scholarly journals Clusters of sub-Saharan African countries based on sociobehavioural characteristics and associated HIV incidence

2019 ◽  
Author(s):  
Aziza Merzouki ◽  
Janne Estill ◽  
Erol Orel ◽  
Kali Tal ◽  
Olivia Keiser
Keyword(s):  
National Level ◽  
Principal Component ◽  
Sub Saharan Africa ◽  
Demographic And Health Surveys ◽  
People Living With Hiv ◽  
Hiv Incidence ◽  
African Countries ◽  
Aggregated Data ◽  
Sub Saharan ◽  
Ssa Countries

AbstractIntroductionHIV incidence varies widely between sub-Saharan African (SSA) countries. This variation coincides with a substantial sociobehavioural heterogeneity, which complicates the design of effective interventions. In this study, we investigated how sociobehavioural heterogeneity in sub-Saharan Africa could account for the variance of HIV incidence between countries.MethodsWe analysed aggregated data, at the national-level, from the most recent Demographic and Health Surveys of 29 SSA countries [2010-2017], which included 594’644 persons (183’310 men and 411’334 women). We preselected 48 demographic, socio-economic, behavioural and HIV-related attributes to describe each country. We used Principal Component Analysis to visualize sociobehavioural similarity between countries, and to identify the variables that accounted for most sociobehavioural variance in SSA. We used hierarchical clustering to identify groups of countries with similar sociobehavioural profiles, and we compared the distribution of HIV incidence (estimates from UNAIDS) and sociobehavioural variables within each cluster.ResultsThe most important characteristics, which explained 69% of sociobehavioural variance across SSA among the variables we assessed were: religion; male circumcision; number of sexual partners; literacy; uptake of HIV testing; women’s empowerment; accepting attitude toward people living with HIV/AIDS; rurality; ART coverage; and, knowledge about AIDS. Our model revealed three groups of countries, each with characteristic sociobehavioural profiles. HIV incidence was mostly similar within each cluster and different between clusters (median(IQR); 0.5/1000(0.6/1000), 1.8/1000(1.3/1000) and 5.0/1000(4.2/1000)).

scholarly journals Clusters of sub-Saharan African countries based on sociobehavioural characteristics and associated HIV incidence

PeerJ ◽  
2021 ◽  
Vol 9 ◽  
pp. e10660
Author(s):  
Aziza Merzouki ◽  
Janne Estill ◽  
Erol Orel ◽  
Kali Tal ◽  
Olivia Keiser
Keyword(s):  
Behavioural Change ◽  
National Level ◽  
Sub Saharan Africa ◽  
Demographic And Health Surveys ◽  
People Living With Hiv ◽  
Hiv Incidence ◽  
Targeted Interventions ◽  
Hiv Epidemic ◽  
Sub Saharan ◽  
Ssa Countries

Introduction HIV incidence varies widely between sub-Saharan African (SSA) countries. This variation coincides with a substantial sociobehavioural heterogeneity, which complicates the design of effective interventions. In this study, we investigated how sociobehavioural heterogeneity in sub-Saharan Africa could account for the variance of HIV incidence between countries. Methods We analysed aggregated data, at the national-level, from the most recent Demographic and Health Surveys of 29 SSA countries (2010–2017), which included 594,644 persons (183,310 men and 411,334 women). We preselected 48 demographic, socio-economic, behavioural and HIV-related attributes to describe each country. We used Principal Component Analysis to visualize sociobehavioural similarity between countries, and to identify the variables that accounted for most sociobehavioural variance in SSA. We used hierarchical clustering to identify groups of countries with similar sociobehavioural profiles, and we compared the distribution of HIV incidence (estimates from UNAIDS) and sociobehavioural variables within each cluster. Results The most important characteristics, which explained 69% of sociobehavioural variance across SSA among the variables we assessed were: religion; male circumcision; number of sexual partners; literacy; uptake of HIV testing; women’s empowerment; accepting attitude toward people living with HIV/AIDS; rurality; ART coverage; and, knowledge about AIDS. Our model revealed three groups of countries, each with characteristic sociobehavioural profiles. HIV incidence was mostly similar within each cluster and different between clusters (median (IQR); 0.5/1000 (0.6/1000), 1.8/1000 (1.3/1000) and 5.0/1000 (4.2/1000)). Conclusions Our findings suggest that the combination of sociobehavioural factors play a key role in determining the course of the HIV epidemic, and that similar techniques can help to predict the effects of behavioural change on the HIV epidemic and to design targeted interventions to impede HIV transmission in SSA.

Developing a User-Based Decision-Aid Framework for Water Storage Systems in Sub-Saharan Africa: The Case of Blue Nile Basin in Ethiopia

2015 ◽  
Vol 01 (04) ◽  
pp. 1550012
Author(s):  
Stefanos Xenarios ◽  
Heracles Polatidis ◽  
Matthew McCartney ◽  
Attila Nemes
Keyword(s):  
National Level ◽  
Water Storage ◽  
Feasibility Studies ◽  
Data Availability ◽  
Sub Saharan Africa ◽  
Crop Modeling ◽  
African Countries ◽  
Promethee Ii ◽  
Sub Saharan ◽  
Ssa Countries

The development of water storage schemes in Sub-Saharan Africa (SSA) is considered a major aid for those regions with unequal water distribution, limited accessibility and anticipated climate change impacts. Great attention is given by many SSA countries to set up different water storage schemes that may improve rural and urban development on a national level. The funding for the water storage schemes is often derived from foreign agencies which conduct feasibility studies for the financing of potential investments. Often however, the feasibility studies rely on a single monetary criterion which may not identify the most appropriate water storage in each case. In addition, limited data availability in many SSA countries increases the difficulty of identifying the most suitable storage option. This paper develops a multicriteria framework for the integrated evaluation of water storage strategies in Sub-Saharan African countries. A set of economic, agronomic and opinion-based criteria are assessed through the PROMETHEE II outranking approach. The introduction of crop modeling complements the limited field data available in agronomic criteria and enhances the scientific rigor of the method. Ethiopia is adopted as a representative case of SSA countries where a diverse set of water storage options is currently under construction, often financed by foreign agencies.

scholarly journals Monitoring socioeconomic inequalities across HIV knowledge, attitudes, behaviours and prevention: results from cross-sectional surveys in 18 sub-Saharan African countries

2021 ◽  
Author(s):  
Mohamed Hamidouche ◽  
Pearl Anne Ante-Testard ◽  
Rachel Baggaley ◽  
Laura Temime ◽  
Kévin Jean
Keyword(s):  
Hiv Prevention ◽  
Socioeconomic Inequalities ◽  
Sub Saharan Africa ◽  
Absolute Difference ◽  
People Living With Hiv ◽  
African Countries ◽  
Medical Male Circumcision ◽  
Prevention Services ◽  
Sub Saharan ◽  
Ssa Countries

ObjectivesSocioeconomic inequalities in the access to and uptake of HIV prevention services constitute important barriers to global prevention targets, especially in sub-Saharan Africa (SSA). We aimed at monitoring these inequalities based on data from population-based surveys conducted in 18 SSA countries between 2010 and 2018.MethodsWe defined eight HIV indicators aimed at capturing access to and uptake of HIV prevention services among adult participants. Country-specific wealth-related inequalities were measured using the Relative and Slope Index of Inequalities (RII and SII, respectively) and were then pooled using random-effects meta-analyses. We compared inequalities between African regions using the Wilcoxon rank-sum test.ResultsThe sample consisted of 358,591 participants (66% women). Despite the variability in inequalities between countries and indicators, the meta-analysis revealed significant levels of relative and absolute inequalities in 6 out of 8 HIV indicators. For instance, the richest participants were five times more likely than the poorest to report condom use at last sexual intercourse (RII=5.02; 95% confidence interval, CI: 2.79-9.05), corresponding to an absolute difference of 16 percentage-points (SII=0.16; 95% CI: 0.12-0.20). Similar significant inequalities were observed in HIV-related knowledge, positive attitudes toward people living with HIV, recent HIV testing, participation to prevention of mother-to-child transmission programs and medical male circumcision. Overall, inequalities tended to be larger in West and Central vs. East and Southern African countries.ConclusionsDespite efforts to scale-up HIV-prevention programs, socioeconomic inequalities remain substantial over the continuum of HIV primary and secondary prevention in several SSA countries.

scholarly journals Risk factors associated with the coexistence of stunting, underweight, and wasting in children under 5 from 31 sub-Saharan African countries

BMJ Open ◽  
2021 ◽  
Vol 11 (12) ◽  
pp. e052267
Author(s):  
Iddrisu Amadu ◽  
Abdul-Aziz Seidu ◽  
Eric Duku ◽  
James Boadu Frimpong ◽  
John Elvis Hagan Jnr. ◽  
...  
Keyword(s):  
Risk Factors ◽  
Multinomial Logistic Regression ◽  
National Level ◽  
Three Dimensions ◽  
Sub Saharan Africa ◽  
Demographic And Health Surveys ◽  
African Countries ◽  
Factors Associated ◽  
Z Scores ◽  
Sub Saharan

ObjectiveThis study investigated the risk factors associated with the coexistence of stunting, underweight, and wasting among children under age 5 in sub-Saharan Africa (SSA).DesignData of 127, 487 under-5 children from 31 countries in SSA were pooled from the Demographic and Health Surveys collected between 2010 and 2019. We examined the risk of coexistence of stunting, underweight, and wasting using multinomial logistic regression models. The results were presented using relative risk ratios (RRR) with corresponding confidence intervals (CIs).SettingThirty-one sub-Saharan African countries.ParticipantsChildren under age 5.Outcome measuresThe outcome variables were three child anthropometrics: stunting (height-for-age z-scores); underweight (weight-for-age z-scores) and wasting (weight-for-height z-scores).ResultsThe prevalence of coexistence of stunting, underweight, and wasting varied across countries, with the highest (12.14%) and lowest (0.58%) prevalences of coexistence of stunting, underweight and wasting in Benin and Gambia respectively. The risk of coexistence of the three indicators of undernutrition was higher among children aged 1 year (RRR=3.714; 95% CI 3.319 to 4.156) compared with those aged 0. The risk of coexistence of the three dimensions was lower among female children (RRR=0.468 95% CI 0.420 to 0.51), but higher for those with small size at birth (RRR=3.818; CI 3.383 to 4.308), those whose mothers had no education (RRR=3.291; 95% CI 1.961 to 5.522), not working (RRR=1.195; 95% CI 1.086 to 1.314), had no antenatal visits during pregnancy (RRR=1.364; 95% CI 1.20 to 1.541), children delivered at home (RRR=1.372; CI 1.232 to 1.529), those from poor households (RRR=1.408; 95% CI 1.235 to 1.605), those whose mothers had no access to media (RRR=1.255; 95% CI 1.144 to 1.377) and living in households with an unimproved toilet facility (RRR=1.158; 95% CI 1.032 to 1.300).ConclusionsFindings suggest the urgent need for consideration of the coexistence of stunting, wasting and underweight among under-5 children in policy design and programming of interventions to eradicate child malnutrition in SSA. In the short-term, national-level policies and interventions need to be well tailored considering the compositional characteristics.

scholarly journals Incidence of HIV in Sub-Saharan Africa, 2000–2015: The Interplay Between Social Determinants and Behavioral Risk Factors

2021 ◽  
Author(s):  
Deepa Jahagirdar ◽  
Magdalene Walters ◽  
Avina Vongpradith ◽  
Xiaochen Dai ◽  
Amanda Novotney ◽  
...  
Keyword(s):  
Incidence Rate ◽  
Incidence Rates ◽  
Sub Saharan Africa ◽  
Behavioral Risk ◽  
Hiv Incidence ◽  
Hiv Knowledge ◽  
African Countries ◽  
Final Model ◽  
Sub Saharan ◽  
Disease Study

AbstractHIV incidence in sub-Saharan Africa declined substantially between 2000 and 2015. In this analysis, we consider the relative associations of nine structural and individual determinants with this decline. A linear mixed effects model of logged HIV incidence rates versus determinants was used. The data were from mathematical modelling as part of the 2019 Global Burden of Disease Study in 43 sub-Saharan African countries. We used forwards selection to determine a single final model of HIV incidence rate. The association of economic variables and HIV knowledge with incidence was found to be driven by education, while ART coverage had the largest impact on other determinants’ coefficients. In the final model, education years per capita contributed the most to explaining variation in HIV incidence rates; a 1-year increase in mean education years was associated with a 0.39 (− 0.56; − 0.2, t = − 4.48 p < 0.01) % decline in incidence rate while a unit increase in ART coverage was associated with a 0.81 (− 1.34; − 0.28, t = − 3.01, p < 0.01) % decline in incidence rate.

HIV/AIDS

2020 ◽  
pp. 901-933
Author(s):  
Sarah Fidler ◽  
Timothy E.A. Peto ◽  
Philip Goulder ◽  
Christopher P. Conlon
Keyword(s):  
Large Scale ◽  
Sub Saharan Africa ◽  
People Living With Hiv ◽  
African Countries ◽  
Global Pandemic ◽  
The People ◽  
Reduce Life Expectancy ◽  
Sub Saharan ◽  
Living With Hiv ◽  
The Impact

Since its discovery in 1983, the human immunodeficiency virus (HIV) has been associated with a global pandemic that has affected more than 78 million people and caused more than 39 million deaths. Globally, 36.9 million (34.3–41.4 million) people were living with HIV at the end of 2013. An estimated 0.8% of adults aged 15–49 years worldwide are living with HIV, although the burden of the epidemic continues to vary considerably between countries and regions. Sub-Saharan Africa remains most severely affected, with nearly 1 in every 20 adults living with HIV and accounting for nearly 71% of the people living with HIV worldwide. The impact of HIV in some African countries has been sufficient to reverse population growth and reduce life expectancy into the mid-30s, although HIV incidence has declined in some of these high-prevalence countries. However, there are large-scale HIV epidemics elsewhere (e.g. India, the Russian Federation, and Eastern Europe).

scholarly journals Adherence to Iron Supplementation in 22 Sub-Saharan African Countries and Associated Factors among Pregnant Women: A Large Population-Based Study

2019 ◽  
Vol 3 (12) ◽  
Author(s):  
Djibril M Ba ◽  
Paddy Ssentongo ◽  
Kristen H Kjerulff ◽  
Muzi Na ◽  
Guodong Liu ◽  
...  
Keyword(s):  
Pregnant Women ◽  
Iron Supplementation ◽  
Population Based ◽  
Sub Saharan Africa ◽  
Deficiency Anemia ◽  
Demographic And Health Surveys ◽  
Factors Associated ◽  
Sub Saharan ◽  
Ssa Countries ◽  
Antenatal Visits

ABSTRACT Background Iron deficiency anemia during pregnancy is a significant public health problem in sub-Saharan Africa (SSA) and is associated with serious adverse health outcomes. Although it is recommended that all women receive iron supplementation during pregnancy, little research has been conducted to measure overall compliance with this recommendation or variation across SSA countries. Objectives To assess prevalence and sociodemographic-economic factors associated with adherence to iron supplementation among pregnant women in SSA. Methods This was a weighted population-based cross-sectional study of 148,528 pregnant women aged 15–49 y in 22 SSA countries that participated in the Demographic and Health Surveys (DHS) in 2013–2018 and measured iron supplementation during pregnancy. Adherence to iron supplementation was defined as using iron supplementation for ≥90 d during pregnancy of the most recent birth. Results The overall prevalence of adherence to ≥90 d of iron supplementation during pregnancy was 28.7%, ranging from 1.4% in Burundi to 73.0% in Senegal. Factors associated with adherence included receiving ≥4 antenatal care visits [adjusted Prevalence Ratio (aPR): 25.73; 95% CI: 22.36, 29.60] compared with no antenatal visits; secondary or higher education (aPR: 1.17; 95% CI: 1.14, 1.19) compared with no education; wealthy (aPR: 1.13; 95% CI: 1.10, 1.16) compared with poor; and older women aged 35–49 y (aPR: 1.07; 95% CI: 1.05, 1.10) compared with younger women aged 15–24 y. Conclusions Adherence to iron supplementation during pregnancy in SSA is low and varies substantially across countries and in relation to factors such as number of antenatal visits, education, and level of family wealth. These results underscore the need for increased efforts to improve the uptake of iron supplementation for pregnant women in SSA.

scholarly journals Correlates of the double burden of malnutrition among women: an analysis of cross sectional survey data from sub-Saharan Africa

BMJ Open ◽  
2019 ◽  
Vol 9 (7) ◽  
pp. e029545 ◽  
Author(s):  
Dickson Abanimi Amugsi ◽  
Zacharie Tsala Dimbuene ◽  
Catherine Kyobutungi
Keyword(s):  
Household Wealth ◽  
Normal Weight ◽  
Overweight And Obesity ◽  
Sub Saharan Africa ◽  
Outcome Variable ◽  
Demographic And Health Surveys ◽  
African Countries ◽  
Double Burden ◽  
Double Burden Of Malnutrition ◽  
Sub Saharan

ObjectiveTo investigate the correlates of the double burden of malnutrition (DBM) among women in five sub-Saharan African countries.DesignSecondary analysis of Demographic and Health Surveys (DHS). The outcome variable was body mass index (BMI), a measure of DBM. The BMI was classified into underweight (BMI <18.50 kg/m2), normal weight (18.50–24.99 kg/m2), overweight (25.0–29.9 kg/m2) and obesity (≥30.0 kg/m2).SettingsGhana, Nigeria, Kenya, Mozambique and Democratic Republic of Congo (DRC).SubjectsWomen aged 15–49 years (n=64698).ResultsCompared with normal weight women, number of years of formal education was associated with the likelihood of being overweight and obese in Ghana, Mozambique and Nigeria, while associated with the likelihood of being underweight in Kenya and Nigeria. Older age was associated with the likelihood of being underweight, overweight and obese in all countries. Positive associations were also observed between living in better-off households and overweight and obesity, while a negative association was observed for underweight. Breastfeeding was associated with less likelihood of underweight in DRC and Nigeria, obesity in DRC and Ghana, overweight in Kenya and overweight and obesity in Mozambique and Nigeria relative to normal weight.ConclusionsOur analysis reveals that in all the countries, women who are breastfeeding are less likely to be underweight, overweight and obese. Education, age and household wealth index tend to associate with a higher likelihood of DBM among women. Interventions to address DBM should take into account the variations in the effects of these correlates.

scholarly journals Condom Use for Preventing STI/HIV and Unintended Pregnancy Among Young Men in Sub-Saharan Africa

2008 ◽  
Vol 3 (1) ◽  
pp. 60-78 ◽  
Author(s):  
Akinrinola Bankole ◽  
Susheela Singh ◽  
Rubina Hussain ◽  
Gabrielle Oestreicher
Keyword(s):  
Condom Use ◽  
Unplanned Pregnancy ◽  
Young Men ◽  
Sub Saharan Africa ◽  
Demographic And Health Surveys ◽  
Sexually Active ◽  
African Countries ◽  
Sexually Transmitted ◽  
Union Status ◽  
Sub Saharan

The condom is the only known method that provides simultaneous protection against unplanned pregnancy and some sexually transmitted infections (STIs), including HIV, among sexually active people. Using data from the Demographic and Health Surveys from 18 Sub-Saharan African countries, this study examined condom use and reasons for using the method at last intercourse among sexually active young men aged 15 to 29. Most young men were aware of the condom (73%-98%), but its use at last intercourse was quite variable, ranging from 6% in Madagascar to 74% in Namibia. In 10 countries, more young men reportedly used condoms for preventing STIs alone than they did for preventing pregnancy alone. In 6 countries, at least one third of the users used the method for both purposes. Use of the condom at last intercourse was associated with union status, education, residence, and exposure to television in at least two thirds of the countries.

Ethnic inequality and coups in sub-Saharan Africa

2017 ◽  
Vol 54 (3) ◽  
pp. 382-396 ◽  
Author(s):  
Christian Houle ◽  
Cristina Bodea
Keyword(s):  
Ethnic Group ◽  
Ethnic Groups ◽  
Strong Support ◽  
Sub Saharan Africa ◽  
Demographic And Health Surveys ◽  
Ethnic Inequality ◽  
African Countries ◽  
Sub Saharan ◽  
Coups D'etat ◽  
Group Inequality

Does ethnic inequality breed coups? The recent literature on civil war shows both that inequality between ethnic groups induces war and, importantly, that civil wars and coups, although fundamentally different, are related. The literature on coups d’état, however, has yet to theorize and test the effect of ethnic inequality on coups. The link is plausible because many coups are ‘ethnic coups’, which depend on the capacity of plotters to mobilize their co-ethnics. We argue that large income and wealth disparities between ethnic groups accompanied by within-group homogeneity increase the salience of ethnicity and solidify within-group preferences vis-à-vis the preferences of other ethnic groups, increasing the appeal and feasibility of a coup. We use group-level data for 32 sub-Saharan African countries and 141 ethnic groups between 1960 and 2005 and provide the first large-N test to date of the effect of ethnic inequality on coups. Between- and within-group inequality measures are constructed based on survey data from the Afrobarometer and the Demographic and Health Surveys. We find strong support for our hypothesis: between-ethnic-group inequality (BGI) increases the likelihood that an ethnic group stages a coup only when within-ethnic-group inequality (WGI) is low. Coups remain frequent in sub-Saharan Africa and coups are the main threat to democracy in the region, by harming democratic consolidation and economic development, and by provoking further political instability. Our work provides a novel rationale to be concerned about ethnic inequality, showing that when ethnic and income cleavages overlap, destabilizing coups d’état are more likely.

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