Sub-Saharan African Men Research Articles

Natural history of castration-resistant prostate cancer in sub-Saharan African black men: a single-centre study of Nigerian men.

PurposeNative sub-Saharan African black men (SSBM) are disproportionately impacted by higher stage and incurable forms of prostate cancer (PCa). This study evaluates the natural history and survival of a cohort of SSBM with castration-resistant prostate cancer (CRPC).MethodsA retrospective study of patients with CRPC as defined by the Prostate Cancer Working Group 2 managed at a centre in sub-Saharan Africa between January 2011 and December 2015 was conducted. The principal endpoint was overall survival (OS). Potential prognostic variables were evaluated using Cox proportional hazard regression models.ResultsA total of 48 patients were identified. Median (IQR) age and prostate-specific antigen (PSA) at diagnosis were 70 (64–74.5) years and 42 (8.0–123.6) ng/mL, respectively. Only 15 (31.3%) patients received docetaxel and one patient each received the novel drugs enzalutamide and abiraterone. Twenty-eight patients (58.3%) died during follow-up with a median OS of 11 (95% CI: 8–14) months. Docetaxel chemotherapy and ECOG performance status were found to be prognostic (docetaxel use: hazard ratio 0·25, 95% CI 0·10–0·67, p = 0·006; ECOG 0–2: 0·26, 0·11–0·62, p = 0·003).ConclusionThis study of SSBM with CRPC revealed a mainly unmodulated clinical course with poor access to active treatments and poor survival. Improving access to new active therapies would improve survival.

Dietary Vitamin D Knowledge of Sub-Saharan African Men Who Migrate to Australia

Dietary Vitamin D Knowledge of Sub-Saharan African Men Who Migrate to Australia

Health-Illness Transition Experiences With Type 2 Diabetes Self-management of Sub-Saharan African Immigrants in the United States.

Purpose The purpose of this study was to describe Sub-Saharan African immigrants' health-illness transition experiences associated with type 2 diabetes mellitus (T2DM) self-management. Methods A qualitative description methodology was used in this study. Face-to-face semi-structured in-depth interviews lasting 60 to 90 minutes were conducted with 10 Sub-Saharan African immigrant men and women with T2DM recruited using purposive and snowball sampling. Each interview was audio-taped, transcribed, and analyzed using qualitative content analysis. Results Participants' mean age was 60.3 years (range, 44-76 years), 5 men and 5 women; most had lived in the US for more than 10 years (70%) and with T2DM for more than 5 years (60%). Four overarching domains described the health-illness transition experiences the participants had with T2DM self-management: (1) knowledge of T2DM self-management behaviors, (2) current T2DM self-management behaviors, (3) inhibitors of T2DM self-management, and (4) facilitators of T2DM self-management. Conclusions Health professionals should be equipped with an understanding of the properties and conditions of health-illness transition. This understanding is necessary to build a foundation that facilitates healthy adaptation to the T2DM transition requiring the development and mastery of new skills consistent with gaining control of T2DM. Culturally tailored interventions need to be developed to decrease inhibitors of and encourage self-management in daily T2DM care for Sub-Saharan African immigrants with T2DM.

There has been little progress in implementing comprehensive alcohol control strategies in Africa

ABSTRACTAlcohol is the most common substance of addiction and a threat not only to health but also to sustainable human development. Consequently, at least a 10% relative reduction in the harmful use of alcohol has been advocated by the World Health Organization (WHO). This perspective describes alcohol use in Africa, strategies to reduce harmful alcohol use, and the ability of African countries to meet this target. Although alcohol consumption in Africa was intermediate compared to other world regions, the total alcohol per capita among alcohol consumers was the second highest (19.5 liters); 19% of Sub-Saharan African men could be classified as binge drinkers. The alcohol industry is the key driver behind the uptake of alcohol use and misuse. The most cost-effective ways to reduce alcohol-related harm is to make alcohol less available and more expensive and to prohibit alcohol advertising. Most African countries have alcohol excise taxes, but these are not adjusted for inflation, meaning that the effectiveness of these taxes will likely decrease with time, leading to greater affordability. The majority of African countries do not have legally binding regulations for alcohol marketing. Alcohol misuse in Africa is not being addressed at a time when available strategies can efficiently and cost-effectively control alcohol-related harm.

Performance of the Androgen Deficiency in Aging Male questionnaire for the clinical detection of androgen deficiency in black sub-Saharan African men with Type-2 diabetes mellitus

Background: The Androgen Deficiency in Aging Male (ADAM) questionnaire is increasingly popular for evaluation of androgen deficiency (AD) in sub-Saharan African men with type 2 diabetes mellitus (DM). However, its reliability in this population is unknown.Methods: Total testosterone < 8 nmol/L was used as the gold standard for diagnosis of AD in this cross-sectional survey of 200 type 2 DM males aged 30–69 years. Participants also completed the Saint Louis University ADAM questionnaire whereby AD was diagnosed by a ‘yes’ answer to question 1 (reduced libido) or 7 (erectile dysfunction) or any other three questions. The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and overall accuracy of the ADAM tool were computed.Results: The mean age of the participants was 58.0 ± 8.8 years. A total of 142 subjects (71.0%) had AD based on the ADAM questionnaire. However, AD was biochemically confirmed in 59 subjects (29.5%). The ADAM questionnaire rendered a sensitivity of 8...

Pulmonary vascular function and exercise capacity in black sub-Saharan Africans.

Sex and age affect the pulmonary circulation. Whether there may be racial differences in pulmonary vascular function is unknown. Thirty white European Caucasian subjects (15 women) and age and body-size matched 30 black sub-Saharan African subjects (15 women) underwent a cardiopulmonary exercise test and exercise stress echocardiography with measurements of pulmonary artery pressure (PAP) and cardiac output (CO). A pulmonary vascular distensibility coefficient α was mathematically determined from the natural curvilinearity of multipoint mean PAP (mPAP)-CO plots. Maximum oxygen uptake (V̇o2max) and workload were higher in the whites, while maximum respiratory exchange ratio and ventilatory equivalents for CO2 were the same. Pulmonary hemodynamics were not different at rest. Exercise was associated with a higher maximum total pulmonary vascular resistance, steeper mPAP-CO relationships, and lower α-coefficients in the blacks. These differences were entirely driven by higher slopes of mPAP-CO relationships (2.5 ± 0.7 vs. 1.4 ± 0.7 mmHg·l(-1)·min; P < 0.001) and lower α-coefficients (0.85 ± 0.33 vs. 1.35 ± 0.51%/mmHg; P < 0.01) in black men compared with white men. There were no differences in any of the hemodynamic variables between black and white women. In men only, the slopes of mPAP-CO relationships were inversely correlated to V̇o2max (P < 0.01). Thus the pulmonary circulation is intrinsically less distensible in black sub-Saharan African men compared with white Caucasian Europeans men, and this is associated with a lower exercise capacity. This study did not identify racial differences in pulmonary vascular function in women.

Risk of Kaposi Sarcoma Among Immigrants to Sweden

Kaposi sarcoma (KS) is a locally aggressive endothelial tumour that is classified into 4 clinico-epidemiological forms: classic KS affecting lower limbs in elderly Mediterranean or East European men; endemic KS occurring in extremities among Equatorial African middle-aged men and children; iatrogenic KS involving lower limbs in immunosuppressive patients; and AIDS-associated (epidemic) KS observed among homo- and bisexual HIV-1-infected young men (1, 2). The world-wide epidemiology of KS has changed by spreading of HIV infection (1). For example, KS represented 7% of all cancers in Sub-Saharan African men in the 1960s, whereas in the 1980s the rate increased to 50%. Furthermore, the age distribution of KS has changed from elderly (in classic form) to the late thirties (in epidemic form). KS is a rare tumour in Nordic countries; the incidence is 0.1-0.2/100,000 according to the Cancer Incidence in Five Continents (CI5) report (3). According to this source, the rate in many Asian countries is <0.5/100,000, whereas African American men have a rate of 6.2/100,000. The highest rate is in men from Zimbabwe (52.2/100,000) (3). Human herpesvirus 8 (HHV-8) is the recognised cause of all forms of KS (2). There is discrepancy between the prevalence of HHV-8 and KS incidence in some populations suggesting underreporting of KS or the existance of some unknown protective factors for KS (1). Migrant studies provide data on international differences in cancer rates (4). Furthermore, studies on immigrants may provide supplementary and confirmatory data on the incidence of cancer in countries without local cancer registries. A few available studies on immigrants have focused only on classic KS (5, 6). In the present study, we report mean age at diagnosis and KS rates by site in first-generation immigrants to Sweden. (Less)

Health-related quality of life, ethnicity and perceived discrimination among immigrants and natives in Spain

ObjectivesThe current study compares subjective mental and physical health among native Spaniards and immigrant groups, and examines the effects of ethnicity and perceived discrimination (PD) on subjective health in immigrants.DesignTwo random samples of 1250 immigrants to Spain from Colombia, Bolivia, Romania, Morocco, and Sub-Saharan Africa and 500 native Spaniards, aged between 18 and 65, were recruited for this cross-sectional study. Several hierarchical regression analyses of ethnicity and PD on subjective mental and physical health (assessed using the health-related quality of life items, HRQLSF-12) were carried out separately for men and women.ResultsMale immigrants from Colombia and Sub-Saharan Africa showed better physical health than natives, controlling for age and socioeconomic and marital status. The immigrants – except for the Colombians – had poorer mental health than natives, especially African men and Bolivian women. Socioeconomic status had no impact on these differences. Among immigrants, PD was the best predictor of physical and mental health (controlling for socio-demographic variables). African men, Bolivian women and women without legal status exhibited the poorest self-rated mental health.ConclusionClear differences in health status among natives and immigrants were recorded. The self-selection hypothesis was plausible for physical health of Colombians and Sub-Saharan African men. Acculturation stress could explain poorer mental health in immigrants compared with natives. The association between ethnicity and poor self-reported mental health appears to be partially mediated by discrimination.

A cross-national comparative study of smoking prevalence and cessation between English and Dutch South Asian and African origin populations: the role of national context

Evidence suggests that Dutch people smoke substantially more than their British counterparts. These differences have been suggested to relate, in part, to the health-related policy differences between the two countries. It is unclear whether these differences affect smoking among ethnic minority groups in similar ways. We assessed whether the lower smoking prevalence in the U.K. general population compared with the Netherlands is also observed in ethnic minority groups (i.e., Dutch vs. English South Asians and Dutch- vs. English-Africans). We used similar surveys from the United Kingdom and the Netherlands to explore these questions. The response rate ranges from 60% in the Health Survey for England and the SUNSET study to 67.5% in Newcastle Heart Project (n = 21,429). After adjustment for other factors, compared with White-Dutch, the prevalence ratio (PR) of current smoking was lower in White-English men (PR = 0.58, 95% CI: 0.49-0.67) and women (PR = 0.56, 0.49-0.65). Among African groups, compared with Dutch-African, the prevalence of current smoking was lower in English- African Caribbean men (PR = 0.48, 0.31-0.75) and women (PR = 0.47, 0.39-0.69) and Sub-Saharan African men (PR = 0.53, 0.29-0.99) and women (PR = 0.37, 0.14-0.99). Among South Asian groups, compared with Dutch South Asian, the prevalence of smoking was lower in English-Indian men (PR = 0.67, 0.51-0.89) and women (PR = 0.16, 0.07-0.37), Pakistani men (PR = 0.62, 0.46-0.82) and women (PR = 0.13, 0.05-0.33), and Bangladeshi men (PR = 0.77, 0.59-0.99) and women (PR = 0.11, 0.03-0.45). Ever-smoking rates were lower and smoking cessation rates were higher in the English ethnic groups than in the Dutch ethnic groups except for smoking cessation among the South Asian women. Similar to the White group, the prevalence of smoking was lower in South Asian and African men and women in England than their corresponding Dutch counterparts. These differences suggest that, among other factors, antismoking policies might have a similar influence on both ethnic majority and minority groups and illustrate the potential importance of national context on public health policy on ethnic minority groups' smoking behavior.

Safety and Efficacy of Nontherapeutic Male Circumcision: A Systematic Review

We wanted to assess the safety and efficacy of nontherapeutic male circumcision through a systematic review of the literature. We systematically searched The York Centre for Reviews and Disseminations, Cochrane Library, PubMed, and EMBASE databases for randomized controlled trials published between January 1997 and August 2008. Studies reporting on circumcision in an operative setting in males of any age with no contraindications to or medical indications for circumcision were eligible for inclusion. The main comparator was intact genitalia. From 73 retrieved studies, 8 randomized controlled trials were ultimately included for analysis. Severe complications were uncommon. Analgesia/anesthesia during circumcision was promoted. The prevalence of self-reported genital ulcers was significantly lower in circumcised men than uncircumcised men (3.1% vs 5.8%; prevalence risk ratio 0.53; 95% confidence interval [CI], 0.43-0.64; P<.001). Circumcised sub-Saharan African men were at significantly lower risk of acquiring human immunodeficiency virus/acquired immune deficiency syndrome than were uncircumcised men (random effects odds ratio = 0.44, 95% CI, 0.32-0.59; P <.001). The evidence suggests that adult circumcision does not affect sexual satisfaction and function. Strong evidence suggests circumcision can prevent human immunodeficiency virus/acquired immune deficiency syndrome acquisition in sub-Saharan African men. These findings remain uncertain in men residing in other countries. The role of adult nontherapeutic male circumcision in preventing sexually transmitted infections, urinary tract infections, and penile cancer remains unclear. Current evidence fails to recommend widespread neonatal circumcision for these purposes.

Risk behavior and social-cognitive determinants of condom use among ethnic minority communities in Amsterdam.

This study assessed sexual risk behavior and determinants of condom use among migrants in Amsterdam, The Netherlands. We tested the predictive utility of constructs derived from the health belief model and the theory of planned behavior. Data were collected by means of a cross-sectional study in a community sample of 537 Surinamese, Antillean, and sub-Saharan African heterosexual men and women randomly recruited from participants in an epidemiological study. Participants donated saliva for HIV testing and were interviewed using two structured questionnaires. Inconsistent condom use occurred in 82% of the primary partnerships and in 25% of the casual partnerships. Multivariate analyses, controlling for sociodemographic and behavioral factors, showed that perceived behavioral control and subjective norm regarding condom use were main social-cognitive determinants of consistent condom use. However, contrary to predictions, the relation between consistent condom use and sociodemographic and behavioral factors was not entirely mediated by these social-cognitive factors.

Men, Marriage, And Ideal Family Size In Francophone Africa

Sub-Saharan African marriage analyses typically ignore the fact that many monogamous men may intend to become polygynous in the future. Analyses using data from the Niger, Burkina Faso, and Senegal Demographic and Health Surveys illustrate that I) currently monogamous men can be divided into two distinct marriage groups based on their future marriage intentions, and 2) future marriage intentions may be associated with reported ideal family size desires. Hence researchers need to consider sub-Saharan African men’s unique roles and relationships in the development of survey questions for men, and in the planning of family planning program initiatives targeted to men.