Anaemia among women of reproductive age in selected sub-Saharan African countries: multivariate decomposition analyses of the demographic and health surveys data 2008-2018

Objectives

The burden and highest regional prevalence of anaemia is reported in sub-Saharan Africa (SSA). The study evaluated changes in anaemia prevalence across the Demographic Health Surveys (DHS) periods in SSA and reported factors influencing observed changes in the trend.

Method

The study was implemented by a two-stage cross-sectional stratified sampling approach. The study involved women of reproductive age (15-49 years) in sub-Saharan Africa countries (Ghana, Sierra Leone, Mali, and Benin) using two different periods of their demographic health surveys (DHS) data. The study adopted both descriptive and inferential statistical methods. The chi-square test was used to determine the existence of a statistically significant relationship between the outcome and predictor variables and test the observed changes in anaemia. Multivariable logistic regression analyses were conducted on each survey year and the pooled dataset for eligible study countries. Multivariate decomposition analysis was performed to explain how compositional changes and behavioural effects of women characteristics affected the changes in anaemia prevalence. The study reported frequencies, percentages and odds ratios along with their 95% confidence intervals (CI).

Results

Ghana and Sierra Leone experienced 17.07% [95% CI: 14.76-19.37, p < 0.001] and 1% [95% CI: 1.0-2.9, p > 0.05] of anaemia decrease from period 1 to period 2, respectively, while Mali and Benin experienced 11% [95% CI: 9.14-12.90, p < 0.001] and 16.7% [95% CI: 14.99-18.5, p < 0.001] of increase in anaemia prevalence from period 1 to period 2, respectively. Behavioural effects explained the decrease in Ghana and the increase in Benin and Mali while endowments or compositional changes explained the decrease in Sierra Leone.

Conclusion

Anaemia continues to pose a significant challenge in sub-Saharan Africa. Therefore, there is an imperative need to scale up the implementation of nutrition-related programmes and advocacies to ensure optimum changes in women nutrition-related behaviours.

Spatial analysis of climatic factors and plasmodium falciparum malaria prevalence among children in Ghana

Malaria is a major public health problem especially in Africa where 94% of global malaria cases occur. Malaria prevalence and mortalities are disproportionately higher among children. In 2019, children accounted for 67% of malaria deaths globally. Recently, climatic factors have been acknowledged to influence the number and severity of malaria cases. Plasmodium falciparum-the most deadly malaria parasite, accounts for more than 95% of malaria infections among children in Ghana. Using the 2017 Ghana Demographic Health Survey data, we examined the local variation in the prevalence and climatic determinants of child malaria. The findings showed that climatic factors such as temperature, rainfall aridity and Enhanced Vegetation Index are significantly and positively associated with Plasmodium falciparum malaria prevalence among children in Ghana. However, there are local variations in how these climatic factors affect child malaria prevalence. Plasmodium falciparum malaria prevalence was highest among children in the south western, north western and northern Ghana.

COVID-19 vaccine acceptance among health care workers in Africa: A systematic review and meta-analysis

INTRODUCTION

Coronavirus Disease (COVID-19) vaccine acceptance, and hesitancy amongst Health Care Workers (HCWs) on the African continent have been examined through observational studies. However, there are currently no comprehensive reviews among these cadre of population in Africa. Hence, we aimed to review the acceptance rate and possible reasons for COVID-19 vaccine non-acceptance/hesitancy amongst HCWs in Africa.

METHODS

We searched Medline/PubMed, Google Scholar, and Africa Journal Online from January, 2020 to September, 2021. The Newcastle-Ottawa Quality Assessment tool adapted for cross-sectional studies was used to assess the quality of the retrieved studies. DerSimonian and Laird random-effects model was used to pool the COVID-19 vaccine acceptance rate. Sub-group and sensitivity analyses were performed. Reasons for COVID-19 vaccine hesitancy were also systematically analyzed.

RESULTS

Twenty-one (21) studies were found to be eligible for review out of the 513 initial records. The estimated pooled COVID-19 vaccine acceptance rate was 46% [95% CI: 37%-54%]. The pooled estimated COVID-19 vaccine acceptance rate was 37% [95% CI: 27%-47%] in North Africa, 28% [95% CI: 20%-36%] in Central Africa, 48% [CI: 38%-58%] in West Africa, 49% [95% CI: 30%-69%] in East Africa, and 90% [CI: 85%-96%] in Southern Africa. The estimated pooled vaccine acceptance was 48% [95% CI:38%-57%] for healthcare workers, and 34% [95% CI:29%-39%] for the healthcare students. Major drivers and reasons were the side effects of the vaccine, vaccine's safety, efficacy and effectiveness, short duration of the clinical trials, COVID-19 infections, limited information, and social trust.

CONCLUSION

The data revealed generally low acceptance of the vaccine amongst HCWs across Africa. The side effects of the vaccine, vaccine's safety, efficacy and effectiveness, short duration of the clinical trials, COVID-19 infections, limited information, and social trust were the major reasons for COVID-19 hesitancy in Africa. The misconceptions and barriers to COVID-19 vaccine acceptance amongst HCWs must be addressed as soon as possible in the continent to boost COVID-19 vaccination rates in Africa.

Impact of COVID-19 pandemic on acute stroke admissions and case-fatality rate in lower-income and middle-income countries: a protocol for systematic review and meta-analysis

INTRODUCTION

The current review primarily aims to ascertain the impact of COVID-19 on stroke admission as well as stroke case fatality in Low-income and Middle-Income Countries (LMICs).

METHODS AND ANALYSIS

Four international databases (PubMed/Medline, Google Scholar, African Journals Online, Latin American and Caribbean Health Sciences Literature) and one preprint database (medRxiv). Studies will be included if they are conducted in LMICs, all stroke types without age and language restriction, from December 2019 to 31 December 2021. Two authors will screen the titles and abstracts against the prespecified eligibility criteria for inclusion in the review, and then repeat the process after retrieving the full text. Joanna Briggs critical appraisal checklist for analytical cross-sectional studies will be used for the quality assessment and risk of bias by two coauthors. The characteristics of the studies will be presented and summarised in a table. We aim to perform meta-analyses on a pooled proportional change in acute stroke admissions and case fatality with 95% CI using a random-effects meta-analysis. Publication bias will be assessed using funnel plot and Egger's regression test if ≥10 studies are involved. A sub group analysis will be performed to determine the sources of heterogeneity. Leave-one-out sensitivity analysis will be performed to examine the impact of a single study on the overall pool estimate.

ETHICS AND DISSEMINATION

Ethical approval is not required as this is secondary research and will use reported data in scientific literature. A full manuscript will be submitted to a reputable peer-review journal for publication and disseminated electronically and in print.

PROSPERO REGISTRATION NUMBER

CRD42021281580.

Estimated prevalence and gender disparity of physical activity among 64,127 in-school adolescents (aged 12-17 years): A multi-country analysis of Global School-based Health Surveys from 23 African countries

The Africa sub-region currently lacks quantitative normative data to illustrate the extent of burden and gender inequities of physical activity level in order to inform policy and education, towards meeting the WHO's 2030 physical activity milestone. The study aimed to provide insights on the current prevalence of sufficient physical activity and gender disparity, using a nationally representative data from the Global School-based student Health Survey (GSHS) from 23 African countries. The study used the multi-country GSHS data from 23 African countries (2003-2017). Sufficient physical activity was measured through self-administered questionnaire. The prevalence of sufficient physical activity among in-school adolescents in each country was estimated by proportion with corresponding 95% confidence intervals. Meta-analysis with random effect was employed to pool the prevalence of physical activity level in the 23 African countries. Additionally, sub-group, sensitivity, and meta-regression analyses were performed. The study included 23 African countries representing 64,127 in-school adolescents aged 12-17 years. Overall, only 20% [95% CI: 18%-22%] of adolescents in Africa engaged in sufficient physical activity. With respect to sex, only 25% [95% CI: 22%-28%] of males and 16% [95% CI: 14%-18%] of females met the WHO recommendation of sufficient physical activity. Sufficient physical activity ranged from 11.6% [9.2%-14.5%] in Sudan to 38.3% [CI:30.2%-47.1%] in Benin. Sufficient physical activity in boys ranged from 7.5% [95% CI: 6.2%-9.0%] in Zambia to 29.2% [95% CI: 22.5%-36.8%] in Benin, and ranged from 2.5% [95% CI: 1.6%-4.0%] in Senegal to 12.2% [95% CI:10.6%-14.1%] in Tanzania for girls. Only 20% of in-school adolescents met the WHO's recommended physical activity level. Generally, adolescent girls in Africa are less active than adolescent boys. Addressing the rising burden of insufficient physical activity in adolescents and narrowing the gender gap could ultimately increase the overall physical activity engagement and achieve the WHO's global physical activity target by 2030.

Estimated burden, and associated factors of Urinary Incontinence among Sub-Saharan African women aged 15-100 years: A systematic review and meta-analysis

Hospital and community based-studies had been conducted for Urinary Incontinence (UI) in Sub-Sahara Africa (SSA) countries. A significant limitation of these studies is likely under-estimation of the burden of UI in SSA. It is therefore, imperative that a well-structured systematic review and meta-analytical models in SSA are required to accurately and reliably estimate the burden of UI. Medline/PubMed, Google Scholar, Africa Journal Online (AJOL) were searched to identified data on burden of UI studies in SSA. Two independent authors performed the initial screening of studies based on the details found in their titles and abstracts. The quality of the retrieved studies was assessed using the Newcastle-Ottawa Quality Assessment instrument. The pooled burden of UI was calculated using a weighted inverse variance random-effects model. A sub-group and meta-regression analyses were performed. Publication bias was checked by the funnel plot and Egger's test. Of the 25 studies included, 14 were hospital-based, 10 community- based, and 1 university-based studies involving an overall 17863 participants from SSA. The systematic review showed that the prevalence of UI ranged from 0.6% in Sierra Leone to 42.1% in Tanzania. The estimated pooled burden of UI across all studies was 21% [95% CI: 16%-26%, I2 = 91.01%]. The estimated pooled prevalence of stress UI was 52% [95% CI: 42%-62%], urgency UI 21% [95% CI: 15%-26%], and mixed UI 27% [95% CI: 20%-35%]. The common significant independent factors were; parity, constipation, overweight/obese, vaginal delivery, chronic cough, gestational age, and aging. One out of every five women in SSA suffers from UI. Parity, constipation, overweight/obesity, vaginal delivery, chronic cough, gestational age, and age were the most important risk variables. As a result, interventions aimed at reducing the burden of UI in SSA women aged 15 to 100 years old in the context of identified determinants could have significant public health implications.

Estimated incidence and case fatality rate of traumatic brain injury among children (0-18 years) in Sub-Saharan Africa. A systematic review and meta-analysis

INTRODUCTION

Studies from Sub-Saharan Africa (SSA) countries have reported on the incidence and case fatality rate of children with Traumatic Brain Injury (TBI). However, there is lack of a general epidemiologic description of the phenomenon in this sub-region underpinning the need for an accurate and reliable estimate of incidence and outcome of children (0-18 years) with TBI. This study therefore, extensively reviewed data to reliably estimate incidence, case fatality rate of children with TBI and its mechanism of injury in SSA.

METHODS

Electronic databases were systematically searched in English via Medline (PubMed), Google Scholar, and Africa Journal Online (AJOL). Two independent authors performed an initial screening of studies based on the details found in their titles and abstracts. Studies were assessed for quality/risk of bias using the modified Newcastle-Ottawa Scale (NOS). The pooled case fatality rate and incidence were estimated using DerSimonian and Laird random-effects model (REM). A sub-group and sensitivity analyses were performed. Publication bias was checked by the funnel plot and Egger's test. Furthermore, trim and fill analysis was used to adjust for publication bias using Duval and Tweedie's method.

RESULTS

Thirteen (13) hospital-based articles involving a total of 40685 participants met the inclusion criteria. The pooled case fatality rate for all the included studies in SSA was 8.0%; [95% CI: 3.0%-13.0%], and the approximate case fatality rate was adjusted to 8.2%, [95% CI:3.4%-13.0%], after the trim-and-fill analysis was used to correct for publication bias. A sub-group analysis of sub-region revealed that case fatality rate was 8% [95% CI: 2.0%-13.0%] in East Africa, 1.0% [95% CI: 0.1% -3.0%] in Southern Africa and 18.0% [95% CI: 6.0%-29.0%] in west Africa. The pooled incidence proportion of TBI was 18% [95% CI: 2.0%-33.0%]. The current review showed that Road Traffic Accident (RTA) was the predominant cause of children's TBI in SSA. It ranged from 19.1% in South Africa to 79.1% in Togo.

CONCLUSION

TBI affects 18% of children aged 0 to 18 years, with almost one-tenth dying in SSA. The most common causes of TBI among this population in SSA were RTA and falls. TBI incidence and case fatality rate of people aged 0-18 years could be significantly reduced if novel policies focusing on reducing RTA and falls are introduced and implemented in SSA.

Estimating the burden of hypertension and its significant risk factors among male commercial drivers in sub-Saharan Africa: A systematic review and meta-analysis

OBJECTIVE

The study was designed to assess the burden and significant risk factors among male commercial drivers in sub-Saharan Africa (SSA).

DESIGN

Systematic review and meta-analysis.

DATA SOURCES

Medline via PubMed, Google Scholar, Cochrane databases and Africa Journal Online were searched from January 2010 to December 2020.

ELIGIBILITY CRITERIA FOR SELECTING STUDIES

The authors included observational studies reporting on the burden and/or risk factors for hypertension among commercial drivers in SSA. Male adult population ≥18 years working as a commercial driver in SSA as well articles published in English.

DATA EXTRACTION AND SYNTHESIS

Two independent coauthors used a prepared data extraction form to extract data from the eligible published papers and assessed the risk of bias. DerSimonian and Laird random effects model was used to pool the burden of hypertension and significant risk factors among male commercial drivers in SSA. The presence of heterogeneity among studies was quantified by estimating variance using both Cochrane's Q statistics and the I² statistics. A subgroup and sensitivity analyses were performed.

RESULTS

Overall, 14 articles met the inclusion criteria involving a total of 4285 male commercial drivers in SSA. The estimated pooled burden of hypertension among the male commercial drivers in SSA was 32% (95% CI 24% to 39%). The risk factors identified were age OR=1.10 (95% CI 1.06 to 1.15), overweight/obese OR=3.38 (95% CI 2.46 to 4.29), alcohol consumption OR=3.00 (95% CI 2.05 to 3.95) and duration of driving (≥5 years) OR=1.83 (95% CI 1.03 to 2.63). Funnel plot inspection and Egger's regression test of small effect (0.5838) showed no evidence of publication bias.

CONCLUSIONS

Our review showed that nearly one-third of male commercial drivers in SSA have hypertension. Reduction of modifiable risk factors such as overweight/obesity, alcohol consumption and long-term driving through multifaceted implementation strategies are recommended for prevention and control of hypertension among male commercial drivers in SSA.

TRIAL REGISTRATION NUMBER

CRD42021250910.

Prevalence and Predictors of Contraceptives Use among Women Aged (15-49 years) with Induced Abortion History in Ghana

BACKGROUND

The incidence of abortion in Ghana ranges from 27 per 1000 to 61 per 1000 women, causing gynecological complications and maternal mortality. The use of modern contraceptives and its associated factors among women aged 15-49 years have been documented. However, utilization of modern contraceptives specifically among women with induced abortion history is underreported. This study therefore aimed at determining the proportion and identifying predictors of contraceptives use in this underreported population.

METHODS

This study used secondary data from the 2017 Ghana Maternal Health Survey (GMHS) for the analysis. The analysis is on a weighted sample of 3,039 women aged (15-49 years) with a history of induced abortion. Both descriptive and inferential methods were employed. The chi-square test, univariate and multivariate logistic regression techniques were used to assess statistical associations between the outcome variable and the predictors. Statistical significance was set at 95% confidence interval and p values ≤0.05.

RESULTS

Out of the 3,039 participants, 37% (95% CI: 34.6, 38.84) used contraceptives. We identified women' age, union, place of residence, knowledge of fertile period, total pregnancy outcomes, and region as strong significant (95% CI, p ≤ 0.05) predictors of post induced abortion contraceptives use.

CONCLUSION

Contraceptives use among this vulnerable population is low. Therefore, there is a need to provide widespread access to postabortion contraception services and enhance efforts to efficiently integrate safe abortion practices law into health services in Ghana.