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- Amouzou, A, et al.
(författare)
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Health service utilisation during the COVID-19 pandemic in sub-Saharan Africa in 2020: a multicountry empirical assessment with a focus on maternal, newborn and child health services
- 2022
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Ingår i: BMJ global health. - : BMJ. - 2059-7908. ; 7:5
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Tidskriftsartikel (refereegranskat)abstract
- There are concerns about the impact of the COVID-19 pandemic on the continuation of essential health services in sub-Saharan Africa. Through the Countdown to 2030 for Women’s, Children’s and Adolescents’ Health country collaborations, analysts from country and global public health institutions and ministries of health assessed the trends in selected services for maternal, newborn and child health, general service utilisation.MethodsMonthly routine health facility data by district for the period 2017–2020 were compiled by 12 country teams and adjusted after extensive quality assessments. Mixed effects linear regressions were used to estimate the size of any change in service utilisation for each month from March to December 2020 and for the whole COVID-19 period in 2020.ResultsThe completeness of reporting of health facilities was high in 2020 (median of 12 countries, 96% national and 91% of districts ≥90%), higher than in the preceding years and extreme outliers were few. The country median reduction in utilisation of nine health services for the whole period March–December 2020 was 3.9% (range: −8.2 to 2.4). The greatest reductions were observed for inpatient admissions (median=−17.0%) and outpatient admissions (median=−7.1%), while antenatal, delivery care and immunisation services generally had smaller reductions (median from −2% to −6%). Eastern African countries had greater reductions than those in West Africa, and rural districts were slightly more affected than urban districts. The greatest drop in services was observed for March–June 2020 for general services, when the response was strongest as measured by a stringency index.ConclusionThe district health facility reports provide a solid basis for trend assessment after extensive data quality assessment and adjustment. Even the modest negative impact on service utilisation observed in most countries will require major efforts, supported by the international partners, to maintain progress towards the SDG health targets by 2030.
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- Dinede, Getachew, et al.
(författare)
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Foodborne hazards in food in Burkina Faso, 1990-2019 : a systematic review and meta-analysis
- 2023
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Ingår i: Frontiers in Sustainable Food Systems. - : Frontiers Media S.A.. - 2571-581X. ; 7
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Forskningsöversikt (refereegranskat)abstract
- Background: Foodborne diseases impose substantial public health burden and jeopardize socio-economic development worldwide. While accurate information on foodborne hazards is needed for informed decision in food safety interventions, such information is scarce in developing countries such as Burkina Faso. We conducted a systematic review and meta-analysis of studies reporting foodborne hazards in foods in Burkina Faso to describe the present knowledge of the situation.Methods: Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guideline was used to conduct this review. Abstracts were searched in PubMed and CAB direct between 1 January 1990 to 30 September 2019. We used random-effects models to estimate pooled prevalence and I2 values to measure heterogeneity between studies.Results: 188 articles were identified, of which 14 are included in this review: 12 were on bacterial hazards (Salmonella, Campylobacter, Staphylococcus, E. coli, Shigella), three on fungal hazards and one on parasitic hazards (Toxoplasma gondii). The overall pooled prevalence of Salmonella spp. was 13% (95% CI: 8–21), the highest in lettuce: 50% (95% CI: 30–70) and the lowest in milk: 1.2% (95% CI: 0–5), demonstrating substantial variation among the studies (I2 = 85, 95% CI: 79–90%, p < 0.01). Campylobacter spp. was reported in chicken carcass, with 50% of the samples being positive. The overall pooled microbial load of Staphylococcus in the studied food samples was 3.2 log (95% CI: 2.8–3.6) CFU per g or ml of food, the highest in poultry samples: 4.5 log (95% CI: 2.8–6.2) CFU per g or ml of food. The overall pooled prevalence of Escherichia coli (E. coli) was 40% (95% CI: 29–51), the highest in beef intestines: 62% (95% CI: 22–91) and the lowest in dairy products: 31% (95% CI: 17–50), showing substantial variation across the studies (I2 = 86, 95% CI: 80–90%, p < 0.01).Conclusion: Our results showed widespread contamination of foods with foodborne hazards across various food value chains indicating poor hygienic handling of foods, raising consumers’ health risk due to foodborne illnesses from the foods. We recommend promotion of awareness creation in food safety and improved monitoring of hazards in food.
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- Nduva, George M., et al.
(författare)
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Quantifying rates of HIV-1 flow between risk groups and geographic locations in Kenya : A country-wide phylogenetic study
- 2022
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Ingår i: Virus Evolution. - : Oxford University Press (OUP). - 2057-1577. ; 8:1
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Tidskriftsartikel (refereegranskat)abstract
- In Kenya, HIV-1 key populations including men having sex with men (MSM), people who inject drugs (PWID) and female sex workers (FSW) are thought to significantly contribute to HIV-1 transmission in the wider, mostly heterosexual (HET) HIV-1 transmission network. However, clear data on HIV-1 transmission dynamics within and between these groups are limited. We aimed to empirically quantify rates of HIV-1 flow between key populations and the HET population, as well as between different geographic regions to determine HIV-1 'hotspots' and their contribution to HIV-1 transmission in Kenya. We used maximum-likelihood phylogenetic and Bayesian inference to analyse 4058 HIV-1 pol sequences (representing 0.3 per cent of the epidemic in Kenya) sampled 1986-2019 from individuals of different risk groups and regions in Kenya. We found 89 per cent within-risk group transmission and 11 per cent mixing between risk groups, cyclic HIV-1 exchange between adjoining geographic provinces and strong evidence of HIV-1 dissemination from (i) West-to-East (i.e. higher-to-lower HIV-1 prevalence regions), and (ii) heterosexual-to-key populations. Low HIV-1 prevalence regions and key populations are sinks rather than major sources of HIV-1 transmission in Kenya. Targeting key populations in Kenya needs to occur concurrently with strengthening interventions in the general epidemic.
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- Nduva, George M., et al.
(författare)
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Temporal trends and transmission dynamics of pre-treatment HIV-1 drug resistance within and between risk groups in Kenya, 1986–2020
- 2024
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Ingår i: Journal of Antimicrobial Chemotherapy. - 0305-7453. ; 79:2, s. 287-296
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Tidskriftsartikel (refereegranskat)abstract
- Background: Evidence on the distribution of pre-treatment HIV-1 drug resistance (HIVDR) among risk groups is limited in Africa. We assessed the prevalence, trends and transmission dynamics of pre-treatment HIVDR within and between MSM, people who inject drugs (PWID), female sex workers (FSWs), heterosexuals (HETs) and perinatally infected children in Kenya. Methods: HIV-1 partial pol sequences from antiretroviral-naive individuals collected from multiple sources between 1986 and 2020 were used. Pre-treatment reverse transcriptase inhibitor (RTI), PI and integrase inhibitor (INSTI) mutations were assessed using the Stanford HIVDR database. Phylogenetic methods were used to determine and date transmission clusters. Results: Of 3567 sequences analysed, 550 (15.4%, 95% CI: 14.2–16.6) had at least one pre-treatment HIVDR mutation, which was most prevalent amongst children (41.3%), followed by PWID (31.0%), MSM (19.9%), FSWs (15.1%) and HETs (13.9%). Overall, pre-treatment HIVDR increased consistently, from 6.9% (before 2005) to 24.2% (2016–20). Among HETs, pre-treatment HIVDR increased from 6.6% (before 2005) to 20.2% (2011–15), but dropped to 6.5% (2016–20). Additionally, 32 clusters with shared pre-treatment HIVDR mutations were identified. The majority of clusters had R0 ≥ 1.0, indicating ongoing transmissions. The largest was a K103N cluster involving 16 MSM sequences sampled between 2010 and 2017, with an estimated time to the most recent common ancestor (tMRCA) of 2005 [95% higher posterior density (HPD), 2000–08], indicating propagation over 12 years. Conclusions: Compared to HETs, children and key populations had higher levels of pre-treatment HIVDR. Introduction of INSTIs after 2017 may have abrogated the increase in pre-treatment RTI mutations, albeit in the HET population only. Taken together, our findings underscore the need for targeted efforts towards equitable access to ART for children and key populations in Kenya.
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