WHO Africa Region Research Articles

Evidence on the accreditation of health professionals' education in the WHO Africa region: a scoping review protocol.

This scoping review aims to map and examine the extent and type of available evidence on health professionals' education accreditation within Africa. The demand for health professionals is unprecedentedly high globally. One response to this challenge has been expanding training through more liberal education policies, facilitating private sector participation in education service provision. Some evidence suggests that this is a double-edged sword, increasing quantity but compromising the quality of health professionals produced. Regulation can provide a framework to assure and continuously improve quality, with such regulation in place in 79% of World Health Organization African countries. However, it is unclear how much and what evidence has been generated on how accreditation happens, where it is concentrated, and the prevailing evidence gaps within this region; therefore, we propose to conduct a scoping review. This review will include articles and dissertations focusing on the accreditation of health professionals' education in Africa. All methodological approaches and designs will be included. Conference abstracts and protocols will be excluded. This review will be carried out according to the JBI scoping review methodology. We conducted an initial search of CINAHL and MEDLINE to identify relevant articles. This informed our selection of keywords, along with index terms, to create a comprehensive search strategy for CINAHL (EBSCOhost), MEDLINE (Ovid), Global Health (Ovid), ERIC (EBSCOhost), Web of Science Core Collection, Embase, and Scopus. Sources included will be limited to those published starting from 2000 onwards. Data will be presented using tables and charts, accompanied by a narrative summary. https://doi.org/10.17605/OSF.IO/W5G7T.

Projected health workforce requirements and shortage for addressing the disease burden in the WHO Africa Region, 2022–2030: a needs-based modelling study

IntroductionAn adequate health workforce (HWF) is essential to achieving the targets of the Sustainable Development Goals (SDG), including universal health coverage. However, weak HWF planning and constrained fiscal space for...

A quantitative comparison between the essential medicines for rheumatic diseases in children and young people in Africa and the WHO model list

BackgroundThe World Health Organisation Essential Medicines List (WHO EML) guides National Essential Medicines Lists and Standard Treatment Guidelines for clearly identified disease priorities especially in low- and middle-income countries. This study compares the degree to which the basket of medicines recommended for rheumatic diseases in children and young people in National Essential Medicines Lists of countries in the WHO Africa region, corresponds to the 2021 WHO EML and WHO EML for children, as a proxy of availability.MethodsAn online search of the WHO medicines and health technology portal, the Health Ministry websites of the 54 African countries, PUBMED and Google Scholar, with search terms for ‘National Essential Medicines List’, AND/OR ‘standard treatment guidelines’ AND/OR ‘Lista Nacional de Medicamentos Essenciais’ AND/ OR ‘Liste Nationale de Medicaments Essentiels’ AND Africa AND/OR < Name of African country > was conducted. The number of medicines on the national lists were compared according to a predefined template of medicines; and the percentage similarity calculated. Descriptive statistics were derived using STATA.ResultsForty-seven countries in the WHO Africa region have developed a National Essential Medicines List. Eleven countries do not have any medicines listed for rheumatic diseases.The majority of countries had less than or equal to 50% similarity with the WHO EML for rheumatic disease in children and young people, median 3 medicines (IQR 1— 4). The most common medicines on the national lists from Africa were methotrexate, sulfasalazine and azathioprine, with etanercept available in 6 countries. Seven countries had only one medicine, acetylsalicylic acid listed in the section ‘Juvenile Joint diseases’.A multiple linear regression model for the predictors of the number of medicines on the national lists established that 20% of the variability was predicted by health expenditure per capita, socio-demographic index and the availability of rheumatology services (adult and/or paediatric) p = 0.006, with socio-demographic index (p = 0.035, 95% CI 0.64—16.16) and the availability of rheumatology services (p = 0.033, 95% CI 0.13 – 2.90) significant.ConclusionFour countries (8.5%) in Africa have updated their National Essential Medicines Lists to reflect adequate care for children and young people with rheumatic diseases. Moving forward, efforts should focus on aligning available medicines with the WHO EML, and strengthening healthcare policy for rheumatology and pharmaceutical services, for affordable access to care and medicines.

The emergency medical teams initiative in the WHO African region: a review of the development and progress over the past 7 years.

The WHO Emergency Medical Teams (EMT) Initiative coordinates the deployment of qualified medical teams who promptly respond to public health emergencies (PHEs) and provide quality service during emergencies whilst strengthening capacity. Globally, 40 EMTs have been classified between 2016 and the present (as of the writing of this article in December 2023) and are from across all the WHO regions except the WHO Africa Region (AFRO). However, WHO Africa has prioritised the implementation of EMTs in 10 priority countries to address the public health emergencies (PHEs) affecting the region. This article describes the development and progress of national EMTs in the WHO African Region over the past 7 years and elucidates the main lessons learned and the complexity and challenges in the process. This study employed a case study approach because of its appropriateness in examining a complex social phenomenon in a socio-political context in depth, using multiple lenses simultaneously. Data and information were obtained through document reviews and key informant interviews (KIIs) (n = 5) with the members of the EMT Initiative on shared field experiences. Data were systematically analysed using the Stages of Implementation Completion (SIC) framework, and the lessons learnt were presented using components of a framework from Adini et al. The Initiative commenced in the WHO African Region following its launch in December 2017 in Senegal. The assessments of the concept's engagement (involved learning and deciding), feasibility (reviewing expectation and capacity), and readiness planning (collaborating and preparing) showed that the context-specific (African context) challenges, lessons from different emergency response actions mainly guided the Initiative's pre-implementation phase in the region and prompted the WHO emergency leadership on the urgency and need for the EMT concept in the region. The assessment of the implementation processes showed progress in key areas, with staff demonstrating improved competency, EMT services maintaining high fidelity, effective consultation launching critical components, and ongoing services providing successful support and monitoring. Creating the N-EMTs and revitalising the EMT concept required an aligned strategy with other regional emergency programmes and a futuristic vision. Proposed sustainability and governance components include creating N-EMT, developing a coordination structure, collaborating with partners, and finalising the N-EMT. The Initiative is an imperative component that would allow better-targeted management of health emergencies in the region. The continuous refinement of the EMT initiative is crucial. There is a need to work on additional components, such as a context-specific framework for collaborations and partnerships that would enhance deployment and procurement modalities and the complementarity between other regional initiatives to improve the work. Emphasis should be placed on strengthening local health systems, enhancing training and capacity-building programmes, and fostering regional and international collaborations. Additionally, sustainable funding and resource allocation are essential to ensure the resilience of EMTs in the African region and their long-term success.

Characterizing hepatitis B virus infection in children in the Democratic Republic of Congo to inform elimination efforts.

Despite global reductions in hepatitis B virus (HBV) prevalence, an estimated 6.2 million children are infected, two-thirds of whom live in the WHO Africa region. We sought to characterize childhood HBV to inform elimination efforts in the Democratic Republic of Congo (DRC), one of the largest and most populous African countries. Using the most recent (2013-14) nationally representative Demographic and Health Survey in the DRC, we analyzed HBV surface antigen (HBsAg) on dried blood spots and associated survey data from children aged 6-59 months. We estimated HBsAg-positivity prevalence nationally, regionally, and by potential correlates of infection. We evaluated spatial variation in HBsAg-positivity prevalence, overall and by age, sex, and vaccination status. Using data from 5,679 children, we found national HBsAg-positivity prevalence was 1.3% (95% CI: 0.9%-1.7%), but ranged from 0.0% in DRC's capital city province, Kinshasa, to 5.6% in northwestern Sud-Ubangi Province. Prevalence among boys (1.8%, 95% CI: 1.2%-2.7%) was double that among girls (0.7%, 95%CI: 0.4%-1.3%). Tetanus antibody-negativity, rurality, and lower household wealth were also significantly associated with higher HBsAg-positivity prevalence. We observed no difference in prevalence by age. Children had higher HBsAg-positivity odds if living with ≥1 HBsAg-positive adult household member (OR: 2.3, 95%CI: 0.7-7.8), particularly an HBsAg-positive mother (OR: 7.2, 95%CI:1.6-32.2). In the largest national survey of HBV among children and household contacts in the DRC, we found that childhood HBV prevalence was 10-60 times the global target of 0.1%. We highlight specific regions and populations for further investigation and focused prevention efforts.

Country uptake of WHO recommendations on differentiated HIV testing services approaches: a global policy review

ObjectivesIn 2015 and 2016, WHO issued guidelines on HIV testing services (HTS) highlighting recommendations for a strategic mix of differentiated HTS approaches. The policy review examines the uptake of differentiated...

A systematic scoping review of medicine availability and affordability in Africa

BackgroundThe most recent World Medicines Situation Report published in 2011 found substantial medicine availability and affordability challenges across WHO regions, including Africa. Since publication of the 2011 report, medicine availability and affordability has risen on the international agenda and was included in the Sustainable Development Goals as Target 3.8. While numerous medicine availability and affordability studies have been conducted in Africa since the last World Medicines Situation Report, there has not been a systematic analysis of the methods used in these studies, measures of medicine availability and affordability, categories of medicines studied, or geographic distribution. Filling this knowledge gap can help inform future medicine availability and affordability studies, design systems to monitor progress toward Sustainable Development Goal Target 3.8 in Africa and beyond, and inform policy and program decisions to improve medicine availability and affordability.MethodsWe conducted a systematic scoping review of studies assessing medicine availability or affordability conducted in the WHO Africa region published from 2009–2021.ResultsTwo hundred forty one articles met our eligibility criteria. 88% of the articles (213/241) reported descriptive studies, while 12% (28/241) reported interventional studies. Of the 198 studies measuring medicine availability, the most commonly used measure of medicine availability was whether a medicine was in stock on the date of a survey (124/198, 63%). We also identified multiple other availability methods and measures, including retrospective stock record reviews and self-reported medicine availability surveys. Of the 59 articles that included affordability measures, 32 (54%) compared the price of the medicine to the daily wage of the lowest paid government worker. Other affordability measures were patient self-reported affordability, capacity to pay measures, and comparing medicines prices with a population-level income standard (such as minimum wage, poverty line, or per capita income). The most commonly studied medicines were antiparasitic and anti-bacterial medicines. We did not identify studies in 22 out of 48 (46%) countries in the WHO Africa Region and more than half of the studies identified were conducted in Ethiopia, Kenya, Tanzania, and/or Uganda.ConclusionOur results revealed a wide range of medicine availability and affordability assessment methodologies and measures, including cross-sectional facility surveys, population surveys, and retrospective data analyses. Our review also indicated a need for greater focus on medicines for certain non-communicable diseases, greater geographic diversity of studies, and the need for more intervention studies to identify approaches to improve access to medicines in the region.

Uptake of indoor residual spray as a malaria vector control strategy among the residents in Migori County, Kenya

Background: Globally unexpected 219 million malaria cases occurred in 2021, with 90% of these cases happening in the WHO Africa region and unexpected 435,000 malaria transmissions worldwide, with children less than five years being the most-at-risk (61%) of malaria infections (World Malaria Report, 2021). In 2019, IRS coverage was 94.6%. This was reason enough to assess contributing factors leading to not reaching targeted 100% of the households mapped despite massive resources. Methods: The study adopted analytical cross-sectional design. The study area was Migori County (Awendo, Uriri, Rongo, Suna East, Suna West and Nyatike sub counties) where IRS had been implemented in four sessions. The study period November 2021 to April 2022. The respondents sample size was determined using Cochran (1963) for a single population of 1,000 households. The respondents were randomly selected villages from purposively selected Migori County. Kenyatta University Ethics Review Committee and NACOSTI provided ethical clearance. Quantitative data analyzed using SPSS version 2.6 and thematically for qualitative data. A Chi-squared test used to compute statistically significant differences between independent variables at p value &lt;0.05. Results: Some 249 (90%) of the respondents confirmed their houses were IRS- covered while 32 (10%) of the houses were not sprayed because they were not informed in advance (p value &lt;0.000). Conclusions: Using the Chi-squared test of significance the spray operators` arrival time for IRS activities affected the respondents daily calendar of events significantly (p=0.013, &lt;0.05) resulting into respondents’ non-participation and unmet targets.

Harnessing Capacity in Southern Africa to Support and Develop Human Resources for Nursing and Midwifery in Africa – Part 2: Case Studies from the DRC and Mozambique

Human resources for health has been the centre of attention for many decades as more African countries fail to meet health targets even though there is no shortage of country-specific policies and strategies to improve these resources. The WHO Africa region has a critical shortage of nurses and midwives, which will remain unresolved as long as funding and policy implementation challenges persist. In the interim, the profession itself must find innovative and collaborative ways to make inroads into the nursing shortages – specifically in areas where advanced clinical skills are needed. Harnessing capacity from within universities in southern Africa is posited as one of the ways to bolster the education of nurses and midwives. Presented in part 1, the New Partnership for Africa’s Development project aimed to increase the number and enhance the quality of postgraduate education and clinical training of nurses and midwives to improve the quality of healthcare services with particular reference to the reduction of maternal and neonatal mortality rates. In fulfilling this aim, clinical master’s programmes were developed and implemented in seven African countries. In this article, we chose illustrative case studies to describe the master’s programme design and roll-out, in line with the health profile of the Democratic Republic of the Congo and the Republic of Mozambique. We explain the programme electives, enrolments and throughput, including outputs and outcomes. From experiences gained and lessons learnt, we extrapolate implications for future cases that employ pan-African and south-to-south university partnerships.

From research to a political commitment to strengthen access to surgical, obstetric, and anesthesia care in Africa by 2030.

This study aimed to engage African leaders and key stakeholders to commit themselves toward the strengthening of surgical, obstetric, and anesthesia care systems by 2030 in Africa. From research to a political commitment, a baseline assessment was performed to foster the identification of the gaps in surgical care as a first step of an inclusive process. The preliminary findings were discussed during the International Symposium on Surgical, Obstetric, and Anesthesia Systems Strengthening by 2030 in Africa. The conclusions served to draft the Dakar Declaration and its Regional Action Plan 2022-2030 to improve access to surgical care by 2030 in Africa, endorsed by Heads of State. The International Symposium was composed of two meetings that gathered (i) 85 scientific experts and (ii) 28 ministers of health or representatives from 28 sub-Saharan African countries. The 28 African countries represent (i) 51% of the continent's total population, (ii) 68% of the 47 African countries of the WHO Africa Region, (iii) 58% of all African Union countries, and (vi) 79% (3,371) of the WHO Africa Region's total (4,271) health districts. The International Symposium and the Heads of State Summit successfully produced the Dakar Declaration on access to equitable, affordable, and quality Surgical, Obstetric, and Anesthesia Care by 2030 in Africa and its Regional Actions Plan 2022-2030 which prioritizes 12 urgent actions needed to be implemented, six strategic priorities, 16 key indicators, and an annual dashboard to monitor progress. The Dakar Declaration and its Regional Action Plan 2022-2030 are a commitment to establish quality and sustainable surgical, obstetric, and anesthesia care in each African country within the ambitious framework of "The Africa we want" Agenda 2063.

COVID-19 and Malaria Vaccine Advanced Market Commitments: Opportunities to Incentivize Investment in Africa’s Vaccine Manufacturing Industry

Introduction Using push dynamics to drive the purchase of commodities with forecasted demand, the advanced market commitment (AMC) model has been applied to the development of vaccines catering to low-income countries in Africa and the globe. This model is currently the driving force behind both the delivery of COVID-19 vaccines to countries unable to afford open market prices and the roll out of the RTS,S/AS01 (Mosquirix) malaria vaccine in the WHO Africa region. Methods This literature review instills a comprehensive understanding of the costs associated with vaccine manufacturing development in the Africa region and draws particular focus to the prices paid by African national governments for the recently rolled out COVID-19 vaccines through the COMAX AMC as well as the estimated costs (based on birth cohort data and DPT vaccination coverage data) of the recently WHO recommended malaria vaccine program. Results Ethiopia, a GAVI supported country, is projected to pay between 4.2 and 9.9 million USD annually to vaccinate its target population with RTS,S/AS01b. GAVI ineligible countries such as South Africa and Egypt are projected to spend approximately 15.5 million and 43.3 million USD respectively. Of the GAVI ineligible and self financing countries, those with COVID-19 vaccine manufacturing capacity such as South Africa are able to access vaccine costs at 10 USD/dose compared to the 37 USD/dose spent by the 8 countries without manufacturing capacity. Results Investment in existing vaccine manufacturing companies in Eastern and Western Africa has projected growth with CAGR as high as 37% within 10 years. By purchasing and procuring vaccines from local regional manufacturing hubs, a number of donor un-supported self-financing countries in Africa have the potential to save up to 10 USD per vaccine dose.

Hepatitis B in Africa Collaborative Network: cohort profile and analysis of baseline data.

Approximately 80 million people live with chronic hepatitis B virus (HBV) infection in the WHO Africa Region. The natural history of HBV infection in this population is poorly characterised, and may differ from patterns observed elsewhere due to differences in prevailing genotypes, environmental exposures, co-infections, and host genetics. Existing research is largely drawn from small, single-centre cohorts, with limited follow-up time. The Hepatitis B in Africa Collaborative Network (HEPSANET) was established in 2022 to harmonise the process of ongoing data collection, analysis, and dissemination from 13 collaborating HBV cohorts in eight African countries. Research priorities for the next 5years were agreed upon through a modified Delphi survey prior to baseline data analysis being conducted. Baseline data on 4,173 participants with chronic HBV mono-infection were collected, of whom 38.3% were women and the median age was 34years (interquartile range 28-42). In total, 81.3% of cases were identified through testing of asymptomatic individuals. HBeAg-positivity was seen in 9.6% of participants. Follow-up of HEPSANET participants will generate evidence to improve the diagnosis and management of HBV in this region.

Overview of Tools and Measures Investigating Vaccine Hesitancy in a Ten Year Period: A Scoping Review.

The challenge of vaccine hesitancy, a growing global concern in the last decade, has been aggravated by the COVID-19 pandemic. The need for monitoring vaccine sentiments and early detection of vaccine hesitancy in a population recommended by the WHO calls for the availability of contextually relevant tools and measures. This scoping review covers a ten year-period from 2010–2019 which included the first nine years of the decade of vaccines and aims to give a broad overview of tools and measures, and present a summary of their nature, similarities, and differences. We conducted the review using the framework for scoping reviews by Arksey and O’Malley (2005) and reported it following the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews’ guidelines. Of the 26 studies included, only one was conducted in the WHO African Region. Measures for routine childhood vaccines were found to be the most preponderant in the reviewed literature. The need for validated, contextually relevant tools in the WHO Africa Region is essential, and made more so by the scourge of the ongoing pandemic in which vaccination is critical for curtailment.

National action plan on antimicrobial resistance: An evaluation of implementation in the World Health Organization Africa region

In line with global instruments, within the last five years, two-thirds of all countries in the WHO Africa Region (WHO AFR) have developed a National Action Plan (NAP) on Antimicrobial Resistance (AMR). We sought to evaluate progress made across the countries implementing NAP for effective response to AMR. A semi-structured survey tool was administered to obtain information from national focal persons on the implementation of strategic elements of NAP on AMR. This was followed by a Lessons Learnt Workshop in June 2019 at Douala, Cameroon, where focal persons made presentations on the country’s progress. Later, a desktop review of the LLW report and other key documents was conducted. Countries in WHO AFR that have set up a national surveillance system and are enrolled into the WHO global antimicrobial resistance surveillance system have progressively increased to 30 (of 47 countries), of which 15 are already submitting surveillance data. Of the 20 countries at the Lessons Learnt Workshop, 14 have infection prevention and control (IPC) policies and functional healthcare facility IPC programs, 15 participate in the commemoration of the annual world hand hygiene days. Although almost all countries surveyed have national standard treatment guidelines, only five have incorporated the WHO AWaRe classification into the national essential medicines list. Fourteen of 20 countries have established an active/functional national secretariat/coordinating center for AMR. Discernible progress is being made on the implementation of NAP in WHO AFR region. Gaps identified in the strategic elements of action plans need to be filled for effective AMR control.

A review of food-based dietary guidelines in Africa: Opportunities to enhance the healthiness and environmental sustainability of population diets

Food-based dietary guidelines (FBDGs) are important tools for promoting healthy eating and nutrition education at the population level. Currently, more than 100 countries worldwide have developed FBDGs with majority of existing FBDGs in high-income countries. However, there are a few countries in Africa which have developed FBDGs. This review describes and compares the characteristics of existing FBDGs in Africa. Data were extracted from all existing FBDGs from African countries which have been archived in the Food and Agriculture Organization’s (FAO) online repository of FBDGs. In addition, supporting documentation from other sources linked to the identified FBDGs were also reviewed. Extracted data were coded and synthesized to describe the purpose of the FBDGs, the process for developing the FBDGs, and how healthy diets were expressed in the FBDGs. In addition, the FBDGs were examined for content on considerations for planetary health, and non-dietary recommendations. A checklist was used to extract the evidence in the identified documents. Of the 47 African countries in the WHO Africa region, only eight FBDGs were identified from seven countries. South Africa had two FBDGs (including a FBDG for young children). Multi-disciplinary technical working groups were convened in developing majority of the FBDGs. The working groups utilised scientific evidence on diet-related diseases and nutrient requirements as a basis for recommendations. All the FBDGs were intended as a tool for promoting healthy diets among the lay population. The FBDGs that were reviewed included between six and sixteen dietary messages. Diet diversification was promoted as the most common recommendation across African country FBDGs. The recommendations often promoted consumption of four to six food groups communicated using text as well as images (food guide). Local availability and cultural acceptability were important values promoted as part of an optimal diet in some of the countries. However, none of the recommendations addressed environmental sustainability. Apart from South Africa, none of the FBDGs had been evaluated or revised. Across Africa, there is a need for increased focus on developing new FBDGs or revising existing ones as a tool for meeting the dietary information needs of populations at risk of malnutrition in all its forms. Key words: Food-based, Dietary, Guidelines, diversity, Africa, Health, Non-communicable, Sustainability

Prevalence and Correlates of Intimate Partner Violence against Women in Liberia: Findings from 2019-2020 Demographic and Health Survey.

Background: Intimate partner violence is a global public health crisis and a human rights issue. The objectives of the study were to conduct secondary analysis of the most recent Liberia Demographic and Health Survey (2019–2020) to determine the descriptive and analytical epidemiology of intimate partner violence (IPV) and its correlates in 15–49 year old ever-married women. Methods: Association of physical, emotional, sexual, and having experienced any type of IPV with 10 explanatory socio-demographic, attitudinal, and experiences were analyzed using simple and multiple logistic regression models. Results: 55.29% of women reported having ever experienced some form of IPV perpetrated by their current or most recent husband/partner, with the most common type being physical violence. Having been slapped, insulted, made to feel bad, and physically forced into unwanted sex were the most common types of physical, emotional, and sexual IPV. The multivariable analysis showed statistically significant association with IPV for number of living children, women’s acceptance of IPV, husband/partner’s use of alcohol, and having witnessed parental physical IPV. Conclusions: The prevalence of having experienced physical and/or sexual intimate partner violence in Liberia was much higher than the prevalence for the WHO Africa region of 33%, highlighting the need for better women empowerment and gender equality in Liberia.

Opportunities to Integrate Primary Health Care Digital Innovations in Maternal and Child Health Care Services in Kenya

Background: Adequate and quality Maternal and Child Health (MNCH) care is considered essential in reduction of maternal and child mortality. More than half of the global maternal deaths (66%) are in sub-Saharan Africa with infant mortality of 51/1000 live births in the WHO Africa region [1]. There is potential to improve access and utilization of health services through investing in Primary Health Care (PHC) digital innovations [2] especially in underserved settings [3]. In the last quarter of the year 2021 after lifting of the COVID-19 restrictions, Tekeleza project, aims to integrate digital health innovations into MNCH care within PHC settings in Kenya. The project team undertook a baseline survey in three rural counties (Kisii, Kajiado and Migori) characterized with low social-economic status to identify opportunities to leverage on the use of evidence-based digital innovations to reverse the adverse trends in Maternal and Child Health. Methods: A cross-sectional and descriptive study was conducted in 15 Community Health Units (CHUs) in Kenya that were linked to selected Primary Health Care (PHC) facilities from three rural counties. Mixed methods were used to collect data from 404 Households (HHs) selected across the sampled CHUs on Probability Proportionate to Size (PPS). The selected households were assigned unique household or respondent identifiers. The sampling frame for household surveys consisted of all women 18 - 49 years of age, who were either pregnant or in their 18 months post-delivery. From the constructed sampling frame, a simple random sampling procedure was used to select the study sample. An audit was also carried out at the selected PHC facilities and sixty-two (62) Primary Health Workers (PHCWs) including facility managers were interviewed to establish challenges affecting ICT infrastructure and sustainable financing of MNCH services. Findings: The majority of the sampled women (64.9%) were lactating at the time of the study, with 34.4% being pregnant and 0.7% both pregnant and lactating. Despite the high proportions of mothers who received Skilled Birth Attendance, discontinuity in seeking antenatal and postnatal care services was observed in all three counties. The proportion of mothers (n = 404) who reported to have attended at least one ANC was 46.8%. This was attributed to limited access to health facilities, poor staff attitude, and negative cultural practices that got exacerbated by the COVID-19 pandemic. An average of 53.2% of the respondents started attending ANC clinics much later after 12 weeks of gestation to minimize the costs and time they will spend on attending ANC clinics. It also emerged that 68.7% of the respondents had low knowledge levels of selected perinatal and infant care practices. On the making of Sexual and Reproductive Health (SRH) health-seeking decisions, 54.7% of the respondents said, it is their husbands who decide. The PHCWs expressed limited access to Continuing Professional Development (CPDs), a situation that worsened with the COVID-19 Pandemic. Notably, only 54.9% of the PHCWs reported having access to either a Smartphone or desktop at the point of service delivery. Nearly the same proportion (54.8%) has access to the internet at their workstations. Facilities reported delayed reimbursement of National Hospital Insurance Fund (NHIF) and only 54% of the women interviewed had registered in Linda mama NHIF package meant to enable them to access free maternity care. Only one county (Migori) had significant utilization of CHVs. Conclusion: There is increasing access to Skilled Birth Attendance (SBA) in rural Kenya but discontinuous pregnancy care is still a problem and it got worse during the COVID-19 pandemic. Rural PHC facilities have poor ICT infrastructure and despite the 98% rural access to a phone by women, there is limited bankable usage of handheld technology to improve health information literacy on self and infant care among women of reproductive age. Recommendations: Feasibility studies to be conducted on how to sustainably deploy Primary Health Care digital solutions to improve the quality of, access to, and Utilization of Maternal and Child Health (MNCH) services.

Scoping review of food safety at transport stations in Africa

ObjectiveThe WHO has declared food safety as a public health concern. Transport hubs such as taxi ranks, bus stations and other transport exchange sites are major food trading/purchasing sites, particularly...

Sustainable Surveillance of Neglected Tropical Diseases for the Post-Elimination Era.

The World Health Organization’s (WHO’s) 2030 road map for neglected tropical diseases (NTDs) emphasizes the importance of strengthened, institutionalized “post-elimination” surveillance. The required shift from disease-siloed, campaign-based programming to routine, integrated surveillance and response activities presents epidemiological, logistical, and financial challenges, yet practical guidance on implementation is lacking. Nationally representative survey programs, such as demographic and health surveys (DHS), may offer a platform for the integration of NTD surveillance within national health systems and health information systems. Here, we describe characteristics of DHS and other surveys conducted within the WHO Africa region in terms of frequency, target populations, and sample types and discuss applicability for post-validation and post-elimination surveillance. Maximizing utility depends not only on the availability of improved diagnostics but also on better understanding of the spatial and temporal dynamics of transmission at low prevalence. To this end, we outline priorities for obtaining additional data to better characterize optimal post-elimination surveillance platforms.

Setting Research Priorities for Cervical Cancer Prevalence, Prevention and Treatment in WHO Africa Region

Background: Cervical cancer has been ranked among the leading causes of deaths among women in Africa. Despite this, priority setting mechanisms used in planning for programmes and interventions that respond to sexual and reproductive health and rights services particularly in cervical cancer prevalence, prevention and treatment have not adequately taken into account research based evidence to respond appropriately. Methods: We adapted the Child Health and Nutrition Research Initiative method. A wide range of stakeholders identified potential research areas in an online survey. A technical working group comprising of 67 participants reviewed the questions for modification and removal of out scope questions. Finally, scoring and ranking was done to provide the top ten priorities questions. Results: “Cost-benefit analysis of systematic human papillomavirus vaccination compared to the current cost of cervical cancer in public health care systems” scored 27. This was followed by two research questions ranked at 24 points: “assessment of women’s and girls’ knowledge on the importance of early cervical cancer screening,” and “human papilloma virus vaccination and contributions of new technologies to the supply and storage of vaccines, including human papillomavirus vaccine”. Conclusion: The study identified 10 priority research questions that can guide the agenda for cervical cancer prevalence, prevention and treatment in the WHO Africa region. The identified priorities will be of use to policy makers, researchers and programmers and other stakeholders who can invest in areas that greatly affect cervical cancer prevalence, prevention and treatment.