Countries In African Region Research Articles

Overview of global, regional, and national routine vaccination coverage trends and growth patterns from 1980 to 2009: implications for vaccine-preventable disease eradication and elimination initiatives.

Review of the historical growth in annual vaccination coverage across countries and regions can better inform decision makers' development of future goals and strategies to improve routine vaccination services. Using the World Health Organization (WHO) and the United Nations Children's Fund estimates of annual national third dose of diphtheria-tetanus-pertussis-containing vaccine (DTP3) and third dose of polio vaccine (POL3) coverage for 1980-2009, we calculated the mean absolute annual rate of change in national DTP3 coverage among all countries (globally) and among countries within each WHO region, as well as the number of years taken by each region to reach specific regional coverage levels. Last, we assessed differences in mean absolute annual rate of change in DTP3 coverage, stratified by baseline level of DTP3 coverage. During the 1980s, global DTP3 coverage increased a mean of 5.3 percentage points/year. Annual rate of change decreased to 0.5 percentage points/year in the 1990s and then increased to 0.9 percentage points/year during the 2000s. Mean annual rate of change in coverage across all countries was highest (9.2 percentage points) when national coverage levels were 26%-30% and lowest (-0.9 percentage points) when national coverage levels were 96%-100%. Regional differences existed as both WHO South-East Asia Region and WHO African Region countries experienced mean negative DTP3 coverage growth at lower coverage levels (81%-85%) than other regions. The regions that have achieved 95% DTP3 coverage (Americas, Western Pacific, and European) took 25-29 years to reach that level from a level of 50% DTP3 coverage. POL3 coverage change trends were similar to described DTP3 coverage change trends. Mean national coverage growth patterns across all regions are nonlinear as coverage levels increase. Saturation points of mean 0 percentage-point growth in annual coverage varies by region and require further investigation. The achievement of >90% routine coverage is observed to take decades, which has implications for disease eradication and elimination initiatives.

Polio eradication in the World Health Organization African Region, 2008-2012.

A renewed commitment at the regional and the global levels led to substantial progress in the fight for polio eradication in the African Region (AFR) of the World Health Organization (WHO) during 2008-2012. In 2008, there were 912 reported cases of wild poliovirus (WPV) infection in 12 countries in the region. This number had been reduced to 128 cases in 3 countries in 2012, of which 122 were in Nigeria, the only remaining country with endemic circulation of WPV in AFR. During 2008-2012, circulation apparently ceased in the 3 AFR countries with reestablished WPV transmission-Angola, the Democratic Republic of the Congo, and Chad. Outbreaks in West Africa continued to occur in 2008-2010 but were more rapidly contained, with fewer cases than during earlier years. This progress has been attributed to better implementation of core strategies, increased accountability, and implementation of innovative approaches. During this period, routine coverage with 3 doses of oral polio vaccine in AFR, as measured by WHO-United Nations Children's Fund estimates, increased slightly, from 72% to 74%. Despite this progress, challenges persist in AFR, and 2013 was marked by new setbacks and importations. High population immunity and strong surveillance are essential to sustain progress and assure that AFR reaches its goal of eradicating WPV.

Resources, indicators, data management, dissemination and use in health information systems in sub-Saharan Africa: results of a questionnaire-based survey.

To describe the status of health information systems in 14 sub-Saharan African countries of the World Health Organization African Region. A questionnaire-based survey. Fourteen sub-Saharan African countries of the African Region. Key informants in the ministries of health, national statistics offices, health programmes, donors and technical agencies. State of resources, indicators, data sources, data management, information products, dissemination and use of health information. The highest average score was in the identification and harmonisation of indicators (73%), reflecting successful efforts to identify priority indicators and reach international consensus on indicators for several diseases. This was followed by information products (63%), which indicated the availability of accurate and reliable data. The lowest score (41%) was in data management, the ability to collect, store, analyse and distribute data, followed by resources - policy and planning, human and financial resources, and infrastructure (53%). Data sources (e.g. censuses, surveys) were on average inadequate with a score of 56%. The average score for dissemination and use of health information was 57%, which indicated limited or inadequate use of data for advocacy, planning and decision-making. National health information systems are weak in the surveyed countries and much more needs to be done to improve the quality and relevance of data, and their management, sharing and use for policy-making and decision-making.

Does the adoption of IFRS promote emerging stock markets development? Evidence from MENA countries

The purpose of this study is to investigate the effects of IFRS adoption on MENA’s emerging stock markets and to shed some light on the macro-economic determinants which have had an important influence on stock market development. The empirical study is conducted using a balanced panel data from 14 Middle Eastern and North African region countries. Econometrics issues are based on estimations of two random effects specifications. We find that the adoption of IFRS affects positively and significantly stock market development. This paper has some policy implications for MENA region countries. In order to promote stock market development in the region, it is important to encourage non-adopting countries to harmonise their accounting standards with IASB’s ones. Most existing empirical literature has focused largely on the consequences of IFRS at the firm-level. In this paper, we examine the country-level association between IFRS adoption and stock market development. This paper aims at making an in-depth analysis of 14 MENA countries’ financial markets in order to assess how they can improve their capital markets, and hence, be of benefit to the global investor.

Benchmarking to Assess Potential Under-Diagnosis of Smear-Negative and Extrapulmonary Tuberculosis. A Case Study from Mozambique

No tool exists to identify potential under-diagnosis of smear-negative and extrapulmonary TB. In an ecological study, we used a simple tool plotting percentages of smear-positive pulmonary TB amongst newly diagnosed TB in African region countries and provinces in Mozambique against the country's and provinces' HIV prevalence. We visually inspected the plots to determine potential under-diagnosis of smear-negative and extrapulmonary TB in three facilities in Manica Province, Mozambique. In these facilities, we found 67% smear-positivity among new TB cases in an area with HIV prevalence of more than 10%. All African region countries with an HIV prevalence of more than 10% had a smear-positivity lower than 50%. Most Mozambican provinces with a high HIV prevalence have smear-positivity rate of below 51%. Our findings show that benchmarking can be used to assist in identifying potential under-diagnosis of smear-negative and extrapulmonary TB. The findings also suggest that potentially under-diagnosis of these forms of TB exists in the study population.

Factors Affecting the Introduction of New Vaccines to Poor Nations: A Comparative Study of the Haemophilus influenzae Type B and Hepatitis B Vaccines

BackgroundA major effort to introduce new vaccines into poor nations of the world was initiated in recent years with the help of the GAVI alliance. The first vaccines introduced have been the Haemophilus influenzae type B (Hib) and the hepatitis B (Hep B) vaccines. The introduction of these vaccines during the first phase of GAVI's operations demonstrated considerable variability. We set out to study the factors affecting the introduction of these vaccines. The African Region (AFRO), where new vaccines were introduced to a substantial number of countries during the first phase of GAVI's funding, was selected for this study.Methodology/Principal FindingsGAVI-eligible AFRO countries with a population of 0.5 million or more were included in the study. Countries were analyzed and compared for new vaccine introduction, healthcare indicators, financial indicators related to healthcare and country-level Governance Indicators, using One Way ANOVA, correlation analysis and Qualitative Comparative Analysis (QCA). Introduction of new vaccines into AFRO nations was associated primarily with high country-level Governance Indicator scores. The use of individual Governance Indicator scores, as well as a combined Governance Indicator score we developed, demonstrated similar results.Conclusions/SignificanceOur study results indicate that good country-level governance is an imperative pre-requisite for the successful early introduction of new vaccines into poor African nations. Enhanced support measures may be required to effectively introduce new vaccines to countries with low governance scores. The combined governance score we developed may thus constitute a useful tool for helping philanthropic organizations make decisions regarding the type of support needed by different countries to achieve success.

Response to Ooms and Van Damme

The thesis of our base paper is that if African Region countries armed themselves with a strategy for weaning themselves off donor funding for health, which is backed up by effective programmes for improving economic efficiency in public and private expenditure; identifying and pruning unproductive public expenditure; raising additional domestic revenue; creating an enabling environment for private health sector growth; and boosting health development governance to curb corruption, they would have a high probability of succeeding in this century, i.e. in the next 92 years. In their commentary, Ooms and Van Damme attempt to argue that none of the above-mentioned strategies would singly enable African countries to raise the US$ 40 per person required to provide an essential package of health interventions. They do not propose an alternative set of strategies that would enable African countries to mobilize the US$ 40 per capita without depending solely on donor funding. Instead, they make a rallying cry for sustained international health aid. The commentators mistakenly assumed that our proposed strategies are mutually exclusive. Of course, none of the five strategies alone would be able to raise enough domestic resources needed to wean countries off donor funding. However, our argument is that the five strategies, depending on each country’s context, should be implemented in tandem. Our argument was that 8 countries (Algeria, Angola, Botswana, Gabon, Lesotho, Namibia, Seychelles and South Africa), whose current military spending is above the regional average of US$ 16 per person, may have scope for savings. Ooms and Van Damme argue that this strategy would not make a difference to Liberia, Madagascar, Malawi, Mozambique, Rwanda, Sao Tome and Principe, Sierra Leone and Zambia. This is tautological since the military expenditure of the latter set of countries is below our assumed US$ 16 per capita threshold. Concerning the strategy on raising additional revenue, we argued that 13 countries whose tax share of GDP is less than 15% have scope for raising additional revenue by improving efficiency of their tax administration systems. Commentators argue that countries such as Madagascar and Rwanda would raise merely an additional US$ 1.5 and US$ 0.8 per person per year. When multiplied with the total population, those seemingly small figures would yield an additional US$ 36.15 million per year for Madagascar and US$ 9.68 million per year for Rwanda. Those amounts are not insignificant in these countries where more than 60% of the population live below the international poverty line of US$ 1 per person per day.1 We concur with the WHO Director-General’s call for increased and more predictable international aid for Africa which adheres to the principles of the Paris Declaration on Aid Effectiveness.2 In our opinion, the effectiveness of international aid should also be judged on the extent to which it helps recipient countries to develop and implement strategies for weaning themselves off external donor funding before the end of this century. ■

Epidemiological comparisons of codon usage patterns among HIV-1 isolates from Asia, Europe, Africa and the Americas

To investigate the genomic properties of HIV-1, we collected 3,081 sequences from the HIV Sequence Database. The sequences were categorized according to sampling region, country, year, subtype, gene name, and sequence and were saved in a database constructed for this study. The relative synonymous codon usage (RSCU) values of matrix, capsid, and gp120 and gp41 genes were calculated using correspondence analysis. The synonymous codon usage patterns based on the geographical regions of African countries showed broad distributions; when all the other regions, including Asia, Europe, and the Americas, were taken into account, the Asian countries tended to be divided into two groups. The sequences were clustered into nine non-CRF subtypes. Among these, subtype C showed the most distinct codon usage pattern. To determine why the codon usage patterns in Asian countries were divided into two groups for four target genes, the sequences of the isolates from the Asian countries were analyzed. As a result, the synonymous codon usage patterns among Asian countries were divided into two groups, the southern Asian countries and the other Asian countries, with subtype 01_AE being the most dominant subtype in southern Asia. In summary, the synonymous codon usage patterns among the individual HIV-1 subtypes reflect genetic variations, and this bioinformatics technique may be useful in conjunction with phylogenetic methods for predicting the evolutionary patterns of pandemic viruses.