COVID-19 and mental health services in Sub-Saharan Africa: A critical literature review

BACKGROUND

The COVID-19 pandemic has wrought a profound impact on mental health in Sub- Saharan Africa, exacerbating existing disparities and rendering individuals undergoing treatment particularly susceptible. This comprehensive critical review delves into the scope, nature, and extent of COVID-19 impact on mental health services in Sub- Saharan Africa, while concurrently elucidating pivotal lessons and exemplary practices learnt from periods of lockdown.

METHODS

The methodology was guided by Jesson & Laccy's guide on how to conduct critical literature reviews. Articles were comprehensively sought through two academic databases (PubMed and Google Scholar), complemented by targeted searches on the WHO website and official public health websites of relevant Sub-Saharan African countries.

RESULTS

The investigation reveals a surge in mental health challenges, notably marked by a significant escalation in anxiety, depression, and post-traumatic stress disorder. Disruptions to care services, financial hardships, and the pervasive effects of social isolation further compound this escalation. The pre-existing inequalities in access to and quality of care were accentuated during this crisis, with marginalized groups encountering heightened impediments to essential services. In navigating this unprecedented challenge, communities emerged as integral agents in establishing supportive networks and implementing culturally sensitive interventions. Technology, such as telemedicine and online resources, played a pivotal role in bridging access gaps, particularly in remote areas. The synthesis of best practices for supporting mental health patients during lockdowns encompasses targeted interventions for vulnerable groups, including adolescents and pregnant women. Empowering communities through economic support and mental health literacy programs was identified as crucial. The integration of technology, such as the development of robust telemedicine frameworks, virtual training in curricula, and the utilization of digital platforms for interventions and public messaging, emerged as a cornerstone in addressing access disparities. Community engagement and resilience-building strategies gained prominence, emphasizing the necessity of collaboration between healthcare providers and communities. Promotion of peer support groups, home-based care, and the preservation of traditional healing practices were underscored as essential components.

CONCLUSION

The study underscores the need to adapt and optimize mental health services during emergencies. This entails prioritizing mental health within emergency response frameworks, exploring alternative service delivery methods, and fortifying data collection and research efforts.

Men's involvement in maternal health in sub-Saharan Africa: A scoping review of enablers and barriers

BACKGROUND

Globally, there are about 800 maternal deaths every day, with low-to-middle-income countries accounting for most of these deaths. A lack of access to maternal healthcare services is one of the main causes of these deaths. In sub-Saharan Africa (SSA), one of the barriers to accessing maternal healthcare services by women is a lack of their male partners' involvement. This scoping review aimed to assess the enablers and barriers to men's involvement in maternal healthcare services.

METHODS

The Preferred Reporting Items for Systematic Reviews and Meta-Analysis extension for Scoping Reviews (PRISMA-ScR) checklist was used as a guide for this review. We searched for peer-reviewed articles published between 2013 and 2023 in the English language from SCOPUS, ScienceDirect, PubMed, Africa Journals Online (AJOL), and Google Scholar databases. Two reviewers independently conducted the data extraction and article selection. All of the authors discussed and decided on the codes and categories for enablers and barriers after using NVivo to generate them.

RESULTS

Twenty-seven articles were used in this review. Of these, seventeen were qualitative studies, six were quantitative studies, and four were mixed-methods studies. The enablers of men's involvement in maternal healthcare were grouped into sociodemographic factors, health system factors, and policy factors, while barriers were grouped into sociodemographic, cultural, economic, and health system barriers. The lack of maternal health knowledge, insufficient economic resources, and unfriendly staff at healthcare facilities all contributed to a lack of involvement by men.

CONCLUSION

To improve men's involvement in maternal healthcare in SSA, there should be economic empowerment of both men and women, health education, and the provision of adequate infrastructure in healthcare facilities to accommodate men.

Genetic variants associated with dengue hemorrhagic fever. A systematic review and meta-analysis

Dengue hemorrhagic fever (DHF) is a severe condition resulting from the dengue virus, with four serotypes known as DEN-1, DEN-2, DEN-3, and DEN-4. Genetic variations play a crucial role in influencing susceptibility to DHF. Therefore, this investigation conducted a meta-analysis to uncover genetic changes that might have remained undetected in individual studies due to small sample sizes or methodological differences. Among 2212 initially identified studies, 23 were deemed suitable for analysis based on PRISMA guidelines. Toll-like receptors (TLR) and CD209 showed significant association with DHF (odds ratios: TLR=0.56, CD209 =0.55), indicating protective effects. However, tumor necrosis factor (TNF) and human leukocyte antigen (HLA) did not exhibit a statistically significant relationship with DHF. This study emphasizes the relevance of TLR and CD209 in DHF susceptibility and resistance across diverse geographical locations.

Presence of tuberculosis symptoms among HIV-positive men who have sex with men (MSM) in Zimbabwe

We conducted secondary data analysis using a biobehavioral survey dataset of 1538 MSM from Zimbabwe. Survey participants were screened for the four symptoms suggestive of tuberculosis infection using the WHO TB screening algorithm. Results: All participants experienced at least one symptom suggestive of tuberculosis. 40% of HIV-positive MSM reported having had a cough in the last month and 13% of them experienced unexpected weight loss. The prevalence of experiencing any of the four TB symptoms amongst HIV-positive MSM was 23%. Contribution There is an urgent need for active TB case finding and treatment amongst HIV-positive MSM in Zimbabwe. Clinicians will need to ensure that MSM who need TB testing receive it timeously.

Barriers and enablers for implementation of digital-linked diagnostics models at point-of-care in South Africa: stakeholder engagement

The integration of digital technologies holds significant promise in enhancing accessibility to disease diagnosis and treatment at point-of-care (POC) settings. Effective implementation of such interventions necessitates comprehensive stakeholder engagements. This study presents the outcomes of a workshop conducted with key stakeholders, aiming to discern barriers and enablers in implementing digital-connected POC diagnostic models in South Africa. The workshop, a component of the 2022 REASSURED Diagnostics symposium, employed the nominal group technique (NGT) and comprised two phases: Phase 1 focused on identifying barriers, while Phase 2 centered on enablers for the implementation of digital-linked POC diagnostic models. Stakeholders identified limited connectivity, restricted offline functionality, and challenges related to load shedding or rolling electricity blackouts as primary barriers. Conversely, ease of use, subsidies provided by the National Health Insurance, and 24-h assistance emerged as crucial enablers for the implementation of digital-linked POC diagnostic models. The NGT workshop proved to be an effective platform for elucidating key barriers and enablers in implementing digital-linked POC diagnostic models. Subsequent research endeavors should concentrate on identifying optimal strategies for implementing these advanced diagnostic models in underserved populations.

The HIV/AIDS responses pre and during the COVID-19 pandemic in sub-Saharan Africa: A basis for sustainable health system strengthening post-COVID-19

In May 2023, the World Health Organization announced that COVID-19 was no longer a global emergency. The impact of COVID-19 on the provision of HIV/AIDS services was not that severe due to the reprogramming of key resources. For health systems in sub-Saharan Africa to become resilient to future pandemics, lessons should be learned from the successful HIV/AIDS response in the region, and how the HIV/AIDS services were successfully adapted to the COVID-19 pandemic. In this article, we reviewed the 6 World Health Organization health system building blocks on how the best practices from the provision of HIV/AIDS services and the services' response to the COVID-19 pandemic can be used as a basis for restoring and strengthening health systems to offer universal access to quality essential health services. The success of the leadership and governance for universal access to anti-retroviral therapy can be a blueprint for the realization of universal health coverage. Significant efficiencies that resulted in the reduction in anti-retroviral therapy costs can be leveraged to ensure cheaper essential drugs while differentiated service delivery models can be used to improve health service accessibility. New technologies that have proven to be successful in HIV/AIDS care can also be used in the care of other diseases, including disease outbreaks. The strong health information systems developed for HIV programs can be used as a foundation for developing health information systems for the whole health sector while the healthcare professionals trained for the provision of HIV/AIDS services can be trained to provide services for a variety of other conditions.

Risk factors and clinical presentations of long COVID in Africa: A scoping review

COVID-19-related complications can last for years, even in patients who are asymptomatic during the acute phase, a phenomenon referred to as long COVID. This scoping review aimed to summarize the risk factors and clinical symptoms of long COVID in Africa between 2020 and 2022. Five studies were included. Three of the studies used in this review were retrospective cross-sectional studies, one was a prospective cohort study while another one was a case-control study. The review identified several risk factors for long COVID, including being female, being older than 40 years, having more than four acute COVID-19 symptoms, and having concomitant conditions such as asthma, hypertension, and depression. General, respiratory, cardiovascular, otolaryngological, gastrointestinal, and neurological symptoms were among the reported long COVID symptoms. To ensure that patients with long COVID are diagnosed and treated early, the risk factors and clinical symptoms of long COVID need to be identified for different population groups.

Making every baby count - An urgent reproductive health priority as sub-Saharan Africa continues to witness a high incidence of stillbirths

The expected culmination of a positive pregnancy experience is a healthy mother and a bouncing live baby. Unfortunately, globally an estimated 2 million babies are still born every year, with the largest incidence of stillbirths of about 50% of the global burden occurring in sub-Saharan Africa (SSA). Significant gaps in access to quality antenatal care (ANC) and labour and delivery remain in SSA. It is estimated that only 24% of women receive at least four ANC visits in SSA. Women are prepared for labour and delivery during this period, and risk factors are identified, and potential complications can be averted. Access to labour and delivery services is critical for picking up foetal compromise. Women must deliver in facilities that can offer assisted delivery and offer foetal and neonatal resuscitation, to prevent stillbirths and early neonatal deaths. In SSA, many primary healthcare facilities are unable to offer these services, whilst higher level facilities that can offer these may be difficult to access. The majority of stillbirths are preventable if women access quality ANC and can access modern facilities for labour and delivery. Therefore, stakeholders in reproductive health must ensure access to ANC for a positive pregnancy experience.

Co-creation of human papillomavirus self-sampling delivery strategies for cervical cancer screening in rural Zimbabwe: nominal group technique

Background

Human papillomavirus (HPV) self-sampling is recommended for cervical cancer screening, particularly among women who do not participate in or have access to current screening methods offered in Zimbabwe. Key stakeholder involvement is critical in co-creating acceptable delivery strategies for implementing HPV self-sampling to ensure demand and facilitate uptake by the target population. The main objective of this study was to engage key stakeholders in co-creating acceptable HPV self-sampling delivery strategies for cervical cancer screening in rural Zimbabwe.

Methods

We invited key stakeholders and employed a nominal group technique (NGT) for data collection. We employed the NGT to (1) identify barriers to access and utilisation of available cervical cancer screening services and (2) co-create delivery strategies for HPV self-sampling. The workshop included 8 participants (women n = 4, health workers n = 2 and policymakers n = 2). Quantitative data was gathered by ranking ideas and qualitative data were collected from participant group discussions and analysed thematically. The results of the ranking exercise were fed back to the participants for comments.

Results

The most significant barriers to accessing and utilising current cervical cancer screening services by women were: Inadequate information and education on cervical cancer, lack of resources and funding for cervical cancer programmes, long distances to nearest health facilities, and low perceived personal risk of cervical cancer. Key stakeholders recommended enhanced education and awareness, results notification, linkage to care, community-based self-sampling, and the choice of sampling devices as potential HPV self-sampling delivery strategies.

Conclusion

Our study demonstrated the utility of the NGT for reaching a consensus. Using the NGT, we established priority delivery strategies for HPV self-sampling cervical cancer screening. Adequate education and awareness, early results notification, choice of sampling device and community-based self-sampling were crucial to HPV self-sampling screening in rural Zimbabwe. The proposed delivery strategies can guide the development of guidelines for designing and implementing an HPV self-sampling intervention. We recommend a study to determine women's most preferred HPV self-sampling delivery strategies before implementing the intervention.

Diminished health and social outcomes among men who have sex with men who use drugs in Zimbabwe

No abstract available.

Accessibility and utilization of antenatal care services in sub-Saharan Africa during the COVID-19 pandemic: A rapid review

Control measures for the COVID-19 pandemic brought unprecedented challenges to health care delivery. Some countries in sub-Saharan Africa (SSA) stopped the provision of essential health care except for those services that were deemed emergencies or life-threatening. A rapid review was conducted on March 18, 2022, on the accessibility and utilization of antenatal care services in sub-Saharan Africa during the COVID-19 pandemic. PubMed, Google Scholar, SCOPUS, and the World Health Organization library databases were searched for relevant studies. A modified Population, Intervention, Control, and Outcomes (PICO) framework informed the development of the search strategy. The review included studies conducted within Africa that described the availability, access, and utilization of antenatal services during the COVID-19 pandemic. Eighteen studies met the inclusion criteria. This review revealed a reduction in access to ANC services, an increase in the number of home deliveries, and a reduction in the number of women attending ANC visits during the COVID-19 pandemic. A decrease in ANC service utilization was reported in some studies in the review. Barriers to ANC access and utilization during the COVID-19 pandemic included movement restrictions, limited transport access, fear of contracting COVID-19 at the health facilities, and facility barriers. The use of telemedicine needs to be improved in African countries to allow for the continued provision of health services during pandemics. In addition, there should strengthening of community involvement in the provision of maternal health services post-COVID-19 so that services may be able to better withstand future public health emergencies.

Understanding the role of intimate partner violence on HIV transmission in Zimbabwe: Secondary data analysis of data from the Zimbabwe demographic survey 2015-2016

Background

Gender-based violence (GBV) has been shown to have significant and long-lasting impacts on women's physical and mental health. It is, therefore, important to study its occurrence in a population and its intersect with infectious diseases such as HIV to inform the wider health promotion agenda. This study aimed to determine the association between GBV and HIV status in women and adolescent girls in Zimbabwe.

Methods

A secondary data analysis of data from a cross-sectional Zimbabwe Demographic and Health Survey (ZDHS) was conducted. Statistical analysis was employed to establish the association between GBV and HIV status. Geospatial mapping was conducted using a kernel smoothing method was employed to generate a continuous kernel density surface to illustrate the local spatial variations of female HIV and GBV prevalence.

Results

Women and adolescent girls suffering emotional GBV, such as those subjected to humiliation by their husbands or partners, were 1.45 (1.14-1.84) [OR (95% CIs)] times more likely to be HIV positive than those who were never humiliated. The same was true for women and adolescent girls whose husbands or partners threatened to harm them or someone they love, 1.33 (1.04-1.68). There is a relationship between women's HIV status and intimate partner aggression, such as when their partners pushed, shook, or threw something at them or physically abused them. This was also the case for those who reported that partners kicked, dragged, or beat them, tried to choke or burn them on purpose, or threatened or attacked them with a knife, gun, or other weapons. Women who experienced forced sexual violence with threats were more likely 1.61 (1.08-2.41), to be HIV positive than those women who did not experience the same.

Conclusion

GBV is widely spread in Zimbabwe. There is a need for the government to implement creative strategies to reach out to survivors, especially those that are forced to have unprotected sex and are at increased risk of HIV acquisition. This manuscript raises issues that can be addressed by robust health promotion strategies to reduce the impact of the syndemic of GBV and HIV acquisition in Zimbabwe.

Social media for public health: Reaping the benefits, mitigating the harms

With more than 4.26 billion social media users worldwide, social media has become a primary source of health information, exchange, and influence. As its use has rapidly expanded, social media has proven to be a "doubled-edged sword," with considerable benefits as well as notable harms. It can be used to encourage preventive behaviors, foster social connectivity for better mental health, enable health officials to deliver timely information, and connect individuals to reliable information. But social media also has contributed to public health crises by exacerbating a decline in public trust, deteriorating mental health (especially in young people), and spreading dangerous misinformation. These realities have profound implications for health professionals, social media companies, governments, and users. We discuss promising guidelines, digital safety practices, and regulations on which to build a comprehensive approach to healthy use of social media. Concerted efforts from social media companies, governments, users, public interest groups, and academia are essential to mitigate the harms and unlock the benefits of this powerful new technology.

Advancing the use of Long-Acting Extended Delivery formulations for HIV prevention in sub-Saharan Africa: challenges, opportunities, and recommendations

INTRODUCTION

The burden of HIV in sub-Saharan Africa (SSA) remains unacceptably high, and disproportionately affects girls and women. While the introduction of oral HIV pre-exposure prophylaxis (PrEP) in 2012 revolutionized HIV prevention, its effectiveness is dependent on user adherence and its implementation in SSA has faced numerous challenges. Patient-level, interpersonal and structural barriers, including, for example, daily pill burden, side effects, lack of partner support, testing and disclosure, and costs have been found to reduce adherence to oral PrEP.

DISCUSSION

Long-acting extended delivery (LAED) formulations for PrEP, such as injectable long-acting cabotegravir (CAB-LA) and dapivirine vaginal ring (DPV-VR) are critical additions to the HIV prevention toolkit and are especially important for populations such as adolescent girls and young women (AGYW) and other key populations who remain at significant risk of HIV acquisition while facing substantial barriers to preventive services. These LAED formulations have been shown to result in better adherence and fewer side effects, with CAB-LA being superior to oral PrEP in reducing the risk of HIV acquisition. They can be used to overcome user burden and adherence challenges. However, the successful rollout of the DPV-VR and CAB-LA may be hampered by issues such as a shortage of healthcare providers (HCPs), inadequate parenteral medication infrastructure, increased workload for HCPs, patient concerns, the price of the medications and the possibility of drug resistance.

CONCLUSIONS

SSA must develop laboratory capabilities for monitoring patients on LAED formulations and enhance research on developing more non-injectable LAED formulations. There is a need to train and retain more HCPs, implement task shifting, invest in healthcare infrastructure and integrate healthcare services. To reduce costs and improve availability, the region must advocate for patent license waivers for LAED formulations and procure drugs collectively as a region.

Health effects of climate change in Africa: A call for an improved implementation of prevention measures

The world's climate, particularly in Africa, has changed substantially during the past few decades, contributed by several human activities. Africa is one of the continents that is most vulnerable to climate change globally. Since the beginning of 2022, extreme weather events in Africa have affected about 19 million people and killed at least 4,000 individuals. Cyclones, floods, heatwaves, wildfires, droughts, and famine were among the severe weather occurrences. Natural disasters and extreme weather events brought on by climate change may compromise access to clean water, sanitation systems, and healthcare facilities, making people more vulnerable to a number of illnesses. Floods and drought can lead to both communicable and non-communicable diseases. The African population is more likely to experience more mental health disorders than before because of natural disasters, which result in the loss of property and sometimes loss of lives more frequently. We, therefore, call for an improved implementation of strategies to prevent the health effects of climate change so that the health of the people in Africa can be maintained.

Highlights on the Development, Related Patents, and Prospects of Lenacapavir: The First-in-Class HIV-1 Capsid Inhibitor for the Treatment of Multi-Drug-Resistant HIV-1 Infection

The multidrug-resistant (MDR) human immunodeficiency virus 1 (HIV-1) infection is an unmet medical need. HIV-1 capsid plays an important role at different stages of the HIV-1 replication cycle and is an attractive drug target for developing therapies against MDR HIV-1 infection. Lenacapavir (LEN) is the first-in-class HIV-1 capsid inhibitor approved by the USFDA, EMA, and Health Canada for treating MDR HIV-1 infection. This article highlights the development, pharmaceutical aspects, clinical studies, patent literature, and future directions on LEN-based therapies. The literature for this review was collected from PubMed, authentic websites (USFDA, EMA, Health Canada, Gilead, and NIH), and the free patent database (Espacenet, USPTO, and Patent scope). LEN has been developed by Gilead and is marketed as Sunlenca (tablet and subcutaneous injection). The long-acting and patient-compliant LEN demonstrated a low level of drug-related mutations, is active against MDR HIV-1 infection, and does not reveal cross-resistance to other anti-HIV drugs. LEN is also an excellent drug for patients having difficult or limited access to healthcare facilities. The literature has established additive/synergistic effects of combining LEN with rilpivirine, cabotegravir, islatravir, bictegravir, and tenofovir. HIV-1 infection may be accompanied by opportunistic infections such as tuberculosis (TB). The associated diseases make HIV treatment complex and warrant drug interaction studies (drug-drug, drug-food, and drug-disease interaction). Many inventions on different aspects of LEN have been claimed in patent literature. However, there is a great scope for developing more inventions related to the drug combination of LEN with anti-HIV/anti-TB drugs in a single dosage form, new formulations, and methods of treating HIV and TB co-infection. Additional research may provide more LEN-based treatments with favorable pharmacokinetic parameters for MDR HIV-1 infections and associated opportunistic infections such as TB.

Stakeholder's perspectives on acceptable interventions for promoting hypertension medication adherence in Namibia: nominal group technique

OBJECTIVE

To determine the most acceptable hypertension intervention package to promote hypertension adherence based on stakeholders' perspectives.

DESIGN

We employed the nominal group technique method and purposively sampled and invited key stakeholders offering hypertension services and patients with hypertension. Phase 1 was focused on determining barriers to hypertension adherence, phase 2 on enablers and phase 3 on the strategies. We employed the ranking method based on a maximum of 60 scores to establish consensus regarding hypertension adherence barriers, enablers and proposed strategies.

SETTING AND PARTICIPANTS

12 key stakeholders were identified and invited to participate in the workshop in Khomas region. Key stakeholders included subject matter experts in non-communicable diseases, family medicine and representatives of our target population (hypertensive patients).

RESULTS

The stakeholders reported 14 factors as barriers and enablers to hypertension adherence. The most important barriers were: lack of knowledge on hypertension (57 scores), unavailability of drugs (55 scores) and lack of social support (49 scores). Patient education emerged as the most important enabler (57 scores), availability of drugs emerged second (53 scores) and third having a support system (47 scores). Strategies were 17 and ranked as follows: continuous patient education as the most desirable (54 scores) strategy to help promote hypertension adherence, followed by developing a national dashboard to primarily monitor stock (52 scores) and community support groups for peer counselling (49 scores).

CONCLUSIONS

Multifaceted educational intervention package targeting patient and healthcare system factors may be considered in implementing Namibia's most acceptable hypertension package. These findings will offer an opportunity to promote adherence to hypertension therapy and reduce cardiovascular outcomes. We recommend a follow-up study to evaluate the proposed adherence package's feasibility.

Postnatal care services availability and utilization during the COVID-19 era in sub-Saharan Africa: A rapid review

BACKGROUND

Considerable progress has been made globally in improving maternal and newborn babies' health. The COVID-19 pandemic has posed considerable challenges for countries to maintain the provision of high-quality, essential maternal and newborn healthcare services.

METHODS

A rapid review was carried out on 20 March 2022 on postnatal care (PNC) services availability and utilization during the COVID-19 era in sub-Saharan Africa. PubMed, Google Scholar, and Africa Journals Online (AJOL) databases were searched for relevant studies. Studies included in the review utilized both primary data and secondary data.

FINDINGS

Nineteen studies met the inclusion criteria. The review revealed that there were significant declines in the availability and utilization of PNC services during and after the COVID-19 lockdown. Several reasons were found to contribute to the decline.

DISCUSSION

New, innovative strategies are therefore required to ensure that mothers and their newborn babies receive essential PNC to reduce maternal and neonatal morbidity and mortality in sub-Saharan Africa. Some of the strategies that can be used include home-based PNC visits, the use of telemedicine, phone-based referral networks, social media, and community radios.

Mapping evidence on the acceptability of human papillomavirus self-sampling for cervical cancer screening among women in sub-Saharan Africa: a scoping review

OBJECTIVES

The objective of this scoping review was to map evidence on the acceptability of self-sampling for human papillomavirus testing (HPVSS) for cervical cancer screening among women in the sub-Saharan Africa region.

DESIGN

Scoping review.

METHODS

Using Arksey and O'Malley's framework, we searched Scopus, PubMed, Medline Ovid, Cochrane and Web of Science databases for evidence on the acceptability of HPVSS among women aged 25 years and older published between January 2011 and July 2021. We included studies that reported evidence on the acceptability of HPVSS for cervical cancer screening. Review articles and protocols were excluded. We also searched for evidence from grey literature sources such as dissertations/theses, conference proceedings, websites of international organisations such as WHO and relevant government reports. Two reviewers independently performed the extraction using a pre-designed Excel spreadsheet and emerging themes were narratively summarised.

RESULTS

The initial search retrieved 1018 articles. Of these, 19 articles were eligible and included in the review. The following themes emerged from the included articles: acceptability of HPVSS; lack of self-efficacy to perform HPVSS, complications when performing HPVSS, preferences for provider sampling or assistance; setting of HPVSS; HPVSS by vulnerable populations.

CONCLUSION

Evidence shows that HPVSS is highly acceptable for cervical cancer screening in sub-Saharan Africa. Further research exploring the acceptability of HPVSS among women residing in rural areas is required, as well as studies to determine women's preferences for HPVSS intervention including the preferred type of sampling devices. Knowledge on the acceptability and preferences for HPVSS is important in designing women-centred interventions that have the potential to increase screening coverage and participation in cervical cancer screening programmes.

Prevention of antimicrobial resistance in sub-Saharan Africa: What has worked? What still needs to be done?

Antibiotics help in preventing and treating infections and increasing life expectancy globally. Globally, many people's lives are being threatened by the emergence of antimicrobial resistance (AMR). The cost of treating and preventing infectious diseases has increased due to AMR. Bacteria can resist the effects of antibiotics by altering drug targets, inactivating drugs, and activating drug efflux pumps. According to estimates, five million individuals died in 2019 from AMR-related causes, wherein 1.3 million deaths were directly linked to bacterial AMR. Sub-Saharan Africa (SSA) experienced the greatest mortality rate from AMR in 2019. In this article, we discuss AMR's causes and challenges SSA faces in implementing AMR prevention measures and propose recommendations to address the challenges. Antibiotic misuse and overuse, widespread usage in agriculture, and the pharmaceutical industry's absence of new antibiotic development are the factors contributing to AMR. SSA's challenges in preventing AMR include poor AMR surveillance and lack of collaboration, irrational use of antibiotics, weak medicine regulatory systems, lack of infrastructural and institutional capacities, lack of human resources, and inefficient infection prevention and control (IPC) practices. The challenges faced by countries in SSA can be addressed by increasing the public's knowledge of antibiotics and AMR, promoting antibiotic stewardship, improving AMR surveillance, promoting collaboration within and beyond countries, antibiotics regulatory enforcement, and improving the practice of IPC measures at home, food handling establishments, and healthcare facilities.

The Use of Economic Evaluation Tools in Essential Health Benefits Package Selection for Universal Health Coverage

OBJECTIVES

The sustainable development goals launched in 2015 are a follow-up commitment to the successful Millennium Development Goals. Goal number 3 of ensuring "good health and well-being" is a target to ensure universal health coverage. Universal health coverage means the provision of quality services that meet the needs of populations without risking financial impoverishment in the process. The guaranteed minimum health services in every health system constitute the health benefits package (HBP), which should be explicit and be composed of services that represent the best value for money and guarantee the best return on investment. The objective of this study was to review the application of cost-effectiveness analysis (CEA) and budget impact analysis in the development of HBP in low-to-middle income countries across the world.

METHODOLOGY

A literature review using a systematic approach was used. A search of PubMed, Google Scholar, World Health Organization, and World Bank databases was made for articles outlining the development of HBP in low- and middle-income countries, and a narrative synthesis was used for analysis.

RESULTS

Results from processes in Armenia, Ethiopia, Kyrgyz Republic, Lebanon, and Malawi showed CEA and budget impact analysis as 2 criteria used in HBP development in a limited number of countries with either no reference to the two or no reporting from the others. Local CEA estimates and cost data limitations were the biggest challenges to efforts to use robust methods.

CONCLUSION

Sustained efforts are needed to understand and address the challenges to the use of economic evaluation in the development of HBPs.

Engagement in HIV continuum of care: another step needed to close the gap towards UNAIDS 90-90-90 targets among younger men in Rwanda

In this study, we measured Rwandan men's engagement in HIV services based on the UNAIDS 90-90-90 targets and assessed factors associated with linkage to HIV services. We analyzed the Rwanda Population-based HIV Impact Assessment (RPHIA) data for 15-64-year-old males. We conducted bivariate analysis to assess the distribution and association of sociodemographic characteristics with UNAIDS 90-90-90 targets. We adjusted multi-variable models to understand the effect measurement of associated factors and determine the factors that best predict the achievement of UNAIDS 90-90-90. Of 13,780 males aged 15-64 years who participated in the RPHIA and consented to the blood draw and HIV testing, 302 had a positive HIV result while 301 had valid responses to all variables analyzed in this paper and were included in the analysis. We found that age group was an explanatory and predictive factor for achievement of UNAIDS 90-90-90. Younger men living with HIV (MLHIV) are less likely to have achieved UNAIDS 90-90-90 compared to MLHIV 50-64 years old: aOR for MLHIV aged 15-34 years was 0.21 (0.08, 0.53) and aOR for MLHIV aged 35-49 years was0.77 (0.36, 1.66). To close the UNAIDS 90-90-90 gap in Rwanda, innovative service delivery strategies are needed to support young MLHIV to reach 90-90-90. This article is protected by copyright. All rights reserved.

Implementation of Public Health Genomics in Africa: Lessons from the COVID-19 pandemic, challenges, and recommendations

Public Health Genomics (PHG) is a relatively new field. The wide application of genomic technologies played a pivotal role in elucidating the full genomic sequence of the SARS-CoV-2 virus. This breakthrough proved to be the starting point in the manufacture of diagnostic kits and the subsequent making of vaccines. Beyond the COVID-19 pandemic, many African countries can take advantage of the various investments in genomic technologies to introduce and intensify the use of genomics for public health gain. Public Health Genomics effectively monitors, prevents, and manages non-communicable and infectious diseases. However, there are several challenges to implementing PHG in Africa. In this perspective article, we discuss the utilization of PHG during the COVID-19 pandemic, the lessons learned from using PHG to manage and contain the COVID-19 pandemic, as well as potential challenges Africa may face when putting PHG into practice compared to challenges of other regions. We also discuss our recommendations for overcoming these challenges.

Abnormal vaginal discharge among women of reproductive age in sub-Saharan Africa: the need for a paradigm shift from a syndromic approach to specific pathogen identification and directed treatment

BACKGROUND

An abnormal vaginal discharge is a frequent manifestation of reproductive tract infections, including sexually transmitted infections (STIs) and vulvovaginal candidiasis. It is also a manifestation of bacterial vaginosis, which has a prevalence of up to 50% among women of reproductive age. Reproductive tract infections are associated with a range of reproductive health challenges and increase the risk of HIV acquisition.

METHODS

This study was performed to critically review and discuss the current diagnostic and treatment approaches to abnormal vaginal discharge among women of reproductive age in sub-Saharan Africa, and to call for a paradigm shift from the syndromic approach to specific pathogen identification and directed antimicrobial therapy.

DISCUSSION

Young women have the highest incidence of HIV infection in sub-Saharan Africa. Countries in sub-Saharan Africa where the prevalence of both STIs and bacterial vaginosis is very high have been employing a syndromic approach for the treatment of abnormal vaginal discharge since around 1984. However, the syndromic approach has several limitations, with the potential to miss infections, over-diagnose and over-treat STIs, and propagate antimicrobial resistance, which is one of the greatest global health challenges of the 21^st century.

CONCLUSIONS

The low to middle-income countries of sub-Saharan Africa must innovate and leverage improved diagnostics to capacitate primary health care and other levels for point-of-care diagnostic testing, in order to provide an immediate diagnosis and treatment for women with an abnormal vaginal discharge.

The re-emergence of wild poliovirus type 1 in Africa and the role of environmental surveillance in interrupting poliovirus transmission

Although there has been a global reduction in wild poliovirus (WPV) type 1 cases, Africa has experienced a re-emergence of the disease. This article discusses the re-emergence of WPV in Africa, the transmission and pathogenesis of WPV, and the role of environmental surveillance and other strategies used to interrupt all WPV transmission in the region permanently.

Cervical cancer in sub-Saharan Africa: an urgent call for improving accessibility and use of preventive services

Sub-Saharan Africa has the highest rates of cervical cancer in the world, largely attributed to low cervical cancer screening coverage. Cervical cancer is the most common cause of death among women in 21 of the 48 countries in sub-Saharan Africa. Close to 100% of all cases of cervical cancer are attributable to Human papillomavirus (HPV). HPV types 16 and 18 cause at least 70% of all cervical cancers globally, while types 31, 33, 45, 52, and 58 cause a further 20% of the cases. Women living with HIV are six times more likely to develop cervical cancer than those without HIV. Considering that sub-Saharan Africa carries the greatest burden of cervical cancer, ways to increase accessibility and use of preventive services are urgently required. With this review, we discuss the preventive measures required to reduce the burden of cervical cancer in sub-Saharan Africa, the challenges to improving accessibility and use of the preventive services, and the recommendations to address these challenges.

Estimating the budget impact of adopting tenofovir/emtricitabine for pre-exposure prophylaxis of HIV in the public health sector in Namibia (2021 - 2023)

BACKGROUND

Although Namibia started implementing pre-exposure prophylaxis (PrEP) of Human Immunodeficiency Virus (HIV) in 2016, no study to determine its budget impact has been conducted. This study, therefore, aimed to estimate the budget impact of adopting tenofovir/emtricitabine for PrEP of HIV for all eligible people in the public health sector in Namibia from 2021 to 2023.

METHODS

A country-specific model was developed for this budget impact analysis (BIA). PrEP has targeted all eligible people in Namibia who receive health services from the public sector. It was assumed that the adherence rate was 75% and PrEP effectiveness 60% in this study. Costs used in this study were taken from a study that included Namibian costs.

RESULTS

The BIA suggests that adopting PrEP may be cost saving as US$104 823, US$143 620, and US$182 452 of additional HIV care costs will potentially be saved in 2021, 2022, and 2023, respectively. Cost savings rely on high adherence rates, high PrEP effectiveness rates, low PrEP costs, and a small number of people living with HIV (PLHIV).

CONCLUSION

Further economic analysis could aid decision-making in Namibia, both to stress test assumptions in the BIA and conduct cost-effectiveness analysis to estimate the value for money of PrEP.

Monkeypox outbreak: a perspective on Africa's diagnostic and containment capacity

Since the first monkeypox (MPX) case was reported in humans in 1970, there have been several outbreaks of the disease. MPX is endemic in central and western Africa. MPX virus infection is confirmed using the conventional polymerase chain reaction, which detects the viral DNA in samples from the rash. Of concern is that the current outbreak has affected five regions of the world. Although MPX confirmatory tests are available worldwide, there are concerns about Africa's capacity to diagnose and contain the disease. The challenges faced by Africa include a lack of adequate laboratory infrastructure and health care workers, weak disease surveillance systems, and a lack of MPX knowledge among health care workers and communities. These challenges can be addressed by mobilizing resources for MPX virus testing, strengthening surveillance systems, collaboration among countries, training health care workers, task shifting, and engaging communities.

The HIV epidemic and the COVID-19 pandemic: A double tragedy for sub-Saharan African women

After four decades of the HIV epidemic, women from sub-Saharan Africa remain at a differentially high risk of acquisition. The Joint United Nations Programme on HIV and AIDS (UNAIDS) statistics show that the majority of HIV infections occur in this population and region. Evidence from previous humanitarian crises demonstrated adverse maternal consequences as a result of neglect for the provision of essential maternal, sexual and reproductive health services. The ongoing COVID-19 pandemic has had a similar effect, including an additional risk of HIV acquisition amongst women in sub-Saharan Africa. The COVID-19 pandemic has aggravated the risk of sub-Saharan Africa women to HIV infection because of a multitude of factors including child marriages, teenage pregnancies, dropping out of school, increase in incidence of sexual and gender-based violence and reduced access to preventive and treatment services for HIV and sexually transmitted infections. These include provision of care for rape and sexual and gender-based violence victims and provision of pre-exposure and postexposure prophylaxis for HIV and other STIs. Failure to urgently restore and maintain robust HIV prevention and treatment during the ongoing COVID-19 pandemic poses a risk of reversing the gains made over the years in reducing the incidence and morbidity from HIV amongst the population of sub-Saharan Africa women. There is need for an urgent and robust discourse to formulate effective interventions for protecting women and girls living in sub-Saharan Africa from an aggravated risk of HIV infection during the ongoing COVID-19 pandemic and other future humanitarian crises.

The role of social media during the COVID-19 pandemic: Salvaging its 'power' for positive social behaviour change in Africa

The ongoing coronavirus disease 2019 (COVID-19) pandemic remains a significant global public health crisis. The unique evolution of the COVID-19 pandemic has seen social media emerging and growing into an important vehicle for rapid information dissemination. This has in turn given rise to multiple sources of information, leading to what has come to be known as ‘infodemic’, associated with the plethora of misinformation and conspiracy theories. In this perspective, we explore the growth of the social media industry and the impact it has had during the ongoing COVID-19 crisis. We argue that while the multiple information pieces circulating on social media cause misinformation and panic, this might not necessarily and in all the cases influence sustained behaviours in the target population groups. We offer suggestions on how the power of social media can be harnessed and integrated into social and public health for a better digital balance for communication for development.

The case to scale up edutainment as an effective public health communication intervention to combat the COVID-19 pandemic in Zimbabwe

Efforts to control the coronavirus disease 2019 (COVID-19) pandemic have been negatively affected by myths, misconceptions and misinformation, fuelled by an "infodemic" spread via social media platforms. In response, The Zimbabwean COVID-19 response built on its experience with past public health communication strategies to employ edutainment strategies for COVID-19 awareness campaigns. This article discusses the different strategies and how they were employed. In this perspective piece, the authors discuss edutainment as an effective vehicle for reaching wider sectors of society. In tackling complex social issues with simple language, integrated into various entertainment formats, edutainment can bring about change in contexts where traditional strategies and actions may prove unsuccessful.

Towards equitable and sustainable availability of blood products in Zimbabwe: An analysis of strengths, weaknesses, opportunities and challenges

Blood transfusion can be a lifesaving intervention in a number of medical emergencies. To attain sustainable and equitable availability of blood products, it is important to understand the strengths, weaknesses, opportunities, and challenges of the national blood services programme. We, therefore, with this letter to the editor, discuss some of the strengths, weaknesses, opportunities and threats to the Zimbabwean programme since its inception. Despite several strengths and opportunities that the national blood services of Zimbabwe (NBSZ) leverages on, we argue that among other challenges, donor shortages and an upsurge of transfusion transmittable infections in the eligible donor population continue to be the biggest threats to the achievement of the programme objectives. These can be addressed through expanding the blood donor base and the catchment area. Additionally, improving the level of knowledge and attitude towards blood donation in the communities is critical for driving the sustainable and equitable distribution of safe blood products to the population.