Epidemiology of Coxiella burnetii infection in Africa: a OneHealth systematic review

Background: Q fever is a common cause of febrile illness and community-acquired pneumonia in resource-limited settings. Coxiella burnetii, the causative pathogen, is transmitted among varied host species, but the epidemiology of the organism in Africa is poorly understood. We conducted a systematic review of C. burnetii epidemiology in Africa from a “One Health” perspective to synthesize the published data and identify knowledge gaps.<p></p> Methods/Principal Findings: We searched nine databases to identify articles relevant to four key aspects of C. burnetii epidemiology in human and animal populations in Africa: infection prevalence; disease incidence; transmission risk factors; and infection control efforts. We identified 929 unique articles, 100 of which remained after full-text review. Of these, 41 articles describing 51 studies qualified for data extraction. Animal seroprevalence studies revealed infection by C. burnetii (≤13%) among cattle except for studies in Western and Middle Africa (18–55%). Small ruminant seroprevalence ranged from 11–33%. Human seroprevalence was <8% with the exception of studies among children and in Egypt (10–32%). Close contact with camels and rural residence were associated with increased seropositivity among humans. C. burnetii infection has been associated with livestock abortion. In human cohort studies, Q fever accounted for 2–9% of febrile illness hospitalizations and 1–3% of infective endocarditis cases. We found no studies of disease incidence estimates or disease control efforts.<p></p> Conclusions/Significance: C. burnetii infection is detected in humans and in a wide range of animal species across Africa, but seroprevalence varies widely by species and location. Risk factors underlying this variability are poorly understood as is the role of C. burnetii in livestock abortion. Q fever consistently accounts for a notable proportion of undifferentiated human febrile illness and infective endocarditis in cohort studies, but incidence estimates are lacking. C. burnetii presents a real yet underappreciated threat to human and animal health throughout Africa.<p></p&gt

Urbanization and health in Africa : exploring the interconnections between poverty, inequality and the burden of disease

There are few changes in the history of human existence comparable to urbanization in scope and potential to bring about biologic change. The transition in the developed world from an agricultural to an industrial-urban society has already produced substantial changes in human health, morphology and growth (Schell, Smith and Bilsborough, 1993, p.1). By the year 2000, about 50% of the world s total population will be living crowded in urban areas and soon thereafter, by the year 2025 as the global urban population reaches the 5 billion mark more of the world s population will be living in urban areas. This has enormous health consequences. By the close of the twenty-first century, more people will be packed into the urban areas of the developing world than are alive on the planet today (UNCHS (Habitat), 1996, p.xxi). Africa presents a particularly poignant example of the problems involved, as it has the fastest population and urban growth in the world as well as the lowest economic development and growth and many of the poorest countries, especially in Tropical Africa. Thus it exemplifies in stark reality many of the worst difficulties of urban health and ecology (Clarke, 1993, p.260). This essay is therefore concerned to analyse the trends of urbanization in Africa. This is followed by an overview of the environmental conditions of Africa s towns and cities. The subsequent section explores the links between the urban environment and health. Although the focus is with physical hazards it is important to note that the social milieu is also vital in the reproduction of health. The paper concludes by providing some policy recommendations

Left Behind: Intergenerational Transmission of Human Capital in the Midst of HIV/AIDS

This paper provides evidence on how adverse health conditions affect the transfer of human capital from one generation to the next. We explore the differential exposure to HIV/AIDS epidemic in sub-Saharan Africa as a substantial health shock to both household and community environment. We utilize the recent rounds of the Demographic and Health Surveys (DHS) for 11 countries in sub-Saharan Africa that provide information on mother’s HIV status and enable us to link mothers and their children. The data also allow us to distinguish between two separate channels that are likely to differentially affect the intergenerational transfers: mother’s HIV status and community HIV prevalence. First, we find that mothers transfer 37% of their human capital to their children in the developing economies in sub-Saharan Africa. Second, our results show that mother's HIV status has large detrimental effect on inheritability of human capital. HIV-infected mothers are 30% less likely to transfer their human capital to their children. Finally, focusing only on non-infected mothers and their children, we find that HIV prevalence in the community also significantly impairs the intergenerational human capital transfers even if mother is HIV negative. The findings of this paper is particularly distressing for these already poor, HIV-torn countries as in the future they will have even lower overall level of human capital due to the epidemic.HIV/AIDS, intergenerational transmission, human capital investment

The Mortality and Morbidity Transitions in Sub-Saharan Africa: Evidence from Adult Heights

In most developing countries, rising levels of nutrition and improvements in public health have led to declines in infant mortality and rising adult heights. In Sub-Saharan Africa we see a different pattern. Sub-Saharan Africa has seen large reductions in infant mortality over the last fifty years, but without any increase in protein and energy intake and against a background of stagnant, or declining, adult height. Adult height is a sensitive indicator of the nutrition and morbidity prevailing during the childhood of the cohort and can be taken as a measure of health human capital. Declining infant mortality rates in Sub-Saharan Africa appear to be driven by medical interventions that reduce infant mortality, rather than by broad based improvements in nutrition and public health measures, and may not be reflective of broad based health improvements.mortality, Sub-Saharan, morbidity, heights

Building capacity for public and population health research in Africa : the consortium for advanced research training in Africa (CARTA) model

Background: Globally, sub-Saharan Africa bears the greatest burden of disease. Strengthened research capacity to understand the social determinants of health among different African populations is key to addressing the drivers of poor health and developing interventions to improve health outcomes and health systems in the region. Yet, the continent clearly lacks centers of research excellence that can generate a strong evidence base to address the region’s socio-economic and health problems. Objective and program overview: We describe the recently launched Consortium for Advanced Research Training in Africa (CARTA), which brings together a network of nine academic and four research institutions from West, East, Central, and Southern Africa, and select northern universities and training institutes. CARTA’s program of activities comprises two primary, interrelated, and mutually reinforcing objectives: to strengthen research infrastructure and capacity at African universities; and to support doctoral training through the creation of a collaborative doctoral training program in population and public health. The ultimate goal of CARTA is to build local research capacity to understand the determinants of population health and effectively intervene to improve health outcomes and health systems. Conclusions: CARTA’s focus on the local production of networked and high-skilled researchers committed to working in sub-Saharan Africa, and on the concomitant increase in local research and training capacity of African universities and research institutes addresses the inability of existing programs to create a critical mass of well-trained and networked researchers across the continent. The initiative’s goal of strengthening human resources and university-wide systems critical to the success and sustainability of research productivity in public and population health will rejuvenate institutional teaching, research, and administrative systems

One health research in Northern Tanzania – challenges and progress

East Africa has one of the world’s fastest growing human populations—many of whom are dependent on livestock—as well as some of the world’s largest wildlife populations. Humans, livestock, and wildlife often interact closely, intimately linking human, animal, and environmental health. The concept of One Health captures this interconnectedness, including the social structures and beliefs driving interactions between species and their environments. East African policymakers and researchers are recognising and encouraging One Health research, with both groups increasingly playing a leading role in this subject area. One Health research requires interaction between scientists from different disciplines, such as the biological and social sciences and human and veterinary medicine. Different disciplines draw on norms, methodologies, and terminologies that have evolved within their respective institutions and that may be distinct from or in conflict with one another. These differences impact interdisciplinary research, both around theoretical and methodological approaches and during project operationalisation. We present experiential knowledge gained from numerous ongoing projects in northern Tanzania, including those dealing with bacterial zoonoses associated with febrile illness, foodborne disease, and anthrax. We use the examples to illustrate differences between and within social and biological sciences and between industrialised and traditional societies, for example, with regard to consenting procedures or the ethical treatment of animals. We describe challenges encountered in ethical approval processes, consenting procedures, and field and laboratory logistics and offer suggestions for improvement. While considerable investment of time in sensitisation, communication, and collaboration is needed to overcome interdisciplinary challenges inherent in One Health research, this can yield great rewards in paving the way for successful implementation of One Health projects. Furthermore, continued investment in African institutions and scientists will strengthen the role of East Africa as a world leader in One Health research

Human resources for primary health care in sub-Saharan Africa: progress or stagnation?

BACKGROUND: The World Health Organization defines a "critical shortage" of health workers as being fewer than 2.28 health workers per 1000 population and failing to attain 80% coverage for deliveries by skilled birth attendants. We aimed to quantify the number of health workers in five African countries and the proportion of these currently working in primary health care facilities, to compare this to estimates of numbers needed and to assess how the situation has changed in recent years. METHODS: This study is a review of published and unpublished "grey" literature on human resources for health in five disparate countries: Mali, Sudan, Uganda, Botswana and South Africa. RESULTS: Health worker density has increased steadily since 2000 in South Africa and Botswana which already meet WHO targets but has not significantly increased since 2004 in Sudan, Mali and Uganda which have a critical shortage of health workers. In all five countries, a minority of doctors, nurses and midwives are working in primary health care, and shortages of qualified staff are greatest in rural areas. In Uganda, shortages are greater in primary health care settings than at higher levels. In Mali, few community health centres have a midwife or a doctor. Even South Africa has a shortage of doctors in primary health care in poorer districts. Although most countries recognize village health workers, traditional healers and traditional birth attendants, there are insufficient data on their numbers. CONCLUSION: There is an "inverse primary health care law" in the countries studied: staffing is inversely related to poverty and level of need, and health worker density is not increasing in the lowest income countries. Unless there is money to recruit and retain staff in these areas, training programmes will not improve health worker density because the trained staff will simply leave to work elsewhere. Information systems need to be improved in a way that informs policy on the health workforce. It may be possible to use existing resources more cost-effectively by involving skilled staff to supervise and support lower level health care workers who currently provide the front line of primary health care in most of Africa

Working Paper 39 - Human Capital and Economic Development

Health and education are both components of human capital and contributors to human welfare. Oneindex of human welfare, which incorporates income, education and health, shows that Africa’s level of‘human development’ is the lowest of any region in the world. In this paper we will frequently compareAfrica with South Asia. While Africa’s level of human development is lower than that of South Asia, itsper capita income is higher. Africa’s poor economic performance has been most marked in its growthrate which has been half that of South Asia. As Africa has found since 1980, slow economic growthseverely limits the ability of governments and households to fund further investments in health andeducation. Low investments in human capital may impinge on already low growth rates of income. Suchinterrelations might be thought to imply a vicious circle of development, but this should not be overstated.Poor countries have considerable discretion over how much to invest in health and education. SinceIndependence, Africa has achieved a rapid growth of some aspects of human capital - particularly inthe expansion of education - despite starting from a low level of income. The expansion of the humancapital stock has not been matched by a commensurate rise in physical capital. The result has been lowgrowth of incomes and low returns to the educational investment.This paper provides an overview of Africa’s achievements in the formation of human capital, andits impact on economic growth and welfare. Human capital, economic growth and welfare are closelyinterrelated. Section 2 provides an assessment of Africa’s human development in the context of otherdeveloping regions. Section 3 turns to the central issue of how to promote economic growth in Africaand the role of human capital in that process. Section 4 presents evidence on the linkages betweeneducation and health outcomes, while section 5 provides some concluding remarks.

Working Paper 37 - The Formation of Human Capital and the Economic Development of Africa: Returns to Health and Schooling Investments

This paper first outlines a framework within which to assess the contribution of health and schooling to increasing individual and aggregate income, as well as the possible feedback of increasing income on the demand for human resources. It then evaluates how African countries have fared from 1970 to 1985 in terms of survival and schooling, compared with other countries, to place in perspective areas of achievement and the aggregate composition of human capital formation in the African region. Several microeconomic studies are then described in more detail that illustrate the magnitudes of private returns to health and schooling in West Africa, some of the consequences of the rationed supply of schooling in South Africa, and evidence of returns to the quality of schooling. The concluding section extracts lessons as to how to conduct country-specific research based on merged household and community surveys to estimate the key parameters describing the private and social returns to marginal investments in health, education, and mobility.

Financing health services in Africa : an assessment of alternative approaches

This paper outlines a strategy for financing health services in sub-Saharan Africa. The individual components of the strategy are as follows: general tax revenues, international finance, a system of user charges, community finance, health insurance, and contributions from nongovernmental organizations, including the private sector. The author states that financial positions of public health care systems in sub-Saharan Africa would be greatly enhanced if governments in the region were to adopt policies that would use each of the above sources of finance. Since a strong financial base is a prerequisite for an effective health care system, such policies would considerably improve the health status of the population. It is important that for each country different policies be pursued at various levels of society, and in different sectors of the economy.Health Systems Development&Reform,Health Monitoring&Evaluation,Housing&Human Habitats,Health Economics&Finance,Pharmaceuticals&Pharmacoeconomics