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1.
Niger Postgrad Med J ; 27(1): 1-7, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32003355

RESUMO

Pubic health insurance schemes are usually set up by governments to provide cover for their insured populations against healthcare costs. These schemes are usually administered by a government agency and vary both in how they are funded and provide their services. A number of developing countries have introduced such schemes to minimise the impact of financial barriers to healthcare access by their populations. These schemes are expected to bridge the inequality in healthcare. A National Health Insurance Scheme has been in operation in Nigeria since 2005 to provide health cover for government employees and those in private institutions with no less than ten workers. There are similar schemes in a number of countries in sub-Saharan Africa. We conducted a literature review of publications on public health insurance schemes in sub-Saharan Africa to identify the challenges they encounter. We found 76 relevant publications. Although much have been published on these schemes, few have addressed the critical obstacles to effective implementation, management and sustenance in the unique environments we find in sub-Saharan Africa - where poor technological infrastructures, acts of forgery, counterfeiting and other forms of fraud are common. We highlight these challenges, using the scheme in Nigeria for reference. We discuss the potential role of robust electronic medical record (EMR) systems for sustainable schemes in such environments and describe some of the ways robust EMR systems could be used to mitigate the challenges posed by most of the peculiar problems associated with poor infrastructures.


Assuntos
Registros Eletrônicos de Saúde , Acesso aos Serviços de Saúde , Seguro Saúde , África ao Sul do Saara , Humanos , Nigéria
2.
BMC Public Health ; 20(1): 17, 2020 Jan 07.
Artigo em Inglês | MEDLINE | ID: mdl-31910842

RESUMO

BACKGROUND: A recent study found that the gut microbiota, Lactobacillus and Bifidobacterium, have the ability to modulate the severity of malaria. The modulation of the severity of malaria is not however, the typical focal point of most widespread interventions. Thus, an essential element of information required before serious consideration of any intervention that targets reducing severe malaria incidence is a prediction of the health benefits and costs required to be cost-effective. METHODS: Here, we developed a mathematical model of malaria transmission to evaluate an intervention that targets reducing severe malaria incidence. We consider intervention scenarios of a 2-, 7-, and 14-fold reduction in severe malaria incidence, based on the potential reduction in severe malaria incidence caused by gut microbiota, under entomological inoculation rates occurring in 41 countries in sub-Saharan Africa. For each intervention scenario, disability-adjusted life years averted and incremental cost-effectiveness ratios were estimated using country specific data, including the reported proportions of severe malaria incidence in healthcare settings. RESULTS: Our results show that an intervention that targets reducing severe malaria incidence with annual costs between $23.65 to $30.26 USD per person and causes a 14-fold reduction in severe malaria incidence would be cost-effective in 15-19 countries and very cost-effective in 9-14 countries respectively. Furthermore, if model predictions are based on the distribution of gut microbiota through a freeze-dried yogurt that cost $0.20 per serving, a 2- to 14-fold reduction in severe malaria incidence would be cost-effective in 29 countries and very cost-effective in 25 countries. CONCLUSION: Our findings indicate interventions that target severe malaria can be cost-effective, in conjunction with standard interventions, for reducing the health burden and costs attributed to malaria. While our results illustrate a stronger cost-effectiveness for greater reductions, they consistently show that even a limited reduction in severe malaria provides substantial health benefits, and could be economically viable. Therefore, we suggest that interventions that target severe malaria are worthy of consideration, and merit further empirical and clinical investigation.


Assuntos
Antimaláricos/economia , Antimaláricos/uso terapêutico , Transmissão de Doença Infecciosa/economia , Transmissão de Doença Infecciosa/estatística & dados numéricos , Malária/economia , Malária/terapia , Malária/transmissão , África ao Sul do Saara/epidemiologia , Análise Custo-Benefício , Humanos , Incidência , Malária/epidemiologia , Modelos Teóricos
4.
Int J Cancer ; 146(5): 1208-1218, 2020 03 01.
Artigo em Inglês | MEDLINE | ID: mdl-31087650

RESUMO

Breast cancer is the leading cancer diagnosis and second most common cause of cancer deaths in sub-Saharan Africa (SSA). Yet, there are few population-level survival data from Africa and none on the survival differences by stage at diagnosis. Here, we estimate breast cancer survival within SSA by area, stage and country-level human development index (HDI). We obtained data on a random sample of 2,588 breast cancer incident cases, diagnosed in 2008-2015 from 14 population-based cancer registries in 12 countries (Benin, Cote d'Ivoire, Ethiopia, Kenya, Mali, Mauritius, Mozambique, Namibia, Seychelles, South Africa, Uganda and Zimbabwe) through the African Cancer Registry Network. Of these, 2,311 were included for survival analyses. The 1-, 3- and 5-year observed and relative survival (RS) were estimated by registry, stage and country-level HDI. We equally estimated the excess hazards adjusting for potential confounders. Among patients with known stage, 64.9% were diagnosed in late stages, with 18.4% being metastatic at diagnosis. The RS varied by registry, ranging from 21.6%(8.2-39.8) at Year 3 in Bulawayo to 84.5% (70.6-93.5) in Namibia. Patients diagnosed at early stages had a 3-year RS of 78% (71.6-83.3) in contrast to 40.3% (34.9-45.7) at advanced stages (III and IV). The overall RS at Year 1 was 86.1% (84.4-87.6), 65.8% (63.5-68.1) at Year 3 and 59.0% (56.3-61.6) at Year 5. Age at diagnosis was not independently associated with increased mortality risk after adjusting for the effect of stage and country-level HDI. In conclusion, downstaging breast cancer at diagnosis and improving access to quality care could be pivotal in improving breast cancer survival outcomes in Africa.


Assuntos
Neoplasias da Mama/mortalidade , Fatores Socioeconômicos , África ao Sul do Saara/epidemiologia , Fatores Etários , Mama/patologia , Neoplasias da Mama/patologia , Feminino , Seguimentos , Acesso aos Serviços de Saúde/organização & administração , Acesso aos Serviços de Saúde/estatística & dados numéricos , Humanos , Estimativa de Kaplan-Meier , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Melhoria de Qualidade , Sistema de Registros/estatística & dados numéricos , Medição de Risco , Taxa de Sobrevida
5.
Lancet ; 395(10217): 65-74, 2020 01 04.
Artigo em Inglês | MEDLINE | ID: mdl-31852602

RESUMO

The double burden of malnutrition (DBM), defined as the simultaneous manifestation of both undernutrition and overweight and obesity, affects most low-income and middle-income countries (LMICs). This Series paper describes the dynamics of the DBM in LMICs and how it differs by socioeconomic level. This Series paper shows that the DBM has increased in the poorest LMICs, mainly due to overweight and obesity increases. Indonesia is the largest country with a severe DBM, but many other Asian and sub-Saharan African countries also face this problem. We also discuss that overweight increases are mainly due to very rapid changes in the food system, particularly the availability of cheap ultra-processed food and beverages in LMICs, and major reductions in physical activity at work, transportation, home, and even leisure due to introductions of activity-saving technologies. Understanding that the lowest income LMICs face severe levels of the DBM and that the major direct cause is rapid increases in overweight allows identifying selected crucial drivers and possible options for addressing the DBM at all levels.


Assuntos
Desnutrição/epidemiologia , Obesidade/epidemiologia , Sobrepeso/epidemiologia , África ao Sul do Saara/epidemiologia , Qualidade dos Alimentos , Humanos , Indonésia/epidemiologia , Desnutrição/etiologia , Estado Nutricional , Valor Nutritivo , Obesidade/etiologia , Sobrepeso/etiologia , Pobreza , Prevalência , Fatores Socioeconômicos
6.
Lancet ; 395(10217): 75-88, 2020 01 04.
Artigo em Inglês | MEDLINE | ID: mdl-31852605

RESUMO

Malnutrition has historically been researched and addressed within two distinct silos, focusing either on undernutrition, food insecurity, and micronutrient deficiencies, or on overweight, obesity, and dietary excess. However, through rapid global nutrition transition, an increasing proportion of individuals are exposed to different forms of malnutrition during the life course and have the double burden of malnutrition (DBM) directly. Long-lasting effects of malnutrition in early life can be attributed to interconnected biological pathways, involving imbalance of the gut microbiome, inflammation, metabolic dysregulation, and impaired insulin signalling. Life-course exposure to early undernutrition followed by later overweight increases the risk of non-communicable disease, by imposing a high metabolic load on a depleted capacity for homoeostasis, and in women increases the risk of childbirth complications. These life-course trajectories are shaped both by societal driving factors-ie, rapidly changing diets, norms of eating, and physical activity patterns-and by broader ecological factors such as pathogen burden and extrinsic mortality risk. Mitigation of the DBM will require major societal shifts regarding nutrition and public health, to implement comprehensive change that is sustained over decades, and scaled up into the entire global food system.


Assuntos
Desnutrição/metabolismo , Obesidade/metabolismo , Sobrepeso/metabolismo , África ao Sul do Saara/epidemiologia , Idade de Início , Exercício , Feminino , Microbioma Gastrointestinal , Humanos , Indonésia/epidemiologia , Masculino , Desnutrição/epidemiologia , Desnutrição/microbiologia , Redes e Vias Metabólicas , Estado Nutricional , Obesidade/epidemiologia , Obesidade/microbiologia , Sobrepeso/epidemiologia , Sobrepeso/microbiologia , Prevalência
7.
PLoS Med ; 16(12): e1003003, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31825965

RESUMO

BACKGROUND: Cholera causes an estimated 100,000 deaths annually worldwide, with the majority of burden reported in sub-Saharan Africa. In May 2018, the World Health Assembly committed to reducing worldwide cholera deaths by 90% by 2030. Oral cholera vaccine (OCV) plays a key role in reducing the near-term risk of cholera, although global supplies are limited. Characterizing the potential impact and cost-effectiveness of mass OCV deployment strategies is critical for setting expectations and developing cholera control plans that maximize the chances of success. METHODS AND FINDINGS: We compared the projected impacts of vaccination campaigns across sub-Saharan Africa from 2018 through 2030 when targeting geographically according to historical cholera burden and risk factors. We assessed the number of averted cases, deaths, and disability-adjusted life years and the cost-effectiveness of these campaigns with models that accounted for direct and indirect vaccine effects and population projections over time. Under current vaccine supply projections, an approach optimized to targeting by historical burden is projected to avert 828,971 (95% CI 803,370-859,980) cases (equivalent to 34.0% of projected cases; 95% CI 33.2%-34.8%). An approach that balances logistical feasibility with targeting historical burden is projected to avert 617,424 (95% CI 599,150-643,891) cases. In contrast, approaches optimized for targeting locations with limited access to water and sanitation are projected to avert 273,939 (95% CI 270,319-277,002) and 109,817 (95% CI 103,735-114,110) cases, respectively. We find that the most logistically feasible targeting strategy costs US$1,843 (95% CI 1,328-14,312) per DALY averted during this period and that effective geographic targeting of OCV campaigns can have a greater impact on cost-effectiveness than improvements to vaccine efficacy and moderate increases in coverage. Although our modeling approach does not project annual changes in baseline cholera risk or directly incorporate immunity from natural cholera infection, our estimates of the relative performance of different vaccination strategies should be robust to these factors. CONCLUSIONS: Our study suggests that geographic targeting substantially improves the cost-effectiveness and impact of oral cholera vaccination campaigns. Districts with the poorest access to improved water and sanitation are not the same as districts with the greatest historical cholera incidence. While OCV campaigns can improve cholera control in the near term, without rapid progress in developing water and sanitation services or dramatic increases in OCV supply, our results suggest that vaccine use alone is unlikely to allow us to achieve the 2030 goal.


Assuntos
Cólera/epidemiologia , Vacinação em Massa/economia , Vacinação/economia , Administração Oral , Adulto , África ao Sul do Saara , Cólera/prevenção & controle , Análise Custo-Benefício , Feminino , Humanos , Incidência , Vacinação em Massa/métodos , Fatores de Risco
8.
BMJ ; 367: l6540, 2019 Dec 11.
Artigo em Inglês | MEDLINE | ID: mdl-31826875

RESUMO

OBJECTIVE: To evaluate the impact of the US government's Feed the Future initiative on nutrition outcomes in children younger than 5 years in sub-Saharan Africa. DESIGN: Difference-in-differences quasi-experimental approach. SETTING: Households in 33 low and lower middle income countries in sub-Saharan Africa. POPULATION: 883 309 children aged less than 5 years with weight, height, and age recorded in 118 surveys conducted in 33 countries between 2000 and 2017: 388 052 children were from Feed the Future countries and 495 257 were from non-Feed the Future countries. MAIN OUTCOME MEASURES: A difference-in-differences approach was used to compare outcomes among children in intervention countries after implementation of the initiative with children before its introduction and children in non-intervention countries, controlling for relevant covariates, time invariant national differences, and time trends. The primary outcome was stunting (height for age >2 standard deviations below a reference median), a key indicator of undernutrition in children. Secondary outcomes were wasting (low weight for height) and underweight (low weight for age). RESULTS: Across all years and countries, 38.3% of children in the study sample were stunted, 8.9% showed wasting, and 21.3% were underweight. In the first six years of Feed the Future's implementation, children in 12 countries with the initiative exhibited a 3.9 percentage point (95% confidence interval 2.4 to 5.5) greater decline in stunting, a 1.1 percentage point (0.1 to 2.1) greater decline in wasting, and a 2.8 percentage point (1.6 to 4.0) greater decline in underweight levels compared with children in 21 countries without the initiative and compared with trends in undernutrition before Feed the Future was launched. These decreases translate to around two million fewer stunted and underweight children aged less than 5 years and around a half million fewer children with wasting. For context, about 22 million children were stunted, 11 million children were underweight, and four million children were wasted in the Feed the Future countries at baseline. CONCLUSIONS: Feed the Future's activities were closely linked to notable improvements in stunting and underweight levels and moderate improvements in wasting in children younger than 5 years. These findings highlight the effectiveness of this large, country tailored initiative focused on agriculture and food security and have important implications for the future of this and other nutrition interventions worldwide.


Assuntos
Comportamento Alimentar , Inquéritos Epidemiológicos , Estado Nutricional , Magreza/epidemiologia , África ao Sul do Saara/epidemiologia , Peso Corporal , Transtornos da Nutrição Infantil/epidemiologia , Pré-Escolar , Países em Desenvolvimento , Feminino , Humanos , Incidência , Lactente , Masculino , Magreza/terapia
9.
N Engl J Med ; 381(26): 2519-2528, 2019 12 26.
Artigo em Inglês | MEDLINE | ID: mdl-31881138

RESUMO

BACKGROUND: With the vision of "a world free of schistosomiasis," the World Health Organization (WHO) set ambitious goals of control of this debilitating disease and its elimination as a public health problem by 2020 and 2025, respectively. As these milestones become imminent, and if programs are to succeed, it is important to evaluate the WHO programmatic guidelines empirically. METHODS: We collated and analyzed multiyear cross-sectional data from nine national schistosomiasis control programs (in eight countries in sub-Saharan Africa and in Yemen). Data were analyzed according to schistosome species (Schistosoma mansoni or S. haematobium), number of treatment rounds, overall prevalence, and prevalence of heavy-intensity infection. Disease control was defined as a prevalence of heavy-intensity infection of less than 5% aggregated across sentinel sites, and the elimination target was defined as a prevalence of heavy-intensity infection of less than 1% in all sentinel sites. Heavy-intensity infection was defined as at least 400 eggs per gram of feces for S. mansoni infection or as more than 50 eggs per 10 ml of urine for S. haematobium infection. RESULTS: All but one country program (Niger) reached the disease-control target by two treatment rounds or less, which is earlier than projected by current WHO guidelines (5 to 10 years). Programs in areas with low endemicity levels at baseline were more likely to reach both the control and elimination targets than were programs in areas with moderate and high endemicity levels at baseline, although the elimination target was reached only for S. mansoni infection (in Burkina Faso, Burundi, and Rwanda within three treatment rounds). Intracountry variation was evident in the relationships between overall prevalence and heavy-intensity infection (stratified according to treatment rounds), a finding that highlights the challenges of using one metric to define control or elimination across all epidemiologic settings. CONCLUSIONS: These data suggest the need to reevaluate progress and treatment strategies in national schistosomiasis control programs more frequently, with local epidemiologic data taken into consideration, in order to determine the treatment effect and appropriate resource allocations and move closer to achieving the global goals. (Funded by the Children's Investment Fund Foundation and others.).


Assuntos
Controle de Doenças Transmissíveis , Esquistossomose Urinária/prevenção & controle , Esquistossomose mansoni/prevenção & controle , África ao Sul do Saara/epidemiologia , Animais , Anti-Helmínticos/uso terapêutico , Criança , Estudos Transversais , Doenças Endêmicas/prevenção & controle , Humanos , Objetivos Organizacionais , Prevalência , Schistosoma haematobium/isolamento & purificação , Schistosoma mansoni/isolamento & purificação , Esquistossomose Urinária/tratamento farmacológico , Esquistossomose Urinária/epidemiologia , Esquistossomose mansoni/tratamento farmacológico , Esquistossomose mansoni/epidemiologia , Organização Mundial da Saúde , Iêmen/epidemiologia
10.
Mikrobiyol Bul ; 53(4): 472-479, 2019 Oct.
Artigo em Turco | MEDLINE | ID: mdl-31709945

RESUMO

In spite of the fact that Plasmodium vivax is the leading causative agent of malaria in our country, imported malaria cases have been reported, recently. In this report, two malaria cases originated from sub-Saharan Africa, and their diagnostic and therapeutic approaches were aimed to be presented. First case, 45-year-old male, who has been working in Republic of Ghana, was admitted to Hacettepe University Hospitals Emergency Service with complaints of fever, sweating and shivering, after returning to Turkey. On admission, his general condition was fine and his physical examination revealed no pathological finding. After his admission, a fever episode occured and his blood tests revealed anemia, trombocytopenia and increased alkaline phosphatase level. Second case, 39-year-old-male admitted to the emergency service with the complaints of fever, shivering and myalgia. His physical examination revealed decreased breath sounds and splenomegaly, his laboratory tests resulted in pansitopenia and elevated liver enzymes. In the thick blood smears of the patients ring formed young trophozoites are detected and in the thin films multiple ring forms demonstrated in one erythrocyte with the absence of mature trophozoites and schizont forms, which were compatible with falciparum malaria. The rapid antigen test (Digamed, Belgium) of the second case found to be positive for both Plasmodium falciparum and P.vivax and this patient followed-up in intensive care unit due to his deterioration of general condition, respiratory distress, hematuria and change of consciousness. Neither cases were commenced on malaria prophylaxis. Both patients have been in countries which chloroquine resistance is commonly seen, they were treated with artemether/lumefantrine as current World Health Organization recommended. Targeting hypnozoites of P.vivax, primaquine was added to the therapy of the second patient. Both patients resulted in cure. In conclusion, while travelling to endemic countries, people should be informed about the importance of malaria prophylaxis and prophylaxis should be commenced immediately and continued appropriately. Additionally, malaria should always be considered in the differential diagnosis of high fever for the patients who admitted to the hospital with a travelling history to these countries.


Assuntos
Antimaláricos , Combinação Arteméter e Lumefantrina , Malária , Primaquina , Adulto , África ao Sul do Saara , Antimaláricos/uso terapêutico , Combinação Arteméter e Lumefantrina/uso terapêutico , Doenças Transmissíveis Importadas/diagnóstico , Doenças Transmissíveis Importadas/tratamento farmacológico , Doenças Transmissíveis Importadas/parasitologia , Doenças Transmissíveis Importadas/prevenção & controle , Humanos , Malária/diagnóstico , Malária/tratamento farmacológico , Malária/parasitologia , Malária/prevenção & controle , Masculino , Pessoa de Meia-Idade , Plasmodium falciparum , Plasmodium vivax , Primaquina/uso terapêutico , Viagem , Resultado do Tratamento , Turquia
11.
Pan Afr Med J ; 33: 318, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31692720

RESUMO

Reliable data on the cause of child death is the cornerstone for evidence-informed health policy making towards improving child health outcomes. Unfortunately, accurate data on cause of death is essentially lacking in most countries of sub-Saharan Africa due to the widespread absence of functional Civil Registration and Vital Statistics (CRVS) systems. To address this problem, verbal autopsy (VA) has gained prominence as a strategy for obtaining Cause of Death (COD) information in populations where CRVS are absent. This study reviewed publications that investigated the validation of VA methods for assessment of COD. A MEDLINE PubMed search was undertaken in June 2018 for studies published in English that investigated the validation of VA methods in sub-Saharan Africa from 1990-2018. Of the 17 studies identified, 9 fulfilled the study inclusion criteria from which additional five relevant studies were found by reviewing their references. The result showed that Physician-Certified Verbal Autopsy (PCVA) was the most widely used VA method. Validation studies comparing PCVA to hospital records, expert algorithm and InterVA demonstrated mixed and highly varied outcomes. The accuracy and reliability of the VA methods depended on level of healthcare the respondents have access to and the knowledge of the physicians on the local disease aetiology and epidemiology. As the countries in sub-Saharan Africa continue to battle with dysfunctional CRVS system, VA will remain the only viable option for the supply of child mortality data necessary for policy making.


Assuntos
Autopsia/métodos , Mortalidade da Criança , Política de Saúde , África ao Sul do Saara , Causas de Morte , Criança , Humanos , Formulação de Políticas , Reprodutibilidade dos Testes
12.
Pan Afr Med J ; 33: 207, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31692722

RESUMO

Introduction: Soft tissue sarcomas (STS) consist of over 70 histologic subtypes and constitute only 1% of adult malignancies. The fulcrum of management is surgical resection with neoadjuvant or adjuvant treatment-chemoradiation. Methods: The study is a retrospective review of consecutive STS patients who had surgery at the University College Hospital, Ibadan, between October 2007-2017. Data extraction was from the admission and operative registers, theatre records and histology reports. Statistical analysis was done using the Statistical Package for Social Sciences (SPSS) version 20 (Chicago IL USA). Results were summarized as charts and graphs. Results: Five hundred and ninety six cases of STS were seen over the ten-year period. Of these, 383 (64.3%) patients had surgery and the case files of 326 (85.1%) of these patients was available for review. The duration of soft tissue swelling, ranged from 1-96 months. A third of the tumors were superficial while 68% were deep-seated. Oncoplastic reconstruction was done in 42(13%) patients. The resection margin was negative in 88%. A total of 202 patients were followed up regularly for between 24-36 months only. Conclusion: Patients who benefitted from definitive surgical treatment for STS were found to be the young and middle age group. These patients had extended duration of symptoms with lesions > 5cm in size. Truncal and visceral STS had the worst prognosis. A Multi-Disciplinary Tumor (MDT) board for STS and a robust follow up would enhance the management of STS in a low resource setting.


Assuntos
Sarcoma/cirurgia , Adolescente , Adulto , África ao Sul do Saara , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Estudos de Coortes , Feminino , Seguimentos , Humanos , Masculino , Margens de Excisão , Pessoa de Meia-Idade , Estudos Retrospectivos , Sarcoma/patologia , Fatores de Tempo , Adulto Jovem
13.
Pan Afr Med J ; 33: 271, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31692809

RESUMO

In their article, Choukem et al. report of assessments of the analytical quality of blood glucose monitoring systems. Although there are some commendable aspects regarding the methodology, some major shortcomings could preclude the conclusions drawn by Choukem et al. Nevertheless, independent assessments of the performance of blood glucose monitoring systems are an important issue.


Assuntos
Automonitorização da Glicemia , Glicemia , África ao Sul do Saara , Estudos Transversais , Sistemas Automatizados de Assistência Junto ao Leito
14.
J Glob Health ; 9(2): 020422, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31673338

RESUMO

Background: Half of all under-5 deaths occur in sub-Saharan Africa. Reducing child mortality requires understanding of the modifiable factors that contribute to death. Social autopsies collect information about place of death, care-seeking and care-provision, but this has not been pooled to learn wider lessons. We therefore undertook a systematic review to collect, evaluate, map, and pool all the available evidence for sub-Saharan Africa. Methods: We searched PubMed, Embase, Global Health, the Cochrane Library and grey literature for studies relating to under-5 deaths in sub-Saharan Africa with information on place of death and/or care-seeking during a child's final illness. We assessed study quality with a modified Axis tool. We pooled proportions using random effects meta-analysis for place of death and for each stage of the Pathways to Survival framework. Pre-specified subgroup analysis included age group, national income and user-fee policy. We explored heterogeneity with meta-regression. Our protocol was published prospectively (CRD42018111484). Results: We included 34 studies from 17 countries. Approximately half of the children died at home, irrespective of age. More children died at home in settings with user-fees (69.1%, 95% confidence interval (CI) = 56.2-80.6, I2 = 98.4%) compared to settings without user-fees (43.8%, 95% CI = 34.3-53.5, I2 = 96.7%). Signs of illness were present in over 95% of children but care-seeking differed by age. 40.1% of neonates (95% CI = 20.7-61.3, I2 = 98.0%) died without receiving any care, compared to 6.4% of older children (95% CI = 4.2%-9.0%, I2 = 90.6%). Care-seeking outside the home was less common in neonatal deaths (50.5%, 95% CI = 35.6-65.3, I2 = 98.3%) compared to infants and young children (82.4%, 95% CI = 79.4%-85.2%, I2 = 87.5%). In both age groups, most children were taken for formal care. Healthcare facilities discharged 69.6% of infants and young children who arrived alive (95% CI = 59.6-78.7, I2 = 95.5%), of whom only 34.9% were referred for further care (95% CI = 15.1-57.9, I2 = 98.7%). Conclusions: Despite similar distributions in place of death for neonates and infants and young children, care-seeking behaviour differed by age groups. Poor illness recognition is implicated in neonatal deaths, but death despite care-seeking implies inadequate quality care and referral for older children. Understanding such care-seeking patterns enables targeted interventions to reduce under-5 mortality across the region.


Assuntos
Morte , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Assistência Terminal/estatística & dados numéricos , África ao Sul do Saara/epidemiologia , Mortalidade da Criança , Pré-Escolar , Humanos , Lactente , Mortalidade Infantil , Recém-Nascido
15.
Praxis (Bern 1994) ; 108(15): 997-1005, 2019 11.
Artigo em Inglês, Alemão | MEDLINE | ID: mdl-31771492

RESUMO

In sub-Saharan Africa, the burden of non-communicable diseases (NCDs) remains under appreciated, but emerging evidence suggests it to be substantial. NCDs such as arterial hypertension, heart diseases, diabetes mellitus and chronic kidney diseases are especially relevant, and put additional strain on the already challenged health systems in this region. Moreover, NCDs appear to be associated with higher mortality and morbidity rates and are more common in younger population groups, in people from sub-Saharan Africa when compared to more developed countries. In this review, we summarize the current literature on the burden of NCDs in sub-Saharan Africa, and highlight the clinical implications of the most relevant etiologies, i.e. arterial hypertension, heart diseases, diabetes mellitus and chronic kidney diseases.


Assuntos
Diabetes Mellitus , Hipertensão , Doenças não Transmissíveis , África ao Sul do Saara , Humanos
16.
Praxis (Bern 1994) ; 108(15): 971-976, 2019 Nov.
Artigo em Alemão | MEDLINE | ID: mdl-31771494

RESUMO

HIV in Sub-Saharan Africa: Where Are We Today? Abstract. In sub-Saharan Africa the HIV epidemic has changed remarkedly due to expanded testing and easier access to antiretroviral medication. The rate of new infections has decreased substantially since 2005, the life expectancy of people living with HIV has increased and the mortality rate has declined. Yet still a lot needs to be achieved to stop the ongoing epidemic. Women are still at a higher risk to get infected and stigma and discrimination are a hindrance to further reduce the incidence. Challenges like the lack of technical capacities, especially to perform viral load and resistance testing, refusal of testing or condom use and increasing drug resistance to first-line therapies jeopardize the goal of 90-90-90: 90 % of people tested, 90 % of positives under care and 90 % of treated persons virologically controlled. New testing strategies and medication with higher efficacies which, when taken regularly, stop the transmission completely, provide hope in the fight against HIV.


Assuntos
Fármacos Anti-HIV , Infecções por HIV , África ao Sul do Saara , Feminino , Humanos , Incidência , Estigma Social
17.
Afr J AIDS Res ; 18(4): 277-288, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31779568

RESUMO

The past decade has seen a growing emphasis on the production of high-quality costing data to improve the efficiency and cost-effectiveness of global health interventions. The need for such data is especially important for decision making and priority setting across HIV services from prevention and testing to treatment and care. To help address this critical need, the Global Health Cost Consortium was created in 2016, in part to conduct a systematic search and screening of the costing literature for HIV and TB interventions in low- and middle-income countries (LMIC). The purpose of this portion of the remit was to compile, standardise, and make publicly available published cost data (peer-reviewed and gray) for public use. We limit our analysis to a review of the quantity and characteristics of published cost data from HIV interventions in sub-Saharan Africa. First, we document the production of cost data over 25 years, including density over time, geography, publication venue, authorship and type of intervention. Second, we explore key methods and reporting for characteristics including urbanicity, platform type, ownership and scale. Although the volume of HIV costing data has increased substantially on the continent, cost reporting is lacking across several dimensions. We find a dearth of cost estimates from HIV interventions in west Africa, as well as inconsistent reporting of key dimensions of cost including platform type, ownership and urbanicity. Further, we find clear evidence of a need for renewed focus on the consistent reporting of scale by authors of costing and cost-effectiveness analyses.


Assuntos
Infecções por HIV/economia , Custos de Cuidados de Saúde/estatística & dados numéricos , África ao Sul do Saara , Análise Custo-Benefício , Saúde Global/economia , Infecções por HIV/diagnóstico , Infecções por HIV/prevenção & controle , Infecções por HIV/terapia , Serviços de Saúde/economia , Humanos , Tuberculose/diagnóstico , Tuberculose/economia , Tuberculose/prevenção & controle , Tuberculose/terapia
18.
Afr J AIDS Res ; 18(4): 324-331, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31779570

RESUMO

More than 14.5 of the 36.7 million people living with HIV globally do not know their HIV status, making comprehensive testing interventions a critical step in ending the HIV/AIDS epidemic. Home-based testing and counselling (HBTC) involves small teams of community health workers with basic training going from door-to-door and offering services in people's homes. HBTC is effective in reaching individuals that are unlikely to test otherwise, but there is conflicting evidence on its costs and little insight into why estimates are different. We undertook a comparative review of existing costing studies of HBTC in sub-Saharan Africa. Yield or positivity rate, the number of persons tested positive among all tested, is an important metric to judge the efficacy of a testing campaign. We conducted descriptive analyses to test whether unit costs are associated with yield. Studies varied in size with a maximum of 264 953 and a minimum of 494 persons tested. The average "cost per person tested" across 14 studies was $22.8 (SD $14.5) with a minimum of $6 and a maximum of $55.4, and the average "cost per person tested HIV-positive' across 12 studies was $439.4 (SD $399.7) with a minimum of $66.2 and a maximum of $800.9. Correlations between unit cost estimates and yield were not statistically significant. Existant estimates of the costs of HBTC are conflicting, and it is likely that differences in the setting, design and implementation of the studies are responsible for the discrepancies. This makes it difficult to reliably estimate the costs and cost-effectiveness of HBTC.


Assuntos
Aconselhamento/economia , Infecções por HIV/diagnóstico , Serviços de Assistência Domiciliar/economia , Programas de Rastreamento/economia , África ao Sul do Saara/epidemiologia , Análise Custo-Benefício , Aconselhamento/estatística & dados numéricos , Feminino , Infecções por HIV/epidemiologia , Infecções por HIV/prevenção & controle , Custos de Cuidados de Saúde , Serviços de Assistência Domiciliar/estatística & dados numéricos , Humanos , Programas de Rastreamento/estatística & dados numéricos
19.
J Helminthol ; 94: e96, 2019 Nov 04.
Artigo em Inglês | MEDLINE | ID: mdl-31679534

RESUMO

Toxocariasis is an emerging zoonotic disease caused by Toxocara canis and T. cati. Toxocariasis and its etiological agents are of global public health importance, whose burden appears underestimated, especially in sub-Saharan Africa (SSA). The diversity in the transmission routes of these parasites contributes to disease prevalence and often hinders disease control measures. This study aimed to review the epidemiological distribution of Toxocara infections in SSA region. A systematic review and meta-analysis were performed using PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analysis). We identified 94 relevant, peer-reviewed articles, out of which, 75 articles were found eligible based on Toxocara infections in dogs, cats and humans. Overall, 27,102 samples were examined for T. canis in dogs, T. cati in cats and Toxocara serology in humans, out of which 6142 were positive for Toxocara infection: 3717 (13.7%) in dogs (faecal, 3487; necropsy, 180; hair, 50); 266 (1%) in cats (faecal, 101; necropsy, 165); and 2159 (8%) in humans (serology). Overall mean prevalences of 19% (95% confidence interval (CI): 14-23%), 9% (95% CI: 0-28%) and 36% (95% CI: 24-49%) were recorded in dogs, cats and humans, respectively. Substantial heterogeneity was observed between studies and subgroups (I2 = 99%, P < 0.01). Findings from the review showed that studies on the epidemiology of Toxocara infections in the SSA region are limited. We strongly recommend focused, collaborative and coordinated studies to determine Toxocara spp. prevalence in various hosts, including food animals and the environment, through a 'One Health' approach across SSA countries.


Assuntos
Doenças do Gato/parasitologia , Doenças do Cão/parasitologia , Toxocaríase/parasitologia , África ao Sul do Saara/epidemiologia , Animais , Doenças do Gato/epidemiologia , Doenças do Gato/transmissão , Gatos , Doenças do Cão/epidemiologia , Doenças do Cão/transmissão , Cães , Fezes/parasitologia , Humanos , Toxocara/classificação , Toxocara/genética , Toxocara/isolamento & purificação , Toxocara/fisiologia , Toxocaríase/epidemiologia , Toxocaríase/transmissão , Zoonoses/parasitologia
20.
BMC Public Health ; 19(1): 1541, 2019 Nov 21.
Artigo em Inglês | MEDLINE | ID: mdl-31752773

RESUMO

BACKGROUND: The paper argues that unlike the income literature, the public health literature has not paid much attention to the distribution of substantial improvements in health outcomes over the last decade or more, especially, in the Sub-Saharan African (SSA) context. Thus, the paper examines current levels of utilisation, changes in utilisation as well as inequality in utilisation of reproductive health services over the last 10 years in SSA. METHODS: The paper uses two rounds of Demographic and Health Survey (DHS) data from 30 SSA countries (latest round) and 21 countries (earlier round) to compute simple frequencies, cross-tabulated frequencies and concentration indices for health facility deliveries, skilled delivery assistance, 4+ antenatal visits and use of modern contraceptives. RESULTS: The results confirm the fact that utilisation of the selected reproductive health services have improved substantially over the last 10 year in several SSA countries. However, current levels of inequality in the use of reproductive health services are high in many countries. Interestingly, Guinea's pro-poor inequality in health facility delivery and skilled attendance at birth changed to pro-rich inequality, with the reverse being true in the case of use of modern contraceptives for Ghana, Malawi and Rawanda. The good news however is that in a lot of countries, the use of reproductive health services has increased while inequality has decreased within the period under study. CONCLUSION: The paper argue that whiles income levels may play a key role in explaining the differences in utilisation and the levels of inequality, indepth studies may be needed to explain the reason for differential improvements and stagnation or deterioration in different countries. In this way, best practices from better performing countries can be documented and adapted by poor performing countries to improve their situation.


Assuntos
Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Serviços de Saúde Reprodutiva/estatística & dados numéricos , Adolescente , Adulto , África ao Sul do Saara , Feminino , Humanos , Pessoa de Meia-Idade , Gravidez , Fatores Socioeconômicos , Adulto Jovem
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