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2.
Sci Total Environ ; 804: 150170, 2022 Jan 15.
Artigo em Inglês | MEDLINE | ID: mdl-34517317

RESUMO

Microplastic pollution is a ubiquitous and emerging environmental and public health concern in Africa due to increased plastic production, product and waste importation, and usage. While studies on the environmental monitoring and characterization of microplastics demonstrated the urgent need for a drastic reduction in plastic waste generation, the effectiveness of the various regulatory and policy interventions implemented or proposed in Africa countries remains poorly understood. We critically examined policies, legislations, and regulations enacted to control microplastic pollution in Africa to develop a sustainable, harmonized framework for the coordinated reduction of plastic waste generation across Africa. Analysis of the interventions revealed most African countries employed traditional perspective (i.e., command-and-control) approaches, whereby state instruments such as plastic ban, production and importation levies, and consumer taxes were enacted. However, the continued increase in microplastic waste generation suggests traditional perspective approaches might not be effective in Africa. Although rarely used in Africa, market-oriented approaches such as private-public waste management are often effective in controlling plastic pollution. Hence, we proposed a bottom-up hybrid regulatory approach for managing microplastics pollution in Africa, involving price-based, right-base, legislation and behavioral frameworks based on best practices in microplastic waste management.


Assuntos
Microplásticos , Poluentes Químicos da Água , África , Ecossistema , Monitoramento Ambiental , Plásticos , Políticas , Poluentes Químicos da Água/análise
3.
Sci Total Environ ; 804: 150089, 2022 Jan 15.
Artigo em Inglês | MEDLINE | ID: mdl-34798723

RESUMO

Climate change has occasioned several Earth long-term events, including extreme temperatures. In recent years, Africa was reported as part of the world's regions that experienced extreme temperatures above pre-industrial levels. Despite lower contribution to Green House Gas (GHG) emissions and global warming, Africa remains among the world regions that suffer the most from climate change. However, the impact of climatic factors of temperature and emissions on economic production in Africa has not been broadly investigated, specifically among climate regimes. In this study, we attempt for the first time to understand the heterogeneous impacts of emissions and temperature on income in Africa using panel and time-series techniques on datasets spanning the years 1995-2016. At the global level in Africa, our empirical results reveal that a 1% increase in average temperature reduces income by 1.08%, whereas a 1% rise in CO2 emissions spurs income by 0.23%. The emissions effect result implies that environmental policies specifically designed to reduce CO2 emissions in Africa as a whole may significantly impact production in the long run. Also, the result suggests that a shift from optimal temperature levels to extreme patterns deter economic growth. Despite these revelations, our extended analysis based on climate regimes indicates heterogeneous effects across countries. Considering the Paris agreement on climate, this study suggests that policymakers should emphasise country-specific policies than global climatic policies for sustained CO2 emissions reduction in Africa.


Assuntos
Dióxido de Carbono , Desenvolvimento Econômico , África , Dióxido de Carbono/análise , Mudança Climática , Aquecimento Global
4.
Ann Glob Health ; 87(1): 106, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34786354

RESUMO

COVID-19 poses a particular threat to refugees in Africa. Overcrowded living conditions and lack of effective sanitation make refugees highly vulnerable to infection. Furthermore, migration has the potential to undermine measures to control viral spread. As a result, vaccination of the refugee community in Africa must be considered key in the vaccination plan to end the worldwide COVID-19 pandemic. Although the WHO has approved vaccines for emergency use worldwide in vulnerable groups through the COVID-19 Vaccines Global Access (COVAX) program, there is a lack of a strategy for achieving vaccination in the African refugee population. A specific strategy for refugee vaccination must be among the top priorities at national, regional, and global levels to ensure all refugees and asylum seekers in African countries have equitable and quality vaccine assistance regardless of displacement, statelessness, and financial hardship. We call on leaders in Africa and worldwide to ensure that refugee vaccination is a priority to protect this highly at-risk population and achieve an end to the current pandemic.


Assuntos
COVID-19 , Equidade em Saúde , Refugiados , África/epidemiologia , Vacinas contra COVID-19 , Humanos , Pandemias , SARS-CoV-2 , Justiça Social
6.
Front Public Health ; 9: 751197, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34746085

RESUMO

Background: More than 1 year after the beginning of the international spread of coronavirus 2019 (COVID-19), the reasons explaining its apparently lower reported burden in Africa are still to be fully elucidated. Few studies previously investigated the potential reasons explaining this epidemiological observation using data at the level of a few African countries. However, an updated analysis considering the various epidemiological waves and variables across an array of categories, with a focus on African countries might help to better understand the COVID-19 pandemic on the continent. Thus, we investigated the potential reasons for the persistently lower transmission and mortality rates of COVID-19 in Africa. Methods: Data were collected from publicly available and well-known online sources. The cumulative numbers of COVID-19 cases and deaths per 1 million population reported by the African countries up to February 2021 were used to estimate the transmission and mortality rates of COVID-19, respectively. The covariates were collected across several data sources: clinical/diseases data, health system performance, demographic parameters, economic indicators, climatic, pollution, and radiation variables, and use of social media. The collinearities were corrected using variance inflation factor (VIF) and selected variables were fitted to a multiple regression model using the R statistical package. Results: Our model (adjusted R-squared: 0.7) found that the number of COVID-19 tests per 1 million population, GINI index, global health security (GHS) index, and mean body mass index (BMI) were significantly associated (P < 0.05) with COVID-19 cases per 1 million population. No association was found between the median life expectancy, the proportion of the rural population, and Bacillus Calmette-Guérin (BCG) coverage rate. On the other hand, diabetes prevalence, number of nurses, and GHS index were found to be significantly associated with COVID-19 deaths per 1 million population (adjusted R-squared of 0.5). Moreover, the median life expectancy and lower respiratory infections rate showed a trend towards significance. No association was found with the BCG coverage or communicable disease burden. Conclusions: Low health system capacity, together with some clinical and socio-economic factors were the predictors of the reported burden of COVID-19 in Africa. Our results emphasize the need for Africa to strengthen its overall health system capacity to efficiently detect and respond to public health crises.


Assuntos
COVID-19 , Pandemias , África/epidemiologia , Humanos , Expectativa de Vida , SARS-CoV-2
7.
Artigo em Inglês | MEDLINE | ID: mdl-34769820

RESUMO

Indigenous populations around the world face disproportionately high rates of disease related to the environment and animals. One Health is a concept that has been used effectively to understand and address these health risks. One Health refers to the relationships and interdependencies between animal, human, and environmental health and is an emerging research field that aligns with indigenous views of health. To understand the applicability of One Health in indigenous communities, a critical review was undertaken to investigate evidence of One Health research in indigenous communities internationally, assess the strength of evidence, and understand what gaps are present. This review included the appraisal of twenty-four studies based in five regions: Canada, Africa, Australia, South America, and Central America. The review found that there is a need for studies of high strength, with rigorous methods, local leadership, and active involvement of indigenous viewpoints, to be undertaken in indigenous communities internationally that focus on One Health. It highlights the need to further consider indigenous viewpoints in research to reduce limitations, increase effectiveness of findings, consider appropriateness of recommendations, and benefit communities.


Assuntos
Serviços de Saúde do Indígena , Saúde Única , África , Austrália , Canadá , Humanos , Grupos Populacionais
8.
Artigo em Inglês | MEDLINE | ID: mdl-34770236

RESUMO

Little is known about social determinants among refugees resettled in Germany. This study aims to examine the impact of family separation on refugees' subjective time pressure and mental health. Data come from the FlueGe Health Study (n = 208), a cross-sectional study administered by Bielefeld University. We used logistic regression analysis to investigate the effect of family separation on (i) being time-stressed and (ii) having a high risk for adverse mental health, considering sociodemographic and postmigration factors. As a result, more than 30% of participants with a spouse or partner and about 18% with a child or children reported separation. Multiple logistic regression showed that family separation was not associated with being time-stressed, but separation from at least one child was associated with adverse mental health (OR = 3.53, 95% CI = [1.23, 10.11]). In conclusion, family separation primarily contributes to adverse mental health among refugees from the Middle East and Africa resettled in North Rhine-Westphalia, Germany. Therefore, policies and practices that facilitate family reunification can contribute significantly to the promotion of refugees' mental health and well-being.


Assuntos
Separação da Família , Refugiados , Transtornos de Estresse Pós-Traumáticos , África , Criança , Estudos Transversais , Alemanha , Humanos , Saúde Mental , Oriente Médio
10.
Pan Afr Med J ; 39: 279, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34754356

RESUMO

Introduction: cross-border mobility of persons with Tuberculosis (TB) is a global public health concern. We aimed at documenting health systems´ potential bottlenecks and opportunities in pulmonary TB continuum of care in cross-border expanses of East and Horn of Africa. Methods: a cross-sectional program assessment with descriptive analysis of TB services, health staff capacities, diagnostic capacities, data management and reporting, and treatment outcomes. Data were extracted from health facility TB registers and semi-structured key informant interviews conducted in selected 26 cross-border sites within the 7 member states of the Intergovernmental Authority on Development (IGAD) region. Results: the overall cross-border TB cure rate in the year preceding the study (37%) was way beneath the global target with considerable variations amongst the study countries. The restricted support to the cross-border health facilities was mediated and even exacerbated by expansive distances from the respective capital cities. Restricted geographical access to the facilities by cross-border populations was a longstanding challenge. Substantial staffing gaps, TB service delivery capacity needs and inadequate diagnostics were noticeable. The TB control guidelines were not harmonized between the countries and the inter-country referral systems were either absent or inappreciable, contributing to ineffective cross-border referrals and transfers. The frail linkages between stakeholders were contemptible, but increasing governments´ commitments in tackling infectious diseases were encouraging. Conclusion: cross-border TB interventions should drive regional TB policies, strategies and programs that sustain countries´ coordination, harmonization of management guidelines, advocacy for increased human resources support, enhanced capacity building of cross-border TB staff, adequate diagnostics equipping of the cross-border health facilities and seamless transfer and referral of patients traversing boundaries.


Assuntos
Atenção à Saúde/organização & administração , Emigração e Imigração , Saúde Pública , Tuberculose/terapia , África , Fortalecimento Institucional , Continuidade da Assistência ao Paciente/organização & administração , Estudos Transversais , Guias como Assunto , Política de Saúde , Humanos , Internacionalidade , Tuberculose/diagnóstico , Tuberculose/prevenção & controle
13.
Artigo em Inglês | MEDLINE | ID: mdl-34682528

RESUMO

The ongoing highly contagious coronavirus disease 2019 (COVID-19) pandemic, which started in Wuhan, China, in December 2019, has now become a global public health problem. Using publicly available data from the COVID-19 data repository of Our World in Data, we aimed to investigate the influences of spatial socio-economic vulnerabilities and neighbourliness on the COVID-19 burden in African countries. We analyzed the first wave (January-September 2020) and second wave (October 2020 to May 2021) of the COVID-19 pandemic using spatial statistics regression models. As of 31 May 2021, there was a total of 4,748,948 confirmed COVID-19 cases, with an average, median, and range per country of 101,041, 26,963, and 2191 to 1,665,617, respectively. We found that COVID-19 prevalence in an Africa country was highly dependent on those of neighbouring Africa countries as well as its economic wealth, transparency, and proportion of the population aged 65 or older (p-value < 0.05). Our finding regarding the high COVID-19 burden in countries with better transparency and higher economic wealth is surprising and counterintuitive. We believe this is a reflection on the differences in COVID-19 testing capacity, which is mostly higher in more developed countries, or data modification by less transparent governments. Country-wide integrated COVID suppression strategies such as limiting human mobility from more urbanized to less urbanized countries, as well as an understanding of a county's social-economic characteristics, could prepare a country to promptly and effectively respond to future outbreaks of highly contagious viral infections such as COVID-19.


Assuntos
COVID-19 , Pandemias , África/epidemiologia , Teste para COVID-19 , Humanos , SARS-CoV-2 , Fatores Socioeconômicos , Análise Espacial
14.
JCO Glob Oncol ; 7: 1480-1489, 2021 09.
Artigo em Inglês | MEDLINE | ID: mdl-34648387

RESUMO

PURPOSE: Chemotherapies are considered high-risk drugs for patient and staff safety. Considering the rising burden of cancer and the increasing use of chemotherapy drugs in low- and middle-income countries (LMICs), promoting continuous improvements in the safety and quality of practices in these settings is essential. This paper describes the development and proof of concept of a toolkit to audit chemotherapy handling practices in the health care facilities of LMICs. METHODS: A steering committee defined the audit method and the toolkit content. Several checklists were developed to facilitate the audit and data collection. Items included in checklists were derived from key reference works on safe handling. Different tools were validated using Delphi surveys and expert reviews. Audits of pilot sites were performed to test the toolkit's applicability and relevance. RESULTS: The toolkit contains a 134-item global assessment tool for the different processes at each step of the medication pathway and three step-specific observation checklists to assess different health workers' practices during the prescription, preparation, and administration of chemotherapies. The toolkit also proposes using a surface-wipe sampling method to measure any cytotoxic contamination of the immediate environment. The toolkit was tested in three teaching hospitals in Africa. CONCLUSION: The toolkit developed was successfully implemented in a variety of LMIC settings, providing a comprehensive evaluation of the quality and safety of the chemotherapy drug handling practices in participating health care facilities. This toolkit can help facilities in LMICs to implement a new approach to continuously improving the quality and safety of their practices and ultimately ensure patient and staff safety.


Assuntos
Antineoplásicos , Preparações Farmacêuticas , África , Países em Desenvolvimento , Pessoal de Saúde , Humanos
16.
Front Public Health ; 9: 736532, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34650952

RESUMO

Multiple public health emergencies (PHEs) experienced annually in the World Health Organisation (WHO) Africa region affect the provision of health services, including immunization. However, there is limited information on the performance of national immunization programs (NIPs) in WHO Africa countries that experience PHEs. This study assessed PHEs (armed conflicts, disasters, and disease outbreaks) and the performance of NIPs using global and regional immunization targets outlined for the Decade of Vaccines. Thirteen beneficiary countries of PHE mitigation funds from the African Public Health Emergency Fund were used as case studies. Data on PHEs and immunization indicators between 2010 and 2019 in selected countries were extracted from different PHE databases and the WHO/UNICEF immunization database, respectively. The data were stratified by country and summarized using descriptive statistics. Mann-Whitney U test was done to determine the association between the frequency of PHEs and the performance of NIPs. There were 175 disease outbreaks, 288 armed conflicts, and 318 disasters in the examined countries between 2010 and 2019. The Democratic Republic of Congo had the highest total PHE count (n = 208), while Liberia had the lowest (n = 20). Only three of the 13 countries had a median coverage value for the third dose of the combined Diphtheria, Tetanus, and Pertussis vaccine (DTP3) that had attained the target for ≥90% immunization coverage. Higher counts of armed conflict and total PHEs were associated with not meeting immunization targets for national DTP3 coverage of ≥90% and Maternal and Neonatal Tetanus elimination, p < 0.01. It was clear that in the WHO Africa region, PHEs are prevalent, irrespective of a country's level of immunization maturity, and have the potential to derail the progress of NIPs in the absence of effective interventions. As we transition toward the Immunization Agenda 2030, we recommend that the WHO Africa region prioritizes interventions to mitigate the impacts of PHEs on NIPs.


Assuntos
Vacina contra Difteria, Tétano e Coqueluche , Saúde Pública , África/epidemiologia , Emergências , Saúde Global , Humanos , Programas de Imunização , Organização Mundial da Saúde
17.
Nat Commun ; 12(1): 5929, 2021 10 12.
Artigo em Inglês | MEDLINE | ID: mdl-34642339

RESUMO

Arab populations are largely understudied, notably their genetic structure and history. Here we present an in-depth analysis of 6,218 whole genomes from Qatar, revealing extensive diversity as well as genetic ancestries representing the main founding Arab genealogical lineages of Qahtanite (Peninsular Arabs) and Adnanite (General Arabs and West Eurasian Arabs). We find that Peninsular Arabs are the closest relatives of ancient hunter-gatherers and Neolithic farmers from the Levant, and that founder Arab populations experienced multiple splitting events 12-20 kya, consistent with the aridification of Arabia and farming in the Levant, giving rise to settler and nomadic communities. In terms of recent genetic flow, we show that these ancestries contributed significantly to European, South Asian as well as South American populations, likely as a result of Islamic expansion over the past 1400 years. Notably, we characterize a large cohort of men with the ChrY J1a2b haplogroup (n = 1,491), identifying 29 unique sub-haplogroups. Finally, we leverage genotype novelty to build a reference panel of 12,432 haplotypes, demonstrating improved genotype imputation for both rare and common alleles in Arabs and the wider Middle East.


Assuntos
Cromossomos Humanos Y , Genoma Humano , Haplótipos , Migração Humana/história , Filogenia , África , Alelos , Árabes/genética , Ásia , DNA Mitocondrial/genética , Conjuntos de Dados como Assunto , Europa (Continente) , Feminino , Fluxo Gênico , Frequência do Gene , História do Século XXI , História Antiga , História Medieval , Humanos , Masculino , Filogeografia , Catar , Análise de Sequência de DNA , Sequenciamento Completo do Genoma
18.
BMJ Case Rep ; 14(10)2021 Oct 28.
Artigo em Inglês | MEDLINE | ID: mdl-34711620

RESUMO

Adult-onset Still's disease (AOSD) is characterised by a constellation of systemic inflammatory symptoms and typical laboratory findings like hyperferritinaemia. A high index of suspicion is needed to identify patients as diagnosis is primarily clinical and significant morbidity can result from delayed diagnosis. While AOSD may be self-limited, some patients experience flares over years and require more aggressive treatment approaches. Aetiology is unknown but can be triggered by viral infections and other environmental factors in a susceptible genetic host. We present a case of AOSD triggered after exposure to a sap-like liquid while working in Africa. This inciting event occurred as part of a hostile act towards the patient and involved medicinal practices traditional to the area. Our case highlights the more chronic course of AOSD, which requires escalating biological treatment to avoid long-term corticosteroids, as well as the juncture between traditional and modern medical practices.


Assuntos
Doença de Still de Início Tardio , Corticosteroides/uso terapêutico , Adulto , África , Exposição Ambiental/efeitos adversos , Humanos , Doença de Still de Início Tardio/diagnóstico , Doença de Still de Início Tardio/tratamento farmacológico
19.
PLoS One ; 16(10): e0258352, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34665831

RESUMO

BACKGROUND: A systematic review of randomised trials may be conclusive signalling no further research is needed; or identify gaps requiring further research that may then be included in review updates. In qualitative evidence synthesis (QES), the rationale, triggers, and methods for updating are less clear cut. We updated a QES on adherence to anti-retroviral treatment to examine if thematic saturation renders additional research redundant. METHODS: We adopted the original review search strategy and eligibility criteria to identify studies in the subsequent three years. We assessed studies for conceptual detail, categorised as 'rich' or 'sparse', coding the rich studies. We sought new codes, and appraised whether findings confirmed, extended, enriched, or refuted existing themes. Finally, we examined if the analysis impacted on the original conceptual model. RESULTS: After screening 3895 articles, 301 studies met the inclusion criteria. Rich findings from Africa were available in 82 studies; 146 studies were sparse, contained no additional information on specific populations, and did not contribute to the analysis. New studies enriched our understanding on the relationship between external and internal factors influencing adherence, confirming, extending and enriching the existing themes. Despite careful evaluation of the new literature, we did not identify any new themes, and found no studies that refuted our theory. CONCLUSIONS: Updating an existing QES using the original question confirmed and sometimes enriched evidence within themes but made little or no substantive difference to the theory and overall findings of the original review. We propose this illustrates thematic saturation. We propose a thoughtful approach before embarking on a QES update, and our work underlines the importance of QES priority areas where further primary research may help, and areas where further studies may be redundant.


Assuntos
Infecções por HIV/epidemiologia , Cooperação do Paciente , Pesquisa Qualitativa , África/epidemiologia , Terapia Antirretroviral de Alta Atividade , Infecções por HIV/tratamento farmacológico , Humanos , Autoeficácia , Responsabilidade Social , Apoio Social
20.
Pan Afr Med J ; 39: 192, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34603573

RESUMO

Introduction: following the declaration of the COVID-19 pandemic, many countries imposed restrictions on public gatherings, health workers were repurposed for COVID-19 response, and public demand for preventive health services declined due to fear of getting COVID-19 in health care settings. These factors led to the disruption in health service delivery, including childhood immunization, in the first months of the pandemic. Measles surveillance supported with laboratory confirmation, is implemented in the African Region as part of the strategies towards attaining measles elimination. World Health Organisation developed guidelines to assist countries to continue to safely provide essential health services including immunization and the surveillance of vaccine preventable diseases during the pandemic. Methods: we analysed the measles case-based surveillance and laboratory databases for the years 2014 to 2020, to determine the impact of the COVID-19 pandemic on measles surveillance, comparing the performance in 2020 against the preceding years. Results: the weekly reporting of suspected measles cases declined starting in April 2020. Twelve countries had more than 50% decline in both the number of reported cases as well as in the number of specimens collected in 2020, as compared to the mean for the years 2014-2018. In 2020, only 30% of the specimens from suspected measles cases arrived at the national laboratory within 3 days of collection. At Regional level, 86% of the districts reported suspected measles cases in 2020, while the non-measles febrile rash illness rate was 2.1 per 100,000 population, which was the lowest rate documented since 2014. Only 11 countries met the targets for the two principal surveillance performance indicators in 2020 as compared to an average of 21 countries in the years 2014-2019. Conclusion: the overall quality of measles surveillance has declined during the COVID pandemic in many countries. Countries should implement immediate and proactive measures to revitalise active surveillance for measles and monitor the quality of surveillance. We recommend that countries consider implementing specimen collection and testing methods that can facilitate timely confirmation of suspected measles cases in remote communities and areas with transportation challenges.


Assuntos
COVID-19 , Sarampo/epidemiologia , Vigilância da População/métodos , África/epidemiologia , Humanos , Programas de Imunização , Sarampo/prevenção & controle , Vacina contra Sarampo/administração & dosagem , Vacinação , Organização Mundial da Saúde
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