Association of type of birth attendant and place of delivery on infant mortality in sub-Saharan Africa.

Objective: To examine the association between type of birth attendant and place of delivery, and infant mortality (IM). Methods: This cross-sectional study used self-reported data from the Demographic Health Surveys for women in Ghana, Kenya, and Sierra Leone. Logistic regression estimated odds ratios (ORs) and95% confidence intervals. Results: In Ghana and Sierra Leone, odds of IM were higher for women who delivered at a health facility versus women who delivered at a household residence (OR=3.18, 95% confidence interval, CI: 1.29-7.83, p=0.01 and OR=1.62, 95% CI: 1.15-2.28, p=0.01, respectively). Compared to the use of health professionals, the use of birth attendants for assistance with delivery was not significantly associated with IM for women in Ghana or Sierra Leone (OR=2.17, 95% CI: 0.83-5.69, p=0.12 and OR=1.25, 95% CI: 0.92-1.70, p=0.15, respectively). In Kenya, odds of IM, though nonsignificant, were lower for women who used birth attendants than those who used health professionals to assist with delivery (OR=0.85, 95% CI: 0.51-1.41, p=0.46), and higher with delivery at a health facility versus a household residence (OR=1.29, 95% CI: 0.81-2.03, p=0.28). Conclusions: Women in Ghana and Sierra Leone who delivered at a health facility had statistically significant increased odds of IM. Birth attendant type-IM associations were not statistically significant.Future research should consider culturally-sensitive interventions to improve maternal health and help reduce IM.

Evaluation of factors affecting adherence to asthma controller therapy in chest clinics in a sub-Saharan African setting: a cross-sectional study

Background: Adherence to controller therapy in asthma is a major concern during the management of the disease. Objective: To determine the adherence rate and identify the predictors of low adherence to asthma controller therapy. Methods: A cross-sectional study including asthma patients was conducted from November 1, 2012 to May 31, 2013 in 4 chest clinics in Cameroon. The adherence to asthma treatment was rated using Morisky Medication Adherence Scale. A multivariate logistic regression analysis was performed for the identification of factors associated with adherence to asthma treatment. Results: Among the 201 asthma patients included, 133 (66.2%) were female. The mean age of participants was 41.2 years. Sixty-one (30.3%) of the patients did not visit the chest physician during the last year prior to the study. Asthma was well controlled in 118 patients (58.7%). The prevalence of low adherence rate to asthma controller therapy was 44.8% and the absence of any chest specialist visit within the last 12 months was the only factor associated with the low adherence rate to asthma treatment (OR 5.57 ; 95% CI 2.84–10.93). Conclusion: The adherence rate to asthma controller therapy in Cameroon is low and it could be improved if scheduled visits are respected by patients.

Polio eradication efforts in regions of geopolitical strife: the Boko Haram threat to efforts in sub-Saharan Africa.

The World Health Organization aims to eradicate wild poliovirus worldwide by the end of 2018. Cameroon and Nigeria, neighboring countries, have been affected by the terrorist and militant activities of the Islamist sect Boko Haram. Impacted regions are mainly the far North of Cameroon and Northern Nigeria. Targets of Boko Haram aggression in these zones include violence against polio workers, disruption of polio immunization campaigns, with consequent reduced access to health care and immunization. In addition to this significant problem, Northern Nigeria has historically seen rejection of polio virus vaccine initiatives. It remains to know how health systems can continue operations against polio in areas where Boko Haram operates. If appropriate measures are not urgently taken, it will be not possible to meet the 2018 goal of polio virus eradication. The response should include specialized immunization activities in conflict zones, will engagement of leaders. Countries should also explore immunization activities by soldiers and military personnel.

Review: Head and neck squamous cell carcinoma in sub-Saharan Africa

Aim Review the literature from 1990 to 2013 to determine known anatomic sites, risk factors, treatments, and outcomes of head and neck squamous cell carcinoma (HNSCC) in sub-Saharan Africa. Methods Using a systematic search strategy, literature pertaining to HNSCC in sub-Saharan Africa was reviewed and patient demographics, anatomic sites, histology, stage, treatment, and outcomes were abstracted. The contributions of human immunodeficiency virus (HIV), human papillomavirus (HPV) and behavioural risk factors to HNSCC in the region were assessed. Results Of the 342 papers identified, 46 were utilized for review, including 8611 patients. In sub-Saharan Africa, the oropharyngeal/oral cavity was found to be the most common site, with 7750 cases (90% of all cases). Few papers distinguished oropharyngeal from oral cavity, making identification of possible HPV-associated oropharyngeal squamous cell carcinoma (SCC) difficult. SCC of the nasopharynx, nasal cavity, or paranasal sinuses was identified in 410 patients (4.8% of all cases). Laryngeal SCC was found in 385 patients (4.5% of all cases), and only 66 patients (0.8% of all cases) with hypopharyngeal SCC were identified. In 862 patients with data available, 43% used tobacco and 42% used alcohol, and reported use varied widely and was more common in laryngeal SCC than that of the oropharyngeal/oral cavity. Toombak and kola nut use was reported to be higher in patients with HNSCC. Several papers reported HIV-positive patients with HNSCC, but it was not possible to determine HNSCC prevalence in HIV-positive compared to negative patients. Reports of treatment and outcomes were rare. Conclusions The oropharyngeal/oral cavity was by far the most commonly reported site of HNSCC reported in sub-Saharan Africa. The roles of risk factors in HNSCC incidence in sub-Saharan Africa were difficult to delineate from the available studies, but a majority of patients did not use tobacco and alcohol.

Santé et mortalité en Afrique sub-saharienne francophone : introduction à l’édition spéciale

This introduction underlies the specificities of the health transition that is underway in Francophone Africa to place the special issue in context. It also presents the different contributions collected in this issue and outlines new research directions suggested by these papers.

GENETIC DIVERSITY AMONG SORGHUM LANDRACES OF SOUTHWESTERN HIGHLANDS OF UGANDA

Sorghum ( Sorghum bicolor L. Moench) is an economic and staple crop in sub-Saharan Africa. The genetic diversity in its germplasm is an invaluable aid for its crop improvement. The objective of this study was to assess the existing genetic diversity among sorghum landraces in the southwestern highlands of Uganda. A total of 47 sorghum landraces, collected from southwestern highlands of Uganda, were characterised using 12 qualitative and 13 quantitative traits. The study was conducted at Kachwekano Research Farm in Kabale District, at an altitude of 2,223 m above sea level, during growing season of December 2014 to August 2015. Panicle shape and compactness were the most varied qualitative traits. Grain yield (1.23 to 11.31 t ha-1) and plant height (144.7 to 351.6 cm) were among quantitative traits that showed high variability. Days to 50% flowering (115 to 130 days) showed the least variability. Results of UPGMA cluster analysis generated a dendrogram with three clusters. Panicle weight, leaf width, stem girth, exertion length, peduncle length, panicle shape and compactness, glume colour and threshability were major traits responsible for the observed clustering (P<0.001). Principal Component Analysis revealed the largest variation contributors.

HERITABILITY FOR RESISTANCE TO ROSETTE DISEASE IN EXOTIC VALENCIA GROUNDNUTS

Groundnut rosette disease (GRD) is the most destructive virus disease of Valencia groundnuts ( Arachis hypogaea L.) in sub-Saharan Africa. Cultural, biological and chemical control measures have received limited success due to small scale farmers’ inability to use them. Use of host plant resistance provides the most effective and economically viable management option for the resource poor farmers. This study was conducted to determine heritability for resistance to GRD in Valencia groundnuts. Six crosses; Valencia C (P1) × ICGV-SM 90704 (P2), Valencia C (P1) × ICGV-SM 96801(P2), Valencia C (P1) × ICGV-SM 99566 (P2), NuMex-M3 (P1) × ICGV-SM 90704 (P2), NuMex-M3 × ICGV-SM 96801 (P2), and NuMex-M3 (P1) × ICGV-SM 99566 (P2), were made to generate F1, F2, BC1P1 and BC1P2 populations. Data on GRD severity were collected on a 1-9 score scale. Genetic Advance as a percentage of the mean (GAM) and heritability were estimated using variance components. Phenotypic Coefficient of Variation (PCV) and Genotypic Coefficient of Variation (GCV) estimates were high (20.04-70.1%) in the six crosses, except for Valencia C × ICGV-SM 96801(18.1%) and NuMex-M3 × ICGV-SM 96801(17.1%), which exhibited moderate GCV values. Broad and narrow sense heritability estimates for GRD disease score ranged from 64.1 to 73.7% and 31 to 41.9%, respectively, in all the crosses. GAM was high in all the crosses (21-50.7%), except for Valencia C x ICGV-SM 96801 (14.67), M3 x ICGV-SM 99566 (18%) and NuMex-M3 x ICGV-SM 96801 (13.5%) crosses that exhibited moderate GAM. The study revealed the presence of variability of GRD resistance, implying that genetic improvement of these exotic materials is possible.

Hardpan and maize root distribution under conservation and conventional tillage in Agro-Ecological Zone IIA, Zambia

Hardpans (plough/hoe pans) are commonly believed to restrict plant root growth and crop yields under conventional small-scale agriculture in sub-Saharan Africa. This study questions the notion of widespread hardpans in Zambia and their remedy under conservation tillage. Soil penetration resistance was measured in 8x12 grids, covering 80 cm wide and 60 cm deep profiles in 32 soil pits. Large and fine maize roots were counted in 8x6 grids. Soil samples from mid-rows were analysed for pH, exchangeable H+, exchangeable Al3+, cation exchange capacity, total N and extractable P (Bray 1) at six depths from 0-10 to 50-60 cm. Cultivation-induced hardpans were not detected. Soils under conservation tillage were more compact at 5 cm depth than soils under conventional tillage. No differences in root distributions between conservation and conventional tillage were found. Maize ( Zea mays L. ) roots were largely confined to a relatively small soil volume of about 30 cm x 30 cm x 30 cm. Root growth appeared to be restricted by a combination of low concentrations of N and P. Soil acidity and Al saturation appeared to play a minor role in root distribution. L-shaped taproots in soils under manual tillage reported earlier were not necessarily due to hardpans, but may rather be caused by temporarily dry, impenetrable subsoils early in the rain season. There is no scientific basis for the recommendation given to farmers by agricultural extension workers to “break the hardpan” in fields under manual or animal tillage in the study areas.

L’effet à long terme de la vie reproductive sur la mortalité des femmes en milieu rural sénégalais

Population ageing in sub-Saharan Africa raises new concerns about mature adult mortality patterns and differentials, but little is known in this region due to the lack of data. This study examines the long term effects of reproductive history on female mortality in three local rural areas in Senegal where population have been followed up for decades. We study mortality differentials according to the past reproductive history of females aged between 50 and 70 in the period 1985-2011. We find that age at first and last deliveries impact mortality levels, as does the number of children ever born. Looking at the sex of the childrenand their vital status at age 5, we note that the number of boys is negatively associated with mortality rates, by a larger extent than the number of girls. In virilocal societies, social factors probably have a strong impact. This result opens future research avenues on the issue of the care of the elderly.

Facteurs de risque pour les maladies diarrhéiques chez les enfants à Dakar : une analyse multi-niveaux avec variables latentes

Au Sénégal, les maladies diarrhéiques constituent un fardeau important, qui pèse encore lourdement sur la santé des enfants. Ces maladies sont influencées par un large éventail de facteurs, appartenant à différents niveaux et sphères d'analyse. Cet article analyse ces facteurs de risque et leur rôle relatif dans les maladies diarrhéiques de l'enfant à Dakar. Ce faisant, elle illustre une nouvelle approche pour synthétiser le réseau de ces déterminants. Une analyse en classes latentes (LCA) est d’abord menée, puis les variables latentes ainsi construites sont utilisées comme variables explicatives dans une régression logistique sur trois niveaux. Les résultats confirment que les déterminants des diarrhées chez l'enfant appartiennent aux trois niveaux d'analyse et que les facteurs comportementaux et l'assainissement du quartier jouent un rôle prépondérant. Les résultats illustrent aussi l'utilité des LCA pour synthétiser plusieurs indicateurs, afin de créer une image causale intégrée, tout en utilisant des modèles statistiques parcimonieux.

Dynamiques urbaines et santé des enfants en Afrique subsaharienne : Perspectives théoriques

Les enjeux de développement en rapport avec la santé urbaine des enfants en Afrique sub-saharienne deviennent d’autant plus importants qu’on a eu à observer dans certaines villes un paradoxe sanitaire se traduisant par une mortalité relativement plus élevée que celle du milieu rural. En outre, concilier la croissance rapide des villes africaines avec l’objectif d’un environnement sanitaire adéquat et adapté à l’ampleur et à la diversité des besoins relève du défi. Cet article propose un état des lieux critique de la littérature sur la santé urbaine, à travers une synthèse de 82 travaux scientifiques portant sur les relations entre dynamiques urbaines et sanitaires. L’étude accorde un regard particulier à la santé des enfants en Afrique subsaharienne francophone. Cette synthèse met en évidence les points de convergences et de divergences de santé urbaine, et aborde aussi, sous un angle critique, les aspects méthodologiques. Elle met en évidence une pluralité de situations sanitaires urbaines, ainsi que la complexité des mécanismes explicatifs des relations entre dynamique urbaine et santé des populations.

Evaluation des estimations indirectes de mortalité dans trois observatoires de population au Sénégal

En Afrique sub-saharienne, les recensements constituent une source de données fondamentale pour estimer la mortalité, en raison de l’incomplétude de l’enregistrement des décès à l'état civil. Afin d’évaluer la fiabilité des niveaux de mortalité qui peuvent en être déduits, nous appliquons différentes méthodes d’estimation à des extraits des recensements sénégalais de 2002 et 2013, couvrant trois observatoires de population situés à Bandafassi, Mlomp et Niakhar. Les taux de mortalité des moins de cinq ans tirés du nombre d’enfants nés vivants et survivants s’avèrent plus bas que les niveaux attendus au vu des données du suivi démographique. Les estimations déduites des déclarations sur la survie des parents sont largement inférieures aux niveaux de mortalité adulte réellement observés selon le suivi. Par contre, les taux de mortalité par âge basés sur les décès récents déclarés dans les ménages sont conformes aux données du suivi, sauf pour la mortalité infantile qui est sensiblement sous-déclarée en 2002. Cette évaluation confirme que les méthodes indirectes procurent des estimations qui ne peuvent être considérées isolément mais doivent plutôt être systématiquement comparées les unes aux autres. Des études d’évaluation directes menées au niveau individuel à l’aide d’appariements sont nécessaires pour mieux identifier les différentes sources de biais.

The impact of household size on poverty: An analysis of various low-income townships in the Northern Free State region, South Africa

Poverty is a multi-dimensional socio-economic problem in most sub-Saharan African countries. The purpose of this study is to analyse the relationship between household size and poverty in low-income communities. The Northern Free State region in South Africa was selected as the study region. A sample of approximately 2 900 households was randomly selected within 12 poor communities in the region. A poverty line was calculated and 74% of all households were found to live below the poverty line. The Pearson’s chi-square test indicated a positive relationship between household size and poverty in eleven of the twelve low-income communities. Households below the poverty line presented larger households than those households above the poverty line. This finding is in contradiction with some findings in other African countries due to the fact that South Africa has higher levels of modernisation with less access to land for subsistence farming. Effective provision of basic needs, community facilities and access to assets such as land could assist poor households with better quality of life. Poor households also need to be granted access to economic opportunities, while also receiving adult education regarding financial management and reproductive health.

Indirect child mortality estimation technique to identify trends of under-five mortality in Ethiopia.

Background: In sub-Saharan African countries, the chance of a child dying before the age of five years is high. The problem is similar in Ethiopia, but it shows a decrease over years. Methods: The 2000; 2005 and 2011 Ethiopian Demographic and Health Survey results were used for this work. The purpose of the study is to detect the pattern of under-five child mortality overtime. Indirect child mortality estimation technique is adapted to examine the under-five child mortality trend in Ethiopia. Results: From the result, it was possible to see the trend of under-five child mortality in Ethiopia. The under-five child mortality shows a decline in Ethiopia. Conclusion: From the study, it can be seen that there is a positive correlation between mother and child survival which is almost certain in any population. Therefore, this study shows the trend of under-five mortality in Ethiopia and decline over time.