Analysis of non-communicable diseases prevention policies in Cameroon : Final report

This research is part of a multi-centre project on the Analysis of NCD Prevention funded by the African Population and Health Research Centre (APHRC) in partnership with the International Development Research Centre (IDRC).Non-communicable diseases (NCDs) currently constitute a serious threat to health worldwide, with the situation expected to worsen if concerted actions are not urgently taken. The World Health Organisation (WHO) identified population-based interventions addressing four NCD risk factors – tobacco use, harmful use of alcohol, unhealthy diet, and physical inactivity; also known as “best buys” – and proposes the use of multi-sectoral approaches (MSA) to engage the public, private, and non-profit sectors to implement these best buys. In November 2014, the African Population and Health Research Centre (APHRC), with funding from the International Development Research Centre (IDRC), led Cameroon and five other African countries in a study to analyse how countries are addressing NCD prevention in order to best facilitate MSA for NCD prevention in Africa

Accomplishments of the Partnership for Higher Education in Africa, 2000-2010

Details the investments and impact of a funder collaborative focused on higher education in nine African countries, and each foundation's contribution. Discusses enduring improvements, increased resources, value added, and additional foundation efforts

Trends in childhood mortality in Kenya: the urban advantage has seemingly been wiped out

Background: we describe trends in childhood mortality in Kenya, paying attention to the urban–rural and intra-urban differentials.Methods: we use data from the Kenya Demographic and Health Surveys (KDHS) collected between 1993 and 2008 and the Nairobi Urban Health and Demographic Surveillance System (NUHDSS) collected in two Nairobi slums between 2003 and 2010, to estimate infant mortality rate (IMR), child mortality rate (CMR) and under-five mortality rate (U5MR).Results: between 1993 and 2008, there was a downward trend in IMR, CMR and U5MR in both rural and urban areas. The decline was more rapid and statistically significant in rural areas but not in urban areas, hence the gap in urban–rural differentials narrowed over time. There was also a downward trend in childhood mortality in the slums between 2003 and 2010 from 83 to 57 for IMR, 33 to 24 for CMR, and 113 to 79 for U5MR, although the rates remained higher compared to those for rural and non-slum urban areas in Kenya.Conclusions: the narrowing gap between urban and rural areas may be attributed to the deplorable living conditions in urban slums. To reduce childhood mortality, extra emphasis is needed on the urban slums

Disease Surveillance Networks Initiative Africa: Final Evaluation

The overall objective of the Foundation's Disease Surveillance Networks (DSN) Initiative is to strengthen technical capacity at the country level for disease surveillance and to bolster response to outbreaks through the sharing of technical information and expertise. It supports formalizing collaboration, information sharing and best practices among established networks as well as trans-national, interdisciplinary and multi-sectoral efforts, and is experienced in developing and fostering innovative partnerships. In order to more effectively address disease threats, the DSN has four key outcome areas:(1) forming and sustaining trans-boundary DSN;(2) strengthening and applying technical and communication skills by local experts and institutions;(3) increasing access and use of improved tools and methods on information sharing, reporting and monitoring; and(4) emphasizing One Health and transdisciplinary approaches to policy and practice at global, regional and local levels

Birth spacing and child mortality: an analysis of prospective data from the Nairobi urban health and demographic surveillance system.

The majority of studies of the birth spacing-child survival relationship rely on retrospective data, which are vulnerable to errors that might bias results. The relationship is re-assessed using prospective data on 13,502 children born in two Nairobi slums between 2003 and 2009. Nearly 48% were first births. Among the remainder, short preceding intervals are common: 20% of second and higher order births were delivered within 24 months of an elder sibling, including 9% with a very short preceding interval of less than 18 months. After adjustment for potential confounders, the length of the preceding birth interval is a major determinant of infant and early childhood mortality. In infancy, a preceding birth interval of less than 18 months is associated with a two-fold increase in mortality risks (compared with lengthened intervals of 36 months or longer), while an interval of 18-23 months is associated with an increase of 18%. During the early childhood period, children born within 18 months of an elder sibling are more than twice as likely to die as those born after an interval of 36 months or more. Only 592 children experienced the birth of a younger sibling within 20 months; their second-year mortality was about twice as high as that of other children. These results support the findings based on retrospective data

Assessing the effect of mother's migration on childhood mortality in the informal settlements of Nairobi

Between one and two million migrants reside in cramped conditions in Nairobi's slums without proper access to sanitation or affordable clean water. Children in such areas are exposed to enormous risks, health risks in particular. Using longitudinal data collected every four months during the period between 2002 and 2004, we analyze their survival patterns of children under five year of age who resided in two informal settlements (Viwandani and Korogocho). The research question assumes that children born to recent migrant mothers are more likely to die. The assumption is that migrant mothers do not have social network, which translates to a lack of information and lower access to health facilities. In the subsequent event history analysis, childhood mortality is shown to remain very high in the Nairobi informal settlements, especially among new migrants. Given the high degree of rural urban migration, which is bound to increase in the foreseeable future for most African countries, our study raises critical public health concerns. Another important finding in the context of the HIV AIDS pandemic is the risk factor associated to the mortality among children who have lost their mother. Our study also demonstrated a persistent disadvantage of children born to migrant mothers irrespective the length of stay in the receiving zone. The latter seems to point out the difficulties for migrant to develop social network outside their area of origin

Uncontrolled hypertension among patients with comorbidities in sub-Saharan Africa : protocol for a systematic review and meta-analysis

Background Uncontrolled hypertension is the most important risk factor and leading cause of cardiovascular diseases. It is predicted that the number of people with hypertension will increase, and a large proportion of this increase will occur in developing countries. The highest prevalence of uncontrolled hypertension is reported in sub-Saharan Africa, and treatment for hypertension is unacceptably low. Hypertension commonly co-exists with comorbidities and this is associated with poorer health outcomes for patients. This review aims to estimate the prevalence of uncontrolled hypertension among patients with comorbidities in sub-Saharan Africa. Methods and analysis All published and unpublished studies on the prevalence of uncontrolled hypertension among patients with comorbidities in sub-Saharan Africa will be included. MEDLINE via OVID, Embase, and Web of Science will be searched to identify all relevant articles published from January 2000 to June 2019. Experts in the field will be contacted for unpublished literature, and Open SIGLE will be reviewed for relevant information. No language restriction will be imposed. Two reviewers will select, screen, extract data, and assess the risk of bias while a third reviewer will arbitrate the disagreements. A meta-analysis will be performed on variables that are similar across the included studies. Proportions will be stabilized before estimates are pooled using a random effects model. The presence of publication bias will be assessed using Egger’s test and visual inspection of the funnel plots. This systematic and meta-analysis review protocol will be reported in accordance with the PRISMA-P protocol guidelines. Results will be stratified by country, comorbidity, and geographic region

No. 06: The Urban Food System of Nairobi, Kenya

Nairobi is a city of stark contrasts. Nearly half a million of its three million residents live in abject poverty in some of Africa’s largest slums, yet the Kenyan capital is also an international and regional hub. In East Africa, rapid urbanization is stretching existing food and agriculture systems as growing cities struggle to provide food and nutrition security for their inhabitants. Nairobi is no exception; it is a dynamically growing city and its food supply chains are constantly adapting and responding to changing local conditions. It is also an international city and the extent to which it is food secure is increasingly predicated on food imports from the regional East African Community and other international sources. Informal traditional value chains have a variety of actors and intermediaries that increase transaction costs and create an inefficient post-harvest procurement network, thereby pushing food products out of the reach of those who need them most. The majority of Nairobi’s food purchases are from informal food vendors. The city’s urban poor rely on the informal food sector for several reasons including that it provides food close to where they live and work, credit and barter are often available, small quantities can be purchased, and many items are sold more cheaply than at formal outlets. The leading income-generating activity for women in Nairobi’s poor communities is selling fruit and vegetables

Hunger and Food Insecurity in Nairobi's Slums: An assessment using IRT models'

Although linked to poverty as conditions reflecting inadequate access to resources to obtain food, issues such as hunger and food insecurity have seldom been recognized as important in urban settings. Overall, little is known about the prevalence and magnitude of hunger and food insecurity in most cities. Yet, in sub-Saharan Africa where the majority of urban dwellers live on less than one dollar a day, it is obvious a large proportion of the urban population must be satisfied with just one meal a day. This paper suggests using the one- and two-parameter item response theory (IRT) models to infer a reliable and valid measure of hunger and food insecurity relevant to low income urban settings, drawing evidence from the Nairobi Urban Health and Demographic Surveillance System (NUHDSS). The reliability and accuracy of the items are tested using both the Mokken Scale Analysis and the Cronbach test. The validity of the inferred household food insecurity measure is assessed by examining how it is associated with households? economic status. Results show that food insecurity is pervasive amongst slum dwellers in Nairobi. Only one household in five is food secure, and nearly half of all households are categorized as ?food insecure with both adult and child hunger?. Moreover, in line with what is known about household allocation of resources, evidence indicates that parents often forego food in order to prioritize their children. (229 words)Food insecurity; Hunger; Sub-Saharan Africa; Slum; Nairobi

Physical and sexual abuse in orphaned compared to non-orphaned children in sub-Saharan Africa: A systematic review and meta-analysis

This systematic review assessed the quantitative literature to determine whether orphans are more likely to experience physical and/or sexual abuse compared to non-orphans in sub-Saharan Africa (SSA). It also evaluated the quality of evidence and identified research gaps. Our search identified 10 studies, all published after 2005, from Zimbabwe, South Africa, Kenya and Uganda. The studies consisted of a total 17,336 participants (51% female and 58% non-orphans). Of those classified as orphans (n = 7,315), 73% were single orphans, and 27% were double orphans. The majority of single orphans were paternal orphans (74%). Quality assessment revealed significant variability in the quality of the studies, although most scored higher for general design than dimensions specific to the domain of orphans and abuse. Combined estimates of data suggested that, compared to non-orphans, orphans are not more likely to experience physical abuse (combined OR = 0.96, 95% CI [0.79, 1.16]) or sexual abuse (combined OR = 1.25, 95% CI [0.88, 1.78]). These data suggest that orphans are not systematically at higher risk of experiencing physical or sexual abuse compared to non-orphans in sub-Saharan Africa. However, because of inconsistent quality of data and reporting, these findings should be interpreted with caution. Several recommendations are made for improving data quality and reporting consistency on this important issue