Africa's Response Research Articles

Key populations and Sub-Saharan Africa's HIV response.

Key populations and Sub-Saharan Africa's HIV response.

COVID-19 response in Africa: impacts and lessons for environmental management and climate change adaptation.

The online version contains supplementary material available at 10.1007/s10668-023-02956-0.

Effects of tuberculosis and/or HIV-1 infection on COVID-19 presentation and immune response in Africa

Few studies from Africa have described the clinical impact of co-infections on SARS-CoV-2 infection. Here, we investigate the presentation and outcome of SARS-CoV-2 infection in an African setting of high HIV-1 and tuberculosis prevalence by an observational case cohort of SARS-CoV-2 patients. A comparator group of non SARS-CoV-2 participants is included. The study includes 104 adults with SARS-CoV-2 infection of whom 29.8% are HIV-1 co-infected. Two or more co-morbidities are present in 57.7% of participants, including HIV-1 (30%) and active tuberculosis (14%). Amongst patients dually infected by tuberculosis and SARS-CoV-2, clinical features can be typical of either SARS-CoV-2 or tuberculosis: lymphopenia is exacerbated, and some markers of inflammation (D-dimer and ferritin) are further elevated (p < 0.05). Amongst HIV-1 co-infected participants those with low CD4 percentage strata exhibit reduced total, but not neutralising, anti-SARS-CoV-2 antibodies. SARS-CoV-2 specific CD8 T cell responses are present in 35.8% participants overall but undetectable in combined HIV-1 and tuberculosis. Death occurred in 30/104 (29%) of all COVID-19 patients and in 6/15 (40%) of patients with coincident SARS-CoV-2 and tuberculosis. This shows that in a high incidence setting, tuberculosis is a common co-morbidity in patients admitted to hospital with COVID-19. The immune response to SARS-CoV-2 is adversely affected by co-existent HIV-1 and tuberculosis.

Research successfully integrated into the Ebola outbreak response in Africa

Research successfully integrated into the Ebola outbreak response in Africa

Coordination and Management of COVID-19 in Africa through Health Operations and Technical Expertise Pillar: A Case Study from WHO AFRO One Year into Response.

Background: following the importation of the first Coronavirus disease 2019 (COVID-19) case into Africa on 14 February 2020 in Egypt, the World Health Organisation (WHO) regional office for Africa (AFRO) activated a three-level incident management support team (IMST), with technical pillars, to coordinate planning, implementing, supervision, and monitoring of the situation and progress of implementation as well as response to the pandemic in the region. At WHO AFRO, one of the pillars was the health operations and technical expertise (HOTE) pillar with five sub-pillars: case management, infection prevention and control, risk communication and community engagement, laboratory, and emergency medical team (EMT). This paper documents the learnings (both positive and negative for consideration of change) from the activities of the HOTE pillar and recommends future actions for improving its coordination for future emergencies, especially for multi-country outbreaks or pandemic emergency responses. Method: we conducted a document review of the HOTE pillar coordination meetings’ minutes, reports, policy and strategy documents of the activities, and outcomes and feedback on updates on the HOTE pillar given at regular intervals to the Regional IMST. In addition, key informant interviews were conducted with 14 members of the HOTE sub pillar. Key Learnings: the pandemic response revealed that shared decision making, collaborative coordination, and planning have been significant in the COVID-19 response in Africa. The HOTE pillar’s response structure contributed to attaining the IMST objectives in the African region and translated to timely support for the WHO AFRO and the member states. However, while the coordination mechanism appeared robust, some challenges included duplication of coordination efforts, communication, documentation, and information management. Recommendations: we recommend streamlining the flow of information to better understand the challenges that countries face. There is a need to define the role and responsibilities of sub-pillar team members and provide new team members with information briefs to guide them on where and how to access internal information and work under the pillar. A unified documentation system is important and could help to strengthen intra-pillar collaboration and communication. Various indicators should be developed to constantly monitor the HOTE team’s deliverables, performance and its members.

Challenges and Opportunities for Mental Health and Psychosocial Support in the COVID-19 Response in Africa: A Mixed-Methods Study.

This research aimed to (1) assess the extent to which mental health and psycho-social support (MHPSS) was included in the national response to the COVID-19 pandemic in African countries, and (2) explore barriers and enablers to MHPSS integration into the COVID-19 response. A mixed-methods study, using an online survey and in-depth interviews, was conducted. Participants included Mental Health Focal Points at the Ministries of Health, the World Health Organization (WHO) country and regional offices, and civil society representatives. Responses were received from 28 countries out of 55 contacted. The implementation level, based on standard guidelines, of MHPSS activities was below 50% in most countries. The most implemented MHPSS activities were establishing coordination groups (57%) and developing MHPSS strategy (45%), while the least implemented activities included implementing the developed MHPSS strategy (32%) and establishing monitoring and evaluation mechanisms (21%). Key factors that hindered implementing MHPSS activities included lack of political commitment and low prioritisation of mental health during emergencies, as it was seen as a “less important” issue during the COVID-19 pandemic, when more importance was given to infection prevention and control (IPC). However, there are signs of optimism, as mental health gained some attention during COVID-19. It is imperative to build on the attention gained by integrating MHPSS in emergency preparedness and response and strengthening mental health systems in the longer term.

Public Health Emergency Preparedness and Response in Africa - The Nigerian Case

Public Health Emergency Preparedness and Response in Africa - The Nigerian Case

South African community health workers' pursuit of occupational security

AbstractCommunity health workers (CHWs) are central to the global health response to crises like the AIDS epidemic. Yet community health work remains undervalued and undercompensated worldwide owing in large part to the gendered and racialized contexts of care work. This paper investigates the possibility of occupational security for CHWs by comparing two cases from South Africa's response to AIDS. The first draws on ethnographic research (2007–2009) in rural KwaZulu‐Natal province and documents the fraught formation of a union representing CHWs. The second examines legal action in the Free State province for a group of CHWs known as the Bophelo House 94, who were arrested and criminally charged in June 2014 after protesting their sudden dismissal by the government. This case comparison finds that collective action has thus far had limited effects on CHWs' position as a nascent occupation. The South African Ministry of Health has obstructed CHW professionalization, and non‐state actors' involvement has been a mixture of benefit and impediment: some social justice agencies have facilitated CHW advocacy, while many AIDS service organizations have cooperated with the state and exacerbated the precarity of CHWs' working conditions. However, the consolidation of CHW work roles—owing to advances in AIDS prevention and treatment—holds promise for future CHW collective organization.

The impacts of Covid policy responses in Africa: The Covid Consensus one year on

The impacts of Covid policy responses in Africa: <i>The Covid Consensus</i> one year on

Legacies of Islamic Rule in Africa: Colonial Responses and Contemporary Development

Colonial rule had long-lasting effects on economic and political development. However, colonial policies and investments varied across and within colonial territories, often in response to local geographic and political conditions. We argue that the religious basis of authority in pre-colonial societies was an important political factor shaping the colonial response in Africa. In particular, we argue the presence of Islamic rule affected long-term economic development through its impact on the investments made by colonial administrators and missionaries. Focusing on historical kingdoms in Africa, we find that areas governed by Islamic states in the pre-colonial period experience higher infant mortality, fewer years of education, and lower density of nightlights in the contemporary period in comparison to areas governed by traditional or Christian kingdoms or stateless areas. The evidence suggests that these long-run effects of Islamic rule are better explained by the location of missionaries and weak penetration of the colonial administration than by the influence of Islamic beliefs.

Land-Related Conflicts and the Nature of Government Responses in Africa: The Case of Farmer-Herder Crises in Nigeria

Land-Related Conflicts and the Nature of Government Responses in Africa: The Case of Farmer-Herder Crises in Nigeria

PEPFAR's Role in Protecting and Leveraging HIV Services in the COVID-19 Response in Africa.

Purpose of ReviewWe describe the impact of COVID-19 on PEPFAR programs in Africa and how PEPFAR adapted and leveraged its interventions to the changing landscape of the COVID-19 pandemic.Recent FindingsTo mitigate the potential impact of COVID-19 on the HIV response and protect the gains, continuity of treatment was the guiding principle regarding the provision of services in PEPFAR-supported countries. As the COVID-19 pandemic matured, PEPFAR’s approach evolved from a strictly “protect and salvage” approach to a “restore and accelerate” approach that embraced innovative adaptations in service and “person-centered” care.SummaryThe impact of service delivery interruptions caused by COVID-19 on progress towards HIV epidemic control in PEPFAR-supported African countries remains undetermined. With COVID vaccine coverage many months away and more transmissible variants being reported, Africa may experience more pandemic surges. HIV programs will depend on nimble and innovative adaptations in prevention and treatment services in order to advance epidemic control objectives.

Negotiating Intersecting Precarities: COVID-19, Pandemic Preparedness and Response in Africa

ABSTRACT This article shares findings on COVID-19 in Africa across 2020 to examine concepts and practices of epidemic preparedness and response. Amidst uncertainties about the trajectory of COVID-19, the stages of emergency response emerge in practice as interconnected. We illustrate how complex dynamics manifest as diverse actors interpret and modify approaches according to contexts and experiences. We suggest that the concept of “intersecting precarities” best captures the temporalities at stake; that these precarities include the effects of epidemic control measures; and that people do not just accept but actively negotiate these intersections as they seek to sustain their lives and livelihoods.

Global Oil Crisis and Early COVID-19 Strategic Containment Responses in Africa: The Nigerian Experience

African countries have been hit by a dual shock of COVID-19 pandemic and global oil crisis, which have caused severe economic and social disruptions. Most studies shed light on the correlates between COVID-19 and the global oil crisis, including their economic impacts on oil producing/exporting countries. However, the objective of this study is to examine the effects of the global oil crisis on the implementation of World Health Organization’s (WHO) healthcare and public health measures to contain COVID-19 in Nigeria. Empirical data from Nigeria was collected and analysed using content analysis based on WHO’s methodology. There was low level of healthcare preparedness and emergency response capacities to contain the COVID-19 pandemic. Public health measures against COVID-19 such as lockdowns and social distancing policies were poorly implemented at the expense of the people without adequate countercyclical stimulus packages and palliatives.

Encephalitic Arboviruses of Africa: Emergence, Clinical Presentation and Neuropathogenesis.

Many mosquito-borne viruses (arboviruses) are endemic in Africa, contributing to systemic and neurological infections in various geographical locations on the continent. While most arboviral infections do not lead to neuroinvasive diseases of the central nervous system, neurologic diseases caused by arboviruses include flaccid paralysis, meningitis, encephalitis, myelitis, encephalomyelitis, neuritis, and post-infectious autoimmune or memory disorders. Here we review endemic members of the Flaviviridae and Togaviridae families that cause neurologic infections, their neuropathogenesis and host neuroimmunological responses in Africa. We also discuss the potential for neuroimmune responses to aide in the development of new diagnostics and therapeutics, and current knowledge gaps to be addressed by arbovirus research.

COVID-19 and beyond: Use of digital technology for pandemic response in Africa

The use of technology has been ubiquitous in efforts to combat the ongoing COVID-19 pandemic. In this perspective, we review technologies and new approaches developed at the start of the pandemic; efforts earmarked by a flexible approach to problem solving, local tech entrepreneurship, and swift adoption of technology. We performed a systematic review of the use of technology during the initial wave of the COVID-19 pandemic in most African countries. We identified relevant articles by searching for mentions of technology, COVID-19, and specific country names. Articles were included if they specifically mentioned the use of technology or novel innovations in the response to the COVID-19 pandemic in an African country. The article search was conducted in August and included articles published between January and August 2020. We retrieved articles from journals, trusted news, government, and organization websites on Google, Google Scholar and PubMed. A total of 80 articles were retained and categorized under Disease Prevention (19 articles), Disease Surveillance (30 articles), and Clinical Supplies and Management (31 articles). African nations used technology and innovative techniques to manage patients, monitor cases and disseminate information to counter the spread of COVID-19. The nature and outcomes of these efforts sometimes differed in Africa compared to other regions of the world due to its unique challenges and opportunities.

Equity in human adaptation-related responses: A systematic global review

Equity in human adaptation-related responses: A systematic global review

Impact of poor disease surveillance system on COVID-19 response in africa: Time to rethink and rebuilt

Infectious disease outbreaks have long posed a public health threat, especially in Africa, where the incidence of infectious outbreaks has risen exponentially. Although, Africa has witnessed several outbreaks of emerging and re-emerging infectious diseases such as Ebola virus disease and other epidemic-prone diseases, little attention has been given towards strengthening the health surveillance systems. However, the recent COVID-19 pandemic has uncovered the region's already due to inefficient and ineffective health surveillance systems. However, the impact posed by the COVID-19 pandemic on health systems in the region has been catastrophic, it has also stressed the importance of rethinking and focusing on lessons learned during the COVID-19 pandemic. In this paper, we examine how Africa's poor disease surveillance systems affected the responses and strategies aimed at COVID-19 containment. To ensure early disease outbreak identification and prompt public health interventions in Africa, the current disease surveillance and response mechanisms must be strengthened.

Covid‐19 Responses in Africa

Africa Research Bulletin: Political, Social and Cultural SeriesVolume 58, Issue 7 p. 23252A-23252B Social and Cultural Covid-19 Responses in Africa First published: 19 August 2021 https://doi.org/10.1111/j.1467-825X.2021.10112.xRead the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat No abstract is available for this article. Volume58, Issue7August 2021Pages 23252A-23252B RelatedInformation

HIV Incidence by Male Circumcision Status From the Population-Based HIV Impact Assessment Surveys-Eight Sub-Saharan African Countries, 2015-2017.

Male circumcision (MC) offers men lifelong partial protection from heterosexually acquired HIV infection. The impact of MC on HIV incidence has not been quantified in nationally representative samples. Data from the population-based HIV impact assessments were used to compare HIV incidence by MC status in countries implementing voluntary medical MC (VMMC) programs. Data were pooled from population-based HIV impact assessments conducted in Eswatini, Lesotho, Malawi, Namibia, Tanzania, Uganda, Zambia, and Zimbabwe from 2015 to 2017. Incidence was measured using a recent infection testing algorithm and analyzed by self-reported MC status distinguishing between medical and nonmedical MC. Country, marital status, urban setting, sexual risk behaviors, and mean population HIV viral load among women as an indicator of treatment scale-up were included in a random-effects logistic regression model using pooled survey weights. Analyses were age stratified (15-34 and 35-59 years). Annualized incidence rates and 95% confidence intervals (CIs) and incidence differences were calculated between medically circumcised and uncircumcised men. Men 15-34 years reporting medical MC had lower HIV incidence than uncircumcised men [0.04% (95% CI: 0.00% to 0.10%) versus 0.34% (95% CI: 0.10% to 0.57%), respectively; P value = 0.01]; whereas among men 35-59 years, there was no significant incidence difference [1.36% (95% CI: 0.32% to 2.39%) versus 0.55% (95% CI: 0.14% to 0.67%), respectively; P value = 0.14]. Medical MC was associated with lower HIV incidence in men aged 15-34 years in nationally representative surveys in Africa. These findings are consistent with the expected ongoing VMMC program impact and highlight the importance of VMMC for the HIV response in Africa.