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.

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 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 Management of TB/HIV co-infection: the state of the evidence

2020 ◽  
Vol 54 (3) ◽  
pp. 186-196
Author(s):  
Kwasi Torpey ◽  
Adwoa Agyei-Nkansah ◽  
Lily Ogyiri ◽  
Audrey Forson ◽  
Margaret Lartey ◽  
...  
Keyword(s):  
National Level ◽  
Hiv Treatment ◽  
The State ◽  
Sub Saharan Africa ◽  
People Living With Hiv ◽  
Increased Risk ◽  
Mdr Tb ◽  
Sub Saharan ◽  
Living With Hiv ◽  
Hiv Negative

Tuberculosis (TB) and HIV are strongly linked. There is a 19 times increased risk of developing active TB in people living with HIV than in HIV-negative people with Sub-Saharan Africa being the hardest hit region. According to the WHO, 1.3 million people died from TB, and an additional 300,000 TB-related deaths among people living with HIV. Although some progress has been made in reducing TB-related deaths among people living with HIV due to the evolution of diagnostics, treatment and antiretroviral HIV treatment, multi drug resistant TB is becoming a source of worry. Though significant progress has been made at the national level, understanding the state of the evidence and the challenges will better inform the national response of the opportunities for improved patient outcomes.Keywords: Tuberculosis, management, HIV, MDR TB, GhanaFunding: None

scholarly journals Women’s decision-making capacity and HIV testing in sub-Saharan Africa: A multi-country analysis of Demographic and Health Surveys

2020 ◽  
Author(s):  
Abdul-Aziz Seidu ◽  
Joseph Kojo Oduro ◽  
Bright Opoku Ahinkorah ◽  
Eugene Budu ◽  
Francis Appiah ◽  
...  
Keyword(s):  
Decision Making ◽  
Hiv Testing ◽  
Health Surveys ◽  
Demographic Characteristics ◽  
Sub Saharan Africa ◽  
Demographic And Health Surveys ◽  
Odds Ratios ◽  
Decision Making Capacity ◽  
Sub Saharan ◽  
Ssa Countries

Abstract IntroductionGlobal commitment to stop HIV and ensure access to HIV treatment call for women empowering as these efforts play a major role in mother to child transmission. We explored the association between women decision-making capacity and HIV testing in sub-Saharan Africa (SSA). Materials and methodsWe used data from current Demographic and Health Surveys (DHS) conducted between January 1, 2010 and December 31, 2016 in 30 countries within SSA. At the descriptive level, we calculated the prevalence of women who had undergone HIV testing and decision-making capacity in each of the countries as well as prevalence of HIV testing across their socio-demographic characteristics. We used Binary Logistic Regression to explore the likelihood of HIV testing by decision-making capacity and socio-demographic characteristics at 5% margin of error. The results were presented as Crude Odds Ratios (CORs) and Adjusted Odds Ratios (AORs). ResultsWe found that overall, 10.0% of women had decision-making with Nigeria (4.5%) and Zimbabwe (21.3%) recording the least and the highest respectively. In terms of HIV testing, the prevalence of HIV testing in the 30 SSA countries was 64.4%, with Guinea (12.8%) having the least. The highest occurred in Lesotho (99%) and Rwanda (99%). Women who had capacity to make decisions had higher likelihood of HIV testing [AOR=1.04, CI=1.02–1.09]. Women from Rwanda had the highest likelihood of HIV testing [AOR=53.92, CI=41.31–70.37] with women from Guinea having the least likelihood [AOR=0.10, CI=0.08–0.11]. Other determinants to HIV testing were level of education, wealth status, believing that a healthy-looking person can have HIV, watching television almost every day, age and place of residence.Conclusion SSA countries intending to improve HIV testing need to incorporate women decision-making capacity strategies in terms of education and counselling into the available policies. This is essential because our study indicates that as women are able to make decisions in their households, the possibility for them to test for their HIV status increases.

scholarly journals Prenatal care coverage and correlates of HIV testing in sub-Saharan Africa: Insight from demographic and health surveys of 16 countries

PLoS ONE ◽  
2020 ◽  
Vol 15 (11) ◽  
pp. e0242001
Author(s):  
Oluwafemi Emmanuel Awopegba ◽  
Amarachi Kalu ◽  
Bright Opoku Ahinkorah ◽  
Abdul-Aziz Seidu ◽  
Anthony Idowu Ajayi
Keyword(s):  
Prenatal Care ◽  
Pregnant Women ◽  
Hiv Testing ◽  
Health Surveys ◽  
Central Africa ◽  
Sub Saharan Africa ◽  
Demographic And Health Surveys ◽  
West And Central Africa ◽  
Sub Saharan ◽  
Ssa Countries

Background Prenatal screening of pregnant women for HIV is central to eliminating mother-to-child-transmission (MTCT) of HIV. While some countries in sub-Saharan Africa (SSA) have scaled up their prevention of MTCT programmes, ensuring a near-universal prenatal care HIV testing, and recording a significant reduction in new infection among children, several others have poor outcomes due to inadequate testing. We conducted a multi-country analysis of demographic and health surveys (DHS) to assess the coverage of HIV testing during pregnancy and also examine the factors associated with uptake. Methods We analysed data of 64,933 women from 16 SSA countries with recent DHS datasets (2015–2018) using Stata version 16. Adjusted and unadjusted logistic regression models were used to examine correlates of prenatal care uptake of HIV testing. Statistical significance was set at p<0.05. Results Progress in scaling up of prenatal care HIV testing was uneven across SSA, with only 6.1% of pregnant women tested in Chad compared to 98.1% in Rwanda. While inequality in access to HIV testing among pregnant women is pervasive in most SSA countries and particularly in West and Central Africa sub-regions, a few countries, including Rwanda, South Africa, Zimbabwe, Malawi and Zambia have managed to eliminate wealth and rural-urban inequalities in access to prenatal care HIV testing. Conclusion Our findings highlight the between countries and sub-regional disparities in prenatal care uptake of HIV testing in SSA. Even though no country has universal coverage of prenatal care HIV testing, East and Southern African regions have made remarkable progress towards ensuring no pregnant woman is left untested. However, the West and Central Africa regions had low coverage of prenatal care testing, with the rich and well educated having better access to testing, while the poor rarely tested. Addressing the inequitable access and coverage of HIV testing among pregnant women is vital in these sub-regions.

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.

The HIV Epidemic in Sub-Saharan Africa is Aging: Evidence from the Demographic and Health Surveys in Sub-Saharan Africa

2016 ◽  
Vol 21 (S1) ◽  
pp. 101-113 ◽  
Author(s):  
Sebastian Vollmer ◽  
Kenneth Harttgen ◽  
Tobias Alfven ◽  
Jude Padayachy ◽  
Peter Ghys ◽  
...  
Keyword(s):  
Health Surveys ◽  
Sub Saharan Africa ◽  
Demographic And Health Surveys ◽  
Hiv Epidemic ◽  
Sub Saharan

Association Between Girl-child Marriage and Intimate Partner Violence in Sub-Saharan Africa: Insights From a Multicountry Analysis of Demographic and Health Surveys

2021 ◽  
pp. 088626052110051
Author(s):  
Bright Opoku Ahinkorah ◽  
Olayinka Modupe Onayemi ◽  
Abdul-Aziz Seidu ◽  
Oluwafemi Emmanuel Awopegba ◽  
Anthony Idowu Ajayi
Keyword(s):  
Intimate Partner Violence ◽  
East Africa ◽  
Young Women ◽  
Partner Violence ◽  
Intimate Partner ◽  
Sub Saharan Africa ◽  
Child Marriage ◽  
Demographic And Health Surveys ◽  
Sub Saharan ◽  
Ssa Countries

While considerable attention has been given to the health consequences of child marriage in Sub-Saharan Africa (SSA), limited studies exist on its impact on intimate partner violence (IPV) in the region. We address this gap by examining the link between child marriage and IPV. We tested our study hypothesis using demographic and health survey data of 28,206 young women aged 20-24 years from 16 SSA countries with recent surveys (2015-2019). Binary logistic regression models were used to examine the effect of child marriage on IPV. Child marriage prevalence ranged from 13.5% in Rwanda, in East Africa, to 77% in Chad, in Central Africa, while IPV ranged from 17.5% in Mozambique in Southern Africa to 42% in Uganda, in East Africa. Past year experience of IPV was higher among young women who married or begun cohabiting before the age of 18 (36.9%) than those who did at age 18 or more (32.5%). This result was consistent for all forms of violence: physical violence (22.7% vs 19.7%), emotional violence (25.3% vs 21.9%), and sexual violence (12% vs 10.4%). After controlling for covariates, we found that young women in SSA who married before 18 years were more likely to experience IPV than those who married as adults (AOR: 1.20; 95% CI [1.12, 1.29]). Significant heterogeneity was observed in the country-level results, with a higher likelihood of IPV found in 14 of the 16 countries and lower in Angola and Chad. Child marriage is associated with a higher likelihood of IPV in most SSA countries, suggesting that ending child marriage will result in a substantial reduction in IPV. There is a need to institute policies to support and protect women who marry as children from abusive relationships in SSA.

scholarly journals Epidemiological rather than macro-economic factors correlate with socioeconomic inequalities in HIV testing in 16 sub-Saharan African countries

2021 ◽  
Author(s):  
Pearl Anne Ante-Testard ◽  
Laura Temime ◽  
Kevin Jean
Keyword(s):  
Hiv Testing ◽  
Contextual Factors ◽  
Socioeconomic Inequalities ◽  
Sub Saharan Africa ◽  
People Living With Hiv ◽  
Economic Factors ◽  
African Countries ◽  
Hiv Epidemic ◽  
Testing Uptake ◽  
Sub Saharan

In order to reach the first 95 (i.e., 95% of people living with HIV having knowledge of their status) of the 2030 UNAIDS 95-95-95 targets, it is crucial to better understand the contextual or structural factors driving socioeconomic inequalities in HIV testing uptake. It is still unclear whether they are mostly influenced by epidemiological or by macro-economic factors. Here, to shed light on this issue, we measured and decomposed socioeconomic inequalities in HIV testing in sub-Saharan Africa in relation to contextual factors using a novel method, the Recentered Influence Function decomposition method. Indeed, we found that HIV testing uptake was more concentrated among the rich in 12 of 16 sub-Saharan African countries based on population-based surveys. The level of the HIV epidemic seems to drive the level of response of HIV testing programs, rather than the per capita Gross Domestic Product of a country (i.e., national indicator of economic development). Our results suggest that when responding to the HIV epidemic, there is a need to monitor and assess inequalities in addition to monitoring HIV incidence and prevalence. Keywords: HIV, HIV testing, socioeconomic inequalities, contextual factors, sub-Saharan Africa, decomposing inequalities

scholarly journals HIV Treatment in sub-Saharan Africa: Did bureaucratic headwinds delay access to dolutegravir?

2019 ◽  
Author(s):  
Reuben Granich ◽  
Somya Gupta
Keyword(s):  
Service Delivery ◽  
National Level ◽  
Essential Element ◽  
Hiv Treatment ◽  
Sub Saharan Africa ◽  
World Health ◽  
Critical Element ◽  
People Living With Hiv ◽  
Sub Saharan ◽  
Living With Hiv

IntroductionThe World Health Organization now recommends dolutegravir (DTG) as part of the preferred first-line treatment for all adults living with HIV including women who may become pregnant. The new regimen with its high barrier to resistance, shortened time to suppression, superior side effects profile, and lower health sector and individual costs, represents a significant improvement. The recommendation removes an important obstacle to accessing dolutegravir as an essential element in controlling the epidemic. DiscussionTranslating science to policy to HIV service delivery is complex and vulnerable to significant delays. WHO, assuming a regulatory role, used preliminary Botswana Tsepamo study information regarding neural tube defects to issue a “safety signal” regarding DTG in May 2018. Regulatory evaluations of rare adverse reactions are complex, take time, and require considerable subject area specific expertise. After over a year, the WHO reversed its initial findings and issued revised treatment recommendations. However, the mixed messaging and confusion around dolutegravir’s safety profile has delayed national level adoption. The pace of national adoption of new WHO recommendations is measurable through published national guidelines and/or circulars available in the public domain. After 2015, published guidelines for 22 of 46 sub-Saharan countries (94% of 2018 regional HIV burden) showed that only three countries representing 4% of regional burden have adopted the new WHO preferred 1st line recommendations. ConclusionsMonitoring and evaluating the translation of science to service delivery is a critical element of successful disease control and elimination. The DTG false alarm and ongoing delayed access provides an opportunity to learn valuable lessons and implement corrective actions. However, lessons can only be learned by accurately describing and examining the timeline, processes, and impact of policy decisions that can adversely impact millions of people living with HIV. As with any successful global disease elimination effort or major project, it is important to establish a critical pathway for translation of science to service delivery and hold people and agencies accountable for their roles in accelerating and/or delaying progress.

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