Building a Health Literacy Indicator from Angola Demographic and Health Survey in 2015/2016.

Health literacy is a determinant factor for population health. It is important both for the prevention of health problems and the better management of those problems and unexpected situations that happen. Low health literacy has been consistently associated with poor health outcomes. This study aimed to develop a health literacy indicator for Angola and to analyze pertinent demographic characteristics related to it. Data were obtained from the first Angola Demographic and Health Survey conducted in 2015/16; we included 10 questions related to the American National Academy of Medicine definition of health literacy. Using factor analysis, we extracted one i indicator corresponding to four dimensions of health literacy. The indicator was dichotomized, and we used Logistic Regression to estimate factors associated with health literacy level: we obtained data from 19,785 adolescents and adults, aged 15-49 years. The internal consistency of the i indicator was reliable (Cronbach's α = 0.83). Adjusting for other variables, males with complete secondary education or above and living in urban areas were more likely to have a high level of health literacy. There were substantial differences between the 18 regions. This is the first study evaluating health literacy in Angola using the American National Academy of Medicine definition and a Demographic and Health survey. Our study shows unfavorable results for women, individuals living in rural areas and those less educated.

Impact of the recent Ebola epidemic with pandemic potential on the economies of Guinea, Liberia and Sierra Leone and other West African countries.

West Africa experienced its first Ebola epidemic in 2014. Its magnitude in terms of morbidity and mortality was greater than any other epidemic. It has particularly affected Guinea, Liberia and Sierra Leone. Its impact, beyond the high mortality, is also economic. The Ebola virus disease spread to several other African countries with limited resources, causing a significant financial burden to their health systems but also impacting the entire economy of the countries. The objective of this essay is to reflect on the consequences of the Ebola virus epidemics on West African economies in the short term. Estimates of the economic burden of the epidemic range from $2.8 billion to $32.6 billion in lost gross domestic product. The sectors affected by the economic crisis are the most important of the contaminated countries, namely agriculture, mining and trade. There has been a halt in socio-economic activities in the most affected regions. The decrease in the number of workers affected by the virus, the exodus to the least affected areas, and the repatriation of government employees have contributed to the decrease in the income of individuals and states. The fear of contamination by foreign countries has reduced imports, but also all tourist activities, which in turn have had an impact on the restaurant and hotel sectors. All these financial and food disruptions have exposed the population of these countries to food insecurity. The analysis of the impact of the Ebola virus on West African economies in the short term was as devastating as the health impact. This impact has directly contributed to a decrease in economic growth not only for the affected countries but also for all West African countries that depend on these same resources. A loss of about US$32.6 billion over two years in the West African region has been estimated, which is equivalent to 3.3% of the regional gross domestic product (GDP) in the absence of Ebola in 2014.

HIV Infection, risk factors and health services use among male-to-female transgender sex workers: a cross-sectional study in Portugal.

Male-to-female transgender sex workers (TSW) have been identified as a key population at risk for HIV. This study examined risk behaviors and HIV prevalence among TSW, and described health services use. A participatory cross-sectional survey was conducted with 125 TSW recruited in locations and networks where sex workers congregate. HIV-risk behaviors were common among participants. Inconsistent condom use with clients in the previous month was reported by 12.0% of participants and was associated with Portuguese nationality, inconsistent condom use with non-paying partners and not been reached by HIV prevention programs in the previous year. Ever use of psychoactive substances was reported by 61.6% of participants and was associated with being non-employed, doing full-time sex work, having higher number of non-paying partners and having never used health services. Also, ever use of psychoactive substances was negatively associated with older age and Portuguese nationality. About 34% of the participants reported having not been tested in the previous 12 months; 20.2% never used the health services. Overall, 14.9% (95%CI: 8.0-21.0%) reported being HIV-positive. Of those, 22.2% (95%CI: 1.0-43.5%) had unprotected sex with clients in the previous month, 26.7% (95%CI: 1.3-52.0%) had unprotected sex with non-paying partners in the previous year, 13.3% (95%CI: 0.0-33.0%) had ever injected drugs, 60.0% (95%CI: 23.0-97.0%) reported a past STI and 33.3% (95%CI: 2.0-64.6%) had currently HIV/STI co-infection. The socioeconomic, relational or partnering, and structural contexts conducive to increased risk are warranting further investigation. This knowledge would be valuable to inform prevention programs. HIV interventions, including secondary prevention, should address specific needs of TSW. Outreach initiatives aimed to reach TSW who are difficult to access can play a role in promoting access to health services and reducing HIV infection and transmission.