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BackgroundIn sub-Saharan African cities, the epidemiological transition has shifted a greater proportion of the burden of non-communicable diseases, including mental and behavioral disorder, to the adult population. The burden of major depressive disorder and its social risk factors in the urban sub-Saharan African population are not well understood and estimates vary widely. We conducted a study in Ouagadougou, Burkina Faso, in order to estimate the prevalence of major depressive episodes among adults in this urban setting.MethodsThe Ouagadougou Health and Demographic System Site (HDSS) has followed the inhabitants of five outlying neighborhoods of the city since 2008. In 2010, a representative sample of 2,187 adults (aged 15 and over) from the Ouaga HDSS was interviewed in depth regarding their physical and mental health. Using criteria from the Mini International Neuropsychiatric Interview (MINI), we identified the prevalence of a major depressive episode at the time of the interview among respondents and analyzed its association with demographic, socioeconomic, and health characteristics through a multivariate analysis.ResultsMajor depressive episode prevalence was 4.3 % (95 % CI: 3.1–5.5 %) among the survey respondents. We found a strong association between major depressive episode and reported chronic health problems, functional limitations, ethnicity and religion, household food shortages, having been recently a victim of physical violence and regularly drinking alcohol. Results show a U-shaped association of the relationship between major depressive episode and standard of living, with individuals in both the poorest and richest groups most likely to suffer from major depressive disorder than those in the middle. Though, the poorest group remains the most vulnerable one, even when controlling by health characteristics.ConclusionsMajor depressive disorder is a reality for many urban residents in Burkina Faso and likely urbanites throughout sub-Saharan Africa. Countries in the region should incorporate aspects of mental health prevention and treatment as part of overall approaches to improving health among the region's growing urban populations.

The high acceptability of hypothetical vaccines indicates strong potential for introducing Ebola vaccines across Guinea. Strategies to build public confidence in use of Ebola vaccines should highlight any similarities with safe, effective vaccines routinely used in Guinea.

The border region of Forécariah (Guinea) and Kambia (Sierra Leone) was of immense interest to the West Africa Ebola response. Cross-sectional household surveys with multi-stage cluster sampling procedure were used to collect random samples from Kambia ( n = 635) in July 2015 and Forécariah ( n = 502) in August 2015 to assess public knowledge, attitudes and practices related to Ebola. Knowledge of the disease was high in both places, and handwashing with soap and water was the most widespread prevention practice. Acceptance of safe alternatives to traditional burials was significantly lower in Forécariah compared with Kambia. In both locations, there was a minority who held discriminatory attitudes towards survivors. Radio was the predominant source of information in both locations, but those from Kambia were more likely to have received Ebola information from community sources (mosques/churches, community meetings or health workers) compared with those in Forécariah. These findings contextualize the utility of Ebola health messaging during the epidemic and suggest the importance of continued partnership with community leaders, including religious leaders, as a prominent part of future public health protection. This article is part of the themed issue ‘The 2013–2016 West African Ebola epidemic: data, decision-making and disease control’.

The rapid population growth of many African cities has important implications for population health, yet little is known about factors contributing to increasing population, such as the fertility of internal migrants. We examine whether in-migrants to Kinshasa have different fertility patterns than lifetime Kinshasa residents, and identify characteristics of migrants that may explain differences in fertility. We also use detailed migration histories to examine whether fertility differs by features of migration. We use representative data from the PMA2020 Project for 2197 women in Kinshasa, including 340 women who moved to Kinshasa. We examine differences between migrants and non-migrants in fertility and other fertility-related characteristics. We also examine whether fertility differs by duration of residence in Kinshasa, number of lifetime moves, age at first migration, urban/rural classification of birthplace, and the distinction between intra-Kinshasa migration and migration to Kinshasa.. Migrants have significantly higher fertility than permanent Kinshasa residents, but the difference is relatively small in magnitude. This higher fertility appears due in part to patterns of contraceptive use among migrants. There is noteworthy heterogeneity among migrants: higher fertility among migrants is associated with longer duration in Kinshasa, more lifetime moves, urban-Kinshasa migration, older age at first migration, and moving to Kinshasa from outside (as opposed to intra-Kinshasa migration).

Demographic research in sub-Saharan Africa (SSA) has long relied on a blunt urban/rural dichotomy that may obscure important inter-urban fertility and mortality differentials. This paper uses Demographic and Health Survey (DHS) geo-referenced data to look beyond the simple urban/rural division by spatially locating survey clusters along an urban continuum and producing estimates of fertility and child mortality by four city size categories in West Africa. Results show a gradient in urban characteristics and demographic outcomes: the largest cities are the most advantaged and smaller cities least advantaged with respect to access to urban amenities, lower fertility and under-5 survival rates. There is a difference in the patterns of fertility and under-five survival across urban categories, with fertility more linearly associated with city size while the only significant distinction for under-5 survival in urban areas is broadly between the larger and smaller cities. Notably, the small urban “satellite cities” that are adjacent to the largest cities have the most favorable outcomes of all categories. Although smaller urban areas have significantly lower fertility and child mortality than rural areas, in some cases this difference is nearly as large between the smallest and largest urban areas. These results are used to argue for the need to give greater consideration to employing an urban continuum in demographic research.

Between 2013 and 2014, IUD insertions for women increased more than threefold, from 22,893 to 79,162, in 417 public facilities in Guatemala, Laos, Mali, and Uganda through a Population Services International pilot that engaged the public sector alongside existing private-sector interventions. Based on family planning market analyses, the country-specific interventions focused on strengthening policy, service delivery, supply chain management, and demand creation.