The prevalence of emotional abuse in children living in Sub-Saharan Africa - A systematic review

OBJECTIVES

This study is meant to put a focus on the prevalence of emotional abuse in low-income states like the Sub-Saharan region.

METHODOLOGY

Searching PubMed, Google scholar, and web of science during February and April 2021 a total of 2264 articles were identified, 27 met the inclusion criteria. We added the results of 13 VAC (Violence Against Children and Youth) studies, conducted by UNICEF capturing information about experienced sexual, physical, or emotional violence in 13-24-year-olds, as well as 56 MIC (Multiple Indicator Cluster) studies, conducted by the CDC to research the disciplinary methods used with children aged 1-14 years in the past month by older household members. Finally, in a meta-analytic approach, we aimed to calculate a pooled estimate of the prevalence.

RESULTS

The included studies depicted a wide range in prevalence rates across countries. For example, while the VAC study in Lesotho in 2018 showed low incidence rates of emotional violence (6.9 % Females, 3.8 % Males), the average prevalence recorded by the MIC study was as high as 57.8 % for females and 59.2 % for males. On average, the MIC studies displayed a higher incidence and the discrepancy of prevalence of emotional abuse between females and males was small. Calculating a pooled estimate of the prevalence was not possible, due to the heterogeneity of the data.

CONCLUSIONS

In general countries displayed a high prevalence. A standardized use of a uniform definition of emotional abuse might help to display a more homogenous data set in the future, giving the opportunity for pooled estimates of prevalence.

Prevalence of unnecessary antibiotic use in European hospitals – a systematic review

Background

Antibiotics (AB) are essential to modern day medicine as prophylaxis and therapy. Yet, unnecessary use has various negative effects on individual and global health, such as antimicrobial resistance (AMR) and contribution to high greenhouse gas (GHG) emissions of the healthcare sector. This systematic review provides an overview of unnecessary AB use in European hospitals in order to present possible ways forward.

Methods

The systematic review followed PRISMA guidelines, included as databases were: Embase, ProQuest Environmental Science Collection, PubMed, ScienceDirect, Scopus and Web of Science. Studies conducted among adult in-patients in EU/EEA countries were included if they provided assessment methodology, included a clear standard of measurement and chart reviews were used as evaluation basis.

Results

Fifty-six included studies were categorised into the following three groups: (1) Studies using an established evaluation method; 20 studies belong to this group, 18 used the same, established approach. Eleven of these studies performed an observational audit, while the interventions in the remaining studies were of educational or advisory nature. Unnecessary AB use ranged from 1.5% to 51% of all observed prescriptions. Outcomes of interventions showed great variation of effects on unnecessary use (-34.7% - +11.6). (2) Studies using a newly developed, clearly stated evaluation method (4 studies); (3) Studies which conform with established evaluation methods but the processes were not specified (32 studies). Results are subject to further analysis.

Conclusions

The studies included reported a great range of unnecessary AB use in adult in-patients, for both prophylactic and therapeutic indications. Evaluation methods of unnecessary AB use vary greatly between studies. In future research, comprehensive application of established approaches is essential for better overview and identification of key areas for AMR and GHG emission reduction activities.

Key messages

• Unnecessary antibiotic use varies greatly among studies conducted in European adult in-patients.

• In future research, wider application of established evaluation methods will improve comparability and targeting of interventions.

The economic burden of treating uncomplicated hypertension in Sub-Saharan Africa: a systematic literature review

Background and Objectives

Hypertension is one of the leading cardiovascular risk factors with high numbers of undiagnosed and untreated patients in Sub Saharan Africa (SSA). The health systems and affected people are often overwhelmed by the social and economic burden that comes with the disease. However, the research on the economic burden and consequences of hypertension treatment remains scare in SSA. The objective of our review was to compare different hypertension treatment costs across the continent and identify major cost drivers.

Material and Methods

Systematic literature searches were conducted in multiple databases (e.g., PubMed, Web of Science, Google Scholar) for peer reviewed articles written in English language with a publication date from inception to Jan. 2022. We included studies assessing direct and indirect costs of hypertension therapy in SSA from a provider or user perspective. The search and a quality assessment were independently executed by two researchers. All results were converted to 2021 US Dollar.

Results

Of 3999 results identified in the initial search, 33 were selected for data extraction. Costs differed between countries, costing perspectives and cost categories. Only 25% of the SSA countries were mentioned in the studies, with Nigeria dominating the research with a share of 27% of the studies. We identified 15 results each from a user or provider perspective. Medication costs were accountable for the most part of the expenditures with a range from 1.70$ to 97.06$ from a patient perspective and 0.09$ to 193.55$ from a provider perspective per patient per month. Major cost drivers were multidrug treatment, inpatient or hospital care and having a comorbidity like diabetes.

Conclusion

Hypertension poses a significant economic burden for patients and governments in SSA. Interpreting and comparing the results from different countries and studies is difficult as there are different financing methods and cost items are defined in different ways. However, our results identify medication costs as one of the biggest cost contributors. When fighting the economic burden in SSA, reducing medication costs in form of subsidies or special interventions needs to be considered.

Trial registration

Registration: PROSPERO, ID CRD42020220957.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-022-13877-4.

Biomass smoke in Burkina Faso: what is the relationship between particulate matter, carbon monoxide, and kitchen characteristics?

In Burkina Faso where cooking with biomass is very common, little information exists regarding kitchen characteristics and their impact on air pollutant levels. The measurement of air pollutants such as respirable particulate matter (PM10), an important component of biomass smoke that has been linked to adverse health outcomes, can also pose challenges in terms of cost and the type of equipment needed. Carbon monoxide could potentially be a more economical and simpler measure of air pollution. The focus of this study was to first assess the association of kitchen characteristics with measured PM10 and CO levels and second, the relationship of PM10 with CO concentrations, across these different kitchen characteristics in households in Nouna, Burkina Faso. Twenty-four-hour concentrations of PM10 (area) were measured with portable monitors and CO (area and personal) estimated using color dosimeter tubes. Data on kitchen characteristics were collected through surveys. Most households used both wood and charcoal burned in three-stone and charcoal stoves. Mean outdoor kitchen PM10 levels were relatively high (774 μg/m(3), 95 % CI 329-1,218 μg/m(3)), but lower than indoor concentrations (Satterthwaite t value, -6.14; p < 0.0001). In multivariable analyses, outdoor kitchens were negatively associated with PM10 (OR = 0.06, 95 % CI 0.02-0.16, p value <0.0001) and CO (OR = 0.03, 95 % CI 0.01-0.11, p value <0.0001) concentrations. Strong area PM10 and area CO correlations were found with indoor kitchens (Spearman's r = 0.82, p < 0.0001), indoor stove use (Spearman's r = 0.82, p < 0.0001), and the presence of a smoker in the household (Spearman's r = 0.83, p < 0.0001). Weak correlations between area PM10 and personal CO levels were observed with three-stone (Spearman's r = 0.23, p = 0.008) and improved stoves (Spearman's r = 0.34, p = 0.003). This indicates that the extensive use of biomass fuels and multiple stove types for cooking still produce relatively high levels of exposure, even outdoors, suggesting that both fuel subsidies and stove improvement programs are likely necessary to address this problem. These findings also indicate that area CO color dosimeter tubes could be a useful measure of area PM10 concentrations when levels are influenced by strong emission sources or when used in indoors. The weaker correlation observed between area PM10 and personal CO levels suggests that area exposures are not as useful as proxies for personal exposures, which can vary widely from those recorded by stationary monitors.

Malnutrition in young children of rural Burkina Faso: comparison of survey data from 1999 with 2009

OBJECTIVE

For measurement of progress towards the Millennium Development Goal (MDG) 1, reliable data on nutrition indicators of specific countries are essential. Malnutrition is also the main determinant for childhood mortality, which is addressed in MDG 4.

METHODS

In the health and demographic surveillance area of Kossi Province in north-western Burkina Faso, nutritional parameters were compared in two cohorts of young children of the same age range from eight villages. Surveys took place in June and December of the year 1999 and 2009. A multivariate model was used to control for confounding variables.

RESULTS

For the 1999 study, data were analysed for 179 and 197 children who took part in the June and December survey respectively. In 2009, corresponding data were analysed for 460 and 409 children. Prevalence of underweight was highest in December 1999 (42.6%) and lowest in December 2009 (34.1%). After adjustment for age, sex and village, there was a slight but not always significant improvement in the z-scores of weight-for-age, weight-for-length, length-for-age, and mid-arm circumference over time.

CONCLUSIONS

The findings from this study confirm the still unacceptable high prevalence of malnutrition in young children of rural sub-Saharan Africa (SSA). Progress in the reduction of malnutrition remains slow on this continent making it rather unlikely that the corresponding MDGs will be achieved. Large-scale multi-sectoral community-based interventions are urgently needed for a sustainable improvement of child health in SSA.