ObjectiveSTIs remain a global public health problem with a high burden among pregnant women. STIs in pregnant women may lead to various adverse pregnancy outcomes. In most sub-Saharan African countries, syndromic management is used for screening and treatment of STIs. We aimed to update and summarise pooled prevalence of curable STIs and bacterial vaginosis (BV) among pregnant women in sub-Saharan Africa.MethodsElectronic databases and reference lists of relevant published and unpublished studies were searched from March 2015 to October 2020. Studies were included if they estimated prevalence of Chlamydia trachomatis (CT), Trichomonas vaginalis (TV), Neisseria gonorrhoeae (NG), Treponema pallidum (syphilis), Mycoplasma genitalium (MG) and BV among pregnant women in sub-Saharan Africa. Meta-analyses were performed with observed prevalences corrected for diagnostic errors to estimate the pooled prevalence of diagnosed infections by region.ResultsA total of 48 studies met the inclusion criteria, providing 85-point prevalence estimates for curable STIs and BV. Pooled prevalence estimates (with 95% CI and number of women tested) were as follows: MG: 13.5% (4.0–27.2, n=1076); CT: 10.8% (6.9–15.5, n=6700); TV: 13.8% (10.0–18.0, n=9264); NG: 3.3% (2.1–4.7, n=6019); syphilis: 2.9% (2.0–4.0, n=95 308) and BV: 36.6% (27.1–46.6, n=5042). By region, BV was the most prevalent and ranged from 28.5% (24.5–32.8, n=1030) in Eastern Africa to 52.4% (33.5–70.9, n=2305) in Southern Africa; NG had the lowest prevalence, ranging from 1.4% (95% CI 0.1 to 3.1, n=367) in Central Africa to 4.4% (95% CI 2.6 to 6.4, n=4042) in Southern Africa.ConclusionThe prevalence of curable STIs and BV in sub-Saharan Africa is substantial in pregnant women but most prevalent in Southern Africa where HIV prevalence is highest. It is crucial to integrate screening of curable STIs into antenatal care programmes that have previously focused on diagnosis and treatment of syphilis and HIV.
Introduction: Armed conflicts are a threat to the health of populations in affected areas. The threat can have several forms, such as direct injury or disruption of health service delivery and utilisation. There has been an armed conflict (Anglophone crisis) in the English-speaking regions of Cameroon since 2017. We assessed the utilisation of health services before and during the armed conflict s in the Southwest region of Cameroon. Methods: A retrospective study of surveillance data was carried out between 2016 and 2018. Regional data for selected routine immunisation, reproductive health, disease surveillance and HIV/AIDS indicators were retrieved. The data were presented as frequencies and described narratively. Results: In general, there was a difference in the utilisation of health services before and during the armed conflict. Specifically, there was an improvement in health service utilisation indicators from 2016 to 2017, followed by a decline in 2018. The DPT3 vaccination coverage dropped from 90% in 2017 to 55% in 2018; deliveries attended by qualified personnel dropped from 46% in 2017 to 26% in 2018; the absolute number of people tested for HIV dropped from 20,3987 in 2017 to 18,3654 in 2018. Conclusion: The utilisation of health services by the population of the Southwest region declined during the armed conflict. This decline could have a significant impact on the population’s health and potentially affect the set global health targets such as improved vaccination coverage in all districts. Due to the armed conflict, there were challenges with regard to accessing health services. Local, national, regional and global authorities must work together to develop risk mitigating interventions in settings with armed conflicts to preserve the delivery and utilisation of health services.
Multiple public health emergencies (PHEs) experienced annually in the World Health Organisation (WHO) Africa region affect the provision of health services, including immunization. However, there is limited information on the performance of national immunization programs (NIPs) in WHO Africa countries that experience PHEs. This study assessed PHEs (armed conflicts, disasters, and disease outbreaks) and the performance of NIPs using global and regional immunization targets outlined for the Decade of Vaccines. Thirteen beneficiary countries of PHE mitigation funds from the African Public Health Emergency Fund were used as case studies. Data on PHEs and immunization indicators between 2010 and 2019 in selected countries were extracted from different PHE databases and the WHO/UNICEF immunization database, respectively. The data were stratified by country and summarized using descriptive statistics. Mann-Whitney U test was done to determine the association between the frequency of PHEs and the performance of NIPs. There were 175 disease outbreaks, 288 armed conflicts, and 318 disasters in the examined countries between 2010 and 2019. The Democratic Republic of Congo had the highest total PHE count (n = 208), while Liberia had the lowest (n = 20). Only three of the 13 countries had a median coverage value for the third dose of the combined Diphtheria, Tetanus, and Pertussis vaccine (DTP3) that had attained the target for ≥90% immunization coverage. Higher counts of armed conflict and total PHEs were associated with not meeting immunization targets for national DTP3 coverage of ≥90% and Maternal and Neonatal Tetanus elimination, p < 0.01. It was clear that in the WHO Africa region, PHEs are prevalent, irrespective of a country’s level of immunization maturity, and have the potential to derail the progress of NIPs in the absence of effective interventions. As we transition toward the Immunization Agenda 2030, we recommend that the WHO Africa region prioritizes interventions to mitigate the impacts of PHEs on NIPs.
Highlights Update of an analysis used to synthesise data on childhood immunisation in Africa. PubMed and Africa Wide databases were searched from January 2011 to September 2017 for articles on childhood immunisation. There was a remarkable increase in immunisation output from 2011 to 2017 compared to the previous decades. Most studies focused on the EPI and a majority of the studies were generated by Nigeria and South Africa. There is need for collaboration between high and low research generating countries to foster research on the continent.
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