Prevalence of curable STIs and bacterial vaginosis during pregnancy in sub-Saharan Africa: a systematic review and meta-analysis.

OBJECTIVE: STIs remain a global public health problem with a high burden among pregnant women. STIs in pregnant women may lead to various adverse pregnancy outcomes. In most sub-Saharan African countries, syndromic management is used for screening and treatment of STIs. We aimed to update and summarise pooled prevalence of curable STIs and bacterial vaginosis (BV) among pregnant women in sub-Saharan Africa. METHODS: Electronic databases and reference lists of relevant published and unpublished studies were searched from March 2015 to October 2020. Studies were included if they estimated prevalence of Chlamydia trachomatis (CT), Trichomonas vaginalis (TV), Neisseria gonorrhoeae (NG), Treponema pallidum (syphilis), Mycoplasma genitalium (MG) and BV among pregnant women in sub-Saharan Africa. Meta-analyses were performed with observed prevalences corrected for diagnostic errors to estimate the pooled prevalence of diagnosed infections by region. RESULTS: A total of 48 studies met the inclusion criteria, providing 85-point prevalence estimates for curable STIs and BV. Pooled prevalence estimates (with 95% CI and number of women tested) were as follows: MG: 13.5% (4.0-27.2, n=1076); CT: 10.8% (6.9-15.5, n=6700); TV: 13.8% (10.0-18.0, n=9264); NG: 3.3% (2.1-4.7, n=6019); syphilis: 2.9% (2.0-4.0, n=95 308) and BV: 36.6% (27.1-46.6, n=5042). By region, BV was the most prevalent and ranged from 28.5% (24.5-32.8, n=1030) in Eastern Africa to 52.4% (33.5-70.9, n=2305) in Southern Africa; NG had the lowest prevalence, ranging from 1.4% (95% CI 0.1 to 3.1, n=367) in Central Africa to 4.4% (95% CI 2.6 to 6.4, n=4042) in Southern Africa. CONCLUSION: The prevalence of curable STIs and BV in sub-Saharan Africa is substantial in pregnant women but most prevalent in Southern Africa where HIV prevalence is highest. It is crucial to integrate screening of curable STIs into antenatal care programmes that have previously focused on diagnosis and treatment of syphilis and HIV.

An update on trends in the types and quality of childhood immunization research outputs from Africa 2011-2017: Mapping the evidence base.

BACKGROUND: Strengthening immunisation programmes in Africa remains a key strategy of improving vaccine coverage. Research plays a vital role in the design and implementation of strategic immunisation plans for improving vaccination coverage, in turn providing context specific evidence to inform policy and practice. We therefore updated an evidence map describing the types and quality of available literature on childhood immunisation in Africa from 2011 to 2017. METHODS: PubMed and Africa Wide databases were searched for English studies on childhood immunisation in Africa published from January 2011 to September 2017. Studies had to be conducted in humans and the reported information needed to be on either: vaccines; immunisation programmes; immunisation policies; or epidemiology of vaccine preventable diseases targeted by Expanded Programme on Immunisation vaccines. RESULTS: Out of 5567 studies retrieved, 797 studies from 165 journals met the inclusion criteria. During 2011-2017, 42 African countries contributed to research on childhood immunisation. Most studies were carried out in multiple countries (15.1%). Five countries contributed 41% of the total research output. Nigeria and South Africa contributed the highest proportion of studies at 12% and 11.4% respectively. The quantity of research output increased progressively from 2011 to 2015 after which there was a significant decline. CONCLUSION: There was a remarkable increase in childhood immunisation research in the period 2011 to 2017 when compared to the initial assessment. However, the reason for decline in research output from 2015 requires further investigation. Most childhood immunisation research was still generated by five countries as previously observed, highlighting the critical need for strategic investment in research capacities and improved collaboration between countries in Africa.

Successful polio supplementary immunisation activities in a security compromised zone - Experiences from the Southwest region of Cameroon.

BACKGROUND: Supplementary immunisation activities (SIAs) play a central role in polio eradication efforts. Armed conflicts resulting in insecurity negatively affect SIAs. In the Southwest region of Cameroon, armed conflicts persisted in 2018. We present our experiences of conducting a polio SIA in an insecure region. METHODS: The SIA took place from the 2nd to 4th of March 2018 and targeted 307,920 children aged 0-59 months. Bivalent polio vaccine was used. Before the SIA, extensive planning was done under the leadership of a Central Technical Group. Planning included security assessment, advocacy and social mobilisation. RESULTS: Only 4 of the 18 health districts (HDs) of the Southwest region were considered safe. Regardless, vaccination teams worked in all HDs. The SIA achieved a coverage of 89.9%. Town criers and social mobilisers were the main sources of information about the SIA. Most (76%) children were vaccinated using the door to door strategy. There was no case of vaccine refusal. CONCLUSION: Community members were very receptive of the SIA and this may be due to the communication that was adopted. Strong dedication by vaccination teams, community members' understanding and acceptance of polio SIAs are all key factors to the eradication of polio in conflict zones.

Comparison of school based and supplemental vaccination strategies in the delivery of vaccines to 5-19 year olds in Africa - a systematic review.

BACKGROUND: Some vaccine preventable diseases (VPDs) still remain a public health burden in many African countries. The occurrence of VPDs in all age groups has led to the realization of the need to extend routine immunisation services to school age children, adolescents and adults. Supplemental immunisation activities (SIAs) and school based vaccinations (SBVs) are common strategies used to complement the expanded programme on immunisation (EPI). This review aimed to assess the effectiveness of SIAs compared to SBVs in the administration of vaccines to 5-19 year olds in Africa. METHODS: Systematic review methods were used to address our study aim. Several electronic databases were searched up to March 30, 2017 for primary studies investigating the delivery of vaccines via SIAs or SBVs to 5-19 year olds. This search was complemented by browsing reference lists of potential studies obtained from search outputs. Outcomes considered for inclusion were: vaccination coverage, costs of the strategy or its effect on routine immunisation services. RESULTS: Out of the 4938 studies identified, 31 studies met the review inclusion criteria. Both SIAs and SBVs showed high vaccination coverage. However, the SIAs reported higher coverage than SBVs: 91% (95% CI: 84%, 98%) versus 75% (95% CI: 67%, 83%). In most settings, SBVs were reported to be more expensive than SIAs. The SIAs were found to negatively affect routine immunisation services. CONCLUSIONS: Both SIAs and SBVs are routinely used to complement the EPI in the delivery of vaccines in Africa. In settings where school enrolment is suboptimal, as is the case in many African countries, our results show SIAs may be more effective in reaching school age children and adolescents than SBVs. Our results re-iterate the importance of evaluating systematic evidence to best inform African authorities on the optimal vaccine delivery strategies targeting school age children and adolescents.