The evolving SARS-CoV-2 epidemic in Africa: Insights from rapidly expanding genomic surveillance.

Investment in Africa over the past year with regards to SARS-CoV-2 genotyping has led to a massive increase in the number of sequences, exceeding 100,000 genomes generated to track the pandemic on the continent. Our results show an increase in the number of African countries able to sequence within their own borders, coupled with a decrease in sequencing turnaround time. Findings from this genomic surveillance underscores the heterogeneous nature of the pandemic but we observe repeated dissemination of SARS-CoV-2 variants within the continent. Sustained investment for genomic surveillance in Africa is needed as the virus continues to evolve, particularly in the low vaccination landscape. These investments are very crucial for preparedness and response for future pathogen outbreaks. One-Sentence SummaryExpanding Africa SARS-CoV-2 sequencing capacity in a fast evolving pandemic.

A year of genomic surveillance reveals how the SARS-CoV-2 pandemic unfolded in Africa.

The progression of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic in Africa has so far been heterogeneous, and the full impact is not yet well understood. In this study, we describe the genomic epidemiology using a dataset of 8746 genomes from 33 African countries and two overseas territories. We show that the epidemics in most countries were initiated by importations predominantly from Europe, which diminished after the early introduction of international travel restrictions. As the pandemic progressed, ongoing transmission in many countries and increasing mobility led to the emergence and spread within the continent of many variants of concern and interest, such as B.1.351, B.1.525, A.23.1, and C.1.1. Although distorted by low sampling numbers and blind spots, the findings highlight that Africa must not be left behind in the global pandemic response, otherwise it could become a source for new variants.

Age of smoking initiation among adolescents in Africa.

OBJECTIVES: To estimate prevalence and identify correlates of age of smoking initiation among adolescents in Africa. METHODS: Data (n = 16,519) were obtained from nationally representative Global Youth Tobacco Surveys in nine West African countries. Study outcome was adolescents' age of smoking initiation categorized into six groups: ≤7, 8 or 9, 10 or 11, 12 or 13, 14 or 15 and never-smoker. Explanatory variables included sex, parental or peer smoking behavior, exposure to tobacco industry promotions, and knowledge about smoking harm. Weighted multinomial logit models were conducted to determine correlates associated with adolescents' age of smoking initiation. RESULTS: Age of smoking initiation was as early as ≤7 years; prevalence estimates ranged from 0.7 % in Ghana at 10 or 11 years age to 9.6 % in Cote d'Ivoire at 12 or 13 years age. Males, exposures to parental or peer smoking, and industry promotions were identified as significant correlates. CONCLUSIONS: West African policymakers should adopt a preventive approach consistent with the World Health Organization Framework Convention on Tobacco Control to prevent an adolescent from initiating smoking and developing into future regular smokers.

Never-Smoking Adolescents' Exposure to Secondhand Smoke in Africa.

INTRODUCTION: Though Africa is in Stage 1 of the tobacco epidemic, lack of effective public smoking laws or political will implies that secondhand smoke (SHS) exposure may be high in youth. The study objective is to estimate prevalence and identify determinants of SHS exposure among never-smoker adolescents in Africa and make cross-country comparisons. METHODS: Pooled data from the Global Youth Tobacco Surveys conducted in 25 African countries during 2006-2011 were used. Based on the venue of exposure in past 7 days, SHS was categorized into exposure inside, outside, and overall exposure (either inside or outside of the home), respectively. Data were analyzed in 2015 using logistic regression models to identify factors related to SHS exposure in three venues. RESULTS: About 21% and 39% of adolescents were exposed to SHS inside or outside of the home, with overall exposure of 45%. In all 25 African countries, parental smoking was significantly associated with SHS exposure inside the home (ORs ranging from 3.02 [95% CI=2.0, 4.5] to 14.65 [95% CI=10.0, 21.5]). Peer smoking was associated with SHS exposure outside the home in 18 countries (ORs ranging from 1.45 [95% CI=1.0, 2.1] to 3.00 [95% CI=1.8, 5.1]). Parental smoking, peer smoking, and anti-smoking messages in media were identified as three major factors associated with SHS exposure. CONCLUSIONS: A significant proportion of never-smoking adolescents in Africa are exposed to SHS, suggesting the need for countries to adopt policies to protect never smokers through the implementation of the WHO Framework Convention on Tobacco Control.

Epidemiology of tuberculosis and evaluation of treatment outcomes in the national tuberculosis control programme, River Nile state, Sudan, 2011-2013.

Tuberculosis is a major health problem in Sudan, a country that carries 11-15% of the tuberculosis burden in the Eastern Mediterranean Region. This study aimed to describe the epidemiology of tuberculosis in River Nile State and to compare treatment outcomes with WHO recommended indicators. A descriptive study was conducted on data collected from records of 1221 patients registered at tuberculosis management units over the 3 years 2011-2013. The mean age of cases was 37.7 (SD 21.5) years and 65.9% were males; 76.3% were pulmonary tuberculosis and 36.9% were sputum smear-positive cases. Average values for all outcome indicators were suboptimal, notably rates of case notification (30.8 per 100 000), case detection (10.3%), treatment success (79.6%), treatment failure (3.0%), default (8.1%) and death (8.0%). Of the 264 patients tested for HIV, 3.8% were positive. Outcome indicators for the national tuberculosis control programme are lagging behind the required targets.

Epidemiology of tuberculosis and evaluation of treatment outcomes in the national tuberculosis control programme, River Nile state, Sudan, 2011-2013

يعتبر الدرن مشكله صحيه كبيره في السودان هذا البلد يحمل 11-15% من عبء الدرن في اقليم شرق المتوسط وقد هدفت هذه الدراسة الى وصف وبائيات الدرن في ولايه نهر النيل والى مقارنه نتائج العلاج مع المؤشرات الموصى بها من قبل منظمة الصحه العالميه فاجريت دراسه وصفيه على بيانات جمعت من سجلات 1221 مريضا مسجلين في وحدات علاج الدرن خلال السنوات الثلاث 2013-2011 فكان متوسط عمر الحالات (SD 21.5)37.7 عاما وكان 65.9% منها ذكورا كما كانت 76.3% من الحالات سلا رئويا وكانت مسحه البصاق ايجابيه لدى 36.9% من الحالات وكان متوسط القيم لجميع مؤشرات النتائج دون المستوي الامثل لاسيما معدلات التبليغ عن الحالات 30.8 لكل 100.000 واكتشاف الحالات 10.3% ونجاح العلاج 79.6% وفشل العلاج 3.0% والتقصير 8.1% والوفيات 8.0% ومن بين 264 مريضا الذين اجريت لهم الاختبارات الخاصة بفيروس العوز المناعي البشري كان 3.8% ايجابيون ان مؤشرات النتائج المتعلقة بالبرنامج القومي لمكافحه الدرن متخلفة عن الاهداف المطلوبه

Tuberculosis is a major health problem in Sudan, a country that carries 11–15% of the tuberculosis burden in the Eastern Mediterranean Region. This study aimed to describe the epidemiology of tuberculosis in River Nile State and to compare treatment outcomes with WHO recommended indicators. A descriptive study was conducted on data collected from records of 1221 patients registered at tuberculosis management units over the 3 years 2011–2013. The mean age of cases was 37.7 (SD 21.5) years and 65.9% were males; 76.3% were pulmonary tuberculosisand 36.9% were sputum smear-positive cases. Average values for all outcome indicators were suboptimal, notably rates of case notification (30.8 per 100 000), case detection (10.3%), treatment success (79.6%), treatment failure (3.0%), default (8.1%) and death (8.0%). Of the 264 patients tested for HIV, 3.8% were positive. Outcome indicators for the national tuberculosis control programme are lagging behind the required targets.

La tuberculose est un problème de santé majeur au Soudan où elle représente 11 à 15 % de la charge de la maladie dans la Région de la Méditerranée orientale. La présente étude avait pour objectif de décrire l’épidémiologiede la tuberculose dans l’État du Nil et de comparer les résultats du traitement à l’aide d’indicateurs recommandés par l’OMS. Une étude descriptive a été menée à partir de données extraites des dossiers de 1221 patients admis dans des unités de prise en charge de la tuberculose sur une période de trois ans (2011-2013). L’âgemoyen des cas était de 37,7 ans (ET 21,5) et 65,9 % étaient de sexe masculin ; 76,3 % étaient atteints de tuberculose pulmonaire et 36,9 % étaient des cas à frottis positifs. Les valeurs moyennes pour tous les indicateurs de résultats étaient sous-optimales, notamment les taux de notification (30,8 pour 100 000), de dépistage de cas (10,3 %), de guérison (79,6 %), d’échec thérapeutique (3,0 %), d’abandon (8,1 %) et de décès (8,0 %). Sur les 264 patients dépistés pour le VIH, 3,8 % étaient positifs. Les indicateurs de résultats pour le programme nationalde lutte antituberculeuse accusent un retard par rapport aux objectifs fixés.

Prevalence and correlates of tobacco use among school-going adolescents in Madagascar.

Approximately 90% of adults start smoking during adolescence, with limited studies conducted in low-and-middle-income countries where over 80% of global tobacco users reside. The study aims to estimate prevalence and identify predictors associated with adolescents' tobacco use in Madagascar. We utilized tobacco-related information of 1184 school-going adolescents aged 13-15 years, representing a total of 296,111 youth from the 2008 Madagascar Global Youth Tobacco Survey to determine the prevalence of tobacco use. Gender-wise multivariable logistic regression models were conducted to identify key predictors. Approximately 19% (30.7% males; 10.2% females) of adolescents currently smoke cigarettes, and 7% (8.5% males and 5.8% females) currently use non-cigarette tobacco products. Regardless of sex, peer smoking behavior was significantly associated with increased tobacco use among adolescents. In addition, exposures to tobacco industry promotions, secondhand smoke (SHS) and anti-smoking media messages were associated with tobacco use. The strong gender gap in the use of non-cigarette tobacco products, and the role of peer smoking and industry promotions in adolescent females' tobacco use should be of major advocacy and policy concern. A comprehensive tobacco control program integrating parental and peer education, creating social norms, and ban on promotions is necessary to reduce adolescents' tobacco use.

Secondhand smoke exposure among never-smoking youth in 168 countries.

PURPOSE: To estimate the prevalence of secondhand smoke (SHS) exposure among never-smoking adolescents and identify key factors associated with such exposure. METHODS: Data were obtained from nationally representative Global Youth Tobacco Surveys conducted in 168 countries during 1999-2008. SHS exposure was ascertained in relation to the location-exposure inside home, outside home, and both inside and outside home, respectively. Independent variables included parental and/or peer smoking, knowledge about smoke harm, attitudes toward smoking ban, age, sex, and World Health Organization region. Simple and multiple logistic regression analyses were conducted. RESULTS: Of 356,414 never-smoking adolescents included in the study, 30.4%, 44.2%, and 23.2% were exposed to SHS inside home, outside home, and both, respectively. Parental smoking, peer smoking, knowledge about smoke harm, and positive attitudes toward smoke ban were significantly associated with increased odds of SHS exposure. Approximately 14% of adolescents had both smoking parents and peers. Compared with never-smoking adolescents who did not have both smoking parents and peers, those who had both smoking parents and peers had 19 (adjusted odds ratio [aOR], 19.0; 95% confidence interval [CI], 16.86-21.41), eight (aOR, 7.71; 95% CI, 7.05-8.43), and 23 times (aOR, 23.16; 95% CI, 20.74-25.87) higher odds of exposure to SHS inside, outside, and both inside and outcome home, respectively. CONCLUSIONS: Approximately one third and two fifths of never-smoking adolescents were exposed to SHS inside or outside home, and smoking parents and/or peers are the key factors. Study findings highlight the need to develop and implement comprehensive smoke-free policies consistent with the World Health Organization Framework Convention on Tobacco Control.

Using findings from a public opinion poll to build political support for tobacco control policy in Kenya.

OBJECTIVE: To assess the level of public support for tobacco control policies and to discuss how these findings could be used to influence the legislative process in the passing of tobacco control law in the country. METHODS: A cross-sectional study conducted in Kenya between March and May 2007 on a random sample of 2021 (991 men and 1030 women) respondents aged 18 years and above. Interviews were done using a structured questionnaire by a research consultancy firm with long-standing experience in public polling. RESULTS: The majority of respondents supported tobacco control policies as proposed by WHO Framework Convention on Tobacco Control. For example, 95% of the respondents supported smoking restrictions in all enclosed public places and workplaces, 94% supported visible health warnings on tobacco product packages, 83% supported a ban on advertisements of cigarettes and tobacco products and 69% supported a ban on sponsorship of events by tobacco companies. However, 60% perceived that there was very little commitment by legislators to tobacco control. CONCLUSIONS: There was overwhelming public support for tobacco control policies and a general view that government was not doing enough in implementing policies to protect the public from tobacco harm. This public opinion poll was used as an advocacy tool to generate support among legislators for national tobacco control law.

[Selective splenorenal shunt and post-transfusional hepatitis. Short and medium-term follow-up]. / Anastomose espleno-renal seletiva e hepatite pós-transfusional. Seguimento a curto e médio prazos.

Eighteen patients with protal hypertension were studied. Portal hypertension was due to schistosomiasis (N = 9), cirrhosis (N = 7) and congenital hepatic fibrosis (N = 2) diagnosed by surgical biopsy during the decompressive surgery (selective splenorenal shunt). All the patients have had at least one episode of digestive hemorrhage due to rupture of esophageal varices and received blood transfusion before or during surgery. The incidence of post-transfusion hepatitis was 44% (eight cases). The short and medium-term follow-up was good regardless the etiology of portal hypertension. The authors attributed these results mainly to good hepatic function at the time of surgery, younger patient population and good surgical technical conditions.