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Mano RM, Kuona P, Misihairabgwi JM. Determination of birth prevalence of sickle cell disease using point of care test HemotypeSC™ at Rundu Hospital, Namibia. BMC Pediatr 2024; 24:323. [PMID: 38730340 PMCID: PMC11084002 DOI: 10.1186/s12887-024-04805-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Accepted: 05/02/2024] [Indexed: 05/12/2024] Open
Abstract
BACKGROUND Sickle cell disease (SCD), a noncommunicable disease, has the greatest burden in sub-Saharan Africa. The majority of children (50-90%) with SCD die before their 5th birthday, with approximately 150,000-300,000 annual SCD child deaths in Africa. In developed countries, newborn screening (NBS) has been shown to improve the survival of children with sickle cell disease, with under5 childhood mortality reduced tenfold due to interventions performed before the development of complications. Point -of-care tests have been developed for resource limited settings to expand NBS. The aim of this study was to determine the birth prevalence of sickle cell disease in Namibia using the HemoTypeSC™ point-of-care test. METHODS A cross-sectional descriptive study was carried out at Rundu Intermediate Hospital in the Kavango East Region. Two hundred and two (202) well newborns within 72 h of birth were recruited for the study from 22 February to the 23th March 2023. Descriptive statistics were used to compute the haemoglobin types of the study participants. RESULTS The majority of the participants (n = 105, 52%) were females, and (n = 97,48%) were males. The median age of the participants was 23 h (Q1, Q3; 11; 33),) with an age range of 2-98 h. Sickle cell trait was present in 9.4% of the screened newborns, no homozygous disease was detected, and 90.6% had Hb AA. CONCLUSIONS This study is the first to measure HbS gene carriage at birth using HemotypeSC point-of-care testing in Namibia. There was a moderate prevalence of sickle cell traits but no SCD. This baseline study may provide the foundation for larger epidemiological surveys to map HbS gene carriage in Namibia to provide evidence for policy makers to fashion appropriate SCD newborn screening services.
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Affiliation(s)
- Runyararo Mashingaidze Mano
- Department of Maternal & Child Health, Division of Paediatrics, School of Medicine, Faculty of Health Sciences and Veterinary Medicine, University of Namibia Hage Geingob Campus, Bach Street, Windhoek, Namibia.
| | - Patience Kuona
- Department of Child, Adolescent and Women's Health, Faculty of Medicine and Health Sciences, University of Zimbabwe, Harare, Zimbabwe
| | - Jane Masiiwa Misihairabgwi
- Department of Human, Biological and Translational Medical Sciences, School of Medicine, University of Namibia Faculty of Health Sciences & Veterinary Medicine, Windhoek, Namibia
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Loeb T, Willis K, Velishavo F, Lee D, Rao A, Baral S, Rucinski K. Leveraging Routinely Collected Program Data to Inform Extrapolated Size Estimates for Key Populations in Namibia: Small Area Estimation Study. JMIR Public Health Surveill 2024; 10:e48963. [PMID: 38573760 PMCID: PMC11027056 DOI: 10.2196/48963] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Revised: 09/07/2023] [Accepted: 12/13/2023] [Indexed: 04/05/2024] Open
Abstract
BACKGROUND Estimating the size of key populations, including female sex workers (FSW) and men who have sex with men (MSM), can inform planning and resource allocation for HIV programs at local and national levels. In geographic areas where direct population size estimates (PSEs) for key populations have not been collected, small area estimation (SAE) can help fill in gaps using supplemental data sources known as auxiliary data. However, routinely collected program data have not historically been used as auxiliary data to generate subnational estimates for key populations, including in Namibia. OBJECTIVE To systematically generate regional size estimates for FSW and MSM in Namibia, we used a consensus-informed estimation approach with local stakeholders that included the integration of routinely collected HIV program data provided by key populations' HIV service providers. METHODS We used quarterly program data reported by key population implementing partners, including counts of the number of individuals accessing HIV services over time, to weight existing PSEs collected through bio-behavioral surveys using a Bayesian triangulation approach. SAEs were generated through simple imputation, stratified imputation, and multivariable Poisson regression models. We selected final estimates using an iterative qualitative ranking process with local key population implementing partners. RESULTS Extrapolated national estimates for FSW ranged from 4777 to 13,148 across Namibia, comprising 1.5% to 3.6% of female individuals aged between 15 and 49 years. For MSM, estimates ranged from 4611 to 10,171, comprising 0.7% to 1.5% of male individuals aged between 15 and 49 years. After the inclusion of program data as priors, the estimated proportion of FSW derived from simple imputation increased from 1.9% to 2.8%, and the proportion of MSM decreased from 1.5% to 0.75%. When stratified imputation was implemented using HIV prevalence to inform strata, the inclusion of program data increased the proportion of FSW from 2.6% to 4.0% in regions with high prevalence and decreased the proportion from 1.4% to 1.2% in regions with low prevalence. When population density was used to inform strata, the inclusion of program data also increased the proportion of FSW in high-density regions (from 1.1% to 3.4%) and decreased the proportion of MSM in all regions. CONCLUSIONS Using SAE approaches, we combined epidemiologic and program data to generate subnational size estimates for key populations in Namibia. Overall, estimates were highly sensitive to the inclusion of program data. Program data represent a supplemental source of information that can be used to align PSEs with real-world HIV programs, particularly in regions where population-based data collection methods are challenging to implement. Future work is needed to determine how best to include and validate program data in target settings and in key population size estimation studies, ultimately bridging research with practice to support a more comprehensive HIV response.
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Affiliation(s)
- Talia Loeb
- Data for Implementation (Data.FI), Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Kalai Willis
- Data for Implementation (Data.FI), Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | | | - Daniel Lee
- United States Agency for International Development Dominican Republic, Santo Domingo, Dominican Republic
| | - Amrita Rao
- Data for Implementation (Data.FI), Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Stefan Baral
- Data for Implementation (Data.FI), Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Katherine Rucinski
- Data for Implementation (Data.FI), Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
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Brückner TY, Heemelaar S, Endjala T, van den Akker T. Healthcare worker burnout: exploring the experiences of doctors working in a maternity unit in Namibia. BMC Health Serv Res 2024; 24:362. [PMID: 38515163 PMCID: PMC10958874 DOI: 10.1186/s12913-024-10845-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Accepted: 03/11/2024] [Indexed: 03/23/2024] Open
Abstract
BACKGROUND Globally, healthcare workers (HCWs) in maternity units are at high risk of developing burnout. Burnout can lead to multiple harmful impacts on HCWs, their patients, and the broader healthcare system. Little is known about the burden of burnout among sub-Saharan African HCWs. Although evidence suggests that maternity unit doctors in a hospital complex in Namibia are at risk of developing burnout, no studies have been conducted on doctors in this department yet. METHODS Through participant observation and a mixed-methods needs assessment, this study aimed to explore the drivers, experiences, and impact of burnout symptoms among doctors in this department, and current support mechanisms in place. Survey data was collected from 18 participants and seven in-depth interviews were conducted. Burnout risk was assessed using the Burnout Assessment Tool. RESULTS Seven out of 18 participants were at very high risk for burnout and three were at risk, showing a high prevalence of burnout risk. Burnout risk remained similar between levels of staff, while gender qualitatively impacted burnout-related experiences. Drivers of burnout were identified at personal, occupational, and systemic levels. CONCLUSIONS Over half of participants were at risk or at very high risk of burnout. Results highlighted a need for support and identified areas for intervention and further research. Such areas include blame culture, lack of trust between colleagues, and systemic drivers of burnout. This study contributes to the understanding of burnout among HCWs in sub-Saharan Africa.
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Affiliation(s)
| | - S Heemelaar
- Department of Obstetrics and Gynaecology, Leiden University Medical Centre, Leiden, Netherlands
| | - T Endjala
- Department of Community and Mental Health Nursing, University of Namibia, Windhoek, Namibia
| | - T van den Akker
- Athena Institute, Vrije Universiteit, Amsterdam, Netherlands
- Department of Obstetrics and Gynaecology, Leiden University Medical Centre, Leiden, Netherlands
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O’Bryan G, Chirairo H, Munyayi F, Ensminger A, Barnabee G, Dzinotyiweyi E, Mwandingi L, Ashipala L, Forster N, O’Malley G, Golden MR. Assisted Partner Notification Services in Namibia: Comparison of Case-Finding in Persons With New and Previously Diagnosed Human Immunodeficiency Virus, and Success as a Platform for PrEP Referral. Sex Transm Dis 2024; 51:214-219. [PMID: 38412468 PMCID: PMC10901442 DOI: 10.1097/olq.0000000000001922] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/29/2024]
Abstract
BACKGROUND Assisted partner notification services (APS) are widely implemented throughout sub-Saharan Africa. The effectiveness of APS among persons with previously diagnosed human immunodeficiency virus (HIV) infection is uncertain, and there are few published data on the success of integrating referrals for HIV preexposure prophylaxis (PrEP) into APS. METHODS Staff in 22 Namibian Ministry of Health and Social Service clinics offered APS to patients newly and previously diagnosed with HIV (index cases [ICs]) between October 2019 and June 2021. Counselors used a structured interview guide to elicit ICs' sex partners and biological children and assisted ICs to arrange testing of contacts. Contacts testing HIV-positive were linked to HIV services and those 14 years or older testing negative were offered PrEP. The primary outcome was the case-finding index (contacts testing HIV-positive ÷ ICs receiving APS). RESULTS Staff provided APS to 1222 (78%) of 1557 newly diagnosed ICs eliciting 1155 sex partners and 649 biological children. Among 280 previously diagnosed ICs, 279 sex partners and 158 biological children were elicited. The case-finding index was higher among ICs with newly diagnosed HIV compared with previously diagnosed HIV (0.14 vs 0.09, P = 0.46), though this difference was not statistically significant. Most sex partners testing HIV-negative were initiated on PrEP (67% in sex partners from newly diagnosed ICs; 74% in sex partners from previously diagnosed ICs). CONCLUSIONS Assisted partner notification services successfully identified sex partners and biological children with undiagnosed HIV infection when provided to both newly and previously diagnosed ICs. Integration of referral to PrEP resulted in many HIV-negative partners initiating PrEP.
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Affiliation(s)
- Gillian O’Bryan
- International Training and Education Center for Health (I-TECH), University of Washington, Seattle, USA
- Department of Global Health, University of Washington, Seattle, USA
| | - Harugumi Chirairo
- Department of Global Health, University of Washington, Seattle, USA
- International Training and Education Center for Health (I-TECH), University of Washington, Windhoek, Namibia
| | - Farai Munyayi
- Department of Global Health, University of Washington, Seattle, USA
- International Training and Education Center for Health (I-TECH), University of Washington, Windhoek, Namibia
| | - Alison Ensminger
- International Training and Education Center for Health (I-TECH), University of Washington, Seattle, USA
- Department of Global Health, University of Washington, Seattle, USA
| | - Gena Barnabee
- International Training and Education Center for Health (I-TECH), University of Washington, Seattle, USA
- Department of Global Health, University of Washington, Seattle, USA
| | | | | | - Laimi Ashipala
- Ministry of Health and Social Services (MHSS), Windhoek, Namibia
| | - Norbert Forster
- Department of Global Health, University of Washington, Seattle, USA
- International Training and Education Center for Health (I-TECH), University of Washington, Windhoek, Namibia
| | - Gabrielle O’Malley
- International Training and Education Center for Health (I-TECH), University of Washington, Seattle, USA
- Department of Global Health, University of Washington, Seattle, USA
| | - Matthew R. Golden
- International Training and Education Center for Health (I-TECH), University of Washington, Seattle, USA
- Center for AIDS and STD, University of Washington, USA
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Mukisa GW, Shumba TW, Lourens A. Policy framework that addresses malnutrition in Namibia: A retrospective qualitative review. Nutr Health 2024; 30:39-48. [PMID: 37431739 DOI: 10.1177/02601060231185815] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/12/2023]
Abstract
BACKGROUND Although Namibia has made strides in improving the policy enabling environment, eradication of malnutrition is still elusive. OBJECTIVE This review was aimed at determining the extent to which food and nutrition-related policies in Namibia address malnutrition. METHODS This study used a qualitative approach by retrospectively analysing policy frameworks that address malnutrition in Namibia from 1991 to 2022. The analysis employed the policy triangle framework to elucidate the contextual factors, content, actors and process involved in the policy development. Moreover, a comparative analysis of Namibian policies and those of other southern African countries was undertaken. RESULTS The review showed that there is a considerable degree of coherence in policy goals and strategies to address malnutrition despite parallel coordination structures. Policy process involved limited consultations with local communities which might have jeopardised the formulation of community problem-tailored interventions, ownership and participation in policy implementation. There is a strong political commitment to the eradication of malnutrition in Namibia. The Office of the Prime Minister played a leading role in policy development. Influential actors such as the UN agencies elevated the nutrition agenda. Further, the Namibian policy framework was generally similar to those of other southern African countries. CONCLUSIONS The review showed that Namibia has relevant and comprehensive policies to address malnutrition, however, contextual factors indicated high levels of malnutrition still exist in the communities. Further research is needed to understand the barriers and enablers to optimal nutrition for children under five years in Namibia.
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Affiliation(s)
- George Waliomuzibu Mukisa
- Department of Preventative Health Sciences, School of Health Sciences, Faculty of Health, Natural Resources and Applied Sciences, Namibia University of Science and Technology (NUST), Windhoek, Namibia
| | - Tonderai W Shumba
- Department of Occupational Therapy and Physiotherapy, Faculty of Health Sciences and Veterinary Medicine, University of Namibia (UNAM), Windhoek, Namibia
| | - Andrit Lourens
- Department of Preventative Health Sciences, School of Health Sciences, Faculty of Health, Natural Resources and Applied Sciences, Namibia University of Science and Technology (NUST), Windhoek, Namibia
- Division of Emergency Medicine, Department of Family, Community and Emergency Medicine, University of Cape Town (UCT), Cape Town, South Africa
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Günther G, Mhuulu L, Diergaardt A, Dreyer V, Moses M, Anyolo K, Ruswa N, Claassens M, Niemann S, Nepolo E. Bedaquiline Resistance after Effective Treatment of Multidrug-Resistant Tuberculosis, Namibia. Emerg Infect Dis 2024; 30:568-571. [PMID: 38407158 PMCID: PMC10902537 DOI: 10.3201/eid3003.240134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/27/2024] Open
Abstract
Bedaquiline is currently a key drug for treating multidrug-resistant or rifampin-resistant tuberculosis. We report and discuss the unusual development of resistance to bedaquiline in a teenager in Namibia, despite an optimal background regimen and adherence. The report highlights the risk for bedaquiline resistance development and the need for rapid drug-resistance testing.
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Shavuka O, Iipumbu E, Boois L, Günther G, Hoddinott G, Lin HH, Nepolo E, Niemann S, Ruswa N, Seddon J, Claassens MM. Enhanced active case finding of drug-resistant tuberculosis in Namibia: a protocol for the hotspots, hospitals, and households (H3TB) study. BMJ Open 2024; 14:e082665. [PMID: 38341211 PMCID: PMC10862302 DOI: 10.1136/bmjopen-2023-082665] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Accepted: 01/17/2024] [Indexed: 02/12/2024] Open
Abstract
INTRODUCTION Namibia is a high tuberculosis (TB)-burden country with an estimated incidence of 460/100 000 (around 12 000 cases) per year. Approximately 4.5% of new cases and 7.9% of previously treated TB cases are multidrug resistant (MDR) and 47% of patients with MDR-TB are HIV coinfected. Published data suggest a clustering of MDR-TB transmission in specific areas. Identifying transmission clusters is key to implementing high-yield and cost-effective interventions. This includes knowing the yield of finding TB cases in high-transmission zones (eg, community hotspots, hospitals or households) to deliver community-based interventions. We aim to identify such transmission zones for enhanced case finding and evaluate the effectiveness of this approach. METHODS AND ANALYSIS H3TB is an observational cross-sectional study evaluating MDR-TB active case finding strategies. Sputum samples from MDR-TB cases in three regions of Namibia will be evaluated by whole genome sequencing (WGS) in addition to routine sputum investigations (Xpert MTB/RIF, culture and drug susceptibility testing). We will collect information on household contacts, use of community spaces and geographical map intersections between participants, synthesising these data to identify transmission hotspots. We will look at the feasibility, acceptability, yield and cost of case finding strategies in these hotspots, and in households of patients with MDR-TB and visitors of hospitalised patients with MDR-TB. A compartmental transmission dynamic model will be constructed to evaluate the impact and cost-effectiveness of the strategies if scaled. ETHICS AND DISSEMINATION Ethics approval was obtained. Participants will give informed consent. H3TB will capitalise on a partnership with the Ministry of Health and Social Services to follow up individuals diagnosed with MDR-TB and integrate WGS data with innovative contact network mapping, to allow enhanced case finding. Study data will contribute towards a systems approach to TB control. Equally important, it will serve as a role model for similar studies in other high-incidence settings.
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Affiliation(s)
- Olga Shavuka
- Department of Human Biological and Translational Medical Sciences, University of Namibia, Windhoek, Khomas, Namibia
| | - Etuhole Iipumbu
- Department of Human Biological and Translational Medical Sciences, University of Namibia, Windhoek, Khomas, Namibia
| | - Lorraine Boois
- Department of Human Biological and Translational Medical Sciences, University of Namibia, Windhoek, Khomas, Namibia
| | - Gunar Günther
- Department of Human Biological and Translational Medical Sciences, University of Namibia, Windhoek, Khomas, Namibia
- Inselspital, University of Bern, Bern, Switzerland
| | - Graeme Hoddinott
- Desmond Tutu TB Centre, Department of Pediatrics and Child Health, Stellenbosch University Faculty of Medicine and Health Sciences, Cape Town, Western Cape, South Africa
| | | | - Emmanuel Nepolo
- Department of Human Biological and Translational Medical Sciences, University of Namibia, Windhoek, Khomas, Namibia
| | - Stefan Niemann
- Department of Human Biological and Translational Medical Sciences, University of Namibia, Windhoek, Khomas, Namibia
- Molecular and Experimental Mycobacteriology Group, Forschungszentrum Borstel, Borstel, Germany
| | - Nunurai Ruswa
- National Tuberculosis and Leprosy Programme (NTLP), Windhoek, Namibia
| | - James Seddon
- Desmond Tutu TB Centre, Department of Pediatrics and Child Health, Stellenbosch University Faculty of Medicine and Health Sciences, Cape Town, Western Cape, South Africa
- Department of Infectious Disease, Imperial College London, London, UK
| | - Mareli M Claassens
- Department of Human Biological and Translational Medical Sciences, University of Namibia, Windhoek, Khomas, Namibia
- Desmond Tutu TB Centre, Department of Pediatrics and Child Health, Stellenbosch University Faculty of Medicine and Health Sciences, Cape Town, Western Cape, South Africa
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Tenzin T, Hikufe EH, Hedimbi N, Athingo R, Shikongo MB, Shuro T, Iipinge J, Herman N, Naunyango M, Haufiku F, Peter J, Hango L, Gottlieb S, Shoombe K, Denzin N, Busch F, Lohr F, Letshwenyo M, Torres G, Freuling CM, Müller T, Shilongo A. Dog ecology and rabies knowledge, attitude and practice (KAP) in the Northern Communal Areas of Namibia. PLoS Negl Trop Dis 2024; 18:e0011631. [PMID: 38315727 PMCID: PMC10881021 DOI: 10.1371/journal.pntd.0011631] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Revised: 02/21/2024] [Accepted: 01/24/2024] [Indexed: 02/07/2024] Open
Abstract
In 2021, a comprehensive dog demographic questionnaire combined with a KAP survey were conducted in the northern communal areas (NCAs) of Namibia with the aim of gaining a better understanding of dog populations, owner behaviour, and knowledge, attitudes and practices (KAP) relating to rabies. The survey of 3,726 households across the eight regions of the NCAs provided insights that will inform interventions in order to improve human rabies prevention and Namibia's dog rabies control strategy. The results showed a relatively low average human/dog ratio (HDR) of 5.4:1 indicating a surprisingly high dog population of at least 272,000 dogs in the NCAs, 93% of which appear to be owned but are free-roaming. Data analysis revealed opportunities but also highlighted needs for improvements in rabies surveillance and mass dog vaccinations. Although knowledge, attitude, and practice scores towards epidemiologic and clinical aspects, human rabies prevention, and dog rabies vaccination were deemed to be acceptable, the survey nevertheless revealed deficiencies in certain aspects in some of the population. Interestingly, data seemed to indicate relatively high dog bite incidences per 100,000 people, ranging between 262 and 1,369 and a certain number of unreported human rabies cases. Despite the very high number of dogs, only 50% of dog-owning households reported having vaccinated their dogs. In order to address these issues, the planning, announcement, and implementation of mass dog vaccination campaigns needs to be adapted to achieve adequate vaccination coverage. Another focus needs to be on rabies awareness and education if Namibia is to be significantly contributing to the global goal of "Zero by 30".
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Affiliation(s)
- Tenzin Tenzin
- World Organisation for Animal Health (WOAH), Sub-Regional Representation for Southern Africa, Gaborone, Botswana
| | - Emmanuel H. Hikufe
- Directorate of Veterinary Services, Ministry of Agriculture, Water and Land Reform, Windhoek, Namibia
| | - Nehemia Hedimbi
- State Veterinary Office, Ministry of Agriculture, Water & Land Reform, Directorate of Veterinary Services, Kunene region, Opuwo, Namibia
| | - Rauna Athingo
- Animal Disease Control—North, State Veterinary Office, Ministry of Agriculture, Water & Land Reform, Directorate of Veterinary Services, Ongwediva, Namibia
| | - Mainelo Beatrice Shikongo
- State Veterinary Office, Ministry of Agriculture, Water & Land Reform, Directorate of Veterinary Services, Zambezi region, Katima Mulilo, Namibia
| | - Thompson Shuro
- State Veterinary Office, Ministry of Agriculture, Water & Land Reform, Directorate of Veterinary Services, Kavango East region, Rundu, Namibia
| | - Johannes Iipinge
- State Veterinary Office, Ministry of Agriculture, Water & Land Reform, Directorate of Veterinary Services, Oshana region, Ondangwa, Namibia
| | - Nelson Herman
- State Veterinary Office, Ministry of Agriculture, Water & Land Reform, Directorate of Veterinary Services, Oshana region, Ondangwa, Namibia
| | - Matias Naunyango
- State Veterinary Office, Ministry of Agriculture, Water & Land Reform, Directorate of Veterinary Services, Ohangwena region, Eenhana, Namibia
| | - Frenada Haufiku
- State Veterinary Office, Ministry of Agriculture, Water & Land Reform, Directorate of Veterinary Services, Oshikoto region, Omuthiya, Namibia
| | - Josephat Peter
- State Veterinary Office, Ministry of Agriculture, Water & Land Reform, Directorate of Veterinary Services, Omusati region, Outapi, Namibia
| | - Laina Hango
- State Veterinary Office, Ministry of Agriculture, Water & Land Reform, Directorate of Veterinary Services, Omusati region, Outapi, Namibia
| | - Sara Gottlieb
- State Veterinary Office, Ministry of Agriculture, Water & Land Reform, Directorate of Veterinary Services, Kavango East region, Nkurunkuru, Namibia
| | - Kenneth Shoombe
- Animal Disease Control—North, State Veterinary Office, Ministry of Agriculture, Water & Land Reform, Directorate of Veterinary Services, Ongwediva, Namibia
| | - Nicolai Denzin
- Institute of Epidemiology, Friedrich-Loeffler-Institut (FLI), Greifswald-Insel Riems, Germany
| | - Frank Busch
- Institute of International Animal Health/One Health, Friedrich-Loeffler-Institut (FLI), Greifswald-Insel Riems, Germany
| | | | - Moetapele Letshwenyo
- World Organisation for Animal Health (WOAH), Sub-Regional Representation for Southern Africa, Gaborone, Botswana
| | | | - Conrad M. Freuling
- Institute of Molecular Virology and Cell Biology, Friedrich-Loeffler-Institut (FLI), WHO Collaborating Centre for Rabies Surveillance and Research, WOAH Reference Laboratory for Rabies, Greifswald-Insel Riems, Germany
| | - Thomas Müller
- Institute of Molecular Virology and Cell Biology, Friedrich-Loeffler-Institut (FLI), WHO Collaborating Centre for Rabies Surveillance and Research, WOAH Reference Laboratory for Rabies, Greifswald-Insel Riems, Germany
| | - Albertina Shilongo
- Directorate of Veterinary Services, Ministry of Agriculture, Water and Land Reform, Windhoek, Namibia
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Dunaiski CM, Kock MM, Chan WY, Ismail A, Peters RPH. Molecular epidemiology and antimicrobial resistance of vaginal Candida glabrata isolates in Namibia. Med Mycol 2024; 62:myae009. [PMID: 38308518 DOI: 10.1093/mmy/myae009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Revised: 12/16/2023] [Accepted: 02/01/2024] [Indexed: 02/04/2024] Open
Abstract
Candida glabrata is the most common non-albicans Candida species that causes vulvovaginal candidiasis (VVC). Given the intrinsically low susceptibility of C. glabrata to azole drugs, investigations into C. glabrata prevalence, fungal susceptibility profile, and molecular epidemiology are necessary to optimise the treatment of VVC. This molecular epidemiological study was conducted to determine antifungal drug profile, single nucleotide polymorphisms (SNPs) associated with phenotypic antifungal resistance and epidemic diversity of C. glabrata isolates from women with VVC in Namibia. Candida glabrata isolates were identified using phenotypic and molecular methods. Antifungal susceptibility of strains was determined for fluconazole, itraconazole, amphotericin B, and anidulafungin. Whole genome sequencing was used to determine SNPs in antifungal resistance genes and sequence type (ST) allocation. Among C. glabrata isolates, all (20/20; 100%) exhibited phenotypic resistance to the azole class antifungal drug, (fluconazole), and phenotypic susceptibility to the polyene class (amphotericin B), and the echinocandins (anidulafungin). Non-synonymous SNPs were identified in antifungal resistance genes of all fluconazole-resistant C. glabrata isolates including ERG6 (15%), ERG7 (15%), CgCDR1 (25%), CgPDR1 (60%), SNQ2 (10%), FKS1 (5.0%), FKS2 (5.0%), CgFPS1 (5.0%), and MSH2 (15%). ST15 (n = 8/20, 40%) was predominant. This study provides important insight into phenotypic and genotypic antifungal resistance across C. glabrata isolates from women with VVC in Namibia. In this study, azole resistance is determined by an extensive range of SNPs, while the observed polyene and echinocandin resistance-associated SNPs despite phenotypic susceptibility require further investigation.
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Affiliation(s)
- Cara M Dunaiski
- Namibia University of Sciences and Technology, Department of Health and Applied Sciences, Windhoek 10005, Namibia
- University of Pretoria, Department of Medical Microbiology, Pretoria 0001, South Africa
| | - Marleen M Kock
- University of Pretoria, Department of Medical Microbiology, Pretoria 0001, South Africa
- National Health Laboratory Service, Tshwane, Academic Division, Pretoria 3191, South Africa
| | - Wai Yin Chan
- Sequencing Core Facility, National Institute for Communicable Diseases a Division of the National Health Laboratory Service, Johannesburg 2131, South Africa
- Department of Biochemistry, Genetics and Microbiology, University of Pretoria, Pretoria 0081, South Africa
- Right to care, Centurion 0157, South Africa
| | - Arshad Ismail
- Sequencing Core Facility, National Institute for Communicable Diseases a Division of the National Health Laboratory Service, Johannesburg 2131, South Africa
- Department of Biochemistry and Microbiology, Faculty of Science, Engineering and Agriculture, University of Venda, Thohoyandou 0950, South Africa
- Institute for Water and Wastewater Technology, Durban University of Technology, Durban 4000, South Africa
| | - Remco P H Peters
- University of Pretoria, Department of Medical Microbiology, Pretoria 0001, South Africa
- University of Cape Town, Division of Medical Microbiology, Cape Town 7701, South Africa
- Foundation for Professional Development, Research Unit, East London 5217, South Africa
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10
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Mahalie R, Angula P, Mitonga KH, Oladimeji O. Patterns of availability and accuracy of risk factor data for cardiovascular diseases among people initiated on antiretroviral therapy at selected health facilities in Khomas region, Namibia: a retrospective, cross-sectional, quantitative study. Pan Afr Med J 2024; 47:33. [PMID: 38586067 PMCID: PMC10998256 DOI: 10.11604/pamj.2024.47.33.25340] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Accepted: 12/27/2023] [Indexed: 04/09/2024] Open
Abstract
Introduction quality data is a prerequisite for timely decision-making and measuring health outcomes in public health settings. Comorbidities such as cardiovascular diseases (CVDs) among people living with HIV (PLHIV), require a robust system that ensures credible data at all data-producing levels. The study at determining the level of availability and completeness of CVDs risk factors data of PLHIV. Methods a quantitative study was conducted to extract CVDs risk factors data retrospectively from 529 patient care booklets (PCBs) between 2004 and 2017. The analysis was done with the Statistical Package for Social Sciences (SPSS) version 25. Pearson Chi-Square was used to test for associations. The level of significance was at p ≤ 0.05. Results the study revealed that 72.8% of patients are at risk of CVDs due to incomplete demographics (73.72%) and other systemic data (41.18%). A significant association was found (Pearson Chi-Square test 19.907; p-value of 0.001) between average visits per year, accurate data recording, and active status of the patient. Lost to follow-up (15%) and true retention (27.2%) was significantly associated with the last Antiretroviral Therapy (ART) status of a patient (Pearson Chi-Square test 87.754; p-value of 0.001). Conclusion the study that despite concerted efforts to improve data quality, the availability and completeness of data remain unsatisfactory. Lack of harmonised data screening and analysis efforts for CVDs risk factors is found to be a significant risk factor in ensuring integrated routine measuring of CVDs health outcomes for PLHIV.
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Affiliation(s)
- Roswitha Mahalie
- Faculty of Health and Applied Sciences, Namibia University of Science and Technology, Windhoek, Namibia
| | - Penehafo Angula
- School of Public Health, Oshakati Campus, Faculty of Health Sciences, University of Namibia, Oshakati, Namibia
| | - Kabwebwe Honoré Mitonga
- School of Public Health, Oshakati Campus, Faculty of Health Sciences, University of Namibia, Oshakati, Namibia
| | - Olanrewaju Oladimeji
- Department of Epidemiology and Biostatistics, School of Public Health, Sefako Makgatho Health Sciences University, Pretoria, South Africa
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11
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Heemelaar S, Callard B, Shikwambi H, Ellmies J, Kafitha W, Stekelenburg J, van den Akker T, Mackenzie S. Confidential Enquiry into Maternal Deaths in Namibia, 2018-2019: A Local Approach to Strengthen the Review Process and a Description of Review Findings and Recommendations. Matern Child Health J 2023; 27:2165-2174. [PMID: 37777707 PMCID: PMC10618300 DOI: 10.1007/s10995-023-03771-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/01/2023] [Indexed: 10/02/2023]
Abstract
OBJECTIVES First objective was to strengthen the national maternal death review, by addressing local challenges with each step of the review cycle. Second objective was to describe review findings and compare these with available findings of previous reviews. METHODS Confidential Enquiry into Maternal Deaths methodology was used to review maternal deaths. To improve reporting, the national committee focussed on addressing fear of blame among healthcare providers. Second focus was on dissemination of findings and acting on recommendations forthcoming the review. Reviewed were reported maternal deaths, that occurred between 1 April 2018 and 31 March 2019. RESULTS Seventy maternal deaths were reported; for 69 (98.6%) medical records were available, compared to 80/119 (67.2%) in 2012-2015. Reported maternal mortality ratio increased with 48% (92/100,000 live births compared to 62/100,000 in 2012-2015). Obstetric haemorrhage was leading cause of death in the past three reviews. The "no name, no blame" policy, aiming to identify health system failures, rather than mistakes of individuals, was repeatedly explained to healthcare providers during facility visits. Recommendations based on findings of the review, such as retaining experienced staff, continuous in-service training and guidance, were shared with decision makers at regional and national levels. Healthcare providers received training based on review findings, which resulted in improved management of similar cases. CONCLUSIONS FOR PRACTICE Enhanced implementation of Confidential Enquiry into Maternal Deaths was possible after addressing local challenges. Focussing on obtaining trust of healthcare providers and feeding back findings, resulted in better reporting and prevention of potential maternal deaths.
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Affiliation(s)
- Steffie Heemelaar
- National Maternal Death, Stillbirth and Neonatal Death Review Committee, Division of Quality Assurance, Ministry of Health and Social Services, Windhoek, Namibia.
- Department of Obstetrics and Gynaecology, Leiden University Medical Center, Leiden, The Netherlands.
| | - Beatrix Callard
- National Maternal Death, Stillbirth and Neonatal Death Review Committee, Division of Quality Assurance, Ministry of Health and Social Services, Windhoek, Namibia
| | - Hilma Shikwambi
- National Maternal Death, Stillbirth and Neonatal Death Review Committee, Division of Quality Assurance, Ministry of Health and Social Services, Windhoek, Namibia
- Department of Nursing and Midwifery, International University of Management, Windhoek, Namibia
| | - Jana Ellmies
- National Maternal Death, Stillbirth and Neonatal Death Review Committee, Division of Quality Assurance, Ministry of Health and Social Services, Windhoek, Namibia
- Independent Midwives Association of Namibia, Windhoek, Namibia
| | - Wilhelmina Kafitha
- Division of Quality Assurance, Ministry of Health and Social Services, Windhoek, Namibia
| | - Jelle Stekelenburg
- Department of Health Science, Global Health, University Medical Center Groningen, Groningen, The Netherlands
- Department of Obstetrics and Gynaecology, Medical Center Leeuwarden, Leeuwarden, The Netherlands
| | - Thomas van den Akker
- Department of Obstetrics and Gynaecology, Leiden University Medical Center, Leiden, The Netherlands
- Athena Institute, VU University, Amsterdam, The Netherlands
| | - Shonag Mackenzie
- National Maternal Death, Stillbirth and Neonatal Death Review Committee, Division of Quality Assurance, Ministry of Health and Social Services, Windhoek, Namibia
- Department of Obstetrics and Gynaecology, University of Namibia, Windhoek, Namibia
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12
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Kaholongo NO, Mashingaidze-Mano R. Paediatric cancer burden in Namibia: A 10-year retrospective, analytical cohort study of patients admitted at Windhoek Central Hospital. PLoS One 2023; 18:e0292794. [PMID: 37972109 PMCID: PMC10653541 DOI: 10.1371/journal.pone.0292794] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Accepted: 09/28/2023] [Indexed: 11/19/2023] Open
Abstract
BACKGROUND Childhood cancers are known to cause significant morbidity and mortality, and the incidence has been increasing exponentially in developing countries. Two studies performed in Namibia in 1988 and 2010 have shown changes in the pattern of paediatric cancers over the years. There is a constant need to have updated statistics on the changing trends in the frequency of different types of cancers to inform policy hence the reason for the current study. METHODS An analytical retrospective cohort study was performed to analyse paediatric oncology cases that were admitted to the paediatric oncology unit (ward 8 west) at Windhoek Central Hospital (WCH) between 01 January 2011 and 31 December 2020. The study analysed the files of paediatric patients admitted with a paediatric cancer diagnosis from the age of 0 to 16 years. The research data was collected between July 2021 and September 2022. RESULTS A total of 174 paediatric cancer patient files met the inclusion criteria. Haematopoietic cancers were the most commonly occurring diagnosis of a paediatric cancer type in the study population (44.8%), of which leukaemias were the most common type of haematopoietic cancer. The other types of cancer apart from haematopoietic cancers consisted of embryonal cancers (37.9%), soft tissue and bone sarcomas (13.8%), and brain or CNS cancers (3.4%). The median age at diagnosis was 5.13 years, with an age range of 0 to 15 years. Fifty five point seven percent (55.7%) were males and 44.3% were females, with a male: female ratio of 1.26:1. Overall, most of the cancers were positively correlated with age, with the interactive-forward test indicating that the method of diagnosis and time significantly (P < 0.05) affected identification at the hospital. CONCLUSIONS Haematopoietic cancers remain most common type in Namibia. However, there has been a change in the ranking of the other childhood cancer subtypes over the last 3 decades. Good access to diagnosis and treatment modalities was noted as key to detection and clinical outcomes in the last 10 years (2011 to 2020). For future follow-up studies, prospective studies are recommended.
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Affiliation(s)
- Ndapewa Ottilie Kaholongo
- School of Medicine, Faculty of Medicine and Veterinary Sciences, University of Namibia, Windhoek, Namibia
| | - Runyararo Mashingaidze-Mano
- Division of Paediatrics, Department of Maternal and Child Health, School of Medicine, Faculty of Medicine and Veterinary Sciences, University of Namibia, Windhoek, Namibia
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13
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Boucheron P, Zietsman A, Pontac J, Hansen R, Anderson BO, Togawa K, Macharia PM, Foerster M, Schüz J, dos-Santos-Silva I, McCormack V. Analysis of the Breast Cancer Journey in Namibia. JAMA Netw Open 2023; 6:e2341402. [PMID: 37921764 PMCID: PMC10625043 DOI: 10.1001/jamanetworkopen.2023.41402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Accepted: 09/23/2023] [Indexed: 11/04/2023] Open
Abstract
Importance Breast cancer (BC) is the leading cancer among women in Namibia. Examining the BC journey in this multiracial country where inequalities remain large is needed to inform effective interventions to reduce BC mortality. Objective To describe the entire BC journey of Namibian women by race, utilizing the World Health Organization Global Breast Cancer Initiative (GBCI) framework. Design, Setting, and Participants This cohort study used the Namibian subset of the African Breast Cancer-Disparities in Outcomes prospective cohort. Participants were all Namibian residents with confirmed incident BC who presented at the main national public oncology center of the Windhoek Central Hospital (WCH). Follow-up started from recruitment (September 8, 2014, to October 5, 2016) and ended up to 3 years after diagnosis (December 13, 2014, to September 27, 2019). Data analysis was conducted from June 2022 to August 2023. Exposures Participants' self-reported ethnicities were aggregated into 3 population groups: Black, mixed ancestry, and White. Main Outcomes and Measures Three-year overall survival (OS) was examined using Cox models, and summary statistics were used to describe women's BC journey, including GBCI pillar key performance indicators: (1) early stage (TNM I or II) diagnosis (population benchmark ≥60%), (2) prompt diagnosis, ie, 60 days or less to first health care practitioner visit (population benchmark 100%), and (3) completion of recommended multimodal treatment (MT, ie, surgery plus chemotherapy) (population benchmark ≥80%). Results Of 405 women, there were 300 (74%) Black (mean [SD] age, 53 [15] years), 49 (12%) mixed ancestry (mean [SD] age, 53 [7] years), and 56 (14%) White (mean [SD] age, 59 [12] years) patients. Three-year OS was lowest in Black women (60% [95% CI, 54%-66%]; mixed ancestry: 80% [95% CI, 65%-89%]; White: 89% [95% CI, 77%-95%]), who had lower prevalence of early stage diagnosis (Black: 37% [95% CI, 31%-42%]; mixed ancestry and White: 75% [95% CI, 66%-83%]) and timely diagnosis (Black: 60% [95% CI, 54%-66%]; mixed ancestry and White: 77% [95% CI, 69%-85%]), while MT completion (Black: 53% [95% CI, 46%-59%]; mixed ancestry and White: 63% [95% CI, 50%-73%]) was low in all women. Conclusions and Relevance In this cohort study of 405 Namibian residents with BC, marked racial disparities in survival were paralleled by inequities all along the BC journey. To improve BC survival, interventions are needed to promote earlier diagnosis in Black Namibian women and to increase MT initiation and completion in all women.
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Affiliation(s)
- Pauline Boucheron
- International Agency for Research on Cancer, Environment and Lifestyle Epidemiology Branch, Lyon, France
| | - Annelle Zietsman
- AB May Cancer Centre, Windhoek Central Hospital, Windhoek, Namibia
| | - Johanna Pontac
- AB May Cancer Centre, Windhoek Central Hospital, Windhoek, Namibia
| | - Rolf Hansen
- Cancer Association of Namibia, Windhoek, Namibia
| | | | - Kayo Togawa
- International Agency for Research on Cancer, Environment and Lifestyle Epidemiology Branch, Lyon, France
- National Cancer Centre Institute for Cancer Control, Division of Population Data Science, Tokyo, Japan
| | - Peter M. Macharia
- Population Health Unit, Kenya Medical Research Institute–Wellcome Trust Research Programme, Nairobi, Kenya
- Centre for Health Informatics, Computing, and Statistics, Lancaster Medical School, Lancaster University, Lancaster, United Kingdom
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
| | - Milena Foerster
- International Agency for Research on Cancer, Environment and Lifestyle Epidemiology Branch, Lyon, France
| | - Joachim Schüz
- International Agency for Research on Cancer, Environment and Lifestyle Epidemiology Branch, Lyon, France
| | - Isabel dos-Santos-Silva
- Department of Non-Communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Valerie McCormack
- International Agency for Research on Cancer, Environment and Lifestyle Epidemiology Branch, Lyon, France
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14
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Shimanda PP, Söderberg S, Iipinge SN, Lindholm L, Shidhika FF, Norström F. Health-related quality of life and healthcare consultations among adult patients before and after diagnosis with rheumatic heart disease in Namibia. BMC Cardiovasc Disord 2023; 23:456. [PMID: 37704961 PMCID: PMC10500941 DOI: 10.1186/s12872-023-03504-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Accepted: 09/07/2023] [Indexed: 09/15/2023] Open
Abstract
BACKGROUND Rheumatic Heart Disease (RHD) causes high morbidity and mortality rates among children and young adults, impacting negatively on their health-related quality of life (HRQoL). This study aimed to evaluate the HRQoL and healthcare consultations of adult patients with RHD in Namibia. METHODS From June 2019 to March 2020, a questionnaire was administered to 83 RHD patients during routine follow-ups. The EQ-5D-5L instrument was used to assess the health-related quality of life before diagnosis and at the time of the survey. The Ethiopian value set for EQ-5D-5L was used to calculate Quality-Adjusted Life Years (QALY). RESULTS Most respondents were women (77%), young adults below the age of 30 years (42%), and individuals who grew up in rural areas (87%). The mean QALY statistically significantly improved from 0.773 pre-diagnosis to 0.942 in the last 12 months (p < 0.001). Sixty-six patients who had surgery reported a better QALY. Healthcare visits statistically significantly increased from on average 1.6 pre-diagnosis to 2.7 days in the last 12 months (p < 0.001). The mean distance to the nearest facility was 55 km, mean cost of transport was N$65, and mean time spent at the clinic was 3.6 h. The median time from diagnosis to the survey was 7 years (quartiles 4 and 14 years). CONCLUSION Treatment and surgery can improve HRQoL substantially among RHD patients. Being diagnosed with RHD affects patients living in socioeconomically disadvantaged rural areas through cost and time for healthcare visits. It would be valuable with further research to understand differences between disease severities.
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Affiliation(s)
- Panduleni Penipawa Shimanda
- Department of Epidemiology and Global Health, Umeå University, 901 87, Umeå, SE, Sweden.
- Clara Barton School of Nursing, Welwitchia Health Training Centre, Pelican Square, P.O. Box 1835, Windhoek, Namibia.
| | - Stefan Söderberg
- Department of Public Health and Clinical Medicine, Umeå University, 901 87, Cardiology, Umeå, SE, Sweden
| | - Scholastika Ndatinda Iipinge
- Clara Barton School of Nursing, Welwitchia Health Training Centre, Pelican Square, P.O. Box 1835, Windhoek, Namibia
| | - Lars Lindholm
- Department of Epidemiology and Global Health, Umeå University, 901 87, Umeå, SE, Sweden
| | | | - Fredrik Norström
- Department of Epidemiology and Global Health, Umeå University, 901 87, Umeå, SE, Sweden
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15
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Shinyemba TW, Cloete K. Exploring the nexus of water insecurity and psychological distress in Windhoek's informal settlements, Namibia. J Water Health 2023; 21:1051-1063. [PMID: 37632380 PMCID: wh_2023_076 DOI: 10.2166/wh.2023.076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/28/2023]
Abstract
Water insecurity has long been a pressing issue, particularly in the informal settlements of Windhoek. The current study aims to investigate the relationship between water insecurity and residents' psychological distress in Windhoek's informal settlements. The study draws upon secondary data collected by Future Resilience for African Cities and Lands in 2017. Confirmatory factor analysis was used to establish the relationship between water insecurity, psychological distress, and three manifest variables (source of income, housing type, and household structure). The study findings revealed a positive association between housing type and psychological distress (β = 0.056, p < 0.001). Household structure was negatively associated with psychological distress (β = -0.035, p < 0.001) and water insecurity (β = -0.054, p < 0.001). In addition, a positive association (β = 0.595, p < 0.001) was found between water insecurity and psychological distress, suggesting that water scarcity negatively impacts residents' mental well-being. The study highlights the need to address the issue of water insecurity in informal settlements across Windhoek. This can be achieved by setting measures to make water and essential sanitation services more accessible and affordable to residents in these communities. Such approaches would help mitigate the effect of water insecurity on the psychological distress of persons living in informal settlements and create more resilient and sustainable settlements.
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Affiliation(s)
- Tobias Willem Shinyemba
- Department of Computing, Mathematical and Statistical Sciences, School of Science, University of Namibia, Private Bag 13301, Windhoek, Namibia E-mail:
| | - Khanyisile Cloete
- Department of Computing, Mathematical and Statistical Sciences, School of Science, University of Namibia, Private Bag 13301, Windhoek, Namibia
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Agathis NT, Annor FB, Xu L, Swedo E, Chiang L, Coomer R, Hegle J, Patel P, Forster N, O’Malley G, Ensminger AL, Kamuingona R, Andjamba H, Nshimyimana B, Manyando M, Massetti GM. Strong Father-Child Relationships and Other Positive Childhood Experiences, Adverse Childhood Experiences, and Sexual Risk Factors for HIV among Young Adults Aged 19-24 Years, Namibia, 2019: A Cross-Sectional Study. Int J Environ Res Public Health 2023; 20:6376. [PMID: 37510608 PMCID: PMC10378761 DOI: 10.3390/ijerph20146376] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Revised: 07/07/2023] [Accepted: 07/11/2023] [Indexed: 07/30/2023]
Abstract
Using cross-sectional data from the 2019 Namibia Violence Against Children and Youth Survey and sex-stratified multivariable models, we assessed the associations between four different positive childhood experiences (PCEs) and having ≥3 adverse childhood experiences (ACEs), including ≥3 ACE-PCE interaction terms, and seven sexual risk factors for HIV acquisition among young adults aged 19-24 years. One PCE, having a strong father-child relationship, was inversely associated with two risk factors among women (lifetime transactional sex (OR, 0.4; 95% CI, 0.2-0.7) and recent age-disparate sexual relationships (OR, 0.3; 95% CI, 0.2-0.5)), and significantly interacted with having ≥3 ACEs for three risk factors among women (not knowing a partner's HIV status, infrequently using condoms, and ever having an STI) and one among men (having multiple sexual partners in the past year). The other PCEs were significantly associated with ≤1 HIV risk factor and had no significant interaction terms. Strong father-child relationships may reduce HIV acquisition risk and mitigate the effect of childhood adversity on HIV risk among young adults in Namibia.
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Affiliation(s)
- Nickolas T. Agathis
- Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA
- Division of Violence Prevention, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA 30341, USA
| | - Francis B. Annor
- Division of Violence Prevention, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA 30341, USA
| | - Likang Xu
- Division of Violence Prevention, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA 30341, USA
| | - Elizabeth Swedo
- Division of Violence Prevention, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA 30341, USA
| | - Laura Chiang
- Division of Violence Prevention, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA 30341, USA
| | - Rachel Coomer
- Division of Global HIV and TB, Global Health Center, Centers for Disease Control and Prevention, Private Bag, Windhoek 12029, Namibia
| | - Jennifer Hegle
- Division of Global HIV and TB, Global Health Center, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA
| | - Pragna Patel
- Division of Global HIV and TB, Global Health Center, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA
| | - Norbert Forster
- International Training and Education Center for Health, Department of Global Health, University of Washington, Seattle, WA 98195, USA
| | - Gabrielle O’Malley
- International Training and Education Center for Health, Department of Global Health, University of Washington, Seattle, WA 98195, USA
| | - Alison L. Ensminger
- International Training and Education Center for Health, Department of Global Health, University of Washington, Seattle, WA 98195, USA
| | - Rahimisa Kamuingona
- Ministry of Gender Equality, Poverty Eradication, and Social Welfare, Private Bag, Windhoek 13359, Namibia
| | - Helena Andjamba
- Ministry of Gender Equality, Poverty Eradication, and Social Welfare, Private Bag, Windhoek 13359, Namibia
| | - Brigitte Nshimyimana
- Ministry of Gender Equality, Poverty Eradication, and Social Welfare, Private Bag, Windhoek 13359, Namibia
| | - Molisa Manyando
- US Agency for International Development, Washington, DC 20004, USA
| | - Greta M. Massetti
- Division of Violence Prevention, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA 30341, USA
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van der Brug M, Wojtkowiak J, Hango VN. Caregiver-child communication on parental loss in the context of the AIDS epidemic in Namibia. Death Stud 2023; 48:293-302. [PMID: 37296529 DOI: 10.1080/07481187.2023.2219647] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Personal grief takes place in a social context, such as the family setting. This study aimed to understand how Namibian caregivers and children/adolescents communicate parental loss, in the context of the HIV/AIDS epidemic. An ethnographic design was used, in which 38 children, adolescents, and their caregivers were interviewed. The results show that caregivers shared few memories and provided minimal information about the deceased parents. However, the majority of adolescents and children wished for information. A relational Sender-Message-Channel-Receiver model was used to map the reasons for this silence. This model is useful for grief interventions that aim to strengthen communication.
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18
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Quarshie ENB, Dey NEY, Oppong Asante K. Adolescent suicidal behaviour in Namibia: a cross-sectional study of prevalence and correlates among 3,152 school learners aged 12-17 years. BMC Psychiatry 2023; 23:169. [PMID: 36922818 PMCID: PMC10018865 DOI: 10.1186/s12888-023-04646-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Accepted: 03/01/2023] [Indexed: 03/17/2023] Open
Abstract
BACKGROUND While adolescent suicidal behaviour (ideation, planning, and attempt) remains a global public health concern, available county-specific evidence on the phenomenon from African countries is relatively less than enough. The present study was conducted to estimate the 12-month prevalence and describe some of the associated factors of suicide behaviour among school-going adolescents aged 12-17 years old in Namibia. METHODS Participants (n = 4531) answered a self-administered anonymous questionnaire developed and validated for the nationally representative Namibia World Health Organization Global School-based Student Health Survey conducted in 2013. We applied univariate, bivariable, and multivariable statistical approaches to the data. RESULTS Of the 3,152 analytical sample, 20.2% (95% confidence interval [CI]: 18.3-22.2%) reported suicidal ideation, 25.2% (95% CI: 22.3-28.4%) engaged in suicide planning, and 24.5% (95% CI: 20.9-28.6%) attempted suicide during the previous 12 months. Of those who attempted suicide, 14.6% (95% CI: 12.5-16.9%) reported one-time suicide attempt, and 9.9% (95% CI: 8.1-12.1%) attempted suicide at least twice in the previous 12 months. The final adjusted multivariable models showed physical attack victimisation, bullying victimisation, loneliness, and parental intrusion of privacy as key factors associated with increased likelihood of suicidal ideation, planning, one-time suicide attempt, and repeated attempted suicide. Cannabis use showed the strongest association with increased relative risk of repeated attempted suicide. CONCLUSION The evidence highlights the importance of paying more attention to addressing the mental health needs (including those related to psychological and social wellness) of school-going adolescents in Namibia. While the current study suggests that further research is warranted to explicate the pathways to adolescent suicide in Namibia, identifying and understanding the correlates (at the individual-level, family-level, interpersonal-level, school context and the broader community context) of adolescent suicidal ideations and non-fatal suicidal behaviours are useful for intervention and prevention programmes.
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Affiliation(s)
| | | | - Kwaku Oppong Asante
- Department of Psychology, University of Ghana, P.O. Box LG 84, Accra, Ghana
- Department of Psychology, University of the Free State, Bloemfontein, South Africa
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Nghipandulwa MT, Mukong AK. Estimating Income-Related Health Inequalities Associated with Tobacco and Alcohol Consumption in Namibia. Int J Environ Res Public Health 2023; 20:1062. [PMID: 36673818 PMCID: PMC9859020 DOI: 10.3390/ijerph20021062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Revised: 12/31/2022] [Accepted: 01/04/2023] [Indexed: 06/17/2023]
Abstract
Disparities in resources and access to material opportunities are important determinants of income-related health inequality. This paper hypothesises that the gradient of the inequality in health between the poor and the rich is likely to depend on differences in lifestyle practices including tobacco use and alcohol abuse. Using the 2015/16 Namibia Household Income and Expenditure Survey and the Erreygers corrected concentration index, we estimate the effect of tobacco and alcohol use on income-related health inequalities. A decomposition technique was used to estimate the separate and joint contribution of tobacco and alcohol use to income-related health inequalities. The results indicate that tobacco use widens the income-related health inequality gap while alcohol consumption reduces health disparities. The simultaneous consumption of these goods has a stronger multiplicative effect on income-related health inequality. For instance, the simultaneous consumption of both goods contribute up to 1.03% of the inequality in health while tobacco use alone contributed only 0.6%. While policy options for each of these goods could be essential in reducing inequalities in health, there is a need to advocate additional measures that could simultaneously control the consumption of both goods.
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Mthoko NFN, Pazvakawambwa L, Leonhardt M, Lien L. Risk factors for cardiovascular disease among people with mental illness in Namibia. Ghana Med J 2022; 56:285-294. [PMID: 37575634 PMCID: PMC10416288 DOI: 10.4314/gmj.v56i4.7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/15/2023] Open
Abstract
Objectives To determine the prevalence of risk factors for cardiovascular disease (CVD) among people with mental illness attending the Mental Health Care Centre, Windhoek, Namibia. Design Observational, cross-sectional study. Setting Mental health Care Centre, Windhoek Central Hospital. Namibia. Participants Adult patients with a mental illness attending the Mental Health Care Centre, Windhoek. Data collection Within a systematic random sampling method, 385 adult patients with mental illness were recruited between May and December 2017. Statistical analysis Validated assessment tools were used. Descriptive summary statistics and Chi-squared tests of association were conducted. Results One-third (31.7%) of participants used alcohol, 21% used nicotine, 21.3% had hypertension, 55% were over-weight or obese, 59.2% of females and 11.5% of males had abdominal obesity. About twenty per cent (19.9%) of participants did meet the World Health Organisation recommended level of activity, while more than two-thirds of participants did not participate in moderate or vigorous physical activities. The patient's psychiatric condition was significantly associated with alcohol use (Chi-square=20.450, p=0.002) and physical activity (Chi-square=20.989, p=0.002). The psychiatric condition was not associated with the waist circumference and gender of the participant. Conclusions The increased prevalence of CVD risk factors in people with mental illness calls for mental health practitioners to screen, monitor and manage these risk factors regularly. Systematically screening and monitoring for cardiovascular risk factors is likely to contribute to National targets and significantly impact cardiovascular morbidity and mortality in people with mental illness. Funding This work was financed by internal resources of the Mental Health Care Centre, Windhoek Central Hospital.
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Affiliation(s)
| | - Lilian Pazvakawambwa
- Department of Statistics and Population Studies, University of Namibia, P. O. Box 40933, Ausspannplatz, Windhoek, Namibia
| | - Marja Leonhardt
- Norwegian National Advisory Unit on Concurrent Substance Abuse and Mental Health Disorders, Innlandet Hospital Trust, Post box 104, 2381 Brumunddal, Norway
- Faculty of Health Studies, VID – Specialized University, Oslo, Norway
| | - Lars Lien
- Norwegian National Advisory Unit on Concurrent Substance Abuse and Mental Health Disorders, Innlandet Hospital Trust, Post box 104, 2381 Brumunddal, Norway
- Department of Health and Social Science, Innlandet University of Applied Science, Elverum, Norway
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21
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Velloza J, Davies LD, Ensminger AL, Theofelus FM, Andjamba H, Kamuingona R, Masseti G, Coomer R, Forster N, O’Malley G. Cycles of Violence Among Young Women in Namibia: Exploring the Links Between Childhood Violence and Adult Intimate Partner Violence From the Violence Against Children and Youth Survey. J Interpers Violence 2022; 37:NP22992-NP23014. [PMID: 35156448 PMCID: PMC9661872 DOI: 10.1177/08862605211073107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Background: Violence against children is a global public health crisis and is associated with poor mental and physical health outcomes. Childhood violence may also increase the risk of subsequent violence revictimization by an intimate partner. We aimed to understand cycles of violence among adolescent girls and young women in Namibia to inform violence prevention and treatment interventions. Methods: The 2019 Namibia Violence Against Children and Youth Survey (VACS) examined the prevalence of childhood violence and intimate partner violence among 18-24 year old adolescent girls and young women (N = 2434). Using the data, we assessed the prevalence of childhood violence, defined as any physical, sexual, or emotional violence victimization prior to age 18, and estimated the prevalence of intimate partner violence (IPV) after age 18. We used a weighted logistic regression to assess whether childhood violence exposure was associated with subsequent experience of IPV after age 18. Results: Adolescent girls and young women in Namibia had a statistically significant higher odds of experiencing IPV if they had experienced any childhood violence including physical, sexual, and/or emotional violence (adjusted odds ratio [aOR]: 2.93; 95% Confidence Interval [95% CI: 1.64-5.23). IPV was also significantly associated with childhood physical (aOR: 1.81; 95% CI: 1.07-3.05), sexual (aOR: 3.79; 95% CI: 2.54-5.67), or emotional (aOR: 2.39; 95% CI: 1.18-4.86) violence when each were considered separately. We also observed a dose-response relationship between the number of types of childhood violence and IPV experience as a young adult. Conclusions: Childhood violence is a significant predictor of subsequent violence revictimization by an intimate partner. This analysis provides unique insights on cycles of violence among adolescent girls and young women in Namibia and points to the need for interventions during childhood to prevent violence against children and break this cycle among young women in sub-Saharan Africa.
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Affiliation(s)
- Jennifer Velloza
- University of Washington, Department of Global Health, Seattle, WA, USA
| | - Luke D. Davies
- University of Washington, Department of Global Health, Seattle, WA, USA
- International Training and Education Center for Health (I-TECH), University of Washington, Seattle, WA, USA
| | - Alison L. Ensminger
- University of Washington, Department of Global Health, Seattle, WA, USA
- International Training and Education Center for Health (I-TECH), University of Washington, Seattle, WA, USA
| | | | - Helena Andjamba
- Ministry of Gender Equality and Child Welfare, Government of Namibia, Windhoek, Namibia
| | - Rahimisa Kamuingona
- Ministry of Gender Equality and Child Welfare, Government of Namibia, Windhoek, Namibia
| | - Greta Masseti
- Division of Violence Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Rachel Coomer
- Centers for Disease Control and Prevention, Windhoek, Namibia
| | - Norbert Forster
- University of Washington, Department of Global Health, Seattle, WA, USA
- International Training and Education Center for Health (I-TECH), University of Washington, Windhoek, Namibia
| | - Gabrielle O’Malley
- University of Washington, Department of Global Health, Seattle, WA, USA
- International Training and Education Center for Health (I-TECH), University of Washington, Seattle, WA, USA
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22
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Munyayi FK, van Wyk B. Closing the HIV Treatment Gap for Adolescents in Windhoek, Namibia: A Retrospective Analysis of Predictors of Viral Non-Suppression. Int J Environ Res Public Health 2022; 19:ijerph192214710. [PMID: 36429431 PMCID: PMC9690371 DOI: 10.3390/ijerph192214710] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/15/2022] [Revised: 11/04/2022] [Accepted: 11/05/2022] [Indexed: 05/04/2023]
Abstract
Windhoek joined the Fast-Track Cities Initiative in 2017 to optimize HIV service delivery for adolescents, promoting adherence and sustaining viral suppression. Recent surveys and programmatic data show that the treatment gap remains greatest among children and adolescents living with HIV. A retrospective cohort analysis of adolescents living with HIV (ALHIV) receiving antiretroviral therapy (ART) at Windhoek healthcare facilities was conducted. Routine clinical data were extracted from the electronic Patient Monitoring System (ePMS). The SPSS statistical package was used to determine viral non-suppression and perform inferential statistics. 695 ALHIV were analysed with median age of 16 years (IQR = 13-18). Viral non-suppression at 1000 copies/mL threshold was 12%. Viral non-suppression was associated with age at ART initiation, duration on ART, current ART regimen and WHO Clinical Stage. In multivariate analysis, longer duration on ART was a protective factor for viral non-suppression (13-24 months vs. >24 months: aOR = 8.92, 95% CI 2.60-30.61), while being on third line regimen (vs. first line) was protective against viral non-suppression (aOR = 0.11, 95% CI 0.03-0.49). A significant treatment gap is evident for ALHIV with high viral non-suppression levels. Interventions are required to counter treatment fatigue to keep adolescents engaged in ART, and timely switching to rescue regimens for failing adolescents.
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23
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Adewoyin Y, Odimegwu CO. Gender relations and the utilization of contraceptives and antenatal care services in Kenya, Namibia and Nigeria. Afr J Reprod Health 2022; 26:141-153. [PMID: 37585141 DOI: 10.29063/ajrh2022/v26i11.13] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/17/2023]
Abstract
The impacts of gender relations (GR) on reproductive health in sub-Saharan Africa (SSA) have received little attention. Virtually non-existent are studies that take cognizance of the socio-cultural diversity of SSA countries in assessing the impacts. Using Demographic and Health Survey data from Namibia, Kenya and Nigeria, this study investigated whether feminine gender relations (FGR) predict higher uptake of contraceptives and antenatal care services (ANC) in SSA. Results from univariate, bivariate and multivariate analyses showed that Namibia had the highest prevalence of FGR (20.0%) and contraceptive use (57.8%) while Nigeria had the lowest FGR (5.7%) but highest ANC utilization (42.1%). At the unadjusted levels, FGR predicted higher contraceptive use in Namibia and Nigeria but became insignificant when sociodemographic confounders were controlled for. Masculine gender relations (MGR) however predicted increased contraceptive and ANC utilization in the three countries at the unadjusted levels and contraceptive use in Kenya and Nigeria when adjusted. That MGR predicted higher odds of using contraceptives in a largely gender egalitarian Kenya and patriarchal Nigeria while FGR was insignificant even in the largely feministic Namibia, suggests that promoting equality in GR, rather than emphasizing female autonomy, possesses greater capacity for improving reproductive health outcomes in SSA.
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Affiliation(s)
- Yemi Adewoyin
- Department of Geography, Faculty of the Social Sciences, University of Nigeria, Nsukka, Nigeria
- Demography and Population Studies Programme, Schools of Public Health and Social Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Clifford O Odimegwu
- Demography and Population Studies Programme, Schools of Public Health and Social Sciences, University of the Witwatersrand, Johannesburg, South Africa
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24
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Samkange A, van der Westhuizen J, Voigts AS, Chitate F, Kaatura I, Khaiseb S, Hikufe EH, Kabajani J, Bishi AS, Mbiri P, Hawanga NN, Mushonga B. Investigation of the outbreaks of abortions and orchitis in livestock in Namibia during 2016-2018. Trop Anim Health Prod 2022; 54:346. [PMID: 36242679 DOI: 10.1007/s11250-022-03342-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2022] [Accepted: 10/04/2022] [Indexed: 11/28/2022]
Abstract
This study investigated outbreaks of seemingly related abortions and orchitis which occurred in the Khomas, Omaheke and Otjozondjupa regions of Namibia from 2016 to 2018, affecting cattle, sheep and goats. Fifty-nine questionnaires were administered, and 48 were completed giving an 81.4% return. The outbreaks were limited to Namibia's east and central regions, mainly on farms rearing cattle, sheep and goats and on farms with a mixture of these species. There was no significant difference between Khomas and other regions on abortion reporting at the farm level [X2 (1, N = 48) = 0.0002, p = 0.987851]. However, there was a significant difference in the abortions at the animal level among the three regions [X2 (2, N = 6246) = 239.8339, p = .00001]. In addition, the proportions of abortions calculated at the animal level at each farm were significantly different when the Khomas region was compared to the other regions. Seventeen cattle sera, 35 sheep sera, 52 caprine sera, 18 bovine liver samples, one caprine liver, five aborted cattle foetuses, two cattle placentas, 18 testes (one bull, eight bucks and nine rams) and ten bull sheath scrapings were collected and tested. Histopathology, microbiology, serology, immunohistochemistry, real-time PCR and mineral analytical techniques were used to establish the aetiology of the abortion and orchitis outbreaks. The gross and histopathological findings on the 18 testicles were characteristic of chronic orchitis. In aborted foetuses, significant histopathological findings included meconium aspiration, funisitis and cardiomyopathy. Placentitis and endometritis were the primary pathologies observed in cows. The bacteria isolated from microbiological samples included Enterococcus spp. (65.5% [19/29]), Enterobacter spp. (6.9% [2/29]) and Streptococcus spp. (10.3% [3/29]), Trueperella pyogenes (3.4% [1/29]), Stenotrophomonas maltophilia (3.4% [1/29]), Staphylococcus epidermidis (3.4% [1/29]), Providencia rettgeri (3.4% [1/29]) and Acinetobacter lwoffii (3.4% [1/29]), mostly opportunistic bacteria. On mineral analysis, 28%, 33%, 83%, 33% and 17% (n = 18) of cattle livers were low in copper, zinc, manganese, selenium and iron, respectively. Twenty-three percent (12/52) of the caprine sera were positive for Brucella melitensis on the Rose Bengal and complement fixation tests. Thirty-five ovine sera were tested for B. melitensis, B. ovis and Coxiella burnetii, and the prevalence for each was 2.9% (1/35). PCR tests on foetuses were all negative for Brucella spp., Coxiella burnetii, Chlamydia spp., Listeria monocytogenes, Salmonella spp., Campylobacter fetus spp., Leptospira pathogenic strains, bovine viral diarrhoea virus, Rift Valley fever virus, Anaplasma phagocytophilum and bovine herpes virus 4 Campylobacter fetus spp. and Trichomonas foetus spp. The authors concluded that Brucella spp., Enterococcus spp., Escherichia coli, Streptococcus spp., Trueperella pyogenes and Coxiella burnetii could have contributed to this outbreak. Micronutrient imbalances and pathogenic abiotic nanoparticles were also identified as possible contributors to the abortion outbreaks.
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Affiliation(s)
- Alaster Samkange
- School of Veterinary Medicine, Faculty of Health Sciences and Veterinary Medicine, University of Namibia, P. Bag 13301, Windhoek, Namibia.
| | | | | | - Frank Chitate
- School of Veterinary Medicine, Faculty of Health Sciences and Veterinary Medicine, University of Namibia, P. Bag 13301, Windhoek, Namibia
| | - Israel Kaatura
- School of Veterinary Medicine, Faculty of Health Sciences and Veterinary Medicine, University of Namibia, P. Bag 13301, Windhoek, Namibia
| | - Siegfried Khaiseb
- Directorate of Veterinary Services, Central Veterinary Laboratory, Private Bag 13187, Windhoek, Namibia
| | - Emmanuel H Hikufe
- Directorate of Veterinary Services, Central Veterinary Laboratory, Private Bag 13187, Windhoek, Namibia
| | - Juliet Kabajani
- Directorate of Veterinary Services, Central Veterinary Laboratory, Private Bag 13187, Windhoek, Namibia
| | - Alec S Bishi
- School of Veterinary Medicine, Faculty of Health Sciences and Veterinary Medicine, University of Namibia, P. Bag 13301, Windhoek, Namibia
| | - Pricilla Mbiri
- School of Veterinary Medicine, Faculty of Health Sciences and Veterinary Medicine, University of Namibia, P. Bag 13301, Windhoek, Namibia
| | - Ndahafa N Hawanga
- School of Veterinary Medicine, Faculty of Health Sciences and Veterinary Medicine, University of Namibia, P. Bag 13301, Windhoek, Namibia
| | - Borden Mushonga
- School of Veterinary Medicine, Faculty of Health Sciences and Veterinary Medicine, University of Namibia, P. Bag 13301, Windhoek, Namibia
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25
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Uushona SI, Sheehama JA, Iita H. Sociocultural factors that influence the prevention of malaria in Ohangwena region, Namibia. Afr J Prim Health Care Fam Med 2022; 14:e1-e10. [PMID: 36073126 PMCID: PMC9453133 DOI: 10.4102/phcfm.v14i1.3524] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Revised: 06/10/2022] [Accepted: 06/20/2022] [Indexed: 11/29/2022] Open
Abstract
Background Namibia is undergoing an epidemiological transition after decline in local transmission of malaria, and the country is now in a position to move towards eliminating local transmission by 2030. However, malaria prevalence cannot be adequately explained from medical and modern prevention points of view alone. The persistence of malaria might appear as a result of not recognising sociocultural factors that seem useful in the prevention of malaria, Hence, studies on sociocultural factors are limited. Aim The aim of this study was to describe the sociocultural factors that influence the prevention of malaria in Ohangwena region. Setting The study was conducted in Ohangwena region of northern Namibia. Methods This study was a cross-sectional study and a mixed methods, convergent parallel design was employed. Results The major theme revealed that traditional prevention methods of malaria are widely available in rural communities. The best accepted traditional prevention methods include tumbleweed, bitter bush and animal dung. Quantitative findings indicated that 67.0% of participants felt that nets are expensive. Key barriers included the long distance to access health facilities (29.1%), long waiting times (25.8%) and the lack of money to pay for services and transport (22.5%). Conclusion The limited access to and cost of Western prevention methods minimise protection because of priority and resource allocations, but it could be mitigated with the use of locally available traditional prevention practices used for many years in curbing malaria. There is a need to create awareness about socioculturally congruent malaria care. Contribution This study has revealed the need to combine standard prevention with traditional prevention practices in the fight against malaria, and it intensified research focusing on interventions that address sociocultural factors for the prevention of malaria in endemic regions. In addition, part of the novelty of the study is establishing the need to test the efficacy of traditional practices used.
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Affiliation(s)
- Selma I Uushona
- Department of Community and Mental Health, Faculty of Health Sciences, University of Namibia, Oshakati.
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26
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Basenero A, Neidel J, Ikeda DJ, Ashivudhi H, Mpariwa S, Kamangu JWN, Mpalang Kakubu MA, Hans L, Mutandi G, Jed S, Tjituka F, Hamunime N, Agins BD. Integrating hypertension and HIV care in Namibia: A quality improvement collaborative approach. PLoS One 2022; 17:e0272727. [PMID: 35951592 PMCID: PMC9371294 DOI: 10.1371/journal.pone.0272727] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Accepted: 07/25/2022] [Indexed: 11/24/2022] Open
Abstract
Background Hypertension (HTN) is highly prevalent among people with HIV (PWH) in Namibia, but screening and treatment for HTN are not routinely offered as part of HIV care delivery. We report the implementation of a quality improvement collaborative (QIC) to accelerate integration of HTN and HIV care within public-sector health facilities in Namibia. Methods Twenty-four facilities participated in the QIC with the aim of increasing HTN screening and treatment among adult PWH (>15 years). HTN was defined according to national treatment guidelines (i.e., systolic blood pressure >140 and/or diastolic blood pressure >90 across three measurements and at least two occasions), and decisions regarding initiation of treatment were made by physicians only. Teams from participating hospitals used quality improvement methods, monthly measurement of performance indicators, and small-scale tests of change to implement contextually tailored interventions. Coaching of sites was performed on a monthly basis by clinical officers with expertise in QI and HIV, and sites were convened as part of learning sessions to facilitate diffusion of effective interventions. Results Between March 2017 and March 2018, hypertension screening occurred as part of 183,043 (86%) clinical encounters at participating facilities. Among 1,759 PWH newly diagnosed with HTN, 992 (56%) were initiated on first-line treatment. Rates of treatment initiation were higher in facilities with an on-site physician (61%) compared to those without one (51%). During the QIC, facility teams identified fourteen interventions to improve HTN screening and treatment. Among barriers to implementation, teams pointed to malfunctions of blood pressure machines and stock outs of antihypertensive medications as common challenges. Conclusions Implementation of a QIC provided a structured approach for integrating HTN and HIV services across 24 high-volume facilities in Namibia. As rates of HTN treatment remained low despite ongoing facility-level changes, policy-level interventions—such as task sharing and supply chain strengthening—should be pursued to further improve delivery of HTN care among PWH beyond initial screening.
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Affiliation(s)
| | - Julie Neidel
- Institute for Global Health Sciences, University of California, San Francisco, California, United States of America
| | - Daniel J. Ikeda
- Harvard Medical School, Boston, Massachusetts, United States of America
| | | | | | | | | | - Linea Hans
- U.S. Centers for Disease Control and Prevention, Windhoek, Namibia
| | - Gram Mutandi
- U.S. Centers for Disease Control and Prevention, Windhoek, Namibia
| | - Suzanne Jed
- Office of the U.S. Global AIDS Coordinator and Health Diplomacy, Pretoria, South Africa
| | | | | | - Bruce D. Agins
- Institute for Global Health Sciences, University of California, San Francisco, California, United States of America
- * E-mail:
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27
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Ntuku H, Smith-Gueye C, Scott V, Njau J, Whittemore B, Zelman B, Tambo M, Prach LM, Wu L, Schrubbe L, Kang Dufour MS, Mwilima A, Uusiku P, Sturrock H, Bennett A, Smith J, Kleinschmidt I, Mumbengegwi D, Gosling R, Hsiang M. Cost and cost effectiveness of reactive case detection (RACD), reactive focal mass drug administration (rfMDA) and reactive focal vector control (RAVC) to reduce malaria in the low endemic setting of Namibia: an analysis alongside a 2×2 factorial design cluster randomised controlled trial. BMJ Open 2022; 12:e049050. [PMID: 35738650 PMCID: PMC9226870 DOI: 10.1136/bmjopen-2021-049050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
OBJECTIVES To estimate the cost and cost effectiveness of reactive case detection (RACD), reactive focal mass drug administration (rfMDA) and reactive focal vector control (RAVC) to reduce malaria in a low endemic setting. SETTING The study was part of a 2×2 factorial design cluster randomised controlled trial within the catchment area of 11 primary health facilities in Zambezi, Namibia. PARTICIPANTS Cost and outcome data were collected from the trial, which included 8948 community members that received interventions due to their residence within 500 m of malaria index cases. OUTCOME MEASURES The primary outcome was incremental cost effectiveness ratio (ICER) per in incident case averted. ICER per prevalent case and per disability-adjusted life years (DALY) averted were secondary outcomes, as were per unit interventions costs and personnel time. Outcomes were compared as: (1) rfMDA versus RACD, (2) RAVC versus no RAVC and (3) rfMDA+RAVC versus RACD only. RESULTS rfMDA cost 1.1× more than RACD, and RAVC cost 1.7× more than no RAVC. Relative to RACD only, the cost of rfMDA+RAVC was double ($3082 vs $1553 per event). The ICERs for rfMDA versus RACD, RAVC versus no RAVC and rfMDA+RAVC versus RACD only were $114, $1472 and $842, per incident case averted, respectively. Using prevalent infections and DALYs as outcomes, trends were similar. The median personnel time to implement rfMDA was 20% lower than for RACD (30 vs 38 min per person). The median personnel time for RAVC was 34 min per structure sprayed. CONCLUSION Implemented alone or in combination, rfMDA and RAVC were cost effective in reducing malaria incidence and prevalence despite higher implementation costs in the intervention compared with control arms. Compared with RACD, rfMDA was time saving. Cost and time requirements for the combined intervention could be decreased by implementing rfMDA and RAVC simultaneously by a single team. TRIAL REGISTRATION NUMBER NCT02610400; Post-results.
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Affiliation(s)
- Henry Ntuku
- Malaria Elimination Initiative, Global Health Group, University of California San Francisco, San Francisco, California, USA
| | - Cara Smith-Gueye
- Malaria Elimination Initiative, Global Health Group, University of California San Francisco, San Francisco, California, USA
| | - Valerie Scott
- Malaria Elimination Initiative, Global Health Group, University of California San Francisco, San Francisco, California, USA
| | - Joseph Njau
- JoDon Consulting Group LLC, Atlanta, Georgia, USA
| | - Brooke Whittemore
- Department of Pediatrics, The University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Brittany Zelman
- Malaria Elimination Initiative, Global Health Group, University of California San Francisco, San Francisco, California, USA
| | - Munyaradzi Tambo
- Multidisciplinary Research Centre, University of Namibia, Windhoek, Namibia
| | - Lisa M Prach
- Malaria Elimination Initiative, Global Health Group, University of California San Francisco, San Francisco, California, USA
| | - Lindsey Wu
- Department of Infection Biology, London School of Hygiene & Tropical Medicine, London, UK
| | - Leah Schrubbe
- Malaria Elimination Initiative, Global Health Group, University of California San Francisco, San Francisco, California, USA
| | - Mi-Suk Kang Dufour
- Division of Prevention Science, University of California San Francisco, San Francisco, California, USA
| | - Agnes Mwilima
- Ministry of Health and Social Services, Zambezi Region, Katima Mulilo, Namibia
| | - Petrina Uusiku
- Ministry of Health and Social Services, Windhoek, Namibia
| | - Hugh Sturrock
- Malaria Elimination Initiative, Global Health Group, University of California San Francisco, San Francisco, California, USA
| | - Adam Bennett
- Malaria Elimination Initiative, Global Health Group, University of California San Francisco, San Francisco, California, USA
| | - Jennifer Smith
- Malaria Elimination Initiative, Global Health Group, University of California San Francisco, San Francisco, California, USA
| | - Immo Kleinschmidt
- Faculty of Health Sciences, School of Pathology, University of the Witwatersrand, Johannesburg, South Africa
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | - Davis Mumbengegwi
- Multidisciplinary Research Centre, University of Namibia, Windhoek, Namibia
| | - Roly Gosling
- Malaria Elimination Initiative, Global Health Group, University of California San Francisco, San Francisco, California, USA
| | - Michelle Hsiang
- Malaria Elimination Initiative, Global Health Group, University of California San Francisco, San Francisco, California, USA
- Department of Pediatrics, The University of Texas Southwestern Medical Center, Dallas, Texas, USA
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28
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Molini U, Franzo G, Rautenbach I, Otto HV, Khaiseb S, Di Gennaro A, Ntahonshikira C, Baines I, Monaco F, Savini G, D'Alterio N. Neutralising antibodies to West Nile virus detected in horses in Windhoek, Namibia. J S Afr Vet Assoc 2022; 93:39a-39c. [PMID: 35950809] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2023] Open
Abstract
West Nile virus (WNV) is a vector-borne virus maintained in nature by a bird-mosquito cycle. However, it can occasionally and accidentally infect horses and human beings, leading to sometimes severe or even fatal outcomes in these species. Therefore, the monitoring of its circulation and disease occurrence is of relevance. Unfortunately, it is underdiagnosed or not diagnosed in several African counties, including Namibia, where no data is currently available for horses. In this study, 98 horses in three different stables in the Windhoek city area were investigated. They were found to have a seroprevalence of approximately 7%. Positive reactions were seen at all three stables, suggesting a greater than expected prevalence of the virus. This is the first report of serological evidence for the presence of the virus in horses in Nambia. Even though clinical signs were not reported in any of the stables from which the sera were derived, the seroprevalence to the virus suggests that horses with high genetic and/or economic value could benefit from vaccination against WNV. Because of the zoonotic potential of the virus, these findings are also of significance to human health authorities.
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Affiliation(s)
- U Molini
- Department of Para-Clinical Studies, School of Veterinary Medicine, Faculty of Health Sciences and Veterinary Medicine, University of Namibia, Namibia and Department of Biotechnology, Central Veterinary Laboratory, Namibia
| | - G Franzo
- Department of Animal Medicine, Production and Health, University of Padova, Italy
| | - I Rautenbach
- Department of Para-Clinical Studies, School of Veterinary Medicine, Faculty of Health Sciences and Veterinary Medicine, University of Namibia, Namibia
| | - H V Otto
- Department of Para-Clinical Studies, School of Veterinary Medicine, Faculty of Health Sciences and Veterinary Medicine, University of Namibia, Namibia
| | - S Khaiseb
- Department of Biotechnology, Central Veterinary Laboratory, Namibia
| | - A Di Gennaro
- Istituto Zooprofilattico Sperimentale dell'Abruzzo e del Molise G. Caporale, Teramo, Italy
| | - C Ntahonshikira
- Department of Para-Clinical Studies, School of Veterinary Medicine, Faculty of Health Sciences and Veterinary Medicine, University of Namibia, Namibia
| | - I Baines
- Department of Production Animal Clinical Studies, School of Veterinary Medicine, Faculty of Agriculture and Natural Resources, University of Namibia, Namibia
| | - F Monaco
- Istituto Zooprofilattico Sperimentale dell'Abruzzo e del Molise G. Caporale, Teramo, Italy
| | - G Savini
- Istituto Zooprofilattico Sperimentale dell'Abruzzo e del Molise G. Caporale, Teramo, Italy
| | - N D'Alterio
- Istituto Zooprofilattico Sperimentale dell'Abruzzo e del Molise G. Caporale, Teramo, Italy
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Aschenborn J, Schneider C, Addy F, Aschenborn O, Kern P, Romig T, Deplazes P, Wassermann M. Cystic echinococcosis of ruminant livestock in Namibia. Vet Parasitol Reg Stud Reports 2022; 31:100727. [PMID: 35569909 DOI: 10.1016/j.vprsr.2022.100727] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Revised: 03/10/2022] [Accepted: 03/28/2022] [Indexed: 06/15/2023]
Abstract
Cystic echinococcosis (CE) is widespread and locally frequent in southern Africa where it affects humans, livestock, and wild mammals. However, most data from the region are old and do not provide information on the causative Echinococcus species. For Namibian livestock only anecdotal records were available prior to this preliminary survey. Our retrospective analysis of slaughterhouse records of CE in cattle from the commercial farming area in central and southern Namibia resulted in 1.65% CE prevalence among 35,143 slaughtered cattle in the period 2015-2016. For comparison, carcasses of ruminant livestock were prospectively examined in the communal farming areas of northern Namibia, resulting in three CE cases among only 12 cattle, and no cases among nine goats. To determine the Echinococcus species affecting Namibian livestock, a total of 53 cysts were collected from all parts of the country and analysed for species and genotype by amplification and sequencing of the nad1 gene. All 50 cattle cysts (isolated from 40 cattle), both from the commercial and communal farming areas, were Echinococcus ortleppi (all fertile, and 42/50 from the lungs), while three opportunistically collected cysts from three sheep in southern Namibia were E. canadensis G7. Our data suggest that E. ortleppi is the only CE agent that is relevant for cattle infection in Namibia, and that low prevalence in the commercial farming areas contrasts with high CE burden in the northern traditional husbandry systems. The present data provide baseline information to stimulate epidemiological studies on the transmission pathways of various CE agents in livestock, wildlife, and humans in Namibia and neighbouring countries.
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Affiliation(s)
- Julia Aschenborn
- University of Hohenheim, Parasitology Unit, Stuttgart, Germany; University of Zurich, Institute of Parasitology, Zurich, Switzerland.
| | | | - Francis Addy
- University for Development Studies, Department of Biotechnology, Tamale, Ghana
| | - Ortwin Aschenborn
- University of Namibia, School of Veterinary Medicine, Windhoek, Namibia.
| | | | - Thomas Romig
- University of Hohenheim, Parasitology Unit, Stuttgart, Germany.
| | - Peter Deplazes
- University of Zurich, Institute of Parasitology, Zurich, Switzerland.
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Metheny N, Stephenson R, Darbes LA, Chavanduka TMD, Essack Z, van Rooyen H. Correlates of Substance Misuse, Transactional Sex, and Depressive Symptomatology Among Partnered Gay, Bisexual and Other Men Who Have Sex with Men in South Africa and Namibia. AIDS Behav 2022; 26:2003-2014. [PMID: 34997385 DOI: 10.1007/s10461-021-03549-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/25/2021] [Indexed: 11/26/2022]
Abstract
Despite having some of the world's highest rates of HIV, there is a lack of knowledge on correlates of transmission risk among gay, bisexual and other men who have sex with men in Southern Africa. There is even less known about the factors that shape HIV risk in male-male couples. Using data from Together Tomorrow, a study of partnered GBMSM in South Africa and Namibia, this study assessed the individual and dyadic correlates of three major HIV risk factors in this population: substance misuse, transactional sex, and depressive symptomatology. Data were collected during November 2016-March 2017 via a quantitative survey conducted with 140 partnered MSM (70 couples) in Windohoek, Keetmanshoop, Walvis Bay, and Swakopmund, Namibia and 300 partnered MSM (150 couples) in Pietermaritzburg and Durban, KwaZulu-Natal, South Africa for a total sample size of 440 partnered MSM (220 couples). Results of multilevel modeling analyses show several significant factors present in partnered GBMSM that differ from studies of single GBMSM, with intimate partner violence being a significant correlate across all three risk factors. Future interventions should consider dyadic approaches and integrate IPV prevention and mitigation efforts to reduce HIV in this population as part of a multisectoral approach. To reduce rates of HIV in partnered GBMSM in Namibia and South Africa multilevel, multisectoral work is needed in policy, social norms change, and relationship-focused dyadic interventions to reduce the social and structural stigma facing male couples.
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Affiliation(s)
- Nicholas Metheny
- School of Nursing and Health Studies, University of Miami, 5030 Brunson Drive, Coral Gables, FL, 33146, USA.
| | - Rob Stephenson
- University of Michigan School of Nursing, Ann Arbor, MI, USA
- University of Michigan Center for Sexuality and Health Disparities, Ann Arbor, MI, USA
| | - Lynae A Darbes
- University of Michigan School of Nursing, Ann Arbor, MI, USA
- University of Michigan Center for Sexuality and Health Disparities, Ann Arbor, MI, USA
| | - Tanaka M D Chavanduka
- University of Michigan School of Nursing, Ann Arbor, MI, USA
- University of Michigan Center for Sexuality and Health Disparities, Ann Arbor, MI, USA
| | - Zaynab Essack
- Human Sciences Research Council of South Africa, Pretoria, Gauteng, South Africa
- School of Law, University of KwaZulu-Natal, KwaZulu-Natal, Pietermaritzburg, South Africa
| | - Heidi van Rooyen
- Human Sciences Research Council of South Africa, Pretoria, Gauteng, South Africa
- MRC/Wits Developmental Pathways for Health Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, Gauteng, South Africa
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Velloza J, Davies L, Ensminger A, Theofelus FM, Andjamba H, Kamuingona R, Nakuta J, Uiras W, Massetti G, Coomer R, Wolkon A, Forster N, O'Malley G. Disclosure and help-seeking behaviors related to sexual and physical violence in childhood and adolescence: Results from the Namibia Violence Against Children and Youth Survey. Child Abuse Negl 2022; 128:105624. [PMID: 35381545 PMCID: PMC9119951 DOI: 10.1016/j.chiabu.2022.105624] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Revised: 03/21/2022] [Accepted: 03/25/2022] [Indexed: 05/21/2023]
Abstract
BACKGROUND Violence disclosure and help-seeking can mitigate adverse health effects associated with childhood violence, but little is known about facilitators and barriers of disclosure and help-seeking behaviors in sub-Saharan Africa. OBJECTIVE To understand factors associated with disclosure and help-seeking to inform care. PARTICIPANTS AND SETTING Participants aged 13-24 years old in the 2019 Namibia Violence Against Children and Youth Survey (VACS). METHODS We assessed the prevalence of victimization, disclosure, and help-seeking and examined factors associated with violence disclosure and help-seeking, separately, by gender. RESULTS 4211 girls and 980 boys participated in the Namibia VACS. The prevalence of childhood sexual violence differed significantly by gender (15.7% among girls, 9.8% among boys), but physical violence prevalence did not differ by gender. Among victims of sexual violence, 57.3% of girls disclosed and 10.4% sought help, compared with only 30.7% and 3.2% of boys. Among victims of physical violence, 61.1% of girls and 53.4% of boys disclosed, and 16.9% of girls and 17.7% of boys sought help. Older age, social support, and experiencing more types of violence were associated with sexual violence disclosure among boys, but none of these factors were associated with sexual violence disclosure among girls. Lower education, perpetrator type, and witnessing violence were associated with physical violence disclosure among girls, while peer support and perpetrator type were associated with physical violence disclosure among boys. CONCLUSIONS Factors associated with childhood violence differed by gender and violence type in Namibia, highlighting a need for gender-specific violence services to facilitate violence disclosure and help-seeking.
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Affiliation(s)
- Jennifer Velloza
- University of Washington, Department of Global Health, Seattle, WA, USA.
| | - Luke Davies
- University of Washington, Department of Global Health, Seattle, WA, USA; International Training and Education Center for Health (I-TECH), University of Washington, Seattle, WA, USA
| | - Alison Ensminger
- University of Washington, Department of Global Health, Seattle, WA, USA; International Training and Education Center for Health (I-TECH), University of Washington, Seattle, WA, USA
| | | | - Helena Andjamba
- Ministry of Gender Equality, Poverty Eradication and Social Welfare (formerly Ministry of Gender Equality and Child Welfare), Government of Namibia, Windhoek, Namibia
| | - Rahimisa Kamuingona
- Ministry of Gender Equality, Poverty Eradication and Social Welfare (formerly Ministry of Gender Equality and Child Welfare), Government of Namibia, Windhoek, Namibia
| | - Joyce Nakuta
- Ministry of Gender Equality, Poverty Eradication and Social Welfare (formerly Ministry of Gender Equality and Child Welfare), Government of Namibia, Windhoek, Namibia
| | - Wilhencia Uiras
- Ministry of Gender Equality, Poverty Eradication and Social Welfare (formerly Ministry of Gender Equality and Child Welfare), Government of Namibia, Windhoek, Namibia
| | - Greta Massetti
- Centers of Disease Control and Prevention, Division of Violence Prevention, Atlanta, GA, United States of America
| | - Rachel Coomer
- Centers for Disease Control and Prevention, Division of Global HIV & Tuberculosis, Windhoek, Namibia
| | - Adam Wolkon
- Centers for Disease Control and Prevention, Division of Global HIV & Tuberculosis, Windhoek, Namibia
| | - Norbert Forster
- University of Washington, Department of Global Health, Seattle, WA, USA; International Training and Education Center for Health (I-TECH), University of Washington, Windhoek, Namibia
| | - Gabrielle O'Malley
- University of Washington, Department of Global Health, Seattle, WA, USA; International Training and Education Center for Health (I-TECH), University of Washington, Seattle, WA, USA
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Kalomo EN, Shamrova D, Jun JS, Kaddu MN, Kalb A. Risk and protective factors for depressive symptoms among the youth living with HIV in Namibia. Afr J AIDS Res 2022; 21:65-76. [PMID: 35361060 DOI: 10.2989/16085906.2022.2041054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Revised: 11/01/2021] [Accepted: 02/01/2022] [Indexed: 06/14/2023]
Abstract
BACKGROUND : Namibia has one of the highest HIV prevalence rates among young people living with HIV and AIDS. The study of mental well-being among this vulnerable population is emerging as an important area of public health research. METHODS : This study examined how gender, social support, food insecurity, HIV-related stigma, HIV treatment adherence and HIV transmission knowledge are related to depressive symptoms among young people living with HIV in rural northern Namibia. Data were collected from 188 participants from the Zambezi region. RESULTS : The hierarchical regression analysis revealed that being a female infected with HIV, having perceived food insecurity, experiencing more HIV-related stigma and having low levels of social support can exacerbate the severity of depressive symptoms in this sample of Namibian youth. DISCUSSION : Our findings point to the need to expand social support interventions, enhance socio-economic programmes and reduce HIV-related stigma among young people living with HIV, especially those residing in rural, HIV endemic, resource-limited communities in developing countries.
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Affiliation(s)
| | - Dasha Shamrova
- School of Social Work, Wichita State University, Wichita, USA
| | - Jung Sim Jun
- Department of Sociology, Anthropology, and Social Work, Kansas State University, Manhattan, USA
| | | | - Amy Kalb
- School of Social Work, Wichita State University, Wichita, USA
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Mthoko NFN, Pazvakawambwa L, Leonhardt M, Lien L. Physical comorbidity among patients attending mental health services at Windhoek Central Hospital, Namibia. Pan Afr Med J 2022; 41:270. [PMID: 35734337 PMCID: PMC9187991 DOI: 10.11604/pamj.2022.41.270.27134] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2020] [Accepted: 11/08/2021] [Indexed: 11/11/2022] Open
Abstract
Introduction physical health problems are common among people with mental illness. Understanding common co-occurring mental and physical conditions can aid health providers to effectively screen individuals and also integrate care for both conditions. The study aimed to determine the prevalence and types of comorbidity among patients attending the outpatient section of the Mental Health Care Centre, Windhoek Central Hospital. Methods a cross-sectional survey of 385 patients attending the Mental Health Care Centre of Windhoek Central Hospital was carried out using structured questionnaire. Results the study found that 33.8% of participants had comorbid physical and mental conditions. The most common co-occurring physical conditions were from the cardiovascular system (40.8%), infections (30.8%), and neurological conditions (13.0%). Female patients were more likely to have comorbidity compared to their male counterparts (OR=2.8; CI = 1.5-5.0; p=0.001), and the risk of comorbidity increased with age (OR=1.1; CI = 1.0-1.1; p<0.001). Conclusion the study emphasizes the inseparability of mental and physical health, and the bidirectional association between mental and physical conditions. The high prevalence of somatic disorder points to the need of integration of physical and mental health services. Mental health and somatic services must be adjusted to the fact that most of the people who come to seek help are likely to suffer from more than one illness.
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Affiliation(s)
- Ndahambelela Frederika Nepando Mthoko
- Windhoek Central Hospital, Windhoek, Namibia
- Corresponding author: Ndahambelela Frederika Nepando Mthoko, Windhoek Central Hospital, Windhoek, Namibia.
| | - Lilian Pazvakawambwa
- Department of Statistics and Population Studies, University of Namibia, Windhoek, Namibia
| | - Marja Leonhardt
- KoRus Øst, Hospital Innlandet Trust, PO Box 104, Brumunddal, Norway and Faculty of Health, VID-Specialized University, Oslo, Norway
| | - Lars Lien
- Norwegian National Advisory Unit on Concurrent Substance Abuse and Mental Health Disorders, Hospital Innlandet Trust, PO Box 104, Brumunddal, Norway and Faculty of Social and Health Sciences, Inland Norway University of Applied Science, Elverum, Oslo, Norway
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Agathis NT, Annor FB, Coomer R, Hegle J, Patel P, Forster N, O'Malley G, Ensminger AL, Kamuingona R, Andjamba H, Manyando M, Massetti GM. HIV Prevention Program Eligibility Among Adolescent Girls and Young Women - Namibia, 2019. MMWR Morb Mortal Wkly Rep 2021; 70:1570-1574. [PMID: 34758009 PMCID: PMC8580202 DOI: 10.15585/mmwr.mm7045a2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
The U.S. President's Emergency Plan for AIDS Relief (PEPFAR) relies on comprehensive and reliable population data to implement interventions to reduce HIV transmission in high-incidence areas among populations disproportionately affected by the HIV epidemic. Adolescent girls and young women in sub-Saharan Africa account for a disproportionate number of new HIV infections compared with their male peers (1). The DREAMS (Determined, Resilient, Empowered, AIDS-free, Mentored, and Safe) program includes multisectoral, layered interventions aimed at reducing factors that contribute to vulnerability to HIV infection among adolescent girls and young women in PEPFAR-supported sub-Saharan African countries (1). Namibia, a southern African country with a population of approximately 2.55 million among whom approximately 8% live with HIV infection, had their DREAMS program first implemented in 2017* (2,3). Data from the 2019 Namibia Violence Against Children and Youth Survey (VACS), the most recent and comprehensive nationally representative data source available to study the epidemiology of violence and other HIV risk factors, were used to estimate the percentage of adolescent girls and young women aged 13-24 years who would be eligible for DREAMS program services. The prevalence of individual DREAMS eligibility criteria, which comprise known age-specific risk factors associated with HIV acquisition, were estimated by age group. Among all adolescent girls and young women in Namibia, 62% were eligible for DREAMS based on meeting at least one criterion. Common eligibility criteria included adverse childhood experiences, specifically exposure to physical, emotional, and sexual violence and being an orphan;† and high-risk behaviors, such as early alcohol use,§ recent heavy alcohol use,¶ and infrequent condom use.** Using VACS data to estimate the prevalence of HIV risk factors and identify adolescent girls and young women at elevated risk for HIV acquisition in countries like Namibia with high HIV-incidence can inform programs and policies aimed at improving the well-being of these adolescent girls and young women and help control the HIV epidemics in these countries.
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35
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Grasso MA, Hamunime N, Maher AD, Cockburn D, Williams DB, Taffa N, Hong SY, Jackson K, Wolkon A, Low A, Stephens SC. Improving the benefits of HIV testing and referrals in large household surveys through active linkages to care: lessons and recommendations from the Namibia population-based HIV impact assessment (NAMPHIA), 2017. AIDS Care 2021; 33:1308-1311. [PMID: 33486974 PMCID: PMC10988420 DOI: 10.1080/09540121.2021.1874266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Accepted: 01/01/2021] [Indexed: 10/22/2022]
Abstract
In household-based surveys that include rapid HIV testing services (HTS), passive referral systems that give HIV-positive participants information about how and where to access ART but minimal follow-up support from survey staff may result in suboptimal linkage. In the 2017 Namibia Population-based HIV Impact Assessment (NAMPHIA), we piloted a system of active linkage to care and ART (ALCART) that utilized the infrastructure of existing community-based partner organizations (CBPOs). All HIV-positive participants age 15-64 years not on ART were given standard passive referrals to ART plus the option to participate in ALCART. Cases were assigned to CBPOs in participants' localities. Healthcare workers from the CBPO's contacted cases and facilitated their linkage to facility-based ART. A total of 510 participants were eligible and consented to ALCART. The majority were new diagnoses (80.8%), while the remainder were previously diagnosed but not on ART (19.2%). Of the 510, 473 (92.7%) were successfully linked into care. Of these, all but one initiated ART. Our ALCART system used existing CBPOs and contributed to >90% linkage-to-care and >99% ART-initiation among linked participants in a large, nationally-representative survey. This approach can be used to improve the potential benefits of HTS in other large population-based surveys.
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Affiliation(s)
- Michael A. Grasso
- Institute for Global Health Sciences, University of California San Francisco, San Francisco, CA, USA
| | - Ndapewa Hamunime
- Namibia Ministry of Health and Social Services, Directorate for Special Programs, Windhoek, Namibia
| | - Andrew D. Maher
- Institute for Global Health Sciences, University of California San Francisco, San Francisco, CA, USA
| | - David Cockburn
- Development Aid from People to People (DAPP), Windhoek, Namibia
| | - Dan B. Williams
- U.S. Centers for Disease Control and Prevention, Division of Global HIV and TB, Atlanta, GA, USA
| | - Negussie Taffa
- Namibia Ministry of Health and Social Services, Directorate for Special Programs, Windhoek, Namibia
| | - Steven Y. Hong
- U.S. Centers for Disease Control and Prevention, Division of Global HIV and TB, Atlanta, GA, USA
| | - Keisha Jackson
- U.S. Centers for Disease Control and Prevention, Division of Global HIV and TB, Atlanta, GA, USA
| | - Adam Wolkon
- U.S. Centers for Disease Control and Prevention, Division of Global HIV and TB, Atlanta, GA, USA
| | - Andrea Low
- ICAP at Columbia University, New York, NY, USA
| | - Sally C. Stephens
- Institute for Global Health Sciences, University of California San Francisco, San Francisco, CA, USA
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Chatukuta M, Groce N, Mindell J, Kett M. The availability of psychological support following road travel injuries in Namibia: A qualitative study. PLoS One 2021; 16:e0258197. [PMID: 34597352 PMCID: PMC8486108 DOI: 10.1371/journal.pone.0258197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Accepted: 09/21/2021] [Indexed: 11/28/2022] Open
Abstract
Road traffic injuries (RTIs) are a major problem worldwide with a high burden of mental health problems and the importance of psychological support following road injury is well documented. However, globally there has been very little research on the accessibility of psychological services following road injury. Namibia is one of the countries most affected by RTIs but no previous studies have been done on this. In this qualitative study we investigated the availability of psychological services to RTI injured in Namibia. Our study findings are in line with those of other global studies in showing inadequate access to psychological support for injury survivors and we discuss the reasons. It is hoped these findings will help policymakers develop ways of enhancing access to psychological support for the many people injured in RTIs in Namibia. The models they develop may also be of use to other LMICs countries with high RTI rates.
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Affiliation(s)
- Mitchel Chatukuta
- Research Department of Epidemiology and Public Health, University College London (UCL), London, United Kingdom
| | - Nora Groce
- Research Department of Epidemiology and Public Health, University College London (UCL), London, United Kingdom
| | - Jenny Mindell
- Research Department of Epidemiology and Public Health, University College London (UCL), London, United Kingdom
| | - Maria Kett
- Research Department of Epidemiology and Public Health, University College London (UCL), London, United Kingdom
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Ekholuenetale M, Onuoha H, Ekholuenetale CE, Barrow A, Nzoputam CI. Socioeconomic Inequalities in Human Immunodeficiency Virus (HIV) Sero-Prevalence among Women in Namibia: Further Analysis of Population-Based Data. Int J Environ Res Public Health 2021; 18:ijerph18179397. [PMID: 34501987 PMCID: PMC8431544 DOI: 10.3390/ijerph18179397] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Revised: 09/02/2021] [Accepted: 09/04/2021] [Indexed: 11/16/2022]
Abstract
Socioeconomic inequality is a major factor to consider in the prevention of human immunodeficiency virus (HIV) transmission. The aim of this study was to investigate socioeconomic inequalities in HIV prevalence among Namibian women. Data from a population-based household survey with multistage-stratified sample of 6501 women were used to examine the link between socioeconomic inequalities and HIV prevalence. The weighted HIV prevalence was 13.2% (95% CI: 12.1–14.3%). The HIV prevalence among the poorest, poorer, middle, richer, and richest households was 21.4%, 19.7%, 16.3%, 11.0%, and 3.7%, respectively. Similarly, 21.2%, 21.7%, 11.8%, and 2.1% HIV prevalence was estimated among women with no formal education and primary, secondary, and higher education, respectively. Women from poor households (Conc. Index = −0.258; SE = 0.017) and those with no formal education (Conc. Index = −0.199; SE = 0.015) had high concentration of HIV infection, respectively. In light of these findings, HIV prevention strategies must be tailored to the specific drivers of transmission in low socioeconomic groups, with special attention paid to the vulnerabilities faced by women and the dynamic and contextual nature of the relationship between socioeconomic status and HIV infection.
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Affiliation(s)
- Michael Ekholuenetale
- Department of Epidemiology and Medical Statistics, Faculty of Public Health, College of Medicine, University of Ibadan, Ibadan 200284, Nigeria
- Correspondence:
| | - Herbert Onuoha
- Department of Tropical Hygiene and Public Health, Medical Faculty, Heidelberg University, 69117 Heidelberg, Germany;
| | | | - Amadou Barrow
- Department of Public & Environmental Health, School of Medicine & Allied Health Sciences, University of The Gambia, Kanifing 3530, The Gambia;
| | - Chimezie Igwegbe Nzoputam
- Department of Community Health, Center of Excellence in Reproductive Health Innovation (CERHI), College of Medical Sciences, University of Benin, Benin City 300001, Nigeria;
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Low A, Sachathep K, Rutherford G, Nitschke AM, Wolkon A, Banda K, Miller LA, Solmo C, Jackson K, Patel H, McCracken S, Findley S, Mutenda N. Migration in Namibia and its association with HIV acquisition and treatment outcomes. PLoS One 2021; 16:e0256865. [PMID: 34473757 PMCID: PMC8412347 DOI: 10.1371/journal.pone.0256865] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Accepted: 08/17/2021] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND In the 21st century, understanding how population migration impacts human health is critical. Namibia has high migration rates and HIV prevalence, but little is known about how these intersect. We examined the association between migration and HIV-related outcomes using data from the 2017 Namibia Population-based HIV Impact Assessment (NAMPHIA). METHODS AND FINDINGS The NAMPHIA survey selected a nationally representative sample of adults in 2017. All adults aged 15-64 years were invited to complete an interview and home-based HIV test. Recent infection (<130 days) was measured using HIV-1 LAg avidity combined with viral load (>1000 copies/mL) and antiretroviral analyte data. Awareness of HIV status and antiretroviral use were based on self-report and/or detectable antiretrovirals in blood. Viremia was defined as having a viral load ≥1000 copies/mL, including all participants in the denominator regardless of serostatus. We generated community viremia values as a weighted proportion at the EA level, excluding those classified as recently infected. Significant migrants were those who had lived outside their current region or away from home >one month in the past three years. Recent cross-community in-migrants were those who had moved to the community <two years ago. Separate analyses were done to compare significant migrants to non-migrants and recent cross-community in-migrants to those who in-migrated >two years ago to determine the association of migration and timing with recent infection or viral load suppression (VLS). All proportions are weighted. Of eligible adults, we had HIV results and migration data on 9,625 (83.9%) of 11,474 women and 7,291 (73.0%) of 9,990 men. Most respondents (62.5%) reported significant migration. Of cross-community in-migrants, 15.3% were recent. HIV prevalence was 12.6% and did not differ by migration status. Population VLS was 77.4%. Recent cross-community in-migration was associated with recent HIV infection (aOR: 4.01, 95% CI 0.99-16.22) after adjusting for community viremia. Significant migration (aOR 0.73, 95% CI: 0.55-0.97) and recent cross-community in-migration (aOR 0.57, 95% CI: 0.35-0.92) were associated with lower VLS, primarily due to lack of awareness of HIV infection. The study was limited by lack of precise data on trajectory of migration. CONCLUSIONS Despite a high population-level VLS, Namibia still has migrant populations that are not accessing effective treatment for HIV. Targeting migrants with effective prevention and testing programs in communities with viremia could enable further epidemic control.
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Affiliation(s)
- Andrea Low
- ICAP at Columbia University, Mailman School of Public Health, Columbia University, New York, NY, United States of America
- * E-mail:
| | - Karam Sachathep
- ICAP at Columbia University, Mailman School of Public Health, Columbia University, New York, NY, United States of America
| | - George Rutherford
- Institute for Global Health Sciences, University of California, San Francisco, CA, United States of America
| | | | - Adam Wolkon
- Centers for Disease Control and Prevention, Windhoek, Namibia
| | - Karen Banda
- Institute for Global Health Sciences, University of California, San Francisco, CA, United States of America
| | | | - Chelsea Solmo
- ICAP at Columbia University, Mailman School of Public Health, Columbia University, New York, NY, United States of America
| | - Keisha Jackson
- Division of Global HIV and Tuberculosis, Centers for Disease Control and Prevention, Center for Global Health, Atlanta, GA, United States of America
| | - Hetal Patel
- Division of Global HIV and Tuberculosis, Centers for Disease Control and Prevention, Center for Global Health, Atlanta, GA, United States of America
| | - Stephen McCracken
- Division of Global HIV and Tuberculosis, Centers for Disease Control and Prevention, Center for Global Health, Atlanta, GA, United States of America
| | - Sally Findley
- ICAP at Columbia University, Mailman School of Public Health, Columbia University, New York, NY, United States of America
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Gentz S, Zeng C, Ruiz-Casares M. The role of individual-, family-, and school-level resilience in the subjective well-being of children exposed to violence in Namibia. Child Abuse Negl 2021; 119:105087. [PMID: 33992423 DOI: 10.1016/j.chiabu.2021.105087] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Revised: 04/11/2021] [Accepted: 04/25/2021] [Indexed: 06/12/2023]
Abstract
BACKGROUND Children exposed to violence are at risk of a range of adverse outcomes. Given the unique cultural and social context, understanding what fosters children's resilience in resource-limited areas such as sub-Saharan Africa, is vital. OBJECTIVES Using data from the International Survey of Children's Well-Being (ISCWeB), this paper explores individual-, family-, and school-level factors associated with positive outcomes for children who have experienced some form of violence in Khomas region, Namibia. METHOD AND PARTICIPANTS Using a cross-sectional survey design, the ISCWeB questionnaire, assessing cognitive, affective, and psychological dimensions of well-being, child protection factors and violence exposure was administered to 2124 Grade four and six children. RESULTS Our sample had a mean age of 11.2 years. Overall, 56.8 % of children reported at least one incident of violence from an adult caregiver at home and 86.0 % of children reported some form of peer violence at school. Materially deprived children experienced higher incidence of both family and peer violence. The quality of children's relationships at home (β = 0.17, p < 0.001), and school (β = 0.07, p < 0.001) emerged as important protective factors for children's well-being for both types of violence, suggesting that supportive family and school relationships may be more important to the subjective well-being of children who experienced violence than material wellbeing, violence severity, and individual child factors. CONCLUSIONS Providing positive social interaction and emotional security in contextually and culturally appropriate ways within children's proximal systems should be prioritized while challenging norms that support violence in Namibian families and schools.
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Affiliation(s)
- Shelene Gentz
- Department of Psychology and Social Work, University of Namibia, Windhoek, Namibia.
| | - Chengbo Zeng
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA
| | - Mónica Ruiz-Casares
- Department of Psychiatry and Centre for Research on Children and Families, McGill University, Montreal, Quebec, Canada; Sherpa University Institute, Integrated University Health and Social Services Centre West-Central Montreal, Montreal, Quebec, Canada
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Giles JR, Cummings DAT, Grenfell BT, Tatem AJ, zu Erbach-Schoenberg E, Metcalf CJE, Wesolowski A. Trip duration drives shift in travel network structure with implications for the predictability of spatial disease spread. PLoS Comput Biol 2021; 17:e1009127. [PMID: 34375331 PMCID: PMC8378725 DOI: 10.1371/journal.pcbi.1009127] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Revised: 08/20/2021] [Accepted: 05/28/2021] [Indexed: 11/19/2022] Open
Abstract
Human travel is one of the primary drivers of infectious disease spread. Models of travel are often used that assume the amount of travel to a specific destination decreases as cost of travel increases with higher travel volumes to more populated destinations. Trip duration, the length of time spent in a destination, can also impact travel patterns. We investigated the spatial patterns of travel conditioned on trip duration and find distinct differences between short and long duration trips. In short-trip duration travel networks, trips are skewed towards urban destinations, compared with long-trip duration networks where travel is more evenly spread among locations. Using gravity models to inform connectivity patterns in simulations of disease transmission, we show that pathogens with shorter generation times exhibit initial patterns of spatial propagation that are more predictable among urban locations. Further, pathogens with a longer generation time have more diffusive patterns of spatial spread reflecting more unpredictable disease dynamics. During an epidemic of an infectious pathogen, cases of disease can be imported to new locations when people travel. The amount of time that an infected person spends in a destination (trip duration) determines how likely they are to infect others while travelling. In this study, we analyzed travel data and found specific spatial patterns in trip duration, where short-duration trips are more common between urban destinations and long-duration trips are evenly spread out among locations. To show how this spatial pattern impacts the spread of infectious diseases, we used data-driven models and simulations to show that pathogens with shorter generation times have patterns of spatial spread that are more predictable among urban locations. However, pathogens with longer generation times tend to spread along the long-duration travel networks that are more evenly distributed among locations giving them more unpredictable disease dynamics.
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Affiliation(s)
- John R. Giles
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
- * E-mail:
| | - Derek A. T. Cummings
- Department of Biology and the Emerging Pathogens Institute, University of Florida, Gainesville, Florida, United States of America
| | - Bryan T. Grenfell
- Department of Ecology and Evolutionary Biology and the Princeton School of Public and International Affairs, Princeton University, Princeton, New Jersey, United States of America
| | - Andrew J. Tatem
- WorldPop, School of Geography and Environmental Science, University of Southampton, Southampton, United Kingdom
| | | | - CJE Metcalf
- Department of Ecology and Evolutionary Biology and the Princeton School of Public and International Affairs, Princeton University, Princeton, New Jersey, United States of America
| | - Amy Wesolowski
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
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Ojifinni O, Maposa I, Ibisomi L. Bayesian semi-parametric spatial modelling of intimate partner violence in Namibia using 2013 Demographic Health Survey Data. BMC Womens Health 2021; 21:286. [PMID: 34353318 PMCID: PMC8340378 DOI: 10.1186/s12905-021-01421-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Accepted: 07/07/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Intimate partner violence (IPV) is an important public health problem with health and socioeconomic consequences and is endemic in Namibia. Studies assessing risk factors for IPV often use logistic and Poisson regression without geographical location information and spatial effects. We used a Bayesian spatial semi-parametric regression model to determine the risk factors for IPV in Namibia; assess the non-linear effects of age difference between partners and determine spatial effects in the different regions on IPV prevalence. METHODS We used the couples' dataset of the 2013-2014 Namibia Demographic and Health Survey (DHS) obtained on request from Measure DHS. The DHS domestic violence module included 2226 women. We generated a binary variable measuring IPV from the questions "ever experienced physical, sexual or emotional violence?" Covariates included respondent's educational level, age, couples' age difference, place of residence and partner's educational level. All estimation was done with the full Bayesian approach using R version 3.5.2 implementing the R2BayesX package. RESULTS IPV country prevalence was 33.3% (95% CI = 30.1-36.5%); Kavango had the highest [50.6% (95% CI = 41.2-60.1%)] and Oshana the lowest [11.5% (95% CI = 3.2-19.9%)] regional prevalence. IPV prevalence was highest among teenagers [60.8% (95% CI = 36.9-84.7%)]). The spatial semi-parametric model used for adjusted results controlled for regional spatial effects, respondent's age, age difference, respondent's years of education, residence, wealth, and education levels. Women with higher education were 50% less likely to experience IPV [aOR: 0.46, 95% CI = 0.23-0.87]. For non-linear effects, the risk of IPV was high for women ≥ 5 years older or ≥ 25 years younger than their partners. Younger and older women had higher risks of IPV than those between 25 and 45 years. For spatial variation of IPV prevalence, northern regions had low spatial effects while western regions had very high spatial effects. CONCLUSION The prevalence of IPV among Namibia women was high especially among teenagers, with higher educational levels being protective. The risk of IPV was lower in rural than urban areas and higher with wide partner age differences. Interventions and policies for IPV prevention in Namibia are needed for couples with wide age differences as well as for younger women, women with lower educational attainment and in urban and western regions.
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Affiliation(s)
- Oludoyinmola Ojifinni
- School of Public Health, University of the Witwatersrand, Johannesburg, South Africa.
| | - Innocent Maposa
- Division of Epidemiology and Biostatistics, Wits School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
- Health Science Research Office, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Latifat Ibisomi
- Division of Epidemiology and Biostatistics, Wits School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
- Nigerian Institute of Medical Research, Lagos, Nigeria
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Smith JL, Mumbengegwi D, Haindongo E, Cueto C, Roberts KW, Gosling R, Uusiku P, Kleinschmidt I, Bennett A, Sturrock HJ. Malaria risk factors in northern Namibia: The importance of occupation, age and mobility in characterizing high-risk populations. PLoS One 2021; 16:e0252690. [PMID: 34170917 PMCID: PMC8232432 DOI: 10.1371/journal.pone.0252690] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Accepted: 05/20/2021] [Indexed: 11/19/2022] Open
Abstract
In areas of low and unstable transmission, malaria cases occur in populations with lower access to malaria services and interventions, and in groups with specific malaria risk exposures often away from the household. In support of the Namibian National Vector Borne Disease Program's drive to better target interventions based upon risk, we implemented a health facility-based case control study aimed to identify risk factors for symptomatic malaria in Zambezi Region, northern Namibia. A total of 770 febrile individuals reporting to 6 health facilities and testing positive by rapid diagnostic test (RDT) between February 2015 and April 2016 were recruited as cases; 641 febrile individuals testing negative by RDT at the same health facilities through June 2016 were recruited as controls. Data on socio-demographics, housing construction, overnight travel, use of malaria prevention and outdoor behaviors at night were collected through interview and recorded on a tablet-based questionnaire. Remotely-sensed environmental data were extracted for geo-located village residence locations. Multivariable logistic regression was conducted to identify risk factors and latent class analyses (LCA) used to identify and characterize high-risk subgroups. The majority of participants (87% of cases and 69% of controls) were recruited during the 2016 transmission season, an outbreak year in Southern Africa. After adjustment, cases were more likely to be cattle herders (Adjusted Odds Ratio (aOR): 4.46 95%CI 1.05-18.96), members of the police or other security personnel (aOR: 4.60 95%CI: 1.16-18.16), and pensioners/unemployed persons (aOR: 2.25 95%CI 1.24-4.08), compared to agricultural workers (most common category). Children (aOR 2.28 95%CI 1.13-4.59) and self-identified students were at higher risk of malaria (aOR: 4.32 95%CI 2.31-8.10). Other actionable risk factors for malaria included housing and behavioral characteristics, including traditional home construction and sleeping in an open structure (versus modern structure: aOR: 2.01 95%CI 1.45-2.79 and aOR: 4.76 95%CI: 2.14-10.57); cross border travel in the prior 30 days (aOR: 10.55 95%CI 2.94-37.84); and outdoor agricultural work at night (aOR: 2.09 95%CI 1.12-3.87). Malaria preventive activities were all protective and included personal use of an insecticide treated net (ITN) (aOR: 0.61 95%CI 0.42-0.87), adequate household ITN coverage (aOR: 0.63 95%CI 0.42-0.94), and household indoor residual spraying (IRS) in the past year (versus never sprayed: (aOR: 0.63 95%CI 0.44-0.90). A number of environmental factors were associated with increased risk of malaria, including lower temperatures, higher rainfall and increased vegetation for the 30 days prior to diagnosis and residing more than 5 minutes from a health facility. LCA identified six classes of cases, with class membership strongly correlated with occupation, age and select behavioral risk factors. Use of ITNs and IRS coverage was similarly low across classes. For malaria elimination these high-risk groups will need targeted and tailored intervention strategies, for example, by implementing alternative delivery methods of interventions through schools and worksites, as well as the use of specific interventions that address outdoor transmission.
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Affiliation(s)
- Jennifer L. Smith
- Malaria Elimination Initiative, Global Health Group, University of California San Francisco (UCSF), San Francisco, California, United States of America
| | - Davis Mumbengegwi
- Multidisciplinary Research Centre, University of Namibia, Windhoek, Namibia
| | - Erastus Haindongo
- School of Medicine, Faculty of Health Sciences, University of Namibia, Windhoek, Namibia
| | - Carmen Cueto
- Malaria Elimination Initiative, Global Health Group, University of California San Francisco (UCSF), San Francisco, California, United States of America
| | - Kathryn W. Roberts
- Malaria Elimination Initiative, Global Health Group, University of California San Francisco (UCSF), San Francisco, California, United States of America
| | - Roly Gosling
- Malaria Elimination Initiative, Global Health Group, University of California San Francisco (UCSF), San Francisco, California, United States of America
| | - Petrina Uusiku
- National Ministry of Health and Social Services, Windhoek, Namibia
| | - Immo Kleinschmidt
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, United Kingdom
- Department of Immunology and Infection, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Adam Bennett
- Malaria Elimination Initiative, Global Health Group, University of California San Francisco (UCSF), San Francisco, California, United States of America
| | - Hugh J. Sturrock
- Malaria Elimination Initiative, Global Health Group, University of California San Francisco (UCSF), San Francisco, California, United States of America
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Valdano E, Okano JT, Colizza V, Mitonga HK, Blower S. Using mobile phone data to reveal risk flow networks underlying the HIV epidemic in Namibia. Nat Commun 2021; 12:2837. [PMID: 33990578 PMCID: PMC8121904 DOI: 10.1038/s41467-021-23051-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Accepted: 04/08/2021] [Indexed: 12/22/2022] Open
Abstract
Twenty-six million people are living with HIV in sub-Saharan Africa; epidemics are widely dispersed, due to high levels of mobility. However, global elimination strategies do not consider mobility. We use Call Detail Records from 9 billion calls/texts to model mobility in Namibia; we quantify the epidemic-level impact by using a mathematical framework based on spatial networks. We find complex networks of risk flows dispersed risk countrywide: increasing the risk of acquiring HIV in some areas, decreasing it in others. Overall, 40% of risk was mobility-driven. Networks contained multiple risk hubs. All constituencies (administrative units) imported and exported risk, to varying degrees. A few exported very high levels of risk: their residents infected many residents of other constituencies. Notably, prevalence in the constituency exporting the most risk was below average. Large-scale networks of mobility-driven risk flows underlie generalized HIV epidemics in sub-Saharan Africa. In order to eliminate HIV, it is likely to become increasingly important to implement innovative control strategies that focus on disrupting risk flows.
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Affiliation(s)
- Eugenio Valdano
- Center for Biomedical Modeling, The Semel Institute for Neuroscience and Human Behavior, David Geffen School of Medicine, University of California, Los Angeles, CA, USA
| | - Justin T Okano
- Center for Biomedical Modeling, The Semel Institute for Neuroscience and Human Behavior, David Geffen School of Medicine, University of California, Los Angeles, CA, USA
| | - Vittoria Colizza
- INSERM, Sorbonne Université, Institut Pierre Louis d'Epidémiologie et de Santé Publique, IPLESP, Paris, France
| | - Honore K Mitonga
- Department of Epidemiology and Biostatistics, School of Public Health, University of Namibia, Windhoek, Namibia
| | - Sally Blower
- Center for Biomedical Modeling, The Semel Institute for Neuroscience and Human Behavior, David Geffen School of Medicine, University of California, Los Angeles, CA, USA.
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Lee S, Washburn DJ, Colwell B, Gwarzo IH, Kellstedt D, Ahenda P, Maddock JE. Examining social determinants of undiagnosed diabetes in Namibia and South Africa using a behavioral model of health services use. Diabetes Res Clin Pract 2021; 175:108814. [PMID: 33872630 DOI: 10.1016/j.diabres.2021.108814] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2020] [Revised: 01/27/2021] [Accepted: 04/08/2021] [Indexed: 01/21/2023]
Abstract
AIMS To examine factors associated with undiagnosed diabetes in Namibia and South Africa. METHODS This study used the most recent Demographic and Health Surveys (DHS) from Namibia (2013) and South Africa (2016). This study focused on adults at 35-64 years old. Using Andersen's Behavioral Model, potential contributing factors were categorized into predisposing factors (sex and education), enabling factors (wealth, health insurance, and residence), and a need factor (age, BMI, and high blood pressure). Separate multivariable logistic regression models were used to examine factors associated with undiagnosed diabetes in Namibia (N = 242) and South Africa (N = 525). RESULTS In Namibia, higher odds of having undiagnosed diabetes were associated with rural residence (adjusted odds ratio (aOR) = 2.21) and age younger than 45 years old (aOR = 3.20). In South Africa, odds of having undiagnosed diabetes were higher among the poorest-to-poorer group than it was in the richer-to-richest group (aOR = 2.33). In both countries, having high blood pressure was associated with lower odds of having undiagnosed diabetes (aOR = 0.31 in Namibia; aOR = 0.21 in South Africa). DISCUSSION Different enabling and need factors were associated with undiagnosed diabetes in these two countries, which implies potentially-different mechanisms driving the high prevalence of undiagnosed diabetes, as well as the needs for different solutions.
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Affiliation(s)
- Shinduk Lee
- Center for Population Health and Aging, Texas A&M University, 212 Adriance Lab Road, College Station, TX 77843, USA.
| | - David J Washburn
- Department of Health Policy and Management, Texas A&M University, 212 Adriance Lab Road, College Station, TX 77843, USA
| | - Brian Colwell
- Department of Health Promotion and Community Health Sciences, Texas A&M University, 212 Adriance Lab Road, College Station, TX 77843, USA
| | - Ibrahim H Gwarzo
- Department of Epidemiology & Biostatistics, Texas A&M University, 212 Adriance Lab Road, College Station, TX 77843, USA
| | - Debra Kellstedt
- Department of Health Promotion, University of Nebraska Medical Center, 984365 Nebraska Medical Center, Omaha, NE 68198, USA
| | - Petronella Ahenda
- Department of Public Health Studies, Texas A&M University, 212 Adriance Lab Road, College Station, TX 77843, USA
| | - Jay E Maddock
- Department of Environmental and Occupational Health, Texas A&M University, 212 Adriance Lab Road, College Station, TX 77843, USA
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Nyarko KM, Miller LA, Baughman AL, Katjiuanjo P, Evering-Watley M, Antara S, Angula P, Mitonga HK, Prybylski D, Dziuban EJ, Ndevaetela EE. The role of Namibia Field Epidemiology and Laboratory Training Programme in strengthening the public health workforce in Namibia, 2012-2019. BMJ Glob Health 2021; 6:e005597. [PMID: 33849899 PMCID: PMC8051409 DOI: 10.1136/bmjgh-2021-005597] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Accepted: 03/28/2021] [Indexed: 11/16/2022] Open
Abstract
Namibia faces a critical shortage of skilled public health workers to perform emergency response operations, preparedness activities and real-time surveillance. The Namibia Field Epidemiology and Laboratory Training Programme (NamFELTP) increases the number of skilled public health professionals and strengthens the public health system in Namibia. We describe the NamFELTP during its first 7 years, assess its impact on the public health workforce and provide recommendations to further strengthen the workforce. We reviewed disease outbreak investigations and response reports, field projects and epidemiological investigations conducted during 2012-2019. The data were analysed using descriptive methods such as frequencies and rates. Maps representing the geographical distribution of NamFELTP workforce were produced using QGIS software V.3.2. There were no formally trained field epidemiologists working in Namibia before the NamFELTP. In its 7 years of operation, the programme graduated 189 field epidemiologists, of which 28 have completed the Advanced FELTP. The graduates increased epidemiological capacity for surveillance and response in Namibia at the national and provincial levels, and enhanced epidemiologist-led outbreak responses on 35 occasions, including responses to outbreaks of human and zoonotic diseases. Trainees analysed data from 51 surveillance systems and completed 31 epidemiological studies. The NamFELTP improved outcomes in the Namibia's public health systems; including functional and robust public health surveillance systems that timely and effectively respond to public health emergencies. However, the current epidemiological capacity is insufficient and there is a need to continue training and mentorship to fill key leadership and strategic roles in the public health system.
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Affiliation(s)
- Kofi Mensah Nyarko
- Namibia Ministry of Health and Social Services, Windhoek, Khomas, Namibia
- School of Public Health, University of Namibia, Windhoek, Namibia
| | - Leigh Ann Miller
- US Centers for Disease Control and Prevention, Windhoek, Namibia
| | | | - Puumue Katjiuanjo
- Namibia Ministry of Health and Social Services, Windhoek, Khomas, Namibia
| | | | - Simon Antara
- Namibia Ministry of Health and Social Services, Windhoek, Khomas, Namibia
| | - Penehafo Angula
- School of Public Health, University of Namibia, Windhoek, Namibia
| | - Honore K Mitonga
- School of Public Health, University of Namibia, Windhoek, Namibia
| | | | - Eric J Dziuban
- US Centers for Disease Control and Prevention, Windhoek, Namibia
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Madzingira O, Fasina FO, Kalinda C, Van Heerden H. Seroprevalence of Brucellosis among Clinically Suspected Human Cases Presenting at Health Facilities in Namibia from 2012 to 2017. Biomed Environ Sci 2021; 34:232-235. [PMID: 33766220 DOI: 10.3967/bes2021.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Accepted: 10/13/2020] [Indexed: 02/05/2023]
Affiliation(s)
- Oscar Madzingira
- School of Veterinary Medicine, Faculty of Agriculture and Natural Resources, University of Namibia, P. Bag 13301, Windhoek 09000, Namibia;Department of Veterinary Tropical Diseases, University of Pretoria, Private Bag X04, Onderstepoort 0110, South Africa
| | - Folorunso Oludayo Fasina
- Department of Veterinary Tropical Diseases, University of Pretoria, Private Bag X04, Onderstepoort 0110, South Africa;Emergency Centre for Transboundary Animal Diseases-Food and Agriculture Organisation of the United Nations (ECTAD-FAO), Dar es Salaam 11000, Tanzania
| | - Chester Kalinda
- Faculty of Agriculture and Natural Resources, University of Namibia, P. Bag 1096, Ngweze, Katima Mulilo 0900, Namibia;University of KwaZulu-Natal, Howard College Campus, Department of Public Health, College of Health Sciences, School of Nursing and Public Health, Durban 4001, South Africa
| | - Henriette Van Heerden
- Department of Veterinary Tropical Diseases, University of Pretoria, Private Bag X04, Onderstepoort 0110, South Africa
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Athingo R, Tenzin T, Coetzer A, Hikufe EH, Peter J, Hango L, Haimbodi T, Lipinge J, Haufiku F, Naunyango M, Kephas M, Shilongo A, Shoombe KK, Khaiseb S, Letshwenyo M, Pozzetti P, Nake L, Nel LH, Freuling CM, Müller T, Torres G. Application of the GARC Data Logger-a custom-developed data collection device-to capture and monitor mass dog vaccination campaigns in Namibia. PLoS Negl Trop Dis 2020; 14:e0008948. [PMID: 33370285 PMCID: PMC7793283 DOI: 10.1371/journal.pntd.0008948] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Revised: 01/08/2021] [Accepted: 11/05/2020] [Indexed: 12/30/2022] Open
Abstract
Domestic dogs are responsible for 99% of all cases of human rabies and thus, mass dog vaccination has been demonstrated to be the most effective approach towards the elimination of dog-mediated human rabies. Namibia demonstrated the feasibility of this approach by applying government-led strategic rabies vaccination campaigns to reduce both human and dog rabies incidences in the Northern Communal Areas of Namibia since 2016. The lessons learnt using paper-based form for data capturing and management of mass dog vaccination campaign during the pilot and roll out phase of the project (2016–2018) led to the implementation of a simple and accurate data collection tool in the second phase (2019–2022) of the rabies elimination program. In this paper, we describe the implementation of such custom-developed vaccination tracking device, i.e. the Global Alliance for Rabies Control (GARC) Data Logger (GDL), and the integration of the collected data into a website-based rabies surveillance system (Rabies Epidemiological Bulletin—REB) during 2019 and 2020 campaigns. A total of 10,037 dogs and 520 cats were vaccinated during the 2019 campaign and 13,219 dogs and 1,044 cats during the 2020 campaign. The vaccination data were recorded with the GDL and visualized via REB. Subsequent GIS-analysis using gridded population data revealed a suboptimal vaccination coverage in the great majority of grid cells (82%) with a vaccination coverage below 50%. Spatial regression analysis identified the number of schools, estimated human density, and adult dog population were associated with the vaccination performance. However, there was an inverse correlation to human densities. Nonetheless, the use of the GDL improved data capturing and monitoring capacity of the campaign, enabling the Namibian government to improve strategies for the vaccination of at-risk areas towards achieving adequate vaccination coverage which would effectively break the transmission of rabies. We used a custom-developed vaccination tracking device—the Global Alliance for Rabies Control (GARC) Data Logger—to capture dog rabies vaccination data during the 2019 and 2020 mass vaccination campaign in the Northern Communal Areas of Namibia, and then integrated the collected data into the web-based Rabies Epidemiological Bulletin, a rabies-specific disease surveillance platform for rabies-endemic countries. This approach allowed automatic collation, analysis and, visualization of data and drastically improved the data capturing and monitoring capacity of the Namibian government led campaign. Additionally, subsequent GIS analysis enabled a better estimation of vaccination coverage at a much higher spatial resolution, thus identifying areas where improvements in the vaccination strategy are needed to ensure long-term success of the project.
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Affiliation(s)
- Rauna Athingo
- Animal Disease Control, Sub-division, North-West, Directorate of Veterinary Services (DVS), Ministry of Agriculture, Water and Land Reform, Ongwediva, Namibia
| | - Tenzin Tenzin
- World Organisation for Animal Health (OIE), Sub-Regional Representation for Southern Africa, Gaborone, Botswana
- * E-mail: ,
| | - Andre Coetzer
- Global Alliance for Rabies Control (GARC), Pretoria, South Africa
- Department of Biochemistry, Genetics and Microbiology, Faculty of Natural and Agricultural Sciences, University of Pretoria, South Africa
| | - Emmanuel H. Hikufe
- Directorate of Veterinary Services (DVS), Ministry of Agriculture, Water and Land Reform, Windhoek, Namibia
| | - Josephat Peter
- Outapi State Veterinary Office, Directorate of Veterinary Services (DVS), Ministry of Agriculture, Water and Land Reform, Omusati region, Outapi, Namibia
| | - Laina Hango
- Outapi State Veterinary Office, Directorate of Veterinary Services (DVS), Ministry of Agriculture, Water and Land Reform, Omusati region, Outapi, Namibia
| | - Tangeni Haimbodi
- Ondangwa State Veterinary Office, Directorate of Veterinary Services (DVS), Ministry of Agriculture, Water and Land Reform, Oshana region, Ondangwa, Namibia
| | - Johannes Lipinge
- Ondangwa State Veterinary Office, Directorate of Veterinary Services (DVS), Ministry of Agriculture, Water and Land Reform, Oshana region, Ondangwa, Namibia
| | - Frenada Haufiku
- Omuthiya State Veterinary Office, Directorate of Veterinary Services (DVS), Ministry of Agriculture, Water and Land Reform, Oshikoto region, Omuthiya, Namibia
| | - Matias Naunyango
- Eenhana State Veterinary Office, Directorate of Veterinary Services (DVS), Ministry of Agriculture, Water and Land Reform, Ohangwena region, Eenhana, Namibia
| | - Magano Kephas
- Eenhana State Veterinary Office, Directorate of Veterinary Services (DVS), Ministry of Agriculture, Water and Land Reform, Ohangwena region, Eenhana, Namibia
| | - Albertina Shilongo
- Directorate of Veterinary Services (DVS), Ministry of Agriculture, Water and Land Reform, Windhoek, Namibia
| | - Kenneth K. Shoombe
- Animal Disease Control, Sub-division, North-West, Directorate of Veterinary Services (DVS), Ministry of Agriculture, Water and Land Reform, Ongwediva, Namibia
| | - Siegfried Khaiseb
- Central Veterinary Laboratory, Directorate of Veterinary Services (DVS), Ministry of Agriculture Water and Land Reform, Windhoek, Namibia
| | - Moetapele Letshwenyo
- World Organisation for Animal Health (OIE), Sub-Regional Representation for Southern Africa, Gaborone, Botswana
| | | | - Lorenz Nake
- World Organisation for Animal Health (OIE), Paris, France
| | - Louis H. Nel
- Global Alliance for Rabies Control (GARC), Pretoria, South Africa
- Department of Biochemistry, Genetics and Microbiology, Faculty of Natural and Agricultural Sciences, University of Pretoria, South Africa
| | - Conrad M. Freuling
- Institute of Molecular Virology and Cell Biology, Friedrich-Loeffler-Institute, Greifswald—Insel Riems, Germany
| | - Thomas Müller
- Institute of Molecular Virology and Cell Biology, Friedrich-Loeffler-Institute, Greifswald—Insel Riems, Germany
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48
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Madzingira O, Fasina FO, Kandiwa E, Musilika-Shilongo A, Chitate F, van Heerden H. A retrospective sero-epidemiological survey of bovine brucellosis on commercial and communal farming systems in Namibia from 2004 to 2018. Trop Anim Health Prod 2020; 52:3099-3107. [PMID: 32577935 DOI: 10.1007/s11250-020-02332-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2019] [Accepted: 06/16/2020] [Indexed: 02/08/2023]
Abstract
Cattle production is the major livestock production activity and the mainstay of Namibia's economy. Sustained beef exports are contingent on a sound sanitary environment where diseases such as brucellosis are under control. In this retrospective study, 49,718 bovine brucellosis testing results from 2004 to 2018 were analyzed to determine the proportion of sero-positive cattle and herds, and the spatial distribution of positive reactors from commercial and communal areas. In total, 244 positive reactors were identified based on the Rose Bengal Test (RBT) and the Complement Fixation Test (CFT) in series, giving an overall proportion of infected animals of 0.49% (244/49,718; 95% CI, 0.43-0.56%) and an overall proportion of infected herds of 9.26% (78/842; 95% CI, 7.49-11.41%). There was a higher proportion of sero-positive communal herds (33.09%) and cattle (10.27%) than commercial herds (4.67%) and cattle (0.24%; p < 0.05). Annually, the proportion of positive reactors was 0-1.37% in the commercial area and 0-52.38% in the communal areas, with a clear decline in positive reactors in the communal areas. Within the commercial sector, the proportion of positive reactor dairy, beef, and export cattle was 0.19% (51/27,067; 95% CI, 0.14-0.25%), 0.30% (48/16,098; 95% CI, 0.22-0.40%), and 0.33% (16/4811; 95% CI, 0.20-0.54%), respectively. Abortions were found to be the major reason for Brucella testing in the communal areas. About 12.65% (96/759) of abortion-linked sera tested positive in the communal areas, but none were positive in beef or dairy cattle. Widespread vaccination of cattle and robust planned surveillance is recommended to reduce the incidence of the disease, its associated production losses and public health risk.
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Affiliation(s)
- Oscar Madzingira
- School of Veterinary Medicine, Faculty of Agriculture and Natural Resources, University of Namibia, Windhoek, P. Bag 13301, Namibia.
- Department of Veterinary Tropical Diseases, Faculty of Veterinary Science, University of Pretoria, Private Bag X04, Onderstepoort, 0110, South Africa.
| | - Folorunso Oludayo Fasina
- Emergency Centre for Transboundary Animal Diseases-Food and Agriculture Organisation of the United Nations (ECTAD-FAO), Dar es Salaam, Tanzania
- Department of Veterinary Tropical Diseases, Faculty of Veterinary Science, University of Pretoria, Private Bag X04, Onderstepoort, 0110, South Africa
| | - Erick Kandiwa
- School of Veterinary Medicine, Faculty of Agriculture and Natural Resources, University of Namibia, Windhoek, P. Bag 13301, Namibia
| | - Albertina Musilika-Shilongo
- Directorate of Veterinary Services, Ministry of Agriculture, Water and Forestry, P. Bag 12022, Government Office Park, Windhoek, Namibia
| | - Frank Chitate
- School of Veterinary Medicine, Faculty of Agriculture and Natural Resources, University of Namibia, Windhoek, P. Bag 13301, Namibia
| | - Henriette van Heerden
- Department of Veterinary Tropical Diseases, Faculty of Veterinary Science, University of Pretoria, Private Bag X04, Onderstepoort, 0110, South Africa
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49
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Hong SY, Ashipala LS, Bikinesi L, Hamunime N, Kamangu JW, Boylan A, Sithole E, Pietersen IC, Mutandi G, McLean C, Dziuban EJ. Rapid Adaptation of HIV Treatment Programs in Response to COVID-19 - Namibia, 2020. MMWR Morb Mortal Wkly Rep 2020; 69:1549-1551. [PMID: 33090979 PMCID: PMC7583497 DOI: 10.15585/mmwr.mm6942a6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
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50
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Ba DM, Ssentongo P, Agbese E, Yang Y, Cisse R, Diakite B, Traore CB, Kamate B, Kassogue Y, Dolo G, Dembele E, Diallo H, Maiga M. Prevalence and determinants of breast cancer screening in four sub-Saharan African countries: a population-based study. BMJ Open 2020; 10:e039464. [PMID: 33046473 PMCID: PMC7552834 DOI: 10.1136/bmjopen-2020-039464] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
OBJECTIVES Breast cancer is the most prevalent cancer and the second leading cause of cancer-related deaths among women after cervical cancer in much of sub-Saharan Africa. This study aims to examine the prevalence and sociodemographic-socioeconomic factors associated with breast cancer screening among women of reproductive age in sub-Saharan Africa. DESIGN A weighted population-based cross-sectional study using Demographic and Health Surveys (DHS) data. We used all available data on breast cancer screening from the DHS for four sub-Saharan African countries (Burkina Faso, Ivory Coast, Kenya and Namibia). Breast cancer screening was the outcome of interest for this study. Multivariable Poisson regression was used to identify independent factors associated with breast cancer screening. SETTING Four countries participating in the DHS from 2010 to 2014 with data on breast cancer screening. PARTICIPANTS Women of reproductive age 15-49 years (N=39 646). RESULTS The overall prevalence of breast cancer screening was only 12.9% during the study period, ranging from 5.2% in Ivory Coast to 23.1% in Namibia. Factors associated with breast cancer screening were secondary/higher education with adjusted prevalence ratio (adjusted PR)=2.33 (95% CI: 2.05 to 2.66) compared with no education; older participants, 35-49 years (adjusted PR=1.73, 95% CI : 1.56 to 1.91) compared with younger participants 15-24 years; health insurance coverage (adjusted PR=1.57, 95% CI: 1.47 to 1.68) compared with those with no health insurance and highest socioeconomic status (adjusted PR=1.33, 95% CI : 1.19 to 1.49) compared with lowest socioeconomic status. CONCLUSION Despite high breast cancer mortality rates in sub-Saharan Africa, the prevalence of breast cancer screening is substantially low and varies gradually across countries and in relation to factors such as education, age, health insurance coverage and household wealth index level. These results highlight the need for increased efforts to improve the uptake of breast cancer screening in sub-Saharan Africa.
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Affiliation(s)
- Djibril M Ba
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, Pennsylvania, USA
| | - Paddy Ssentongo
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, Pennsylvania, USA
| | - Edeanya Agbese
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, Pennsylvania, USA
| | - Yanxu Yang
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, Pennsylvania, USA
| | - Ramata Cisse
- Department of Psychology, Stony Brook University, Stony Brook, New York, USA
| | - Brehima Diakite
- Faculty of Medicine and Odontostomatology, University of Sciences Techniques and Technologies of Bamako, Bamako, Mali
| | - Cheick Bougadari Traore
- Faculty of Medicine and Odontostomatology, University of Sciences Techniques and Technologies of Bamako, Bamako, Mali
| | - Bakarou Kamate
- Faculty of Medicine and Odontostomatology, University of Sciences Techniques and Technologies of Bamako, Bamako, Mali
| | - Yaya Kassogue
- Faculty of Medicine and Odontostomatology, University of Sciences Techniques and Technologies of Bamako, Bamako, Mali
| | - Guimogo Dolo
- Faculty of Medicine and Odontostomatology, University of Sciences Techniques and Technologies of Bamako, Bamako, Mali
| | - Etienne Dembele
- Department of Biomedical Engineering, Northwestern University, Evanston, Illinois, USA
| | - Hama Diallo
- Faculty of Medicine and Odontostomatology, University of Sciences Techniques and Technologies of Bamako, Bamako, Mali
| | - Mamoudou Maiga
- Department of Biomedical Engineering, Northwestern University, Evanston, Illinois, USA
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