Reduction in diarrhea cases following implementation of COVID-19 hand hygiene interventions in Ghana: A causal impact analysis.

BACKGROUND: The human hand has constant contact with the environment, hence requires regular hand hygiene. Hand hygiene has gained recognition because of the COVID-19 pandemic and is a largely effective, affordable preventive measure against infectious diseases. This study used both national and sub-national analyses to evaluate the effect of COVID-19 handwashing guidelines on instances of diarrhea in Ghana. METHODS: Data on diarrhea cases spanning February 2018 and March 2022 were retrieved from the District Health Information Management System (DHIMS 2) using a data extraction guide. The data were summarized using descriptive statistics. The difference in diarrhea cases between the pre-COVID-19 and COVID-19 periods was measured using a two-sample t-test across Ghana's 16 administrative areas. Causal Impact package in R statistical software was employed to determine the impact of the introduction of COVID-19 hand hygiene protocols on diarrheal disease. RESULTS: A total of 5,645,533 diarrheal cases reported between February 2018 and March 2022 through the routine MIS (DHIMS2) were examined. Fifty-three percent of the cases occurred before the introduction of the hand hygiene protocol. Descriptive statistics indicated a statistically significant decrease in average diarrheal cases during the hand hygiene implementation era (13,463 cases reduction, p<0.001). Sub-national analyses revealed significant reductions in various regions: Greater Accra, Ashanti, Ahafo, Central, Eastern, Northern, Upper East, Upper West, and Volta (p<0.05). Causal impact analysis confirmed 11.0% nationwide reduction in diarrheal cases attributed to the COVID-19 hand hygiene protocols (p<0.001). CONCLUSION: This study underscores the effectiveness of COVID-19 hand hygiene protocols in reducing diarrheal morbidity in Ghana, with varying regional impacts. These findings advocate for the sustenance of investments and commitments made at the COVID hand hygiene protocols, particularly in this era where the pandemic appears controlled.

An assessment of the direct and indirect costs of breast cancer treatment in leading cancer hospitals in Ghana.

BACKGROUND: In Ghana, breast cancer remains the most common cancer and the leading cause of cancer deaths among women. The cost of treating cancer is huge and poses a great challenge for patients, their families, and health care systems. While comprehensive studies have been conducted on the economic burden of cancers in developed economies such as the EU and the US, there are limited studies in Africa, and Ghana, in particular. This study quantitatively assessed Ghana's direct and indirect costs of breast cancer treatment. METHODS: Primary data were collected using a questionnaire administered to 217 breast cancer patients at the Korle-Bu and Komfo Anokye Teaching Hospitals, Ghana's two leading hospitals, and Sweden Ghana Medical Centre. Direct and indirect costs were computed using the Cost-of-Illness Approach. Quantitative analysis was done using multivariate linear regression. RESULTS: The findings showed that the breast cancer patients studied paid a median amount of Ghana cedis (GHC) 31,021.0 (IQR; 25,262.5-42,147.0), approximating USD 5,500.2 (IQR: 4,477.0-7,469.2 USD) for their treatment within one year of active treatment in 2019. About 61.9% (95% CI: 61.8-62.0%) of this cost was direct cost, while the remaining 38.1% (95% CI: 38.0-38.1%) was indirect cost. Patients who sought care from public facilities for breast cancer paid a median amount of GHC 29,606.3 (USD 5,249.3), while those who sought care from private facilities paid GHC 55,071.2 (USD 9,744.4). Findings from the multivariate linear regression indicate that being married/cohabiting, divorced/separated and having tertiary level education predicted higher cost of breast cancer treatment while patients on retirement and patients in the middle stage (Stage II) of breast cancer diagnoses were associated with lower cost of breast cancer treatment. CONCLUSIONS: The cost of breast cancer treatment poses a significant burden on patients and their families. There is a need for increased public funding for breast cancer treatment to reduce the huge economic burden its treatment poses for patients and their families.

Factors Associated with Childhood Stunting in Four North African Countries: Evidence from Multiple Indicator Cluster Surveys, 2014-2019.

Stunting remains a significant public health issue among North African children, even though significant progress has been made in reducing hunger and poverty. This study aimed to identify factors associated with stunting among children in four North African countries (Algeria, Egypt, Sudan, and Tunisia). A logistic regression model adjusted for clustering and sampling weights was used to identify factors associated with childhood stunting. It was found that the prevalence of stunting in Algeria, Egypt, Sudan, and Tunisia was 9.7%(95% CI: 9.1, 10.3), 21.1% (95% CI: 19.8, 22.5), 33.8% (95% CI: 32.7, 34.9), and 8.2% (95% CI: 7.3, 9.2), respectively. Stunting was more common among children from Sudan and Egypt. Our analysis showed that a low wealth index, being a boy, low BMI, dietary diversity <5 foods, and low birth weight were associated with stunting from 0 to 23 months; however, rural residency, a low-educated mother, low BMI, family size, and diarrhea were associated with stunting from 24 to 59 months. A collaborative approach that prioritizes maternal health and nutrition, invests in struggling families, and customizes interventions to meet the specific needs of each North African country is essential for eradicating undernutrition by 2030.

Population-Modifiable Risk Factors Associated With Childhood Stunting in Sub-Saharan Africa.

Importance: Identifying modifiable risk factors associated with childhood stunting in sub-Saharan Africa (SSA) is imperative for the development of evidence-based interventions and to achieve the Sustainable Development Goals. Objective: To evaluate key modifiable risk factors associated with childhood stunting in SSA. Design, Setting, and Participants: This cross-sectional study examined the most recent (2014-2021) Demographic and Health Surveys data for children younger than 5 years from 25 SSA countries. Exposures: Modifiable risk factors included history of diarrhea within 2 weeks, consumption of dairy products, maternal body mass index, maternal educational level, antenatal care visits, place of birth, wealth index, type of toilet, and type of cooking fuel. Main Outcomes and Measures: Stunting and severe stunting, measured using the height-for-age z score, were the main outcomes. Children who scored below -2.0 SDs or -3.0 SDs were classified as having stunted or severely stunted growth, respectively. Relative risks and 95% CIs were computed using generalized linear latent and mixed models and log-binomial link functions. Population-attributable fractions (PAFs) were calculated using adjusted relative risks and prevalence estimates for key modifiable risk factors. Results: This study included 145 900 children from 25 SSA countries. The mean (SD) age of the children was 29.4 (17.3) months, and 50.6% were male. The highest PAFs of severe childhood stunting were observed for mothers lacking a formal education (PAF, 21.9%; 95% CI, 19.0%-24.8%), children lacking consumption of dairy products (PAF, 20.8%; 95% CI, 16.8%-24.9%), unclean cooking fuel (PAF, 9.5%; 95% CI, 2.6%-16.3%), home birth (PAF, 8.3%; 95% CI, 6.3%-10.0%), and low-income household (PAF, 5.8%; 95% CI, 3.4%-8.0%). These 5 modifiable risk factors were associated with 51.6% (95% CI, 40.5%-60.9%) of the severe childhood stunting in SSA. Conclusions and Relevance: This cross-sectional study identified 5 modifiable risk factors that were associated with 51.6% of severe childhood stunting in SSA. These factors should be a priority for policy makers when considering future child health interventions to address chronic malnutrition in SSA.

Demographic factors associated with myopia knowledge, attitude and preventive practices among adults in Ghana: a population-based cross-sectional survey.

PURPOSE: Knowledge, positive attitude and good preventive practices are keys to successful myopia control, but information on these is lacking in Africa. This study determined the KAP on myopia in Ghana. METHODS: This was a population-based cross-sectional survey conducted among adults (aged 18 years and older) living across 16 regions of Ghana between May and October 2021. Data on socio-demographic factors (sex, age, gender, level of education, working status, type of employment, monthly income, and region of residence), respondents' awareness, and knowledge, attitude and preventive practices (KAP) about myopia were collected. Composite and mean scores were calculated from eleven knowledge (total score = 61), eight attitude (48), and nine preventive practice items (33). Differences in mean scores were assessed using one-way analysis of variance (ANOVA) and standardized coefficients (ß) with 95% confidence intervals (CI), using multiple linear regression to determine the associations between the dependent (KAP) and demographic variables. RESULTS: Of the 1,919 participants, mean age was 37.4 ± 13.4 years, 42.3% were aged 18-30 years, 52.6% were men, 55.8% had completed tertiary education, and 49.2% had either heard about myopia, or accurately defined myopia as short sightedness. The mean KAP scores were 22.9 ± 23.7, 33.9 ± 5.4, and 22.3 ± 2.8, respectively and varied significantly with many of the demographic variables particularly with age group, region, marital status, and type of employment. Multiple linear regression analyses revealed significant associations between region of residence and knowledge (ß =-0.54, 95%CI:-0.87, -0.23, p < 0.001), attitude (ß =-0.24, 95%CI:-0.35,-0.14, p < 0.001) and preventive practices (ß = 0.07, 95%CI: 0.01, 0.12, p = 0.015). Preventive practices were also associated with type of employment (self-employed vs employee: ß = 0.25, 95%CI: 0.15, 4.91, p < 0.05). Knowledge scores were significantly higher in those who lived in the Greater Accra (39.5 ± 18.5) and Eastern regions (39.1 ± 17.5) and lower among those who lived in the Upper West region (6.4 ± 15.6). Government employees and those with tertiary education had significantly higher mean knowledge scores compared with non-government employees (ß = 4.56, 95%CI 1.22, 7.89, p = 0.007), and those with primary/no education (ß = 18.35, 95%CI: 14.42, 22.27, p < 0.001). CONCLUSION: Ghanaian participants had adequate knowledge of myopia but showed poor attitude and low preventive practices, which varied significantly between regions and were modified by socio-demographic factors. Further research into how education can be used to stimulate Ghanaians' engagement in preventive practices is needed.

Depression, anxiety, and stress and adverse pregnancy outcomes in pregnant women with history of recurrent pregnancy loss in Nigeria.

OBJECTIVE: The primary purpose of this study was to examine whether pregnant women with a history of recurrent pregnancy loss (RPL) are more likely to experience moderate-to-severe depression, anxiety, or stress symptoms than pregnant women without a history of RPL. The secondary purpose was to determine whether women with prior RPL experienced more unfavorable pregnancy outcomes if they had depression, anxiety, or stress. METHODS: A prospective case-control study was conducted that included 47 pregnant women with a history of RPL and 94 pregnant women without prior RPL. Participants 20 weeks of gestation or earlier were included. Both groups completed the Depression, Anxiety, and Stress Scale (DASS-21), and were followed up until delivery to determine the pregnancy outcomes. Multivariate logistic regression was used to compare adverse pregnancy outcomes. RESULT: Among the 47 women with prior RPL, 10 had primary RPL (two or more miscarriages without a successful pregnancy) and 37 secondary RPL (two or more miscarriages with a history of successful pregnancy). RPL was significantly associated with moderate-to-severe levels of depression (P < .001), anxiety (P < .001), and stress (P < .001). Among the RPL group, high stress level was significantly associated with repeat miscarriage (adjusted odds ratio (AOR) = 5.28, 95%CI = 1.25-100.0, P = .03) and preterm labor (AOR = 6.07, 95%CI = 1.61-100.0, P = .04). Depression and anxiety were not associated with adverse pregnancy outcomes. CONCLUSION: Pregnant women with a history of RPL had considerably higher rates of moderate-to-severe depression, anxiety, and stress. Repeat miscarriage and preterm labor were considerably higher among pregnant women with RPL who were experiencing high stress levels at baseline.

The psychosocial burden of women seeking treatment for breast and cervical cancers in Ghana's major cancer hospitals.

BACKGROUND: Breast and cervical cancers remain the most common cancers and the leading cause of cancer deaths in Ghana. Non-communicable diseases such as cancers, have been associated with psychological burdens such as anxiety and depression disorders as well as severe mental disorders such as bipolar disorder. As such the World Health Organisation has noted that mental health and well-being are crucial in reducing the NCD burden. METHODS: A convergent mixed method approach was used to ascertain the psychosocial burden of breast and cervical cancer patients who sought treatment in three major cancer hospitals in Ghana. Primary data were collected using a questionnaire and an interview guide from 298 breast and cervical cancer patients seeking treatment at the Korle-Bu and Komfo Anokye Teaching Hospitals as well as the Sweden Ghana Medical Centre. Qualitative analysis was done using thematic content analysis while quantitative analysis was done using logistic regression. RESULTS: The findings of the study showed that patients not only battled with psychological burdens such as anxiety, depression, pain, stigma, fear of death and loss of spouses but also struggled with physical, social, and dietary restrictions. Patients with low educational levels and income status, retired or unemployed, and/or had larger household sizes suffered more psychosocial burdens. CONCLUSION: There is a need for liaison psychiatrists and health psychologists to assist oncologists to provide psychological support such as free and routine counselling services for cancer patients and their caregivers. Educational campaigns on mainstream and social media need to be intensified to demystify the stigma surrounding cancers in Ghana.

Profiling and factors associated with glaucoma diagnostic practice in sub-Saharan Africa-a cross sectional study of Nigerian and Ghanaian optometrists.

BACKGROUND: Ghana and Nigeria are the two countries in Africa that currently run the Doctor of Optometry (OD) program in sub-Saharan Africa (SSA). Optometrists in these countries are licensed to provide glaucoma care. Despite the clinically relevant practice guidelines for glaucoma, there is no data on the practice patterns for glaucoma eye care in SSA, a region with the highest prevalence of glaucoma. This study aimed to profile glaucoma diagnosis adherence to practice guidelines among optometrists in two neighbouring anglophone countries (Nigeria and Ghana). METHODS: A web-based cross-sectional survey of practising optometrists was conducted in both countries. Each country data was weighted to reflect the total number of licensed and practising optometrists at the time of this survey. Descriptive analyses were performed against demography and practice factors using survey commands to adjust for sampling weights when estimating confidence intervals (CI) around prevalence estimates. Simple and multiple logistic regression analyses were performed to identify factors associated with glaucoma diagnosis. RESULTS: A total of 493 optometrists (238, 48.3% and 255, 51.7%) from Ghana and Nigeria respectively, responded to the survey-the first to document and compare the glaucoma diagnostic criteria between optometrists in Ghana and Nigeria. More Ghanaian than Nigerian optometrists diagnosed glaucoma and over 90% in both countries reported that they frequently performed either tonometry, visual field testing, or fundus examination during glaucoma diagnosis. Ghanaian optometrists were significantly more likely to diagnose glaucoma than Nigerian optometrists (adjusted odd ratio, AOR = 6.15, 95%CI:1.63-23.15, P = .007). Optometrists who have practiced for more than 10 years (AOR = 7.04; 95%CI:1.74-28.47, P = .006) and private practice optometrists (AOR = 3.33; 95%CI:1.13-9.83, P = .03) were more likely to diagnose glaucoma. CONCLUSIONS: The study provides information for evaluating glaucoma assessment for optometrists in both countries. Optometrists in both countries are reasonably well-equipped to diagnose glaucoma and are practicing at an adequate level, but with room for improvement.

Childhood undernutrition in North Africa: systematic review and meta-analysis of observational studies.

BACKGROUND: Undernutrition remains a major public health issue in low- and middle-income countries. Objective Our aim for this study was to identify the factors contributing to undernutrition in children under five years old in North Africa. METHODS: We searched five electronic bibliographic databases (Ovid MEDLINE, Web of Science, Embase (Ovid), ProQuest, and CINAHL) for eligible observational studies published after 2006. STATA version 17 software was used to calculate the odds ratios between associated factors and indicators of undernutrition, with 95% confidence intervals. For each factor, the overall odds were pooled using a forest plot. Due to the significant heterogeneity among the studies (I2 > 50%), a random-effects model was used, and sensitivity analysis was conducted to examine the effect of outliers. RESULTS: Out of 1093 initially identified studies, 14 met the selection criteria. Our meta-analysis revealed that uneducated mothers were the most common factor associated with undernutrition in North African children. Children aged 0-23 months were significantly associated with stunting (odds ratios (OR) = 1.27; 95% CI: 1.18; 1.37) and wasting (OR = 1.68; 95% CI: 1.42; 1.99). Children living in rural areas were also at higher odds of being stunted (OR = 1.74; 95% CI: 1.64; 1.84) and underweight (OR = 1.59; 95% CI: 1.35; 1.88). These analyses also indicated that a lower wealth index, mothers' nutritional health, uneducated fathers, and low birth weight were other factors significantly associated with stunting. CONCLUSION: Addressing undernutrition in Northern Africa requires a multidisciplinary approach prioritising mothers and young children, especially families in underprivileged areas.

Wasting and Underweight in Northern African Children: Findings from Multiple-Indicator Cluster Surveys, 2014-2018.

Northern Africa faces multiple severe detrimental factors that impact child nutrition. This study aimed to identify the predictors for wasting and underweight in children aged 0-59 months in Northern Africa. We analysed pooled cross-sectional data from multiple-indicator cluster surveys conducted in four countries (Algeria, Egypt, Sudan, and Tunisia) involving 37,816 children aged 0-59 months. A logistic regression analysis was used, considering clustering and sampling weights, to identify factors associated with wasting and underweight among children aged 0-23, 24-59, and 0-59 months. Among children aged 0-59 months, the overall prevalence was 7.2% (95% CI: 6.8-7.5) for wasting and 12.1% (95% CI:11.7-12.5) for underweight. Sudan and Algeria had the highest rates of wasting, while Sudan and Egypt had the highest rates of underweight. Multiple regression analyses indicate that factors associated with wasting and being underweight include child age, country, rural residency, poor wealth index, being male, birth order, maternal education, body mass index, media use, lack of diverse foods, longer duration of breastfeeding, perceived small baby size, and diarrhoea. These findings highlight the importance of implementing targeted health and nutrition initiatives, such as maternal education, family planning, and community engagement. Priority should be given to children from underprivileged areas who lack proper dietary variety.

Pharmacovigilance in the Caribbean Countries: an Overview.

Purpose of overview: The constant surge in accessing essential medicines creates a greater need for continuous monitoring of usage. The inability to source active pharmaceutical ingredients during the COVID-19 pandemic resulted in drug shortages that increased online requests for medications. E-commerce and social sites have opened the floodgate for the marketing of falsified, substandard, and unregistered pharmaceuticals, making them easily accessible to consumers with the click of a button. A high prevalence of such products with compromised quality highlights further the need for enhanced post-marketing vigilance of safety and quality within the pharmaceutical industry. This review aims to assess the extent to which pharmacovigilance (PV) systems in selected Caribbean countries conform to the minimum World Health Organization (WHO) requirements, highlight the importance of PV in ensuring the safer use of medicines across the Caribbean region, and identify opportunities and challenges in building comprehensive PV systems. Recent Findings: The review finds that while major advancements in PV and adverse drug reaction (ADR) monitoring have occurred in Europe and other parts of the Americas, little has been done in the Caribbean region. Only a few countries in the region are active members of the WHO's global PV network, and ADR reporting is minimal. The reason for low reporting includes a lack of awareness, commitment, and participation of healthcare professionals, manufacturers, authorized distributors, and the general consumers. Summary: Nearly all established national PV systems do not fully conform to the minimum PV requirements by the WHO. Legislation, regulatory framework, political commitment, adequate funding, strategies, and incentives to encourage reporting of ADRs are needed to build sustainable PV systems in the Caribbean.

Prevalence and factors associated with mental health problems of psychological distress and depression among rural Victorians - analysis of cross-sectional data (Crossroads II).

BACKGROUND: Research suggests that rates of mental illness are similar in rural and urban Australia, although there are significant workforce shortages in rural regions along with higher rates of chronic disease and obesity and lower levels of socioeconomic status. However, there are variations across rural Australia and limited local data on mental health prevalence, risk, service use and protective factors. This study describes the prevalence of self-reported mental health problems of psychological distress and depression, in a rural region in Australia and aims to identify the factors associated with these problems. METHODS: The Crossroads II study was a large-scale cross-sectional study undertaken in the Goulburn Valley region of Victoria, Australia in 2016-18. Data were collected from randomly selected households across four rural and regional towns and then screening clinics from individuals from these households. The main outcome measures were self-reported mental health problems of psychological distress assessed by the Kessler 10 and depression assessed by Patient Health Questionnaire-9. Unadjusted odd ratios and 95% confidence intervals of factors associated with the two mental health problems were calculated using simple logistic regression with multiple logistic regression using hierarchical modelling to adjust for the potential confounders. RESULTS: Of the 741 adult participants (55.6% females), 67.4% were aged ≥ 55 years. Based on the questionnaires, 16.2% and 13.6% had threshold-level psychological distress and depression, respectively. Of those with threshold-level K-10 scores, 19.0% and 10.5% had seen a psychologist or a psychiatrist respectively while 24.2% and 9.5% of those experiencing depression had seen a psychologist or a psychiatrist, respectively in the past year. Factors such as being unmarried, current smoker, obesity, were significantly associated with a higher prevalence of mental health problems whereas physical activity, and community participation reduced the risk of mental health problems. Compared to rural towns, the regional town had higher risk of depression which was non-significant after adjusting for community participation and health conditions. CONCLUSIONS: The high prevalence of psychological distress and depression in this rural population was consistent with other rural studies. Personal and lifestyle factors were more relevant to mental health problems than degree of rurality in Victoria. Targeted lifestyle interventions could assist in reducing mental illness risk and preventing further distress.

Underlying biochemical effects of intermittent fasting, exercise and honey on streptozotocin-induced liver damage in rats.

Purpose: Derangements of liver transcriptional factors and enzymes have important implications in diabetes-induced related complications. Hence, this study which consists of two experimental phases was aimed at evaluating the possible underlying molecular mechanisms of intermittent fasting (IF), exercise starvation and honey in streptozotocin (STZ)-mediated liver damage in diabetic rats. Methods: The diabetic rats were treated orally with distilled water (0.5 ml/kg), IF, starvation and honey at 1 g/kg body weight in the non-diabetic phase for four (4) weeks. After STZ injections, four (4) weeks of IF, exercise, starvation, and honey therapy were used as interventions prior to a biochemical evaluation of the liver. Results: IF and exercise greatly decreased liver transcription factor (resistin, SREBP-1c), inflammatory cytokines/enzyme (TNF-α, IL-6, IL-1ß, MPO) as well as oxidative and nitrergic stress with correspondence increased liver PPAR-γ, IL-10, SOD, CAT and GSH in diabetic rats unlike starvation and honey regimen relative to diabetic controls. Furthermore, IF and exercise significantly improved hepatic glycogen synthase and decreased glycogen phosphorylase in diabetic rats compared to the diabetic control group, but starvation and honey therapy had no such influence. IF and exercise strategically reduces STZ-induced liver metabolic disorder via through modulation of liver transcriptional factors and inhibition of pro-inflammatory cytokines, oxido-nitrergic and adipokine signaling pathway.

Adsorption of direct blue 106 dye using zinc oxide nanoparticles prepared via green synthesis technique.

Zinc oxide nanoparticles (ZnO-NPs) have in recent times shown effective adsorption capability for the confiscation of colour contaminants from aqueous environments (aquatic ecosystems or water bodies) due to the fact that ZnO contains more functional groups. Direct blue 106 (DB106) dye was selected for this present study as a model composite due to its wide range of uses in textiles (cotton and wools), woods, and paper industries, as well as their therapeutic applications, along with its potential for impairments. This study therefore focuses on the use of DB106 dye as a model composite due to its wide range of uses in textiles (cotton and wools), woods, and paper industries, as well as their therapeutic applications and their potential for impairments. Furthermore, the surface functionalization, shape, and composite pore size were revealed by TEM, FTIR, UV, and BET techniques. The current study uses green synthesis method to prepare ZnO-NPs as an adsorbent for the DB106 dye molecules adsorption under various conditions using the batch adsorption process. The adsorption of DB106 dye to the ZnO-NPs biosorbent was detected to be pH-dependent, with optimal adsorption of DB106 (anionic) dye particles observed at pH 7. DB106 dye adsorption to the synthesized ZnO-NPs adsorbent was distinct by means of the linearized Langmuir (LNR) and pseudo-second-order (SO) models, with an estimated maximum adsorption capacity (Qm) of 370.37 mg/g.

A systematic review and meta-analysis of the prevalence of childhood undernutrition in North Africa.

Undernutrition (stunting, wasting and underweight) among children remains a public health concern in North Africa, especially following recent conflicts in the region. Therefore, this paper systematically reviews and meta-analyses the prevalence of undernutrition among children under five in North Africa to determine whether efforts to reduce undernutrition are on track to achieving the Sustainable Development Goals (SDGs) by 2030. Eligible studies published between 1st January 2006 and 10th April 2022 were searched for, using five electronic bibliographic databases (Ovid MEDLINE, Web of Science, Embase (Ovid), ProQuest and CINAHL). The JBI critical appraisal tool was used, and a meta-analysis was conducted using the 'metaprop' command in STATA, to estimate the prevalence of each undernutrition indicator in the seven North African countries (Egypt, Sudan, Libya, Algeria, Tunisia, Morocco, and Western Sahara). Due to the significant heterogeneity among studies (I2 >50%), a random effect model and sensitivity analysis were conducted to examine the effect of outliers. Out of 1592 initially identified, 27 met the selection criteria. The prevalence of stunting, wasting and being underweight were 23.5%, 7.9% and 12.9%, respectively. Significant variations between the countries with the highest rates of stunting and wasting were reported in Sudan (36%, 14.1%), Egypt (23.7%, 7.5%), Libya (23.1%, 5.9%), and Morocco (19.9%, 5.1%). Sudan also had the highest prevalence of underweight (24.6%), followed by Egypt (7%), Morocco (6.1%), and Libya (4.3%) with more than one in ten children in Algeria and Tunisia having stunted growth. In conclusion, undernutrition is widespread in the North African region, particularly in Sudan, Egypt, Libya, and Morocco, making it challenging to meet the SDGs by 2030. Nutrition monitoring and evaluation in these countries is highly recommended.

Factors associated with residential fire-related hospitalisations and deaths: A 10-year population-based study.

This study aims to identify residential fire risk factors and their health outcomes in terms of hospital admissions from burns and smoke inhalation together with related readmissions, length of hospital stay (LOS), costs of hospitalisation and mortality within 30 days of the fire incidence. Residential fire-related hospitalisations from 2005 to 2014 in New South Wales, Australia were identified using linked data. Univariate and multivariable Poisson regression analyses were performed to determine factors associated with residential fires on hospital admission and loss of life. During the study period, 1862 individuals were hospitalised due to residential fires. In terms of prolonged LOS, high hospitalisation cost or mortality, fire incidents' that damaged both contents and structures of the property; were ignited by smokers' materials and/or due to mental or physical impairment of the residents had more adverse outcomes. Individuals aged 65 and over with comorbidities and/or acquired severe injuries from the fire incident were at a higher risk of long-term hospitalisation and death. This study provides information to response agencies in communicating fire safety messages and intervention programs to target vulnerable population. In addition, it also supplies indicators on hospital usage and LOS following residential fires to health administrators.

Acceptance and Risk Perception of COVID-19 Vaccination among Pregnant and Non Pregnant Women in Sub-Saharan Africa: A Cross-Sectional Matched-Sample Study.

This study aims to evaluate the acceptance and risk perception of pregnant and non pregnant women towards COVID-19 vaccines using a cross-sectional matched-sample study approach. A web-based questionnaire with closed- and open-ended questions was administered to adults older than 18 years in the sub-Saharan African (SSA) region. Respondents (n = 131) were grouped based on their pregnancy status (54 pregnant and 77 non pregnant women) and matched for comparison by age. The matched groups were compared using the chi-square test and the t-test where appropriate. Compared to non pregnant women, pregnant women reported significantly lower risk perception scores of COVID-19 infection (3.74 vs. 5.78, p < 0.001) and were less likely to take the COVID-19 vaccine (odds ratio = 0.12, 95% confidence interval (CI) 0.06-0.27, p < 0.001). A similar proportion of pregnant and non pregnant women believed in false information about the COVID-19 vaccine, and 40% of unvaccinated pregnant women (n = 40) were concerned about the safety of the vaccine. After adjustment, women's education, marital status, belief in misconceptions and risk perception were associated with non-vaccination among pregnant women. The content analysis revealed that pregnant women refused the vaccine due to mistrust of their countries' health systems, concerns about the country where the vaccines were manufactured and a lack of confidence in the production process of the vaccines. This study shows the poor acceptance of COVID-19 vaccines among pregnant women in SSA, who perceived a lower risk of COVID-19 infection. Understanding the reasons for non-acceptance and the motivation to accept the COVID-19 vaccine could guide the development of health education and promotion programmes, and aid governments and policymakers in implementing targeted policy changes.

Mapping Local Variations and the Determinants of Childhood Stunting in Nigeria.

INTRODUCTION: Understanding the specific geospatial variations in childhood stunting is essential for aligning appropriate health services to where new and/or additional nutritional interventions are required to achieve the Sustainable Development Goals (SDGs) and national targets. OBJECTIVES: We described local variations in the prevalence of childhood stunting at the second administrative level and its determinants in Nigeria after accounting for the influence of geospatial dependencies. METHODS: This study used the 2018 national Nigeria Demographic and Health Survey datasets (NDHS; N = 12,627). We used a Bayesian geostatistical modelling approach to investigate the prevalence of stunting at the second administrative level and its proximal and contextual determinants among children under five years of age in Nigeria. RESULTS: In 2018, the overall prevalence of childhood stunting in Nigeria was 41.5% (95% credible interval (CrI) from 26.4% to 55.7%). There were striking variations in the prevalence of stunting that ranged from 2.0% in Shomolu in Lagos State, Southern Nigeria to 66.4% in Biriniwa in Jigawa State, Northern Nigeria. Factors positively associated with stunting included being perceived as small at the time of birth and experience of three or more episodes of diarrhoea in the two weeks before the survey. Children whose mothers received a formal education and/or were overweight or obese were less likely to be stunted compared to their counterparts. Children who were from rich households, resided in households with improved cooking fuel, resided in urban centres, and lived in medium-rainfall geographic locations were also less likely to be stunted. CONCLUSION: The study findings showed wide variations in childhood stunting in Nigeria, suggesting the need for a realignment of health services to the poorest regions of Northern Nigeria.

Concurrent wasting and stunting among under-five children in the context of Ethiopia: A generalised mixed-effects modelling.

Concurrent wasting and stunting (WaSt) is a condition where both wasting and stunting exist in a child at the same time. This study aimed to assess the prevalence of WaSt and to identify potential associated factors in Ethiopia.  A total of 33,650 children aged between 0 and 59 months were included in the analysis from the four waves of the Ethiopian Demographic and Health Survey. A mixed-effects logistic regression model was used to identify the determinants of WaSt. The prevalence of WaSt was found to be 4.7% (95% confidence interval [CI]: (4.5-4.9)), with respectively 2.5% (95% CI: 2.1-3.1) and 4.9% (95% CI: 4.7-5.2) among children in urban and rural settings. Children: (i) in the age group 12-23 months (adjusted odds ratio [AOR]: 4.16, 95% CI: (3.20-5.42)) and 24-59 months (AOR: 3.08, 95% CI: (2.28-4.17)); (ii) who were perceived by their mothers to be smaller than normal at birth (AOR: 1.98, 95% CI: (1.57-2.50)); (iii) had diarrhoea (AOR: 1.38, 95% CI: (1.11-1.71)); and (iv) fever in the past 2 weeks (AOR: 1.38, 95% CI: (1.10-1.71)) reported higher odds of WaSt. Being a female child (AOR: 0.57, 95% CI: (0.48-0.69)), having received measles vaccination (AOR: 0.71, 95% CI: (0.55-0.89)), having a mother with a normal body mass index (18.5-24.9 kg/m2 ) (AOR: 0.57, 95% CI: (0.48-0.68)), having a wealthier household (AOR: 0.67, 95% CI: (0.50-0.90)), and living in rural setting (AOR: 0.49, 95% CI: (0.32-0.74)) were associated with reduced odds of WaSt. The prevalence of WaSt was high, with approximately 1 in 20 Ethiopian children suffering from the condition and needing a prompt response to minimize the poor health and developmental outcomes. Children perceived by their mother to be smaller than normal at birth, older children, and babies with diarrhoea and fever had higher odds of WaSt.

The impact of information sources on COVID-19 vaccine hesitancy and resistance in sub-Saharan Africa.

BACKGROUND: Vaccination remains the most powerful weapon against the emergence of new variants of coronavirus (COVID-19). However, false information about COVID-19 vaccines through various platforms including social media remains a major threat to global public health. This study examined the impact of information sources on COVID-19 vaccine hesitancy and resistance in sub-Saharan Africa (SSA). METHODS: A validated web-based cross-sectional study was conducted from 14 March to 16 May 2021, and was administered in both French and English to 2572 participants aged 18 years and over. Data on sociodemographic characteristics, medical and vaccination history, and the information sources (mainstream media and social media) used by the participants during the pandemic were obtained. There were three main outcomes: The vaccinated group were those who responded in the affirmation (Yes) to the question of whether they have been vaccinated against COVID-19. Those who responded 'not sure' or 'no' to the question were then asked if they were willing to be vaccinated when the vaccine became available in their home countries. The responses to this follow-up question were used to derive the second and third outcome variables of 'vaccine hesitancy' and 'vaccine resistance', respectively. A series of logistic regression analyses were used to examine the impact of information sources on the three main outcomes. RESULTS: The prevalence of COVID-19 vaccine hesitancy among the participants was lowest among newspaper readers (42%) and highest among TV (72%) and social media users (73%). The prevalence of COVID-19 vaccine-resistance was also lowest among newspaper readers (37%) but highest among social media users (87%). Multivariate analyses revealed that compared to those who did not use these information sources, SSA participants who relied on the radio (aOR 0.83, 95%CI = 0.70, 0.99), TV (aOR 0.80, 95%CI = 0.65, 0.97) and social media (aOR 0.79, 95%CI = 0.65, 0.97) for information during the pandemic were less likely to be hesitant towards taking the vaccines. However, social media users (aOR 2.13, 95%CI = 1.62, 2.80), those who watched TV (aOR 1.40, 95%CI =1.08, 1.80), relied on healthcare workers (HCWs: aOR 1.32, 95%CI = 1.07, 1.63) and families/friends (aOR 1.31, 95%CI = 1.06, 1.61) for COVID-19 related information during the pandemic were more likely to resist taking the COVID vaccines in this study. Participants who relied on the newspaper for information during the pandemic were less likely to resist the vaccines (aOR 0.77, 95%CI = 0.62, 0.95) compared to non-readers of a newspaper. CONCLUSION: We found that all six information sources except radio were strong predictors of the resistance towards COVID-19 vaccination. Further research on how these channels can be used to improve the availability of reliable healthcare information is needed. Investments in these resources will protect people and empower them to make appropriate choices about their health.