sub-Saharan Contexts Research Articles

Spiritual and religious aspects influence mental health and viral load: a quantitative study among young people living with HIV in Zimbabwe

IntroductionThe role of religion and spirituality as social determinants of health has been widely discussed. Studies among people living with HIV describe positive and negative influences of religion and spirituality...

Disruptions to the procurement of medical abortion medicines during COVID-19: a scoping review

ObjectivesThis scoping review aimed to systematically search, retrieve and map the extent and characteristics of available literature on the evidenced disruptions to medical abortion (MA) medicine procurement caused by the...

Two-fold increase in the HIV viral load suppression rate along with decreased incidence over six years in Ndhiwa sub-county, Kenya.

BackgroundHIV‐positive individuals who maintain an undetectable viral load cannot transmit the virus to others. In 2012, an HIV population‐based survey was conducted in Ndhiwa sub‐county (Kenya) to provide information on the HIV local epidemic. We carried out a second survey 6 years after the first one, to assess progress in HIV diagnosis and care and differences in the HIV prevalence and incidence between the two surveys.MethodsA cross‐sectional, population‐based survey using cluster sampling and geospatial random selection was implemented in 2018, using the same design as 2012. Consenting participants aged 15–59 years were interviewed and tested for HIV at home. HIV‐positive individuals received viral load testing (viral suppression defined as <1000 copies/ml) and Lag‐Avidity EIA assay (to measure recent infection). The 90–90–90 UNAIDS indicators were also assessed.ResultsOverall, 6029 individuals were included in 2018. HIV prevalence was 16.9%. Viral suppression among all HIV‐positive was 88.3% in 2018 (vs. 39.9% in 2012, p < 0.001). HIV incidence was 0.75% in 2018 vs. 1.90% in 2012 (p = 0.07). In 2018, the 90–90–90 indicators were 93%–97%–95% (vs. 60%–68%–83% in 2012).ConclusionA two‐fold increase in the HIV viral load suppression rate along with a decreasing trend in incidence was observed over 6 years in Ndhiwa sub‐county. Achieving high rates of viral suppression in HIV populations that can lead to reducing HIV transmission in sub‐Saharan contexts is feasible. Nevertheless, we will need further efforts to sustain this progress.

Factors Associated with Stunted Growth in Children Under Five Years in Antananarivo, Madagascar and Bangui, Central African Republic

ObjectivesWith a fourth of all under-five children affected, stunting remains one of the biggest health challenges worldwide. Even though the main underlying factors are known, the exact pathways to stunting varying in affected regions, and interventions thus need to be tailored to the local contexts. This study aimed assessing and comparing factors associated with stunting in two understudied sub-Saharan urban contexts with some of the highest stunting prevalence globally: Bangui, Central African Republic (~ 36%) and Antananarivo, Madagascar (42%).MethodsWe performed a case–control study on 175 + 194 stunted and 237 + 230 non-stunted control children aged 2–5 years and matched for age, gender and district of residency. Factors associated with stunting were identified using a standardized, paper questionnaire delivered by trained interviewers. Statistical analysis was done using logistic regression modelling.ResultsIn both sites, formal maternal education lowered the risk of being stunted and restricted access to soap, suffering of anaemia and low birth weight were associated with higher risk of stunting. Short maternal stature, household head different from parents, diarrhoea and coughing were associated with an increased risk and continuing breastfeeding was associated with a lower risk of stunting in Antananarivo. Previous severe undernutrition and dermatitis/ fungal skin infections were associated with higher and changes in diet during pregnancy with lower risk of stunting in Bangui.ConclusionsOur results suggest maternal education, antenatal care, iron supplementation and simple WASH interventions such as using soap and infection control as general and breastfeeding (Antananarivo) or better nutrition (Bangui) as area-specified interventions.

Impact of land use intensification and local features on plants and pollinators in Sub-Saharan smallholder farms

Sub-Saharan African crop production largely relies on smallholder farms, located both in urban and agricultural landscapes. In this context, the investigation of plant and pollinator diversity and their interactions is of primary importance since both these factors are threatened by land use intensification and the consequent loss of natural habitats. In this study, we evaluated for the first time how plant and pollinator insect assemblages and interactions in Sub-Saharan farming conditions are shaped by land use intensification. To do that, we complemented biodiversity field surveys in Northern Tanzania with a modern DNA metabarcoding approach to characterize the foraged plants and thus built networks describing plant-pollinator interactions at the individual insect level. Moreover, we coupled this information with quantitative traits of landscape composition and floral availability surrounding each farm. We found that pollinator richness decreased with increasing impervious and agricultural cover in the landscape, whereas the flower density at each farm correlated with pollinator richness. The intensification of agricultural land use and urbanization correlated with a higher foraging niche overlap among pollinators due to convergence of individuals’ flower visiting strategies. Furthermore, within farms, the higher availability of floral resources drove lower niche overlap among individuals, while a greater flower visitors abundance shaped higher generalization at the networks level (H2′), possibly due to increased competition. These mechanistic understandings leading to individuals’ foraging niche overlap and generalism at the network level, could imply stability of interactions and of the pollination ecosystem service. Our integrative survey proved that plant-pollinator systems are largely affected by land use intensification and by local factors in smallholder farms of Sub-Saharan Africa. Thus, policies promoting nature-based solutions, among which the introduction of more pollinator-friendly practices by smallholder farmers, could be effective in mitigating the intensification of both urban and rural landscapes in this region, as well as in similar Sub-Saharan contexts.

In the eye of the beholder: Considering culture in assessing the social desirability of personality.

Multinational organizations are increasingly looking to deploy assessments on a global basis. However, the social desirability of different personality characteristics may vary as a function of culture, yet limited research has explored this idea. Based on the GLOBE cultural dimensions and the theory of purposeful behavior, we examined potential connections between cultural practice dimensions and the desirability of personality aspects with a large personality item bank, utilizing raters across 34 countries. Findings indicated few connections of societal level cultural practices and social desirability perceptions for particular aspects. An exception to this was the finding that higher social desirability ratings were given for cooperativeness, sensitivity, and assertiveness in Confucian Asian, South Asian, and Sub-Saharan contexts compared with Germanic Europe, Eastern Europe, Latin America, and Latin Europe contexts. Limitations of the study as well as implications for development and use of personality assessments globally in high stakes contexts are discussed. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Examining expansion and trends in higher education in Mozambique, Africa

Concerns about expansion in higher education (HE) have increasingly become a focus of educational policymakers in sub-Saharan countries. However, critical analysis and discussion of the expansion of higher education in Mozambique and changes in its composition have received little attention. We used historical track data provided by the Ministry of Science and Technology, Higher and Professional and Technical Education of Mozambique (MCTESTP) from 2008 to 2015 to examine the growth from 58,643 to 116,037 students in the social sciences, humanities and social services (SSHSS). The natural sciences, engineering, agriculture and healthcare (NSEAH) registered growth from 15,051 to 41,092 students. The total number of students registered annually in SSHSS and NSEAH in 49 public and private institutions averaged 84,083 and 28,114 students, respectively, totalling approximately 174,680 students. The data allowed assessing the expansion and trends of HE rooted in practices of isomorphism reflected in diversification and fragmentation of the country’s HE system. Our analyses identified coercive and mimetic practices in general patterns of the expansion of HE, revealed by drastic expansion from 2 to 49 institutions, which since 1995 have been fragmented and restructured in response to labour market, political forces, economic and educational market forces. The information presented will support educational policy makers to reformulate suitable models of expansion of higher education for a mass public in Mozambique, framed in the sub-Saharan and international contexts.

‘I’m waiting for that’: Interest in the use of PrEP for safer conception in Botswana

ABSTRACT Safe and effective low-cost safer conception (SC) methods are increasingly available and being integrated into national guidelines in sub-Saharan African contexts. Sero-different couples of childbearing age can benefit from such services and the routine provision of SC counselling. Pre-exposure prophylaxis (PrEP) to prevent HIV acquisition to uninfected partners can reduce the chances of HIV transmission when trying to achieve pregnancy. Botswana has a strong commitment to reducing new HIV infections but PrEP is not yet widely available and little guidance has been offered on counselling sero-different couples. We conducted qualitative in-depth interviews in Gaborone, Botswana with 10 HIV healthcare providers and 10 women living with HIV of childbearing age because they act as a key conduit for reaching sero-different partners with information about PrEP. We examined knowledge and attitudes towards PrEP to assess the viability and develop a deeper understanding of this SC option. Interviews were analysed using an interpretive phenomenological approach. Three themes emerged: (1) awareness of PrEP is limited, (2) providers and women overwhelmingly showed interest in PrEP and (3) women living with HIV and providers have concerns about PrEP use. With the correct support, PrEP could be a useful SC option for sero-different couples in Botswana and other sub-Saharan contexts.

Reproductive Autonomy and Modern Contraceptive Use at Last Sex Among Young Women in Ghana

Variability in the conceptualization and measurement of women's empowerment has resulted in inconsistent findings regarding the relationships between empowerment and sexual and reproductive health outcomes. Reproductive autonomy-a specific measure of empowerment-and its role in modern contraceptive use have rarely been assessed in Sub-Saharan contexts. Survey data were collected from a sample of 325 urban Ghanaian women aged 15-24 recruited from health facilities and schools in Kumasi and Accra in March 2015. Bivariate and multivariable logistic regression analyses were used to examine associations between two adapted reproductive autonomy subscales-decision making and communication-and women's use of modern contraceptives at last sex, controlling for demographic, reproductive and social context (i.e., approval of and stigma toward adolescent sexual and reproductive health) covariates. In multivariable analyses, reproductive autonomy decision making-but not reproductive autonomy communication-was positively associated with women's modern contraceptive use at last sex (odds ratio, 1.1); age, having been employed in the last seven days and living in Kumasi were also positively associated with modern contraceptive use (1.1-9.8), whereas ever having had a previous pregnancy was negatively associated with the outcome (0.3). Reproductive autonomy decision making remained positively associated with contraceptive use in a subsequent model that included social approval of adolescent sexual and reproductive health (1.1), but not in models that included stigma toward adolescent sexual and reproductive health. The reproductive autonomy construct, and the decision-making subscale in particular, demonstrated relevance for family planning outcomes among young women in Ghana and may have utility in global settings. Future research should explore reproductive autonomy communication and the potential confounding effects of social context.

Historical trends in global energy policy and renewable power system issues in Sub-Saharan Africa: The case of solar PV

From 1972 and the Meadows report to 1997 and the ratification of the Kyoto Protocol by most of the countries in the world, the global energy policy framework has moved on to considering the concept of sustainable development. Regarding electrification, modern renewable power systems such as solar PV have sprung up in the wake of this major mutation and have typically undergone a significant growth since the beginning of this century. In this paper, we first investigate the historical interactions between energy and society in both global and Sub-Saharan contexts and how renewable power has ended up being considered accordingly. From the need for sustainable development to grid-connected architecture on the one hand; from the lack of human development to rural off-grid electrification on the other. Then, using the case of solar PV, we propose a reading of the issues and challenges renewable power systems are currently facing in Sub-Saharan Africa, by linking those aspects to the previously stated global policy framework, and in particular the historical segmentation of the renewable energy worldwide market between grid-connected and off-grid sectors.

Exploring Barriers and Practical Solutions for the Uptake and Use of Clean Cooking through Photovoice Methods: The LPG Adoption in Cameroon Evaluation (LACE) Studies

Background: Each year up to 4 million people die prematurely from household air pollution due to domestic use of solid fuel, mainly in low and middle-income countries (LMICs). Liquefied Petroleum Gas (LPG) is an affordable, scalable, and widely available clean fuel that provides health and environmental benefits when used for household energy in LMICs. In Cameroon, where 70% of people rely on biomass for cooking, the Government aims to increase LPG use from &amp;lt; 20% to 58% by 2035. Few qualitative studies have explored households&amp;#8217; perceptions of factors affecting LPG uptake. We conducted community-based participatory research using photovoice methods to explore factors influencing LPG uptake and sustained use in South-West Cameroon. Methods: Two groups of participants from rural (n&amp;#61;7) and peri-urban (n&amp;#61;8) areas photographed aspects of their lives which prevented/enabled LPG uptake in their communities. Individual interviews (n&amp;#61;15) and group discussions (n&amp;#61;5) explored participants&amp;#8217; reflections on the issues photographed. We conducted thematic analysis using NVivo 10 software. Results: Main barriers included difficulty in affording the initial LPG equipment and ongoing refills, scarcity of LPG retail shops and safety concerns. Key enablers/solutions included (i) increasing awareness of the benefits of LPG, (ii) additional retail shops, (iii) addressing safety concerns, (iv) repairing roads to improve distribution, and (v) reducing the refill price. We organised an exhibition of participants&amp;#8217; photos to generate discussions between participants and representatives from government, communities, industry and media about how to assist communities with fuel transition. Conclusions: Photovoice was found to be an effective participatory approach that (i) identified factors affecting uptake and use of LPG, which could be transferable to Sub-Saharan contexts, and (ii) engaged with participants and key stakeholders to identify how to advance equitable access to LPG in Cameroon.

The Flexibility of Fertility Preferences in a Context of Uncertainty.

The Flexibility of Fertility Preferences in a Context of Uncertainty.

Grassroots volunteers in context: rewarding and adverse experiences of local women working on HIV and AIDS in Kilimanjaro, Tanzania.

Many nongovernmental organizations in Africa rely on grassroots volunteers to provide critical health services. Considering context and the interplay of individual, organizational, and societal influences on the experience of volunteers, this paper addresses three questions: What do grassroots volunteers contribute? What organizational processes promote volunteer engagement? What are the positive and negative consequences of volunteering? Eighteen members and staff of the Tanzanian HIV and AIDS NGO, KIWAKKUKI, were selected from 6000+ women volunteers to be interviewed. The interviews were recorded, transcribed, and analyzed for themes. Within KIWAKKUKI, volunteers contributed time and local knowledge, leading to an indigenous educational approach building on local norms and customs. Volunteers' engagement was motivated by the desire to support family members, reverse stigma, and work/socialize with other women. Benefits to volunteers included skills acquisition and community recognition; yet some volunteers also reported negative experiences including burnout, conferred stigma, and domestic violence. Positive organizational processes built on cultural practices such as collective decision-making and singing. The findings point to important considerations about context, including the synergistic effect training can have on local traditions of caring, complications of gender inequity, and how community health planning processes may need to be modified in extremely poor settings. This research also suggests good utility of the research framework (the Bergen Model of Collaborative Functioning) that was used to analyze volunteer engagement for service delivery in sub-Saharan contexts.

After Rio+20: Translating words in action

From 1972 and the Meadows report to 1997 and the ratification of the Kyoto Protocol by most of the countries in the world, the global energy policy framework has moved on to considering the concept of sustainable development. Regarding electrification, modern renewable power systems such as solar PV have sprung up in the wake of this major mutation and have typically undergone a significant growth since the beginning of this century. In this paper, we first investigate the historical interactions between energy and society in both global and Sub-Saharan contexts and how renewable power has ended up being considered accordingly. From the need for sustainable development to grid-connected architecture on the one hand; from the lack of human development to rural off-grid electrification on the other. Then, using the case of solar PV, we propose a reading of the issues and challenges renewable power systems are currently facing in Sub-Saharan Africa, by linking those aspects to the previously stated global policy framework, and in particular the historical segmentation of the renewable energy worldwide market between grid-connected and off-grid sectors.

Evaluating health and disease in Sub-Saharan Africa: minimally invasive collection of plasma in the Malawi Longitudinal Study of Families and Health (MLSFH).

The collection of biomarker-based indicators of adult health is an important addition to socioeconomic surveys since they can provide valuable insights into the biological functions, and the complex causal pathways between socioeconomic environments and health outcomes. We document the collection of blood-plasma based biomarkers as a pilot project within the Malawi Longitudinal Study of Families and Health (MLSFH). Using the LabAnywhere system as a minimally-invasive approach previously not used in less-developed countries, we collected biomarkers of lipids, metabolic processes, organ function, and the immune system. Overall, only small proportions of the collected samples are above the upper limits of the normal clinical ranges as defined by western standards. The correlational patterns between the biomarkers are consistent with observations from developed countries and the comparison with other low-income populations shows remarkably similar age-specific patterns of the biomarkers despite differences in the mode of blood sampling. The present study confirms that the collection of biomarker-based indicators of adult health using the LabAnywhere system is feasible in rural sub-Saharan contexts and this approach provides an attractive alternative to the collection of dried blood spots (DBS) and venous blood samples. Iliana V. KOHLER, Researcher and Associate Director, Population Aging Research Center, and Population Studies Center, University of Pennsylvania, 3718 Locust Walk, Philadelphia, PA 19104, USA. E-mail: iliana@pop.upenn.edu . Philip ANGLEWCZ, Assistant Professor, School of Public Health & Tropical Medicine and Department of Global Health System and Development, 1440 Canal St., Suite 2200, New Orleans, LA 70112-2737, USA. E-mail: panglewi@tulane.edu . Hans-Peter KOHLER, Frederick J.\ Warren Professor of Demography and Professor in Sociology, Department of Sociology and Population Studies Center, University of Pennsylvania, 3718 Locust Walk, Philadelphia, PA 19104-6299, USA;. E-mail: hpkohler@pop.upenn.edu . John F. McCABE, Programmer/Data Analyst, Population Aging Research Center (PARC), University of Pennsylvania, 3718 Locust Walk, Philadelphia, PA 19104, USA. E-mail: mccabef@pop.upenn.edu . Ben CHILIMA, Director, Community Health Sciences Unit, Ministry of Health and Population Community Health Sciences Unit, Private Bag 65, Lilonge, Malawi. E-mail: bchilima2@yahoo.com . Beth J. SOLDO, Distinguished Senior Scholar in Sociology, University of Pennsylvania, 3718 Locust Walk, Philadelphia, PA 19104, USA. E-mail: bsoldo@pop.upen.edu