihood and lowest deviance was chosen as the best-fitted model. The adjusted relative risk ratio (aRRR) with its corresponding 95% confidence interval (CI) was presented as a measure of the effect. Results: The overall prevalence of undernutrition among under-five children in SSA was 34.59% (95% CI: 34.35–34.82). Additionally, 20.49% (95% CI: 20.30–20.69) and 14.09% (95% CI: 13.92–14.26) of under-five children had standalone and coexisting undernutrition, respectively. The mother’s educational level and household wealth status were the most significant shared drivers for standalone and coexisting undernutrition. On the other hand, child and health service factors were differentiating factors between standalone and coexisting undernutrition. Age of the child, sex of the child, type of birth, birth weight, adherence to age-appropriate feeding, antenatal care visit (ANC), place of delivery, and maternal educational status were the most significant determinants of various undernutrition forms in 0–23-month-old children. For 24–59-month-old children, age of the child, sex of the child, type of birth, household wealth status, and maternal education were identified as the main determinants of different forms of undernutrition. Conclusions: Our analysis revealed that distal factors were shared risk factors among standalone and coexisting forms of undernutrition. However, proximal and intermediate factors varied in the type and strength of the association between standalone and coexisting undernutrition. This implies that holistic and category-specific strategies are needed to significantly reduce undernutrition among under-five children in SSA.

Mathematical modelling to estimate the impact of maternal and perinatal healthcare services and interventions on health in sub-Saharan Africa: A scoping review.

Mathematical modelling is a commonly utilised tool to predict the impact of policy on health outcomes globally. Given the persistently high levels of maternal and perinatal morbidity and mortality in sub-Saharan Africa, mathematical modelling is a potentially valuable tool to guide strategic planning for health and improve outcomes. The aim of this scoping review was to explore the characteristics of mathematical models and modelling studies evaluating the impact of maternal and/or perinatal healthcare interventions or services on health-related outcomes in the region. A search across three databases was conducted on 2nd November 2023 which returned 8660 potentially relevant studies, from which 60 were included in the final review. Characteristics of these studies, the interventions which were evaluated, the models utilised, and the analyses conducted were extracted and summarised. Findings suggest that the popularity of modelling within this field is increasing over time with most studies published after 2015 and that population-based, deterministic, linear models were most frequently utilised, with the Lives Saved Tool being applied in over half of the reviewed studies (n = 34, 57%). Much less frequently (n = 6) models utilising system-thinking approaches, such as individual-based modelling or systems dynamics modelling, were developed and applied. Models were most applied to estimate the impact of interventions or services on maternal mortality (n = 34, 57%) or neonatal mortality outcomes (n = 39, 65%) with maternal morbidity (n = 4, 7%) and neonatal morbidity (n = 6, 10%) outcomes and stillbirth reported on much less often (n = 14, 23%). Going forward, given that healthcare delivery systems have long been identified as complex adaptive systems, modellers may consider the advantages of applying systems-thinking approaches to evaluate the impact of maternal and perinatal health policy. Such approaches allow for a more realistic and explicit representation of the systems- and individual- level factors which impact the effectiveness of interventions delivered within health systems.

Immune responses to SARS-CoV-2 in sub-Saharan Africa andwestern Europe: a retrospective, population-based, cross-sectional study.

SARS-CoV-2 has been associated with a higher proportion of asymptomatic infections and lower mortality in sub-Saharan Africa than high-income countries. However, there is currently a lack of data on cellular immune responses to SARS-CoV-2 in people living in Africa compared with people in high-income regions of the world. We aimed to assess geographical variation in peripheral and mucosal immune responses. In this retrospective, population-based, cross-sectional study, we analysed peripheral blood and nasal curettage samples from seven clinical studies involving individuals from Senegal (Senegalese cohort), the Netherlands, and Germany (European cohort). Samples were collected between Nov 1, 2018, and Dec 20, 2021. Weincluded samples from individuals with no, mild, or severe COVID-19. Avalidation cohort of individuals from Senegal and Gabon (n=64) was used to validate key findings from the main cohort. Matching of individuals between geographical regions by age, sex, viral load, and infection severity and duration was used to address confounding factors. We examined the cellular, humoral, and cytokine immune responses using cytometry by time of flight, spectral flow cytometry, ELISA, and Luminex. We included 133individuals (59 from the Senegalese cohort and 74from the European cohort). In contrast to the European cohort, mild COVID-19 in the Senegalese cohort was not associated with any statistically significant perturbations in blood or nasal immune cell profiles, nor with increased pro-inflammatory cytokines, although SARS-CoV-2-specific adaptive immunity was readily induced, as seen in Europeans. In severe COVID-19, both theSenegalese and European cohorts showed lymphopenia (Senegal: 2·9-times decrease, p=0·0010 vs Europe: 1·6-times decrease, p=0·0046) and increased neutrophil frequencies in blood (Senegal: 2·0-times increase, p=0·0044 vs Europe: 1·3-times increase, p=0·026) and the nasal mucosa CD66b+CD16low neutrophils (Senegal: 9·9-times increase, p=0·045 vs Europe: 392-times increase, p<0·0001). However, in contrast to Europeans, the Senegalese cohort had no significant expansion of immature immune populations, inflammasome activation, or monocyte recruitment to the nasal mucosa. The observed divergent immunological trajectories during SARS-CoV-2 infection offer a potential explanation for the reported attenuated disease course in sub-Saharan Africa and highlight the need to further investigate immune responses to SARS-CoV-2 in understudied populations. European and Developing Countries Clinical Trials Partnership 2programme (AIDCO), LUMC Gisela Thier Fellowship, Dutch Research Council (NWO), European Research Council, and Leids Universitair Fonds.

Determinants of Neonatal Mortality at a Referral Paediatric Hospital in Angola: A Case-Control Study Using Theoretical Frameworks.

Neonatal mortality rates in developing countries are influenced by a complex array of factors. Despite advancements in healthcare, Angola has one of the highest neonatal mortality rates in sub-Saharan Africa, with significant contributors including premature birth, intrapartum events, tetanus, and sepsis. This study, utilizing key theoretical frameworks such as intersectionality, social determinants of health (SDOH), and ecosocial theory, aimed to identify the primary causes and contributing factors of neonatal mortality among infants admitted to the Neonatology Service at DBPH in Luanda from May 2022 to June 2023. A retrospective matched case-control design was employed, pairing each neonatal death with two surviving neonates based on age and sex. The analysis included 318 newborns, of whom 106 experienced hospital deaths. A stepwise binary logistic regression model was used to examine associations between variables and neonatal mortality. Variables with p < 0.25 in bivariate analysis were included in the multivariate model. Significant factors associated with neonatal mortality included the following: a low Apgar score at 1 min (<7) (OR 2.172; 95% CI: 1.436-4.731); maternal age under 20 years (OR 3.746; 95% CI: 2.172-6.459); home delivery (OR 1.769; 95% CI: 1.034-3.027); and duration of illness before admission ≥ 3 days (OR 2.600; 95% CI: 1.317-5.200). Addressing these issues requires urgent interventions, including improving Apgar score management through enhanced training for healthcare professionals, supporting young mothers with intensified maternal education, ensuring deliveries occur in appropriate healthcare settings, and improving universal health coverage and referral systems. These measures could be crucial for enhancing neonatal care and reducing mortality.

Agricultural droughts and under-five mortality in Côte d’Ivoire: Differential impacts across social and demographic groups

Little research explores how climate extremes affect early childhood mortality in sub-Saharan Africa, despite great vulnerability to both climate extremes and high rates of early childhood mortality. Although there have been substantial improvements in early childhood mortality in recent decades, climate change threatens to offset this progress. Focusing on the case of Côte d’Ivoire, I combine individual-level data from the Demographic and Health Surveys with high-resolution climate data to investigate how and when in-utero exposure to severe agricultural droughts influences early childhood mortality. I find that in-utero exposure to severe agricultural droughts increases the probability of under-five mortality, and most recent droughts seem to exert the greatest impact. I also find that boys and children born into families with little to no formal education are highly vulnerable to drought exposure during gestation. Maternal education mitigates the negative impact of droughts on under-five survival, regardless of urban or rural residence, suggesting that its protective effects may be linked to specific knowledge, behaviours, and practices that highly educated mothers employ rather than their living environment. These findings carry important lessons for policymakers, emphasising the need for policies that enhance educational opportunities for parents and develop targeted interventions for boys and children from families with little formal education.

Exploring machine learning algorithms to predict acute respiratory tract infection and identify its determinants among children under five in Sub-Saharan Africa.

The primary cause of death for children under the age of five is acute respiratory infections (ARI). Early predicting acute respiratory tract infections (ARI) and identifying their predictors using supervised machine learning algorithms is the most effective way to save the lives of millions of children. Hence, this study aimed to predict acute respiratory tract infections (ARI) and identify their determinants using the current state-of-the-art machine learning models. We used the most recent demographic and health survey (DHS) dataset from 36 Sub-Saharan African countries collected between 2005 and 2022. Python software was used for data processing and machine learning model building. We employed five machine learning algorithms, such as Random Forest, Decision Tree (DT), XGBoost, Logistic Regression (LR), and Naive Bayes, to analyze risk factors associated with ARI and predict ARI in children. We evaluated the predictive models' performance using performance assessment criteria such as accuracy, precision, recall, and the AUC curve. In this study, 75,827 children under five were used in the final analysis. Among the proposed machine learning models, random forest performed best overall in the proposed classifier, with an accuracy of 96.40%, precision of 87.9%, F-measure of 82.8%, ROC curve of 94%, and recall of 78%. Naïve Bayes accuracy has also achieved the least classification with accuracy (87.53%), precision (67%), F-score (48%), ROC curve (82%), and recall (53%). The most significant determinants of preventing acute respiratory tract infection among under five children were having been breastfed, having ever been vaccinated, having media exposure, having no diarrhea in the last two weeks, and giving birth in a health facility. These were associated positively with the outcome variable. According to this study, children who didn't take vaccinations had weakened immune systems and were highly affected by ARIs in Sub-Saharan Africa. The random forest machine learning model provides greater predictive power for estimating acute respiratory infections and identifying risk factors. This leads to a recommendation for policy direction to reduce infant mortality in Sub-Saharan Africa.

Characteristics of longitudinal maternal health studies in sub-Saharan Africa: A systematic mapping of literature between 2012 and 2022.

High maternal mortality rates in sub-Saharan Africa necessitate the need for aligned research focusing on prevalent causes and neglected conditions in the region. This mapping review aimed to describe the characteristics of longitudinal maternal health studies between 2012 and 2022 in sub-Saharan Africa and identify gaps in priority conditions or geographical locations. We identified references through a Medline (PubMed) search covering September 2012 to June 2022. We included prospective cohort or clinical trials that enrolled at least 1000 pregnant women, with a study site in sub-Saharan Africa, and published in English or French. Screening and data extraction were done in duplicate using EPPI-reviewer software. Descriptive analysis was used to summarize the results, identifying patterns in studies across time, country, study design, topics, and funders. We identified 213 eligible studies, which were covered in 534 publications. We identified studies in 33 of the 48 sub-Saharan African countries, with the majority in east and southern Africa. The predominant study topics were HIV (36.4%), nutrition (20%), and malaria (16.3%), with very few publications on hypertensive disorders of pregnancy (6.4%), ante/postpartum hemorrhage (3.7%), and sexually transmitted infections (3.2%). More studies were cohorts (115/213; 54%) than clinical trials. The National Institutes of Health (31.5%), Bill and Melinda Gates Foundation (22.1%), and USAID (10.8%) were the largest research funders. Identifying research trends and mismatches between research topics and disease burden provides useful information for guiding future research prioritization. In particular, gaps exist for studies on hypertensive disorders of pregnancy and ante/postpartum hemorrhage, among the top causes of maternal mortality in sub-Saharan Africa.

Prevalence of Child Fever, Acute Respiratory Infection, and Diarrhea and Their Risk Factors in Sierra Leone.

Sierra Leone has the fourth-highest child mortality rate in Sub-Saharan Africa. This retrospective study aimed to estimate the nationwide prevalence of fever, acute respiratory infection (ARI), and diarrhea in children under 5 years in Sierra Leone, and to identify the risk factors associated with these diseases. We extracted patient information from the 2019 Sierra Leone Demographic and Health Survey data. Data were analyzed using multivariate logistic regression. In total, 8659, 8652, and 8650 children were included in the analyses of fever, ARI, and diarrhea, respectively. The analysis revealed that the nationwide prevalence rates of fever, ARI, and diarrhea were 16.8%, 14.2%, and 7.2%, respectively. Children aged 12-23 months were found to be the most susceptible. Compared to children consuming unimproved water, the highest prevalence rates of fever, ARI, and diarrhea were observed among children residing in households with tube wells or boreholes. The adjusted odds ratio for diarrhea prevalence among children drinking water from household tube wells or boreholes was 1.47 (95% confidence interval: 1.17-1.84, p < 0.001). This study has several limitations, including recall bias due to parental reporting. We suspect that the diseases may be associated with potential water contamination in tube wells or boreholes. We recommend national-level periodic inspections of water quality and community-level education on water supply management.

Associations between early marriage, women’s empowerment, and infant mortality in Sub-Saharan Africa

Sub-Saharan Africa (SSA) is characterized by high gender inequality and a high rate of early marriages of girl children, which could have a negative influence on child health outcomes and child mortality in the region. This study examined the influence of child marriage on infant mortality in selected countries in SSA. We used Cox proportional hazard models to analyze pooled data (N = 33,549 children) from the Demographic and Health Surveys of 28 SSA countries. Our study established that children of child brides faced heightened risks of infant mortality compared with children of women who married after the age of 18, although this relationship became insignificant after controlling for women&amp;rsquo;s empowerment and other control variables. Therefore, the findings support the hypothesis that a certain extent of women&amp;rsquo;s empowerment could moderate the relationship between early marriage and infant mortality in regions where early marriages occur due to the low socioeconomic status of women. We conclude that ensuring women empowerment and increasing their economic opportunities (such as involvement in the agriculture and formal employment sectors) will lead to decreases in child marriage, thereby reducing infant mortality in SSA.

Detection of Bacterial Infections and Malaria among Blood Culture-Negative Samples of Hospitalized Febrile Patients from a Tertiary Hospital in Ethiopia.

Febrile illnesses contribute significantly to morbidity and mortality in sub-Saharan Africa, but the lack of diagnostic facilities and the broad spectrum of pathogens can lead to inadequate clinical management. The timely and reliable identification of the causative pathogens in febrile patients is the basis for the administration of optimal treatment. We aimed to evaluate the performance of a multiplex polymerase chain reaction (PCR) among blood culture-negative patients presenting with febrile diseases in Central Ethiopia. From April 2016 to June 2018, we collected blood samples from adults and children ≥1 year of age admitted with febrile diseases to the Asella Referral and Teaching Hospital, which is located at an altitude of 2,400 m. Total nucleic acids were extracted from frozen plasma samples using a MagNA Pure 96 instrument (Roche, Mannheim, Germany). The multiplex PCR assays were used in combination with LightCycler multiplex DNA master mix (Roche) on a LightCycler 480 instrument (Roche). We used the pathogen-specific assays targeted to Plasmodium spp., Borrelia spp., Rickettsia spp., Leptospira spp., Salmonella spp., and arboviruses. We tested plasma samples of 511 patients and found positive results for Plasmodium spp. (13, 2.5%), Borrelia spp. (12, 2.3%), and Rickettsia species (7, 1.3%); in total, pathogens were detected in 32 of the samples (6.3%). No pathogen was detected by multiplex PCR in 94% of blood culture-negative samples. Even if the pathogens identified by PCR were not necessarily causes of fever, molecular testing using a multiplex PCR can contribute to pathogen diagnosis in a proportion of febrile patients in the highland part of Ethiopia and help to improve the clinical management.

DISP-07. CURRENT NEURO-ONCOLOGY CAPACITY IN SUB-SAHARAN AFRICAN COUNTRIES: A QUESTIONNAIRE-BASED SURVEY

Abstract Brain tumors constitute significant morbidity and mortality in sub-Saharan Africa (SSA). There is no previous large-scale effort focusing on brain tumor genetics in SSA. This project aims to map out the current neuro-oncology capacity in terms of workforce and available services in SSA. This is an ongoing online survey among a cross section of neuro-oncology practitioners spread across SSA countries to capture information on the distribution, number of available neuro-oncology care practitioners, capacity for neuropathology and molecular diagnosis, management of brain tumors, cancer registration, and tumor biobanking. The survey was disseminated by the Society for Neuro-oncology in SSA (SNOSSA). There were 83 respondents representing 15 countries and 52 health institutions: 46 tertiary, 4 secondary, 1 private and 1 other. Here, we present data on the 52 institutions. The prevalence of specialties was 87% neurosurgery, 75% anatomic pathology, 69% medical oncology, 64% neurology, 60% radiation oncology, and 39% neuropathology. For radiologic evaluation, 81% of institutions were reported to have both CT and MRI, 17% CT only, and one institution neither. For molecular testing, 46% have access to IHC or NGS testing, whereas 52% were reported to have neither. A neuro-oncology tumor board was reported at 58% of institutions. A general cancer registry is available in 64% of institutions, 31% have a brain tumor specific registry and 10% have a brain tumor biorepository. This study shows that SSA has substantial potential in neuro-oncology care practice capacity and facilities. Most significant gaps remain in areas such as neuropathology and molecular testing, which makes widespread implementation of the WHO 2021 diagnosis challenging. Understanding the prevalence of CNS tumor subtypes is also difficult due to low number of brain tumor registries and biobanks in SSA. The present findings reveal strategic opportunities, especially in neuropathology, tumor registries, biobanks, and infrastructure for IHC and NGS in SSA.

Factors influencing antenatal care attendance in the eight contact era policy: a case of selected maternal health service facilities in Blantyre, Malawi

BackgroundMaternal mortality in sub-Saharan Africa and Malawi remains high. Effective antenatal care (ANC) services can reduce maternal morbidity and mortality. However, attendance to ANC clinics and the quality of services provided remain a challenge. Malawi adopted the 2016 WHO antenatal care model and there is a need to assess factors that influence antenatal care attendance. The main objective of this study was to assess factors influencing attendance in the era of the eight ANC contact policy in Blantyre.MethodsThis was an exploratory qualitative design in which 28 respondents participated using in-depth interviews and focus group discussions for the data collection process. The study sites included two healthcare facilities, namely Queen Elizabeth Central Hospital and Bangwe Health Centre, and a rural community (William Village Bangwe Rural) in Blantyre district. The 28 study participants included 11 ANC attendees, which comprised seven women in their final trimester and four postpartum women who attended ANC during their pregnancy, five midwives running the ANC clinics, and 12 non-users of ANC. The recordings were transcribed verbatim. The data were organized using Microsoft Excel and Microsoft word and analyzed using inductive content analysis.ResultsThe factors promoting ANC attendance in the context of the eight ANC contact policy include; motivation from health workers, family, and spouses and the women’s perceptions of ANC particularly the role it plays in preventing, detecting, and treating illness, but also preventing adverse pregnancy outcomes. On the other hand, the hindering factors to ANC attendance included lack of knowledge of the new ANC visit guidelines, financial constraints, quality of health services provided, attitude of healthcare workers, inadequate availability and training of healthcare workers, perceived poor quality of ANC services and personal beliefs.ConclusionIt is essential to provide comprehensive training to healthcare workers in the antenatal department regarding the new WHO ANC recommendations. This will help improve the quality of services at the antenatal clinics, including ensuring the availability of all necessary resources to encourage attendance. Additionally, promoting comprehensive spousal support, encouraging participation in activities, and adequately planning scheduled visits can help overcome financial barriers and further support antenatal attendance.

Rhizomatoflavonoid D and Other Flavonoids from the Twigs of Ochna Rhizomatosa as a Potential Inhibitor of HIV-1

Currently, HIV morbidity and mortality in sub-Saharan Africa remain a huge concern and awaiting interventions. Even though the combination antiretroviral therapy (cART) has recorded significant success, drug resistance and limited access to available therapeutics are major factors responsible for the low impact of cART in several African communities. Herein, as part of our continuous effort on the investigation of bioactive metabolites of Ochna rhizomatosa, we report the isolation of a new flavonoid; Rhizomatoflavonoid D (1), alongside with four known ones (2–5). The structures of these compounds were elucidated by using spectroscopic techniques (1H NMR, 13C NMR, HSQC, HMBC, 1H-1H COSY, and ROESY) and mass spectrometry. The antiviral activity of the resulting compounds was assessed using deCIPhR assay run in parallel with the Alamar Blue based cytotoxicity assay. This assay revealed a moderate activity for compound 4 (72% inhibition at 2.5 µg/mL) while compound 1 had minimal activity (36% inhibition at 2.5 µg/mL). The prominent inhibitory effect on HIV-1 was showed by compound 4 (IC50 = 3.1 µM). Unfortunately, compound 4 proved to be non-selective as it demonstrated also a CC50 = 5.2 µg/mL (Selectivity index of 1.7). The prominent inhibitory effect on HIV-1 showed by compound 4 (IC50 = 3.1 µM) could be due the presence of a methoxy group at C-7, since this group enhances the lipophilicity of biflavonoids, thereby improving its incorporation into cells.

OTHR-05 FEASIBILITY STUDY ON BRAIN TUMOR BIOBANKING AND REGISTRY IN SUB-SAHARAN AFRICAN COUNTRIES: A QUESTIONNAIRE-BASED SURVEY

Abstract INTRODUCTION Brain tumors constitute significant morbidity and mortality in sub-Saharan Africa (SSA). Improvements in neuro-oncology practice and research have seen increased diagnosis of brain tumors. However, to our knowledge, there have been no previous projects on brain tumor genetics in SSA. To understand the feasibility of developing brain tumor biobanking and registries, this project aims to start by mapping out the current neuro-oncology capacity in terms of workforce and available services. METHODOLOGY We will conduct a descriptive questionnaire-based online survey among a cross section of neuro-oncology practitioners spread across SSA countries. The dissemination of the survey questionnaire will be facilitated by the Society for Neuro-oncology in SSA (SNOSSA). The Google designed questionnaire will capture information on the distribution, and number of available neuro-oncology care practitioners, capacity for brain tumor diagnosis and management, cancer registration, tumor biobanking, and research. CLINICAL IMPACT AND CONCLUSION This study will generate robust data from SSA, which can be used to improve future research and promote advocacy towards brain tumor diagnosis and management. This work will also serve as a pilot study for subsequent research that will focus on the development of brain tumor-specific registries and biorepositories in SSA.

Inpatient and postdischarge mortality among children with anaemia and malaria parasitaemia in Kenya: a cohort study

BackgroundAnaemia and malaria are leading causes of paediatric hospitalisation and inpatient mortality in sub-Saharan Africa. However, there is limited empirical data on survival following hospital discharge. We aimed to estimate...

Spatial distribution of teenage pregnancy and its associated factors in Ethiopia: spatial and multilevel analysis of EDHS 2019

BackgroundOne of the reasons for the high rates of maternal and child morbidity and mortality in Sub-Saharan Africa is the rising proportion of teenage pregnancy. Preventing teenage pregnancy is critical to meeting sustainable development goal number three which aims to reduce the global maternal mortality ratio to less than 70 per 100,000 live births. To support the achievement of this goal, this study aimed to assess the spatial variation and factors associated with teenage pregnancy in Ethiopia using the recent nationally representative data.MethodsA secondary data analysis of the 2019 Ethiopian mini Demographic and Health Survey was conducted with a total weighted sample of 2211 (unweighted 2100) teenagers. The Bernoulli model was fitted using SaTScan version 9.6 to identify hotspot areas and the geospatial pattern and prediction of teenage pregnancy were mapped using ArcGIS version 10.7. A multilevel logistic regression model was fitted to identify factors associated with teenage pregnancy among teenagers. Adjusted OR with 95% CI was calculated and variables having a p-value less than 0.05 were statistically significant factors of teenage pregnancy.ResultThe prevalence of teenage pregnancy among adolescents aged 15–19 years in Ethiopia was 12.89% (95% CI: 11.56%, 14.36%). The SaTScan analysis identified a primary cluster in the Gambella region of Ethiopia (log-likelihood ratio = 14.02, p < 0.001). A high prevalence of teenage pregnancy was observed in Somalia, Afar, Gambella, and the southern part of the Oromia regions of Ethiopia. Age, educational status- primary and secondary, religion- protestant, having television, contraceptive knowledge, household head-female, and region- Small peripheral were significant determinants of teenage pregnancy.ConclusionThe spatial distribution of teenage pregnancy in Ethiopia was nonrandom. Age, educational status, religion, having television, contraceptive knowledge, sex of household head, and region were significant determinants of teenage pregnancy. Therefore, concerned government bodies and other stakeholders should organize periodic educational campaigns and youth-friendly reproductive health services. Collaboration between healthcare professionals, and religious and community leaders could also form a strategic partnership that makes interventions more comprehensive, culturally sensitive, and effective in reducing teenage pregnancy.

Empowering adolescents living with perinatally-acquired HIV: tailored CD4+ count assessment for optimized care, the EDCTP READY-study.

The elevated rate of AIDS-related mortality in Sub-Saharan Africa among adolescents living with HIV (ALHIV) is influenced by various factors, notably immunosuppression, within a framework of limited therapeutic alternatives. We aimed to enhance the management of pediatric HIV by assessing the immune response and associated factors in perinatally-infected ALHIV on antiretroviral therapy (ART) in Cameroon. A cohort study was conducted from 2018-2020 among 271 ART-experienced ALHIV in Cameroon. Sociodemographic data, immunological (CD4), and virological (plasma viral load, PVL) responses were measured at enrolment (T0), 6-months (T1), and 12-months (T2) using PIMA CD4 (Abbott/Pantech (Pty) Ltd) and Abbott Applied Biosystem platform (Real-Time PCR m2000RT) respectively. Immunological failure (IF) was defined as absolute CD4 < 250 cells/mm3, and Virological failure (VF) as PVL ≥ 1,000 copies/ml. A linear mixed-effects model with R version 4.4.1 was used to estimate both fixed and random effects, with significance set at p < 0.05. Of the 271 perinatally-infected ALHIV enrolled over three phases, females were predominant (55.7, 55.1, and 56.0%); median age was 14 (IQR: 12-17); majority of the participants were followed-up in urban areas (77.5, 74.5, and 78.6%); and the age distribution favored older adolescents (48.7, 61.2, and 58.5%). Most participants achieved clinical success (93.1, 89.7, 88.9%), predominantly on first-line ART (80.8, 66.2, and 53.0%), with good adherence (64.2, 58.9, and 64.5%). Most participants had secondary education (67.2, 70.1, and 67.5%). Median CD4+ counts fluctuated overtime, with values of 563 (IQR: 249.0-845.0), 502 (IQR: 319.0-783.5), and 628 (IQR: 427.5-817.5), respectively. Of note, being male was linked to a reduction in CD4+ count compared to females, [-200.63 (-379.32 to -21.95), p = 0.028]. Similarly, late adolescence was associated with lower CD4+ counts compared to early adolescence, [-181.08 (-301.08 to -61.09), p = 0.003]. Moreover, participants experiencing VF showed significantly lower CD4+ counts compared to those with undetectable viral loads, [-353.08 (-465.81 to -240.36), p < 0.001]. Additionally, there was a marginally significant interaction between male gender and secondary educational level, [209.78 (-6.94-426.51), p = 0.058]. Among perinatally-infected ALHIV, age, gender, educational level, and virological status are key factors influencing their immune health and treatment outcomes. Prioritizing targeted interventions and close monitoring within these subgroups is crucial for optimal management, employing holistic care strategies that consider not only medical interventions but also psychosocial support and education.

Exposure to extreme heat increases perinatal mortality in sub-Saharan Africa.

Exposure to extreme heat increases perinatal mortality in sub-Saharan Africa.

Bridging the Gap: Immune Checkpoint Inhibitor as an Option in the Management of Advanced and Recurrent Cervical Cancer in Sub-Saharan Africa.

Cervical cancer remains a leading cause of cancer-related mortality in women in low and middle-income countries despite efforts to improve prevention and standard-of-care interventions. Sub-Saharan Africa (SSA) leads the numbers for global cervical cancer incidence and mortality, with the majority of the incidence diagnosed in the late stage of the malignancy. Although the global cervical cancer death rate has been on the decline for the last two decades owing to advancements in screening and treatment options, the mortality rate in SSA has not declined very much. Chemotherapy has been the treatment of choice for cervical cancer in SSA without meeting the expected survival outcomes in these patients, with the majority having advanced diseases at diagnosis. Immune checkpoint inhibitors have recently shown clinical promise in improving the survival of patients with advanced cervical cancer and have been integrated into the treatment guidelines in most high-income countries, which have helped further reduce the mortality rate of cervical cancer. However, many SSA countries are yet to fully benefit from using immune checkpoint inhibitors in cervical cancer. In this review, we discuss the challenges hindering the effective use of immune checkpoint inhibitors for advanced cervical cancer in Africa and possible solutions.

First Results From a Calibrated Network of Low-Cost PM2.5 Monitors in Mombasa, Kenya Show Exceedance of Healthy Guidelines.

The paucity of fine particulate matter (PM2.5) measurements limits estimates of air pollution mortality in Sub-Saharan Africa. Well calibrated low-cost sensors can provide reliable data especially where reference monitors are unavailable. We evaluate the performance of Clarity Node-S PM monitors against a Tapered element oscillating microbalance (TEOM) 1400a and develop a calibration model in Mombasa, Kenya's second largest city. As-reported Clarity Node-S data from January 2023 through April 2023 was moderately correlated with the TEOM-1400a measurements (R 2=0.61) and exhibited a mean absolute error (MAE) of 7.03μgm-3. Employing three calibration models, namely, multiple linear regression (MLR), Gaussian mixture regression and random forest (RF) decreased the MAE to 4.28, 3.93, and 4.40μgm-3 respectively. The R 2 value improved to 0.63 for the MLR model but all other models registered a decrease (R 2=0.44 and 0.60 respectively). Applying the correction factor to a five-sensor network in Mombasa that was operated between July 2021 and July 2022 gave insights to the air quality in the city. The average daily concentrations of PM2.5 within the city ranged from 12 to 18μgm-3. The concentrations exceeded the WHO daily PM2.5 limits more than 50% of the time, in particular at the sites nearby frequent industrial activity. Higher averages were observed during the dry and cold seasons and during early morning and evening periods of high activity. These results represent some of the first air quality monitoring measurements in Mombasa and highlight the need for more study.