WHO Africa Research Articles

Impact of COVID-19 pandemic on HCV care cascade in Rwanda: Ecological study from July 2019 to June 2021.

Content available: Author Interview and Audio Recording

HPR2 COVID-19 and the Use of Antenatal Care Services in Côte d'Ivoire, an Africa South of the Sahara's Country

According to WHO Africa, the COVID-19 pandemic has impacted key health services in Africa, raising concerns that some of the major health problems will worsen. The objective of this study is to describe the effects of COVID-19 on the use of antenatal care services in Côte d'Ivoire.

The process of developing health workforce strategic plans in Africa: a document analysis

BackgroundMany countries are faced with a multitude of health workforce-related challenges partly attributed to defective health workforce planning. Earlier efforts to guide the process and harmonise approaches to national health...

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 Data were extracted from all existing FBDGs from African countries which have been archived in the Food and Agriculture Organization’s (FAO) online repository of FBDGs.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

Extending political will into action in African LMICs: abating global antimicrobial resistance

Extending political will into action in African LMICs: abating global antimicrobial resistance

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.

Global Study: Participation in One Health Networks and Involvement in COVID-19 Response Activities

PurposeThis global study examined whether being part of a One Health Network (OHN) was associated with being involved in COVID-19 response activities at the early stages of the pandemic. Barriers to workforce involvement in the pandemic response and the perceived value of OHN activities were studied to inform future targeted evidence-based strategies for workforce capacity-building.Methods & MaterialsWe conducted a cross-sectional descriptive study, using an online questionnaire that was globally distributed in July-August 2020. With a snowball sampling approach via OHN listservs, social media, and further sharing, we aimed to reach individuals in the global health workforce across locations, organizations, and sectors to survey their participation in OHN activities and involvement in COVID-19 response.ResultsThe sample included 1050 respondents from various types of organizations and work sectors, from 94 countries across all WHO regions. Being part of an OHN was positively associated with involvement in the COVID-19 response (odds ratio: 1.8, 95% confidence interval: 1.3 - 2.4). The OHN activities most indicated as useful during COVID-19 pandemic by the survey respondents included 'increased public awareness of One Health' and 'networking with professionals across sectors with common interests'. Overall, 44% of survey respondents who were part of an OHN found OHN activities very or extremely helpful to their COVID-19 response. Lack of opportunities was a commonly reported barrier to involvement in COVID-19 response globally, and lack of funding was a barrier particularly in the WHO Africa region.ConclusionThis study provides a snapshot of the multisectoral response to COVID-19 and an assessment of the contribution of OHNs. The lessons learned during this pandemic can be used to identify measures to improve global health capacity, including OHN activities to build and strengthen workforce response to future global health challenges.

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.

Lessons Learnt from Interregional and Interagency Collaboration in Polio Outbreak Response in the Horn of Africa.

Following the outbreak of poliovirus in the countries in the Horn of Africa, Somalia, Kenya and Ethiopia, in two WHO regions, an outbreak response involving the WHO Africa and WHO East and Mediterranean Regions and partner agencies like the UNICEF in East and Southern African was developed. This paper documents response to polio virus outbreak in the Horn of Africa and the lessons learnt for the interregional and inter-agency collaboration on the response. This collaboration led to speedy interruption of the outbreak and within a period of one year the total virus load of 217 in 2013 was brought down to mere six. This resulted from collaborative planning and implementation of activities to boost the hitherto low immunity in the countries andimprove surveillance among others. A number of lesson were generated from the process. Some of the lessons is critical role such collaboration plays in ensuring simultaneous immunity boosting, information and resources sharing, among other. Some challenges were equally encountered, chiefly in the appropriation of authorities. In conclusion, however, one is safe to note that the collaboration was very fruitful given the timely interruption of transmission.

Technical capacities needed to implement the WHO’s primary eye care package for Africa: results of a Delphi process

ObjectiveThe aim of the study was to establish the technical capacities needed to deliver the WHO African Region’s primary eye care package in primary healthcare facilities.DesignA two-round Delphi exercise was...

Monitoring Quality of Care in the WHO Africa Region-A study design for measurement and tracking, towards UHC attainment

ABSTRACT This paper reports on the design of a study to generate a quality of care index for countries in the World Health Organization Africa Region. Quality of care, for all people at all times, remains pivotal to the advancement of the 2030 agenda and the attainment of Universal Health Coverage. We present a study protocol for deriving a quality of care index, hinged on indicators and data elements currently monitored through routine information systems and institutionalized facility assessments in the World Health Organization Africa Region. This paper seeks to offer more insight into options in the Region for strengthening monitoring processes of quality of care, as a step towards generating empirical evidence which can galvanize action towards an improved care process. The methodology proposed in this study design has broad implications for policymaking and priority setting for countries, emphasizing the need for robust empirical measures to understand the functionality of health systems for the delivery of quality essential services. Application of this protocol will guide policymaking, as countries work to increasingly improve quality of care and adopt policies that will best facilitate their advancement towards Universal Health Coverage.

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.

Research Priorities for Addressing Gender Based Violence in the WHO Africa Region

Background: There is an increasing emphasis on conducting research to identify gender based violence issues to enable development of appropriate programs and interventions. However, these efforts are mixed in quality and often raise ethical questions. The increased pressure on policy makers to move to a more evidence-based approach in addressing gender based issues creates the need for this research prioritization activity. Inadequate evaluative evidence in this area poses a challenge in the planning for responsive interventions especially in resource limited settings. The purpose of this paper is to present gender based violence research priority areas for the WHO Africa Region. Methods: We utilized a modified version of the Child Health and Nutrition Research Initiative approach to reach consensus on research priorities on the thematic area of gender based violence. In three phases, we first conducted an online survey with sexual and reproductive health and rights experts in academia, ministries of health, non-governmental organizations and other health actors with a wide range of experiences. These questions were consolidated by three experts from World Health Organization headquarters into themes. Secondly, experts were invited in a meeting in Cape Town South Africa to analyze and generate relevant areas of research based on the themes. Finally, a smaller group of experts prioritized research areas based on agreed criteria. Results: A list of 10 priority research questions for addressing gender based violence were scored and ranked. Four priority research questions scored 30 points out of the possible 30 points and were thus ranked as the highest priority. These included questions that “engage young adolescents in behavioral interventions to influence gender roles”, “determinants of gender based violence analysis”, “both long and short term complications of gender based violence on survivors” and “assessment of men’s involvement in addressing gender-based violence against women”. The second most highly ranked question was on the assessment of the extent and strategies to prevent gender-based violence in the context of humanitarian crises. Conclusions: Priority research questions for addressing gender based violence were identified. This exercise provides a three year investment case for research with high potential of effectively identifying interventions with high impact on addressing gender based violence.

Research Priorities for Preventing Unsafe Abortions in the WHO Africa Region

Background: Unsafe abortion is a commonly neglected sexual and reproductive health and rights issue despite the serious health problems it causes to women and girls in their reproductive ages. It is classified as a main cause of maternal mortality and morbidity. This paper has considered questions that have the greatest potential to successfully reduce unsafe abortions in the resource poor settings. Methods: We adapted the Child Health and Nutrition Research Initiative (CHNRI) to identify and prioritize many competing sexual and reproductive health and rights research ideas that impact the health of the populations. The implementation was done in three phases which included generation and collection of research ideas from various experts virtually in August 2019 consolidation of the potential questions through thematic analysis conducted in September 2019. Finally, scoring and ranking of the research questions was done in a workshop of experts. Results: Out of a list of 45 priority research questions, two questions were ranked the highest scoring 28 out of the possible 30. The research priorities include: “The effectiveness of interventions (e.g. counseling or incentives or home visits) to increase post abortion uptake and continuance”, “Reducing repeat abortion on improving maternal health outcomes” and “Evaluation of community-based awareness programs to reduce unwanted pregnancies and encourage women to seek help early”. Conclusions: Ten key research priorities in preventing unsafe abortion were identified. The priority list covers areas of focus that could effectively impact preventing unsafe abortions while also acting as a knowledge base for researchers, policy makers and other interested stakeholders who would want to invest in this area.

Research Priorities for mHealth and Innovative Strategies in Sexual and Reproductive Health and Rights in the WHO Africa Region

Background: The use of mobile phones continues to rise rapidly in the provision of health related services. Many countries have adopted the use of mobiles to provide sexual and reproductive health and rights and especially among the adolescents where specific messages are tailored for various audiences with specific messages. The purpose of this paper is to present the results of a research priority setting exercise on mHealth and innovative strategies. Methods: We adapted Child Health and Nutrition Research Initiative methodology to identify and set research priorities on mHealth and innovative strategies that respond to sexual and reproductive health and rights services. General potential research questions were gathered online from multiple stakeholders in the region and sent for consolidation consolidated to technical experts in World Health Organization headquarters. The second phase involved a meeting with experts to review and thematically analyze the questions list of 33 questions producing a list of 22 research questions. The questions were scored against a six point criteria and ranked accordingly. Ten top priority research questions were identified. Results: Lists of 33 priority research questions for mHealth and innovative strategies were proposed for discussions by 67 stakeholders. The questions were reviewed, scored and ranked in a technical meeting by experts. The highest ranking questions at 87% include evaluation of mHealth for data management and sexual and reproductive health and rights decision making, assessment of innovative local financing techniques to support community based sexual reproductive health and rights and evaluation of the role of mobile technologies in referral and counter referral. Conclusions: Information and communication technology is developing drastically and has a great potential in improving health especially in sexual and reproductive health and rights service delivery. This potential must be demonstrated with more relevant and quality research on mHealth and innovative strategies priorities identified.

Setting Regional Research Priorities for Sexual and Reproductive Health and Rights Services in Humanitarian Settings

Background: Despite increased recognition of the need for sexual and reproductive health and rights in humanitarian settings, evidence focusing on mainstreaming reproductive health services such as maternal, neonatal mortality, human immunodeficiency virus transmission and unsafe abortion still remains inadequate. The ability to understand the magnitude of the needs and highlight existing gaps is supported by improved data which is critical to informing effective policies, programming and funding decisions. The purpose of this report is to present the results of a research prioritization exercise on sexual and reproductive health and rights services in humanitarian settings for the WHO Africa region for the next three years. Methods: We adapted the Child Health and Nutrition Research Initiative method in three phases. Experts from the region participated in an online survey to identify key areas for research in sexual and reproductive health and rights. To identify potential areas for research, the experts ensured answerability, effectiveness, deliverability, equity and potential impact of the questions. The research areas they identified were reviewed by World Health Organization technical team from headquarters. In a meeting of 67 participants, the questions were subjected to further review and analysis. Using a modified for scoring criteria, the questions were scored and ranked to provide the top ten priority questions to address sexual and reproductive health and rights services in humanitarian settings. Results: A list of 21 priority research questions on sexual and reproductive health and rights services in humanitarian settings were scored and ranked. Top ten priorities research questions were identified. Those that scored highly by scoring 30 points out of the possible maximum of 30 include: “determining the prevalence and associated factors of unwanted pregnancies and abortions performed in emergency and humanitarian settings”, “evidence on gender-based violence in humanitarian situations and its associated factors” and “defining an optimal model for coordinating sexual and reproductive health and rights interventions and responses in crisis situations”. Conclusions: Top ten research priorities in sexual and reproductive health and rights services in humanitarian settings were identified. The priority research areas have the potential to identify the best areas for programming of services in humanitarian settings. It is our hope that the identified research areas will be prioritized to support programming of services in humanitarian settings based on scientific evidence.

Converging pandemics: implications of COVID-19 for the viral hepatitis response in sub-Saharan Africa

Sub-Saharan Africa is currently bracing itself as the next front in the fight against the coronavirus disease 2019 (COVID-19) pandemic. Despite low testing capacity, 61 991 cases and 1778 deaths had been reported in the WHO Africa Region as of May 18, 2020, with a recent increase in reported daily cases and deaths. Despite younger age demographics and less travel than in other regions, and strong efforts for early containment, the potential for widespread community-based transmission in sub-Saharan Africa is high, but current modelled estimates vary widely.

The IUPHAR/BPS Guide to PHARMACOLOGY in 2020: extending immunopharmacology content and introducing the IUPHAR/MMV Guide to MALARIA PHARMACOLOGY.

The IUPHAR/BPS Guide to PHARMACOLOGY (www.guidetopharmacology.org) is an open-access, expert-curated database of molecular interactions between ligands and their targets. We describe significant updates made over the seven releases during the last two years. The database is notably enhanced through the continued linking of relevant pharmacology with key immunological data types as part of the IUPHAR Guide to IMMUNOPHARMACOLOGY (www.guidetoimmunopharmacology.org) and by a major new extension, the IUPHAR/MMV Guide to Malaria PHARMACOLOGY (www.guidetomalariapharmacology.org). The latter has been constructed in partnership with the Medicines for Malaria Venture, an organization dedicated to identifying, developing and delivering new antimalarial therapies that are both effective and affordable. This is in response to the global challenge of over 200 million cases of malaria and 400 000 deaths worldwide, with the majority in the WHO Africa Region. It provides new pharmacological content, including molecular targets in the malaria parasite, interaction data for ligands with antimalarial activity, and establishes curation of data from screening assays, used routinely in antimalarial drug discovery, against the whole organism. A dedicated portal has been developed to provide quick and focused access to these new data.