sub-Saharan African Region Research Articles

Impact of COVID-19 on Utilization of Healthcare Services Among People Living with HIV (PLHIV): A Systematic Review

Background and Objectives: People living with HIV/AIDS have been impacted notably by the COVID-19 pandemic in diverse dimensions. Although some impacts of COVID-19 on PLHIV have been well documented, there is still insufficient research that captures the overall understanding of the implications of COVID-19 for the healthcare utilization among PLHIV. This review aims to evaluate the impact of COVID-19 on PLHIV, narrowing it down to women living with HIV/AIDS. Materials and Methods: An electronic database search of primary studies that obtained information from health facility data regarding PLHIV since 2020 was carried out according to the PRISMA statement. A combination of search terms, e.g., “COVID-19 pandemic”, “SARS-CoV-2”, “Health services utilization”, “People living with Human immunodeficiency virus”, was included. Results: There was an overall decline in the utilization of health services such as medical consultations, ART uptake, and viral load monitoring by PLHIV at primary health centers at the forefront of care delivery. However, the countries in the sub-Saharan African region showed a progressive service increase over the pandemic. There was a scarcity of research on the impact of COVID-19 on women populations living with HIV/AIDS. Other methods of healthcare delivery such as telemedicine and postage services were instrumental to the delivery of HIV care services. Conclusions: The COVID-19 pandemic reduced the overall uptake of healthcare services among PLHIV and women living with HIV/AIDS. There is a need to boost research and strengthen health emergency preparedness for PLHIV, particularly women living with HIV/AIDS, during pandemics and further harness and maximize the use of contemporary healthcare delivery methods other than the traditional ones.

What Do Mothers Know About Nutrition? Impacts on Childhood Nutrition Outcomes in Sub-Saharan Africa.

Globally, the prevalence of undernutrition is highest in the sub-Saharan African region with over a third of the world's stunted children residing in this region. Many studies have explored child nutrition in sub-Saharan Africa, but they often overlook the intricate nuances of maternal knowledge. We examined the association between maternal nutritional knowledge and childhood nutritional outcomes. This was a secondary analysis utilizing data from the Demographic and Health Survey of eight sub-Saharan African countries that were conducted between 2019 and 2022, focusing on children aged 6 to 23 months. The study used latent class analysis to identify discrete patterns of nutrition and health-related knowledge and mixed-effects logistic regression to assess their association with childhood nutritional outcomes namely, stunting and wasting. Statistical significance was determined at p < 0.05. Most participants knew the importance of colostrum (76.8%) and continued breastfeeding (76.7%), as well as immunization (60.0%) and diarrhoea prevention and treatment strategies (65.1%). However, only 24.49% knew about family planning. Children of high knowledge group/class had a 17% lower risk of childhood stunting (crude model; COR = 0.83; 95%CI: 0.77, 0.90, adjusted model; AOR = 0.89; 95%CI: 0.82, 0.97) and a 22% lower risk of wasting (COR = 0.78; 95%CI: 0.69, 0.89, adjusted model; AOR = 0.84; 95%CI: 0.73, 0.96) compared to those from the low knowledge group/class. These results highlight the pivotal role of maternal knowledge in shaping children's health outcomes and emphasize the urgent need for targeted interventions and comprehensive maternal education programs to address the identified knowledge gaps and improve child health outcomes.

Revisiting the drivers of electricity consumption in designated Sub-Saharan African regions: Unraveling the role of education.

It has been established that steady supply of energy to various sectors of the economy is critical for societal growth and development. According to recent figures, barely one-third of the whole population in Sub-Saharan Africa has access to electricity, making the region the poorest in the world in terms of access to electrical power today. This stands in stark contrast to the vast energy resources that could be utilized to provide the necessary energy. In this context, various researches have attempted to identify various factors that influence electricity use. However, in Sub-Saharan Africa, there is relatively limited empirical study carried out to quantify the influence of latent drivers of electricity consumption, particularly taking into account the important role of education. Thus, this existing study effectively investigates the potential factors influencing electricity consumption by taking into account the impact of education in ten selected Sub-Saharan African nations between 1990 and 2020. In addition to education, the study included population, urbanization, and economic growth as relevant variables to mitigate concerns about variable bias resulting from omission. Bearing in mind the potential occurrence of residual cross-sectional connectedness and slope heterogeneity issues, the augmented mean group and the common correlated effect mean group techniques were utilized as the prime estimation methods. Key findings revealed that education has an enormous and palpable effect on the consumption of electricity in the panel scenario, whereas country-specific results yielded a mixed bag of meaningful outcomes. Such cutting-edge approaches and results suggest that education is important in terms of Sub-Saharan Africa's electricity consumption. Based on the empirical findings, additional practical policy recommendations are presented.

Lupus nephritis randomised controlled trials: evidence gaps and under-represented groups

ObjectiveWe performed a scoping review of randomised clinical trials (RCTs) assessing pharmacological therapies for the initial management of lupus nephritis (LN), focusing on study design, included populations and outcome definitions,...

Malaria pervasiveness in Sub-Saharan Africa: Overcoming the scuffle.

Malaria has posed a momentous health and economic burden to the Sub-Saharan African region. The Sub-Saharan African region accounts for more than 90% of global malaria-related mortality and morbidity. Pregnant women and children under 5 years old are the most vulnerable. Mosquitoes transmit the plasmodium which is the parasite responsible for malaria. The climatic conditions, poverty, and poor healthcare system of the Sub-Saharan African region are some factors fueling this menace. There have been concerted efforts to annihilate malaria but the scuffle has been a tedious one. Malarial eradication campaigns have been focused on mosquito control through the use of insecticide-treated bed nets, use of indoor insecticide sprays, and use of larvicides. The use of artemisinin in combination with other drugs has been effective to some extent. Despite the aforementioned strategies, the pervasiveness of malaria infection in the Sub-Saharan African region is worrisome. Thus, strengthening the already existing control measures, finding novel measures through intensive research, and embracing malaria vaccination could help accelerate the overcoming of this scuffle. In this review, we utilized relevant published data from various databases to reexamine the factors fueling malaria pervasiveness in this region and spelled out point-by-point intervention protocols to end malaria scuffle.

Exploration of Agronomic Efficacy and Drought Amelioration Ability of Municipal Solid-Waste-Derived Co-Compost on Lettuce and Maize

Organic soil amendments, such as composts, mitigate the negative impacts on the environment that are caused by poor waste management practices. However, in the sub-Saharan African region, and Malawi in particular, studies investigating the agronomical efficacy and their ability to ameliorate drought stress when used as a soil amendment are minimal. This study aimed to evaluate the efficacy of sewage sludge and municipal solid waste (MSW) co-compost to ameliorate drought stress and improve crop productivity. Three experiments were conducted (i) to determine optimal application rate for co-compost, (ii) to evaluate yield response of maize and lettuce to co-compost application under contrasting soils, and (iii) to assess the effect of co-compost under water-limited conditions. Our results indicate that an application rate of 350 g co-compost per station was the most effective. This rate is 50% and 37% lower than the currently recommended rate for applying conventional compost to green vegetables and maize, respectively. In addition, under drought conditions, the co-compost application enhanced growth in lettuce, with less wilting, increased biomass and yield, approximately 130% greater leaf yield, and a 138% improvement in root growth. Furthermore, the relative root mass ratio (RRMR) was enhanced with the co-compost application by 103% under drought stress. This suggests that the co-compost amendment resulted in a greater allocation of biomass to the roots, which is a crucial morphological attribute for adapting to drought conditions. The concentration of K in the leaves and roots of plants treated with co-compost was significantly increased by 44% and 61%, respectively, under drought conditions, which may have contributed to osmotic adjustment, resulting in a significant increase in leaf relative water content (RWC) by a magnitude of 11 times. Therefore, in light of the rising inorganic fertilizer costs and the limited availability of water resources, these results demonstrate the potential of MSW and sludge co-composting in ameliorating the drastic effects of water- and nutrient-deficient conditions and optimizing growth and yield under these constraining environments.

Trade Globalization, Overseas Investment, and Tax Revenue Growth in Sub-Saharan Africa

Abstract The financial setbacks of the sub-Saharan African regions have necessitated this study. The study assesses the role of trade openness and foreign direct investment (FDI) in driving tax revenue growth in sub-Saharan Africa. The major parameter representing the dependent variable is tax revenue growth while the independent factors include trade openness, exports, imports, and GDP as a moderating element. The research runs from 1990 to 2022 and employs the vector error correction model (VECM), with a unit root test that yields order one, while the Johansen co-integration test shows a long-run connection for all variables. The VECM results suggest that the long-run disequilibrium is corrected at a positive rate of 8.5%. It is also noteworthy that a percentage change in trade openness would result in a 13.7% decrease in tax income, but fluctuations in all other parameters except GDP will enhance tax revenue growth in sub-Saharan Africa. The test for the impact of all criteria on tax revenue growth yields minor results; however, tax revenue growth initiatives in Sub-Saharan Africa have a negative short- term effect on FDI but a favourable long-term impact. In addition, trade openness has a negative effect on GDP and exports in the short run, while imports have a negative impact on foreign investment. The policy implications include that bilateral trade policies will need to be reviewed, with an emphasis on exports, economic growth, and tax collection schemes. In addition, the governments in sub-Saharan African regions are encouraged to enact tax policies that would engender the inflow of overseas investment.

Infrastructure Development And External Financing Nexus In Sub-Saharan Africa: Panel Vecm Analysis

Abstract Research background It is evident that relying solely on domestic financing cannot bridge the infrastructure gap in the Sub-Saharan African (SSA) region. Therefore, exploring alternative sources of financing becomes crucial to complement domestic efforts and address the infrastructure needs effectively. Purpose This study investigates the relationship between infrastructure development and external financing factors (foreign direct investment – FDI, private participation in infrastructure – PPI, and official development assistance – ODA) by considering the short- and long-run equilibrium and their causal direction. Research methodology These objectives are achieved by employing the panel vector error correction mechanism (PVECM), impulse response functions (IRF), variance decomposition analysis (VDCs), and VAR causality on a dataset covering 43 SSA countries from 2000 to 2021. Results The results reveal the presence of feedback causal relationships between infrastructure development and external financing factors, and PVECM results demonstrate that only private participation in infrastructure has a positive influence on infrastructure development both in the long and short-run, while ODA and FDI only influence infrastructure development in the long- run. Novelty The current study contributes to the existing literature by examining the impact of external financing factors on infrastructure development, with a specific focus on SSA, by considering the three major external financing factors (PPI, FDI, and ODA) as the determinants of infrastructure.

The role of green finance and natural resources rent in eradicating energy poverty – the case of the Sub-Saharan African countries

This research addresses energy poverty in Sub-Saharan African (SSA) countries, emphasizing improved access to clean cooking electricity and technologies in urban areas. Urbanization in the SSA region has intensified the problem, with informal settlements relying on traditional and polluting cooking methods, causing indoor air pollution, environmental damage, and economic struggles. The research employs the Methods of Moments Quantile Regression with fixed effects to assess the factors that enhance access to clean energy and technologies for cooking in the urban areas. The data of forty-four SSA countries during the timeframe spanning 2004 to 2020 is used. This research adds to the growing body of literature on how energy poverty can be eradicated, considering the few studies that has been done to address this issue. Specifically, the effect of green finance and financial development on energy poverty has not been widely done, thus this research covers the literature gap present. The major results of this research depicts that financial development, government effectiveness, natural resources rents and technological innovations are fundamental in improving access to clean electricity in the urban areas of the SSA nations. We also show that economic growth, foreign direct investment and green finance are counterproductive in fostering the access to clean electricity in this region. This research show that the resource curse hypothesis does not hold in the SSA countries in the context of energy poverty. The major policies presented in this research calls for the developing countries to promote financial development, technological innovations and natural resource rents in alleviating energy poverty. Corruption levels and political instability in these countries should be reduced.

Determinants of persistent malaria transmission in the Arjo-Didessa farm area in Ethiopia.

In tropical and subtropical areas of the world, malaria is still a serious public health concern. Activities related to agricultural development that involve irrigation schemes likely increase the risk of malaria in tropical and sub-Saharan African regions. Ethiopia is a sub-Saharan country where malaria is endemic. The aim of the study was to investigate the determinants related to the persistence of malaria transmission in the Arjo-Didessa sugarcane farm area in southwest Ethiopia. The study employed a quantitative survey design. Quantitative data were collected from 397 households using structured questionnaires. SPSS Statistics version 26 was used to analyse the data. Z- and Chi-square tests were applied, and the data were analysed using logistic regression. The determinants that were identified included variation in land use, water management practices, socioeconomic status and knowledge about the use of anti-malaria treatment. These were shown to contribute to increased malaria transmission and the rise in malaria cases in agricultural areas. The effectiveness of malaria control in agricultural settings can be improved through free access to malaria testing and treatment as well as knowledge about anti-malaria treatment among the residents in agricultural areas. The study revealed key determinants, including the promotion of free access to anti-malaria treatment, which should be considered for the effective management of malaria in agricultural areas.

Adaptation of the G-NORM (Gender norms scale) in Uganda: An examination of how gender norms are associated with reproductive health decision-making.

Restrictive gender norms exacerbate health inequalities all over the world. More specifically, they prevent women from seeking preventive health services, constrain women's economic empowerment, and are associated with reproductive health decision making. Gender norms, a subset of social norms, are dynamic and change over time. However, we lack data on how they are changing and how these changes affect health outcomes because current measures do not adequately capture the complex concept of gender norms. We originally developed and validated a gender norms scale, the G-NORM, in India. In this study, using cross-sectional data, we adapted the G-NORM from Southeast Asia (India and Nepal) to sub-Saharan Africa (Uganda) in four steps: 1. Formulation of new scale items (via qualitative analysis) 2. Cognitive Interviewing 3. Questionnaire Administration (n = 2422 women of reproductive age) and 4. Psychometric analysis (Confirmatory Factor Analysis). Like the original scale, descriptive norms and injunctive norms comprised two unique sub scales with high Cronbach's alphas (.80 & .92). Average scores differed depending on the type of norm suggesting that some gender norms are changing faster than others. Specifically, more equitable injunctive norms were associated with lower odds of partner-dominated contraceptive decision making but descriptive norms were not. Gender norms serve as a multi-faceted determinant of health and wellbeing and require measurement tools which account for their conceptual complexity. Validating the G-NORM in Uganda expands measurement options for researchers in the sub-Saharan African region working to change norms to reduce health inequalities or to understand the gender normative context before beginning a study.

Projected impact of climate change on human health in low- and middle-income countries: a systematic review

Low- and middle-income countries (LMICs) contribute relatively little to global carbon emissions but are recognised to be among the most vulnerable parts of the world to health-related consequences of climate...

Property rights protection and intangible investment in the Sub-Saharan African non-financial firms

This empirical study examines the impact of property rights on intangible investments in sub-Saharan African (SSA) non-financial firms using firm-level data. The study employs a local projections methodology for twelve SSA countries over the period 1996–2020. Our empirical results show that property rights protection increases intangible investment in non-financial firms in the SSA region. This effect is significant for the SSA region in the long run.

Why becoming a positive deviant for malaria prevention and control: a sequential explanatory mixed methods study in Bugesera district, Rwanda

BackgroundMalaria continues to be a significant global health challenge, particularly in sub-Saharan African regions. Effective prevention and control strategies are crucial in mitigating its impact. Therefore, assessing the use of malaria preventive measures, treatment-seeking behaviours, and understanding the motivating factors behind positive behaviours/practices and barriers to using malaria preventive and control measures is essential for designing successful intervention programs.MethodsUsing a sequential explanatory mixed methods design, a descriptive cross-sectional study was conducted among 382 heads of households in the Mareba sector, Bugesera district, Rwanda. A qualitative study followed with 30 in-depth interviews among the top performers and other community members to explore the motivations and barriers to performing positive behaviours. Descriptive statistics for quantitative data and thematic analysis for qualitative data were used.ResultsThis study revealed that among those who own insecticide-treated nets, 234(89.3%) reported that they slept under the bed net the night preceding the survey; 256(67%) had fever cases in the last 24 months preceding the survey; and 214(87%) reported seeking care within 24 h. While almost all 243(98.8%) of participants who had fever case reported that they have taken all medicines as prescribed, however, a large number 263(68.8%) and 148(38.7%) still think that there are people in the community who do not take all malaria medications as prescribed and there are people who share malaria medications in the community, respectively. 82(65.1%) of those who never had a fever case believe that they have been using malaria preventive measures correctly and consistently. This study found that knowledge about malaria, family support, and community mobilization are the top motivating factors to practice positive behaviours while, lack of bet nets, poverty, and lack of time were reported as main barriers.ConclusionInterventions that target key motivating factors for adopting positive behaviours in malaria prevention and control should be prioritized. This, in turn, will reduce the disease burden on affected populations. Efforts to overcome barriers in malaria prevention and control should also be participatory. Community involvement should be at the centre of these interventions.

Economic growth, foreign direct investment and corruption nexus in sub-Saharan African countries: moderation model

This study aligns with Sustainable Development Goal 8 which borders on “economic growth by ensuring FDI inflows continue to increase so as to spur sustained economic growth”. It contributes to the economic growth literature by evaluating the role of FDI inflows and corruption on economic growth. The Sub-Saharan African region has witnessed an increase in FDI inflows for the last three decades. However, economic growth has been reducing. For example, the region witnessed a contraction in economic growth to 2.7 percent in 2022 down from 4.4 percent of 2021. The literature indicates that corruption can impede FDI inflows from translating to high economic growth. Many studies have examined the role of FDI inflows in economic growth but have not studied the moderating effect of corruption thus creating a gap for this study. To achieve the objective, the study uses the Fixed Effects Panel data approach on unbalanced panel data for 46 sub-Saharan African countries from 1998 to 2021 to interrogate the nexus. The results revealed a positive relationship between FDI inflows and economic growth. The findings align to the endogenous growth model that explains the link between foreign direct investment and economic growth. However, corruption was found to reduce the effectiveness of FDI inflows in realizing economic growth. The study therefore recommendsthat the governments of the Sub-Saharan Africa countries need to address corruption so as to achieve the desired economic growth. They should implement measures focusing on improving institutional quality to control corruption. In addition, the policy makers should relook at anti-corruption initiatives aimed at reducing poor governance. For instance, financing anti-corruption agencies and legislating their independence to ensure corruption is reduced.

Cross-cultural adaptation and psychometric validation of the Chichewa (Malawi) PedsQL™ 4.0 Generic Core Scales child self-report and PedsQL™ 4.0 GCS teen self-report

BackgroundThe PedsQL™ 4.0 Generic Core Scales (GSC) have been translated into over 60 languages, but use in the sub-Saharan African region is limited. This study aimed to cross-culturally adapt and validate the PedsQL™ 4.0 GCS child self-report and teen self-report versions into the Chichewa language for Malawi.MethodsThe English (USA) versions were adapted (translation, back translation and cognitive interviews to evaluate conceptual equivalence) into Chichewa. We recruited 289 children (8–17 years) in Blantyre, Malawi. Classical psychometrics at the item level (missing data, endorsement frequencies, item redundancy) and scale level (internal consistency, convergent, discriminant and known groups validity) was used to evaluate the new Chichewa versions.ResultsSix items were found to need cultural adaptation for Malawi. There were problems with missing data (< 5%) and adjacent endorsement frequency (< 10%) among younger children. Internal consistency reliability was acceptable (Cronbach α > 0.7). Convergent validity was generally strong (correlations > 0.4). Discriminant validity (p > 0.05) was evident with respect to gender and age, but not for school grade (p < 0.05). Effect sizes indicating known groups validity were in the expected direction but of variable magnitude.ConclusionWe have successfully adapted the PedsQL™ 4.0 GCS child self-report and teen self-report into Chichewa for use in Malawi. Many aspects of the psychometric evaluation were promising, though some elements were more mixed and we have not yet been able to evaluate test-retest reliability or responsiveness. We suggest that the PedsQL™4.0 GCS child and teen self-reports should be used with caution among children and adolescents in Malawi.

Navigating the impact of remittances on environmental quality in Africa: The crucial role of institutional quality

The Sub-Saharan African (SSA) region remains the world's largest recipient of remittances. Due to growing concerns over climate change issues, recent studies have examined how these financial flows have affected environmental quality. Sundry variables were controlled in such studies concerning the remittances-environment nexus, including institutional quality. Notwithstanding that remittance and institutional quality are imperative, their combined effect on environmental quality has been overlooked. The present study has inspected how remittances and institutional quality have jointly influenced environmental quality in 44 economies in the SSA region between 2000 and 2022. Using PMG-ARDL analysis, the findings revealed that remittances had a negative long-term impact on environmental quality. Conversely, the study found that institutional quality positively affected the per capita ecological footprints, as measured by the six indicators' average. Furthermore, the results indicated that improvements in institutional quality over time mitigated the adverse impact of remittances on the environment in the sampled SSA countries. Additionally, a threshold level of institutional quality effectively moderates remittances' detrimental effects on environmental quality were identified. Therefore, most regional countries must enhance their institutional quality to mitigate the negative environmental impact of remittances.

Knowledge gaps related to HIV and condom use for preventing pregnancy: a cross-sectional study among migrants in Sweden

BackgroundInformation and knowledge of sexual and reproductive health and rights (SRHR) plays a crucial role in promoting safe sexual practices among young migrants. We aimed to assess the sociodemographic factors of migrants associated with knowledge of condoms and the prevention, treatment, and transmission of HIV to highlight the need for SRHR information, including comprehensive sexual health education.MethodsA cross-sectional survey was conducted (2018–2019) among migrants at Swedish language schools and high schools across Sweden. The survey included questions about knowledge of condom use for preventing pregnancy and HIV treatment and transmission. Descriptive statistics were calculated, and multivariable logistic regression analyses were performed to assess the responses to the knowledge questions and sociodemographic characteristics.ResultsOut of 3430 respondents (median age: 35, interquartile range: 20), approximately 39% were unaware that condoms can prevent unplanned pregnancies. Only 58% of the respondents knew that condoms reduce the risk of contracting HIV. About 77% were unaware of HIV treatment, and 52% reported not knowing that a woman with HIV could transmit the virus to her baby during pregnancy or breastfeeding. Incorrect knowledge about condom use to prevent unwanted pregnancy was associated with several factors: younger age (15–19 years) adjusted odds ratio (aOR) 1.35; 95% confidence interval (CI), 1.02–1.79); female respondents (aOR: 1.68; 95% CI 1.36–2.07); lack of previous sexual health education (aOR: 2.57; 95% CI 2.11–3.13); low level of education (aOR: 1.30; 95% CI 1.04–1.61). Originating from the Americas, European, or sub-Saharan African regions was associated with a 34–42% decreased likelihood of incorrect knowledge that condoms can reduce the risk of HIV infection compared to respondents from the Middle East and North Africa (MENA). More than half (64%) of respondents reported needing more SRHR information.ConclusionsWe found significant knowledge gaps on HIV and condom use for preventing pregnancy among migrants in Sweden. Comprehensive sexual health education in language schools, along with information to newly arrived migrants from diverse regional backgrounds and targeted sexual health services to younger individuals, women, and those who lack sexual health education, are needed to address these information gaps and provide crucial SRHR education and information.

Determinants of Hepatitis B Viral Infection among Pregnant Women in Greater Monrovia, Liberia

Background: The global prevalence of hepatitis B virus infection is estimated to affect over 2 billion individuals, with a notable proportion ranging from 6% to 25% residing in the Sub-Saharan African region. The prevalence of hepatitis B virus (HBV) in Liberia, Guinea, and Sierra Leone has been estimated to be approximately 2%. However, current understanding of the actual risk factors associated with HBV in the Greater Monrovia remains unclear. Consequently, this study aimed to identify the factors associated with hepatitis B viral infection among pregnant women residing in Greater Monrovia, Liberia. Methods: An unmatched case control study of 141 cases of HBV infected pregnant women and 141 controls was conducted. Data on socio-demographic characteristics, lifestyle activities and medical related risk factors were collected for both groups with a structured questionnaire. Bivariate and multivariate analyses established associations between the HBV infection and risk factors studied. Results: In all, 141 cases of HBV infected pregnant women and 141 controls participated in this study. The mean age of cases was 35.6 years (SD ±9.5) and 36.1 years (SD ±8.4) for controls. Low-income level &lt;100 dollars [aOR 13.0 (4.48-37.82, p&lt;0.001)], employment [aOR 0.04 (0.09-0.18) p&lt;0.001], STI history [aOR 5.19 (1.68-16.02, p=0.004)] and living with a HBV infected person [aOR 35.11 (4.24-58.90), p=0.001] were factors associated with HBV infection among pregnant women in Greater Monrovia. Conclusion: The risk factors of HBV infection among pregnant women in Greater Monrovia were engagement in formal employment, low-income level, history of sexually transmitted infections (STIs), and residing with an individual infected with hepatitis B virus (HBV). Control efforts by designated state institutions should include advocacy and awareness creation on HBV status identification, safe sex, and vaccination of uninfected individuals.

Far behind 90-70-90’s screening target: the prevalence and determinants of cervical cancer screening among Sub-Saharan African women: evidence from Demographic and Health Survey

BackgroundCervical cancer screening is the primary goal in 90-70-90 targets to reduce cervical cancer incidence and mortality by identifying and treating women with precancerous lesions. Although several studies have been conducted in Sub-Saharan African (SSA) countries on cervical cancer screening, their coverage was limited to the regional or national level, and/or did not address individual- and community-level determinants, with existing evidence gaps to the wider SSA region using the most recent data. Hence, this study aimed to assess the pooled prevalence and multilevel correlates of cervical cancer screening among women with SSA.MethodsThis study was conducted using the Demographic Health Survey data (2015–2022) from 11 countries, and a total weighted sample of 124,787 women was considered in the analysis. Using multilevel mixed-effects logistic regression, the influence of each factor on cervical cancer screening uptake was investigated, and significant predictors were reported using the adjusted odds ratio (aOR) with their respective 95% confidence intervals (95% CI).ResultsThe overall weighted prevalence of cervical cancer screening was 10.29 (95% CI: 7.77, 11.26), with the highest and lowest screening rates detected in Namibia and Benin at 39.3% (95% CI: 38.05, 40.54) and 0.5% (95% CI: 0.36, 0.69), respectively. Higher cervical screening uptake was observed among women aged 35–49 [aOR = 4.11; 95% CI: 3.69, 4.58] compared to 15–24 years, attending higher education [aOR = 2.71; 95% CI: 2.35, 3.23] than no formal education, being in the richest wealth quintile [aOR = 1.45; 95% CI: 1.26, 1.67], having a recent visit to a health facility [aOR = 1.83; 95% CI: 1.71, 1.95], using contraception [aOR = 1.54; 95% CI: 1.45, 1.64], recent sexual activity [aOR = 3.59; 95% CI: 2.97, 4.34], and listening to the radio [aOR = 1.78; 95%CI: 1.60, 2.15].ConclusionThe overall prevalence of cervical cancer screening in SSA countries was found to be low; only one in every ten women has been screened. Strengthening universal health coverage, and promoting screening programs with an emphasis on rural areas and low socioeconomic status are key to improving screening rates and equity. Additionally, integrating cervical cancer screening with existing reproductive health programs, e.g. contraceptive service would be important.